FIBROMYALGIA

Introduction

‘Newer’ diseases or conditions are being analysed and named, leading us to believe that newer diseases are being formed, perhaps rightly so, looking at it from a bio-medical approach. But looking at it from a purely Ayurvedic perspective, there seems to be no need to see this ‘development’ of ‘new diseases’ as beyond the scope of diagnosis / treatment of Ayurveda. A true vaidya need not believe that the newer diseases not mentioned in the classical texts are new events; he also need not believe that if we do not have a parallel disease (and its cikitsā) described in classical Ayurvedic texts, then we cannot do anything about it.

On the contrary, Caraka mentions multiple times in various chapters that “here is the description of such-an-such a condition… this is its cikitsā… and a ‘wise’ vaidya will perform the cikitsā taking into account variable and various factors of agni, deśa, kāla, dravya etc…” He speaks in places about parināma (change) also called as kāla (time) implying that everything changes with time and one has to account for these changes before one performs cikitsā.

Having said this, we need to remember that the cikitsādhiṣṭhita puruṣa – the entity on which the cikitsā is to be done is a (live) human being… and whatever the saṃprāpti of the disease, it is still in the same human being (body and mind). So we are still dealing with the same set of variables - the doṣa, the dhātu, the mala or more simply the mahābhūta.

And even if the ratha (chariot) is today replaced by cars, airplanes; the effect travel or movement, of increasing the vāta still remains… and the cikitsā, for example would still be a yukta-ratha-basti.

So by framing the nidāna-pañcaka of an apparently ‘newer’ vyādhi, one can still arrive at a successful cikitsā (if the disease is sādhya) without the need to ‘name’ the vyādhi… or it would most of the time be still possible to categorise this ‘new’ vyādhi into already known nīdāna/ diagnoses and cikitsā.

Fibromyalgia – the perspective of bio-medicine (western conventional medicine).

Doctors don't know what causes fibromyalgia, but it most likely involves a variety of factors working together. Fibromyalgia is a disorder characterized bywidespread musculoskeletal painaccompanied by:

  • Fatigue.
  • Sleep. People with fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is frequently disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea, that further worsen symptoms.
  • Headaches esp tension headaches.
  • Memory problems.
  • Irritable bowel syndrome.
  • Mood issues, anxiety, depression.
  • Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event.
  • Women are much more likely to develop fibromyalgia than are men.
  • Genetics.Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder.
  • Infections.Some illnesses appear to trigger or aggravate fibromyalgia.
  • Family history.You may be more likely to develop fibromyalgia if a relative also has the condition.
  • Rheumatic disease.If you have a rheumatic disease, such as rheumatoid arthritis or lupus, you may be more likely to develop fibromyalgia.
  • Physical or emotional trauma.Post-traumatic stress disorder has been linked to fibromyalgia.While there is no cure for fibromyalgia, a variety of medications can help control symptoms. Exercise, relaxation and stress-reduction measures also may help.

Why does it hurt?

  • Central sensitization. This theory states that people with fibromyalgia have a lower threshold for pain because of increased sensitivity in the brain to pain signals.
  • Researchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain's pain receptors seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals.

The pain associated with fibromyalgia often is described as a constant dull ache, typically arising from muscles. To be considered widespread, the pain must occur on both sides of your body and above and below your waist.

Fibromyalgia is characterized by additional pain when firm pressure is applied to specific areas of your body, called tender points.

Tender point locations include:

  • Back of the head
  • Between shoulder blades
  • Top of shoulders
  • Front sides of neck
  • Upper chest
  • Outer elbows
  • Upper hips
  • Sides of hips
  • Inner knees

First, from an Āyurvedic perspective, it needs to be understood that this is not a single vyādhi. It is a complexity arising out of 2 or more vyādhi coming together. This condition is often referred to as ‘vyādhi-saṇkara’.

The closest parallel of ‘saṇkara’ is the Greek word - syndrome.

Syn – coming together/combination; dromos – course, way, path;

a combination of phenomena seen in association.

Inmedicineandpsychology, asyndromeis the association of several clinically recognizable features,signs(observed by someone other than thepatient),symptoms(reported by the patient),phenomenaor characteristics that often occur together.

Life exists as an organized whole system emerging from a volley of patterns. Higher order patterns of this whole functional system cannot be understood by a simple summation of all the patterns. New properties emerge because the components interact, not because the basic nature of the components is changed. Naturally, in trying to understand a vyādhi saṇkara, it becomes crucial to comprehend the complexity that arises out of this interaction between various vyādhi, their vyādhi-ghaṭaka and their mechanisms.

What needs to be considered:

  • Dūṣyam(dhātu, upadhātu, ojas… qqf)
  • Deṣam(jāngal, anupa, sādhāraṇa)
  • Balam(esp. māṃsa, śukra, ojas)
  • Kālam(ṛtu, kāla whether ādāna, visarga)
  • Analam(agni – jāṭharāgni, dhātu agni)
  • Prakṛtim(doṣic, guṇaja)
  • Vaya(age, stage of person, vyādhi)
  • Sattvam(mānas, bala)
  • Sātmayam(habit agreeable to natural constitution)
  • Āharam(diet, nutrition)

Involvement of ojas

The dhātu make up the body and obviously the bala (strength) of each dhātu – quantitatively, qualitatively and functionally, defines the overall strength of the person. Balawāndhatu (strong tissues) themselves imply a general strength in a person, making him/her resistant to disease. Besides this, each dhātu contributes its sāra-bhāga (pure, refined or excellent part) which eventally is converted into ojas – the quintessential part of all dhātu. This acts like a ‘reserve’ strength that is useful generally, and more importantly in times of distress/disease for the ‘physic (body)’. In day-to-day life dhatu impart strength to the physical aspect of the person and ojas provides additional or reserve bala for it. Besides this, the ojas being a very subtle ‘substance’, has the capacity to impart its strength to the subtler levels of mānas (mind). Ojas thus provides sattva (which is also another name for ‘light’) that nutrifies the mānas. Ojas is thus important for śarīra as well as mānas health. Since the bala (strength) of the person – qqf – comes also from ojas. It is thus vyādhi-pratihāraṇa (disease resistant).

Every condition of dis-ease affects and taxes, the body well as the mind; meaning thereby that every dis-ease has both attributes – śārira and mānas. The condition that has a greater effect on the śarīra (body) is categorised as a śārīra vyādhi and like wise we have mānas vyādhi. In a diseased condition, cikitsā (treatment) is given to bring the person back to ‘normalcy’. Ojas aids this ‘restoration’ of normalcy by providing strength to the śārīra as well as mānas attributes. Summarily, it can be said that ojas has a preventive action before disease formation by aiding to maintain the status of health; and has a re-habilitative or restorative aspect, post disease formation.

Ojo-vṛddhi:

Ojo vivṛddhau dehasya tuṣṭi-puṣṭi balodayāḥ…

Identification of :

  • Doṣa(s) involved.
  • Doṣa sthiti – whether sāma, nirāma.
  • Doṣa gati – whether koṣṭha, śākhā, marma-asthi-sandhi.
  • Vyādhi marga – whether abhyantara, bāhya, madhyam.

Cikitsopakrama:

Āmapācana if necessary.

Śodhana if necessary/possible.

Śamana.

Rasāyana.

Fibromyalgia – (Go back to symptoms etc of fibromyalgia above)…

  • Vāta pitta bahulatā…
  • Upastaṃbhita/avaruddha vāta (chronic) leading to dhātu kṣaya
  • Dhātu kṣaya due to trauma, surgery etc
  • Pitta increased by ūṣṇa and tīkṣṇa esp. tīkṣṇa
  • Dhātu kṣayaja condition…
  • Māmsa, majjā, asthi, rasa - main dhātu affected
  • Understanding the snigdhatā of majjā and the effect of vāta and pitta on it
  • Sā eva asthi dharā kalā tā eva pūriṣa dharā kalā
  • Sā eva majjā dharā kalā tā eva pitta dharā kalā
  • Rajo/ tamo (usually and esp. rājas) guṇa bahulatā…
  • Oja vikṛti

Ojo-vikṛti : 3 types – ojo-visransa (sthāna cyuti), ojo-vyāpat (duṣṭi), ksaya (qqf reduction)…

Ojo-visransa:

Sandhi-viśleṣo, gātrāṇam sadanaṃ, doṣa cyavanam, kriyā sannirodhasca…

Ojo-vyāpat:

Stabdha guru gātratā, vāta-śopho, varṇa bhedo, glāni, taṇdrā…

Oja-kṣaya:

  1. Murcchā, māmsa kṣayo, mohaḥ, pralāpaḥ, maraṇam iti ca ksaye…

Suśṛta sūtra.15

  1. Bibheti, durbalo, abhīkṣṇam (afraid), dhyāyati (thinks excessively), vyathitendriyaḥ (sensitive or irritable indriya), du-cchayaḥ (niṣprabha), durmano (improper mānas condition), rukṣaḥ, kṣāmasca (kṛśa) eva ojasaḥ kṣaye…

Carak sūtra.17

Various vyādhi that could be components of a vyādhi saṇkara avasthā called Fibromyalgia:

  • Dhātu kṣaya janya vāta-vyādhi esp rasa, māṃsa, majjā, asthi…
  • Āma vāta or upastambhita vāta vyādhi
  • Māmsa gata vāta, Asthi-majja gata vata or involvement of asthi and majja
  • Āvṛtta vāta esp. pittāvṛtta vāta, majjāvṛtta vāta
  • Sarvanga vāta
  • Mānas vyādhi esp. unmāda or moha
  • Oja vikṛti
  • Other degenerative conditions… etc…

Cikitsopakrama: First consider sāma-nirāma avasthā.

  • Āma pācan
  • Jātharāgni/ Koṣṭhāgni
  • Dhātwāgni
  • Śodhana
  • Virecana usually
  • Rakta mokṣaṇa
  • Niruha basti if vāta avarodhā is still seen
  • Śamana
  • Auṣadhi
  • Snehana
  • Swedana
  • Lepa
  • Anuvāsan basti with kṣīra-pāka, ghṛta, taila…

  • Rasayana
  • Dhātu poṣana
  • Adravya (rasāyana with non-material like ācāra rasāyana – counselling, advising proper life-style/behaviour, mantra etc)

Dravya:

Śatāvari - Pṛthvi + Āpa(śita, balya)

Āśwagandha - Pṛthvi + Agni (balya, nidrākara)

Kapikacchu - Pṛthvi + Āpa (balya, sthira guṇa)

Brāhmi - Āpa + Ākāśa + Vāyu(smṛtikara)

Jatāmānsi - Pṛthvi(sthira for mānas)

Vacā (rarely necessary; only if tāmas guṇa increased) – Agni(making alert)

Vaṭa jaṭā - Pṛthvi + Āpa(sthira to body and mind)

Āmapācaka vaṭi

Haritaki, trikaṭu, kāraskara, śuddha gandhak, hingu, saindhava;

All above mixture triturated with kumari swarasa.

Agneya, also bit pārthiva;

Dārdhyakara (hardness/fixedness/stability/strength), māṃsa bala vardhan due to kāraskara; therefore useful in atonia/dystonia of bladder muscles, colons – uncontrolled micturation/stools.

Useful in aruci, ādhmāna, vātānuloman, pācan, atisāra, grahaṇi, pravāhika…

Māṃsapācak, Majjāpācak are mentioned in Caraka in viṣama jwara cikitsā.

Dhātu / Dravya
Rasa / Kalingaka (Indrayava seeds), Patola patra, Kaṭukarohini (Kuṭakī)
Rakta / Patola, Sārivā, Mustā, Pāṭhā, Kaṭukarohini
Māṃsa / Nimba, Paṭola, Triphalā, Mṛdvikā (dry black grapes), Mustā, Vatsaka (Kutaja)
Meda / Kirātatikta, Amṛtā, Candana (sandal wood), Viśwabheśaja (Śunṭhī)
Asthi-Majjā / Guḍucī, Mustā, Āmalakī

Prajña yoga

This is a combination of:

Sārivā (Hemidesmus indicus) also called Indian sarsaparilla,

Manjiṣṭhā (Rubia cordifolia),

Jatāmānsi (Nardostachys jatāmānsi),

Vaṭa jaṭa (ariel roots of Ficus benghalensis).

Ghṛta for internal consumption like brāhmi ghṛta, sāraswat ghṛta, śatāvari ghṛta siddhi (cooked) 6-7 times.

Taila

Chandan-balā-lākṣādi taila

Nārayaṇa taila/ Mahānārāyan taila

Balā-aśwagandhādi taila

All taila formulations with multiple siddhi, made sa-āmiṣa with māmsa rasa and majjā of animals.

Other medicines:

Yogaraj guggulu

Lākṣādi guggulu

Mahayogaraj guggulu

Pañcamṛta loha guggulu

Suvarṇa kalpa like suvarṇa malini vasanta, vasanta kusumākar…