Complete Medical Systems
Part of A Practical Guide to Complementary Therapies for People Living With HIV
Practitioners of several distinct medical systems are currently practising in Canada. Although their services are not available in all communities, interest in their therapies is growing among PHAs. These systems have their own unique philosophies, diagnostics and treatment methods and their own recognized methods for training practitioners. In some cases, the medical system is the collective medical practice of a specific culture, such as traditional Chinese medicine. In other cases, the system has developed concurrently with Western medical methods but has its own unique methodology. This is true for homeopathy and naturopathy.
However these systems have developed individually, they are grouped together in this section because of what they share. Each system has a comprehensive set of principles dictating the diagnosis and treatment of various conditions -- unlike the wellness strategies and unconventional therapies described in the following two sections.
The effective use of these systems relies heavily on an individual's relationship with a practitioner. For ancient systems of healing, HIV is a relatively new illness. As information about HIV/AIDS is changing rapidly, it is important to find a skilled, experienced practitioner who is knowledgeable about the disease. The latter half of this book includes a brief discussion of points to consider when choosing a practitioner, as well as a listing of organizations that may be able to refer you to qualified practitioners.
Ayurveda, meaning "the science of life," originated in India more than 5,000 years ago. It is an extensively developed science and the oldest known medical system in the world. Ayurveda describes the world as a system of interacting forces. It aims to balance the forces that influence the mind, body and spirit, enabling a person to live in harmony and optimum health.
Prana means "before breath." It is the life force that must exist before anything can live. Prana is similar to the Chinese concept of Chi (see section on traditional Chinese medicine). It is the source of the five elements recognized by Ayurveda: fire, earth, water, air and ether (space). These elements make up all the matter in the universe. They are the building blocks of the human body. The five elements are condensed into three forces, or humours, called vata (wind), kapha (phlegm) and pitta (bile). The interactions of these forces are used to describe the workings of the human body and, together, these forces are called the tridosha. The basic aim of Ayurvedic treatments is to maintain the proper balance of the tridosha.
Ayurveda acknowledges that each person has a unique combination of humours, although one or two usually dominate. During diagnosis, an Ayurvedic physician identifies a person's natural balance of humours -- a process called determining a person's body composition. As part of this process, the physician assesses dietary intake and lifestyle. Pulse reading, tongue diagnosis and an evaluation of a person's skin, nails and complexion are other diagnostic tools.
Ayurveda has a strong preventive aspect focused on maintaining a person's optimum balance of humours. Dietary counselling to maintain health is a central component. Massage, meditation and yoga are also used to maintain the body's health.
When Ayurvedic treatment is necessary, it is individually crafted to return the body to its natural balance of humours. Since each humour is associated with a particular part of the body, treatment is directed to that area where the out-of-balance humour would accumulate. In chronic illness, treatment is much more complicated, because each of the humours affects the others, eventually influencing all of the body's systems.
Maintaining the balance of humours supports the Ojas, or essential energy of the body. In Ayurveda, all living things are viewed as constantly evolving dense energy. Ojas is the essence of this energy. It is described as a sap or nectar that resides primarily in the bone marrow. When it has sufficient Ojas, the body is healthy; when Ojas is deficient, disease develops. AIDS is defined as a disease of low Ojas. Ojas is essential to the immune system and to proper digestion. HIV disease is treated by correcting the imbalance of humours that contribute to specific illness, malabsorption and weakening the immune system.
Once a PHA's body constitution is determined, the practitioner will prescribe treatment to gently assist digestion and the absorption of nutrients as well as to facilitate circulation and elimination. Treatments can include a combination of dietary changes, herbal medicines, cleansing therapies, chakra therapy, massage and meditation. Specific foods and tonics may be used to enhance the Ojas. In addition to strengthening the body, they may also nourish the mind and spirit.
Panchakarma is a cleansing therapy used in Ayurveda to detoxify the body and is ONLY undertaken when the patient is strong and relatively healthy. It is not used during the end stage of a disease. Panchakarma is a complex therapy involving several stages. In the first stage, warm oil is rubbed over the body to induce sweating. The oil penetrates the skin and stimulates nerve endings. Special diets are used to promote the cleansing and detoxification of the digestive tract. The method of detoxification is specific to a person's body type and the humour imbalances identified. It might include the use of enemas, laxatives or herbs that induce vomiting. Such intense procedures have risks and may be detrimental if performed improperly, so supervision from an experienced practitioner is necessary. After this intense cleansing, a pacification treatment is used to re-balance the tridosha and protect the system. Panchakarma is used to eradicate toxins, rejuvenate the system and minimize or halt the disease.
Located in various parts of the body, chakras are energy centres that vibrate at specific frequencies. Although there are thousands of chakras, there are seven major ones, and they are situated along the spine between the tail bone and the top of the head. When the chakras become blocked, the body manifests disease. In Ayurveda, a spiritual approach may be taken to clear these blockages. Such treatment involves wearing gem stones over the heart or throat chakras to enhance the energy at these points.
Meditation and prayer are also used to aid spiritual well-being. But, like many other forms of mind-body medicine, these treatments may be beneficial to a person's physical well-being as well. Prayers focus outside as the individual asks the higher-self or God for guidance. Meditation is more inward looking, focusing on an awareness of the body and the thought processes of the mind. (See section on mind-body medicine.) Mantras and incense are other forms of treatment. Mantras consist of repeated sounds used to calm the mind and provide a glimpse at bliss. Their vibrational quality is thought to heal when used correctly. Incense is used to calm the mind and promote mental clarity.
Oil baths and massage are major components of Ayurvedic medicine, both to treat disease and maintain general health. For general health, warm oil (often mixed with herbs) is massaged into the skin and left on for a specific time. Its application is followed by a warm bath.
A variety of herbal therapies are used in Ayurveda. Several Ayurvedic herbs, including guggul and ashwaganda, are discussed in the CATIE publication, A Practical Guide to Herbal Therapies for People Living With HIV.
Ayurveda practitioners are not regulated by legislation anywhere in Canada. To qualify in India, physicians must take a five-year university level course. No such course is offered in Canada. The average cost per visit to an Ayurveda practitioner is $40 to $100, although some practitioners offer a sliding scale based on income.
Homeopathy involves specially prepared remedies to treat the whole person rather than a diagnosed condition. Homeopathic remedies are chosen by matching the remedy to the unique physical, emotional and mental characteristics of the individual being treated. About 2,500 individual homeopathic remedies are available, and all are prepared from dilute extracts of animal, plant and mineral substances.
Homeopathy literally means "like illness," referring to one of the most important principles of homeopathy, which is "like cures like." Homeopathy involves treating people with tiny doses of natural substances that in larger quantities would cause symptoms similar to those the person has. This method is called the Law of Similars.
The second major principle of homeopathy is called the Law of Infinitesimals, which states that the more dilute a homeopathic remedy, the stronger it is. Homeopathic remedies are systematically diluted to tiny doses. Between each dilution, the remedy is succussed (shaken vigorously).
Homeopathy is popular in Europe, where a number of clinical trials have looked at the effect of homeopathy on various conditions. A recent paper in the British medical journal, The Lancet, concluded that the effects of homeopathy could not be attributed to the placebo effect and urged further clinical study. Although some people living with HIV use homeopathy to treat particular HIV-related infections or symptoms, very little has been published about the experiences of HIV-positive people with homeopathy, and few studies have examined the usefulness of homeopathy in HIV.
Homeopathic combination remedies are sold in some drug and health food stores. These over-the-counter remedies are not carefully matched to specific symptoms. Instead, they contain combinations of different remedies that are most commonly prescribed for particular illnesses. Despite this broad-spectrum approach, these remedies carry little risk of side effects because they are so dilute. For treatments specifically targeted to symptoms, visit a qualified homeopath.
Homeopathic practitioners are not regulated by any province in Canada, but several Canadian colleges offer three-year training courses in homeopathy. The Canadian College of Naturopathic Medicine, which offers a four-year program, trains naturopaths to use homeopathy. The cost of an initial consultation with a qualified homeopath varies widely, from $80 to $250, and may reflect a practitioner's years of experience. Initial sessions are quite intensive and often take more than two hours. Follow-up sessions are generally much less expensive.
The Aboriginal Peoples of North America come from a variety of different cultures. There is no single healing tradition that can be called Aboriginal North American medicine, but many of the different traditions share common ideas and images. That healing is a holistic process is a central belief in Aboriginal healing traditions. Physical healing requires spiritual, mental and emotional healing, in other words. Many Aboriginal healing practices can be described as mind-body medicine because they maintain that the spiritual, emotional, mental and physical aspects of life are connected. The four quarters of the medicine wheel, a symbol that some native elders and healers use to speak about healing, can represent these four aspects of life. A discussion of the medicine wheel as it applies to HIV disease can be found in CATIE's magazine, The Positive Side (Spring 2004 issue).
The circle of the medicine wheel symbolizes another important feature of many Aboriginal healing traditions: the healing circle. Frequently used in Aboriginal gatherings, healing circles allow participants to speak to their community and find, as well as offer, support. The healing circle reflects the emphasis that many Aboriginal healing traditions place on people's connection to their community. Many Aboriginal traditions teach that personal or physical healing will only occur when people work to heal their relationships with the world around them.
Because of this emphasis on community, most Aboriginal healers only work with other Aboriginal people. Even healers who work with non-Aboriginal people usually expect the latter to commit to Aboriginal spiritual beliefs and the idea of shared community.
Sweat lodges and other ceremonies involving dancing, singing and chanting are also used in the healing traditions of Aboriginal cultures. How each ceremony is performed varies across North America and depends on the Aboriginal people involved.
Medicinal herbs are widely used by Aboriginal healers. Four herbs used frequently at First Nations gatherings are tobacco, cedar, sage and sweet grass. These herbs are smudged, meaning they are burnt to release them in the air. The purpose of smudging is to integrate the herbs with the surrounding environment as well as to link participants with that environment and each other. Participants become linked when they breathe in the herb, making it a part of their bodies. Sage is burned to cleanse the area before ceremonies begin, and sweet grass clears the mind of negative thoughts. Cedar cleanses the body and protects it from illness, and tobacco thanks the Creator for many things, including healing and providing food and medicine. Often used together in healing ceremonies, each of these herbs is associated with one of the four directions on the medicine wheel. Other herbs used by Aboriginal healers include Lomatium and goldenseal. Both are described in the CATIE publication A Guide to Herbal Therapies for People Living With HIV.
The 2-Spirited People of the 1st Nations has published Nashine Ginwenimawaziwin, or Constant Care, a guide for Aboriginal people living with HIV/AIDS. The guide reflects a holistic approach with sections devoted to the physical, spiritual, traditional, emotional and mental aspects of life. Although much of the guide focuses on palliative care (care for people who are dying), it integrates material on treatment with the cultural and spiritual health traditions of Aboriginal Peoples. For more information, contact the publisher:
2-Spirited People of the 1st Nations
To begin a healing journey in a native North American tradition, you must find an elder or healer to guide you. Contacting an elder from your own band or nation might be a good place to start. For those without close links to their home communities, Aboriginal communities across Canada are served by a network of clinics and healing centres that offer support and treatment to HIV-positive Aboriginal people. These agencies offer access to Aboriginal healers and help Aboriginal people find a range of services to holistically deal with their illness. In some cases, if the individual desires, such agencies may also help HIV-positive people access conventional Western treatment.
For a listing of AIDS services for Aboriginal people, contact:
The Canadian Aboriginal AIDS Network
The Aboriginal Multi-Media Society is another useful resource. Its Web site is located at www.ammsa.com.
Naturopathy uses natural substances and the body's own healing powers to treat and prevent illness. Naturopaths view the symptoms of illness as warnings of lifestyle flaws or imbalances in the body. Naturopathic treatments are specific responses to extensive reviews of an individual's lifestyle and nutritional requirements. Naturopaths are trained in many of the healing practices discussed in this guide. These practices include acupuncture, herbal treatments, massage, manipulation and homeopathy as well as nutritional counselling. Information about the nutritional requirements of HIV-positive people is available in CATIE's Practical Guide to Nutrition for People Living with HIV. Naturopaths are the generalists of the complementary medicine world, employing methods derived from a variety of different systems. Visiting a naturopath may help you decide which complementary therapies are right for you.
To practise in British Columbia, Alberta, Manitoba, Ontario and Saskatchewan, naturopaths must pass the Naturopathic Physicians Licensing Examination (NPLEX) and be registered with their provincial association. A system of provincial registration is being developed in Nova Scotia. Elsewhere, naturopaths are not registered. The only Canadian training program recognized by the Canadian Association of Naturopathic Doctors (CAND) and the accrediting Council on Naturopathic Medical Education (CNME) is a four-year program at the Canadian College of Naturopathic Medicine in Toronto. An introductory session with a naturopath usually costs $90 to $250, and follow-up visits range from $40 to $150. Many individuals with extended health care plans have some coverage for naturopathic medicine.
Traditional Chinese medicine (TCM) is a complete medical system with its own unique philosophy, diagnostics and treatment methods. The goal of TCM is to balance the yin (vital function) and the yang (vital essence). One analogy describes yang as the gear and yin as the grease that allows the gear to run smoothly. An excess of yang leads to the consumption of yin and the formation of heat, much as a gear that works too hard burns away the grease and builds up heat. The balancing of yin and yang stabilizes a person's energy, otherwise known as Chi, or Qi (pronounced chee). The purpose of TCM is fu-zheng, which means to support the true or righteous Chi to inhibit diseased Chi from progressing.
TCM includes extensive nutritional counselling. A proper diet supports health and vitality, thus promoting the proper or righteous Chi. Qigong is a form of exercise that focuses on breathing and meditation and is used to support and boost a person's Chi. Acupuncture, a third component of TCM, is used to treat illness by stimulating the righteous Chi and ensuring it circulates freely to nourish all parts of the body. Herbal treatments may be used to strengthen the righteous Chi in particular parts of the body, contributing to the balance of the whole.
TCM recognizes that the body and its Chi are vulnerable to damage both from internal and external sources, particularly from wind, heat, cold, dampness and dryness. Many experienced practitioners consider HIV a disease of "hidden heat." As HIV progresses, heat is produced through the consumption of yin in the body. Typical examples of the wasting of yin include symptoms such as night sweats and diarrhea. While the yin is consumed, a more vigorous form of heat or fire forms in the body. This occurrence creates a bodily environment that can support a variety of HIV-related infections. Thus one of the prime TCM treatment strategies for HIV is to counteract the environment of heat. This follows the ancient TCM saying, "Heat breeds many evils." (TCM practitioners often think of wind, heat, cold, dampness and dryness as specific disease-causing forces, or entities, thus treat them as proper nouns. For this reason, you may see these words capitalized in books and articles on the subject.)
Qualifications of practitioners of Traditional Chinese Medicine can vary. The Chinese Medicine and Acupuncture Association of Canada recommends that people with complicated illnesses like HIV visit a fully qualified doctor of traditional Chinese medicine (TCMD) if they wish to use TCM. To be qualified as a doctor of traditional Chinese medicine, a practitioner must graduate from a Chinese Medicine University or have completed a four-year program specializing in TCM after having completed an undergraduate degree. A significant amount of clinical experience is also required. As with any specific medical condition, it is best to seek a practitioner with extensive clinical experience relating to that condition.
Treatment can range from $35 to $100 per session, although some practitioners who sell the herbs they prescribe offer what they call free consultations. An initial visit to a TCM practioner will involve an extensive history, including a review of your nutritional health and a physical examination of various body pulses.
Acupuncture is a component of TCM widely used by HIV-positive people. It stimulates the flow of Chi in specific organs or areas through the insertion of needles at designated points on the body. These acupuncture points have been identified by acupuncturists in China and elsewhere over thousands of years. When undergoing this treatment, make certain that the practitioner uses sterile, disposable needles.
Acupuncture can be used to treat generalized symptoms, such as fatigue, and may be useful for localized symptoms, such as neuropathy (tingling or burning sensation in the hands and feet). Neuropathy, which may be a side effect of antiretroviral drug treatment or a direct result of HIV infection, is notoriously hard to treat. Although different approaches work for different individuals, many reports indicate that neuropathy symptoms and pain decrease for PHAs treated with acupuncture. Clinical trials have shown that acupuncture can reduce the symptoms of peripheral neuropathy in people with diabetes. However, in PHAs with peripheral neuropathy, clinical trials have not duplicated these results. Acupuncture has also been used to stimulate the immune system. Although there have been no studies of this use in HIV disease, acupuncture has been shown to increase CD4+ cells in people with cancer. Anecdotal reports suggest that acupuncture may be useful in the management of other conditions faced by PHAs, including diarrhea and addictions.
Several other forms of Chinese medicine focus on acupuncture points. Through massage, acupressure stimulates the acupuncture points without the use of needles. In moxibustion, the acupuncture points are warmed by applying burning herbs to protected skin. The herb used is mugwort (Artemisia vulgaris). Fat cigar-shaped bundles of the herb wrapped in rice paper are most commonly used. Moxibustion is frequently used to treat digestive complaints such as diarrhea, but it should be avoided if you are experiencing fever, numbness or neuropathy.
Regulations regarding acupuncture vary widely from province to province. Although acupuncture is an integral component of traditional Chinese medicine, other medical professionals are trained in its use, including naturopaths, chiropractors and medical doctors. In British Columbia and Quebec, only those trained and designated as registered acupuncturists may practise. In Alberta, trained acupuncturists are registered, but people who are not registered can practise too. Only medical doctors may be acupuncturists in the Yukon. In all other provinces, acupuncturists are unregulated. The cost of acupuncture treatments varies widely, but one can expect to pay about $45 to $65. The Acupuncture Foundation of Canada Institute (AFCI) can refer you to a medical doctor trained in acupuncture. The Canadian Association of Naturopathic Doctors (CAND) may be able to refer you to a naturopath trained in acupuncture. (See the section Getting Connected for contact information.)
TCM uses many herbal remedies, a number of which are sold in health food stores. This type of availability brings herbal remedies within reach of many people who don't have access to a TCM practitioner or who don't wish to visit one. But the quality of remedies sold unfortunately varies widely. We suggest you ask a TCM practitioner or Chinese herbalist to recommend the safest and most effective products. If you so choose, a TCM practitioner can tailor a combination of TCM treatments that may be more specific to your treatment needs than an over-the-counter single herb preparation. Astralagus, ginseng, Andrographis paniculta and other herbal therapies commonly used in TCM are discussed in A Practical Guide to Herbal Therapies for People With HIV, published by CATIE.
This article was provided by Canadian AIDS Treatment Information Exchange. Visit CATIE's Web site to find out more about their activities, publications and services.