Acupuncture for CFIDS
By David Hoh

Acupuncture is an ancient Chinese medical art, practiced for thousands of years. CFIDS is an illness that has only been identified and studied in the United States for about 15 years. How can  the two possibly come together?

The use of acupuncture is becoming increasingly accepted in Western medicine as a valid treatment for a variety of illnesses, most commonly those involving pain. In 1997, a National Institutes of Health panel said acupuncture was "an acceptable alternative, or part of  a comprehensive treatment program" for certain conditions, particularly nausea and pain following   surgery or chemotherapy but also for a variety of painful conditions.

Acupuncture makes sense to many CFIDS specialists and their patients because it treats the patient as a whole, without trying to identify a particular physiological cause, which Western medicine has not been able to do in CFIDS. Acupuncture also has far fewer side effects than do most drugs, to which many CFIDS patients are sensitive.

The theory
Chuck Hipple, a Charlotte, N.C., acupuncturist, describes the theory behind acupuncture this way: "We're talking about an energy that flows through the body, a life force that the Chinese call qi (pronounced chee). This energy needs to get to every cell in the body, just like blood needs to get to every cell. Just like there are pathways (arteries and capillaries) to get the blood to every cell, there are pathways to get the qi to every cell, and these pathways are called meridians. There  are 12 major meridians, and each one feeds a different internal organ. In Chinese medicine we believe that if the qi, the life force, is balanced and flowing unobstructed throughout the body, then there is health. So when a person is sick, we describe that as an out-of-balance or a blockage in the qi. We want to find out which meridians don't have enough energy and put more energy in them."

An acupuncturist's primary diagnostic tool is his or her fingers, placed on the meridians to feel the flow of qi. "A trained acupuncturist can tell if there is too much or not enough life force in there and if it's irritated in some way," Hipple explained. An acupuncturist also typically will take a detailed family history of health and illness and ask questions about past minor ailments, personal traits, preferences and habits. The patient's normal temperature and the appearance of  his skin and tongue may also be significant.

How it works
Acupuncture works by stimulating specific points along the meridians, using the needles to redirect the flow of qi or to open up a blockage, in much the way that poking a stick into an earthen dam allows water to break through and wash away the obstruction.  Western studies suggest that the insertion of needles at acupuncture points helps release chemicals such as endorphins in the body that affect nerve impulses and help reduce pain and inflammation.

The needles used in acupuncture are not like needles used for injections. These needles are solid, usually stainless steel, very fine and flexible. Mary Jo Fishburn, MD, a professor at Johns Hopkins University and a practicing acupuncturist, says most patients experience an electrical quality or an aching sensation at the point of insertion. Sometimes the sensation travels along the meridian channel. The needle may be inserted a few millimeters and possibly even a few centimeters into the skin, but any pain sensation is usually brief and not severe.

Fishburn describes the risks as minimal, as needles are either disposable or sterilized using standard procedures. "Very rarely," she writes in the Johns Hopkins Insider, "a misplaced needle can puncture a lung, resulting in air entering the chest cavity; this requires immediate medical attention."

Treating the whole patient
An acupuncturist also will use herbs, particularly to help build up energy in the body and support the immune system or to address specific problems such as Candida overgrowth or a retrovirus (called latent heat in Chinese medicine) which may be robbing the body of energy. Herbs are much less potent than pharmaceutical drugs and work over a longer period of time but with fewer side effects, Hipple explained. 

Another potential energy drain is lifestyle, possibly stress from a job or a difficult family situation, and that has to be addressed, too, if it's present. "With CFIDS," Hipple said, "you're trying to put energy back into a person, and it's like trying to fill a barrel with water when it's got all these holes in it. You're never going to get if filled until you plug up the holes, so you have to find out what's draining the energy and address those things first.

Eighty to 90 percent of things people go to doctors about are lifestyle induced-diet, stress, activity. If we don't figure out the source of the problem, then we may be able to cure the symptom, but six months later they'll be back. Unfortunately, a lot of doctors don't look at that. If you go in for headaches, he's not going to ask you what your life is like. He's going to give you a drug."

What to expect
Results are not immediate with acupuncture treatments. Fishburn advises her patients to expect to undergo at least four or five sessions before feeling some benefit. If there is no change during that series of treatments, then acupuncture may not be working for that patient.

Hipple explains that, while the symptoms of CFIDS may be triggered by a sudden injury, infection, environmental toxin or stressful event, the imbalances in the body develop over time and are complex.

"CFIDS is not something you get overnight. Most people who have CFIDS have gone through a very,  very stressful time of overworking, using up too much energy for a very long period of time. Maybe they've worked and taken care of the kids for 10 years, and then it finally happens. They don't notice it as long as their will can push them to get up and do what they need to do. Americans tend to be very out of touch with their bodies. Most are sleep-deprived. They push themselves, or use outside stimulants like caffeine, constantly drinking coffee  or cola. Then one day they're going to crash. One day they can't ignore it. But by then they're already in big trouble.

"One of the reasons Western medicine is having so much trouble with this is that they're always trying to find one cause for things, but there's not one cause, so there's not one cure. With CFIDS, there are too many things out of balance. What happens is one thing gets out of balance, it doesn't get corrected, and then it leads to another imbalance and another, and by the time you get CFIDS, you have 15 or 20 out-of-balances in the body. These have got to be addressed. You have to find out which ones are the major ones, which one needs to be put back in balance first. It's different in each person. No two people that have CFIDS have the same imbalances, and that's the beauty of Chinese medicine. We look at the person, we don't say 'OK, CFIDS, do this and this.' We don't even care about giving the illness a name."

The order in which problems are addressed in acupuncture depends on the individual, Hipple said. If the initial out-of-balance could be identified and repaired, in theory the others will eventually repair themselves, but that could take years. Often the patient has to work for a living or care for a family, so Hipple works on the three most important problems at the same time.

"These people are delicately out of balance, and the imbalances are woven together," Hipple explained. "You've got to unweave them in much the same way they were woven together. You've got to work a little  on the liver meridian, a little on the heart meridian, a little on the spleen. You can't just focus on one at a time, otherwise you'll have a crash. A common saying for CFIDS patients is that if you go to bed tired, you've done too much. You've got to replenish, rebuild the reserve. It's very important to be paced, both in your daily activity and in your treatment."

Finding an acupuncturist
According to the Johns Hopkins Insider, there are approximately 10,000 licensed acupuncturists in the United States. About 3,000 of them are either conventionally trained medical doctors (MD) or doctors of osteopathy (DO). Many of these are members of the American Academy of Medical Acupuncture (800/521-2262) and will have undergone at least an intensive 300-credit training course beyond their medical training. Non-physician acupuncturists have their own schools and should be certified by the National Certification Commission of Acupuncture and Oriental Medicine (703/548-9004).

A number of web sites may also be useful in providing more information to persons considering acupuncture. American Whole Health, a chain of integrated medicine clinics, gives a good overview of acupuncture by one of its doctors, Richard Feely, DO, at http://www.wholehealthmd.com/refshelf/substances_view/0,1525,663,00.html. At Acupuncture.Com, Misha Ruth Cohen explains what to expect when you visit a Chinese Medicine practitioner. That page is at www.acupuncture.com/Diagnosis/firsttreat.htm.

David Hoh is a former editor of the Chronicle.

Acupuncture Glossary
Acupuncture---ancient Chinese practice of puncturing skin with hair-thin needles at particular locations called acupuncture points on the patient’s body. Believed to cure inbalances in yin and yang.

Electroacupuncture---a variation of traditional acupuncture that involved electrical stimulation at needle points.

Qi---life force, energy flowing through body.

Meridians---12 major pathways that bring qi to cells.

Moxibustion---burning herbs to provide local heat over acupuncture points.

Yang---Chinese concept of positive energy and forces in universe and body; counterpart to yin.

Yin---Chinese concept of negative energy and forces in universe and body; counterpart to yang.

SAMe marketing takes off
A dietary supplement that has been around for more than 25 years is now being marketed aggressively in the United States, and CFIDS patients are among the targets. According to a report in the July 5, 1999, issue of   Newsweek, SAMe, or S-adenosylmethionone, is one of the hottest supplements on the market, available at grocery, drug and health food stores.

The supplement has been widely studied, especially in Italy and Germany, for treatment of arthritis and depression, although the studies are not as large as those the U.S. Food and Drug Administration would require for    the product to be approved as a drug. In European trials involving thousands of patients, SAMe has been found to be as effective as pharmaceutical treatments for arthritis and major depression. Research also suggests it contributes to the repair of damaged cartilage in joints and that   it can improve chronic liver conditions.

SAMe is a molecule produced constantly by all living cells. It is an essential part of a cyclical process that occurs a billion times a second throughout our bodies. Methionone, an essential amino acid found in protein-rich foods, combines with a substance called ATP to form SAMe. SAMe then releases a group of four atoms called a methyl group to neighboring molecules and becomes SAH, or S-adenosythomocysteine, which rapidly breaks down  to form homocysteine. If homocysteine builds up, it causes many health problems, so the body converts homocysteine back into methiononine (a process that requires Vitamin  B-12 and folic acid, a B vitamin found in fruits and vegetables) or into the antioxidant glutathione (in a process  requiring Vitamin B-6). The typical American diet is often deficient in B vitamins. Also, as we age, SAMe levels tend to decline and homocysteine levels rise.

(Supplementation with two other components of this methylation cycle,  ATP and glutathione, have also been recommended by some CFIDS specialists.)

Researchers believe SAMe may treat depression by  giving a boost to the mood-enhancing brain messengers such as serotonin and dopamine. In arthritis, the process of converting homocysteine into glutathione releases molecules called sulfate groups that ultimately helps protect and repair cartilage, thus easing joint pain. It also appears to normalize liver function in patients with cirrhosis, hepatitis and blocked bile ducts, and it has been found to prevent or reverse liver damage caused by certain drugs.

Drugs typically prescribed for depression and arthritis pain have potentially serious side effects, but studies have found the most serious side effect from SAMe is a mild stomach upset. The Arthritis Foundation has said its medical experts agree that SAMe provides pain relief but that there is not enough evidence that it repairs damaged joints.

Unfortunately, SAMe is expensive, typically between $2 and $4 for a daily dose (studies have suggested that 400 mg is an effective dose for arthritis and a reasonable starting dose for depression, although some trials have used much higher doses). Experts advise taking it twice a day on an empty stomach, although different people may   benefit from different amounts.

As with any unregulated product, consumers can’t tell from the label whether they are getting full-strength SAMe. According to Newsweek, pharmaceutical grade SAMe comes in two forms: tosylate and a newer, more stable form called botanedisulfonate. Nature Made and GNC sell the butanedisulfonate, but several U.S. manufacturers import reliable tosylate products. Look for a product that is enteric coated, so that it causes less stomach upset.