Fibromyalgia

//Western Diagnosis//
Myalgia - muscular pain Myositis - muscular inflammation Pain in muscles, tendons, ligaments, fibrous tissues, connective tissues Primary or concomitant Generalized or Localized

Etiology
Stress, anxiety, fatigue, insomnia, trauma, exposure to damp & cold, systemic disorders, viral or other infections

Signs & Symptoms
-Gradual onset of pain, achiness, stiffness -Anxiety, insomnia, fatigue -over straining, overuse -localized tenderness, tightness, spasm

Diagnosis
-Clinical pattern -Tenderness at 11 of 18 points: LI-18/ST-9, ST-12, GB-20, GB-21, TW-15, LI-11, BL-28 (PSIS), LR-8, lateral gluteal fold (below GB-30) -R/O all other possibilities

Treatment
-Reassurance, stretching exercises, better sleep, heat massage -Tricyclic antidepressants (amitryptiline) to help with sleep -SSRI's -Lidocaine injection into points of tenderness Naturo: #1&4, bromelain, turmeric, water exercise, vitamin C, skin rolling, cupping, talk therapy

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TCM Pattern Differentiation
(source: http://www.dynamicchiropractic.com/mpacms/at/article.php?id=30049)

**Liver //Qi// Stagnation**
anxiety, emotional upset, headaches (including migraine headache), being easily angered, muscle stiffness in neck and shoulders, insomnia, waking frequently and having difficulty falling back to sleep, irritable bowel syndrome. All symptoms may be triggered by emotional stress.
 * Tongue: slightly dusky or slightly puffy
 * Pulse: wiry/bowstring or slippery
 * Treatment plan: smooth liver, move //qi// and blood
 * Herbal Treatment: modifications based on //xiao yao wan// or //shu gan wan//
 * Acupuncture points: //yin tang//, LI 4, LV 3, GB 34, //an mian//, ren 17, ren 12, ST 25, SP 6, UB 18, 19, and 20
 * Ear points: //shen men//, liver, sympathetic

**//Qi// and Blood Deficiency**
specifically spleen //qi// deficiency and heart blood/liver blood deficiency, with such symptoms as chronic fatigue, exhaustion, dull headache, muscle weakness and numbness, insomnia, dream-disturbed sleep and waking up tired, palpitations and depression.
 * Tongue: pale, with thin white fur
 * Pulse: thready, weak and deep. This pattern eventually creates pattern #3 below.
 * Treatment plan: tonify //qi// and blood, calm the spirit
 * Chinese medicine: modifications based on //ba zhen tang// or //gui pi tang// or //gan mai da zao tang//
 * Acupuncture points: LI 4, ST 36, ren 12, SP 6, 10, PC 6, HT 6, 7, Kid 3, and UB 17, 20
 * Ear points: adrenal, endocrine, heart, spleen

**//Qi// Stagnation and Blood Stasis**
aches and pains in the whole body, burning or gnawing pain with tingling sensations in extremities, headaches.
 * Tongue: purple, dusky
 * Pulse: wiry or irregular
 * Treatment plan: move the //qi// and blood, alleviate pain
 * Chinese medicine: modifications based on //shen tong zhu yu tang// or //tao hong si wu tang//
 * Acupuncture points: DU 20, LI 4, 10, ST 36, SP 9, 10, LV 3, PC 6, UB 17, 18
 * Ear points: //shen men//, adrenal, subcortex.

**Kidney Deficiency (either Yin, Yang, //Qi// or Essence Deficiency)**
there will be impotence or lack of libido for males and infertility issues for both males and females. Other symptoms: sore lower back with restless leg syndrome, irritable bladder, dysmenorrhea, amenorrhea, premenstrual syndrome, hot flashes and night sweats. Fibromyalgia doesn't seem to affect the lung so often, as there are few lung symptoms associated with fibromyalgia such as chest tightness, or shortness of breath in a few cases.
 * Tongue: pale or dry, with cracks
 * Pulse: thin, weak and deep
 * Treatment plan: tonify //qi//, tonify essence and yang, and nourish yin
 * Chinese medicine: modifications based on //you /zuo gui yin// (//wan//), //jin gui sheng qi wan//, //jin suo gu jing wan//
 * Acupuncture points: ren 3, 4, 6, LI 11, LV 2, GB 39, Kid 3, 6, 7, SP6, and UB 23, 31
 * Ear points: adrenal, endocrine, kidney

**Particular Herbs**
Ye Jiao Teng

**Special Acupuncture Points**

 * 1) **//Ashi// points:** Use any tender points that the patient has along with any of the following points listed below. There are a total of 18 tender point sites that may present in fibromyalgia, which are located in Figure 1. Note that the points are in groups of three, so they are referred to as "three points" along with the body area's name (for example, "the three arm points").
 * 2) **Headache (includes migraines):** For frontal/temple headache, GB 14, //tai yang// and //yin tang// or //er zhong// (above //yin tang//, in line with GB14). For vertex headache: Du 20 and //si shen cong//. You can do a variation of //si shen cong// by putting the needles 1.5 //cun// out from Du 20 (//si shen cong// is 1 //cun// out from DU 20). Occipital headache: UB10, DU17 and GB20.
 * 3) **Neck pain:** UB 11, GB 20 and //bai lao//.
 * 4) **Shoulder pain:** LI 15, and two experienced points: point A, 2 //cun// anterior to LI 15 under the clavicle, and point B, 2 //cun// posterior to LI 15 on the back (half way between SJ 14 and LI 16).
 * 5) **Arm pain:** LI 11, SJ 5 and LI 4.
 * 6) **Upper back pain:** UB 11, UB 17, SI 12
 * 7) **Lower back pain:** UB 23, UB 25 and UB 52
 * 8) **Leg pain:** ST 36, SP 6, GB 30
 * 9) **Thigh pain:** SP 10, SP 11/ST 31 and ST 32
 * 10) **For any tight muscle:** release the muscle with three needles - one at each insertion and one in the middle of the muscle.

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IBIS:

Definition:
• Widespread pain, tenderness and stiffness of muscles, tendons, ligaments of greater than 3 months duration, usually accompanied by fatigue and anxiety or depression.

• Fibromyalgia is a complex syndrome with no known cause or cure. Its predominant symptom is severe muscle pain, although other symptoms, such as fatigue, headaches, chest pain, low grade fever, swollen lymph nodes, unrestful sleep or insomnia, frequent abdominal pain, irritable bowel syndrome, anxiety, and depression may be involved.

• Fibromyalgia represents group of common nonarticular rheumatic disorders characterized by achy pain, tenderness, and stiffness of muscles, areas of tendon insertions, and adjacent soft-tissue structures. These may be primary and generalized or concomitant with another associated or underlying condition, or localized and often related to overuse or microtrauma factors. The term myalgia indicates muscular pain. In contrast, myositis is due to inflammation of muscle tissues and is an inappropriate term for fibromyalgia, when such inflammation is absent. Fibromyalgia indicates pain in fibrous tissues, muscles, tendons, ligaments, and other "white" connective tissues. Various combinations of these conditions may occur together as muscular rheumatism. Any of the fibromuscular tissues may be involved, but those of the occiput, low back (lumbago), neck (neck pain or spasm), shoulders, thorax (pleurodynia), and thighs (aches and spasms) are especially affected. There is no specific histologic abnormality, and the absence of cellular inflammation justifies the preferred terminology of fibromyalgia rather than the older terms of fibrositis or fibromyositis.

Etiology:
• Of the estimated three to six million people afflicted with this disorder, the majority are women between 25-45 years old, with females out-numbering males by 6:1. The patients tend to present as stressed, tense, depressed, anxious, and/or striving. It may be induced or intensified by physical or mental stress, chronic overwork, poor sleep or sleep disorders, physical or emotional trauma, depression, exposure to dampness or cold, and occasionally by a systemic, usually rheumatic, disorder. A viral or other systemic infection (e.g., Lyme disease) may precipitate the syndrome in an otherwise predisposed host. Patients often trace the onset of symptoms to an acute event or viral-like illness. Fibromyalgia may also be a complication of hypothyroidism. Men are more likely to develop localized fibromyalgia in association with a particular occupational or recreational strain or as a complication of sleep apnea. A minority of cases may be associated with significant psychogenic or psychophysiologic manifestations. Symptoms can be exacerbated by environmental or emotional stress, or by a physician who does not give proper credence to the patient's concerns and dismisses the distress as "all in the head."

• A variety of metabolic factors have been presented as playing important roles in the causality of this syndrome. No conclusive pattern has been proven responsible for all occurrences of this disorder and a multifactorial causality is more likely predominant than the exception.

• Some research now indicates that fibromyalgia patients may be deficient in certain compounds required for the synthesis of adenosine triphosphate (ATP). ATP synthesis requires the presence of oxygen, magnesium, substrate, ADP and phosphate. Optimal concentrations of each of these allows healthy mitochondrial respiration and the concomitant production of biological energy. Deficiencies, on the other hand can seriously slow the Krebs cycle, increase anaerobic glycolysis, increase lactic acid formation and cause a reduction of Max V02. This combination of factors can clearly lead to the symptoms of fatigue. depression and muscle pain.

• Pain in fibromyalgia patients has been attributed to an unusually high degree of gluconeogenesis. This increased level of muscle tissue breakdown has been hypothesized as one of the main reasons for pain, aching and fatigue.

• Serotonin and dopamine imbalances may constitute a major factor in fibromyalgia. Here, as in many other factors leading to fatigue and inflammation, increased permeability of the intestinal mucous membranes may play a crucial role; 80% of serotonin is produced in a healthy gut. Consequently a history of repeated courses of antibiotics, especially in the 6-12 months prior to onset, may be significant.

• Aluminum toxicity may play a role in symptoms experienced by magnesium deficient fibromyalgia patients since magnesium is needed to help the body block the toxic effects of aluminum. This is especially important since aluminum inhibits glycolysis and oxidative phosphorylation, resulting in decreased intramitochondrial ATP production. Additionally, due to its high affinity for phosphate groups, aluminum blocks the absorption and utilization of phosphates vital to the synthesis of ATP. This further contributes to the problem of intramitochondrial phosphate deficiency.

• Fatigue is one of the most prominent features of fibromyalgia syndrome, and studies show that both chronic fatigue syndrome and fibromyalgia may have a common link in manganese-dependent neuroendocrine changes, especially along the hypothalamic-pituitary thyroid axis. The cycle begins with hypothalamic production of thyrotrophin-releasing hormone (TRH). TRH stimulates the pituitary gland to produce thyroid stimulating hormone (TSH), which in turn stimulates thyroid production of thyroxin.

• Several studies conducted in Sweden on patients with fibromyalgia reported appear to have microcirculation disturbances, along with mitochondrial damage and abnormally low phosphate counts - strongly suggesting an energy deficient state in the muscle tissues. At the conclusion of the study, scientists hypothesized that fibromyalgia might be the result of any condition that could lead to constant muscle hypoxia, specifically through the establishment of abnormal motor patterns.

Somatic Therapies:
• Low intensity exercise may improve fibromyalgia symptoms, and patients who exercise regularly suffer less severe symptoms than patients who remain sedentary. (Wilke, W, p. 153-170; Carette, S., p. 590-594; Mengshail, AM, et al, p. 345-349) • stretching exercises: for affected areas • ROM exercises: for affected areas • relaxation breathing

Nutrition:
eating principles: • elimination/rotation diet, rotation diet, rotation diet expanded • anti-candida diet: eliminate sugar, fruit juices, vinegar, yeast and fermented products high fiber • decrease use of stimulants, especially caffeine sources

therapeutic foods: • foods that tonify the Kidney, nourish Xue (Blood) • foods rich in bioflavonoids, Zinc, Vitamins E, C and B-complex • garlic, onions • meat, beans • olives, rye, lima beans, rice bran, bananas, sprouts, watercress, apples (Jensen, p. 61)

fresh juices: • potato peeling broth (Jensen, p. 61) • dried olive tea (Jensen, p. 61) • nut milk and liquid chlorophyll (Jensen, p. 61) • carrot (Walker, p. 137) • carrot and spinach (Jensen, p. 61) • carrot, beet, and cucumber (Walker, p. 137) • carrot and celery (Shefi) • celery and sour apple (Shefi)

avoid: • food intolerances • coffee, caffeine, sugar, refined foods, processed foods, sweets and candies, stress

Botanicals
• Avena sativa: nerve tonic, nervous exhaustion, low fevers, nutritive for convalescence (Felter and Lloyd, p. 316) • Beta vulgaris: general stimulant, resistance-enhancing effect; large amounts (1 liter) of juice taken for months; may cause nausea (Weiss, p. 232) • Echinacea spp.: antiviral; immune stimulant, enhances resistance to infection (Weiss, p. 229) • Eupatorium perfoliatum: enhances resistance to infection (Weiss, p. 229); specific for generalized sensation of deep ache (Boericke, p. 274-275) • Eleutherococcus senticosus: adaptogenic effects to reduce effects of stress and facilitate adrenal revitalization, 2-3 g per day, divided doses; continuously for 6-8 weeks, followed by a 1-2 week break before resuming (Brown, p. 69-77); occasionally, may cause overstimulation, gastrointestinal upset, and possibly insomnia; best to avoid caffeine • Glycyrrhiza glabra: Licorice products without the glycyrrhizin removed may increase blood pressure and cause water retention. Some people are more sensitive to this effect that others. Long term intake more than 1 gram of glycyrrhizin (which is the amount in approximately 10 g of root) daily is the usual amount required to cause these effects. As a result of these possible side effects, long term intake of high levels of glycyrrhizin are discouraged and should only be undertaken if prescribed by a qualified health care professional. Deglycyrrhizinated licorice extracts do not cause these side effects. • Hypericum perforatum: MAO action leads to increased levels of norepinephrine in the brain, for depression aspects, 200-300 mg three times daily • Panax ginseng : 1-2 g per day, if using crude, non-standardized extracts, divided doses; continuously for 2-3 weeks, followed by a 1-2 week break before resuming (Brown, p. 137); occasionally, may cause overstimulation, gastrointestinal upset, and possibly insomnia; best to avoid caffeine; contraindicated with uncontrolled high blood pressure and for pregnant or lactating women; extended use may cause menstrual abnormalities and breast tenderness in some women.

Chinese Formulae
· Compound GL (patent) with Clematis 19 (patent): fibromyalgia (Dharmananda, 1992, p. 101) · Tang Kuei and Jujube C. (Dang Gui Si Ni Tang): Cold in the Channels with Xue Xu (Blood Deficiency): cold hands and feet, fibromyalgia (Hsu, 1980, p. 321; Yeung, p. 79; Bensky and Barolet, p. 216) · Bupleurum and Cinnamon C. (Chai Hu Gui Zhi Tang); Bupleurum 12 (patent): Liver Qi Stagnation, weak constitution (Bupleurum and Cinnamon: Hsu, 1980, p. 117; Dharmananda, 1986, p. 134; Bensky and Barolet, p. 138; Bupleurum 12: Dharmananda, 1990, p. 39) · Ren Shen Lu Rong Wan (patent) plus Tai Pan Tang Yi Pian (Placenta Sugar Coated Tablets) (patent): Kidney Yang Xu (Deficiency) with Kidney Jing Xu (Essence Deficiency) (Zhu, p. 292 and 265) · Ci Wu Jia Pian (patent): Kidney Qi Xu (Deficiency) with Kidney Jing Xu (Essence Deficiency): decreased immunity (Zhu, p. 284) · Rehmannia Eight F. (Jin Gui Shen Qi Wan); Quan Lu Wan (patent): Kidney Yang Xu (Deficiency) with Kidney Yin Xu (Deficiency): low back pain, weak lower extremities, pale swollen tongue (Hsu, 1980, p. 250; Yeung, p. 138; Dharmananda, 1986, p. 173; Bensky and Barolet, p. 275; Quan Lu Wan: Zhu, p. 307) · Ling Zhi Feng Wang Jiang (patent): Qi Xu (Deficiency) with Xue Xu (Blood Deficiency) (Zhu, p. 262) · Ginseng Nutritive C. (Ren Shen Yang Rong Tang); Tang Kuei Four C. (Si Wu Tang): Xue Xu (Blood Deficiency): forgetfulness, feverishness, reduced appetite, fatigue, weight loss, dry skin, dizziness, irregular menstruation (Ginseng: Hsu, 1980, p. 239; Yeung, p. 182; Dharmananda, 1986, p. 407; Bensky and Barolet, p. 260; Tang Kuei: Hsu, 1980, p. 433; Yeung, p. 220; Dharmananda, 1986, p. 327; Bensky and Barolet, p. 248) · Ginseng and Longan C. (Gui Pi Tang): Spleen Qi Xu (Deficiency) with Heart Xue Xu (Blood Deficiency): forgetfulness, insomnia, dream-disturbed sleep, reduced appetite, pale tongue (Hsu, 1980, p. 425; Yeung, p. 112; Dharmananda, 1986, p. 244; Bensky and Barolet, p. 255) · Composition A (patent): Kidney Yin Xu (Deficiency) with Kidney Yang Xu (Deficiency) (Dharmananda, 1990, p. 82) · Antler 8 (patent); Gecko A (patent): Kidney Yang Xu (Deficiency) (Dharmananda, 1990: Antler 8, p. 10: Gecko A, p. 17) · Ginseng 18 (patent): Spleen Qi Xu (Deficiency): loose stool, low body weight (Dharmananda, 1990, p. 19) · Ganoderma 18 (patent): Qi Xu (Deficiency), Kidney Yin Xu (Deficiency), Kidney Yang Xu (Deficiency) and Xue Xu (Blood Deficiency) (Dharmananda, 1990, p. 16)

Acupuncture
after assessing the person and palpating, consider these patterns: Liver Qi Stagnation/Constraint; Qi Stagnation and Xue Yu (Blood Stasis); Spleen Xu (Deficiency); Kidney Xu (Deficiency); Xue Xu (Blood Deficiency); Jing Xu (Essence Deficiency); Cold in the Channels with Damp-Heat; dysfunction of the Chong Mai (Penetrating Vessel); dysfunction of the Yang Qiao Mai (Yang Motility Vessel) and/or Yin Qiao Mai (Yin Motility Vessel)

» therapeutic notes: • Avoid long retention of needles unless Constrained Liver Qi is predominant and even then watch not to sedate excessively. Use very light stimulus. Patient should barely feel needles. (Ambrose) • Abdominal palpation valuable for assessing involvement and dysfunction of Extraordinary Vessels, which is quite common in this syndrome • Fibromyalgia may be a part of a general pattern of glandular/lymphatic exhaustion that can often be rooted in or at least exacerbated by a chronic, often subclinical, infection in the sinuses and irritation in the oropharyngeal mucous membranes. This area is a common site of primary focal infection from which secondary infections derive. Palpation at reflex sites in proximity of TW-16 ("East Wind") and LI-10.5 and above and below the eyes will confirm this hypothesis. If tender and/or painful points are found, consider needling Lu-7 and the reactive points in the areas of "LI-10.5", "St-2.5", yu yao, east wind/TW-16, and "St-43". Sinus irrigation with saline solution is usually also helpful - see "patient handout: sinus wash". (Matsumoto) See also "sinusitis".

» illustrative combinations: • Lv-3 and LI-4: open the Four Gates; expel Wind, stop pain; regulate Qi and Xue (Blood) circulation; remove Obstruction of the channels; open the Orifices; release bodily tension; relax clenching of jaws; free constraint; calm the mind; relieve mental cloudiness; provide sedative and analgesic effect; pacify Liver Yang (Finkelstein, p. 7; Flaws, 1989, p. 76) • LI-11, LI-4, PC-6, TW-5, LI-15, GB-21 and local points to facilitate the flow of Qi and Xue (Blood): to disperse Stagnation in the lower limbs (Eisen) • GB-30, GB-31, St-32, Sp-10, St-36, GB-34 and local points to facilitate the flow of Qi and Xue (Blood): to disperse Stagnation in the upper limbs (Eisen) • CV-8 (ginger moxa); UB-23, GV-4, LI-4, Lv-3, LI-11, St-36, CV-12, UB-38/43 and left TW-4 for neurasthenia (McWilliams, et al., Lesson 31, p. 158) • PC-6 after Sp-4 (=): activate Chong Mai (Penetrating Vessel) to regulate digestion and nourish Xue (Blood); Master and Couple points of the Chong Mai (Penetrating Vessel) • TW-5 and GB-41: open the Yang Wei Mai (Yang Linking Vessel) for which loss of strength, esp. during rainy or cold weather, is a symptom of Xu (Deficiency) • UB-62 and SI-3: open and regulate the Yang Qiao Mai (Yang Motility Vessel) which regulates muscular activity, esp. with flaccidity of the muscles of the medial aspect of the lower extremity and spasm of the lateral aspect • Kd-6 and Lu-7: open and regulate the Yin Qiao Mai (Yin Motility Vessel) which regulates muscular activity, esp. with Shi (Excess) of the Yang channels or flaccidity of the muscles of the lateral aspect of the lower extremity and spasm of the medial aspect • Kd-6 and Kd-27 (+): tonify Kidney Qi and strengthen adrenal glands (Matsumoto) • CV-4 and St-36: tonify the Spleen and Kidney to strengthen the vitality (Finkelstein, p. 85) • CV-4, CV-6 and UB-54/40: "address vacuity", i.e., Xu (Deficiency) (Ellis, et al, 1988, p. 220) • Sp-2, Kd-7, PC-7 and CV-6 (+) for lack of Will Power (McWilliams, et al., Lesson 31, p. 160) • PC-6, Ht-7, yin tang (threaded inferiorly), an mian, St-36 and Kd-3 (also consider GB-20, GV-20, TW-23, CV-12, UB-20, UB-18, Sp-6, UB-18, Sp-6, UB-15, UB-23, GV-4, CV-4, CV-6, Lv-2 and PC-4) for neurasthenia (Lee and Cheung, p. 305) an mian, Ht-7 and PC-6 (also consider yi ming, St-36 and Sp-6) for neurasthenia (Lee and Cheung, p. 305) • GB-20, UB-11, UB-22, CV-4, PC-6, St-36 and UB-15; alternate with UB-10, GV-12, UB-14, UB-23, CV-6, Ht-5 and Sp-6 for neurasthenia (Lee and Cheung, p. 305) • "yu yao", "St-2.5", "east wind", "LI-10.5", Lu-7, and "St-43", with other points sensitive to palpation, for sinusitis and glandular/lymphatic exhaustion, esp. with a primary focal infection in the sinuses and oropharyngeal mucous membranes (Matsumoto) • UB-38/43, CV-4 and St-36 (D) for general weakness caused by prolonged illness (Shanghai, p. 201) • Kd-3, Sp-6, LI-4, GB-20 and Lv-2: reinforce the Kidney and nourishes Yin (Finkelstein, p. 53) • Kd-3 and UB-23: nourish Kidney Yin and facilitates Jing (Essence) (Finkelstein, p. 53) • Kd-3, UB-23 and UB-15: adjust disharmony of the Heart and Kidney (Finkelstein, p. 53) • Kd-3, UB-23, GV-4 and CV-4 (all: D): support Kidney Yang (Finkelstein, p. 53) • Kd-6, Kd-7 and Sp-6: nourish Yin and moistens dryness (Finkelstein, p. 54) • GB-34 and CV-12 (+): strengthen the Spleen and Stomach to help transportation and transformation of water and cereals to support body resistance (Zheng Qi) (Finkelstein, p. 69) • CV-12 and Sp-4: treat lack of appetite (Finkelstein, p. 89) • St-36, CV-4 and CV-6: restore the primary Qi (Finkelstein, p. 20) • St-36, Ht-7 and Sp-6: strengthen the Spleen; regulate the circulation of Qi; control the Xue (Blood); and calm the Shen (Flaws, 1989, p. 87) • St-36 and Sp-6: regulate the Spleen and Stomach; nourish the Xue (Blood); descend Rebellious Qi; cultivate the growing source of Qi and Xue (Blood); treat Xu (Deficiency) Cold conditions of the Spleen and Stomach; and ease the Mind (Finkelstein, p. 19) • St-36, Sp-6 and UB-20: invigorate the Spleen and benefit the Root of Post-Natal Qi and Xue (Blood) (Flaws, 1989, p. 70; Finkelstein, p. 19) • St-36 and Kd-3: regulate the Qi of the Liver, Spleen and Kidney (Finkelstein, p. 20) • St-36, CV-12 and Sp-6: tonify the Spleen; regulate the Qi; control the Xue (Blood); and treat Spleen Xu (Deficiency) syndrome (Flaws, 1989, p. 87; Finkelstein, p. 20) • St-36 and CV-4: tonify Spleen and Kidney to strengthen vitality (Finkelstein, p. 20) • St-36, LI-4 and Lu-7: tonify the essential Qi to strengthen Ying (Constructive) and Wei (Protective) Qi (Finkelstein, p. 20) • CV-12, CV-10 and CV-13: tonify the whole body Yang via the Triple Warmer (Finkelstein, p. 90) • CV-12, UB-20, Sp-3 and Lv-13 (+ and D): invigorate Spleen Yang (Finkelstein, p. 90) • Lu-7 -> Lu-8 with threading along superior border of the clavicle: to release scalene muscles (Matsumoto)

Homeopathy
• Aesculus hippocastanum: glandular swellings of bone; sore muscles, < morning on awakening and on motion; spasms of muscles and limbs • Arnica montana: myalgia, particularly after overexertion; bruised feeling in whole body; soreness in the limbs • Bryonia: irritable and hypersensitive to stimuli; soreness appears to be in sheath of tendon, but principally in periosteum and ligaments; < motion • Calcarea fluorica: > motion amel., < rest; > warmth in all ways; induration of glands, muscles, tendons, bones • Human Growth Hormone: tired and achy all over; often 30X, per day-twice daily • Ignatia: emotionally sensitive; trouble making world match their ideals; hysterical; effects of grief, worry, shocks and disappointment • Natrum muriaticum: grief; sad and weepy mood without cause; consolation aggravates; hypochondriacal • Nux vomica: workaholic, idealistic, expect a lot of themselves; ailments from prolonged physical or mental work; anger • Rhus toxicodendron: ailments from strains, overlifting, getting wet while perspiring; inflammation of tendons of muscles; inflammation and swelling of long bones; soreness and stiffness in muscles; better continued motion • Ruta graveolens: periostitis and pains in consequence of external injury; with erysipelatous inflammation of parts; bruised feeling all over as from a fall or blow; < in limbs and joints; pain in long bones as if they were broken • Silicea: chilly and lethargic; cellular tissues inflamed; inflammation of fibrous portions of joints, particularly the knee

tissue remedies of Schüssler » mental state and affections » energy want of: Kali phos. » want of nerve power; prostration, exertion, loss of mental vigor, depression, loss of memory

Subtle Support
pain: • Mendelssohn's Spring Song • Meditation from Thais • Chopin's Preludes • On Wings of Song • Andante, Beethoven's Fifth Symphony • Adagio, Beethoven's Pathetique Symphony (Heline, p. 18)

musculoskeletal: • Sousa's marches • The Anvil Chorus • William Tell Overture • Brahm's Hungarian Dances • By the Waters of the Minnetonka (Heline, p. 18)

mental/emotional: • rhythmic folk songs • County Derry • songs of Steven Foster • Spanish tangos • Brahms' Hungarian dances • Sousa's marches • Strauss' waltzes • Gilbert and Sullivan • Indian Love Call • My Wild Irish Rose • Wishing • Estrellita (Heline, p.18)

Mind/Body
• Chronic pain syndrome develops as a result of having chronically negative attitudes and/or unconscious emotional response mechanisms that keep a person continually in stress. Chronic attitude problems are so much a part of a person's self-image that he or she does not recognize them as separate from the personality. Nothing is more difficult to identify than our assumed 'natural' ways of being in the world that are essentially patterns we have developed to help us cope. Certain body parts susceptible to chronic negative patterns include the spine, the stomach (as in ulcers), and the head (tension and migraine headaches). (Shealy, p. 256-266) • 6:1 in females; 25-50 years old, who tend to present as stressed, tense, depressed, anxious, striving • Stiffness represents thinking in a rigid, stiff manner. (Hay, 1984, p. 184) • Low intensity exercise may improve fibromyalgia symptoms, and patients who exercise regularly suffer less severe symptoms than patients who remain sedentary. (Wilke, W, p. 153-170; Carette, S, p. 590-594; Mengshail, AM, et al, p. 345-349) • Inflammation: fear; inflamed thinking; seeing red; anger and frustration about conditions in one's life. (Hay, 1984, p. 170-171) • Overwhelming life circumstances. (Epstein, p. 103) • Emotional needs repeatedly violated; in unproductive relationship patterns where needs not met; "sick and tired of whole situation" feel incapable of challenging source through which anxiety is generated, primarily due to fear of rejection; dynamic of emotional violation; insecurity, inability to challenge, followed by inability to speak up followed by more violation. (Shealy, p. 212) • Resistance, boredom; lack of love for what one does. (Hay, 1984, p. 164)

• Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores and cleanses the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); controls the muscles, ligaments, and tendons, especially the contractility of the muscles and moistening of the sinews; and reflects emotional harmony and movement. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Xu (Deficiency) signs include impotence; frigidity; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry eyes, skin, and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down. Liver Xue Xu (Blood Deficiency) predisposes to Xue Yu (Blood Stasis). » Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216) Xue Yu (Blood Stasis) often begins with Qi Stagnation. » Mental signs of Liver channel disorders include irritability; difficulty developing ideas; depression; and lack of energy. (Seem, p. 28)
 * Chinese psychophysiology:**

• Gall Bladder ~ Dan is the source of courage and initiative, and is responsible for decision-making as the bodily Minister of Justice; controls circulation of the nourishing and protecting energies [Ying Qi and Wei (Protective) Qi]; and expresses itself through the sinews (ligaments and tendons). Its channel purifies Yang energy in the body. » Healthy expressions are kindness, decisiveness, control, and spirit of initiative. » Gall Bladder Xu (Deficiency) signs include insomnia; wandering pains; chest and side pains; swollen breasts (Seem, p. 29); weakness in muscles and tendons of the legs; difficulty standing; asthenia; vertigo; chills; timidity; cowardice; indecisiveness; and excessive sighing.

• San Jiao ~ Triple Warmer regulates the relations among the three regions roughly delimited by the chest, abdomen, and pelvis; influences the supply of Xue (Blood), Qi and Fluids; is the source of Wei (Protective) Qi; and relates to the function of heat regulation. » Mental signs of Triple Warmer channel disorders include emotional upsets caused by breaking of friendships or family relations; depression; suspicion; anxiety; poor elimination of harmful thoughts. (Seem, p. 28)

• Spleen ~ Pi governs digestion and manifests in the muscle tissues; transforms food into Qi and Xue (Blood); governs the Xue (Blood); resolves Dampness, and relates to the ability to assimilate, stabilize, and feel balanced and centered. » Healthy expressions are fairness, openness, deep thinking, and reminiscence; » Spleen Xu (Deficiency) signs include slightness (deficient "form"); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; easy bruising; pale lips; loose stools; and muscular weakness. » The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen. This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise, overexposure to external Dampness, and excess consumption of sweet and/or Cold foods will also deplete the Spleen. » Mental signs of Spleen channel disorders include mental sluggishness; vertigo; melancholia; obsessions turned toward the past; fixed and rigid ideas; sleepwalking; agitated sleep; and nightmares. (Seem, p. 27)

• Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Zhi (Will) and supports the core vitality; expresses ambition and focus; produces the bone marrow and thereby much of the immune system; and displays the effects of aging, chronic degenerative processes, and extreme stress. » Healthy expressions are gentleness, groundedness, and endurance. » Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); hearing loss; fearfulness; apathy; chronic fatigue; discouragement; scatteredness; lack of will; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch. » Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency). » Mental signs of Kidney channel disorders include anxiety; fear in the pit of the stomach; sadness; mental and physical fatigue; antisocial tendencies; and laziness. (Seem, p. 28)

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Recommended Minerals
-Magnesium

Orthomolecular Treatment
-Tryptophan -5-HTP -SAMe