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Fibromyalgia and its close ally the chronic fatigue syndrome has been a recent addition to the list of Psychosomatic disorders troubling human life. It is clearly a life style disorder when we verify the causes. An outcome of erratic life style, unhealthy food, stress, lack of exercise and a possible injury as a precipitating factor, this disorder disturbs normalcy in ones life.

Many patients feel it is triggered by stresses such as an illness, emotional trauma, hormonal imbalance and heavy physical work. This is often followed by generalized pain, fatigue, sleep and mood disturbance .This is often accompanied by severe fatigue and tiredness. The work hours, family life and social life of the individual is usually affected, as the person fall into a vicious cycle.

Pain is generally distributed, but often has trigger points across the body where it is having higher intensity. Though Fibromyalgia is similar to the chronic fatigue syndrome it is characterised by the presence of severe muscular pain. Modern science relates it to low Serotonin level in blood. Basic approach in management is suggested as steps for Pain reduction, sleep improvement and maintaining stable Serotonin and Magnesium levels in blood. 

Fibromyalgia in ayurvedic
Ayurvedic classics have not referred this name or have mentioned any particular symptom complex similar to it .With a thorough reading of the classics do provide an understanding into this problem and its management.

Diagnosing Fibromyalgia- the ayurveda way
Analysing the symptoms it is clear that all its symptoms resembles a Vatha vikara(disease due to vatha increase or imbalance).But it is not mentioned with a specific name nor mentioned other than its symptoms .Here one may be curious to know ‘what does a Vatha imbalance signifies?’

Vatha one among the three functional attributes of our body is considered to be made of Vayu and Akasa (air and space elements).The reasons for its imbalance are as follows as mentioned in Ashtanga Hridayam the classic: 

a. Dietary reasons - intake of bitter, spicy and astringent tastes in excess, eating too little, eating too dry food, eating too much.
b. Life style reasons- holding natural urges like the one for urination ,defecation etc, pressing the natural urges , non sleeping at night ,talking too loud, excessive physical excretion, excessive sex ,too much of thinking and worrying
c. Clinical reasons- doing too severe purifications like purgation or vomiting
d. Emotional reasons- Fear (anxiety) and sorrow (depression)
e. Climatic reasons- summer
f. Diurnal variations- like end of day and night, and end of food digestion. 

Once Vatha is imbalanced then it could cause a multitude of signs and symptoms including Bala upaghatha(weakness) ,Asthisoola (pain related to bones) Malasanga(constipation),Atopa (bloating) Moha (hallucination )Bhaya (fear- anxiety),Soka(sorrow- depression),Samja nasa(unconsciousness),Nidra nasa(insomnia) and so on. Quite many of these symptoms we see in Fibromyalgia as well. The Primary functions of Vatha being movement and control and co ordination of sensory as well as motor functions- the functions of the Central nervous system, there are implications of vatha imbalance on this most important system of our body. The Vatha imbalance thus in a way may be synonymous to the upset of our nervous system which translates as pain.
Soolam (pain) is considered the cardinal sign of any Vatha imbalance in ayurvedic classics.

The breakthrough in diagnosing this dreaded problem was achieved by Padmasree Dr.K.Rajagopalan MBBS DAM FNAA, my mentor. We had many patients who showed a certain success with the management protocol suggested by him in severe health issues including Cancer and Neurological disorders. In such a clinical consultation he shared his thoughts.

According to him Fibromyalgia resembles Vatha vridhi in the Dhathus- Mamsa and medas (vatha increase in muscle and fat tissues).
Mamsa meda gatho grandheen thodadhyan karkasan bhramam
Gurvangam cha athiruk sthabdham mushti danta hathopamam- (Ashtangahridayam)
The signs of vatha increase in mamsa and medas are abscesses, piercing pain, and squeezing pain, and vertigo, heaviness of the body, severe pain with lack of flexibility and pain resembling the one due to punching by the fist.
Here we may look into the theory of the Dhathus (tissues).

Dhathus represent the structural entity of the human body, and are considered the building blocks. The seven dhathus with their functions are:

1.Rasa - (Lymph or plasma ) - Preenana - Nourishment
2.Raktha -(Blood) -Jeevana - Life giving (oxidation)
3.Mamsa-(Muscle) -Lepa - Coating
4.Medas (Fat) -Snehana -Lubrication
5.Asthi (Bone) -Dharana -Giving the frame work
6.Majja (Bone marrow) -poorana - Filling(the bones )
7.Sukra (Sperm/ovum) -Garbholpada - Embryo formation

Fibromyalgia is considered as the Vatha imbalance caused by any of the above mentioned reasons getting localized and affecting the Mamsa (muscle) and medas (fat) tissues. The two important patterns of Vatha imbalance are “Dhathu kshaya” (tissue degeneration) and “Srotho rodha” (bock in the functional channels).Here the second idea, the block in the functional channel of the muscle and fat tissues seems to be more relevant. More over due to poor digestive activity most patients show the signs of “Ama” (toxic indigestion).

Thus the primary concern in management is “amapachanam” (Digesting away the toxic indigestion) and Srothosodhanam (cleansing the channels).
The main symptom of Vatha affliction of the muscle is “sankocha” (spasm) which may cause more pain which puts one in a vicious cycle of spasm pain- insomnia-depression- spasm ,once and for ever unless checked. Hence early detection and pain reduction is also very important.

The dictum of ayurvedic management of these pathological symptoms are explained in Ashtanga hridayam as-
“Vireko mamsa medasthe niruha samanani cha”
Virechana (purgation), Niruha(decoction enemas) and Samana (pacifying medications) are in this order the steps of managing this problem.
Virechanam is the second among the Panchakarmas or five purification procedures.
Even if it is highly indicated in Pitha dominant disorders, Virechanam with appropriate Erandam (herbal extracts in castor oil) is of great significance in Vatha balancing.

Niruha mentioned as the fourth in the Panchakarmas is of at most importance in the treatment of Vatha imbalances having Neurological impacts.
Samana or pacification often comprises of herbs and life advises to pacify remaining imbalances and to nullify the impacts as well as tendencies.
This was an eye opener for me and my colleagues in the management of fibromyalgia.

Experiences
We had so many Patients suffering from fibromyalgia as health tourists who started traveling in search of its management. My first patient was a US singer; a Grammy award winner in 2001.She was treated by Vaidyamadham Cheriya narayanan Namputhiri at vaidyamadham nursing home and was given the follow up from our hospital. She had considerable progress, though not a total cure. She was advised to do yearly follow ups.

The most stunning result was in 2005 with a UK patient, a girl of 22 years, the daughter of a surgical registrar. Her case sheets were sent earlier. So we arranged her consultation and treatment. She was advised a treatment protocol for 30 days. She meticulously followed it irrespective of the palatability of several ayurvedic medicines and the severe purification procedures.

Her management principle was exactly as mentioned above. Virechanam (purgation) was repeatedly administered with the combination Eranda sukumaram. This has been very important as this combination clears up the channels and digests away ‘ama’ the toxic indigestion, together with its purifying effects.

After seeing indications of the removal of toxic indigestion and good digestive activity, she was also prescribed snehana(oleation) and swedana (sudation) procedures like Dhara,Pizhichil and Elakkizhi. Kheerabalathilam was used for sirodhara for seven consecutive days. This process involves a general oil smearing on the body followed by the application of medicated oil as a stream on the fore head on a person lying down in supine position from a height equal to the thickness of his four fingers. The stream must be as thick as his little finger, and it moves and sways on the forehead, followed by a gentle head massage at intervals during the stream. Duration was from 45 to 90 minutes.

Dhanwantharam kuzhampu was used for Pizhichil. Pizhichil or Sekam is simultaneously oleating and fomenting. The procedure involves a gentle smearing of medicated oil on the body followed by streaming of medicated oil using cotton towels .This treatment is carried out in seven positions- sitting, supine, left lateral, supine, right lateral, supine and sitting in this order ,for seven consecutive days. Duration was 45 to 90 minutes.

Samana chikitsa (pacifying therapy) included the use of ‘Dasamoola hareethaki lehya’ (herbal food supplement with molasses )and Dhanwantharam gulika( herbal tablet) as well as ‘Gandharva hasthadi kwatha’( a poly herbal decoction) . Her food was totally vegetarian, and the amapachana (digesting away toxic indigestion) was given importance. Medicines to stimulate her ‘agni’ (digestive fire) were also administered.

Viharas (life style modifications) and charyas (daily and seasonal routines) were also advised .She took a lot of rest, simple yoga, and relaxation methods. She was rehabilitated under the care of a family like situation. She took home medications for a 3 month follow up, and adhered to it.
Results were simply great. Her occupational therapist checked her biceps capability back home on her arrival. The test showed she could raise 8.5 kg instead of the earlier 1.5kg which he recorded the month before her departure to India.This was a true success story for ayurveda in managing fibromyalgia.

Summary of a few cases from different backgrounds
Among our case reports, most patients were western women and in the age group 30-50yrs. But we had a single case from India, a software engineer, woman, aged 24, possibly indicating the life style changes rapidly attributing to newer health issues. Most of our patients lived a stressed life and had neither specific routines nor dietary regimen until the disease. Most of them had the history of an emotional trauma, like the death of some one so close or family separation and so on.

Some had a physical precipitating cause like a home moving, night shifts with heavy physical strain and lack of sleep etc. The hospital stay was for a minimum of 14 days and a maximum of 40 days. The follow up was suggested for a minimum period of 90 days.  Annual visit for review was also suggested.

The results taking into account the level of analgesia (pain reduction), sleep improvement and recovery from fatigue were encouraging. More than 70 percentages of our patients showed considerable relief from pain and reported better sleep at the end of 90 days follow up. Fatigue was no more bothering around half of our patients at the end of the hospital stay .General improvement in the quality of life and a feeling of wellness were also witnessed.

Conclusion
Ayurveda presents a theoretical and practical stand in the management of fibromyalgia. It is evident that the chances are better with young patients than in middle aged or aged. This emphasizes early detection and management.  Even if it seems to be a western problem, the single Indian patient, being a young software engineer from Bangalore, India, it could be understood as a problem with a western life style. It is also clear that the out patient ayurvedic management also provide a certain help. The life style as well as diet plays an important role in managing this problem. This experiences gives us the conviction that ayurveda may complement modern medicine in searching out an answer for the management of Fibromyalgia and newer life style problems.

Sarve santhu sukhinaha
Sarve santhu niramayah
Sarve bhadrani pasyanthu
Ma kaschith dukhabhag bhaveth (a prayer from the Vedas)
(Let all be happy, let all be healthy- without any diseases,
Let all see only positive things in Life, and let no one suffer pain)

Dr Hari is a medical superintendent at KNM NSS ayurveda hospital Vallamkulam NSS Ayurveda hospital Aranmula Kerala,India.
http://www.doctorhari.com

© 2008 Six Senses Yoga Society