Acupuncture and Chinese Medicine; Interview with Tom Sinclair, L. Ac.

Thomas M. Sinclair, M.S., L.Ac., Diplomate, National Board of
Acupuncture Orthopedics, has treated people with HIV for
eight years. He is executive director of the Immune
Enhancement Project in San Francisco. AIDS TREATMENT NEWS
interviewed him August 22, at the IEP office in San
Francisco's Castro district.

ATN: Where do you have most success with traditional Chinese
medicine, and where does it not work as well?

Sinclair: Traditional Chinese medicine has been particularly
successful in treating peripheral neuropathy, sinusitis,
pain-related problems, night sweats, insomnia, dry skin,
headache, and low energy, and fatigue.

With digestive problems, we do not always get a person
functioning back at a normal level. But often acupuncture,
together with diet changes or medication, can help to return
the digestion to a more normal state.

What has not worked well? The first condition that comes to
mind has been Kaposi's sarcoma (KS). We have not had good
success in that area.

And sometimes in late-stage AIDS it is difficult to make
dramatic changes, as the body's energy is so depleted.

Finding a Practitioner

ATN: How can somebody go about finding a Chinese medicine
practitioner, not just in San Francisco but across the U.S.
How do regulations differ in different states?

Sinclair: Currently in the U.S. there are 27 states where
acupuncture is licensed and regulated. It goes all the way
from California, where we function as primary care
physicians, to some states, even including Illinois, where
acupuncture is illegal at this point. You need to check with
the local licensing bodies.

Most importantly, you want to go to somebody who is licensed,
if licensing exists within your state; that is your assurance
that you will get at least a minimal level of competency. In
most states, there is a tendency to regulate only
acupuncture, as opposed to herbal medicine. In California,
our license covers both herbs and acupuncture.

There are a number of ways to choose a practitioner:

* Referral through friends, people who have seen a
practitioner, is often the best way. You get the most
personal insight about the practitioner.

* Check with your physician. We have been developing a much
better rapport with physicians than in the past. Often
physicians will have practitioners they send people to.

* Check with local HIV agencies. Often they have listings of
practitioners.

* Contact programs like the Quan Yin Healing Arts Center, in
San Francisco, which offers an HIV certification; they have a
list of practitioners across the country who have taken their
HIV training. It's quite a good program -- and an assurance of
a standard.

* Call the state licensing agency (in California, it is the
Department of Consumer Affairs), and ask them to send you a
list of licensed practitioners.

* Also, there is a National Commission for the Certification
of Acupuncturists, NCCA. They have been accepted as the
standard in a number of states that do not have their own
state licensing exam. You can find out if someone has a
national board certification in acupuncture, and also in
herbs. For an individual state listing, send $3. to: NCCA,
P.O. Box 97075, Washington, D.C., 20090-7075; or you can
order the complete directory for the whole U.S. for $22,
(which includes postage). You can also order by phone,
202/232-1404, 9 a.m. through 5 p.m. Monday through Friday
Eastern time.

Probably the most important question I would ask, if I were
going to choose an acupuncturist, is how much experience they
have treating HIV. Choose a practitioner who has as many
years as possible. HIV is a very complex disease; the same
underlying problem can look quite different in different
people.

Private Practitioner Vs. Clinic

ATN: What is the difference between seeing a private
practitioner, going to a clinic, or going to a teaching-
school clinic?

Sinclair: The advantage of a private practitioner is that you
get more individualized treatment.

A clinic will cost less, but you may be treated in a group
setting. It may be a room with as many as ten to twelve
tables, or just two or three tables. The quality of care is
largely equal; the difference is the amount of time the
practitioner can spend with you.

If you go to a teaching school, you will often be seen by
students; it's like going to a teaching hospital and being
seen by medical students. The care certainly can be
excellent; but you need to realize that you are being seen by
someone in training, not a seasoned, licensed practitioner,
but someone on their way there.

Paying for Acupuncture

ATN: In San Francisco, what might people expect to pay for
Chinese medicine treatment?

Sinclair: To see a private practitioner in the San Francisco
area, the average cost is about $55 for an hour appointment.
For a clinic, we try to offer low-cost care, by offering
package programs. The most common program at our clinic is
the 12-week program of herbs and acupuncture. The $240 cost
covers basically all the herbs you need over a three-month
period, plus an initial consultation and acupuncture session,
and three more acupuncture sessions. If you need additional
acupuncture, we charge $25 a session. This is about the going
rate for clinics that have sliding scales.

In San Francisco there are other payment options. Medi-Cal
can pay for two visits a month. The Immune Enhancement
Project, the Bayview-Hunter's Point Foundation, and the
American College of Traditional Chinese Medicine, all have a
Ryan White (Federally funded) program that provides free
herbs and acupuncture to HIV-positive residents of San
Francisco with income no more that $1,160 per month.

ATN: Will insurance companies pay for acupuncture and herbal
treatments?

Sinclair: That depends on the company, and on local
regulation. Call your health-insurance carrier and find out
what they will cover. We have had good results with companies
like ITT Hartford, and Aetna. Some Blue Cross and/or Blue
Shield policies will cover acupuncture, as will some
Prudential policies. You need to check about your policy, and
find out if they will pay for treatment with both herbs and
acupuncture. Often insurance will only pay for acupuncture
treatment.

ATN: In that case, can you bill for the acupuncture
separately, so the patient can pay for only the other part?

Sinclair? Yes.

ATN: I have heard that the FDA is about to reclassify
acupuncture needles. What is the practical meaning of that?

Sinclair: There were five different applications submitted to
the FDA for uses of acupuncture needles. Currently
acupuncture needles are classified as an experimental device.
So a new classification will make it much easier to get
insurance reimbursement, and open a number of possibilities
including applying for Medicare reimbursement. Insurance
companies do not like to pay for things that are regarded as
experimental procedures, and it has been a real drawback that
needles were classified this way. I believe the ruling is due
out sometime in September, and we are pretty certain that
needles will have one classified use. That will improve the
whole realm of insurance reimbursement.

Acupuncture, Herbs, Electrical Stimulation, Moxibustion,
Other Treatments

ATN: Should patients usually take acupuncture and herbal
treatments together?

Sinclair: When I work with patients, I like to work with
both. Often I will work on a more long-term, internal basis
using herbs. They come in decoctions (prepared into a drink
like a strong tea), or tinctures (herbal extracts in
alcohol), or raw compressed tablets. Often they have a slower
effect than acupuncture, but act better over a long time.
Often I will use the acupuncture treatment for immediate
symptom relief.

If someone comes in with a headache, or neuropathy, or
sinusitis, I will probably use acupuncture to treat those
symptoms. But the underlying condition, the HIV infection, we
would probably treat more with herbs. This rule has many
exceptions, of course, in how I work with people.

I think it's best to use both herbs and acupuncture together.
But some people have certain preferences. Some have a fear of
needles, or have had bad experiences, or just do not find
acupuncture pleasant; there is nothing wrong with just using
the herbs. And some people do not like taking herbs;
particularly in HIV infection, people are taking so many
pills, and one of the problems with the herbs is that you
need to take a lot of product to have an effect -- simply
because there is a lot of fiber. Look for a practitioner who
is flexible, to work with you where you're at.

ATN: Can you describe herbal decoctions?

Sinclair: That is the traditional way of taking herbs in
China. They put together a formula by assembling many loose
herbs, as roots, barks, seeds, twigs, berries; then that
mixture is cooked, and the liquid is reduced, and drunk over
a period of time.

ATN: Is acupuncture painful?

Sinclair: That is a concern for many people. Of course you
feel a prick as the needle penetrates the skin. What people
sometimes describe as painful is more the acupuncture
needling sensation; it's the arrival of chi (also spelled qi)
at that point. That can feel like a burning, a tingling,
numbness, a grabbing sensation, an electric sensation. This
is an appropriate response; it's what we are looking for, it
means that your body is responding to the stimulation it is
receiving.

Most people find acupuncture sessions very relaxing, whatever
we treat. Some patients just have a great sensitivity;
usually people are much more sensitive when they first start
treatment. As your body becomes more balanced and more
adjusted, you will find that the needling sensations are much
less painful.

ATN: How often does one receive acupuncture?

Sinclair: What I have observed in eight years of treating
persons with HIV with herbs and acupuncture is that those who
do the best are those who start early, and those who are very
consistent. How often you see a practitioner can depend on
your lifestyle, your economic situation, your commitments.
The best thing is to be very regular; it may be once a month,
twice a month, twice a week -- what is important is to stay
with it over a long period of time. I often tell clients I
would rather they come in once a month for three years than
once a week for three months. Treatment with herbs and
acupuncture is a subtle process which can have dramatic
changes, but you need to think about the long haul.

As Westerners, as members of a pill-popping society, people
want to have immediate results. Of course we try to achieve
that; but you have to temper this goal with the realization
that Chinese medicine is a long-term therapy. If you are
going to do it, to get the best results, think of the long
term.

ATN: Can you explain other procedures, such as moxibustion,
or electrical stimulation of acupuncture points, or qigong?

Sinclair: In California our license covers the use of herbs,
acupuncture, and related methods including electric
stimulation, the application of cups (basically creating a
kind of suction on the body), and the burning of mugwort
(which is called moxibustion).

Often moxibustion is used extensively with HIV. Chinese
medicine looks at the influence of environmental factors,
such as heat, cold, dampness, wind; often, temperature in the
body is very important. In HIV we often see a deficiency,
where the body's energy is very low, the tongue might have a
white coat, digestion might be poor, there could be diarrhea.
One of the treatments for that is the use of moxibustion, or
the burning of mugwort over acupuncture points. The whole
idea here is to put energy into the body, feed energy into a
weak and deficient system.

Practitioners use moxibustion in different ways. They may put
the moxi on an acupuncture needle and burn it. They may burn
a stick of moxi over the needling site. There are other
methods, such as applying moxi onto a piece of aconite which
is placed directly on the body.

ATN: And electrical stimulation?

Sinclair: Often we use that for pain relief; it's a modern
development in acupuncture. We get very good results,
particularly with conditions like neuropathy, through the use
of electrical stimulations.

Chinese and Western Medicine

ATN: How do you integrate Eastern and Western care?

Sinclair: In the last five years we have seen a tremendous
change in physician attitudes. It used to go from
indifference to outright hostility; now there is more
acceptance and, in fact, encouragement of the integration of
care.

My philosophy on HIV is to use whatever you can get your
hands on that is consistent with your belief system. That
might not be acupuncture -- it might be yoga or spiritual
work, or meditation, or strictly pharmaceuticals and drug
trials. There is no one right way with HIV, especially given
the chronic nature of the disease -- and the limitations of
Western medicines. Western medicines often have an impact on
opportunistic infections, but in terms of stopping the
underlying process, I don't think medical science has
achieved that yet. It behooves the individual to bring in
many therapies, and Chinese medicine is a very useful option.

It's important that you have a good working relationship with
your physician; and it's even more important that your
physician supports your integrating Chinese medicine, herbs
and acupuncture, into your treatment program.

If you are having trouble with neuropathy, for example, there
is no entirely satisfactory Western medication to treat it;
doctors have amitriptyline and a few other drugs. The
physician could refer you to acupuncture to treat the
neuropathy, which may be induced by drugs like d4T or ddI or
ddC; that is a valuable synthesis right there. Or if you have
digestive upset, you might have parasite cultures, an
endoscopy, sigmoidoscopy -- standard Western procedures. They
may not identify a pathogen; then you may choose to treat
with Chinese medicine. This is another opportunity to
integrate both models.

The question comes up about the use of AZT, 3TC, or other
antivirals. Here I come back to the philosophy that you need
to use everything you can to stay healthy and stay alive.

I used to feel that if one pill is good, ten pills is much
better. I'm coming to see that an important principle with
HIV is to use the minimum amount of treatment to achieve the
maximum effect. I have seen people come into this clinic who
are on Neupogen and Procrit because they have poor bone
marrow reserves; they are combining ganciclovir, hydroxyurea,
multiple nucleosides, and they wonder why they have problems
with bone marrow.

Other Aspects

ATN: What is "Qigong" -- and how does it relate to "Tai Chi,"
a term more familiar to our readers?

Sinclair: Both are variations of each other. Each is a
systematic series of movements that serve to enhance the
body's energy. Qigong tends to be slower; it is less of a
martial art. Tai Chi can be a defensive martial art, even
though it also is gentle and soothing.

Each gives one a profound sense of relaxation. What I hear
constantly from our clients who do Qigong or Tai Chi is that
they have increased energy. It does not take a lot of
technology or training to learn the basic form; then it's up
to you to practice.

ATN: You mentioned that the practitioner can act as client
advocate, can help the client be informed about lifestyle,
diet, stress, and alternative/complementary treatments. Can
you give some examples?

Sinclair: I look at the relationship between the practitioner
of Chinese medicine and the client as a prevention strategy.
Particularly with a well-trained practitioner, they can
recognize early danger signs. For example, in this clinic, we
have seen patients come in with a splitting headache, they
are sensitive to light, they have a stiff neck -- these are
signs of meningitis. A number of times we have referred
people immediately to the emergency room. Sometimes we will
treat, and then have the patient call their physician, or go
into the emergency room to be treated.

Patients usually see their acupuncturist much more frequently
than they see their Western physician. It is important that
you pick a practitioner who is experienced, so he or she can
be a sentinel for early danger signs, and knows when to refer
you to a Western provider.

The relationship that develops is often intimate, informal.
It's a good opportunity for the practitioner to talk to you
about lifestyle decisions you are making, stress, coffee,
activity, exercise, drug use. Acupuncture has an aspect of
disease prevention; certainly we see that in the reduction of
colds and flu. If we accept the theory that you want to
prevent the immune system from being stimulated (to avoid
stimulating the growth of HIV), Chinese medicine may have a
beneficial effect.

HIV can be very overwhelming; it is difficult for people to
make a lot of choices. A well-informed practitioner can talk
to you about clinical trials, about Western medications,
about other alternative therapies, about nutrients and
supplements. Certainly at our clinic, everyone is very well
trained in these areas.

ATN: You mentioned coffee. Do you think it is best avoided?

Sinclair: My philosophy is that we need to be realistic. Yes,
it's probably good to stop coffee, stop staying up late,
don't smoke, don't do drugs, avoid stress, get appropriate
exercise. But that's not always realistic for the ways people
exist in the real world. I much prefer to see people do
gradual changes over time, changes they are going to stick
with. If someone is drinking ten cups of coffee a day, there
is a reason why they are drinking so much, and they need to
look at that. But I think one or two cups is fine -- although
there are practitioners who will disagree with me. I like to
take a realistic approach; I never want to lecture to my
patients. Generally people know what they should do. It is
not from lack of information (that they don't do it); it is a
number of other factors that influence people's decisions.

Research in Traditional Chinese Medicine

ATN: What research are you doing at the Immune Enhancement
Project?

Sinclair: We received funding through the National Institutes
of Health Office of Alternative Medicine to do a study
comparing the use of antibiotics to herbs and acupuncture for
treating HIV-related sinusitis. It's an eight-week trial with
a four-week washout. We tried to design it to be as objective
as possible, so we are looking at objective measures such as
nasal resistance, nasal air flow, smell testing; and we are
doing paranasal CT scans to show whether the therapy is
having an impact. This study is randomized, with 20 people in
each arm of the study.

ATN: Is the study full, or are you still recruiting?

Sinclair: We are still actively seeking patients. Recruitment
is going much slower than we originally anticipated. Part of
the problem is that by the time people have tried all the
antibiotics, they are ready to do acupuncture; but what this
study offers them is a randomized choice.

ATN: Is there a cost to participate in the study?

Sinclair: There is no cost. And whichever group you are in,
you get a lot from it. You will have a complete ENT exam by
the physician, Kelvin Lee, M.D. Also you will get pre- and
post-treatment paranasal CT scans, as well as either eight
weeks of herbs and acupuncture, or eight weeks of antibiotic
therapy.

For more information about volunteering for this trial, see
AIDS TREATMENT NEWS # 225, June 16, 1995, or call Tom
Sinclair at the Immune Enhancement Project, 415/252-8711.

There is a growing interest in research on traditional
Chinese medicine within the U.S. We have a long way to go;
but we have come a long way already, in being able to
document and show the benefit of these therapies.

Immune Enhancement Project History

ATN: How did the Immune Enhancement Project begin?

Sinclair: The original concept of the Immune Enhancement
Project was developed in 1983. IEP was organized at our
present location in 1990, and incorporated as a non-profit in
July 1992. Our function is to provide low-cost care, to
educate the public about the benefits of traditional Chinese
medicine, and to conduct research. That is our mission, and
that's what we do.

ATN: What are some of the other major centers in San
Francisco?

Sinclair: We are very fortunate in San Francisco that there
are many options. In teaching clinics, there is the American
College of Traditional Chinese Medicine; it has been a leader
in the field of HIV treatment. There is also the Meiji
School; I don't know if they have an HIV program. In terms of
the clinics, there is the Immune Enhancement Project, and
also the Quan Yin Healing Arts Center.

Misha Cohen (the founder of Quan Yin, now in private
practice) should also be acknowledged. We all owe her much
credit. Over the years she has been a pioneer in treating
HIV, in providing education about how to treat HIV, and in
providing access to low-cost care.

Also, in terms of detox, there are treatment programs
available at the Haight Ashbury Free Clinic, and Walden
House. Also the Bayview-Hunter's Point Foundation has Ryan
White funding.

For More Information

ATN: What newsletters or other information about Chinese
medicine can you suggest?

Sinclair: The Immune Enhancement Project publishes a
quarterly newsletter. We try to appeal to general clients;
also, we try to have articles which will be useful to
practitioners working with people who are HIV-positive. [A
sample issue of the newsletter is free; a year's subscription
(4 issues) costs $12. Send a request for a free issue, or a
check or money order for a subscription, to IEP, Newsletter
Subscription, 3450 16th St., San Francisco, CA 94114. Or call
the Immune Enhancement Project at 415/252-8711.]

There is a growing field of journals of alternative medicine.
Some have come out in the last year, and have a number of
well-written articles.

* * *

Tom Sinclair suggested the following books and journals on
traditional Chinese medicine. They can be ordered through
bookstores, or directly from the publisher. AIDS service
organizations which maintain a library could use these to
begin a section on Chinese medicine.

Books

* CHINESE MEDICINE AND HIV, short booklet by Gene London,
1995. $1, Impact AIDS, San Francisco, phone 415/861-3397;
also available from the Immune Enhancement Project, where the
author is a practitioner.

* BETWEEN HEAVEN AND EARTH: A GUIDE TO CHINESE MEDICINE, by
Harriet Beinfield and Efrem Korngold, 1993. $14, Ballantine
Books, New York.

* TREATING AIDS WITH CHINESE MEDICINE, by Mary Kay Ryan and
Arthur Shattuck, 1994. $29.95, Pacific View Press, Berkeley,
California, 510/849-4213.

* THE WEB THAT HAS NO WEAVER; UNDERSTANDING CHINESE
MEDICINE, by Ted J. Kaptchuk, 1983. $19.95, Congdon and Weed,
New York.

* AIDS AND ITS TREATMENT BY TRADITIONAL CHINESE MEDICINE,
by Huang Bing Shan, 1991. $24.95, Blue Poppy Press, Boulder,
Colorado, 303/447-8372 (or place orders at 800/487-9296), 9
a.m. to 2 p.m. Mountain time Monday through Friday.

* NINE OUNCES: A NINE-PART PROGRAM FOR THE PREVENTION OF
AIDS IN HIV-POSITIVE PERSONS, by Bob Flaws, 1992. $9.95, Blue
Poppy Press, Boulder, Colorado (see phone information above).

* AIDS AND CHINESE MEDICINE, by Qingcai Zhang, M.D., 1993.
$19.95, Oriental Healing Arts Center, Long Beach, California,
310/431-3544.

Journals

* ALTERNATIVE THERAPIES IN HEALTH AND MEDICINE. Bimonthly,
$48 per year. Aliso Viejo, California; phone 800/899-1712.

* ALTERNATIVE/COMPLEMENTARY THERAPIES. Bimonthly, $79 per
year plus shipping. Mary Ann Liebert Publications; phone
914/834-3100, ask for customer service.

* THE AMERICAN JOURNAL OF ACUPUNCTURE. Quarterly, $60 per
year. Capitola, California; phone 408/475-1700.