As the AIDS crisis continues two problems persist in the effective medical care for people with HIV/AIDS:

1. The absence of effective medical treatment for HIV disease and acquired immune deficiency despite more than 12 years of intensive research effort.
2. Lack of continuity and integration of medical care across disciplines and across health care providers.

While alternative medicine provides symptomatic relief and possibly slows progression, the immune deficiency that underlies the pathophysiology of AIDS has not been reversed. Not enough is known about the immune system itself to effectively interface with it. And I have come to believe that this information is essential to finding a cure for AIDS. At this moment we continue to fight the resulting infections in much the same way as Western medicine but with less toxic substances and, therefore, less damage to the body's environment. We also offer immune enhancement as best we know how with an understanding that it is in this realm that the real work of stopping AIDS lies.

Although HIV positive patients seek many forms of care, their medical needs are often inadequately met because of fragmentation of services, lack of multi-disciplinary coordination, and therefore lack of continuity of care across the disease process. Alternative and conventional providers often work in isolation of one another and fail to provide a thoughtful, integrated and comprehensive treatment plan for their patients.

The possibility exists that integrated combination therapy will offer new information that will advance a solution towards AIDS.

In Seattle, the most highly developed AIDS care is provided by three medical fields - conventional Western medicine, naturopathic medicine, and Chinese medicine. What we don't know, but need to know, is the synergistic effect of integrating these disciplines. We have a scientific and ethical responsibility to investigate these questions.

In January 1995, with the initiation of the Integrated Care clinic we began to address some of these issues. This clinic incorporates the practice of several forms of medicine working together to understand the best way or ways to help patients maintain their health. In this approach a highly complex treatment plan is generated out of the group intake. The group intake allows everyone to hear the same information at the same time, ask questions pertinent to their form and thus train one another about their medicine. The patient appoints a member to be the main communicant, the person they call in an emergency and who, in turn, calls all of the others.

I'd like to give you an example of how we integrated treatment for one patient. This patient has several serious health issues related to pre- and post-HIV infection. Chronic viral infections pre-HIV include Hepatitis A, B and HSV. He had a long history of pesticide exposure in rural Kansas. Also a long history starting in childhood of digestive problems including diarrhea, stress ulcers and canker sores. Currently these are the health issues for this patient: KS on the arms, legs, trunk and neck; diarrhea, constipation, aphthous stomatitis; chronic and recurrent bronchitis; GI candida (thrush and positive stool culture); low appetite; hemorrhoids; low libido; fatigue/depression; stomach ulcer related to helicobacter; CMV retinitis; recurrent night sweats; chronic sinusitis.

There is a complexity of multiple system failures. When treated solely by conventional medicine the number of drug therapies needed to address all of these issues become very high with ensuing upper GI distress and a complex of side effects that feeds into the disease picture. Many drug therapies can disharmonize the intestinal environment of an individual do to their hot or cold, warm or cool nature. This contributes not only to immunological dysfunction but also to spleen/stomach disorders that are iatrogenic in nature rather than just HIV related.

In May of this year the patient began systemic short course chemotherapy for the KS with Vincristine and Bleomycin. These chemotherapeutic drugs are cold in nature and affect many Blood levels. [It is the opinion of Chinese medicine that it is the anemia's of chronic disease that set the stage for KS and other cancers.] For example, the diagnoses for this patient according to Chinese medicine are deficiency and emptiness of the Zang Fu, deficiency of Qi and Blood with Qi and Blood stasis. If the Qi and Blood are deficient and empty, they do not magnetize one another and blood movement becomes unsmooth. The vessels and smaller capillaries become clogged. Phlegm turbidity from Spleen deficiency becomes bound with stagnant blood and these in turn become knotted with toxins. Spleen and Kidney deficiency with Kidney Essence deficiency are major factors in the above diagnoses.

Always these discussions come back to how to stop the process of immune degradation. In TCM terms we treat it as insidious depletion of Source Qi. We watch this through the pulse and through palpatory diagnostic information. We translate CD4 and CD8 counts into toxic heat and Source Qi levels. The responsibility of maintaining immune function often falls on Chinese medicine and naturopathy, while Western medicine treats the O.I.'s.

A Chinese herbal formula was given to address the anemia, to move and tonify the Blood, to transform phlegm and resolve damp by adjusting middle burner function. Anti-viral or anti-toxic heat and anti-cancer herbs were added. Blood moving and phlegm resolving herbs were powdered and placed in a cloth bag, then steamed and applied warm to the KS lesions that were external. These were all used daily. The chemotherapy was a three hour drip once every three weeks.

The nutritional medicine component prescribed Ultra Clear Sustain shakes to provide hypoallergenic proteins and nutrients to heal the GI mucosa. Also a detox diet with mucilaginous teas was prescribed and several dietary adjustments were made according to present diet analysis.

Several possibilities were considered for anti-viral therapy; these were high doses of glycyrrhiza, hypercium HY-10 and lomatium, possibly in combination or in rotation. Thymic fractions were prescribed to stimulate maturation of more lymphocytes. The supplements were prescribed in either liquid form or powdered form and as much as possible taken in the Chinese herbal soup for better absorption and to buffer any negatives that might affect the upper GI tract.

There is a great need for developing ways of looking at our treatment strategies in order to reach conclusions that are objective but do not undermine the basic concepts of Chinese medicine. It is possible to develop measures that will allow us to analyze treatment outcomes in an objective way. Can we start from our own system of medicine and look at the disease process with a fresh eye and see if we can begin to identify organic and energetic markers that could be measured in varying circumstances to give us information about etiology and progression? I suggest that we begin to identify a means by which we can reference our treatment of HIV/AIDS across all schools of practice and across practitioner levels of practice. What are the main conceptual components within the framework of Chinese medicine that would be important to measure in the treatment of HIV/AIDS?

1. The level of Source Qi
2. The level of Pathogenic Qi
3. The level of Toxic Heat

This idea may possibly have no merit. It is offered as an initial reference point in the evolution of an objective process whereby our fluid form of medicine might be evaluated in such a way as to not break its energetic back bone.