Oriental medicine practitioner Olivier Lejus continues his look at this painful condition and its treatment according to Chinese medical principles
In this follow up article on fibromyalgia, we will look at the treatment of this condition with Chinese medicine. In the January issue of NOVA, (Vol 18.No 11) I explained that this debilitating medical condition is predominantly affecting women. Patients typically report various degrees of muscular pain ("myalgia") in the joints and muscles without any causative factors. The symptoms often begin in one part of the body, such as the shoulders, neck, or lower back, before gradually spreading to wider areas. The pain is exacerbated by a range of factors such as stress, fatigue, anxiety, or cold and damp weather conditions.
Unfortunately, in most cases, laboratory tests are unable to find any abnormalities. This lack of pathological evidence of dysfunctions has left the Western medical community perplexed for a long time as to which course of treatment would be the most appropriate, or even whether this new medical condition actually existed.
In response, in 1990, the American College of Rheumatology (ACR) established a set of classification criteria which defines 18 specific bilateral tender points that are constant in location with all fibromyalgia patients. These range from the occipital muscle at the base of the neck, to the spinal disc area of the shoulders, and around the trapezius muscle. The chest, lateral elbows, buttocks, hips and knees are also included. It is a condition that is quite difficult to treat. The conventional treatment protocol is generally a combination of painkillers and exercises.
Looking from a different perspective, the Chinese medical framework recognises pain as the evidence of imbalances of energy (Qi) or blood in the channels or organs of the body. In contrast to its Western counterpart, one medical condition can be caused by a variety of factors, which will be treated differently according to the symptoms associated with them.
In the case of fibromyalgia, Oriental medical practitioners recognise four common typical pathological patterns, keeping in mind that one person might exhibit a combination of more than one pattern.
One patient suffering from Liver Qi stagnation will be irritable and easily angered, complaining of waking up frequently during the night, and having trouble getting back to sleep. There could be a history of headaches, or migraine, or even severe period pain. The muscle pain will be concentrated around the neck and shoulder areas and triggered by emotional stress.
In a few of these patients, these emotions will affect their bowel functions resulting in Irritable Bowel Syndrome (IBS) with alternate loose stools and constipation. The patient's pulse will be "wiry", meaning tight like the string of an instrument.
Another patient with a Blood and Qi deficiency pattern will be constantly tired, possibly with dry skin (the blood moisturises the skin), dull headaches, dizziness, palpitations or anxiety. The problem will be more one of muscle weakness and numbness in the joints than pain. The patient's tongue will be pale and her pulse will have a thin quality to it, feeling almost like a thread under the finger. For this patient, the treatment will be aimed at strengthening the Qi and the blood with Chinese herbal medicine, and acupuncture points on the spleen meridian will be selected since the spleen makes the blood.
In the third pattern, the patient comes to the clinic complaining of severe aches and pain over her whole body. There will be tingling sensations in her fingers, as well as severe headaches. This is often a progression of the previous pattern.
According to the principles of Chinese medicine, in a blood deficiency pattern, the blood and nutrients are not circulating harmoniously throughout the body. When this disharmony is not resolved quickly, the blood gradually becomes stagnant in specific areas of the body causing various degrees of localised pain. In that case, the pulse will be "choppy", meaning strong and irregular, and the tongue will have a purplish colour as a result of the stagnation. As Chinese medicine recognises the liver as responsible for storing the blood, points in that channel will be selected. Other local points might be included according to the location of the pain.
If the pattern is caused by a weakness of the Kidney Yin or Yang energy, the patient will be complaining of constant tiredness, low sexual drive, or lower back pain with restless legs. Other associated symptoms might be urinary problems, period pain (dysmenorrhea) or absence of period (amenorrhea), or hot flushes and night sweats. The patient's tongue will be pale and dry with cracks on the surface if the internal heat is severe. According to the symptoms, the treatment approach will be aimed at strengthening the kidney, and nourishing the Yin or calming the Yang energy, and eliminating the heat in the body.
Often integrating Western and Eastern medicine therapies together is the best approach for the treatment of fibromyalgia. Both medical systems have their own specific strengths and combining the two will enhance the efficacy of treatment, allowing the patient to gradually reduce her reliance on painkillers as the body's energy regains its original strength.
Olivier Lejus MHSc (TCM), BHSc (Acup.) is an accredited acupuncturist practising in Sydney.