Chinese Medicine and AIDS: What Has Been Learned? Interview with Misha Cohen

Misha Cohen, O.M.D., C.A., founder and clinical director of the Quan Yin Acupuncture and Herb Center in San Francisco, has worked extensively with persons with AIDS and HIV infection for five years. We asked Dr. Cohen to outline the most important lessons from this work--and also to suggest practical treatment options available now, even for persons living in areas which have no access to Chinese doctors or practitioners. AIDS Treatment News: What basic themes or messages are most important to give to our readers?
Dr. Cohen: "We believe that a combination, integration of Eastern and Western concepts is necessary to fully benefit in treating AIDS/HIV. Traditional Chinese medicine is a system in itself, with concepts very different from those of Western medicine.
"Some Chinese doctors have examined persons with AIDS, recognized various syndromes they commonly treated with herbs, and said, 'We can treat those'. But when they tried, often it didn't work. They were masters with herbs, but they had no experience with AIDS.
"For over five years we have been working with AIDS and ARC. It has taken that long to get to where we are now, learning to use Chinese concepts, and also to look at Western concepts, such as viruses, opportunistic infections, and the pathogenesis of the disease as seen by Western medicine. We had to combine Chinese principles in use of herbs, etc., with Western ideas. Others should not start from the beginning all over again.
"Chinese medicine, and natural therapies in general, are very strong on immune enhancement. But by itself that's not
enough. With AIDS the major problem has been antiviral.
"Chinese medicine has hundreds of potentially antiviral herbs. But only recently has it been possible to discover which ones have anti-HIV properties, by modern research. (See "Chinese Herbs Screened for Anti-HIV Activity", AIDS Treatment News July 29, 1988; for a free copy send a self-addressed stamped envelope to AIDS Treatment News, P.O. Box 411256, San Francisco, CA 94141, and ask for issue #61.)
"We are working with the well-known herbalist Subhuti Dharmananda, of the Institute for Traditional Medicine in Portland, Oregon on antiviral and immune enhancing combinations.
"The antiviral work is the leading edge of herbal medicine for AIDS today. The hope is to find strongly antiviral herbal combinations without serious side effects.
"We need to caution readers, don't just take the antiviral herbs. In Chinese medicine, these are known as anti-infection herbs, which "clear heat, clear toxin". But also they are, in Chinese medical terms, "very cold". You want a balance of cold, hot, warm, cool. To take only these herbs together is unbalanced, and people will not feel well, just from the herbs. They may feel drained, colder, and find it hard to digest the herbs. It's much better to use combinations designed according to Chinese medicinal principles, including both antiviral and immune enhancing herbs."

Practical Options

ATN: We know that Chinese medicine is highly individual, so it is better if people can see a practitioner to tailor any treatment to their own situation. How can people start if (1) if they are near San Francisco or in another area where experienced practitioners are available, and (2) if they cannot get to a practitioner but are living in an area where all they
can do is obtain herbal formulas by mail?
First tell us what options you have available or know about for persons within commuting distance of San Francisco. Also, our readers should know the approximate costs of the various options, and your policies on accepting insurance.
Dr. Cohen: "In the San Francisco area, and also in Chicago and New York, there is an herbal treatment and research program sponsored by three organizations: Quan Yin in San Francisco (mentioned above), the Institute for Traditional Medicine in Portland (mentioned above), and the Oriental Healing Arts Institute in Long Beach, CA. At Quan Yin, 105 people are currently participating in this program, and that number will increase by 50 every 12 weeks. In addition, 40-50 are in the program in Chicago, and about 60 in New York.
"This particular program has a reduced cost because it is partly subsidized by the companies which supply the herbs. The exact cost depends on what subsidies are available at the time. At this time, the entire 12-week program costs about $150. If the same herbal formulas were bought at retail, they would cost about $150. per month.
"In addition, since this is a research program, anyone participating will have to have blood work done, which is a good idea anyway. The tests currently required for the study, such as the complete blood count or CBC, are not expensive.
"In San Francisco, this program will have 50 new places available on December 15, and 50 more every 12 weeks thereafter. That's for people who want to reduce the cost by participating in the research. You can start a similar treatment programs any time.
"Anyone who wants more information about our treatment/research program can call the Chinese Herbal Treatment Program for HIV Infection, at Quan Yin, 415/861-4963. There may be an answering machine at this number; ask for information and leave your address. Or write to the program c/o Quan Yin, 513 Valencia St., San Francisco, CA 94110. Anyone can get a copy of the protocol. Arrangements are being made so that persons outside of the San Francisco area can participate in this research through their physician or practitioner wherever they are, receiving the formulas by mail, provided they agree to share the results with us by returning the data forms we provide.
"Incidentally the results of our last study were presented by Qing-Cai Zhang, M.D., at a symposium in Long Beach on October 23. The proceedings will be published by the Oriental Healing Arts Institute; they should be ready in December or January. For more information, call the Oriental Healing Arts Institute at 213/431-3544, or write to them at 1945 Palo Verde Avenue, Suite 208, Long Beach, CA 90815."
ATN: What was the most important finding in that study? Dr. Cohen: "The formulas we used at that time generally made people feel better, and be able to fight certain infections better, and seemed to raise red blood levels. But we also know that those formulas had very little if any effect on T-cell counts, white blood counts, and viral levels in the blood.
"That is why we encourage people to consider other antivirals, including AZT for some people, when used correctly. We hope that there are anti-HIV antiviral herbs which work well with little toxicity, but that hasn't been established yet.
"We have changed the formulas since last time, especially by using the laboratory anti-HIV results to develop a stronger antiviral formula, called 'Isatis 6'. It has that name because it contains Isatis and five other herbs, a total of six in the combination.
"Yet even with the previous formulas, at the beginning of our study, 8 of 23 persons with AIDS, ARC, or HIV could not work because of illness. One of them died in the first month of the study. But by the end of the study, all of the other seven were able to go back to work."
(Note: Two of the seven were temporarily hospitalized at the end of the study for complications unrelated to herbal treatment. One had an infection from a central line used for DHPG, the other had pneumothoraxes. Both are able to work now.
And to complete the account of everybody with HIV who entered this study, one person with ARC dropped out for financial reasons. He was healthy enough to work both at entry to and exit from the study.)
ATN: Besides the research program, what other options do you offer?
Dr. Cohen: "At Quan Yin, we also offer a general Chinese medicine and herbal healing clinic--not just for AIDS/HIV. Besides herbs, we have acupuncture, massage, hypnotherapy, nutritional counseling, psychic counseling, and other therapies. We also have a full Chinese herbal pharmacy. And we refer clients to medical doctors, chiropractors, and others.
"Quan Yin does accept MediCal, private insurance, Workman's Compensation, personal injury (through insurance companies), and of course Catholic Charities and the AIDS Emergency Fund."
ATN: What other programs are you involved with in San Francisco?
Dr. Cohen: "The San Francisco AIDS Alternative Healing Project (AAHP) has comprehensive programs for persons with AIDS or ARC or who are HIV positive--including acupuncture, herbs, and weekly sessions for counseling, hypnotherapy/visualization, massage, and support groups. These are group programs which run for six months, so people have to join when a new group is starting. The programs are intensive, with six to eight hours per week in appointments. For more information, people can call AAHP at 415/558-9292."
ATN: And what options can you suggest for people outside of San Francisco? What about those who cannot find any
experienced Chinese practitioner where they live?
Dr. Cohen: "In some cities they can find a practitioner. The AAHP also runs a referral and information phone service, at the same number (415/558-9292). We mentioned that there are related programs in Chicago and New York. AAHP can also refer people in some other cities; for example, Austin, Texas has a group doing similar work."
ATN: What if they cannot find a Chinese practitioner? What is the best in that situation?
Dr. Cohen: "They should be working with a physician or someone who is following them. Then I could suggest the following four-part program of herbal formulas. Sometimes these formulas can be bought in a local health-food store; if not they can be obtained by mail. These specific recommendations will change over time as we gain more experience from the research treatment programs.
"For people locally, these formulas are available from Quan Yin. But we do not sell mail order, so those who cannot find them in a local health-food store can order directly from the suppliers listed below.
"(1) The 'Astragalus 10+' formula for immune enhancement (from Institute for Traditional Medicine, in Portland, Oregon, 503/233-4907 or Cascade Mushrooms, also in Portland, 503/644- 4236. Cascade sells by the case only).
"(2) The 'Isatis 6' formula is the one we are now trying for antiviral effect. It contains some of the Chinese herbs found to have anti-HIV properties."
(Note: Isatis 6, developed by Subhuti Dharmananda of the Institute for Traditional Medicine, is distributed through practitioners and not sold in stores. Dr. Dharmananda discourages people from ordering it directly and recommends obtaining it through a practitioner, but the Institute will sell it, especially for people following a protocol, such as the one from Quan Yin. The Institute cannot provide any consumer literature about how to use this product. Persons interested should obtain the protocol, from Quan Yin's Chinese Herbal Treatment Program for HIV Infection, at the phone number or address given above.
The six herbs in this formula are Isatis leaf and root, Lonicera, Andrographis, Dandelion, Viola, and Prunella.)
"(3) Some form of ganoderma mushroom for a general tonic. Satisfactory formulas include 'Power Mushrooms' (from Health Concerns, Alameda, CA, 800/233-9355), and 'BIOHERB Instant Reishi' (from BIOHERB, Inc., Schaumberg, IL, 312/885-8789).
"(4) The fourth element is more difficult to get at this time. In the research study, we are using 'Antler 8', a formula containing deer antler, which is highly valued in Chinese medicine. It is hoped that this formula will help the bone marrow and increase white blood cells, red cells, and T- helper counts. However, the Institute for Traditional Medicine has not released this formula commercially until it gains more experience with it and learns that it does work as expected for people with HIV.
"In the meantime, people may be able to get deer horn slices, or 'Pantocrin' (a liquid herbal formula with deer horn), from a Chinese herb company, which can usually be found in Chinatown in various cities. Deer horn is expensive, commonly over $100. per pound."
(The Institute told us that it expects to have 'Antler 8' in about three weeks. It recommends obtaining this formula through a practitioner.)
ATN: What about dosage? Do the formulas usually have adequate suggested doses on the bottle? What about the deer horn? Can people call the phone referral service at AAHP to ask these questions?
Dr. Cohen: "For information on dosage, call or write to the Chinese Herbal Treatment Program for HIV Infection (address and phone number above)."
ATN: For general background, could you recommend a beginning book on the principles of Chinese medicine?
Dr. Cohen: "For theoretical background, people could start with The Web That Has No Weaver: Understanding Chinese Medicine, by Ted J. Kaptchuk, published by Condon & Weed. It is available in bookstores and is now in paperback. This book covers basic Chinese medical theory, including syndromes and diagnosis, such as pulse and tongue diagnosis. It is used by acupuncture students, as well as lay people, as their first contact with Chinese medicine. The book has no treatment information.
"A recent and important book is Subhuti Dharmananda's Chinese Herbal Therapies for Immune Disorders, published by the Institute for Traditional Medicine. To obtain this book, contact the Institute, 503/233-4907."
ATN: One final question. I know it is very difficult to raise money for research on Chinese or any kind of herbal medicine. The U.S. research establishment has little interest, it wants to test single chemicals, because those fit with our
system of pharmaceutical companies and drug regulation.
If you could find a good fundraiser or a private donor who could help you find money for this work, what could you do with more resources? How could you speed the research on Chinese- medicine options for AIDS, and also what could be done on making these options available to people who cannot now afford them?
Dr. Cohen: "If we had funding, we could subsidize people who cannot afford even the reduced rate for the herbal treatment/research program. We would do full laboratory testing on every person. Today we cannot afford to do T-cell counts.
"We would also greatly expand the program, and test different groups of herbal formulas at the same time. We do have the organizing ability; what limits us now is the money.
"Also we would have quicker turnaround as we could tabulate the data, do the statistics, and get papers published more quickly. We could move faster and have more opportunity to find what formulas worked the best."
ATN: Anything else you would like to add? Dr. Cohen: "We are happy and gratified to have maintained good relations with the medical doctors who are treating persons with AIDS. We refer patients to them, and they to us. This cooperation is basic to the comprehensive approach of combining Eastern and Western medical ideas. No one has the whole answer. Everyone benefits by communication and cooperation among the different disciplines."
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