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On pages 101–102 of issue 12, 2009, of Xin Zhong Yi (New Chinese Medicine), Zhou Yi-chen and Wang Bi published an article titled "Treating Fibromyalgia Syndrome Via the Liver." A summary of this article is presented below.
The main symptom of fibromyalgia syndrome is generalized body pain. Most sufferers of FMS are female. In addition to specific sites of pressure pain, other accompanying symptoms include insomnia, vexation and agitation, fatigue, lassitude of the spirit, low-grade fever, and menstrual irregularities. Based on the experience of the Chinese authors of this article, they believe that this condition should mainly be treated via the liver. This is also my own clinical experience. I have never been able to substantiate the presence of externally contracted evils in the case of FMS.
Disease Causes and Mechanisms
According to some Chinese doctors, this condition is due to external contraction of wind, cold, dampness, and/or heat evils which lodge in the body. These evils block and obstruct the channels and network vessels. Hence the flow of the qi and blood is not smooth. According to this point of view, it is mainly this that leads to soreness and pain in the muscles and flesh, sinews and bones, and joints as well as heaviness, numbness, inability to flex and extend, and, if severe, joint swelling and burning heat. Such doctors categorize this condition as the sinew impediment subtype of impediment condition. However, the authors' experience is that treatment for FMS based on impediment condition either gets no or only slight effect. In fact, after finely searching, they have not found evidence of the lodging of external evils in the body. Instead, most patients with this condition also present with frustration, chest oppression, and depression. Even during its initial stage, they commonly see rib-side discomfort, vexation and agitation, insomnia, and bodily fatigue. Only gradually later does generalized muscle pain develop and get worse. Further, due to the enduring nature of this suffering and failure to heal, the psyche becomes tense and the disease condition gets worse. Therefore, Drs. Zhou and Wang believe that FMS should be categorized as depression condition in Chinese medicine, not impediment condition.
If depression and anger are left unsoothed, the liver loses its spreading and extending and the qi loses its coursing and discharge. Thus the liver becomes depressed and the qi becomes bound. The qi is the commander of the blood. If there is qi stagnation, this leads to blood stasis not moving, and blood stasis leads to lack of free flow, lack of construction, and ultimately to pain. If qi depression transforms fire, fire;s nature is to flame upward. This then can give rise to vexation and agitation and easy anger. If anxiety and depression are not resolved, heart yin may be consumed and damaged. In that case, heart yin is unable to provide supplies for and nourish the heart spirit. The heart spirit loses its calm and there is insomnia. If liver yin becomes insufficient, yin vacuity may engender heat. If vacuity heat harasses the spirit, then there may be heart palpitations and dizziness. Further, because "the liver is the root of resistance to fatigue," enduring depression damaging the liver can also give rise to fatigue and lack of strength. If depression damages the heart spirit and the constructive and blood are exhausted and consumed, visceral yin becomes insufficient and vacuity yang may ascend. This may give rise to afternoon low-grade fever. If the liver and kidneys lose their nourishment, the chong and ren become dysregulated, and this may give rise to menstrual irregularity.
Treatment Based on Pattern Discrimination
Based on the foregoing, Drs. Zhou and Wang believe that FMS should be treated by coursing the liver and resolving depression, moving the qi and quickening the blood, freeing the flow of the network vessels and stabilizing pain. For this, they use Chai Hu Shu Gan San (Bupleurum Course the Liver Powder) plus Xue Fu Zhu Yu Tang (Blood Mansion Dispel Stasis Decoction) with additions and subtractions:
Dang Gui (Radix Angelicae Sinensis)
Sheng Di Huang (uncooked Radix Rehmanniae)
Tao Ren (Semen Persicae)
Hong Hua (Flos Carthami)
Mu Dan Pi (Cortex Moutan)
Chuan Xiong (Rhizoma Chuanxiong)
Chai Hu (Radix Bupleuri)
Xiang Fu (Rhizoma Cyperi)
Bai Shao (Radix Alba Paeoniae)
Zhi Qiao (Fructus Aurantii)
Yan Hu Suo (Rhizoma Corydalis)
Dan Shen (Radix Salviae Miltiorrhizae)
Ge Gen (Radix Puerariae)
Gan Cao (Radix Glycyrrhizae)
Within this formula, Dang Gui, Dan Shen, and Sheng Di Huang nourish the blood and emolliate the liver. Tao Ren, Hong Hua, Chuan Xiong, Yan Hu Suo, and Mu Dan Pi quicken and harmonize the blood. Xiang Fu, Chai Hu, and Zhi Qiao course the liver and rectify the qi. Ge Gen, Bai Shao, and Gan Cao relax cramping and stop pain. Using the combination of Chai Hu and Bai Shao, one medicinal scatters while the other restrains. Hence one is able to course the liver and resolve depression at the same time as harmonizing the constructive and restraining or constraining yin. The combination of Bai Shao and Gan Cao makes up the famous formula Shao Yao Gan Cao Tang (Peony and Licorice Decoction), which relaxes cramping and stops pain. When Xiang Fu and Chuan Xiong are used together, they are capable of pushing the depressed qi of the liver-gallbladder, which then obtain stirring (or movement).
If fatigue is severe, they add Huang Qi (Radix Astragali).
If there is insomnia and vexation and agitation, they add Suan Zao Ren (Semen Zizyphi Spinosae), Lian Zi Xin (Plumula Nelumbinis), and Shi Chang Pu (Rhizoma Acori Tatarinowii).
If there is chest oppression, they add Gua Lou (Fructus Trichosanthis) and Yu Jin (Tuber Curcumae).
If pain in the four limbs is severe, they add Jiang Huang (Rhizoma Curcumae Longae), Niu Xi (Radix Achyranthis Bidentatae), and Sang Zhi (Ramulus Mori).
If appetite is poor, they add scorched Bai Zhu (Rhizoma Atractylodis Macrocephalae), Fu Ling (Poria), and scorched Shan Zha (Fructus Crataegi).
If dampness is severe with thick, slimy tongue fur, they add Yi Yi Ren (Semen Coicis), Hou Po (Cortex Magnoliae Officinalis), Bai Bian Dou (Semen Dolichoris), and Can Sha (Excrementum Bombycis).
If the stools are dry and bound, they add Da Huang (Radix Et Rhizoma Rhei).
Also, depending on the symptoms, they may add Qin Jiao (Radix Gentianae Macrophyllae), Qiang Huo (Radix Et Rhizoma Notopterygii), Du Huo (Radix Angelicae Pubescentis), Ren Dong Teng (Caulis Lonicerae), Luo Shi Teng (Caulis Trachelospermi), and/or Shen Jin Cao (Herba Lycopodii) to soothe the sinews and free the flow of the network vessels. (Note: although Qiang Huo and Du Huo are wind-treating medicinals, Drs. Zhou and Wang use them in FMS based on the principles of soothing the sinews and freeing the flow of the network vessels, not resolving the exterior and coursing wind.)
In a representative case history, Drs. Zhou and Wang report that the patient was cured in three months of treatment with variations of the above protocol using one packet of medicinals per day.
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