Traditional Chinese Medicine (TCM) categorizes fibromyalgia as a blockage in the smooth flow of Qi and Blood throughout the energetic pathways in the body. Accordingly, the disorder is classified as a type of Bi, or impediment, syndrome affecting the muscles: Muscle Bi.
Because pain in TCM indicates the presence of a blockage, conditions such as fibromyalgia are called Painful Obstruction Syndromes. The immediate cause of Bi syndromes is environmental: pathogenic influences of Wind, Cold, and Dampness, are said to penetrate the body's defenses and lodge in the muscles, tendons, and joints, creating obstruction and causing pain, stiffness and other symptoms. The confluence of these pathogens also can lead to the generation of Heat in the affected areas, manifesting as inflammation.
While the Qi usually is strong enough to resist invasion by environmental pathogens, several internal disharmonies in the Qi and the Blood can predispose a person to Bi syndrome.
- People under stress often suffer from obstructed flow of Qi and Blood in the body because stress affects the Liver, which is responsible for the smooth flow of Qi. Obstruction creates an environment in which pathogens can invade and lodge.
- Insufficient Blood and Qi can lead to the body's energetic pathways being incompletely filled, allowing pathogens to invade.
- Genetic predisposition, poor diet, overwork, or insufficient exercise can weaken the Zang Organs, such as the Kidney or Spleen – responsible for supplying the kinds of Qi that maintain overall resistance – allowing Pathogenic Influences to invade as well.
Traditional Chinese Medicine Categories of Fibromyalgia
TCM diagnoses Muscle Bi syndrome based on the predominance of Wind, Cold, or Damp symptoms. All three pathogenic factors usually are found together; Wind is said to carry the others into the body. Each, however, has a separate set of symptoms, with one factor playing a primary role. Accordingly, Muscle Bi is differentiated into the following categories:
- Wind Bi: Wind predominates when a patient exhibits pain that begins and ends rapidly, limits the range of comfortable movement, and moves among different parts of the body. Windy weather can make symptoms worse. A patient afflicted with Wind Bi also may have an aversion to wind, a floating pulse, and a tongue of normal color with a thin, white coat. Because this type of Bi moves from area to area, it is also known as "Wandering Bi."
- Cold Bi: Cold predominates when the pain is severe, limits the range of comfortable movement, and has fixed locations. Cold temperatures worsen the condition and warmth improves it. A patient afflicted with Cold Bi may have an aversion to cold, a tight pulse, and a white coat on the tongue. Because this type of Bi usually results in severe pain, it is also known as "Painful Bi."
- Damp Bi: Damp predominates when the pain is characterized by soreness, limits the range of comfortable movement, and is accompanied by feelings of heaviness and sometimes numbness. Pain tends to be fixed in areas of the body. Dampness worsens the condition, and there may be swelling of affected areas. Patients afflicted with Damp Bi usually have an aversion to damp weather, a slippery pulse, and a greasy tongue coating. Because this type of Bi is characterized by fixed areas and sensations of heaviness, it is also known as "Fixed Bi."
Treatment
TCM has a threefold strategy for treating Muscle Bi syndrome:
- Resolve the Bi syndrome and expel the Wind, Cold, and Damp.
- Treat any underlying factors contributing to the development of Bi.
- Provide symptomatic relief by stopping pain.
This comprehensive strategy addresses the symptoms of fibromyalgia and its underlying causes.
Together, acupuncture, herbal medicine and Qi Gong provide a powerful treatment option for patients diagnosed with fibromyalgia. It is common for all three modalities to be employed simultaneously, but each may be used alone. Acupuncture may be best for treating the pain syndromes that accompany fibromyalgia; herbal medicine for treating the Wind, Cold, Damp Bi factors and underlying imbalances in the body; and Qi Gong for providing gentle exercise while treating contributory psychological or emotional factors.
Acupuncture
Bi and other pain syndromes account for more than one-half of acupuncture treatments in the United States each year. Fibromyalgia patients often use acupuncture as a means of pain control, once or twice a week, which can be an effective complementary treatment.
As a type of Muscle Bi, fibromyalgia is treated with a combination of acupuncture and moxibustion. Three different kinds of points are used:
- Local points in areas of tenderness and pain are needled. For example, pain in the trapezius and neck muscles might be needled with points such as Gallbladder 20 (Feng Chi) and Urinary Bladder 10 (Tian Zhu), while pain in the inner thighs might be needled with points such as Liver 8 (Qu Chuan), 9 (Yin Bao), and 10 (Zu Wu Li). Moxibustion and electrical stimulation, if appropriate, may be used. Diathermy (heat lamp) and Tui Na applied to specific acupuncture points or muscle groups may prove useful as well.
- Specific acupuncture points associated with the type of Bi syndrome diagnosed are needled. Patients with a predominance of Wind Bi may have Urinary Bladder 17 (Ge Shu) and Spleen 10 (Xue Hai) needled; with Cold Bi, points such as Urinary Bladder 23 (Shen Shu) and Ren 4 (Guan Yuan); and with Damp Bi, Stomach 36 (Zu San Li) and Spleen 5 (Shang Qiu).
- Other underlying factors contributing to the development of Bi are treated as well. Liver Qi stagnation might be treated by adding Liver 3 (Hun Men); Kidney and Spleen deficiency by adding Kidney 3 (Tai Xi) and Spleen 4 (Gong Sun); and Qi and Blood deficiency might indicate the use of Stomach 36 (Zu San Li) and Spleen 6 (San Yin Jiao). Small acupuncture needles, known as intradermal needles, may be left in painful sites for a few days.
Herbal Medicine
Herbal medicine treatment for fibromyalgia uses specific herbs to address each of the three levels of treatment, but focuses specifically on using herbs that address Bi. These herbs also provide symptomatic relief of pain and discomfort.
An efficient approach to individualizing herbal prescriptions is to use herbs that stop pain but also expel the pathogenic factors responsible for Bi. For example, while all of the following herbs help relieve pain, each focuses on a different type of Bi: Sang Zhi (Ramulus Mori) for Wind Bi, Wei Ling Xian (Radix Clematidis Sinensis) for Cold Bi, and Mu Gua (Fructus Chaenomelis) for Damp Bi.
Because Wind, Cold, and Damp are intertwined in these Bi conditions, all three are treated through herbal combinations. Dosages and herbs are chosen on the basis of predominant symptoms. Specific herbs for Bi syndrome also affect different areas of the body and can be used to make the formula more efficient. Examples are Qiang Huo (Rhizoma et Radix Notopterygii) for the upper part of the body, particularly the neck, shoulders, and upper back; and Du Huo (Radix Angelicae Pubescentis) for the lower back and legs. Herbs to treat Wind, Cold, or Damp in the body also may be added to the formulas.
Finally, herbs that affect any predisposing factors may be used as well, such as the following:
- Chai Hu (Radix Bupleuri) for Liver Qi Stagnation
- Dang Gui (Radix Angelicae Sinensis) for Blood Deficiency
- Huang Qi (Radix Astragali) for Qi Deficiency
This comprehensive approach takes into account the complex and individual nature of the syndrome in each patient.
Qi Gong
Qi Gong exercises offer treatment potential for patients diagnosed with fibromyalgia. Because TCM relates stress, depression, anxiety, and other emotional states to the Zang Organs, exercises such as the organ healing sounds may be used to strengthen the Zang Organs, help correct imbalances in the body, and maintain emotional balance. Qi Gong exercises such as the Eight Brocade Exercises and Tai Qi Quan encourage gentle physical movement and stretching, thus reducing pain, eliminating obstruction in channels and maintaining movement. Mindful Qi Gong massage helps relieve pain and increases the flow of Qi.
