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by Jeffrey Chapman, Dipl.Ac., MTCM, L.Ac.

Subjective Findings

K.N., a 50 year old female health care professional and doctoral candidate, presented with aching muscles all over the body, which she described as feeling like sore muscles after a workout. The pain varied in intensity but was always present, and would generally be more intense on one side, alternating with the other. She also experienced alternating feelings of hot and cold as well as alternating constipation and diarrhea. She was extremely fatigued, routinely needing to be in bed by 7 PM, and she frequently experienced spontaneous sweating. Other symptoms included swollen cervical lymph nodes, a lack of mental clarity, frontal headaches, and susceptibility to bruising.

History

Symptoms of fibromyalgia for almost two years prior to initial visit; formal diagnosis of fibromyalgia made approximately six months prior to initial visit. History of reactive hypoglycemia and allergic asthma. K.N. received conventional treatment for these conditions, and felt that it was partially successful, but she determined that she had reached a plateau and wished to pursue other options.

Objective Findings

The patient's tongue body was pale, slightly purple, and slightly trembling, with a shallow longitudinal fissure over the Stomach region. The fur was thin, white, moist, and evenly distributed.

The radial pulse was superficial in the cun position; wiry and then in the eft guan position and vacuous in the right guan position; vacuous in the left chi position and weak in the right chi position.

The patient's facial complexion was pale with a dim yellow cast. She had dark circles under her eyes.

TCM Assessment

The principal pattern was one of spleen qi vacuity, leading to depression of the upbearing and downbearing functions of the qi mechanism, resulting in accumulation of dampness and phlegm internally, leading to damp painful obstruction.

Treatment Strategies

Boost the qi, upbear the clear yang qi, downbear turbid fluids, and transform dampness and phlegm. When pain was prominent, the method of overcoming dampness using wind medicinals was also employed.

Herbal Prescription

The patient received granules. Three grams each of fu ling, bei xie, chuan xiong, and ban xia were added to Bu Zhong Yi Qi Tang, 48 grams, for a total of 60 grams. The dose was 3 grams, three times daily. Herbs such as qiang huo, fang feng, and ge gen were added to the prescription when headaches and muscle pain were prominent. Minor variations on this prescription were made throughout the course of treatment.

Acupuncture

Du 20, Large Intestine 4, Lung 7, Stomach 36 and 40, Spleen 9 and 6 were needled for qi sensation with even technique. Minor variations were made over the course of treatment, with points selected mainly from the Du, Yangming and Taiyin channels.

Other Recommendations

Avoidance of raw, cold, spicy, greasy, dairy, and fermented foods. Keep a journal of intake. Apply indirect moxibustion to Stomach 36 two to three times weekly, 10-15 minutes each time.

Progress

One week after the first visit, K.N. reported an 85 percent improvement in pain symptoms, diminished fatigue, a reduction in spontaneous sweating, and increased mental clarity. The patient was advised that she would probably need one two courses of ten treatments to maximize the benefits of treatment. Subsequent visit were weekly or biweekly. After the sixth visit, all of her other symptoms were also improved to a similar degree. After 15 visits, she felt much as she had before the onset of her fibromyalgia symptoms. K.N.'s tongue lost its purple cast and her pulse gradually become slippery and acquired a normal root.

Outcome

K.N. received maintenance care, usually once or twice monthly, through one year from her initial visit. She kept a journal of her intake per practitioner recommendation and was able to identify a combination of 5 (!) foodstuffs that aggravated her symptoms. She stopped combining those foods in one meal and credited some of her improvement to this discovery. K.N. considered her treatment to be successful. Her condition is now stable and the complaints she originally brought for care are resolved.

Conclusions

While it can and does present differently, fibromyalgia often corresponds with qi vacuity and resultant depression of the Qi mechanism, specifically inhibition of upbearing and downbearing. When upbearing and downbearing are disrupted, so is the fluid metabolism, hence the saying, "Without upbearing and downbearing, the clear and turbid fluids lose their places." Under these conditions, turbid fluids may accumulate in the muscles and in the head, leading to pain and headaches. Early on, some symptoms appeared to suggest a Shaoyang pattern, but the signs did not support this notion. The apparent similarities arise from the fact that many of the outward manifestations of Shaoyang patterns are likewise due to qi vacuity and depression of the qi mechanism. For example, early in the course of treatment, the patient had been experiencing swelling of the cervical lymph nodes. TCM would typically identify this as heat causing fluids to congeal into phlegm. The knee-jerk response would be to attribute the symptom to wind-heat and toxins or true phlegm-fire and treat it accordingly. In this case, it was the understanding that the heat was depressive, following on middle qi vacuity, that made it clear that boosting qi and promoting upbearing would be enough to resolve the heat without having to resort to the use of heat-clearing medicinals, which can further damage the middle qi.

This history underscores the importance of careful pattern identification and close attention to the disease mechanisms that produce signs and symptoms.

"In Chinese medicine, the main thing is the idea."

Copyright (C) 2002 Jeffrey Chapman. All Rights Reserved.

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