In the past eight years TCM practitioners who have been working with persons with HIV/AIDS in earnest have attempted to construct some models of AIDS based on the etiologic notions of Chinese medicine. Ideally these endeavors are intended to result in a certain predictive ability about the course of the disease and about the best treatment strategies. In this article I will review one such model and suggest some factors which may contribute to any given patients actual presentation.

Our clinical experience with HIV/AIDS is that it remains dormant(1) for an unspecified period of time(2), shows signs and symptoms of low level Heat both at the onset and throughout the course of the disease and is known to be contagious. This kind of configuration is described by the Wen Bing School of Heat induced disorders which developed in China between the 12th and 18th centuries.

In this model(3) a Heat pathogen enters the Blood and Kidney Yin creating initial symptoms of Blood and Yin Deficiency. Initially such signs may be very subtle consisting largely of a dryness of the skin and hair and a kind of thin, drawn look. (This is not to be confused with later stage symptoms of extreme dryness after Blood and Yin have been under assault for a while. In these later stage cases the problem is often exacerbated by the effects of various drugs especially anti-virals which further undermine the Blood.) Symptoms may progress to include mild Heart Blood Deficiency and Heat symptoms such as anxiety and insomnia or may show more overall Yin Deficiency symptoms such as nightsweats, low-grade fevers, dry mouth and thirst. (The severity of any of these is variable and due to a variety of factors including constitutional ones.)

PCP, a very dry form of Yin Deficiency pneumonia is still the most common first infection in HIV/AIDS and of all the opportunistic infections is still the most prolific killer. In a hotter form we have posited that the Heat and Dryness appears in the Lung as TB. The Liver/Blood Yin may also be effected showing symptoms of neuropathy, blurred vision, floaters, CMV retinitis or irritability. If Liver symptoms are hotter and rush to the head, headaches and painful impacted sinus conditions may appear., (These headaches may or may not be diagnosed in Western medical terms as a number of opportunistic infections.) During these initial stages of Blood/Yin deterioration the complimentary opposite, the Qi and Yang will also begin to show signs of deterioration. Subsequent bouts of PCP, for instance, will show increasing Lung Qi Deficiency symptoms and overall weakness. The middle marker of HIV/AIDS, in our opinion occurs when the Spleen Qi and Yang begin to show signs of weakness. This usually begins as loose stools, recurrent bouts of diarrhea and/or as growing intolerance to Cold. At this point it is imperative to try and reverse this trend. More than ever herbs must be carefully balanced between those that are cold and clear the Heat pathogen and those herbs that are warming and intended to offset this growing Qi and Yang weakness.

If this trend is not reversed, patients symptoms of Spleen Qi Deficiency will often progress to Spleen and Kidney Yang Deficiency and include more and more severe chronic recurrent diarrhea, a tendency to contract gastrointestinal pathogens, increasing impotence and the wasting syndrome. It should be remembered that these Qi and Yang symptoms are likely to be intermixed with Heat symptoms as well. Anxiety and insomnia, for instance, may increase or have flair-ups but now they may be combined with more severe fatigue of a Qi Deficient variety.(4) in final stages of any complex disease, a variety of configurations may be seen. In HIV/AIDS massive deficiencies of Qi, Blood Yin and/or Yang may effect almost any Organ system. Although the same opportunistic infections may recur at these later stages they will be much more severe, will include more overall debility and wasting and be more difficult to make a full recovery.

If this model is useful it should be able to assist a practitioner in determining where a patient is along this continuum from Blood/Yin Deficiency of Heart/Kidney/Lung/Liver to Qi/Yang or Spleen/Kidney and more importantly where symptomatology is likely to go. Or it may assist in piecing together the parts of an apparently complex and baffling mix of symptoms.

It cannot be overstated that this is only a model and must not be slavishly applied. Wen Bing theory was obviously not developed to describe HIV/AIDS, an apparently new disease, but rather to describe diseases which progressed and undermined the body in ways that were somewhat similar to this disease. In addition it is an extremely important aspect of Chinese medical theory that each patient will present in his/her own way depending upon a multitude of factors. Such influences may include:

•Constitutional tendencies (i.e. health tendencies one was born with and factors like being a woman)

•Health history (especially other sever illnesses eg., hepatitis, asthma etc.)

•Drug use (both recreational and those prescribed to treat HIV/AIDS problems)

•Lifestyle factors (it is well known, for instance, that the affluent, generally fare better in any illness than the poor. IV drug users often receive severely inadequate health care and live in unhealthy surroundings; malnutrition will effect progression; airplane flight attendants are subject to extremely dry air and recurrent jet lag etc.)

•Climate (I suggested at the 1994 HIV and Chinese Medicine Conference that HIV/AIDS may present somewhat differently in different places in the United States. We have certainly noticed the effect of the severe seasons of the Midwest on our patients)

•Emotional configuration (It has been noticed in many studies how profoundly the mindset of the patient can effect the course of a disease. Be that as it may, according to TCM situational thinking, what turns out to be a healthy emotional configuration for one person might not be for another.)

Of course, it has long been acknowledged and a source of puzzlement to Western medicine that HIV/AIDS looks quite different in different populations. HIV/AIDS in Africa, for instance, looks primarily like the wasting syndrome. A TCM practitioner might hypothesize that is is due to a combination of lifestyle, constitutional and social/economic factors which introduces HIV/AIDS into a population that is already Spleen Qi Deficient from endemic starvation.

Finally, it is important to recall that Chinese medicine does not deal in ideal types. It is a system based on process and change and which, oddly, seems to recognize individual variation better than its Western counterpart which grew up in a highly individualistic culture. We should not then confuse our models with the world or our maps for the terrain.

2 Despite some variability in the particulars, this idea has gained a fairly wide acceptance in the TCM community. See Mary Kay Ryan and Arthur Shattuck, Treating AIDS with Chinese Medicine; Bob Flaws Nine Ounces of Cure; Huang Bing-shan et. al., AIDS and Its Treatment by Traditional Chinese Medicine; Z’ev Rosenberg, Wen Bing Theory in the Treatment of AIDS from the Selected Proceedings of the Second HIV/AIDS and Chinese Medicine Conference; Misha Cohen, The Spleen and Stomach in HIV Disease; Effrem Korngold also stated a similar notion at the First AIDS and Chinese Medicine Conference in San Francisco in 1993. Back to Article

3 We have argued in Treating AIDS with Chinese Medicine that HIV/AIDS progression must be described somewhat differently for women. In this article I am describing the disease as we have observed it primarily in gay men. Back to Article

4 Early in HIV/AIDS fatigue is often of the Blood/Yin Deficient type which occurs in the afternoon and/or is a jittery, nervous kind rather than being wiped out throughout the day even after a nights sleep. Back to Article

Mary Kay Ryan along with Arthur Shattuck wrote “Treating Aids With Chinese Medicine.” She co-founded the North Side HIV Treatment Center in Chicago, Illinois and currently maintains a practice in Chicago.