Fibromyalgia

by Glen Swartwout

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!

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 diagnosed using the CDC 1994 guidelines published in the Annuals of Internal Medicine 121(12):953-959, 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)

Therapeutic Note:

• 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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