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Published in the
Bulletin of Experimental Treatments for AIDS September 1997 issue,
by the San Francisco AIDS Foundation.
September
1997 Table of Contents
Main Page
beta@sfaf.org
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Women and HIV/AIDS:
Chinese Medicine for
HIV Positive Women
by Leslie Hanna
This article was inspired by a presentation jointly delivered by
Carla Wilson, LAc, and Misha Cohen, OMD, LAc, at the National Conference
on Women & HIV in May 1997. Carla Wilson is Executive Director and
Misha Cohen is the Research and Education Director of Quan Yin Healing
Arts Center, located in San Francisco, CA. Cohen is also the author of
a book on Chinese medicine called The Chinese Way to Healing: Many Paths
to Wholeness. Her second book, The HIV Wellness Sourcebook: an East/West
Guide to Living with HIV/AIDS, is due out next May (1998).
Quan Yin Healing Arts Center (Quan Yin) is a nonprofit, alternative medical
clinic that has treated thousands of HIV positive people since 1984. Quan
Yin’s mission is “to provide the best healthcare possible, regardless
of ability to pay and social status.” Staff include a Western medical
doctor (MD), a registered nurse (RN), a doctor of Oriental medicine (OMD),
an acupuncture clinical director, several licensed acupuncturists (LAc),
3 massage therapists and a Qi Gong (a specialized exercise program) instructor.
All Chinese medicine practitioners have completed an HIV certification
course that provides them with information about the most up-to-date Western
and Eastern methods of treating HIV disease.
Currently, Quan Yin provides treatment to about 175 people a week. About
75 are in the HIV program, and approximately 23% of these are HIV positive
women. Quan Yin offers other specialty programs related to chronic viral
hepatitis, premenstrual syndrome (PMS), stress reduction and smoking cessation.
Care is provided in Spanish and English.
Introduction
In the U.S., Chinese medicine is considered alternative medicine. Most
alternatives to Western medicine are collectively referred to as complementary
and alternative medicine (CAM). CAM refers to a broad range of treatments,
approaches and philosophies. CAM encompasses alternative systems of medical
practice (e.g., Tibetan medicine), dietary systems (macrobiotics), “manual
healing” techniques (massage therapy) and integrative mind/body approaches
(biofeedback). In general, “alternative” tends to signify the
use of some type(s) of CAM alone, for example, Chinese medicine instead
of Western medicine. “Complementary” signifies the supplemental
use of CAM in addition to conventional Western medicine, such as when
an HIV positive person uses a Chinese herbal formula in addition to antiretroviral
drugs for HIV infection.
The use of Chinese medicine or any other type of CAM is controversial
in the U.S. CAM treatments are not taught in most U.S. medical schools
and are not generally offered in doctors’ offices or in hospitals.
Furthermore, they are usually not reimbursed by third-party payers like
insurance companies. The safety and efficacy of many CAM treatments have
not been rigorously tested according to Western medical and scientific
standards; thus, many Western healthcare practitioners such as medical
doctors and registered nurses as well as the general public in the U.S.
remain skeptical about CAM.
However, the popularity of CAM continues to rise in the U.S. According
to recent articles in the medical literature (Archives of Family Medicine,
Annals of Internal Medicine), approximately half of the adults in
the U.S. use some type of CAM. (Worldwide, the World Health Organization
reports that 80% of people use CAM.) The article in the Archives of Family
Medicine states that 53% of CAM users report such use to their primary
physicians, and the Annals of Internal Medicine article stresses the necessity
for discussion of CAM between patients and their primary physicians. At
the same time, practitioners of conventional medicine are becoming more
familiar with CAM. In fact, the August 1997 issue of Nature Medicine reports
that 80% of contemporary U.S. medical students are requesting more training
in CAM practices.
Anecdotal data and data from other countries such as China and Germany
indicate that some forms of CAM are effective for treating some medical
conditions. For example, an herbal treatment called St. Johns Wort (Hypericum
perforatus) was clinically tested and approved for the treatment of mild-to-moderate
depression in Germany. Some types of CAM, like massage or meditation,
involve little or no risk to a user. Others, such as herbal medicine,
must be regarded differently. For example, the U.S. Centers for Disease
Control and Prevention (CDC) has reported deaths associated with use of
ephedrine or ma huang, an herb found in various teas and herbal formulations.
In addition, especially for people with HIV who are taking powerful antiretroviral
drug combinations, it is important to know that many herbs and vitamins,
like many anti-HIV drugs, are metabolized by the liver and excreted by
the kidneys. There may be powerful drug/herb interactions and stress on
the body’s metabolic and excretory systems.
CAM, Chinese Medicine and HIV/AIDS
Since the beginning of the AIDS epidemic, people with HIV/AIDS have used
different forms of CAM. Chinese medicine has consistently been one of
the most popular alternative modalities. Despite a lack of controlled
research studies (there have been a few, which will be explored in a later
article), increasing numbers of women with HIV appear very interested
in learning about Chinese medicine and other types of CAM. At the XI International
Conference on AIDS in July 1996, Judith Berrier and colleagues from Mt.
Sinai Medical Center in New York presented a novel survey of CAM use among
women. They analyzed data drawn from nearly 1,300 participants in the
Women’s Interagency HIV Study (WIHS), a multicenter longitudinal
study of the natural history of HIV infection in women. Over half of these
women reported some use of CAM, but far less than half (30%) discussed
CAM use with their primary healthcare provider. The investigators tentatively
concluded that women with HIV may be more likely than men with HIV to
try or to use CAM regularly, and may be more reluctant to discuss CAM
use with health care providers.
In her presentation at the Women & HIV Conference, Misha Cohen noted
that, "in this era of protease inhibitors, undetectable viral loads
and increasing T-cells (for some people), questions have been raised as
to the continuing need for CAM....CAM, especially Chinese medicine, is
very important now to provide the immune support the body will need for
extended years of drug treatments and to battle the onslaught of drug
effects brought on by powerful new drugs. Chinese medicine has been especially
effective as a total system for working with people with HIV, especially
women."
Since information about Chinese medicine and other types of CAM applies
to all adults with HIV, an upcoming issue of BETA will feature
a comprehensive article on CAM that applies to both women and men with
HIV. After some introductory information, this article will present a
Chinese medical perspective on women with HIV. The article will provide
women with HIV with an introduction to the Chinese medical system, its
terminology and concepts, and information about how to access care.
Chinese Medical Perspectives on Health and Immunity
The Chinese medical perspective on disease and health is foreign to Westerners,
who nonetheless appear to be turning to Chinese medicine in increasing
numbers. The philosophical underpinnings, the explanations for symptoms
and diagnosis, and the treatments all may appear abstract, mystical and
barely intelligible to a Westerner. One fundamental principle is that
the whole individual is addressed. During the diagnostic procedure, the
practitioner will, for example, examine and question the patient about
her lifestyle in order to understand why her menstrual period may be heavier
than usual.
Chinese medicine attempts to maintain health by harmonizing the body,
mind and spirit. It is believed that immune strength derives from reinforcing
the "normal" state of the body, which is naturally "intelligent"
and full of vital energy, or Qi. Conceptually, Qi is regarded as being
as vital and necessary to life as air. In fact, a person can learn through
breathing exercises to breathe correctly, which makes more oxygen available
to the bloodstream, and thereby strengthens the body’s Qi. Much crossover
exists between energetic and physiological effects.
The Chinese medical philosophy embraces the concept of the dialectical
opposites of Yin and Yang. The body is considered a microcosm of
the world; the correct balance of Yin and Yang will lead to good health
as well as to a balanced environment. Far from being fixed entities, Yin
and Yang are always in relationship to each other, in flux.
In addition to Qi and Yin and Yang, body fluids, especially Blood, and
organ systems are important concepts. Each organ system governs particular
body tissues, emotional states and activities. For example, the Kidney
system manages fluid metabolism. Beyond that, in Chinese medicine, the
Kidney system is responsible for reproduction, growth and regeneration.
The bones, inner ear, marrow, teeth and lumbar area are all associated
with the Kidney system. Frequent urination and low back pain may be associated
with this system. The emotional state of fear, as well as will, are also
associated with the Kidney system. (For more on organ systems and other
philosophical underpinnings of Chinese medicine, see Cohen’s book
A Chinese Way to Healing: Paths to Wholeness.)
Fu Zheng therapy, which attempts to address the whole person to
restore or maintain health, is thought to address well the needs of women
with HIV. Fu Zheng therapy is believed to increase well-being and quality
of life, to enhance the ability to fight pathogens and to minimize the
need for drug treatment. In other words, the creation of wholeness and
harmony will enable the body to heal itself. Some modalities of Chinese
medicine such as acupuncture or exercise focus on balancing the body’s
energy, while others focus on improving the physical body by adding substances,
such as herbs and food, which balance and change the body materially.
Diagnostic Techniques Used in Chinese Medicine
Diagnosis in Chinese medicine usually entails an extended period of time,
during which the practitioner looks at and listens to the patient. Looking
means closely observing the patient’s size, age, patterns of facial
wrinkles, expression, curvature of the spine and more. Close examination
of the skin, especially around the orifices, and of any discolorations
helps the practitioner "create a visual form of what is now manifesting
on the surface," Cohen explains. The appearance of the tongue is
very important in Chinese medicine. Size, swelling, cracks down the center
and color all are believed to reflect the body’s internal climate.
Wilson says that some people with HIV who learn about Chinese medicine
derive practical information that can help them self-monitor their health
status by examining their tongues in the mirror each morning.
Listening, or inquiry, is very important in Chinese medical diagnosis.
An interview of each individual is central to Chinese medicine, and may
include "unusual" questions such as: What time do you awaken
in the morning? Do you have night sweats early in the night or toward
morning? Do you dream heavily? Taking a patient’s pulse is another
pivotal diagnostic technique and way of "listening" to what
is happening with an individual.
Modalities of Chinese Medicine
According to Wilson, Chinese medicine is a complete system, with its
own understanding of physiology and pathology, and its own forms of diagnosis
and treatment. It has been used for thousands of years in Asia and for
hundreds of years in various parts of the West. Wilson stated that diagnostic
procedures and theory developed over the course of thousands of years
and involved millions of subjects, and that Chinese medical textbooks
represent compilations of thousands of hours of debate among the most
reputable physicians in China. For instance, it could take up to months
or years to determine the physiological effects of a single herb, effects
which had to be reproducible in all people with the same syndromes. Says
Wilson, "this process is similar to what happens in contemporary
Western clinical trials. It was not a simple matter for an herb to become
included in a book of medicine." The same principles continue to
be used to this day when prescribing and practicing Chinese medicine.
A number of modalities are included in Chinese medicine, including acupuncture,
moxibustion, herbal formulas, dietary therapy, exercise and massage. All
of these are commonly used by women for a variety of medical problems.
Many techniques, not all of which use needles, are associated with acupuncture.
Generally, acupuncture is the art of inserting fine metal needles
into certain points on the body in order to control the body’s energy
or Qi flow. Practitioners stimulate the needles manually or electrically.
Acupuncture is relatively painless, and may be accompanied by sensations
of heaviness, warmth, or movement of energy at the point of insertion
or along channels or energy lines. Acupuncture has long been known for
its success in relieving pain. Another benefit is the ability of acupuncture
to help the body rebalance its energy patterns in order to heal itself
of organic symptoms and syndromes.
Wilson noted that acupuncture was first licensed in Hawaii, followed
by New Mexico, California and Florida. Today, 30 states license or register
acupuncturists. In other states, acupuncture remains legally prohibited
or unregulated. A national campaign is being waged to develop licensure
in those states as well as a national certification program. In California,
acupuncturists are required to pass a state board examination that is
regulated by the medical board of acupuncture.
Moxibustion is a form of heat therapy. It involves the burning
of a common herb, mugwort or moxa, which is held over certain areas of
the body for stimulation or for warmth. The herb is usually rolled into
a cigar shape, lit so that a coal forms at one end, and held over the
body. In China, family members often assist with moxibustion. Moxibustion
can also refer to the traditional use of heat packs which are placed strategically
on the body. Moxibustion may be used alone or in conjunction with acupuncture,
and may be prescribed for home use. With moxibustion as with acupuncture,
certain points are considered useful for stimulating appetite and others
for ameliorating neuropathies (nerve damage).
Chinese herbal medicine is a vast subject, involving thousands
of distinct medicines. In the U.S., students learn to use 300-500 herbs
while attending very strict training programs. Thorough training and cautious
use is warranted in the area of herbal medicine because herbal substances
are essentially drugs in that they have specific organic effects. They
are not recommended for casual use. Herbs may produce therapeutic effects
and side effects, and there may be individual sensitivities, as with pharmaceutical
drugs. As of 1997, California is the only state that requires herbal medicine
training for passing state licensure examinations. In other states, licensed
acupuncturists may or may not have studied herbs as well as acupuncture.
Currently, regulations regarding the use of herbs are being rewritten
in some states. Persons interested in seeing an acupuncturist or herbalist
should ask a potential practitioner what type of herbal training she or
he has had. The practitioner also should have additional training in HIV
and AIDS treatment. For instance, a National AIDS and Chinese Medicine
Conference held each year offers courses for acupuncturists. In the setting
of HIV infection, ingestion of certain herbs has been linked to near-fatal
reactions. Sherwood Gorbach, MD, from Tufts University School of Medicine,
identified 10 such herbal substances: chaparral, comfrey, germander, GordoloboYerba
tea, Kombucha tea, margosa oil, mistletoe, pennyroyal (squawmint) oil,
skullcap and certain types of Mate teas.
One of the most important therapies in Chinese medicine relates to food,
which is regarded as the "first fuel." When people become ill
in China, food therapy is often the first line of treatment
considered. Chinese food therapy includes all food used to strengthen
digestion and to increase and balance the body’s energy. Food therapy
is often used prior to or in conjunction with other modalities, in order
to increase the efficacy of all treatments. Food therapy is based on the
concepts of Yin and Yang, or balance of energies. Similarly, Yin and Yang
are fundamental concepts in Japanese macrobiotics and in nutritional supplementation.
For centuries, massage therapy and exercise have been important
aspects of Chinese medicine and health, although not unique to Chinese
medicine. Various techniques are involved in massage therapy. Exercise
ranges from aerobic martial arts to Qi Gong, also known as Tai Chi. Many
practitioners recommend that HIV positive people find some type of exercise
such as Qi Gong that builds energy or helps consolidate Qi in the body.
The idea is that oxygen helps the body move the energy or Qi, thereby
creating more energy and rejuvenating the cells of the body. A practitioner
might recommend that women with HIV join a health club or a clinical study
which provides exercise equipment and instruction.
Meditation is an important aspect of Chinese medicine. Many forms
exist, ranging from the very active to the contemplative. For example,
there are walking meditations and sitting meditations. Watercolor painting
is another meditative technique often used in China. Today, newer forms
of meditation include relaxation exercises, cassette tapes, hypnotherapy
and biofeedback.
Chinese Medicine and Women with HIV
In the Chinese medical view, HIV infection is a Toxic Heat condition.
Symptoms of fever, sore throat, night sweats, rash and itching are all
related to Toxic Heat problems. Cohen notes that, in her experience, many
people with HIV "have red dots on the tongue, an additional indicator
of Toxic Heat in the body." While many HIV-related conditions are
found in both men and women, conditions involving the reproductive tract
are different. Chinese medicine offers its own explanations for gynecologic
disease in women with HIV. For instance, genital warts and cervical dysplasia
are signs of Toxic Heat in women. Genital (and oral ulcers) are also Toxic
Heat manifestations that can be treated by Chinese medicine.
HIV disease begins to manifest Toxic Heat in the central portion of the
body, in the Spleen and Stomach. These organ systems, charged with fluid
metabolism, digestion and provision of energy to the entire body, are
highly affected by HIV. HIV affects digestion and results in symptoms
like nausea, loss of appetite and diarrhea. Menstrual irregularities are
believed to be related to the Spleen’s loss of normal function, which
is viewed as regulating the blood and transforming food into blood and
energy. Women with menstrual irregularities may have a Spleen pulse that
is "soft" or "slippery," and the tongue may be "puffy
or scalloped with an absence of coating in the center and cracks down
the middle, showing that the central Qi (or Spleen Qi) is deficient."
The particular type of menstrual irregularity is diagnosed and the appropriate
herbal remedy is recommended depending on the appearance of the tongue,
the type of pulse and the type of bleeding.
Generally, menstrual problems in HIV positive women are attributed to
Spleen Deficiency. The particular problem of amenorrhea, or scanty or
absent menstruation, results from combination Spleen and Blood Deficiencies,
and possibly Blood Stagnation. All of these distinctions determine which
herbs to use to treat the condition.
Recurrent vaginal candidiasis or yeast infections are a complaint of
many women with HIV. From the Chinese medical perspective, women with
HIV and Spleen Deficiency often have Spleen Dampness, which can lead to
the development of candidiasis at any site. Spleen Deficiency Dampness
in women with HIV is also associated with difficulty digesting sugars
and fermented food and beverages. Dampness leading to vaginal infections
is further characterized as Cold Dampness or Damp Heat, which is revealed
by the color and odor of the vaginal discharge and requires different
herbal treatment. Herbal formulas are tried first. Supplemental acidophilus
bacteria and garlic also may be used, in both intravaginal and dietary
supplemental forms. Nutritional counseling instructs women with candidiasis
to avoid foods such as sugars, yeasts and fermented products, and to increase
intake of greens, vegetables and protein. Chinese dietary recommendations
to combat Dampness include reducing the consumption of dairy products
and increasing barley consumption. For women with esophageal candidiasis,
an AIDS-defining condition, Cohen recommends treatment with pharmaceutical
antifungals as well as Chinese herbal therapy.
When the condition of Spleen Dampness progresses (or, in Chinese medical
parlance, when Dampness sinks to the Lower Burner), genital herpes outbreaks
and pelvic inflammatory disease (PID) may occur. This sinking or progressive
descent of the condition occurs when Damp Heat or Liver Heat pass through
the Liver channel, which passes through the pelvic and groin areas, the
chest, and encircles the mouth. Thus, herpes sores and canker sores also
may develop around the mouth or elsewhere on the body.
HIV positive women with Toxic Heat and Liver Qi congestion may experience
vaginal or cervical human papillomavirus (HPV) infection. From the Chinese
perspective as well as the Western perspective, HPV infection may lead
to cervical neoplasia, a precursor of cervical cancer. Cigarette smoking
is believed to enhance HPV infection by both Chinese and Western medical
practitioners. The uniquely Chinese medical explanation is that chronic
HPV infection and cervical neoplasia are due to Spleen and Kidney Qi Deficiencies,
and the recommendation may be to use herbal formulas specially designed
for women to regulate the Liver, Spleen and Kidney Qi. Herbal formulas
are also available for intravaginal use.
Lifestyle factors such as stress, drug and alcohol abuse, low self-esteem,
history of physical or sexual abuse and abdominal surgery are believed
to have profound effects on an HIV positive woman’s health, and can
result in Liver Qi Stagnation-related PMS, for example. Herbal formulas
designed for balancing women’s health are often recommended.
Women with HIV may experience depression. In Chinese medicine, the liver
is known as the Temperamental Organ or the Sea of Emotions. In Chinese
medicine, the strength of the Spirit is considered crucial to health.
Thus treatment for Liver Stagnation, such as acupuncture, may alleviate
depression or anxiety as well as aggravated PMS.
In Chinese medicine, women with HIV, like men with HIV, must address
the overarching and ongoing HIV-related problems of Toxic Heat and Central
Qi Deficiency. At Quan Yin, a popular Chinese herbal formula called Enhance
is used to "regulate the immune system, tonify the Spleen Qi, clear
the Heat and toxins, and stimulate bone marrow." Many other herbs
believed to have microbicidal (antiviral/antifungal/antibacterial) properties
are used. For example, Cordyceps or Dong Chong Xia Cao, an herb used to
treat HIV, is currently being studied in China for the treatment of cancer.
Many other herbs and herbal formulas are available to treat common HIV-related
problems such as diarrhea and anemia.
Wilson and Cohen advocate comprehensive and individualized treatment
plans for women with HIV. They favor a complementary East/West approach
and recommend that women with HIV receive their primary care from medical
doctors. This way, serious symptoms can be diagnosed early and conventional
treatment can begin when necessary (e.g., in the event of esophageal candidiasis).
Chinese medicine may make it possible to reduce the duration of pharmaceutical
treatment, for example, for candidiasis. Chinese medicine--herbs, Qi Gong
exercise, dietary changes, massage and meditation--can be used in complementary
fashion to strengthen the body before, during or after conventional medical
treatment.
Talking with your primary care provider about CAM
Discussing CAM use with your doctor increases your treatment options
as well as your chances for receiving the best healthcare possible. Since
your doctor may not mention CAM, you can initiate the conversation. David
Eisenberg, MD, in an article in the Annals of Internal Medicine, suggests
some helpful steps:
- Describe your symptoms to your doctor as well as possible.
- Keep a daily symptoms diary in which you record what your symptoms
are, how often they occur and how severe they are, and any related information
such as what medications you take and when. Over time, a symptoms diary
can provide invaluable information about your general health as well
as the efficacy of treatments.
- If you are interested in a form of CAM, ask your doctor what he or
she knows about it (i.e., its safety and efficacy). Ask your doctor
for assistance in finding a qualified CAM practitioner—how to find
a licensed acupuncturist, for example. (Licensing requirements vary
between states.)
- Once you identify a potential CAM healthcare provider, interview him
or her. Ask what the treatment will consist of and what it will cost.
Ask when results should appear and if side effects are likely. Ask if
there is third-party reimbursement.
- Ask if the CAM practitioner would be willing to speak with your primary
care provider about treatment recommendations, side effects, etc., and
to forward your records to your primary care provider.
- Ask if it is possible for you to speak to patients who have been treated
by the CAM provider for the same problem.
- Before you begin any type of CAM, review your overall treatment plan
with your primary care provider to make sure that there are no potentially
dangerous effects, like drug interactions. Discuss any questions or
problems with him or her.
- If you begin CAM, begin one type at a time, and continue to keep your
symptoms diary.
- At the end of the CAM treatment plan, (e.g., a short-term acupuncture
treatment), review your symptoms diary with your primary care provider
to evaluate the efficacy of the CAM.
These suggestions should help improve communication between you and your
primary care provider, give you vital information about your health and
treatment plan, and maximize your opportunities for optimal health care.
Current CAM Research
The following studies of CAM are currently enrolling women with HIV around
the country. Since herbal therapies are generally not considered harmful
to pregnant women, childbearing potential and/or pregnancy are not usually
exclusion criteria for women seeking to enroll.
At the Immune Enhancement Project in San Francisco, an FDA-approved trial
funded by the National Institutes of Health (NIH) is evaluating acupuncture
and herbal treatment vs standard Western medicine (the antibiotic Augmentin)
for chronic HIV-related sinusitis. The trial is still enrolling. For more
information, call 415-252-8711.
Also in San Francisco, the Community Consortium in conjunction with Quan
Yin is conducting a pilot study of Chinese herbs for cryptosporidiosis-negative,
HIV-related diarrhea. The small study will evaluate whether taking Chinese
herbs is safe and effective in reducing diarrhea that is unrelated to
cryptosporidiosis. Call the Community Consortium at 415-476-9554. An upcoming
study, also conducted by the Community Consortium and funded through NIH
and Bastyr University in Washington, is a pilot study of Chinese herbs
for the treatment of mild to moderate anemia.
A Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA)
study of acupuncture and amitriptyline (Elavil) for peripheral neuropathy
is ongoing in several states, including California, Colorado, New Jersey,
New York and Pennsylvania. Another CPCRA study is looking at nutritional
supplementation, including Peptamen, Nubasics, multivitamin and multimineral
supplementation. Call 1-800-TRIALS-A for information about these and other
CPCRA trials.
A double-blind, placebo-controlled trial of oral L-carnitine for the
treatment of AZT-induced myopathy is ongoing in Bethesda, MD. Muscle biopsies
are involved. The study is sponsored by the NIH National Institute of
Neurological Disorders. Call 301-402-4479.
At Mt. Sinai School of Medicine in New York City, an ongoing study is
evaluating supplementation with methionine, an amino acid, for the treatment
of myelopathy, a neurological disease associated with HIV. Call 212-241-8902.
A placebo-controlled study of the hormone DHEA for the treatment of depression
in men and women with HIV, will enroll those with fewer than 400 CD4 cells/mm3
and "low mood/energy." Call the NY State Psychiatric Institute
at 212-543-5762.
Finally, a study of acupuncture and moxibustion for diarrhea related
to chronic malabsorption in HIV is ongoing. Sponsored by the Center for
Holistic Medicine on Long Island, NY, the study is taking place at the
Columbia University School of Nursing. For more information, call 212-305-3852.
Resources and Referrals
If you are interested in Chinese medicine or another type of CAM, first
talk to your primary care provider for a referral and about potential
CAM therapies. Medical and public libraries as well as bookstores are
good places to find information about CAM therapies.
For licensing requirements for any given state, contact:
National Certification Commission for Acupuncture and Oriental Medicine
PO Box 97075
Washington, DC 20090-7075
202-232-1404
The following agencies can provide referrals to local Chinese medicine
practitioners:
American Association of Oriental Medicine
433 Front Street
Catasauqua, PA 18032
610-266-1433
California Association of Acupuncture and Oriental Medicine
1231 State Street, Suite 208-A
Santa Barbara, CA 93101
888-432-5669 (in CA only) or 805-957-4384
Institute for Traditional Medicine
2017 SE Hawthorne Street
Portland, OR 97214
503-233-4907
Finally, the following organization can provide referrals to medical
doctors who also practice acupuncture:
American Academy of Medical Acupuncture
5820 Wilshire Boulevard, Suite 500
Los Angeles, CA 90036
213-937-5514
For other types of CAM, such as chiropractic, naturopathy and homeopathy,
various medical regulatory and licensing agencies in your state may provide
information about a specific practitioner’s credentials and training.
The Office of Alternative Medicine Clearinghouse has several fact sheets
on CAM, including one entitled "Alternative Medicine Research Using
MEDLINE."
References
Berrier J and others. Use of complementary/alternative
therapies by HIV + women: the women’s interagency HIV study (WIHS).
The XI International Conference on AIDS. Vancouver, BC. July 1996. Abstract
Th.D.5120.
Cohen M. The Chinese Way to Healing: Many Paths to
Wholeness. Berkeley/Putnam Group. September 1996.
Cohen M and Surasky A. Chinese medicine for HIV+ women.
Immune Enhancement Project News. Summer 1996.
Cohen M and Wilson C. Chinese medicine and alternative
therapies. The National Conference on Women & HIV. Pasadena, CA. May
1997. Abstract 113.
Gorbach S. Dietary management of AIDS wasting. AIDS wasting
diagnosis and treatment. XI International Conference on AIDS. Vancouver,
BC. July 1996. Satellite symposium.
Jonas WB. Researching alternative medicine. Nature
Medicine 3(8): 824-827. August 1997.
Page last updated 1 October 1997
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