Dr.Vasishth's

APPLIED AYURVEDIC MANAGEMENT OF FIBROMYALGIA

फ़ायब्रो-माइयल्जिया का व्यावहारिक आयुर्वैदिक उपचार

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Dr. Brijbala Vasishth MD (Ay-Kayachikitsa)

Dr. Sunil Vasishth MD (Ay-Kayachikitsa), PhD (Hridroga)

Fibromyalgia (मनोदैहिक सर्वांग-रुक्) is a chronic psycho-somatic disease characterized by generalised pain (सर्वांग-रुक्), allodynia (स्पर्श-असह्यता), and many other physical (दैहिक) and psychological (मानसिक) troubles.     

CAUSES (हेतवः)

Many factors seem to result in Fibromyalgia (मनोदैहिक सर्वांग-रुक्) – 

• Psychological factors (मनोहेतवः) – long-term mental stress, anxiety, depression

• Defective genes (बीजदुष्टि)

• Physical inactivity (अचेष्टा) – Poor or low physical activity

• Trauma (आघात) and post-traumatic stress (aghatottar mano-aghat) disorder

• Diseases (रोगाः) – obesity (स्थौल्यः), chronic fatigue syndrome (जीर्ण श्रम-क्लमः), IBS (क्षुब्धान्त्रः), depression (मनोअवसादः) 

• Poor sleep (हीन-निद्रा)

• Auto-immune process (आमविषः)

PATHO-PHYSIOLOGY (सम्प्राप्ति:)

Acting in a wide variety of mechanisms, the causative factors mentioned above, result in several abnormalities that ultimately result in Fibromyalgia (मनोदैहिक सर्वांग-रुक्). These include – 

1. Fibromyalgia (मनोदैहिक सर्वांग-रुक्) seems to originate from higher brain centers (प्राणवातः), hypothalamic pituitary axis (उदानवातः), and autonomic centers (व्यानवातः) resulting in dysfunction in the cognition, sensory, and motor fucntions. 

2. Dysfunction in the cognition (धी-धृति-स्मृति विभ्रंशः) affects the concentration, memory (स्मृतिह्रासः), speed of performance, ability to multi-task (बहु-क्रियाह्रासः).

3. Involvement of the sensory areas results in lowering the threshold for pain sensitivity decreases (50%), with the result that many stimuli well tolerated normally evoke pain response.

4. Involvement of the motor areas result in fatigue, weakness of the muscles of the limbs, generalized muscular weakness, muscular cramps / twitchings, and prolonged muscle spasm.

DIAGNOSIS (निदानः)

FM is diagnosed on the basis of the following symptoms - 

• Sensory dysfunction (ज्ञानेन्द्रिय-वैषम्यः) – generalized pain (सर्वांग वेदना), allodynia (स्पर्श-असह्यता), paresthesia (तोदः)

• Motor dysfunction (कर्मेन्दिय-वैषम्यः) – fatigue (श्रमः, क्लमः), prolonged muscle spasms (दीर्घ-मांसपेशी-आक्षेपः), muscle twitchings (मांस-धातु-स्फुरणं), limb  weakness (बाहु-सक्थि दौर्बल्यः)

• Cognitive dysfunction (धी-धृति-स्मृति विभ्रंशः) - 

impaired concentration / diminished attention span (विक्षिप्त चित्तः), poor memory (स्मृति-ह्रासः), impaired speed of performance (गति-शैथिल्यः), Inability to multi-task (बहु-क्रिया-ह्रासः)

• Disturbed sleep (बाधित-निद्रा) 

• Palpitation (हृद्-दरः), IBS (क्षुब्धान्त्र), genito-urinary symptoms (मूत्र / प्रजननांग-गत विकृति), low blood sugar (रक्त-माधुर्य-ह्रासः), rheumatoid arthritis (आमवातः), SLE (साम-वातरक्तः)

MANAGEMENT (उपचार:)

The management of fibromyalgia (मनोदैहिक सर्वांग-रुक्) needs a higly individualistic approach as per the underlying etio-pathology. Common used groups of drugs in this disease, include -

1. Medhya Drugs (मेध्य औषधयः)

Based on the strong evidence of the involvement of mind in the causation and progression of fibromyalgia (मनोदैहिक सर्वांग-रुक्), it is advisable to prescribe notropic drugs (मेध्य रसायना:) to the patient in a judicious manner, as follows -

i. In a significant number of patients of fibromyalgia (मनोदैहिक सर्वांग-रुक्), mental depression being the major etio-pathologic factor, it is highly desirable to prescribe anti-depressant drugs (मनोबल्य औषधयः). The effective drugs in this group include - Jyotishmati, Akarkara, Vacha, Gandira (Eleva Tab), Kapikachhu, Ashvagandha, Shilajatu, Yashad (Higro Tab). 

ii. In another group of patients, the underlying anxiety, mental stress, and irritability are the significant etio-pathologic factors. Such patients should be managed with anti-anxiety drugs (मनःशामक औषधयः). The effective drugs in this group include – Tagar, Brahmi (Mentocalm Tab), Shankhpushpi, Mandukparni, Jatamansi.  

2. Immuno-modulator Drugs (आमविषहर औषधयः)

Recent research indicates the involvement of auto-immune process in the development of FM. Use ama-visha-hara (immune-modulator) drugs that help antagoinze the ama-visha (modulate the immunity) may thus be helpful in the related patients. Commonly used drugs, include - 

i.  Ashwagandha, Guduchi, Tulasi, Pippali, Yashad (Imunie Tab).

ii. Bhallatak (RevPlaq Tab, Antivir Tab), Bhumi-amalaki (Phylocil Tab, Livie Tab), Guduchi, Chitrak, Shunthi, Katuki, Suvarna (Suvarnaprashan).

iii. Tamra(-bhasma), Malla(sindur), Tulasi(-swaras), Pippali(-churna), Shilajatu (Shilajatvadi vati), Yashad(-bhasma), Parad (Ras sindur).

3. Analgesic Drugs (वेदनाहर/वातहर औषधयः)

The sensory symptoms – pain, allodynia, paraesthesias - in FM are suggestive of the underlying neuro-endocrine dysfunction (vata-dushti). In order to offer reliefe to the patient in the sensory symptoms, it is therefore important to prescribe drugs that harmonize the neuro-endocrine activity (vata-dosha) and reduce the vedana (pain) due to their vata-hara (blocking pain signals) activity. Commonly used drugs in this group include - 

i. Tagar, Parsika-yavani, Jatiphal, Rakta-marich (DeAlco tab)

ii Jatiphal, Vatsanabh, Godanti (Dolid tab, Maha-vata-vidhwansana rasa, Hinguleshwar rasa)

iii. Shallaki, Erandmula (Loswel Tab), Pippalimula, Guggulu.  

4. Lifestyle modifications (पथ्य-अपथ्यः)

Following non-drug measures and lifestyle modifications have been seen to help in the management of FM – 

i. Exercise (व्यायामः) – Different types of exercises – cardiovascular exercise, aerobic exercise, high-intensity resistance training – have been seen to improve quality of life, and offer relief in pain and fatigue. The exercise should be started with small, frequent exercise periods, and gradually increased in intensity and duration.       

ii. Bio-energy regulation (प्राणायामः) 

iii. Stretching & Relaxation (योगासनाः) 

iv. Meditation (समाधि) 

v. Music therapy (संगीत-उपचारः) 

vi. Art therapy (कला-उपचारः) 

vii. Dietary regulations (आहार-उपचारः) – Vata-vardhak ahar should be avoided. 

5. Psychotherapy (मनःचिकित्सा)

Psycho-therapy (मनःचिकित्सा) given as follows, too have been seen to help in the management of FM – 

i. Thought control (सत्वावजयः) 

ii. Ressurance (आश्वासनम्) 

iii. Do’ and don’ts (यम-नियमः) 

iv. Code of conduct (सद्वृत्तः)

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Released for the information of AYUSH doctors, by:

Dr.Vasishth's AyuRemedies

डाॅ.वसिष्ठस् आयुरैमॅडीज़

Ahmedabad, Gujarat, Bharat 

M. 9419205439, 7043003374

Email: dvfiblon@gmail.com 

Website: www.drvasishths.com