Of all of the complementary and alternative therapies now in vogue, perhaps the most familiar is acupuncture. Despite this ancient therapy's newfound popularity, however, it remains poorly understood in this country.
Acupuncture and Chinese Medicine
Developed in China over 2,000 years ago, acupuncture utilizes the body's own energy to promote healing. Acupuncture and several other types of treatments, such as herbal therapy and tuina (massage and manipulation involving acupressure), comprise the system that we now call Traditional Chinese Medicine. While Asian communities in the United States have been using acupuncture for decades, it is only since the early 1970s that the practice has been more widely embraced in this country. It is now one of the most popular of the alternative or complementary natural healing therapies.
According to Chinese medical philosophy, the body's life force is qi, pronounced chee and loosely translated as "vital energy." In Chinese medical theory, qi has a very close mutual relationship with blood and controls the body's internal mechanisms of homeostasis, immunity, and energy flow. It is the body's qi that connects and maintains communication between the body's organ systems through a series of networks called meridians. Health is seen as the mind and the body, with its organs and vital fluids, being in a state of balance, with the body's qi circulating free of obstruction.
There are several important concepts at the heart of Traditional Chinese Medicine: First, the body is considered an integrated whole, with the different organ systems operating in an interdependent manner. Diagnosis and treatment must reflect this principle. Second, in terms of causality and the way an illness can affect an individual, the mind and body are not distinct. For instance, emotional stress can be at the root of a physical illness, just as a physical illness can undermine the ability to cope with emotional stress. Third, the disease process is multipronged and complex. Rather than being reducible to a single pathogen, it usually involves several factors -- lifestyle, emotional health, external influences, and the body's constitution. Healing addresses multiple possible illness-inducing factors.
Many external influences and internal factors -- stress, diet, lifestyle, pathologies, emotional tendencies, and the degree to which the individual is susceptible to becoming ill -- combine to determine the state of a person's health. When the person is ill, the balance and circulation of the qi are impaired. Acupuncture is designed to correct the imbalance and facilitate the circulation of qi in order to restore health. This is achieved by the insertion of fine sterile needles at specific points on the body's surface, followed by light manual or electrical stimulation.
Acupuncture and HIV
In recent years, people with HIV have been using acupuncture to enhance the immune system and reduce pain, to manage HIV-related disorders and symptoms and the side effects of medication, to help in the process of recovery from drug and alcohol addiction, and to cope with stress and emotional disorders.
That acupuncture is a drug-free, side-effect-free therapy with the potential to boost the immune system is a large part of its appeal to people with HIV. Although immune enhancement isn't exactly a direct translation of a Chinese medical principle, it more or less describes one of the primary goals of acupuncture -- to help the body's own mechanisms maintain a state of balance, improving its ability to stave off or overcome illness and disease.
During the late '80s and early '90s, while western medicine was making little headway in developing effective treatments for HIV disease, people with HIV took to the streets to demand more research. In addition, they took it upon themselves to find other means of effective healthcare, and acupuncture was one of many nontraditional approaches that found broad acceptance.
The health crisis at hand, and the slowness of the U.S. healthcare establishment and government to respond to it, pushed people toward making a paradigm shift. Thanks to the vision and dedication of a handful of practitioners, acupuncture and Chinese medicine were able to offer a vehicle for people with HIV to do some reckoning and renegotiation: When there is little to be offered from without, we can look to the power of our own bodies within. If antivirals and prophylactic drugs make our bodies feel weak, we can try treatments that make our bodies stronger and more resilient. If a prevailing medical system's tendency to reduce our life quotient to a set of numbers does not offer the life-affirming perspective that we need, we can turn to a model that supports us and evaluates our health in terms of the many facets and elements that make up our lives. If we are coming to believe that perhaps some profound transformative changes need to be made in our lives, we can seek support in a system of healing that recognizes the centrality of balance in all aspects of our lives.
HIV Acupuncture in the Protease Era
Now, at the turn of the century, combination drug therapies are offering people with HIV greater hope and seemingly keeping people alive and healthier for much longer. Acupuncture remains a popular treatment, however, while its role in the overall scheme of HIV care has been modified. Jackie Haught is a Licensed Acupuncturist who has been treating people with HIV and AIDS in New York City since before the biological identification of the HIV virus, Before the advent of protease inhibitors, she says, for many PWAs acupuncture was a primary component of their healthcare. Now acupuncture is looked to more for managing the side effects of the new drugs. It is being used to relieve the pain of peripheral neuropathy and ease digestive problems, for example, and ways to address fat imbalances are being explored.
Haught also points out that, before the incorporation of protease inhibitors, mainstream medical practitioners tended to consider cofactors such as stress and poor diet as causing or contributing to, for example, problems with diarrhea. Now it seems these same practitioners are reverting to a narrower view and are now tending to overlook these important factors. Working with an acupuncturist is a way to explore some of these cofactors and develop strategies to address them.
Some health problems seem to respond well to acupuncture whether they are primary disorders or secondary to drug therapy (that is, side effects of medications). These include the nausea, diarrhea and other gastrointestinal problems, low energy, shortness of breath, anxiety, stress, and insomnia so common among people with HIV.
Acupuncture is probably best known in this country for its effectiveness in managing pain. One acupuncture patient, C.J., describes his experience using acupuncture for pain management:
I first sought acupuncture for relief of peripheral neuropathy. I had tried chiropractic, and although there was some relief, there was also more pain. Then I thought about acupuncture. I had heard about acupuncture through some friends. My first visit was interesting. I felt immediate relief. I could feel a connection between the nerves from my lower back to my legs. Within the first few weeks of treatment, I didn't need to use my cane anymore.
A specialized type of acupuncture called ear-point acupuncture is playing an increasingly important role in stress reduction and substance abuse treatment. When used in conjunction with counseling and other supportive therapies, ear-point acupuncture can be highly effective in supporting the process of detoxification and recovery.
Needles are inserted into the five acupuncture points in each ear, where they are retained for up to 45 minutes. The effect is to promote calm and relaxation, reduce cravings and withdrawal symptoms, facilitate the elimination and detoxification processes, and help the patient cope with stress. Since embarking on the path to recovery may be the most important health move a substance abuser with HIV can make, acupuncture has a central role to play in the healing process.
So what, exactly, does acupuncture entail? First, an accurate diagnosis is critical to determining the type of treatment and acupuncture points to be used. Depending on the style of acupuncture (e.g., ear-point or full-body), diagnosis may include a full medical evaluation, involving a detailed intake interview, medical history, assessment of organ systems, review of symptoms and signs, and pulse and tongue evaluation.
For most people, the acupuncture treatment itself is relatively painless. The insertion of the needle causes only a minor prick, which is followed by a dull, heavy sensation that is attributed to the successful arrival or stimulation of qi. If administered appropriately in terms of point selection, clean needle technique, needling depth, and type of stimulation, acupuncture is very safe and should not cause unwanted effects.
How long it takes for acupuncture treatment to be effective depends on the health problem(s) to be treated, preexisting condition(s), the patient's constitution, and other factors. It can have immediate results, as in C.J .'s case described above. In other instances, the effect may be more subtle and take place over a longer term. Another patient, Robert, describes his experience:
With acupuncture, I didn't immediately feel a difference, but after three months, I felt a lot different. My energy came back. My stomach pain, step by step, got better and better. Unlike with western medicine, there are no side effects. With the combination of treatments, western medicine and acupuncture, I feel the side effects less. Normally I have side effects, dizziness and diarrhea. With acupuncture these are a lot less.
Acupuncture has now achieved a certain degree of mainstream respectability in the U.S. In 1997, the National Institutes of Health developed a consensus statement vouching for the efficacy of acupuncture for the treatment of a variety of health issues. Acupuncture needles were recently moved from the Food and Drug Administration's category of "experimental medical devices" to being regulated. Federal and local governments are funding an increasing number of acupuncture programs, especially for HIV and substance use treatment. Discussion about acupuncture is shifting from whether it has a place in the scheme of healthcare in the U.S. to how best to integrate acupuncture (as well as the host of other alternative or complementary therapies) into the prevailing spectrum of care.
People with HIV/AIDS have served as laboratories for fine-tuning experimental drugs for almost two decades now. And although it may not be widely acknowledged, they have also been the testing ground for integrating medicines. People with HIV/AIDS are themselves both the product and the medium of integrated medicine, at a time when the medical establishment and practitioners of alternative medicine have yet to sit down together to work this all out. Questions about interactions are still outstanding. The need for more research, strategies to maximize the benefits of the different types of care, and access to services continue to be unresolved issues. It is likely that it will continue to be people with HIV and AIDS who will lead the way to finding some of the answers.
Milyoung Cho is a Licensed Acupuncturist and Chinese herbal therapist. She currently works at Cabrini Medical Center's Complementary Health Program.
Photograph by Judy Lawne