The Effect of Chinese Medicine on HIV-Infected Individuals

It is now ten years since individuals affected by a mysterious new disease called AIDS began seeking help at the offices of Chinese medical practitioners. Over these few years, these practitioners have gained much experience, and some have collected data, thus giving a glimpse to others of what can be accomplished by Chinese medical techniques. This report looks critically at the claimed outcomes and suggests areas for focus of further investigation and development of the treatment protocols.

While virtually all practitioners express a confidence in being able to help individuals infected by HIV, it is well-recognized that the disease is "managed" by the application of Chinese medicine--usually along with Western drugs--but not "cured". For how long the disease remains manageable through this intervention, and how many of the individuals can be helped, are questions not yet fully answered. Some patients still worsen, a few die. It has become evident that for some individuals, HIV infection can become a chronic disease rather than an acutely fatal one. A large proportion of the long-term survivors of this infection have used Chinese medicine and attribute their survival to a combination of their positive attitudes towards life and the use of this type of medical intervention.

In order to gain a perspective on what requires our attention in relation to applying Chinese medical therapies, it is important to review what has been reported in monitoring programs where the outcome of treatment is tracked. Clinical reports have been generated by several practitioners across the country, but firm reports are yet to be published in the peer-review medical or scientific literature, because of some limitations in the methodology.

First, it should be pointed out that acupuncture is given to most, but not all, persons who seek treatment for HIV at clinics. Some individuals can not visit acupuncturists and therefore only obtain herbs, which can be easily shipped to anywhere in the world. The participation in acupuncture sessions is variable, both as it is offered and as it is actually taken advantage of. For example at PAAC (Portland Addictions Acupuncture Center), where the treatment of addictions with acupuncture serves as the model, HIV patients are encouraged to have acupuncture three times per week. In most other programs weekly acupuncture is offered, though sometimes there is an additional fee for participation at the frequency level of more than once per month. As a survey of actual participation at ITM's local treatment program shows, some individuals do not avail themselves of all offered acupuncture sessions that are free of charge for a variety of reasons. On the whole, and averaged over several projects across the country, the typical attendance rate for acupuncture is roughly twice per month over an extended period of time. In patient surveys, it is revealed that well over 80% of the participants in the acupuncture sessions believe that the treatments are an important part of their health care. A few are unsure of its influence, but pursue it nonetheless, perhaps in response to the positive comments from the other participants.

Acupuncture is best known for its influence on pain. Such influence is accepted even by most who are skeptical of the field as a whole. A Western medical explanation for analgesic action--based on endorphin release--has become widely accepted, even by those who also consider the Oriental explanation (of removing blockage of the circulation of qi) to be correct. The effect on pain has been dramatized by Chinese demonstrations of surgery without full anesthesia using acupuncture as a replacement. A number of medical doctors in the U.S. are willing to suggest to patients suffering from arthritis and back pain that they visit an acupuncturist for relief when surgery or drugs fail to provide adequate analgesia.

In an analysis of reported symptoms by persons participating at IEP in San Francisco and Chicago, four pain syndromes: headaches, neuropathy (marked by numbness, tingling, and, in more advanced cases, pain), muscle ache, and joint pain, have been shown to respond well to Chinese medical treatment. While herbal medicine is also frequently applied in China as a remedy for such problems (e.g. flavonoid-rich herbs and other blood-vitalizers have been found useful in the treatment of diabetic neuropathy), given the nature of herb treatments provided to the patients at American clinics, it is expected that most of the imparted therapeutic effect is due to acupuncture. About 75% of participants suffering from these four conditions reported that they were either relieved of the pain altogether or that the levels decreased.

Unfortunately, from the view of collecting evidence for efficacy of treatment, pain is one of the symptoms that is most responsive to the placebo effect. In some trials of modern drugs, placebos approach 100% effectiveness for pain relief. From long experience with placebo-controlled trials, it has become a general 'rule of thumb' among medical doctors that about one-third of the reported pain relief attributed to any treatment results from the placebo contribution.

A study to compare "real" and "sham" acupuncture treatments for peripheral neuropathy in those with HIV has been designed as is now being carried out at several sites in the U.S.. In this case, the 'real' acupuncture involves needles applied to recognized acupuncture points, though the points in this particular study are not the ones favored by most practitioners experienced in treating HIV patients who suffer from neuropathy. The sham acupuncture is done on the same number of points located nearby, but sufficiently far from standard points that the traditional theory of acupuncture should not support the finding of a beneficial effect.

Chinese medicine is also well-known as a method of resolving low energy, though this aspect is more skeptically viewed by orthodox medical doctors. Chinese herb shops prominently display famous tonics that are supposed to improve vitality, including sexual energy. In fact, because of this emphasis, it is common for people to learn of Chinese herbs first through fantastic stories of $5,000 ginseng roots or horns from the endangered rhino bought by wealthy individuals to enhance their sex life. The most widely sold Chinese herbs in the West are the 'ginseng class of tonics,' most of which are touted to enhance energy, stamina, sports performance, and mental ability. In a double-blind evaluation conducted in 1980 by ITM using Korean red ginseng or placebo in normal individuals, it was found that after elimination of the placebo effect about 1 in 6 persons apparently responded to ginseng in terms of notably increased energy. According to Chinese medical theory, this proportion would be substantially higher if the test group involves individuals with notably depleted vitality.

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