What is FM?
Fibromyalgia (FM), is a term used to identify a group of symptoms that include generalized pain within the muscle tissues accompanied by chronic fatigue. It is the second most common diagnosis made in rheumatology clinics.
In this article, I will present some of my own experience treating FM with Chinese medicine including Qigong, acupuncture and bodywork. I will also share my own hypothesis of the cause of Fibromyalgia.
The term, coined around 1976, is a composite of three Greek words – fibro = fibrous tissue, my = muscle, and algia = pain. Basically, then, fibromyalgia means pain in the muscles.
A quarter of a century has passed since scientists named the mysterious disease and yet a solid diagnostic method has failed to emerge in spite of numerous studies and thousands of patients under current care.
Today, doctors who specialize in treating FM, have identified 18 locations or points in the body that are reactive to finger pressure or digital palpation. 11 of these points need to be tender to pressure for a positive diagnosis of FM. Aside from these 18 points, there is no other method, lab exam, or imaging technique used to diagnose FM. Thus, clinician often employ an approach known as “differential diagnosis”, which is basically a process of eliminating other possible reasons that may be responsible for the symptoms of FM.
Widespread pain is not the only symptom that accompanies FM. In addition, patients often complain of disturbed sleep, fatigue, Numbness or tingling, Digestive disturbances, abdominal pain, bloating. Some patients report difficulty concentrating, “spaciness” or “fibro-fog”.
The disorder is heterogeneous, which means that not all patients display the same additional symptoms, making the disorder difficult to diagnose and treatment programs highly individualized.
What Causes FM?
There are several theories about what causes FM. Some researches believe that low levels of serotonin decreases pain tolerance in FM patients. Serotonin, a neurotransmitter, has many physiological functions in the body including mood regulation, pain tolerance, and sleep regulation. Much research needs to be conducted in the role of serotonin in relation to FM.
Stress has also been linked to fibromyalgia, and while the syndrome itself is enough to produce stress, studies seem to suggest that early life stressful situations may have set the arena for FM symptoms to emerge later in life.
Unfortunately, researches have not been able to point to one particular cause of fibromyalgia. Although equal effort is being placed on its etiology and a cure.
A Few Observations of FM Patients
I started treating FM patients around 1994 while doing my internship at The Florida Institute for Traditional Chinese Medicine. Shortly after opening my first practice, I began to notice a number of conditions and medical history that seem to be common among most of my patients. Naturally, not all patients presented the same patterns, but generally, it seemed to me that most shared a similar background prior to the onset of FM.
The first commonality I noticed, was a prolonged use of antibiotics during the teenage years often prescribed to reduce acne. As we will see later, long term use of antibiotics has a detrimental effect on the digestive system and, in my experience, a contributor to the development of FM.
As I studied my intake forms from my FM patients, I also noticed that poor sleep patterns were a chronic symptom long before the diagnosis of FM. I found this to be significant since good, deep sleep is necessary for the body to be able to recuperate from tissue damage. It has often been observed in clinical practice, that many patients started to develop FM after some type of trauma.
While there are many cases reported of men suffering with FM, it is women who are generally diagnosed with FM. Statistics show that around 3 to 6 million Americans are diagnosed with FM and that about 80 to 90 percent of these are women.
The last common sign I found, and the one that I believe to be main precursor of the syndrome is low blood pressure. I have asked many doctors who treat FM to see if low blood pressure was one of the signs of their FM population and without an exemption all have agreed to it. Naturally, there are cases where the opposite is true. But, in my experience, these are few and far in between.
How I Treat Fibromyalgia
As a practitioner of Chinese medicine, and in accordance to the principles upon which it developed, I must treat each patient based on his/her pattern of disharmony. However, in light of the above findings during the last 15+ years of licensed practice, I have carefully developed a treatment approach that has shown promising results and I hope that other practitioners take notice.
Along with generalized body pain, clinicians have identify sleep disturbance as a common denominator among all fibromyalgia patients and it is the first symptom that I address when treating FM. As I stated above, often a history of trauma precedes FM. The body has a built-in system for repairing tissue damage that is only set in action during deep levels of sleep. And while the pain in FM is normally not the result of tissue damage, if there is any history of trauma unresolved, it becomes a contributor to stress which further aggravates the FM symptoms.
Besides helping in tissue repair, good, deep sleep has been linked to many other health benefits including the prevention of heart disease, stress management, improvement in memory and much more.
The treatment of sleep disturbance with Chinese medicine is complex and beyond the scope of this article. But, in my experience, Chinese medicine including herbal remedies and relaxation techniques from Qi Gong, have given many of my patients the necessary sleep to just enjoy a better life along with helping with fibromyalgia symptoms.
Digestive problems are common symptoms to those afflicted with fibromyalgia. Constipation, diarrhea, bloating, gas, acid reflux, and irritable bowl syndrome are among some of the digestive complaints encountered in clinical practice when addressing FM.
As stated above, many of those who suffer with FM have a history of excessive antibiotics use. It has been well documented that long-term use of antibiotics leads to chaos within the intestinal track and is responsible for yeast proliferation which in turn leads to a host of digestive disorders.
According to Chinese medicine, the digestive system, which includes, the Spleen/Pancreas, stomach and intestines, is easily damaged by substances that are cold in nature. Chinese medicine dietary principles and the classification of its materia medica (herbal catalog), is a deep study and in fear of not doing justice to the topic, I will not even attempt to present an encapsulated version on the subject. However, I will state that antibiotics in general are very cold in nature and will, with prolonged use, damage the digestive system, which in every medical tradition is the root of health, longevity, vitality, and the source of “the life of the flesh”, which is the blood.
To address the digestive symptoms, I normally use a modified version of a classical Chinese medicine herbal formula known as Gui Pi Tang (Restore The Spleen Decoction). I say modified because this formula will be customized to fit the particular pattern my patient presents. The main focus for using this formula in my treatment of FM, is to strengthen the digestive system. I will discuss this prescription in more detail below.
Normalize Blood Pressure
Low blood pressure is common among FM patients. Studies conducted by Dr. Peter Rowe at Johns Hopkins University School of Medicine have linked hypotension to chronic fatigue syndrome, and further studies are being conducted in its relationship to FM.
Low blood pressure in itself is not considered pathological until symptoms of organ dysfunction due to poor blood supply become evident. It is not my intention to suggest that the presence of low blood pressure is a precursor to organ damage. Many people function perfectly and are in a healthy condition who have low blood pressure. Athletes, for example, normally have low blood pressure.
It is my opinion, which is not backed by any scientific analysis but rather anecdotal in nature, that the generalized body pain in FM is directly linked to a lack of sufficient nourishment of muscle tissue through the circulatory system. Just as in extreme hypotension, where vital organs such as the kidneys, heart, and liver become damaged due to poor blood supply, it is my conviction that “normal” low blood pressure is the culprit in FM, and the pain itself, is the message the muscles send asking for nourishment.
My Chinese Medicine Strategy for FM
The treatment of FM with Chinese medicine in my clinic is multi-faceted. The complexity of the syndrome requires a careful intake of medical history and the use of differential diagnosis in order to arrive to a treatment plan.
To illustrate my protocol, I’ve created an image which represents the modalities I use. Notice that at the center of the wheel is the practice of Qi Gong.
Qi Gong practice involves the synchronization of abdominal breathing with postures that are performed in a slow rhythmic pattern while standing. Most postures are repeated a number of times while the weight is shifted from one leg to another.
The abdominal breathing with the shifting of the weight helps improve overall circulation. The legs act as pumps (muscle pump mechanism) that help venous return upwards towards the abdomen. Abdominal breathing creates pressure in the abdominal cavity which helps the large veins in the abdomen move blood back to the heart. In essence then, the legs and the abdomen act as two extra hearts.
Qi Gong is gentle, relaxing and promotes overall well being and is suitable for men and women of all ages. Without Qi Gong or some type of gentle exercise done on a daily basis, FM becomes much more difficult to treat than it already is.
Often patients are perplexed by the lack of energy, vitality and overall sense of well being in spite of eating good quality food and daily intake of supplements. However, unless the digestive system is regulated, the stomach is unable to properly digest food.
The role of herbal medicine in my treatment plan is to address the digestive disorders that afflict FM patients. The formula Gui Pi Tang with modifications, address the function of the digestive system by strengthening the Spleen. In Chinese medicine, the Spleen and the Stomach are the source of the vital energy derived from food, and also the system from which raw material or food essence is manufactured for the creation of the Blood.
Without any modifications, Gui Pi Tang’s main function is to generate Blood to nourish the Heart. When the Heart, which houses the Mind is nourished, the patient can think better, has a clear mind and sleeps better. The formula is ideal for patients whose digestive track has not been seriously compromised by stress and by the use of antibiotics, do not suffer with candida albicans, IBS or any other serious digestive disorder.
However, in clinical practice, these patients are rare. The majority of those diagnosed with FM have numerous digestive complaints and without modification, the formula may exacerbate the symptoms. Furthermore, the gender and age of the patient will also be a factor in the formula’s modification. Women who are perimenopausal need particular attention paid to symptoms brought on during this stage of life.
The beauty of Chinese medicine lies in the ability to effectively treat FM in a per patient basis.
Once the digestive system is regulated, a good nutrition program becomes the single most important component in the generation of vital energy and plays a supportive role in the practice of Qi Gong. Vital energy comes from the fusion of air with the nutrients derived from food. Qi Gong practice provides the oxygen for the fuel while the digestive system provides the raw material from food essence to be transformed into Blood. The fusion takes place in the Lungs and sequentially nourishing the Heart with fresh oxygenated Blood, calming the mind and giving life to the tissues.
Supportive Role of Acupuncture and Bodywork
In my clinical experience, acupuncture and bodywork play a supportive role in the treatment of fibromyalgia. Acupuncture helps the tissue by increasing blood flow and induces relaxation. Bodywork also promotes circulation, and in the hands of a knowledgeable therapist it can bring temporary relief from pain.
Chinese medicine has a long history in the treatment of pain. While FM may be a new disease, the signs and symptoms that make up the syndrome have been addressed successfully by Chinese medicine for thousands of years. It is my hope that more FM patients turn to Chinese medicine in their search for relief from fibromyalgia.
Fernando Bernall, DOM
Saint Augustine, Florida