Gay Men's Health Crisis: Treatment Issues - Volume 5 no. 4, May 15, 1991
Priscilla Scherer, R.N.

The History

The first known writings on acupuncture were in the Nei Ching (also called The Yellow Emperor's Classic of Internal Medicine; a translation is available at bookstores in New York). This early textbook is believed to have been written between 2697 and 2596 B.C., but the elaborate system of therapy outlined in the ancient textbook is based on several thousands of years of study before it. Acupuncture is believed to have its beginnings on primitive battlefields, where weapons included arrows and stones [4]. Apparently, Chinese soldiers and their local internists noticed that after suffering certain war wounds, other chronic, pre-war complaints disappeared. As patterns of healing emerged, physicians began to map them out and a science was born.

Acupuncture has had a slow start in the United States. Currently, it is used primarily as a last resort for the treatment of intractable pain, and for dieting and smoking cessation. Other countries have been much quicker to accept the technique as an alternative and even a partner to Western medicine (standard U.S. care).

Additionally, acupuncture has had recent well-publicized successes in treating drug abuse [5] and less well-known successes with AIDS-associated symptoms such as diarrhea, painful neuropathies, and even Kaposi's sarcoma (KS). Most importantly; however, is that acupuncture is not a treatment for specific, divided conditions. Instead, it depends on the status of the patient as a whole [6]. It is often difficult for Western thinkers to grasp this concept of medicine, but it is vitally important to understanding acupuncture.

At Lincoln Hospital in New York, and at centers in Chicago, Boston, San Francisco and Austin, acupuncture for HIV-related treatment is gaining in popularity and acceptance. It is worth noting that many of programs and clinics offer free acupuncture therapy.

The Principles of Acupuncture

The science of acupuncture is based on Chinese medicine principles. In TCM, the entire universe is in a dynamic (as opposed to static) state of equilibrium. Integral to this dynamic equilibrium is energy (Qi). In such a schema, each person also has ultimate power over his or her own body's equilibrium -- and acupuncture is meant to stimulate that natural power. Thus, the intensity of energy or the relative lack thereof can be said to sustain our health or to detract from it. According to Taoist thought, perfect harmony of the energies within us and of our energies with those of the universe, is health. An imbalance of energy -- either because of an excess or insufficiency -- results in disease.

A variety of external as well as internal factors could affect a person's energy balance. These include viruses and bacteria, traumatic injuries, depression, vitamin and sleep deficiencies, environmental toxins, and drug-related side effects.

There is also a physiologic basis for some of the success of acupuncture in symptom relief. Experiments conducted with rats and rabbits showed that when needles were inserted into specific points on the neck and chest (perhaps stimulating the vagus nerve), the animals' blood vessels dilated, and remained dilated as long as the needles were in place [7]. Needles inserted into specific points along the spinal column resulted in narrowing of the blood vessels of the brain. These phenomena have implications for treating high blood pressure, headaches, digestive problems, and for promoting wound healing.

In another experiment, acupuncture produced higher levels of white blood cells, and certain clotting factors [8]. For pain control, needles inserted into a point that affects a sensory nerve might either block the pain impulse before it reaches awareness in the brain or preoccupy the brain with another sensation, and thus override the sensation of pain. Finally, piercing skin and muscle tissue with needle points could stimulate the production of natural steroids and endorphins, and produce pain-relief as well as reduce inflammation.

To confirm that the effects observed were, indeed, due to acupuncture, scientists in Minneapolis compared acupuncture to placebo in 80 participants from a substance abuse program [9]. Since acupuncture had previously improved compliance and reduced relapses in drug treatment programs [10], these were considered the end points of the study. In the study, 40 participants received acupuncture in prescribed acupuncture points (treatment group) and 40 participants received acupuncture in nonspecific points (placebo group). Twenty-one of the treatment patients completed the program compared to one of the placebo group. Improved compliance and reduced relapse had persisted after six months of follow-up.

The Technique

Acupuncture is based on the understanding that just as energy can be disrupted or depleted, so also can it be rechanneled and replenished. Thus, the acupuncture needles may stimulate the body's own energy reserves or they may transmit energy from the environment into the body. Because each individual will have a unique interplay of energies, organs, and elements, as well as a unique character, the treatment is, theoretically, individualized.

A complex network of pathways, called the twelve meridians, conducts and circulates energy from one part of the body to another. These meridians are connected to various organ systems through the skin. The connections have been carefully mapped out to correspond with specific organs in the body.

It is important to find a licensed acupuncturist who is experienced in treating people with HIV. Local AIDS hotlines and community-based organizations may be helpful in offering referrals. After finding a qualified acupuncturist, the first step in treatment is accurate diagnosis. The practitioner uses several traditional diagnostic techniques to determine whether treatment should be aimed at stimulating or dispersing energy. Needles are then inserted at specific points along the appropriate meridian.

Depending on the treatment indication and the location, needles may be placed slowly, in stages, and left for up to twenty minutes, or they may be placed deeply and withdrawn quickly with a twisting motion. The angle of the needle depends on the location of treatment.

Acupuncture in HIV Infection and AIDS

Initially, practitioners used acupuncture to provide symptom-relief for persons with AIDS. Michael Smith, M.D., D.Ac., of Lincoln Hospital in the Bronx has noted that after the first four or five treatments, most patients begin to experience a decrease in abnormal sweating, diarrhea, and skin rashes [11]. Patients have also reported higher energy levels and many have gained substaintial amounts of weight.

Patients on chemotherapy have noted a reduction in side effects such as nausea, fatigue, and weakness. "Acupuncture helps the body help itelf," claims Dr. Smith, who emphasizes that the affects of the treatment on the overall health of a person is the key to understanding acupuncture [12]. The Somerville Acupuncture Center in Boston, The AIDS Alternative Health Project in Chicago, and Quan Yin herbal support program in San Francisco have reported similar symptomatic relief and overall improvement.

Magnolia Goh, C.M.D., L.Ac, reports a study of 31 patients with painful peripheral neuropathy (nerve damage in the extremities), acupuncture alleviated pain or tingling in 12 (38.7%) of the patients [13]. Another 11 patients from this study noted relief of most symptoms, with the exception of one or two, who were only partially relieved. Five others had a reduction in pain with occasional recurrences. Three patients who received only one treatment did not respond.

In this series, patients received one to three treatments per week; they began to see results within three to five treatments. During the treatment period, 23 of the patients were taking medications such as AZT, acyclovir, ddI, Septra, and Bactrim. Eight patients were taking no medication.

Unfortunately, the response to acupuncture was not examined independently of the effect of medications in the study. In the last several years, practitioners have begun to look at the direct effects of acupuncture on the immune system and more specifically at its effect on HIV disease and AIDS.

Reports from China of a small 20-patient study claim that acupuncture stimulated rises in white blood cell (WBC) counts in previously neutropenic patients and normalization of hemoglobin counts in patients with low red blood cell counts [14]. Research from Japan reports rises in WBC counts, improvement of WBC function, and increased interferon production in response to acupuncture [15]. In the Japanese study, a control group received acupuncture stimulation at points which were non-specific to treatment, and demonstrated no change in blood cell counts or interferon levels.

Specific acupuncture points, according to some small studies, are believed to strengthen the immune system, induce interferon production, raise the energy level, improve and stimulate digestion, strengthen blood, increase body fluids and improve dry skin [16].

As with other treatment regimens, acupuncture seems to be more successful in individuals with healthier immune systems. In one study, fourteen ARC patients and six AIDS patients received acupuncture for at least three months, along with a regimen of Chinese herbs [17]. Nine of the ARC patients improved and four remained stable (by T4 counts and T-cell ratio). Two of AIDS patients improved and two remained stable. One patient with ARC deteriorated, and one patients with AIDS worsened as well. One patient with AIDS died. In the ARC patients, T4 counts rose by an average of 154; they rose an average of 35 in AIDS patients.

Symptomatic relief was also greater in ARC compared to AIDS patients. Again, little information is given regarding other medications in the two groups of patients during the study period.

Transmission of HIV

Some people have raised the fear of contracting HIV through acupuncture. Because the needles used are either sterilized or disposable, risk of transmission is believed to be extremely low. One case of acute HIV infection after acupuncture was reported in a letter to the British medical journal, The Lancet in 1989 [18]. Exposure to HIV was thought to stem from the use of unsterilized needles. The simplest and most effective method of sterilization for acupuncture needles is through physical cleaning followed by autoclaving at 121 degrees celsius (250 degrees Fahrenheit) for at least 15 minutes [19]. Dr. Smith asserts that procedures are no different for acupuncturists than they are for surgeons. "A piece of metal under the skin may seem like a new idea in people's minds," said Smith, "but it is not a new mechanical practice [20]."

Some acupuncturists use disposable needles to eliminate the fear of transmission for their patients altogether. Woodson Merrill, M.D. uses disposable needles in his practice and says that transmission is "near impossible [21]."

Western Views on Acupuncture

Recently, at a local conference on AIDS, Dr. Merrill presented a compelling view regarding acupuncture and HIV-infected individuals [22]. Dr. Merrill stated that he would not recommend alternative therapies as a sole treatment for HIV, but that acupuncture may add significantly to an overall improvement in the sense of well being of HIV-infected patients. Additionally, while Merrill believes acupuncture may not cure infections or increase T4 cells, it does provide subtle enhancing properties, like increasing endorphins and possibly reducing stress and pain. Merrill also stated that acupuncture may be helpful in reducing spasms in gastrointestinal conditions, common drug-induced nausea, and some neurologic problems.

Michael Smith, M.D., D.Ac., has a very different way of talking about acupuncture. He indicates acupuncture is not for specific conditions, but instead for overall vitality and immune capability. Treatment indications depend entirely on the status of the person as a whole.

Magnolia Goh, CM.D., L.Ac. of Queens Hospital asserts that a balance between Western medicine and acupuncture, Chinese herbs, nutrition, meditation, visualization and other holistic treatments may offer more complete care. The combination of Western medicine and acupuncture is working for thousands of HIV patients [23].

Conclusion

The validity of acupuncture and TCM remains controversial in the Western culture. There is no claim that acupuncture has direct antiviral effect on HIV. But many professionals trained in both Western and Chinese medicine, have found that acupuncture offers many benefits to the overall health of a person with HIV. In fact, more and more people with HIV are using acupuncture to reduce stress, pain, and tension, among other conditions. Insurance coverage is erratic for treatments, and therapy, when it is not free, may cost from $35-$75 per acupuncture session [24]. In all likelihood, acupuncture will continue to gain attention and offer alternative views of illness, health, and treatment in HIV disease and other areas.

References:

4. Chang ST. The Complete Book of Acupuncture, Celestial Arts, Berkeley, 1976. 5. Smith, MO. Testimony presented to the select committee on Narcotics of the U.S. House of Representatives. The Lincoln Hospital Drug Abuse Program, July 25, 1989. 6. Smith M. Personal communication. 7. Smith, MO. Testimony presented to the select committee on Narcotics of the U.S. House of Representatives. The Lincoln Hospital Drug Abuse Program, July 25, 1989. 8. Chang ST. The Complete Book of Acupuncture, Celestial Arts, Berkeley, 1976. 9. Bullock M et al. Lancet 1(8652):1435-9, 1989. 10. Smith MO. Testimony presented to the select committee on Narcotics of the U.S. House of Representatives. The Lincoln Hospital Drug Abuse Program, July 25, 1989. 11. Smith MO. Results of chinese medical treatment show frequent symptom relief and some apparent long-term remissions. Presented to the World Congress of Acupuncture and Natural Medicine, Beijing, November, 1987. 12. Smith MO. Personal Communication. 13. Goh M. Acupuncture treatment for neuropathy -- patients with HIV infection. Unpublished paper. 14. ibid. 15. Wang JL, Chinese herbs and acupuncture to treat ARC and AIDS. Unpublished report from the Oriental Medical Center, 1987. 16. ibid. 17. ibid. 18. Vittecoq D et al. Acute HIV infection after acupuncture treatments. Lancet 320 (4); 259-251,1989 19. Favero MS. Sterilization, disinfection and antisepsis in the hospital. In: Lenette EH et al. Manual of clinical microbiology. 4th ed. Washington, D.C. American Society for Microbiology; 129-37, 1985. 20. Smith MO. Personal communication. 21. Merril W. Personal communication 22. Merrill W. Acupuncture and holistic therapies in AIDS, PWA Education Lecture Series and Workshop, NMC homecare, April, 1991. 23. Goh, M. Acupuncture and HIV, unpublished overview, 1990. 24. ibid.

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