MODERN CHINESE MEDICAL METHODS FOR MS:
Clinical Setting and Patient Reports
by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon
OVERVIEW
ITM operates two clinical facilities in Portland, Oregon for multiple sclerosis (MS) patients. One (“Lovejoy Clinic”) initiated an MS program in November 1993 and the other (“Hawthorne Clinic”) provided an additional site in September 1996. The programs were established, and their activities maintained, with the generous support of the National Multiple Sclerosis Foundation in Fort Lauderdale, Florida. The principal clinician for this program is Edythe Vickers, N.D., L.Ac., but there are currently more than a dozen health professionals employed at ITM to provide services to the MS patients, including a team of acupuncturists and massage therapists, two chiropractors, and a medical doctor.
Nearly all participants in the program enrolled on the basis of recommendations from other patients. In total, the two clinics have enrolled 77 patients from November 1993 (including one former patient who was then enrolled in the new program) through end of August 1997. Of these, 50 patients (65%) are currently active participants in the programs; 42 of these patients have participated for three months or longer (8 joined more recently), including 3 long-term participants who visit the clinic infrequently (not currently living in Portland) but continue using the supplements daily. There were 3 patients (4%) who continued participation for more than three months but moved to distant cities, thus ending their participation (they may have found similar services elsewhere).
Drop-outs from the program include 24 patients (31%) who visited the clinic at least once, but discontinued participation (usually within a few weeks) for a variety of reasons. The primary reasons cited for dropping out were the inconvenience of coming to the clinic regularly and personal problems (financial, marital, etc.) preventing regular participation; these participants usually mentioned a desire to pursue this therapy but inability to do so. A few persons (about 8; the exact number is uncertain due to lack of complete follow-up) declined further treatment because they did not feel that the treatment method was suitable for them: for example, not liking acupuncture, not wanting to take supplements, not getting sufficient benefits within a reasonable trial period.
Patients generally come to the clinic once per week for acupuncture, except for missed appointments due to vacations and other personal matters, health problems, or difficulty arranging a convenient appointment time. On a daily basis, patients take one or more nutritional supplements and most patients take one or more herbal supplements (see appendix for details). Most patients receive a vitamin B12 injection each week, either administered at the clinic or self-administered at home, and about one-quarter of the current participants take the adrenal hormone dehydroepiandrosterone (DHEA; prescribed at our clinic). Many patients also receive massage and/or chiropractic therapy at our facilities, usually once or twice per month. This combination of therapeutic approaches is similar to what is offered in some hospitals in China, integrating physical therapies with traditional and modern internal medicine.
Although the total patient costs for such treatments would usually be in the range of $300 to $400 per month, most of our patients do not have insurance coverage or adequate personal financial resources for this relatively modest health care expense. Patients in this situation are asked to contribute $75/month, but for those who have incomes below 2.5 times the poverty level (which is a common status among our group), the fee is reduced accordingly, with some receiving free treatment. Both ITM and the National Multiple Sclerosis Foundation make up the deficit in payments; we also received a small grant from the McKenzie River Gathering Foundation (in Oregon) which supplemented the program for six months in 1997 (and provided additional funds for a substudy on DHEA in MS patients: see separate report).
BASIC DATA: METHODS AND PRESENTATION
ITM offered a comprehensive clinical services program with tracking of basic patient data. A randomized, controlled trial was not possible for a number of reasons, including lack of sufficient funds, difficulty in recruiting a large enough number of patients with reasonably similar disease conditions, and the difficulties of providing a comparable control treatment. Further, randomization is quite difficult because the requirements of the Chinese medical program include intensive participation, such as weekly clinic visits and consumption of large numbers of supplement tablets (patients must be able and willing to cooperate). Therefore, we have relied on the following approaches: maintaining records of health history (duration of MS, type of MS, accompanying diseases and syndromes, history of methods attempted to treat MS) and therapies applied at our facilities (details of treatments at each office visit); simple health status reports at each office visit (patient responses to questions); and obtaining summary statements from both participants and practitioners.
Below is a brief outline report (intended for quick review of outcomes) for the 42 patients who are currently active participants and who have attended the clinic for at least three months, divided between the two clinical sites. For each patient, the following is indicated:
1. The type of MS: RR = relapsing/remitting; P = progressive (as reported by participant).
2. The duration of participation and number of acupuncture treatments received.
3. Any reports of drug therapies that have been deleted or reduced in dosage.
4. Any reports on changes in mobility.
5. Any reports of other symptom changes.
6. Practitioner comments (section labeled “comments”), usually given when patient reports are unavailable or need further clarification.
The reports of drug use changes, mobility changes, and symptom changes are patient responses obtained via a survey from those who were able to fill one out at the end of August 1997. The statements in the section below are close to direct quotation (with editing to fit the presentation format). For those who did not get a chance to fill in the survey report in time, practitioner comments are relied upon instead.
Exacerbation reporting is not included here, except as patients commented on the matter. This is because there was a low incidence of exacerbations in those with relapsing type MS, and exacerbations were difficult to identify. Patients are instructed to act immediately upon an apparent exacerbation, with changes in herb formulations and increased frequency of acupuncture therapy. In general, the apparent exacerbations were resolved quickly and there was no evident permanent damage in any of the instances. Therefore, it was difficult to record the non-distinctive events as a definitive exacerbation. Here is an example of a patient comment on this subject: “If and when a new exacerbation begins, if I come into the clinic right away, the exacerbation can be stopped right away. I’ve had one instance with numbness and foot-dropping of the right leg that was stopped before it really began. I’ve also had eye flare-ups that have been alleviated.” As a result of this experience, the patient also reports that no exacerbations have occurred during this time.
There were a few cases in our group of obvious exacerbation: according to patient descriptions, these arose from severe emotional distress (usually, family problems, including divorce, family member illness or death). However, in all cases where participants came in for treatment following the exacerbation, there was no obvious disease progression. According to the reports of participants, exacerbations are reduced, compared to previous experience, in both severity and duration by the Chinese medical treatments. The only participants who displayed some overall health deterioration in the program were a small number of individuals with progressive type MS who were confined to wheelchairs for some time prior to program entry, and who had multiple health problems at the time of joining the program. Even these individuals report relief of some specific symptoms as a result of their participation.
RESULTS
The information given here is limited to descriptions of participation, disease status, and reported changes in health attributed to participation in the program. Not reported here (but made available in more detailed annual reports) is information about health history, compliance with herbal protocols, and concurrent use of additional therapies (e.g., Avonex, Solu-Medrol, Baclofen; these are mentioned here only if their use has been reduced or discontinued).
The
most frequently reported benefits are: decreased use of analgesics,
antidepressants, and antispasmodics; increased energy, strength, and mobility;
improved sleep, better bladder control, reduced numbness and pain, and lower
frequency of infections.
Maximum attendance time at this clinical site is 12 months (having been made available at the beginning of September 1996). 14 patients with at least 3 months participation are continuing treatments (7 others have joined the program within the past three months). The mean participation time of the 14 participants is 7 months; they received a total of 388 acupuncture treatments, with an average rate of 4 treatments/month.
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Patient KA [RR]: 4 months in program, 19 acupuncture treatments.
Drugs Eliminated: Neuro-Trasentin, Aleve.
Mobility Changes: tightness in legs decreased occasionally, making it easier to walk.
Symptom Changes: slight improvement in bladder control (urination frequency); energy level has greatly improved.
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Patient BC [P]: 12 months in program: 41 acupuncture treatments.
Mobility Changes: more strength in legs [uses a walker].
Symptom Changes: less mental stress, better coordination.
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Patient JC [RR]: 12 months in program: 42 acupuncture treatments.
Comments: She is fully mobile, but suffers from numbness and tingling in the hands; general body pain; blurring vision; weakness of arms and legs, and tightness of muscles. She notes prompt relief of numbness and pain with each acupuncture treatment.
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Patient LC1 [RR]: 3 months in program: 13 acupuncture treatments.
Mobility Changes: better balance, able to stand the whole day and work (full time job).
Symptom Changes: numbness (from abdomen down through legs) improved.
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Patient LC2 [P]: 4 months in program: 18 acupuncture treatments.
Decrease in Drug Use: less pain pills, less antidepressants.
Mobility Changes: is now able to go for walks again.
Symptom Changes: less pain in arms, hands, feet, and legs; less bladder leakage; less depression.
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Patient LF: 10 months in program: 32 acupuncture treatments.
Comments: She suffers from urinary incontinence, numbness and tingling in the fingers, fatigue, right leg weakness and pain, with night time leg cramps, double vision (mainly in left eye). Treatment is reported to help with fatigue; her pain, numbness, and tingling are greatly reduced, and leg cramps alleviated. Vision is improved and her appetite is better. When she took a three week vacation, her symptoms returned.
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Patient JG [RR]: 5 months in program: 35 acupuncture treatments.
Decrease in Drug Use: less Motrin.
Symptom Changes: reduction in back pain; burning pain in feet reduced dramatically.
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Patient EM [RR]: 3 months in program: 9 acupuncture treatments.
Decrease in Drug Use: less Trazodone.
Symptom Changes: reduction of tingling in hands and feet; better sleep.
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Patient RP: 6 months in program: 26 acupuncture treatments.
Mobility Changes: stopped using cane, increased walking distance, increased exercise.
Symptom Changes: acupuncture treatment improves
energy level and ameliorates “Avonex hangover feeling.”
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Patient CR [RR]: 12 months in program: 31 acupuncture treatments.
Mobility Changes: can move left leg better [confined to wheelchair].
Symptom Changes: body heat problems better; sleeps better.
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Patient AS [RR]: 4 months in program: 21 acupuncture treatments.
Symptom Changes: numbness in left arm and hand decreased (frequency of occurrence); asthma symptoms decreased in frequency; increased energy.
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Patient CS [P]: 6 months in program: 47 acupuncture treatments.
Decrease in Drug Use: virtually eliminated Valium for sleep; Fiorinal greatly reduced.
Symptom Changes: slight improvement in right side numbness; improvement in speech after acupuncture; improved vision.
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Patient KS [RR]: 12 months in program; 28 acupuncture treatments.
Symptom Changes: increased mental concentration, less fatigue; almost no mood swings; numbness in extremities decreased; less tingling down spine, motor-coordination and sensory difficulties resolved.
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Patient MV [P]: 5 months in program: 26 acupuncture treatments.
Drugs Eliminated: Baclofen.
Drugs Reduced: quinine sulfate.
Mobility Changes: able to stand for longer periods of time (is usually in wheelchair).
Symptom Changes: reduced drop-foot effect; regained bladder control; reduced pain in collarbone.
The clinic has been open for the MS program 46 months. With a few exceptions (for example, wheel-chair participants were recommended to the Lovejoy site because of better handicapped access), new patients were not enrolled at this site after the Hawthorne site was opened; thus, the participation time is usually in excess of 12 months. There are 28 patients with at least three months program experience: mean participation time for this group is 23 months. They received 2,098 acupuncture treatments; the average rate of acupuncture was 3.3 treatments per month. The lower rate of treatments per month (compared to the Hawthorne site) is mainly due the fact that some patients enrolled here receive infrequent acupuncture treatments (due to their location) but receive herbs and supplements that they use regularly. Patients at this clinic tended to be more severely debilitated than patients at the Hawthorne clinic. This is mainly because the persons initially enrolling in the MS program tended to have complicated and advanced disease conditions. Later, as the potential benefits of Chinese medical treatments became known, persons with less severe conditions began to enroll (more often at the Hawthorne clinic). There are currently 7 wheelchair MS clients (persons who always or mainly use a wheelchair to get around) at Lovejoy; 2 at Hawthorne.
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Patient MA [RR]: 19 months in program: 73 acupuncture treatments.
Mobility Changes: arm and leg movement noticeably improved.
Symptom Changes: better digestion; eye problems alleviated.
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Patient CB [RR]: 28 months in program: 75 acupuncture treatments.
Comments: has had numerous surgeries for non-MS spinal injuries; she has morphine pump. Treatments alleviate pain, reduce bladder infections, and improve energy.
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Patient DC [RR]: 15 months in program: 44 acupuncture treatments.
Mobility Changes: less problem with tripping and stumbling due to reduced stiffness and pain in left leg.
Symptom Changes: reductions in pain, stiffness, tingling feeling, twitching, less fatigue; significant reduction in depression and anxiety; less problem with insomnia, avoided infections all winter.
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Patient JC [P]: 26 months in program: 106 acupuncture treatments.
Drugs Reduced: pain medications.
Mobility Changes: better movement, without as much pain.
Symptom Changes: have had no major exacerbations, been steadily improving; acupuncture treatment effects last for several days.
Comments: she suffers from shoulder and knee pain, left sided weakness, and depression. Treatments improved her sleep, energy, and she gets sick less frequently.
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Patient SC [P]: 23 months in program: 91 acupuncture treatments.
Drugs Eliminated: Zoloft.
Symptom Changes: better digestion and bowel conditions; lost some excess weight. Reduced pain in legs, resolution of bladder infections.
Comments: she suffers from right leg weakness, and very low energy (needed to take naps). Reports better energy, relief of constipation; leg weakness not worsening (as it was before).
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Patient LD [P]: 18 months in program: 65 acupuncture treatments.
Mobility Changes: able to stand with help for about 10 seconds; right arm somewhat stronger, legs stronger.
Symptoms Changes: less depression.
Comments: she is confined to a wheelchair. Has developed ability to move left foot that had been paralyzed before. Weakness of hands has not deteriorated further.
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Patient RF [P]: 27 months in program: 139 acupuncture treatments.
Comments: he is confined to a wheelchair. His energy and sleep are better, his urinary and bowel control have improved.
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Patient DG [RR]: 31 months in program: 82 acupuncture treatments.
Symptom changes: more energy, less pain in back.
Comments: she uses a wheelchair, but sometimes can use a walker; has insulin-dependent diabetes and is legally blind; she has also reported better sleep and constipation relieved.
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Patient EG [RR]: 21 months in program: 80 acupuncture treatments.
Symptom Changes: double vision and right leg numbness present initially has been alleviated; not had any significant exacerbations since staring the program.
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Patient MG [RR]: 46 months in program: 145 acupuncture treatments.
Note: this patient was treated at our clinic for one year prior to the start of the MS program (and at another clinic offering similar types of therapies for a year prior to that). The number of months and number of treatments indicated above reflects only the portion since the MS program started.
Symptom Changes: generally feels better.
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Patient DH [RR]: 42 months in program: 51 acupuncture treatments.
Comments: this patient does not currently live in Portland area; but she comes to Portland sometimes and gets regular treatments during her visits; she takes prescribed herbs and nutritional supplements regularly. Acupuncture improves her gait and vision (which deteriorates after a while of not getting treatments); acupuncture improves her energy.
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Patient BI [RR]: 21 months in program: 82 acupuncture treatments.
Drugs Eliminated: Amantadine, Zanaflex, Solu-Medrol.
Drugs Decreased: Baclofen (half dosage).
Mobility Changes: stopped using the scooter, reduced use of cane.
Symptom Changes: improved energy, less severe spasms, stopped having frequent colds, fewer incidents of urinary incontinence, memory problems gone, numbness in legs and feet resolved, vision problems alleviated.
Comments: this patient suffered from spasms in her legs; treatment has decreased the spasms considerably. Solu-Medrol made her feel sick (her doctor was opposed to her stopping this therapy). An exacerbation that occurred during her time in the program was treated solely by our methods and she recovered completely.
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Patient JJ [RR]: 24 months in program: 91 acupuncture treatments.
Drugs Eliminated: Paxil, Amantadine, Depacote, Baclofen, Trazodone.
Drugs Reduced: Advil.
Mobility Changes: limp is gone.
Symptom Changes: less fatigue.
Comments: walked with limp; sometimes relied on cane; suffers from depression. With treatment, she doesn’t use a cane now and went back to full-time work.
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Patient LK [RR]: 17 months in program: 41 acupuncture treatments.
Comments: gets leg weakness, urinary frequency, suffers from depression. With treatment, is currently healthy, asymptomatic. She entered the program right after MS diagnosis. She is currently in Japan, taking the supplements we prescribed.
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Patient DL [RR]: 28 months in program: 93 acupuncture treatments.
Comments: suffers from urinary incontinence (uses catheter), bladder spasms, etc.; weakness in knee. With treatment, less bladder spasms, knee weakness gone. Very sensitive to heat.
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Patient ML [RR]: 30 months in program: 148 acupuncture treatments.
Mobility Changes: no longer uses a cane.
Symptom Changes: reduction in balance problems; maintenance of weight; sleep problems resolved; episodic depression quickly relieved by treatment; muscle cramps relieved; hives eliminated; sleep improved.
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Patient GM [P] 22 months in program: 70 acupuncture treatments.
Drugs Reduced: Baclofen [half dosage].
Symptom Changes: much better attitude, better bladder control.
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Patient DN [RR]: 24 months in program: 79 acupuncture treatments.
Drugs Eliminated: Klonopin, Oxazapam.
Mobility Changes: can walk further without being tired, can drive a car.
Symptom
Changes: vertigo lessened, eyes better, less constipation, stronger, more
energy, fewer exacerbations (had none in the last two years), better
coordination.
Comments: initially, she walked with a cane, had loss of bladder control, depression. With treatment she is basically healthy; MS symptoms mainly resolved (sometimes gets blurred vision and poor balance, which is resolved again by treatment).
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Patient JN [RR]: 19 months in program: 51 acupuncture treatments.
Mobility Changes: can stand longer; left knee, leg stronger; can walk longer and foot doesn’t drag as much.
Symptom Changes: less pain (in left knee), better mental attitude, better balance.
Comments: had balance problems, weakness in left knee, leg, hand; fatigue and insomnia. With treatment is now walking fine, has gone from part time to full time work, better energy and sleep.
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Patient KN [RR]: 16 months in program: 9 acupuncture treatments.
Comments: he does not live in Portland area, but can drive about three hours to our clinic for some treatments (also gets some acupuncture treatments in Seattle), takes supplements regularly. Had been put on medical leave from Army; was having trouble walking and hand and feet numbness (hand problems interfered with work as mechanic); fatigue. He was able to go back to work.
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Patient IR [RR]: 41 months in program: 94 acupuncture treatments.
Drugs Reduced: lowered dosage frequency of pain pills from three times per day to two times per day.
Mobility Changes: increased use of hands.
Symptom Changes: less pain after acupuncture treatments, an effect that persists for several days; less experience of sadness, more positive attitude.
Comments: she is confined to a wheelchair; is on many drugs, including pain drugs; has chronic bladder problems. Treatment helps alleviate symptoms; bladder control better.
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Patient LR [P]: 28 months in program: 86 acupuncture treatments.
Drugs Eliminated: Avonex, steroids (taken once per month).
Mobility Changes: range of motion increased; able to move head side to side better; arms move up higher, legs move several degrees further.
Symptom Changes: less fatigue, reduced cognitive problems.
Comments: she has suffered from memory and concentration problems; fatigue (naps every day). With treatment, better mental focus, better energy (not taking naps). Less sensitive to heat this year.
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Patient MR [RR]: 12 months in program: 42 acupuncture treatments.
Symptom Changes: increased clarity of thinking; substantial reduction in spontaneous bruising; reduced incidence or duration of common cold; better energy, better sleep; fewer feelings of exacerbation (tingling sensation in fingers and face).
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Patient KS [RR]: 22 months in program: 78 acupuncture treatments.
Symptom Changes: improvement in concentration; exacerbations (numbness, leg pain, double vision) quickly resolved by treatment; better energy, less problems with sleep; better ability to handle stressful situations.
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Patient VS [RR]:16 months in program: 65 acupuncture treatments.
Symptom Changes: better memory, digestion, strength; clearer thinking; urinary incontinence relieved; less pain.
Comments: suffers from incontinence, arm/leg weakness, memory loss. With treatment, less problems of incontinence; improved digestion.
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Patient KS2 [P]: 5 months in program: 15 acupuncture treatments.
Comments: confined to wheelchair, severe muscle spasms; legs paralyzed and numb, hands curling. With treatment, alleviated restless leg syndrome; has more energy, bladder control improved.
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Patient CU [RR]: 23 months in program: 84 acupuncture treatments.
Symptom Changes: more energy, better concentration and memory; relapses following stress or illness were reduced in severity.
Comments: digestive system problems. With treatment her energy is better, digestion is somewhat improved. She self-administers B12 injections every other day.
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Patient CW [P]: 6 months in program: 20 acupuncture treatments.
Drugs Reduced: Ibuprofen.
Symptom Changes: less spasticity in right leg; feels stronger and has more even energy.
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In general, patients notice a beneficial effect of the treatment program within the first six weeks of regular participation; if not, they usually discontinue the therapy, as it is inconvenient to pursue without evident results. After that initial period, many patients report that they notice a difference in how they feel and in the severity of their symptoms if they miss one or two weeks of treatment, indicating that the acupuncture office visits are an important aspect of their health maintenance. Long-term participants in our program (those having over 9 months experience, of which there have been 50 in total), continue to pursue weekly office visits when possible.
APPLICABILITY TO OTHER PERSONS WITH MS
The reduction of drug use attained by many patients is a potential benefit: there will be fewer concerns about drug interactions when prescribing new medications and fewer concerns about immediate or cumulative drug side-effects. Further, reduction of drug dosage can help offset the costs of treatment. The patients report various mobility and symptom changes that may be classified under the general heading of improvements in quality of life.
Chinese medical services are provided by about 8,000 licensed acupuncturists in the U.S., and practitioners with similar training are working in a number of other countries. The specific methods used at the ITM clinic are made known to other acupuncturists via mailings to a membership group (currently, about 500 members), posting on the internet (ITM’s world wide web site), and through published articles (mainly in the International Journal of Oriental Medicine).
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To contact ITM:
Web site: http://www. itmonline.org
Fax: 1-503-233-1017
E-mail: itm@itmonline.org
Phone: 1-503-233-4907
Mail: ITM,
2017 S.E. Hawthorne,
Portland, Oregon 97214 USA
September 1997