A comparative review of Hua Tuo's Five Animal Frolics and Traditional Yang-Style Tai Chi Chuan as Mind-Body Interventions for Cancer Survivors

 Corresponding author: Mary Ngan Bing Cheung Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution License 4.0. A comparative review of Hua Tuo's Five Animal Frolics and Traditional Yang-Style Tai Chi Chuan as Mind-Body Interventions for Cancer Survivors Wings Tjing Yung Loo 1, 2, Mary Ngan Bing Cheung 1, 2, * and Preston Corliss Loo 1, 2 1 P & P Dental and Medical Sciences Ltd and Essence Medical Laboratory, Hong Kong. 2 Institute for Research and Practice of Yang Style Tai Chi Chuan, Hong Kong. World Journal of Biology Pharmacy and Health Sciences, 2025, 24(02), 348-353 Publication history: Received on 30 September 2025; revised on 08 November 2025; accepted on 12 November 2025 Article DOI: https://doi.org/10.30574/wjbphs.2025.24.2.1007 Abstract The growing population of cancer survivors faces a unique set of challenges, including persistent fatigue, psychological distress, and diminished physical function. Mind-body exercises, particularly those rooted in Traditional Chinese Medicine (TCM), have emerged as effective complementary interventions. This review compares two distinct yet philosophically linked practices: Hua Tuo's Five Animal Frolics (五禽戲, Wu Qin Xi) and traditional Yang-style Tai Chi Chuan (楊氏太極拳). While both are low-impact, meditative exercises that integrate movement, breath, and intention, their approaches and potential benefits for cancer survivors differ. The Five Animal Frolics, through its mimicry of animal movements (Tiger, Deer, Bear, Monkey, Bird), emphasizes distinct qualities—power, agility, stability, cleverness, and lightness—offering a dynamic and expressive form of functional training. In contrast, Yang-style Tai Chi is characterized by its slow, continuous, flowing movements and unwavering postural stability, emphasizing internal energy cultivation (氣, Qi) and mindfulness. Evidence suggests both practices significantly improve quality of life, reduce cancer-related fatigue, and alleviate anxiety and depression. The Frolics may offer superior benefits in improving functional mobility, flexibility, and playful engagement, while Tai Chi may provide greater advantages in balance control, fall prevention, and deep relaxation. The choice of intervention should be personalized, considering the survivor's specific physical limitations, psychological needs, and personal preferences. This review synthesizes the historical context, mechanistic foundations, and current evidence for each practice to inform clinicians and survivors in selecting the most appropriate mind-body therapy. Keywords: Cancer Survivorship; Mind-Body Therapy; Tai Chi; Wu Qin Xi; Five Animal Frolics; Quality Of Life; CancerRelated Fatigue; Rehabilitation; Traditional Chinese Medicine; Comparative Effectiveness 1. Introduction Cancer survivorship has evolved into a distinct phase of care, focusing on managing the long-term and late effects of cancer and its treatment [1]. Common issues include cancer-related fatigue (CRF), psychological distress (anxiety, depression, fear of recurrence), sleep disturbances, and declines in physical function and balance [2,3]. Pharmacological interventions often have limited efficacy and carry risks of side effects, driving the need for effective nonpharmacological strategies [4]. Mind-body interventions have gained prominence in oncology rehabilitation for their holistic approach to healing [5]. Among these, practices originating from Traditional Chinese Medicine (TCM), such as Tai Chi Chuan (太極拳) and Qigong (氣功), have demonstrated significant benefits for cancer survivors [6,7]. This review focuses on two specific modalities: the ancient Hua Tuo's Five Animal Frolics (Wu Qin Xi) and the widely practiced traditional Yang-style Tai Chi Chuan. World Journal of Biology Pharmacy and Health Sciences, 2025, 24(02), 348-353 349 Although both share common roots in TCM philosophy—such as the cultivation of Qi and the harmonization of mind and body they represent different expressions of this philosophy. This article aims to: 1) describe the historical and practical characteristics of each practice; 2) review the evidence for their benefits in cancer survivorship; 3) compare their mechanisms of action; and 4) provide practical guidance for their application in a survivor population. 2. Historical and Practical Overview 2.1. Hua Tuo's Five Animal Frolics (Wu Qin Xi) Attributed to the renowned physician Hua Tuo (c. 140–208 AD), the Five Animal Frolics is one of the oldest documented systems of Qigong [8]. Hua Tuo proposed that imitating the movements and spirits of animals could help unblock the body's meridians, promote the flow of Qi and blood, and prevent disease [9]. The practice consists of five distinct sets of movements, each embodying the essence of a different animal: • Tiger (虎, Hu): Develops bone strength and power through fierce, stretching movements that engage muscles and tendons. • Deer (鹿, Lu): Enhances agility and flexibility through graceful, turning motions that benefit the waist and kidneys. • Bear (熊, Xiong): Promotes stability and weight distribution through slow, swaying, and grounding postures that strengthen the spleen and stomach. • Monkey (猿, Yuan): Improves nimbleness and cleverness through quick, playful, and reaching movements that benefit the heart and nervous system. • Bird ( 鶴, He): Cultivates lightness, balance, and expansion through wing-like extensions and balancing postures that benefit the lungs and respiratory system. The practice is often more dynamic and variable than Tai Chi, with shifts in tempo and expression, making it a form of functional and playful exercise [10]. 2.2. Traditional Yang-Style Tai Chi Chuan Yang-style Tai Chi, developed by Yang Luchan in the mid-19th century, is one of the most popular and widely practiced forms of Tai Chi in the world today [11]. It is characterized by: • Slow, Continuous, and Flowing Movements: The form is performed in a smooth, uninterrupted manner, like "pulling silk from a cocoon." • Large, Open Frames: Movements are expansive and graceful, with a wide stance and full range of motion. • Emphasis on Softness and Neutralization: It prioritizes yielding to force and using an opponent's energy against them, translated into a health context as stress resilience. • Upright Posture and Stability: A constant focus on correct spinal alignment, sunk shoulders, and a lowered center of gravity. • Deep Diaphragmatic Breathing: Coordinated with movement to calm the nervous system and guide Qi. The primary goal is to cultivate and harmonize internal energy (Qi) through mindful movement, leading to a state of mental calm and physical relaxation [12]. 3. Mechanisms of Action: A Comparative Perspective Both practices exert their benefits through integrated mind-body pathways, but with nuanced differences (Table 1). World Journal of Biology Pharmacy and Health Sciences, 2025, 24(02), 348-353 350 Table 1 Comparing Five Animal Frolics with Yang-Style Tai Chi based on their different mechanisms Mechanism Five Animal Frolics Yang-Style Tai Chi Physical Functional and Varied: Mimics natural, multiplanar movements; improves joint mobility, coordination, and muscular strength differentially through diverse animal postures. Integrated and Stable: Emphasizes lower-body strength, continuous weight-shifting, and core engagement; superior for proprioception and balance training. Physiological Stimulating and Regulating: The varying intensity may better stimulate circulatory and lymphatic systems. Animal play may boost endorphins and reduce cortisol. Deeply Relaxing: The slow, rhythmic pace strongly promotes parasympathetic dominance ("rest-and-digest"), reducing stress hormones like cortisol more consistently. Psychological Expressive and Metaphorical: Allows for emotional expression and release through animal personas (e.g., expressing power as a Tiger, freedom as a Bird). Meditative and Mindful: The relentless focus on continuous flow cultivates present-moment awareness, reducing ruminative thoughts and anxiety. Energetic (TCM) Organ-Specific: Each animal is linked to a specific organ system and meridian, aimed at regulating the respective organ's Qi. Whole-Body Integration: Aims to cultivate and circulate Qi throughout the entire body seamlessly, harmonizing Yin and Yang globally. 4. Evidence for Benefits in Cancer Survivorship 4.1. Five Animal Frolics A growing body of evidence supports Wu Qin Xi for cancer survivors. A randomized controlled trial (RCT) by Xiao and colleagues [13] found that breast cancer survivors practicing Wu Qin Xi showed significantly greater improvements in shoulder range of motion, functional capacity, and quality of life compared to a conventional exercise group. The varied movements are particularly effective for addressing upper-body impairments common post-lymph node dissection and radiation. Studies have also reported significant reductions in fatigue and anxiety, attributed to its meditative yet engaging nature [14]. A recent meta-analysis by Chen et al. [15] concluded that Wu Qin Xi is an effective intervention for improving psychological well-being and physical function in patients with chronic diseases, including cancer. 4.2. Yang-Style Tai Chi The evidence for Tai Chi is more extensive. Multiple meta-analyses have confirmed its efficacy for cancer survivors [6,16]. Key benefits include: • Cancer-Related Fatigue (CRF): Tai Chi is consistently shown to reduce fatigue levels more effectively than standard care or aerobic exercise [17,18]. • Psychological Well-being: Significant reductions in symptoms of depression, anxiety, and stress have been documented, alongside improvements in overall quality of life [19,20]. • Physical Function: It improves balance, reduces fear of falling, and enhances functional mobility and lowerbody strength [21,22]. • Sleep and Immunity: Some studies indicate improvements in sleep quality and potential immunomodulatory effects, such as reduced inflammatory markers [23,24]. 5. Practical Application and Recommendations for Clinicians Choosing between the two practices should be a personalized decision: 5.1. Recommend Five Animal Frolics for • Survivors with specific joint stiffness or seeking to improve functional, multi-directional mobility. • Those who find standard exercise boring; the playful, expressive nature of the Frolics can enhance adherence [25]. • Individuals who may struggle with the sustained, lower-body endurance required for a long Tai Chi form. World Journal of Biology Pharmacy and Health Sciences, 2025, 24(02), 348-353 351 5.2. Recommend Yang-Style Tai Chi for • Survivors with a primary concern of poor balance, neuropathy, or high fall risk [26,27]. • Those experiencing high levels of anxiety, stress, or sleep disturbances, who would benefit from its deeply calming and meditative rhythm [28,29]. • Older adults or those preferring a more predictable, flowing sequence of movements. 6. Conclusion Both Hua Tuo's Five Animal Frolics and traditional Yang-style Tai Chi Chuan are valuable, evidence-based mind-body interventions that can significantly enhance the physical and psychological well-being of cancer survivors. The Five Animal Frolics offers a dynamic, expressive, and functionally varied practice that mimics nature, while Yang-style Tai Chi provides a steady, flowing, and deeply meditative practice focused on internal integration and balance. There is no universally superior choice. The decision should be guided by the survivor's individual symptoms, physical capabilities, and personal preferences. Future research should include direct head-to-head comparative trials to further elucidate which patient phenotypes respond best to each specific modality. Ultimately, promoting either practice empowers cancer survivors to actively participate in their recovery and long-term health. 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