When I started my practice in the eighties, one of the main reasons people visited acupuncturists and herbalists was for fatigue. This included Chronic Fatigue Syndrome. The first time I heard the term "Fibromyalgia" was several years later, although many of the patients experiencing chronic fatigue also had musculoskeletal pain and other symptoms associated with Fibromyalgia Syndrome (FM). These other symptoms included sleep, memory, mood and digestive issues, as well as headaches, TMJ, anxiety and depression.
In many cases, acupuncture combined with herbs or simply herbal therapy alone, helped these patients. For example, a music teacher came to us presenting fatigue, joint and muscle pain, and digestive issues as her chief symptoms. I noted her level of fatigue and digestive system improved from using herbs and her pain was also reduced. Over several months, all of her symptoms improved and she was able to return to work (she had been on disability). Another patient was a professional dancer who had an injury, developed mononucleosis, and was being treated by a colleague for Epstein Barr Virus. She found that acupuncture twice a week, decoctions, and prepared formulas reduced her fatigue, lymphatic swelling, and perceptions of pain after the first week.
Later, we treated a policeman who was diagnosed with PTSD who had anxiety, depression, and chronic pain. The local HMO offered high dosage ibuprofen and Vicodin, which compromised his liver, kidney and digestive systems. Twice-weekly acupuncture and tabled Chinese herbal formulas helped improve all of his symptoms and allowed him to reduce his pain medications.
One of our more difficult cases was a former nurse and acupuncture student who had been dealing with fibromyalgia-related symptoms for more than twenty years. In addition to herbal formulas, she was able to administer acupuncture to herself every day. These two factors made the biggest difference in her recovery.
Chronic Fatigue Syndrome & FM
Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals.
Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event. Women are much more likely to develop fibromyalgia than are men. While there is no cure for FM, acupuncture, herbs and medications can help control symptoms. Exercise, relaxation and stress-reduction measures are essential for helping patients overcome FM. Chinese herbal therapy that addresses syndromes such as spleen qi deficiency, excess heat, qi and blood stasis can not only lessen pain, but keep pain from returning. We have had excellent results in our clinic helping clients, clients who have a compelling reason to improve, function much better in their home and work life.
In my thirty years' experience, I have noticed patients who have a strong reason to use Chinese medicine do much better than those who merely "wish" to improve. For example, I believe a stress reduction and constitutional exercise program that might start with Tai qi and walking, is necessary for patients to recover from FM. Patients who are able and willing to work with their practitioners on diet and lifestyle issues often make lasting change, whereas clients who can't stick with it, those who often make the rounds with acupuncturists, chiropractors and herbalists, and rarely make lasting improvement. Compliance is important. My colleagues who have practiced in China always recommend acupuncture two to three times a week. I want to reiterate again, clients who initially only come in once a week or less rarely improve.
Importance of Compliance
In our clinic, we mainly recommend prepared herbal formulas to improve compliance. Clients who do not stick with the dosing schedule, "forget" to take their herbs, or who spend an inordinate amount of time "researching" (herbs, nutritional supplements treatments) on the Internet frequently backslide. It motivates practitioners to ask our patients what reasons they have for improving their health. Positive reasons include wanting to go back to work or school, participating in a special event, and professional or personal goals.
In biomedicine, the cause of fibromyalgia is unknown. However, there are several factors that may work together including genetics, infections (which can trigger or aggravate FM), and physical and emotional trauma. Researchers believe that repeated nerve stimulation causes the brains of people with FM to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain's pain receptors seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals.
FM is diagnosed more often in women than men, and in people with a history of certain diseases such as rheumatoid arthritis and lupus. From the perspective of Chinese medicine, most fibromyalgia patients seen in our clinic had a lack of balance in their life before developing FM. Frequently, these clients are both stressed and exhausted. In the cases above, the music teacher had a history of over-caring for other people including family members, students, and members of her church. The dancer had many injuries, was starving herself to be thin, and was under constant stress from auditioning, performing, and practicing. The police officer was involved in a shooting, and he felt rage, frustration and even fear as he had received death threats. His pain seemed to re-trigger an auto accident that left him with back pain.
In the past, doctors would check 18 specific points on a person's body to see how many of them were painful when pressed firmly. Newer guidelines don't require a tender point exam. Instead, a fibromyalgia diagnosis can be made if a person has had widespread pain for more than three months — with no underlying medical condition that could cause the pain. Physicians may run tests to rule out conditions that have similar symptoms. We would urge all professional to make sure to evaluate thyroid function. We have seen both patients with FM and chronic fatigue whose symptoms were resolved when their thyroid was brought into balance.
What Works and What Doesn't
To have the best chance of success, we would suggest acupuncture twice per week with Chinese herbal therapy that has been administered according to pattern differentiation. It's always important to remember to evaluate the patient with fibromyalgia, rather than just traditional formulas for pain. The most frequently administered herbal formulas include herbs for calming, bloo and qi-regulating ingredients, and tonics including medicinal mushrooms. Because many FM patients are highly sensitive, it is important to make sure you are administering herbs which are pure and do not contain additives such as sugar, artificial sweeteners, artificial flavors or coloring agents. Usually bulk herbs are too overwhelming in terms of the taste and smell, and Asian Patent Medicines should be avoided because of adulteration issues. Herbs and nutritional supplements are recommended, especially for sleep, since many FM patients wake up in the morning unrefreshed, and stiff from a night tossing and turning.
Food allergy elimination is very useful as up to 98% of FM patients have digestive disorders. Functional gastrointestinal disorders are found in the majority of FM patients, with one study citing 98%, compared with 39% of controls. Irritable bowel syndrome (IBS) is the most prevalent GI issue. Fifteen studies have demonstrated that patients with IBS alone or in combination with FM, have hypersensitivity to somatic and visceral pain. A majority of patients with IBS identified food sensitivities as a trigger for their symptoms. Immune system activation of IgG and IgE has been associated with IBS, as well as migraines, another common manifestation of FM. Studies showed that elimination of all reactive foods resulted in dramatic improvement in both conditions. In my experience, removal of all reactive foods, found by either IgG testing or a comprehensive elimination diet, significantly reduces a number of symptoms, especially pain. The patient removes the foods for a minimum of 2 to 4 weeks, prior to reintroduction. If symptoms occur upon reintroduction, the food is eliminated from the diet. I have developed a rotation diet that has helped many patients with fibromyalgia and digestive disorders (digestiveclearingdiet.org). If IgG food sensitivity testing is chosen, it is essential to find a reliable laboratory with consistent results.
The most important adage is "treat what you see" when helping people with FM. Oftentimes, beginning practitioners ignore simple solutions for more complicated strategies. Sometimes complex approaches are appropriate, but straightforward diagnosis using symptoms, appearance, pulse and tongue according to TCM should be tried first. It is also important to make sure your herbs are correctly identified, processed and labeled. It is common to see poorly sourced herbs in both Chinatown and acupuncture schools.
Acupoints that are especially useful include the Meriam Lee protocol: ST 36, SP 6, LI 4, LI 11, LU 7 (all points bilateral), plus associated pattern, ear and local points. Additional points for insomnia and anxiety include P6, GI 21, yin tang(Ex-HN2), DU 20, GB20, HT 3, BL 15, BL 16, BL 18, BL 19, BL 20, BL 23.
Shelia was a 42-year-old, overweight office worker. When we saw her, her chief complaints were back, neck, and knee pain, as well as insomnia, fatigue and depression. She also had symptoms of irritable bowel syndrome (IBS). She was not able to work and she was being supported by her husband. The first doctor she saw said she was overworked. He said she should rest more and he prescribed anti-inflammatory drugs. She stopped exercising and gained 30lbs. The second doctor she saw diagnosed her with FM and prescribed more anti-inflammatories, Trazadone (an antidepressant which is also used to treat sleep issues), and C0-q10, a nutritional supplement. She visited an acupuncturist once per week. She felt satisfactory results from the acupuncture, but they only lasted 24 hours beyond the session. When we saw her, her pulse was weak and soggy and her tongue was pale and coated. We initially recommend a formula with Chinese herbs and enzymes for food stagnation and dampness and later recommended herbs to address spleen qi deficiency and tableted version of Duo Huo Sang Ji Sheng. Her final protocol was a high quality mushroom formula with Red Gandoderma, Tremella, Poria and Polyporus.
Shelia is a fairly representational fibromyalgia patient at our clinic. Some of the key points are that we believe that it is important to treat the digestive system first. Many practitioners may have wished to start the patient on a pain relieving formula right away. However, it is our experience that that can be a mistake if the person is having digestive issues as these herbs can be difficult to digest for some patients. Likewise, some of the best herbs for fatigue are the medicinal mushrooms. On the other hand, medicinal mushrooms can be difficult to digest for American patients. Therefore, we need to dispense a formula that is easy to digest on top of making sure the patient does not have an active digestive disease.
In our experience, Trazadone improves not only mood but sleep, and several of our clients have done well on this. In contrast, anti-inflammatories can wreak havoc on the digestive system, liver, and kidneys. According to Natural Comprehensive Database, research indicates C0q10 only presents digestive problems for 1% of people. Despite this, our own experience working with sensitive patients is that this can be a worthwhile supplement; however, digestive reactions are more common than 1%.
For best results, we recommend acupuncture twice a week, a daily stress reduction and gentle exercise program, and herbal formulas to address root and branch issues. As compliance and quality control is important, we recommend Chinese herbs in pill form manufactured in the U.S. In order to customize the formula, up to two internal formulas may be administered to address symptoms and pattern differentiation. Topical treatments such as analgesic herbs, moxa, and alternating hot and cold packs are highly beneficial and work best if they are applied at least twice per day.
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