Fibromyalgia is predominantly a neuroendocrine
disorder, not a musculoskeletal one, that profoundly affects the
central nervous system. Many factors contribute to the chronicity
and therapeutic resistance of Fibromyalgia. For example, many patients
with FMS and MPS have reactive hypoglycemia. This has been described
as a perpetuating factor in MPS and FMS (Travell, Simons 1992; Starlanyl
1997; Starlanyl, Copeland 1996). It may also be a major contributor
to "fibrofog". A multi-faceted, interdisciplinary approach
to fibromyalgia is considered to be the state-of-the-art for treating
this condition which affects 3 million Americans.
Philip Mease, M.D., a rheumatologist and medical consultant for
the Seattle multidisciplinary program for FMS, CFS, and chronic
rheumatic diseases, helped develop this program in the late 1980s.
"The synergy of a group of physical and occupational therapists,
psychologic and vocational counselors, biofeedback specialists,
acupuncturists, nurse educators and physicians all working under
one roof to customize the care of individuals has been beneficial
for the patients and morale-boosting for the providers," claimed
Mease.
Robert Bennett, M.D., director of team program in Portland, OR,
adds another reason why a multi-modal treatment program is important
for FMS/CFS patients: There is currently no one modality that consistently
provides more than 40% improvement in a majority of patients.
Don Goldenberg, M.D., of Boston reports that "90% of the time
[self diagnosis of] FMS/CFS is the correct diagnosis.
I think that patients are usually more accurate than the physicians."
According to Dedra Buchwald, M.D. at the University of Washington,
"patients go to many kinds of physicians in their search for
help. From the frustrated provider's point of view, they are doctor
shopping. From the patient's point of view they are simply trying
to get better." Based on a survey by Dr. Buchwald, undiagnosed
CFS patients arriving at her clinic paid an average of 24 visits
to a health care provider during the previous year. The number for
FMS patients was not significantly different at 27 visits per year.
The breakdown on health care utilization for CFS patients was as
follows:
Environmental physician/clinical ecologist.......11%
Osteopaths..........................................................13%
Other medical physicians...................................98% (e.g.,
family practitioners, internists, physiatrists, rheumatologist,
gynecologists, etc.)
Chiropractor.......................................................35%
Naturopath/Homeopath......................................34%
Acupuncturist....................................................18%
Psychiatrist/Counselor.......................................52%
Other provider (e.g., PT and OT)......................16%
Prescription-drug Treatments:
Sleep
Tricyclics (Elavil, Flexeril, Sinequan, Trazodone, etc.)
Klonopin for restless legs and nighttime muscle jerks
Sedative/Anxiolytic Meds - Xanax, Buspar, Ambien (brief use)
Fatigue/alertness
Serotonin reuptake inhibitors such as Prozac, Zoloft and Paxil
Irritable Bowel
Bentyl
Levsin (Levsin is an oral antispasmodic medication that may help
relieve the pain of intestinal spasms, cramps and diarrhea.)
dietary fiber
Irritable Bladder
Urised and tricyclics (Urised is an oral medication that contains
several compounds. Urised has mild
antiseptic and analgesic properties, and it also works through the
parasympathetic nervous system to help relax the smooth muscles
in the bladder to minimize painful muscle spasms.)
Headaches
Midrin
calcium channel blockers (note: Magnesium is the natural calcium
channel blocker)
Imitrex (sumatriptan)
Tylenol
NSAIDS (non-steroidal anti-inflammatory drugs like ibuprofen, naproxen,
Relafen, etc.)
(Note: NSAIDS impair connective tissue healing and increase recurrence
and chronicity of pain symptoms.)
Non-drug Treatments:
Education
Explanation of the condition, what to expect and coaching on self-management
is often provided by a nurse, psychologist and other team members.
Physical therapy
Numerous modalities are used to improve function, reduce muscle
tightness, strengthen postural muscles,protect joints, and minimize
the toll of stress.
Occupational therapy
Several areas of assistance include time management advice, lifestyle
changes, how and when to use assistive aids, and to make recommended
modifications to the home and work environments.
Acupuncture
The body is an integrated system, and this is another type of non-drug
treatment that may offer symptom relief for patients.
Counseling
Help with vocational changes, family matters and chronic illness
coping may be provided.
Exercise physiologist
Patients need help with building or maintaining their level of physical
fitness because the pain and fatigue tend to limit their activities.
Working with patients to minimize this problem, Sharon Clark, RN,
Ph.D., of the Portland team, recommends the following guidelines:
1.Take your pulse when performing an exerting activity.
2.Compute your Max Heart Rate; MHR = 220 - age.
3.Compute the Intensity of work: I = Pulse/MHR.
4.Multiply I times the number of minutes that you exercise to compute
your Training Index (TI); TI = I times # of minutes. Then add them
up for one week. This number may initially be 2 or 3, but that's
okay. Your goal is to increase this value over several weeks or
months until you reach a value of 40 to 50 per week. By keeping
track of this number, you will hopefully feel a sense of accomplishment
as the value increases over time.
5.The type of exercise that you do can be as simple as walking.
Dr. Clark recommends walking because it's easy to do and you don't
need to hassle with special clothing or equipment. And, when the
weather is bad, you can always take a brisk walk in the local mall--or
around your living room!
Web Links:
Fibromyalgia Network: http://www.fmnetnews.com
See links at http://fibromyalgia.homepage.com/#LINKS
See Fibromyalgia.com for info on the “Fibro Five” connection:
Fibromyalgia
Interstitial Cystitis
Chronic Fatigue
Migraine Headache
Irritable Bowel
Dr. Devin J. Starlanyl has information at http://www.sover.net/~devstar/
The United States Department of Justice Americans With Disabilities
Act (ADA) Home Page: http://www.usdoj.gov/crt/ada/adahom1.htm
The Oregon Fibromyalgia Foundation (OFF) has a web site written
and maintained by researcher Robert M. Bennett, M.D. You can download
two articles on FMS and chronic pain to share with your physician.
Details on how to obtain Dr. Sharon Clark’s exercise/stretching
video specifically produced for FMS/CFS patients is also available.
The address is: http://www.myalgia.com
The home page for David Nye, M.D., is located at: http://www.alternatives.com/cfs-news/fm-md.htm
The home page for the American Association for CFS is: http://weber.u.washington.edu/~dedra/aacfs1.html
The CDC’s 1994 CFS criteria article from Annuals of Internal
Medicine can be downloaded at: http://www.cdc.gov/ncidod/diseases/cfs/defined.htm
The Journal of SLEEP has a home page in which you may download interesting
scientific abstracts pertaining to sleep research. Their site is:
http://www-leland.stanford.edu/dept/sleep/journal/
Roger Burn’s site with up-to-date advocacy information and
links to the rest of the FMS and CFS web world is at: http://www.cais.net/cfs-news/action.htm
Fibromyalgia Symptoms:
Fibromyalgia syndrome (FMS) shares many symptoms with chronic fatigue
syndrome (CFS). FMS (fibromyalgia syndrome) consists of musculoskeletal
pain and fatigue. The term fibromyalgia means pain in the muscles,
ligaments and tendons, the fibrous connective tissues of the body.
FMS was formerly called fibrositis, implying an inflammatory state
in the muscles, but research has shown that inflammation does not
exist.
People with fibromyalgia typically ache all over. The muscles can
feel flu-like, pulled or overworked. Muscles may twitch or burn.
More women than men are afflicted with fibromyalgia, and it affects
people of all ages. A study by Chris Henriksson, O.T., Ph.D., of
Sweden, evaluated 250 days of diaries by 94 FMS/CFS patients. Personal
care activities took up 30% more time compared to healthy people,
so it is important to realize that your healing process is your
main work during this time.
Symptoms:
Pain - The pain of fibromyalgia has no boundaries. People describe
the pain as deep muscular aching, burning, throbbing, shooting and
stabbing. Quite often, the pain and stiffness are worse in the morning
and you may hurt more in muscle groups that are used repetitively.
Fatigue - This symptom can be mild in some patients and yet incapacitating
in others. The fatigue has been described as "brain fatigue"
in which patients feel totally drained of energy. Many patients
depict this situation by saying that they feel as though their arms
and legs are tied to concrete blocks, and they have difficulty concentrating.
Sleep disorder - Most fibromyalgia patients have an associated sleep
disorder called the alpha-EEG anomaly. This condition was uncovered
in a sleep lab with the aid of a machine which recorded the brain
waves of patients during sleep. Researchers found that fibromyalgia
syndrome patients could fall asleep without much trouble, but their
deep level (or stage 4) sleep was constantly interrupted by bursts
of awake-like brain activity. Patients appeared to spend the night
with one foot in sleep and the other one out of it. In most cases,
a physician doesn't have to order expensive sleep lab tests to determine
if you have disturbed sleep. If you wake up feeling as though you
have just been run over by a Mack truck--what doctors refer to as
unrefreshed sleep--it is reasonable for your physician to assume
that you have a sleep disorder. It should be noted that most patients
diagnosed with chronic fatigue syndrome have the same alpha-EEG
sleep pattern and some fibromyalgia-diagnosed patients have been
found to have other sleep disorders, such as sleep myoclonus or
PLMS (nighttime jerking of the arms and legs), restless leg syndrome
and bruxism (teeth grinding). The sleep pattern for clinically depressed
patients is distinctly different from that found in FMS or CFS.
Irritable Bowel Syndrome - Constipation, diarrhea, frequent abdominal
pain, abdominal gas and nausea represent symptoms frequently found
in roughly 40% to 70% of fibromyalgia patients.
Chronic headaches - Recurrent migraine or tension-type headaches
are seen in about 50% of fibromyalgia patients and can pose as a
major problem in coping for this patient group.
Temporomandibular Joint Dysfunction Syndrome - This syndrome, sometimes
referred to as TMJD, causes tremendous face and head pain in one
quarter of FMS patients. However, a 1997 report indicates that as
many as 90% of fibromyalgia patients may have jaw and facial tenderness
that could produce, at least intermittently, symptoms of TMJD. Most
of the problems associated with this condition are thought to be
related to the muscles and ligaments surrounding the joint and not
necessarily the joint itself.
Multiple Chemical Sensitivity Syndrome - Sensitivities to odors,
noise, bright lights, medications and various foods is common in
roughly 50% of FMS or CFS patients.
Other common symptoms - Painful menstrual periods (dysmenorrhea),
chest pain, morning stiffness, cognitive or memory impairment, numbness
and tingling sensations, muscle twitching, irritable bladder, the
feeling of swollen extremities, skin sensitivities, dry eyes and
mouth, frequent changes in eye prescription, dizziness, and impaired
coordination can occur.
Aggravating factors - Changes in weather, cold or drafty environments,
hormonal fluctuations (premenstrual and menopausal states), stress,
depression, anxiety and over-exertion can all contribute to symptom
flare-ups.
Possible Causes:
The cause of fibromyalgia and chronic fatigue syndrome remains elusive,
but there are many triggering events thought to precipitate its
onset. A few examples would be mercury from dental
amalgams, root canals, an infection (viral or bacterial), an
automobile accident or the development of another disorder, such
as rheumatoid arthritis, lupus, or hypothyroidism. These triggering
events probably don't cause FMS, but rather, they may awaken an
underlying physiological abnormality that's already present in the
form of genetic predisposition.
What could this abnormality be? Theories pertaining to alterations
in neurotransmitter regulation (particularly serotonin and norepinephrine,
and substance P), immune system function, sleep physiology, and
hormonal control are under investigation. Substance P is a pain
neurotransmitter that has been found by repeat studies to be elevated
threefold in the spinal fluid of fibromyalgia patients. Two hormones
that have been shown to be abnormal are cortisol and growth hormone.
In addition, modern brain imaging techniques are being used to explore
various aspects of brain function--while the structure may be intact,
there is likely a dysregulation in the way the brain operates. The
body's response to exercise, stress and simple alterations in position
(vertical versus horizontal) are also being evaluated to determine
if the autonomic nervous system is not working properly. Your body
uses many neurotransmitters, such as norepinephrine and epinephrine,
to regulate your heart, lungs and other vital organs that you don't
have to consciously think about. Ironically, many of the drugs prescribed
for FMS/CFS may have a favorable impact on these transmitters as
well.
COMMON TREATMENTS
Traditional treatments are geared toward improving the quality of
sleep, as well as reducing pain. Because deep level (stage 4) sleep
is so crucial for many body functions, such as tissue repair, antibody
production, and perhaps even the regulation of various neurotransmitters,
hormones and immune system chemicals, the sleep disorders that frequently
occur in fibromyalgia and chronic fatigue patients are thought to
be a major contributing factor to the symptoms of this condition.
Medicines that boost your body's level of serotonin and norepinephrine--neurotransmitters
that modulate sleep, pain and immune system function--are commonly
prescribed. Examples of drugs in this category would include Elavil,
Flexeril, Sinequan, Paxil, Serzone, Xanax and Klonopin. A low dose
of one of these medications may be of help. In addition, nonsteroidal,
anti-inflammatory drugs (NSAIDs) like ibuprofen may also be beneficial.
Most patients will probably need to use other treatment methods
as well, such as trigger point injections with lidocaine, physical
therapy, acupuncture, acupressure, relaxation techniques, osteopathic
manipulation, chiropractic care, therapeutic massage, or a gentle
exercise program.
SAMe
Studies on fibromyalgia have shown improvements in trigger point
pain, morning stiffness, fatigue and mood with SAMe. A six week
study involving 47 fibromyalgia patients found significant relief
at painful sites and improved general well-being as well as reduced
depression and anxiety, all with no adverse side effects (Tavoni
A, Jeracitano G, Cirigliano G: Evaluation of S-adenosyl-methionine
in secondary fibromyalgia: a double-blind study. Clinical &
Experimental Rheumatology 16[1]:106-107, Jan/Feb 1998).
Colostrum
A number of serious health syndromes are now known to be associated
with an abnormally increased gut permeability, including fibromyalgia.
Research shows that colostrum can correct this leaky gut syndrome
with its unique combination of immune factors and growth stimulators,
which includes epithelial growth factors.
In fact, research has shown that colostrum is the single most effective
agent for correcting leaky gut syndrome. Of course, other factors
can help, too. These include friendly bacterial flora, folic acid,
vitamin B12 and aloe. In addition, optimal nutrition should be ensured
with a potent, broad-spectrum multi-vitamin and mineral supplementation
program, a high fiber intake and lots of steamed vegetables and
greens in the diet. Avoiding refined foods, sugar, alcohol, caffeine,
chemical additives and tobacco is also crucial.
Another important factor found in colostrum is PRP (polyproline-rich-peptides).
PRP helps to regulate the thymus and normalize both underactive
and overactive immune functions (Wilson J. Immune System Breakthrough:
Colostrum. Journal of Longevity, 1988, 4(2)). This makes it an ideal
remedy for those with autoimmune symptoms like fibromyalgia. PRP
relieves pain and swelling by preventing hyperimmune overproduction
of T-cells and lymphocytes.
“Bovine colostrum contains TgF-B which has an important suppressive
effect on cytotoxic substances (i.e. it is anti-inflammatory). It
inhibits cell growth of human osteosarcoma (cancer) cells (75% inhibition).
Mediator of fibrosis and angiogenesis (healing of heart muscle and
blood vessels), (Roberts et al, 1986), accelerates wound healing
(Sporn, et al, 1983) and bone formation (Centrella, et al, 1987)”
write Drs. Tokuyama at the Cancer Research Institute at Kanazawa
University in Japan.
Pauqel Mason, a practiticing herbalist, reports “The most common
response I get from my clients is ‘I feel so good when I take
it.’ Many of my clients find that after 6-8 months on colostrum,
they are completely clear of all the allergies they had previously.
I’ve also seen excellent results with Fibromyalgia, which is
notoriously difficult to treat.”
Medical doctor, Roberty Y., has seen excellent results with Fibromyalgia,
as well...in himself. A well respected physician, who served as
Chief of Staff at his community hospital and state President for
the American Academy of Family Physicians, he was diagnosed with
Fibromyalgia at the Mayo Clinic. Despite $1,000 a month in medications,
nothing worked to relieve his muscle aches, fatigue, decreased alertness,
poor sleep and depression. Nothing, that is, until he began taking
colostrum. After the first month, people in the community could
even notice the difference and began asking him what he was doing.
He was able to eliminate all medications, and after four months,
considers himself fully 100% improved.
Coral Calcium
According to Dr. Robert Greenberg, author of “Understanding
the Redox (rH2) Measurement of the Biological Terrain”, “oxidative
stress is the key factor in many symptoms and disease states e.g.,
CFIDS, FMS (fibromyalgia syndrome)...” Oxidative stress is
the mechanism by which tissue ages and degenerates. This is regulated
by antioxidants, which include enzymes such as catalase, superoxide
dysmutase (SOD) and glutathione peroxidase, as well as vitamins
such as C, E and the carotenoids, plus co-factors like alpha lipoic
acid, copper, manganese and zinc. The one defining factor of all
anti-oxidants is that by definition they are electron donors. Coral
Calcium supplies -100 mV of electrical charge, producing anti-oxidant
water. This has a major impact on the body’s antioxidant status,
since about 2/3 of the body consists of water. Most tap water and
even purified water is an oxidizing stress on the body on the order
of +300 to +500 mV.
Dr. B. Ogeus, President of Pain Hospice in Soderhamm, Sweden reports
“It seems to me that Coral Calcium has a positive effect on
people suffering from rheumatoid arthritis, diabetes, allergies,
angina, and fibromyalgia.”
Magnesium Malate
Magnesium is needed for healthy muscle tone,nerves and the efficient
synthesis of proteins. It is essential in proper calcium utilization
by the body and keeps calcium in place. Most magnesium is poorly
absorbed and simply loosens the stool, or even contributes to diarrhea.
The best absorbed form is Magnesium Glycinate (e.g. Pure Encapsulations).
The form that is most often recommended for reducing symptoms of
fibromyalgia is the combination of magnesium with malic acid which
increases cellular ATP production, necessary to energize and therefore
relax skeletal muscles. Magnesium Aspartate is another highly beneficial
form which optimizes cellular uptake of magnesium. Individual responses
to the various forms of magnesium can be determined non-invasively
by electrodermal screening techniques developed by Drs. Voll, Schimmel
and others since the 1950’s.
Cat’s Claw, Enzymes, Green Lipped Mussel and Pycnogenols
Cat’s Claw (Uncaria tomentosa), Enzymes, Pycnogenol (OPCs)
and New Zealand Green Lipped Mussel (Perna canaliculus) which supplies
a unique group of ETA's (Eicosatetraenoic Acids) have all been recommended
for fibromyalgia.
Fibromyalgia
Much of the following information is extracted from the Interactive
BodyMind Information SystemTM (IBISTM) software which Dr. Glen Swartwout
co-authored while on staff at the National College of Naturopathic
Medicine.
Fibromyositis is a condition in which adhesions of scar tissue restrict
motion.
Etiology:
Traumatic tearing of soft tissues or long standing muscle spasms
cause production of thixotropic gel which organizes itself into
collagen scar tissue. This is the body's attempt to stabilize what
is perceived as injury. Three problems result from this scar formation:
• the scar tissue is more pain-sensitive than normal structural
and contractile tissue
• the scar tissue is less flexible and therefore diminishes
joint motion
• the scar tissue is more "brittle" than healthy
tissue and susceptible to reinjury
Signs & Symptoms:
• diminished joint play
• pain with deep palpation of the tissue
• a "gritty" feel especially in ligaments and muscles
• local areas of muscle spasm: "trigger points"
Diagnostic Criteria for Fibromyalgia:
Laboratory testing reveals little about fibromylagia and chronic
fatigue syndrome. Physical examination shows sensitivity to pressure
in certain tender points. To meet the diagnostic criteria, patients
must have:
A. Widespread pain in all four quadrants of their body for a minimum
of three months
B. At least 11 of the 18 specified tender points. The 18 sites used
for diagnosis cluster around the neck, shoulder, chest, hip, knee
and elbows. Over 75 other tender points have been found to exist,
but are not used for diagnosis.
While other chronic pain syndromes have symptoms similar to fibromyalgia,
the 1990 ACR multi-center criteria study (February 1990, Arthritis
and Rheumatism) studied 558 patients, of which 265 were controls.
The controls were age and sex matched patients with neck pain syndrome,
low back pain, local tendinitis, trauma-related pain syndromes,
rheumatoid arthritis, lupus, osteoarthritis of the knee or hand,
and other painful disorders. These patients all had some symptoms
that mimic FMS, but the trained examiners were not foiled--they
hand-picked the FMS patients out of the "chronically ill"
melting pot with an accuracy of 88%. FMS is not a wastebasket diagnosis!
Although the above criteria focuses on tender point count, a consensus
of 35 FMS experts published a report in 1996 saying that a person
does not need to have the 11 tender points to be diagnosed and treated
for FMS. This criteria was created for research purposes and many
people may still have FMS with less than 11 tender points as long
as they still have widespread pain and many of the common symptoms
of FMS. The common symptoms are:
fatigue
irritable bowel (e.g., diarrhea, constipation, etc.)
sleep disorder or unrefreshing sleep
chronic headaches, including both tension and migraine headaches
jaw pain, including TMJ problems
cognitive or memory impairment
post-exertion fatigue and pain
morning stiffness
menstrual cramps
numbness and tingling
dizziness or lightheadedness
skin and chemical sensitivities
Diagnostic Criteria for Chronic fatigue syndrome (CFS):
CFS is diagnosed using the CDC 1994 guidelines published in the
Annuals of Internal
Medicine 121(12):953-959. A copy of this article can be downloaded
from the CDC (Centers for Disease Control and Prevention) Internet
site at: http://www.cdc.gov/ncidod/diseases/cfs/defined.htm
To meet the criteria, patients must have:
A. Fatigue
Severe, unexplained fatigue that is not relieved by rest, which
can cause disability and which has an identifiable onset (i.e.,
not lifelong fatigue). It must be persistent or relapsing fatigue
that lasts for at least six or more consecutive months.
B. Four or more of the following symptoms:
impaired memory or concentration problems
tender cervical or axillary lymph nodes in neck region (note that
they do not have to be swollen but just tender; this can be a problem
for people with FMS who have tenderness in these areas as well)
sore throat (but may not show signs of infection)
muscle pain
multi-joint pain (but not arthritis)
new onset headaches (tension-type or migraine)
unrefreshing sleep (wake up in the morning feeling unrested)
post-exertional malaise (fatigue, pain and flu-like symptoms after
exercise)
NOTE: Five of the above eight criteria relate to pain and are often
present in FMS as well. For both the fibromyalgia and chronic fatigue
syndrome criteria, patients should be evaluated for other problems
that could cause pain and fatigue, such as low thyroid function,
low iron stores, arthritis and many other medical conditions. If
any of these problems are found and corrected, but the individual
still meets the FMS criteria, these other disorders (FMS and CFS)
are viewed as co-existing and deserving of special medical attention.
Unfortunately, the CDC criteria excludes people with other medical
problems such as hypothyroidism and lupus, but it is okay to have
the tender points of FMS or a mild case of depression/anxiety.
As a patient, you are deserving of medical care if the CFS symptoms
persist and you should pursue therapy options with your doctor.
However, when it comes to research studies or prevalence figures
determined by the CDC, you will not be included as a CFS patient
if you have any other co-existing medical condition (other than
FMS and mild depression/anxiety). On the other hand, FMS is viewed
as a distinct clinical entity that stands on its own, regardless
of whether a person has other medical problems. This may be one
reason why the prevalence figures for FMS (2% of the general population)
are so much higher than CFS (roughly 0.5% of the general population).
Differential Diagnosis:
• myofascial pain syndrome
• systemic lupus erythematosus
• rheumatoid disorders
• polymyalgia rheumatica
Overlapping Syndromes
Fibromyalgia syndrome (FMS), chronic fatigue syndrome (CFS), multiple
chemical sensitivity syndrome (MCS), myofascial pain syndrome (MPS),
and other conditions form a family of overlapping syndromes. In
fact, researcher Muhammad Yunus, M.D., of the University of Illinois
College of Medicine claims, most patients have more than one syndrome.
Thus, he views FMS and CFS as being part of a larger spectrum of
conditions, which he calls Dysregulation Spectrum Syndrome or DSS
(see diagram below). Dr. Yunus uses the term dysregulation to mean
biophysiological abnormalities, possibly in the neuro-hormonal system.
Backing up Dr. Yunus’ commentary are studies by Dedra Buchwald,
M.D., of the University of Washington, Anthony Komaroff, M.D., of
Brigham and Women’s Hospital and Don Goldenberg, M.D., of Newton-Wellesley
Hospital. It is always important to keep these overlapping syndromes
in mind because the presence of one or more syndromes could impact
your treatment. These three researchers have shown that CFS and
FMS overlap in patients by as much as 75%. When it comes to MCS,
this syndrome is present in roughly 50% of FMS and CFS diagnosed
patients.
Most practicing physicians and researchers alike will tell you that
the chronic pain diagnosis a person first receives is often colored
by their chief symptom complaint. For example, widespread muscular
pain is often diagnosed by rheumatologists as FMS. A person who
is overcome by extreme fatigue and flu-like symptoms might consult
an infectious disease expert and receive the diagnosis of CFS. A
person who has severe jaw pain might see a dentist and be told that
they have temporomandibular joint dysfunction (TMJD). People who
appear to have allergic-type symptoms to a number of chemicals,
foods or odors may be informed by an allergist that they have MCS.
Similar situations occur with the other conditions in the family
of Dysregulation Spectrum Syndrome.
Two common sleep disorders that may be present in FMS/CFS patients
are: restless leg syndrome (RLS) and periodic limb movement during
sleep (PLMS). According to sleep researcher Harvey Moldofsky, M.D.,
of the University of Toronto, RLS has been described as someone
playing soccer all night long. The patient’s arms and legs
just can’t stay still. PLMS may feel like a startling response
that occurs when you think you have reached the last step going
down a flight of stairs and you fling your limbs to catch your balance
as you discover that there is one step remaining. Both RLS and PLMS
can cause continuous arousal movements during sleep and impede your
ability to get a restful night’s sleep.
Referring to the specific sleep disorders of RLS and PLMS, Dr. Yunus
comments that a sleep study might be helpful if a physician suspected
either condition. First of all, it may offer an objective test finding
that is lacking for most FMS/CFS patients. Secondly, the treatment
for RLS or PLMS is a benzodiazepine with anti-seizure properties
such as Klonopin (clonazepam). The most commonly used medications
for FMS/CFS, such as tricyclics like Elavil, can actually make this
subgroup (30%) of patients worse. Therefore, it is important that
you assist your physician by providing accurate symptom information
to help identify related syndromes. This can aid in the development
of appropriate treatment strategies.
Course:
This condition occurs after trauma or in long-standing overloading
of muscles. This can occur in a "postural strain" situation,
for example, when a person works over a desk day after day causing
constant relentless contraction of the neck and upper back muscles.
These muscles and the adjacent articular ligaments (rib joints and
vertebral joints) may become infiltrated with scar tissue adhesions.
Prognosis:
Prognosis is good with appropriate treatment and ergonomic changes
designed to prevent chronicity.
According to the Fibromyalgia Network, “Long term follow-up
studies on fibromyalgia syndrome have shown that it is chronic,
but the symptoms may wax and wane. The impact that FMS can have
on daily-living activities, including the ability to work a full-time
job, differs among patients. Overall, studies have shown that fibromyalgia
can be equally as disabling as rheumatoid arthritis. On the other
hand, follow-up of people meeting the chronic fatigue sydnrome criteria
indicates that as many as 40% may significantly improve but few
are thought to completely recover from this syndrome. Longer term
follow-up studies are not available to indicate whether these "improved"
CFS patients later relapse with an increase in symptoms. A preliminary
follow-up study by the CDC (Centers for Disease Control) reveals
that for those individuals with chronic fatigue syndrome who do
not recover or significantly improve after five years duration,
their most prominent symptom changes from fatigue to muscle pain
with concentration problems (sounds a lot like the permanent syndrome
of fibromyalgia but the CDC is not checking patients for tender
points).
According to a research study by Dedra Buchwald, M.D., people who
meet the criteria for both FMS and CFS tend to be at the more severe
end of the spectrum of symptoms and are more likely to become work-disabled.
Buchwald says her findings underscore the importance of recognizing
concurrent fibromyalgia and chronic fatigue syndrome (Rheumatic
Disease Clinics of North America 22(2):219-243, 1996).”
Exercise:
• stretching exercises: for affected areas
• ROM exercises: for affected areas
Manipulation:
• heat: followed by deep massage daily, 10-15 min devoted to
each region
• spine: manipulate any joint adjoining the muscle, as necessary
to maintain normal joint mobility.
Physical Therapies:
• diathermy
• ultrasound
• iontophoresis: chlorine, iodine, magnesium, PABA, proteolytic
enzymes, SOD
• interferential: see facet syndrome
• vibratory therapy
Therapeutic Foods:
• foods rich in Vitamins C, E, A, and bioflavonoids
• olives, rye, lima beans, rice bran, bananas, sprouts, watercress,
apples (Jensen,
p. 61)
Fresh Juices:
• potato peeling broth (Jensen, p. 61)
• dried olive tea (Jensen, p. 61)
• nut milk and liquid chlorophyll (Jensen, p. 61)
Nutritional Supplements:
• bromelain 2500 mg t.i.d. between meals
• Vitamin C 3 g q.d.
• bioflavonoids 3 g q.d.
• Zinc 15 mg q.d.
• Vitamin E 500 I.U. q.d.
• Vitamin B6 50 mg t.i.d.
• Selenium (Bastyr) 200-300 mcg q.d.
Drug Interaction:
• Potassium and indomethacin (Indocin): as a prostaglandin
inhibitor, indomethacin reduces renin and aldosterone, and consequently
reduces potassium excretion and causes hyperkalemia (Goldszer, et
al., 1981; 141: 802-804; Tan, et al., 1979; 90: 783-785; MacCarthy,
et al., 1979; 1: 550)
Botanical Remedies:
• Arnica montana (toxic): adhesions: counterirritant (NCNM
Botanicals)
• Hypericum perforatum (oil): adhesions; warm Hypericum oil
and apply. Next apply ice to numb area; then manipulate area to
break up adhesions (Jolley)
• Symphytum officinale (toxic) (root): adhesions or myofibrositis;
internally and as poultice (Jolley)
Chinese Herbs:
• Bao Zhen Gao (patent plaster): external application. (Zhu,
p. 116)
• Tang Kuei and Jujube C. (Dang Gui Si Ni Tang): Cold in the
Channels with Xue Xu (Blood Deficiency): cold hands and feet, fibromyalgia
(Hsu, 1980, p. 321; Yeung, p. 79; Bensky and Barolet, p. 216)
• Bupleurum and Cinnamon C. (Chai Hu Gui Zhi Tang); Bupleurum
12 (patent): Liver Qi Stagnation, weak constitution
(Bupleurum and Cinnamon: Hsu, 1980, p. 117; Dharmananda, 1986, p.
134; Bensky and Barolet, p. 138; Bupleurum 12: Dharmananda, 1990,
p. 39)
• Clerodendron 6 (patent) (Dharmananda, 1990, p. 81)
• Compound GL (patent) with Clematis 19 (patent): fibromyalgia
(Dharmananda, 1992, p. 101)
After assessing the person and palpating, consider these patterns:
Cold in the Channels with Xue Xu (Blood Deficiency); Qi Stagnation
and Xue Yu (Blood Stasis); Heat in the Xue (Blood); Damp-Heat; dysfunction
of the Yang Qiao Mai (Yang Motility Vessel) and/or Yin Qiao Mai
(Yin Motility Vessel)
TherapeuticNote:
• Myofibrositis and adhesions may be a part of a general pattern
of glandular/lymphatic exhaustion that is often often rooted in
or at least exacerbated by a chronic, often subclinical, infection
in the sinuses and irritation in the oropharyngeal mucous membranes.
This area is a common site of primary focal infection from which
secondary infections derive. Palpation at reflex sites in proximity
of TW-16 ("East Wind") and LI-10.5 and above and below
the eyes will confirm this hypothesis. If tender and/or painful
points are found, consider needling Lu-7 and the reactive points
in the areas of "LI-10.5", "St-2.5", yu yao,
east wind/TW-16, and "St-43". Sinus irrigation with saline
solution is usually also helpful - see "patient handout: sinus
wash". (Matsumoto) See also "sinusitis".
Palpate and Consider:
• local ashi (tender) points (-): palpate and needle, possibly
add moxa, to facilitate circulation of Qi and Xue (Blood) and disperse
Stagnation; consider encircling painful area with oblique insertions
toward the center of the lesion and allow for dispersion
• bai lao (-): facilitates flow of Lung Qi; disperses Stagnation
and facilitates flow of effused blood; esp. with stiffness, sprain
or spasm of the neck muscles; "One Hundred Labors"
• SI-10 (=): facilitates flow of Qi and Xue (Blood) and disperses
Stagnation; palpate for tender and/or painful point(s) in this area
and needle to release midscapular tension, spasm and pain
• Bl-11 (=): dispels Cold; connects the Du Mai (Governing Vessel)
to the Shu Associated points; distributes Bladder Qi and Jing-Ye
(Yin) to all the dorsal Shu points (Finkelstein, p. 38); removes
Obstruction of Qi circulation of the Tai Yang channels (Bladder
and Small Intestine) and Du Mai (Governing Vessel) of the upper
back; diffuses Lung Qi; expands and relaxes the chest; strengthens
all joints; facilitates Xue (Blood) flow; relaxes the muscles, sinews
and tendons; invigorates the collateral vessels; treats generalized
spasms throughout the body, esp. for neck and back pain, muscular
spasm in the back, soreness and pain of the interscapular region,
and stiffness along the spine; Hui Reunion point of the Bones; Sea
of Xue (Blood) upper entry point
• Bl-17 (+): tonifies the Qi; nourishes and invigorates the
Xue (Blood) (esp. with &Mac198;); transforms Xue Yu (Blood Stasis)
and disperses Obstruction; enriches Yin; generates Fluids; expands
the chest and diaphragm; strengthens Xu (Deficient) conditions and
increases stamina; strengthens the upper back (- then +) (Finkelstein,
p. 40); Diaphragm Shu Associated point; Hui Reunion and Master point
of the Xue (Blood)
• Bl-18 (+): pacifies the Shen; benefits and clears the Liver
and Gall Bladder; cools Damp-Heat; moves Stagnant Qi; strengthens
Xu (Deficiency) conditions; nourishes and regulates the Xue (Blood);
nourishes Liver Yin; relieves mid-back tension; Liver Shu Associated
point
• Bl-20 (+): tonifies the Spleen and Stomach; benefits the
Ying (Constructive) Qi; enhances Spleen Yang to mobilize Stagnant
Qi; tonifies and harmonizes the Xue (Blood); softens masses; provides
strength to the extremities; Spleen Shu Associated point
• yao yi (-): facilitates circulation of Qi and Xue (Blood)
and disperses Stagnation; esp. with acute lumbar pain, chronic muscular
spasm in lumbar region, or injury to the soft tissues of the lower
back
• GB-30 (- or +): invigorates the Kidney; strengthens the lower
back; regulates hip joint; strengthens thigh; benefits the knee;
dissipates Wind-Damp in the channels and connecting vessels; frees
the channels and removes Obstructions; relaxes the muscles and tendons
• GB-31 (- or +): detoxifies the Liver; clears Heat and transforms
Damp; tonifies waist and strengthens thighs; relaxes and strengthens
sinews and tendons
• TW-16 and/or "east wind" (-): palpate lateral aspects
of neck for ashi (tender) points (Matsumoto)
• GB-21 (- or +): spreads Liver Qi; disperses Stagnation and
stops pain; benefits tendons and muscles; benefits shoulder; clears
and invigorates the channels
• Lu-1 (+): regulates Qi of Upper Warmer; clears, opens, and
draws Qi into the Lung channel; increases Qi and stamina; enhances
oxygenation; aids release of old emotions (-); cools and disperses
Heat and Yang from the Upper Warmer; disperses Qi Stagnation, esp.
with painful skin; Lung Mu Alarm and Entry point
• Lu-5 (-): opens the Lung and clears Upper Warmer Heat; stimulates
descending of Lung Qi; relaxes the sinews and muscles; treats inability
to raise the arm, esp. due to hypertonicity and pain in the elbow,
cramping and/or spasmodic pain of the elbow and arm; Lung He Sea
Uniting, Water and Dispersion point
• Lu-10 (-): clears Fire and Heat generally; cools Heat in
Xue (Blood); releases muscular spasm of the arm; Lung Fire point
• LI-15 (- or +): harmonizes the flow of Qi and Xue (Blood);
frees the channels and invigorates the collateral vessels; stops
pain; softens masses; facilitates the joints; benefits skin Qi
• LI-11 (- or +): regulates and harmonizes Qi, Ying and Xue
(Blood); improves immune function (Finkelstein, p. 9); tonifies
Metal to cool inflammatory processes and restrain Wood, esp. the
Liver; benefits sinews, tendons and joints; frees the channels;
Large Intestine Upper He Sea Uniting, Earth and Tonification point
• "LI-10.5" (-): moves Stagnation in sinuses and
cervical lymphatics; locate tender most tender point on each side
of the neck, usually "east wind", near TW-16, then palpate
for the most tender or painful point, distal to the elbow crease,
between the Large Intestine and Triple Warmer channels; needle each
arm to resolve focal infection in the sinuses and oropharyngeal
mucous membranes and oropharyngeal mucous membranes and relieve
glandular/lymphatic exhaustion; verify location and angle of needle
by diminishing of cervical tenderness (Matsumoto)
• LI-4 (=): pacifies the Shen; regulates Qi and Xue (Blood);
stimulates dispersing function of Lung; tonifies Metal to cool inflammatory
processes and restrain Wood, esp. the Liver; elevates Clear Qi and
descends Turbid Qi; clears Toxins; relaxes sinews and tendons; frees
the channels and invigorates the collateral vessels; Large Intestine
Yuan Source and Entry point
• TW-7 (-): clears Heat from the Triple Warmer; expels Toxins;
soothes the Liver; facilitates circulation of Qi; spreads Liver
Qi Stagnation; treats pain and stiffness of the arm, as well as
painful skin conditions; Triple Warmer Xi Cleft Accumulation point
• TW-5 (- or +): opens and moves the Yang Wei Mai (Yang Linking
Vessel) and regulates the Dai Mai (Girdle Vessel); dissolves Toxins;
disperses Qi in the intercostal region; frees the channels to facilitate
the circulation of Qi in the channels; invigorates the collateral
vessels; strengthens and relaxes the sinews and tendons; alleviates
pain; Triple Warmer Luo Connecting point; Master point of the Yang
Wei Mai (Yang Linking Vessel); Couple point of the Dai Mai (Girdle
Vessel)
• PC-6 (= or +): pacifies the Shen and tranquilizes the Heart;
regulates the Qi; opens the chest; harmonizes and spreads the Qi
in the Upper and Middle Warmers; clears and spreads Qi in Pericardium
channel; regulates Liver Qi and relieves Liver Qi Stagnation; opens
the Yin Wei Mai (Yin Linking Vessel) to distribute Qi to the Stomach,
chest and Heart; regulates the Chong Mai (Penetrating Vessel); enhances
purification and dispersement of the Triple Warmer; drains the Triple
Warmer; relaxes the sinews and clears the vessels; relieves pain;
Pericardium Luo Connecting point; Master point of the Yin Wei Mai
(Yin Linking Vessel); Couple point of the Chong Mai (Penetrating
Vessel)
• PC-7 (-): pacifies the Shen and stabilizes the emotions;
nourishes Heart Xue (Blood); opens Heart Orifices; dissipates Heat
from the Ying (nutrient system) and Xue (Blood); influences adrenals
(Worsley, 1975, p. B-20); Pericardium Yuan Source, Earth and Dispersion
point; historically used as the Heart Source point (Maciocia, p.
436)
• Ht-7 (= or +): pacifies the Shen; stimulates secretion of
fluids; calms the Heart; general sedative and regulating effect
on the inner organs; tonifies and nourishes Heart Yin and Xue (Blood);
relieves pain, esp. lateral costal pain; frees the channels; Heart
Yuan Source, Earth and Dispersion point
• SI-6 (=): relaxes the sinews and tendons; benefits the joints;
frees the channels and invigorates the collateral vessels; esp.
for torticollis, pain in the back, shoulder, elbow and forearm,
pain between scapulae, and/or restriction of movement in the lumbar
area; Small Intestine Xi Cleft Accumulation point
• SI-3 (=): pacifies the Shen and clears the Mind; opens the
Du Mai (Governing Vessel) and regulates the Yang Qiao Mai (Yang
Motility Vessel); strengthens the spine; relaxes the sinews and
muscles; benefits the joints; releases muscle spasms; invigorates
the channels; Small Intestine Wood and Tonification point; Master
point of the Du Mai (Governing Vessel); Couple point of the Yang
Qiao Mai (Yang Motility Vessel)
• Lv-13 (+): spreads and promotes smooth flow of Liver Qi;
clears Obstructions of the Liver channel and its Luo channels; invigorates
the Stomach and Spleen; regulates circulation of Qi and Xue (Blood);
quickens the Xue (Blood) and disperses Xue Yu (Blood Stasis); softens
and dispels masses; Spleen Mu Alarm point; Hui Reunion point of
the five Zang (Yin viscera)
• St-32 (=): warms the channels and dissipates Cold; invigorates
the collateral vessels; treats coldness and pain of the low back,
thigh and knees
• St-36 (+): dispels Cold and expels Wind; calms the Shen;
regulates and strengthens Qi and Xue (Blood); disperses Stagnation
in the Upper Warmer; strengthens weak and Xu (Deficient) conditions;
regulates and replenishes the Middle Warmer; strengthens all striated
muscle; regulates Ying (Constructive) Qi; spreads Liver Qi and benefits
the Gall Bladder; nourishes Kidney, Liver and Spleen; drains Shi
(Excess) from the Yang channels, esp. in chronic cases with Heat;
regulates ascension of the Clear and descension of the Turbid (-),
esp. by the Intestines; frees the channels and invigorates the collateral
vessels; Stomach He Sea Lower Uniting, Earth and Horary point; Sea
of Nourishment point
• ca. St-43 (-): palpate for tender or painful point, on the
Stomach channel or between the third and fourth metatarsals; needle
to resolve focal infection in the sinuses and oropharyngeal mucous
membranes, and relieve glandular/lymphatic exhaustion (Matsumoto)
• Sp-10 (=): harmonizes and tonifies Ying (Constructive) Qi;
regulates and invigorates the Xue (Blood); cools Heat and transforms
Damp-Heat in the Xue (Blood); "Sea of Blood"
• Sp-6 (+): pacifies the Shen; nourishes Yin, esp. of the Spleen,
Liver and Kidney; influences the pituitary and adrenals (Worsley,
1985, p. B-20); clears Fire due to Xu (Deficiency); strengthens
the Spleen; tonifies Qi and builds the Xue (Blood); nourishes and
moves the Xue (Blood); transforms Xue Yu (Blood Stasis); frees Qi
Stagnation and spreads the Liver Qi; warms the Middle and Lower
Warmers; Jiao Hui Intersecting point of the three Foot Yin channels
• Sp-4 (+): pacifies the Shen; adjusts and strengthens the
Spleen and Middle Warmer; harmonizes the Chong Mai (Penetrating
Vessel) and circulation of Qi in the Middle Warmer; invigorates
the Xue (Blood) and regulates the Sea of Xue (Blood); disperses
Qi Stagnationand Xue Yu (Blood Stasis), esp. in the Middle Warmer;
tonifies Yuan (Original) Qi; descends the Turbid; Spleen Luo Connecting
point; Master point of Chong Mai (Penetrating Vessel); Couple point
of the Yin Wei Mai (Yin Linking Vessel)
• GB-34 (+): soothes and subdues Yang of the Liver and Gall
Bladder; opens and drains the Gall Bladder to regulate distribution
of functional Qi (Finkelstein, p. 68); clears Dampness and cools
Heat; facilitates and harmonizes the Liver; relieves pain in costal
and hypochondriac regions; strengthens and relaxes sinews and tendons;
relieves soreness from fatigued muscles; benefits joints, esp. knees
and hips; frees the channels and invigorates the collateral vessels;
alleviates pain; Gall Bladder He Sea Uniting and Earth point; Hui
Reunion point of Jin (sinews and tendons)
• GB-37 (=): regulates the Liver; dispels Wind and Damp; transforms
Damp-Heat; relaxes the sinews and muscles; invigorates the channels;
treats blockage and numbness of the leg or muscular pain in legs,
esp. pain of the calf due to gastrocnemius spasm; Gall Bladder Luo
Connecting point
• GB-38 (-): reduces Liver and Gall Bladder; dissipates Heat
from the Gall Bladder; dispels Wind and Dampness; frees the channels;
invigorates the collateral vessels; treats aches and pains throughout
the body, muscular and/or vascular spasm in general, pain and stiffness
of the neck, and pain and soreness in the calf and lateral aspect
of the lower extremities; Gall Bladder Fire and Dispersion point
• GB-40 (=): drains Fire from the Liver and Gall Bladder; spreads
the Liver Qi; benefits Gall Bladder; softens masses; transforms
Damp-Heat; treats external trauma, esp. below the waist; benefits
the joints; frees the channels; relieves muscular spasm, esp. pain
and stiffness of the neck and pain in the lower limbs; Gall Bladder
Yuan Source point
• Lv-6 (-): removes Stagnancy of Liver Qi; harmonizes Qi and
Xue (Blood); frees the channels and invigorates the collateral vessels;
sedates pain; dispels Damp-Heat; relieves coldness and pain in the
lower leg; Liver Xi Cleft Accumulation point
• Lv-5 (=): drains the Liver; spreads Liver Qi and disperses
Liver Qi Stagnation; benefits the Qi; tonifies Liver and Yang; relieves
Obstruction in Lower Warmer; secures Jing (Essence); relaxes the
sinews; frees the channels; esp. with back stiff and unable to bend,
coldness, aching and pain in lower leg and feet, difficulty flexing
knee, and/or skin cold and aching; Liver Luo Connecting point
• Lv-3 (=): pacifies the Shen; "relieves anger and mellows
spirits of those who are frustrated and jealous" (Finkelstein,
p. 73); adjusts and pacifies the Liver and Gall Bladder; promotes
smooth flow of Qi and Xue (Blood); spreads and eliminates Liver
Qi Stagnation; clears and drains the Liver and Gall Bladder; subdues
Liver Yang; tonifies Liver Xue (Blood); opens the channels and relaxes
spasms and cramps; sedates pain; Liver Yuan Source and Earth point;
Independent Associated point for spasms
• Lv-2 (-): calms the Shen and eases the Mind; subdues Yang
Shi (Excess); soothes and loosens Liver to release Liver Qi and
remove Qi Depression; disperses Stagnant Qi of Liver and Gall Bladder;
cools the Xue (Blood); relaxes cramps and spasms; Liver Fire and
Dispersion point
• Kd-8 (=): regulates Qi and Xue (Blood); regulates the Chong
Mai (Penetrating Vessel) and Ren Mai (Conception Vessel); regulates
adrenals and Kidney Qi; removes Obstructions from the channels;
removes masses; esp. with pain in the loins, thighs and legs; Xi
Cleft Accumulation point of Yin Qiao Mai (Yin Motility Vessel)
• Kd-6 (+): pacifies the Shen and stabilizes the Will; nourishes
the Heart; clears Xu (Deficiency) Fire; removes Obstruction from
the Yin Qiao Mai (Yin Motility Vessel); opens the Ren Mai (Conception
Vessel); tonifies Kidney (especially Yin); strengthens lower back
and loins; frees the channels and invigorates the collateral vessels;
sedates pain; Master point and Entry point of the Yin Qiao Mai (Yin
Motility Vessel); Couple point of Ren Mai (Conception Vessel)
• Bl-59 (-): regulates Qi; dispels Wind and clears Heat; promotes
flow of Xue (Blood); disperses Damp-Heat; effects the Yang Qiao
Mai (Yang Motility Vessel); eliminates mild toxins (Finkelstein,
p. 50); relaxes the sinews, tendons and muscles; benefits and strengthens
the lower back; relieves pain and spasm along the Bladder channel;
frees the channels and invigorates the collateral vessels, e.g.,
headache; sedates pain; Xi Cleft Accumulation point of the Yang
Qiao Mai (Yang Motility Vessel)
• Bl-62 (=): dispels Wind and Cold; clears the Shen and Heart;
opens and moves the Yang Qiao Mai (Yang Motility Vessel); regulates
the Du Mai (Governing Vessel) and benefits Du Mai (Governing Vessel)
disorders; soothes sinews, tendons and vessels; relaxes the Muscle
channels; esp. when person describes a sensation of electricity
or excessive Qi in the skin (Mann, p. 42); Master point of the Yang
Qiao Mai (Yang Motility Vessel); Couple point of the Du Mai (Governing
Vessel)
Illustrative Combinations:
• "yu yao", "St-2.5", "east wind",
"LI-10.5", Lu-7, and "St-43", with other points
sensitive to palpation, for sinusitis and glandular/lymphatic exhaustion,
esp. with a primary focal infection in the sinuses and oropharyngeal
mucous membranes (Matsumoto)
• LI-11, LI-4, PC-6, TW-5, LI-15, GB-21 and local points to
facilitate the flow of Qi and Xue (Blood): to disperse Stagnation
in the lower limbs (Eisen)
• GB-30, GB-31, St-32, Sp-10, St-36, GB-34 and local points
to facilitate the flow of Qi and Xue (Blood): to disperse Stagnation
in the upper limbs (Eisen)
• Lv-3 and LI-4: open the Four Gates; expel Wind, stop pain;
regulate Qi and Xue (Blood) circulation; remove Obstruction of the
channels; open the Orifices; release bodily tension; relax clenching
of jaws; free constraint; calm the mind; relieve mental cloudiness;
provide sedative and analgesic effect; pacify Liver Yang (Finkelstein,
p. 7; Flaws, 1989, p. 76)
• Lu-7 -> Lu-8 with threading along superior border of the
clavicle: to release scalene muscles (Matsumoto)
• Bl-62 and SI-3: open and regulate the Yang Qiao Mai (Yang
Motility Vessel) which regulates muscular activity, esp. with flaccidity
of the muscles of the medial aspect of the lower extremity and spasm
of the lateral aspect
• Kd-6 and Lu-7: open and regulate the Yin Qiao Mai (Yin Motility
Vessel) which regulates muscular activity, esp. with Shi (Excess)
of the Yang channels or flaccidity of the muscles of the lateral
aspect of the lower extremity and spasm of the medial aspect
Homeopathic Remedies:
• Aesculus hippocastanum: glandular swellings of bone; sore
muscles, morning on awakening and on motion; spasms of muscles and
limbs
• Arnica montana: myalgia, particularly after overexertion;
bruised feeling in whole body; soreness in the limbs
• Berberis: bone pains; scraping upon bones in muscles; tension,
shooting, tearing, pulsating, gurgling
• Bryonia: soreness appears to be in sheath of tendon, but
principally in periosteum and ligaments; < motion
• Hypericum perforatum: excessive painfulness if injured parts;
lancinating pain in upper and lower limbs
• Rhus toxicodendron: ailments from strains, overlifting, getting
wet while perspiring; inflammation of tendons of muscles; inflammation
and swelling of long bones; soreness and stiffness in muscles; better
continued motion
• Ruta graveolens: periostitis and pains in consequence of
external injury; with erysipelatous inflammation of parts; bruised
feeling all over as from a fall or blow; < in limbs and joints;
pain in long bones as if they were broken
• Silicea: cellular tissues inflamed; inflammation swelling,
caries and necrosis of bones; inflammation of fibrous portions of
joints, particularly the knee
• Thiosinaminum: a resolvent, externally and internally for
dissolving scar tissue, adhesions
Use Calcarea fluorica for chronic problem
Music Therapy for Pain:
• Mendelssohn's Spring Song
• Meditation from Thais
• Chopin's Preludes
• On Wings of Song
• Andante, Beethoven's Fifth Symphony
• Adagio, Beethoven's Pathetique Symphony
(Heline, p. 18)
Musculoskeletal Music Therapy:
• Sousa's marches
• The Anvil Chorus
• William Tell Overture
• Brahm's Hungarian Dances
• By the Waters of the Minnetonka
(Heline, p. 18)
Flower Essences:
• centaury
• holly
(Chancellor, p. 55)
Radionics Rates:
• Abrams: 40 (112)
• Digitron: 61-99
Color Therapy:
• lemon (helps to dissolve blood clots; acts as a chronic alterative)
on area
(Dinshah, 1985, p. 48)
Therapeutic Metaphors & Correlations:
• Stiffness represents thinking in a rigid, stiff manner. (Hay,
1984, p. 184)
• Inflammation: fear; inflamed thinking; seeing red; anger
and frustration about conditions in one's life. (Hay, 1984, p. 170-1)
• Chronic pain syndrome develops as a result of having chronically
negative attitudes and/or unconscious emotional response mechanisms
that keep a person continually in stress. Chronic attitude problems
are so much a part of a person's self-image that he or she does
not recognize them as separate from the personality. Nothing is
more difficult to identify than our assumed 'natural' ways of being
in the world that are essentially patterns we have developed to
help us cope. Certain body parts susceptible to chronic negative
patterns include the spine, the stomach (as in ulcers), and the
head (tension and migraine headaches). (Shealy, p. 256-266)
Chinese psychophysiology:
• Liver &Mac197; Gan is the home of the Hun (Ethereal Soul);
it relates to decisiveness, control, and the principle of emergence;
stores and cleanses the Xue (Blood); maintains smooth flow of Qi
and Xue (Blood); controls the muscles, ligaments, and tendons, especially
the contractility of the muscles and moistening of the sinews; and
reflects emotional harmony and movement.
» Healthy expressions are kindness, spontaneity, and ease
of movement.
» Liver Xu (Deficiency) signs include impotence; frigidity;
pain in thighs, pelvic region, and throat; ready tendency to "the
blahs" (Seem, p. 28); timidity; depression; irritability; vertigo;
pruritus; dry eyes, skin, and/or tendons; asthma; aching at the
waist; hernia; and difficulty raising head up and down. Liver Xue
Xu (Blood Deficiency) predisposes to Xue Yu (Blood Stasis).
» Liver Qi Stagnation reflects and accentuates emotional constraint
as the Liver's function of facilitating smooth flow in the body
is constricted. Stagnation is associated with frustration, irritability,
tension, and feeling stuck. With time this pattern tends to produce
a gloomy emotional state of constant resentment, repressed anger
or depression, along with tightness in the chest, frequent sighing,
abdominal tension or distension, and/or a feeling of a lump in the
throat with difficulty in swallowing. (Maciocia, p. 216) Xue Yu
(Blood Stasis) often begins with Qi Stagnation.
• Gall Bladder &Mac197; Dan is the source of courage and initiative,
and is responsible for decision-making as the bodily Minister of
Justice; controls circulation of the nourishing and protecting energies
[Ying Qi and Wei (Protective) Qi]; and expresses
itself through the sinews (ligaments and tendons). Its channel purifies
Yang energy in the body.
» Healthy expressions are kindness, decisiveness, control,
and spirit of initiative.
» Gall Bladder Xu (Deficiency) signs include insomnia; wandering
pains; chest and side pains; swollen breasts (Seem, p. 29); weakness
in muscles and tendons of the legs; difficulty standing; asthenia;
vertigo; chills; timidity; cowardice; indecisiveness; and excessive
sighing.
imagery:
• Go into pain, and see, hear, feel what happens (pressure,
pulling, rigidity) and follow to symbolic meaning. (Bry, p. 76)
• beaver dammed (Chavez): liver-related tension
affirmation:
• (Inflammation) My thinking is peaceful, calm, and centered.
I am willing to change all patterns of criticism. I love and approve
of myself. (Hay, 1984, p. 170-1)
• I am safe enough to be flexible in my mind. (Hay, 1984, p.
184)
psychotherapy:
• Those who are prone to inflammations are attempting to avoid
conflicts. The following questions may be useful:
» What conflict in my life am I failing to see? hear? feel?
move?
» What conflict am I dodging?
» What conflict am I failing to admit to? (Dethlefsen, p.
108)
Process Paradigm: (experientially oriented)
• What is the symptom preventing me from doing? What is the
symptom making me do? (related materia medica listings: musculoskeletal
system interview)
Related Materia Medica Listings:
the shadow and physical symptoms
body reveals: the spirit
converting a symptom to a signal
state-dependent learning
affirmations: guidelines and precautions
process paradigm
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