By Shihan Mary Bolz, L. Ac., M. Sc.
Fibromyalgia syndrome is a condition which is seen more and more in everyday life and in clinical practice for many medical professionals, including acupuncturists and Oriental medicine doctors. Fibromyalgia syndrome, or simply called fibromyalgia, is a condition that affects mostly the female gender between the ages of 20 and 50 years of age, although sometimes it does appear at a later age than this. In the West, this pattern is very common in perimenopausal women. It is seen much less in countries such as Japan. Some of the characteristics of fibromyalgia are chronic, widespread, severe muscular aching, pain and stiffness accompanied by insomnia, fatigue, and depression. It is unlike osteoarthritis, rheumatoid arthritis and lupus erythematosus in that it is neither a rheumatic, inflammatory, progressive, or degenerative disorder. It is not only a psychosomatic or psychiatric disorder, either. It is a chronic, debilitating condition of unknown etiology which is probably caused by a number od factors involving a complex relationship between the psyche (mind) and the soma (the body). The American Medical Association (AMA) recognized fibromyalgia syndrome (FMS) as a true illness and major cause of disability in 1987.
How is FMS diagnosed in allopathic (Western, conventional) medicine? There has been no single laboratory test or x-ray which can confirm this diagnosis since this condition does not result in any physical damage to the body or the body tissues. It is associated with chronic, enduring fatigue, and can be confused with chronic fatigue syndrome (CFS) or what is also known as chronic fatigue immune deficiency syndrome (CFIDS) in the United States. One of the major differences between these two in diagnosis is the pain and muscle-joint aches. Chronic fatigue syndrome (CFS) will not exhibit the degree of pain shown in FMS. In medical studies of this condition, it is estimated as much as 75% of the CFS-diagnosed patients actually fit the criteria for FMS. One of the ways in which fibromyalgia is diagnosed in allopathic medicine is muscle-joint pain when finger-pressure is applied on at least 11 out of 18 specific points on the body. Interestingly, these 18 points which are tender to palpation are in areas of known acupuncture points. These 18 points have been established by the American College of Rheumatology (ACR). FMS sufferers are typically hypersensitive to colors, odors, bright lights and loud noises. Headaches and jaw pain, such as temporomandibular joint (TMJ) pain are common.
When the word syndrome is used, as in fibromyalgia syndrome it means that this condition presents with a range of accompanying signs and symptoms in addition to the muscle and joint aching and pain. Although allopathic (Western) medicine can not explain why these symptoms occur as they do, Western doctors do recognize this symptomatology as a disease.
More collection of data: 90-100% of FMS sufferers have generalized body pain that affects all four quadrants of the body, fatigue, and muscular stiffness. Typically, these symptoms are typically worse in the morning. The patient may complain that their arms and legs feel “like tied down to something very heavy.” They usually describe the pain as deep, burning, throbbing, shooting and/or stabbing. The degree of fatigue can be from a random feeling of exhaustion to being unable to get out of bed.
Seventy to ninety percent of FMS sufferers will complain of either migraine or tension headaches, sleep disturbances, tenderness to pressure on certain spots of the body, swollen feet, numbness and/or tingling, difficulty thinking and concentrating, a feeling of “fogginess” or “mugginess” of the head, hypersensitivity to stress, dry mouth, or dysmenorrhea. They may also suffer from depression. Most FMS patients are usually able to fall asleep but are not able to sleep soundly or wake up too early in the morning. Some people suffer from a dizziness due to orthostatic hypotension (dizziness when standing up) The dysmenorrhea is sometimes diagnosed as endometriosis. Some people suffer from irritable bowel, blurred vision, mood swings, heart palpitations, cold extremities, feverish feelings, or allergies. There may be symptoms of abdominal bloating, cramping and pain after eating. There may be diarrhea or constipation and mucus in the stools. Many women with this condition also have decreased visual acuity at night which makes them uncomfortable to drive at night.
In order to qualify for a diagnosis of FMS in allopathic medicine, the person must show generalized muscle pain, stiffness, and fatigue that has lasted for not less than three months and must show at least 11 out of 18 specific tender points on the body painful to palpation. Because fibromyalgia involves a number of different symptoms, allopathic medicine tries to treat the disorder by prescribing various medications and treatments for each of these different symptoms. Since the underlying cause has not been identified, allopathic (Western) medicine has no single treatment for it. Sometimes antidepressants, such as Prozac, Elavil, Paxil and Xanax, are commonly prescribed to treat the sleep and mood while non-steroidal anti-inflammatories (NSAIDs), such as Ibuprofen, are prescribed for the pain. Sometimes the trigger points of pain are injected with a type of local anesthetic.
Not all people tolerate antidepressants and many other patients simply do not want to take such Western psychotropic pharmaceuticals. NSAIDs can help the pain, but they also have their own potential side effects, such as skin rashes, hives, and itching, headache, dizziness, blurred vision, ringing in the ears, depression, mouth sores, and gastrointestinal upset. Ironically, some of these side effects include many of the symptoms of FMS.
In Traditional Chinese Medicine (TCM), fibromyalgia is categorized as ji bi , muscle impediment. According to Oriental medicine, most of the complaints associated with fibromyalgia syndrome are disease categories in their own right. When treating FMS, the Oriental medicine doctor will consider the patterns and treatments according to traditional Chinese medical texts of internal and physical medicine. Three main associated disease conditions are xu lao, (deficient fatigue), yu zheng (mental depression) and shi mian (insomnia). The causes and disease mechanisms are studied in traditional Oriental Medicine and a majority of cases have been recorded as liver-spleen disharmony, liver energy depression which may be due to unfulfilled desires or anger damaging the liver. It may also be due to insufficient blood nourishing the liver or insufficient fire in the body to warm the liver. Spleen deficiency is due to faulty diet, excessive work, excessive thinking and worry and anxiety, too little physical exercise, overdose of bitter, cold medicine, including Western antibiotics, or living in a damp, hot environment.
If there is liver trouble, the blood, energy, and body fluids will not flow smoothy and easily and can cause symptoms like chest, breast, rib, and abnormal pain and distention, fullness, emotional depression, irritability, headaches, PMS, and dysmenorrhea. Women of perimenopausal or menopausal age will have the underlying imbalances and conditions they had been carrying and additional symptoms of hot flashes, night sweats, etc. will occur on top of them. They may become “mixed” cold and then hot.
Spleen deficiency symptoms include fatigue, lack of strength and/or warmth in the extremities, poor appetite, and loose stools. If there are damp accumulation symptoms there will be edema, abnormal vaginal discharge, or damp skin lesions. There may also be phlegm, such as nodules, phlegm in the lungs, and/or mental fuzziness. Blood stagnation may result in painful menstruation or pain in any fixed location pain in the body. The prolonged condition may lead to kidney damage with symptoms of extreme cold manifested as constant cold hands and feet, even in the summer months. The water metabolism is affected and this may lead to accumulation of too much water in the body with edema in various parts of the body.
The FMS patient may wake in the middle of the night feeling frightful, startle easily, have heart palpitations, a feeling of something stuck in her throat, and a general timidity. These symptoms involve the heart and gallbladder. All of the signs and symptoms of FMS are due to some combination of interrelated disease mechanisms.Regardless of the name given to the condition, the signs and symptoms are all real and like all other diseases, can be managed and/or cured.
Massage, acupuncture, correctly prescribed Chinese herbs- can all be effective treatments for FMS. Although many patients benefit from regular weekly massage, others may experience a worsening of the muscular pain and stiffness 1-2 days after massage, even light massage. In this case, trigger points, or painful points in the body can be treated with moxibustion. Moxibustion is a form of heated herbs, the major herb being mugwort, sometimes used in combination with others. The herbs are actually lit on fire and left to smoke and this is indirectly applied to the trigger points. Acupuncture, moxibustion, Chinese herbs, all prescribed by a professional acupuncturist can be an effective pain and emotional management system for FMS.
Depending on the length and severity of the condition, patients will respond at varying rates. Acupuncture and Oriental medicine certainly can be a valid form of treatment without the serious side effects and dangers of allopathic medication. It is important for each person to take the responsibility and pro-active attitude of moderate exercise, good nutrition, and keeping a positive emotional attitude by seeking activities they enjoy and surrounding themselves with positive company. People in the Western hemisphere seem to underrate the power of thought, natural living and natural remedies. The emotional psyche plays a major role not only in FMS but in many diseases. It is nature that heals and each person has a great natural ability to obtain and retain good health, but must reach out for it. A competent, caring, professional health care provider can be a guide for a person on the path of self-healing.