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Expert Advice-Treatment of Fibromyalgia in Traditional Chinese Medicine(TCM):

Chinese Medicine for Fibromyalgia

Recent studies indicate that approximately 2% of the population in this country suffers from fibromyalgia. The actual figure is probably much higher than that because fibromyalgia is widely under-diagnosed or misdiagnosed. Even the people who have been given a diagnosis of fibromyalgia have usually spent many frustrating years trying to convince doctors that there was really something wrong with them.

Why is it so hard for conventional Western medicine to diagnose fibromyalgia? For one thing, there are no lab tests or x-rays that can diagnose it. Fibromyalgia is something like Chronic Fatigue Syndrome in that it is not seen as a clear-cut disease caused by a specific agent, but rather as a collection of symptoms. If a patient exhibits enough of the standard fibromyalgia symptoms, then she is diagnosed with fibromyalgia (women are much more likely to have fibromyalgia than men). Fibromyalgia means "pain of the muscle fiber," and the most characteristic symptom is a high level of pain in muscle tissue. Other common symptoms are exhaustion or overwhelming fatigue, insomnia or sleeping disorder, and very stiff muscles upon awakening in the morning. Besides these principal symptoms, fibromyalgia patients often complain of depression, anxiety, headaches, and irritable bowel syndrome (IBS).

Because there is no definitive test for fibromyalgia, and because many of the predominantly female patients complain of depression, it is not unusual for fibromyalgia patients to be treated with anti-depressants. You can imagine how frustrating it is to go to doctor after doctor for years and be told that the problem is all in your head. When fibromyalgia is untreated or ineffectively treated, symptoms can be devastating to the sufferer.

Unfortunately, even when fibromyalgia is diagnosed, Western medicine has no effective treatments to cure the problem. It is recognized that insomnia is the common denominator of fibromyalgia patients, so sleeping medications are almost always prescribed. Exercise is recommended, and pain medications or trigger point injections are often used. Recently, growth hormone injections have been tried on the grounds that insomniacs donít produce as much of this substance as people who sleep normally, but results have been inconclusive.

Before I discuss the traditional Chinese medicine approach to fibromyalgia, let me tell you about Donna. The way her fibromyalgia developed and the way it was treated are very typical. Eight years ago, Donna worked as an office manager and had three young children. Then her husband died, and her children began to have problems adjusting at school. A single working mother with a stressful job, Donna would lie awake nights worrying about her situation. "My sleep went off first Ė I never had trouble falling asleep before, but I would lie awake night after night, thinking about my kids and my job, and it seemed that I never had a deep, sound sleep, even if I dozed off. After a while I would wake up in the morning feeling stiff all over and extremely tired. When I went to see my doctor he gave me an anti-depressant, but it didnít work, plus I gained weight." Gradually, Donnaís condition worsened. All her muscles were stiff and painful, she had frequent headaches, chronic insomnia, irritability, anxiety, and depression. "I kept going to different doctors, and they would test me for rheumatoid arthritis and do EMGs and all kinds of stuff, but nothing ever showed up. After a few years I realized that I couldnít hold down my job any more. I was really disappointed, after putting in fifteen years with my company, but I hoped that staying home and resting would make me better. But even after six years off work, I still didnít feel better. Then one day I read an article in the newspaper about fibromyalgia, and I said, ĎThatís me!" So I went to see my doctor with the newspaper in my hand and made him read the article. He agreed that I fit the fibromyalgia profile, and so I finally had a diagnosis after eight years of illness, but none of the treatments we tried over the next two years gave me any real relief. I decided to try Chinese medicine for my condition after reading about it on the Internet."

In traditional Chinese medicine theory, Donnaís problem is considered to be an imbalance of the Spleen and Heart. This pattern of Spleen/Heart Deficiency fits the classic symptoms of fibromyalgia. Another pattern that fits the profile of a fibromyalgia patient is called Liver Chi Stagnation with Liver invading the Spleen. Both of these patterns will be discussed in more detail in next monthís article. In Donnaís case, the emotion of worry or over-concentration had interfered with the Spleenís ability to nourish the Heart and other muscle tissue. Symptoms of muscle pain and insomnia followed as the Spleen and Heart became more deficient and imbalanced over time. The goal of treatment was to nourish the Spleen so it could properly nourish the Heart and other muscles, and to bring the Spleen and Heart into balance. Acupuncture, Chinese herbal formulas, and dietary recommendations were the modalities used to do this. Calming exercise programs such as Tai Chi or yoga can also promote balance and health. After a series of acupuncture treatments and an herbal formula called Gui Pi Wan, which is specifically designed for Spleen/Heart Deficiency, Donna improved a lot. She said, "This is the best Iíve felt in eight years. I want to tell everybody how much Chinese medicine can help with fibromyalgia."

For the 2% of the population, mostly female, who suffer from fibromyalgia, it can be a long and difficult process even getting a diagnosis, much less getting adequate treatment for this condition. Western medicine has had a hard time coming to grips with fibromyalgia because there are no tests to determine the presence of the disease, only a collection of symptoms. The two most common symptoms are severe muscle pain and chronic insomnia. The approach of Chinese medicine is to differentiate symptoms into patterns of disease, and then treat the patterns based on centuries of clinical experience.

In the first article, Donna illustrated one of the two most common Chinese medicine patterns associated with fibromyalgia Ė the pattern of Spleen/Heart Deficiency. Donna would lie awake nights worrying about her job, children, finances, etc. In the morning she would feel fatigued, with stiff, painful muscles. These symptoms intensified over time, until she was forced by pain to quit her job. Chinese medicine sees the Spleen as being the key to Donnaís spiral into fibromyalgia. The Spleen is responsible for transforming the food that we eat into the energy (Chi) and blood that sustain our bodies. Obviously, the health of the Spleen can be affected by inappropriate diet, but it is also strongly affected by the emotion of worry, or over-concentration. Chronic worry or too much studying eventually interferes with the Spleenís ability to generate and convey sufficient Chi and blood to the muscles and flesh, which is an area of the body that the Spleen is especially responsible for. The principal muscle that the Spleen needs to sustain is the Heart. The Heart is considered to be the home of the Spirit, and has a close relationship with the Spleen. When the Spleen cannot generate enough substance to nourish the Heart, the Heart Chi does not have enough power to house the spirit properly, and symptoms such as anxiety, palpitations, and insomnia result. A Spleen Deficiency condition can result in fatigue, muscle stiffness, and pain; a Heart Deficiency condition usually brings emotional unrest and insomnia. These two deficiencies then feed into each other: insomnia causes muscle pain and stiffness, and muscle pain makes sleep more difficult.

The other common fibromyalgia pattern is called Liver Chi Stagnation with Liver invading the Spleen. Another patient of mine will illustrate this pattern. Carol is an elementary school teacher. Six years ago, her twenty-four year marriage ended in a very bitter divorce. Four years ago, she was diagnosed with fibromyalgia. When she came to my clinic she had multiple complaints Ė fatigue, depression, muscle aches, insomnia, irritable bowel syndrome, and poor memory. An interesting symptom was that she always woke up between 1:00 a.m. and 3:00 a.m., feeling restless and remembering a lot of dreams. She finds her job to be very stressful these days, and often thinks that she canít handle it any more.

When I examined Carol, her tongue looked puffy, with indented tooth marks along the edges, a sign that her Spleen was not functioning well. When I checked her pulses, the Liver pulse felt wiry, and the Spleen pulse was weak. In Chinese medicine terms, her Liver Chi was stuck, or stagnating, and instead of flowing smoothly through its normal channels, it was more or less short-circuiting and attacking Carolís Spleen. As with Spleen Chi deficiency, Liver Chi stagnation can result from an improper diet, but in Carolís case I felt the origin was emotional Ė a combination of stress and deep, unexpressed anger.

One of the major responsibilities of the Liver is to ensure the smooth flow of Chi, blood, and emotions. Since anger is the emotion associated with the Liver, extreme or unexpressed anger can really compromise its functioning. Most people are familiar with the way the emotions of anger and fear can interfere with digestion. When we are emotionally upset, we feel that our stomachs or our intestines are "tied up in knots." Chinese medicine says that the Liver is "invading" the Spleen or Stomach. It is interesting that about fifty percent of people with fibromyalgia also have some form of irritable bowel syndrome. This is entirely consistent with the pattern of Liver Chi Stagnation/Liver invades Spleen.

Both Eastern and Western medicine agree that insomnia is a key to fibromyalgia. Western doctors prescribe sleeping pills. Chinese medicine aims to nourish the Heart and the Liver, which are the two most important internal organs in regard to sleep, and to bring them into balance with the Spleen. With Heart blood deficiency, people find it difficult to fall asleep. With Liver Chi stagnation, sleep becomes restless, with intense dreams and a tendency to wake up early in the morning.

In treating this condition, the goals are to regulate and move Liver Chi, harmonize the Liver and the Spleen, and nourish the Spleen so it can do its vital job of processing food into Chi and blood. This is done with acupuncture treatments combined with herbal formulas. Shu Gan Wan is an old formula which breaks up Liver Chi stagnation. Xiao Yao Wan is a formula used when the Spleen is being affected by a dysfunctional Liver. The length of time it takes to see results from treatment depends on how serious the symptoms are, but most people notice improvement after six to eight treatments.

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