East Meets West
In Chinese medicine, harmony is the goal.
by George M. Carter

While most HIV researchers focus on the complex dynamic between the virus and the immune system and clinicians rely on antiviral drugs to manage HIV disease, practitioners of traditional Chinese and holistic medicine take a different approach, one that focuses on restoring balance. Their tools include a combination of diet, herbs, minerals, acupuncture, meditation, and exercises that seek to restore harmony among the body, mind, and spirit. A 4,000-year-old tradition, Chinese medicine takes a comprehensive approach to health, one that is well founded in science.

When it comes to HIV, an East-meets-West strategy is becoming more frequently used. Chinese medicine is now seen as a complement to antiviral therapy, the focus in the West. Although it's difficult to estimate how many individuals with HIV are being treated by Chinese medicine techniques, studies show that 40 to 70 percent use some type of alternative or complementary therapy. More people are becoming aware of the need to improve immune function and detoxify the body. That's especially true for those taking potent antiretroviral medicines that, over time, can damage major organs, such as the liver, pancreas, and heart.

Jackie Haught, a leading practitioner of Chinese medicine in New York City, has noticed new patients on antiviral meds who arrive at her doorstep looking for help. With the advent of protease therapies for HIV infection, Haught says, "there are more side effects, more neuropathy, more hepatitis, and more exotic disease processes that reflect the collapse of the immune system." Most of her patients with AIDS are on anti-HIV drug therapy "unless they cannot tolerate it, or are at the end of the line in terms of drug failure." Among patients who are HIV-positive and healthy, those recently diagnosed are less apt to be taking antiviral drugs. She also treats HIV patients who do not take any Western medicines.

Haught works by integrating her approach into Western treatment practices-not an easy task. Many Western doctors aren't that familiar with Chinese medicine-and vice versa. "My opinion is that Chinese medicine practitioners, more than ever, really need additional training and knowledge of Western therapies for HIV to treat people correctly," says Haught, who finds the task of treating HIV-and the side effects brought on by HIV meds-a challenge. "There are a lot of people with high viral loads and low CD4s (T-cell counts) who still develop many AIDS-defining infections, and KS [Kaposi's sarcoma] and cancer," she explains. "[Treatment] can be very difficult and takes a lot of knowledge. You usually have to be careful of [herb-drug] interactions, as well as pay attention to see if new infections are beginning."

Balancing The Life Force
In Chinese medicine, practitioners do what Western doctors do: evaluate a patient to establish a diagnosis. The methods and terms used by Chinese medicine practitioners may at first seem odd to those unfamiliar with the fundamental concepts and observations of this healing art. In the West, a doctor may take your pulse and look at your tongue. In Chinese medicine, a doctor takes into account 28 distinct types of pulses, which may be described qualitatively as floating, wiry, slippery, weak, choppy, tight, slow, rapid, thin, big, full, or hollow (empty). Along with a list of symptoms and specific complaints, a patient may be evaluated for skin tone and color, voice, breath odor-all indications of potential imbalances in the Qi (pronounced chee), a basic life, or energy, of essential organs and tissue.

Chinese medicine begins by evaluating the whole person, not just the virus. This includes the tight-knit interrelationship between mind, body, and spirit. Symptoms may indicate a diagnosis that involves all three: a disturbance of the Heart Organ System (known in the West as angina), for example, can adversely affect the mind and spirit, resulting in stress, which aggravates the disease. Since mind, body, and spirit are interrelated, all three must be treated.

Because these traditions are ancient, such diagnoses are rooted in a time before viruses or bacteria were understood. But they continue to reflect a basic view that the body maintains outer health via Protective Qi, which maintains the inner health of the body, much like the Western notion of immune defenses. Instead of warding off viruses and infections, Chinese medicine protects against External Pernicious Influences - heat or cold, damp or dry, wind and summer heat; Epidemic Factors - climactic external influences that penetrate the body and disrupt its functioning, like infections; and Internal Disharmonies-imbalances in the Organ System, coupled with disharmony in the Seven Emotions.

In the Chinese perspective, the body consists of Essential Substances, Organ Systems, and Channels. The Essential Substances, or energies, include the life force, Qi, which takes a variety of forms. One is Wei Qi, the protective force (represented by the skin), which resists and combats external forces. Another Essential Substance, Xue (pronounced shway), represents blood, although the Chinese definition extends beyond the fluid that travels through veins and arteries; Xue contains Qi and Shen. Shen is the spirit that embodies consciousness, emotions, and thoughts.

The Organ Systems of the body interact with these basic forces. The Zang Organs, with their Yin energy, are represented by the kidney, spleen, liver, lung, heart, and pericardium systems; Fu Organs, with their Yang force, include the stomach, and the small and large intestine. Each organ has specific functions and characteristics that influence various aspects of the body's overall life force. For example, the Spleen Organ System creates a healthy digestive tract and proper distribution of food and energy.

The HIV Puzzle
Misha Cohen is the leading researcher in Chinese medicine therapies for HIV, and a founder of the Quan Yin Healing Arts Center in San Francisco. As she points out, HIV is a relatively new disease, requiring fresh insight and analysis.

The flulike symptoms, fever, and rashes that are common signs of acute HIV infection are usually described in Chinese medicine as Toxic Heat, Excess Heat, or Heat in the Xue. In an effort to decode this system for the Western layperson, Cohen explains that the lymph system correlates loosely with the Spleen Organ System; the latter functions to provide protection from disease, keep the blood healthy, and maintain the inner workings of the body, such as digestive functions, in ways strikingly similar to the lymph system. As such, it is seen as a primary target of HIV, an invading pathogen, which also causes deficiencies in the Stomach and Kidney Organ Systems. A diagnosis of Kidney Organ deficiency, for example, manifests itself as bone marrow disruption, a condition also brought on by anti-HIV drugs like AZT.

HIV symptoms can be tricky to evaluate. Diarrhea may be diagnosed as Spleen Qi deficiency, Spleen Yang deficiency, Spleen Damp Heat, or Damp Heat in the Large Intestine. In other words, not all diarrhea is the same. Symptoms like dementia could be a Shen (spirit) Disturbance, or a lack of Shen.

During the asymptomatic phase, the body controls HIV to some extent. But a Chinese practitioner will note alterations in the tongue and pulse. "We see the cracks down the center of the tongue, associated with a disturbance of the central Qi," says Cohen. In her view, this is the best time to treat an individual with herbs, in accordance with a "hit gently, hit early" approach designed to maintain a strong Qi, strengthen organs, enhance Yin (and sometimes Yang) organs, and clear heat from the lungs. Herbs are selected and combined according to their specific properties, and used to treat disinct parts of the body, or, for example, to clear heat from the lungs. A word of caution: Herbs aren't like candy and can be toxic; giving the wrong herb can hasten HIV disease. As with HIV meds, herbs should be tailored to the individual's needs and treatment history. As a person's condition changes, so may the herbs. It's important to consult with doctors who specialize in HIV, as well as experienced alternative care providers, if possible.

The proof is in the pudding, of course, as to how well Chinese medical therapies work. Western doctors have complained about the lack of controlled clinical trials to test herbs' usefulness as an HIV therapy. Such studies, however, are difficult to undertake, because herb combinations are tailored to individual needs and may have to be changed over time to be effective. Still, two herbal blends, Enhance and Clear Heat, have been studied clinically in HIV patients; they reported less fatigue and improved neurological and gastrointestinal functioning but experienced no significant changes in blood values or T-cell counts. Other herbs, such as glycyrrhizin, have been studied individually and showed some modest benefit in slowing progression of HIV disease.

Haught believes more collaboration between Western doctors and providers of alternative care would benefit all parties. She speaks directly to HIV doctors when she needs additional information about their patients in her care, and she makes sure their laboratory tests are sent to her. "I'm not sure what the general standard of care [HIV practice] is at the moment, but I suspect more public health-oriented practitioners are more likely to do this than private practitioners," she says. "I would love to see a joint approach with the [antiviral] drug cocktails, where alternative treatments were used to focus on reclaiming immune system function and increased health and organ function, to see its impact on longevity, health maintenance, and yes, quality of life."

George M. Carter is the Director of Treatment Information Development for DAAIR, an information clearinghouse for holistic HIV therapies in New York City. He manages his hepatitis C coinfection solely through use of micronutrients and herbs.