Tulsi's your special servant; his heart's your abode
Yet, God, he seems to have a surfeit of suffering.
This limb pain's like a wild creeper, so seize
It's spreading roots in monkey play and yank them out!
Whether from my own sins, or just the triple-torment of this world,
Or someone else's curse, this arm pain's passed expression or endurance.
I've tried every tonic, spells, talismans,
Propitiated a whole herd of gods--all in vain.
Tulsidas, Hanuman Bahuk(1)
As vividly portrayed by Tusidas, one of North India's greatest poets and a fibromyalgia sufferer in his later life, the causation of fibromyalgia syndrome (FMS) is unknown and there is likewise no known cure. FMS is widely understood as a yapya condition--one that cannot be cured and yet is not fatal. FMS sufferers may make up a disproportionate amount of the Ayurvedic practitioner's caseload because the lack of effective biomedical treatment, combined with the severity of the suffering involved, often drives patients with FMS to seek out alternative care.
Fibromyalgia is one of a large group of soft tissue pain conditions. Unlike arthritic conditions such as rheumatoid arthritis and osteoarthritis, FMS does not involve the joints. However, it is also different from other forms of soft tissue pain known as myofascial pain syndrome, which largely involves a single muscle or muscle group. The specific diagnostic criteria of FMS used to include widespread pain for at least three months, affecting both sides of the body, both above and below the waist, as well as the presence of at least 11 of 18 specific tender points, also known as trigger points. These are of interest in that they correlate to amsa marma-- (related to fatigue) kukundara marma--(kidney, bladder, colon) Sira matrika and apalapa marma as well as the medial side of the knee joint, lateral side of the elbow joint and the left and right sides of the occiput.
However, in 2010, reliance upon the tender point examination was eliminated. Instead, rheumatologists began using the Widespread Pain Index and Symptom Severity Scale.
FMS is quite a common medical condition, affecting 2% to nearly 12% in the general population. It is increasingly prevalent with age, particularly affecting in women over fifty (7.4% to 10%). Adult women are 4-7 times more likely to be affected than adult men. (2) Children of both genders may be affected with FMS but typically grow out of it. There is no definitive blood test for FMS and a number of serious illnesses including Hepatitis C, Lyme disease and hypothyroidism may mimic the symptom picture of fibromyalgia, so it is important for the Ayurvedic practitioner to be assured that the client has received a biomedical workup. Fibromyalgia may occur as a primary condition or may also be concomitant with one of the auto-immune connective tissue diseases, in which case it is known as secondary fibromyalgia. Nearly 30% of patients with rheumatoid arthritis, 40% of systemic lupus erythematosus patients, and 50% of Sjögren's syndrome patients have concomitant FMS (2).
The issue of whether FMS is a genuine pathology or a psychiatric illness has been hotly debated within the medical profession. At this point, more than 80% of physicians appreciate that FMS is a pathology in its own right and that concomitant depression is a result of chronic pain and physical limitation (2). From an Ayurvedic standpoint FMS falls into the category of mamsagati vata conditions. Vata invades with tiryaga gati (sideways movement) into the muscle tissue, typically pushing pitta and ama into the soft tissues. Hence from our perspective it is hardly surprising to note that FMS is often accompanied by a host of other vatagenic conditions such as vata type of insomnia (waking in the early morning hours), cognitive and short term memory issues, anxiety, headaches, dizziness, fatigue, morning stiffness, numbness and tingling of the extremities, irritable bowel syndrome, temporo-mandibular joint syndrome, cold intolerance and restless legs syndrome (2). Vata-pitta syndromes accompanying FMS include urethral syndrome, also known as irritable bladder syndrome. The onset of FMS is often traced to a severe vata shock such as a car accident with whiplash injury, a fall, surgery or childbirth. Pitta triggers include febrile conditions resulting from a bacterial or viral infection. FMS is related to a low pain threshold and to low levels of serotonin.
A twenty six year old construction worker of pitta prakruti had a history of multiple vata traumas including two car accidents as well as several work-related injuries and falls. He complained of generalized soft tissue pain, with all his muscles feeling constantly sore for the last six months. He also experienced confusion, poor motivation, depression, chronic fatigue, constipation and weakness. His attitude was generally negative, with a perception of his life as an ongoing catastrophe. This symptom is typical both of low serotonin and vata invading manovahasrotas (the channels of the mind) and is frequently found as part of the symptom picture of FMS. Both his vata and pitta were currently provoked. As a home remedy for his generalized pain he took sunthi kalka:
1 tsp organic ginger powder
1tsp white sesame seeds
Grind together and add 4 parts milk as an anupan.
This is used as a fibromyalgia remedy with the addition of 1tsp Ashawagandha. Because of his pitta provocation we also added half a teaspoon of Guduchi.
Although Yogaraj Guggulu is often used in FMS with accompanying vata syndrome, in this case we used Kaishore Guggulu because of the intense pitta provocation. Because of the pitta ama involved with his FMS, it was also beneficial for him to take an infusion of Amlaki daily. To support his serotonin levels and address anxiety and depression he took Brahmi tea three times daily. He could also have used Tranquil Mind, which addresses stress, anxiety, fatigueand muscle aches. Gentle restorative yoga was helpful for his generalized pain and morning stiffness. Weekly abhyanga treatments with Mahanarayana Oil also provided significant relief.
A sixty year old woman of pitta prakruti had a history of auto-immune hypothyroid disease and severe fibromyalgia. She was generally cheerful and outgoing, taking a positive attitude despite her constant experience of chronic pain. She represents the 60% of fibromyalgia patients who are not actively depressed.(2) She took Chyavanprash daily for its rejuvenative capacity in helping her overcome FMS-related fatigue. Regular asana practice and meditation helped her chronic pain and concomitant stress levels. She obtained the most relief from frequent abhyanga with Mahanarayana Oil and shirodhara with Shirodhara Oil. She noted that shirodhara was essential for relief of the central nervous system stress related to chronic pain. The greatest relief of all came from sarvangadhara or pizichil with Vata Massage Oil.
A thirty six year old vata-pitta housewife complained of fibromyalgia, chronic headaches, hyperacidity and diarrhoea-dominant irritable bowel syndrome (a vata-pitta condition) accompanied by fatigue and depression. Like the first patient cited, she was prone to extremely negative thinking. Despite being happily married and leading quite a privileged lifestyle she habitually engaged in catastrophic ideation. She did a full panchakarma treatment including seven days abhyanga with Vata Massage Oil for the general abhyanga and Mahanarayana Oil on the painful areas; sudation in steam medicated with Dashamoola and shirodhara with Brahmi Oil. Brahmi Oil was used for the oil bastis and Dashamoola, Guduchi and Brahmi for the decoction bastis. Following this course of purvakarma and panchakarma therapies her fibromyalgia pain started improving and her digestion normalized. Her negative moods at first worsened and then suddenly dissipated. As long as she continued taking Brahmi tea and Brahmi ghee and doing regular self-abhyanga and bastis she felt peaceful and happy and began doing creative projects such as baking and dressmaking. Once she went off her Ayurvedic regime her condition gradually deteriorated and attempts at other natural therapies only worsened her FMS pain, perhaps because these therapies were not addressing the underlying doshic imbalance. Her history serves to remind us that one round of panchakarma is not a panacea. In a yapya condition, Ayurvedic chikitsa must be continued ongoingly, with regular panchakarma treatments at least annually (in fall for a vata condition) and preferably twice a year.
By addressing the underlying vata and pitta imbalances and offering shodhan therapies to remove ama from the mamsa dhatu, Ayurveda can offer significant relief to patients with FMS. In particular, FMS sufferers can derive ongoing relief from oleation therapies such as abhyanga and sarvangadhara. Herbs that address majjavahasrotas and manovahasrotas, such as Brahmi and Tranquil Mind, help alleviate the underlying serotonin imbalance, while rejuvenatives such as Chyavanprash are helpful for the fatigue component of FMS.
Philip Lutgendorf, Hanuman's tale OUP, 2007 p 98
Jon Russell, MD, PhD Fibromyalgia Syndrome: Presentation, Diagnosis, and Differential Diagnosis Primary Psychiatry. 2006;13(9):40-45
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Alakananda Ma M.B., B.S. (Lond.) is an Ayurvedic Doctor (NAMA) and graduate of a top London medical school. She is co-founder of Alandi Ayurveda Clinic and Alandi Ayurveda Gurukula in Boulder Colorado, as well as a spiritual mother, teacher, flower essence maker and storyteller. Alakananda is a well known and highly respected practitioner in the Ayurveda community both nationally and internationally.
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