Standing like a tree: A randomized controlled trial protocol examining daoist zhanzhuang within a PNEI framework

Psycho-neuro-endocrine-immunology (PNEI) provides a framework for understanding the integration of psychological, neural, endocrine, and immune processes, yet it has rarely engaged non-Western models of mind–body regulation. This study examines Zhanzhuang (aka Chan-chuang), a Daoist standing meditation centered on the cultivation of qi, as a potential PNEI intervention. We present the protocol of a two-arm randomized controlled trial (N = 120) comparing Zhanzhuang with an active control wall-supported standing exercise in a young adult sample. Over a 3-month intervention with longitudinal follow-ups, we assess autonomic regulation (heart rate variability), inflammatory biomarkers (e.g., IL-6, TNF-α, CRP), and psychospiritual outcomes, including interoceptive awareness and mystical experience. Mixed-effects models and longitudinal structural equation modeling will test intervention effects, as well as mediation and moderation pathways. By integrating physiological and phenomenological measures, this study aims to understand the potential effects of qi regulation within a PNEI framework and to clarify mechanisms linking contemplative practice, autonomic balance, and immune function.