WhatsApp Discussion series 25 : Fibromyalgia by Vd. Prathamesh Karpe, Dr. Pawan Madan, Dr. Pawan Rajain, Dr. Anita Gayatri, Vd. Jui Shahane & Others

[16/10, 6:23 PM] Dr. Surendra A. Soni:

Fibromyalgia (FM) is a medical condition characterised by chronic widespread pain and a heightened pain response to pressure.

[2]Other symptoms include feeling tired to a degree that normal activities are affected,sleep problems, and troubles with memory.

[3]Some people also report restless legs syndrome, bowel or bladder problems,numbness and tingling, and sensitivity to noise, lights or temperature.

[4] Fibromyalgia is frequently associated with depression,anxiety, and post-traumatic stress disorder. Other types of chronic pain are also frequently present.

[5]The cause of fibromyalgia is unknown but believed to involve a combination of genetic and environmental factors with half the risk attributed to each.

[6]The condition runs in families and many genes are believed to be involved.

[7]Environmental factors may includepsychological stress, trauma, and certaininfections.

[8] The pain appears to result from processes in the central nervous system and the condition is referred to as a "central sensitization syndrome".

[9]Fibromyalgia is recognized as a disorder by the US National Institutes of Health and the American College of Rheumatology.

[10]There is no specific diagnostic test.

Diagnosis involves first ruling out other potential causes and verifying that a set number of symptoms are present.

The treatment of fibromyalgia can be difficult. Recommendations  often include getting enough sleep, exercising regularly, and eating a healthy diet.
[11] Cognitive behavioral therapy may also be helpful.
[12] The medications duloxetine, milnacipran, or  pregabalin  may  be used.
[13] Use of opioid pain medication is controversial with some stating their use is poorly supported by evidence
[14] and others saying that weak opioids may be reasonable if other medications are not effective.
[15] Dietary supplements also lack evidence to support their use. While fibromyalgia can last a long time, it does not result in death or tissue damage

Wikipedia

Can we say that Fibromyalgia is nothing except vat-dominant signs and symptoms in vat dominated prakriti along with milder form of Dhatukshya in presence of vat-vriddhi...?

AYURVEDAPEETHA

[16/10, 6:52 PM] pawan madan Dr: 

Yes sir....

seems logical....

But when it comes to treatment ......any kind of vaata shaamaka treatment doesnt work in cases of fibromyalgia.

so उपश्यात्मक it doesnt.seem.to be vaata vyaadhi or vaata nanatmaj laxans...

फिर हमे.किसी और angle से सोचना पडेगा....

[16/10, 7:15 PM] Prathamesh Karpe Vd. AP: 

We should think. About saama dosha in FM. 

only pain =vata is just little understanding. 

Vata increases where it finds kshaya samprapti, it occupies empty space. 

Improperly formed rasa dhatu doesnt provide proper nourishment thus depriving nutrition to uttara dhatu n aama blocks the srotasa causing margavarodhajanya vata prakop. 

We can think of applying saama vata chikitsa in FM cases. 

I have not treated single case of FM, it is my understanding of the disease.

[16/10, 7:15 PM] Dr. Surendra A. Soni: 

Shall have to do dhatuposhan .....

Alongwith nidanaparivarjan that usually ignored...

[16/10, 7:16 PM] Dr. Surendra A. Soni: 

Saam dosha..

Justified....

[16/10, 7:17 PM] Pawan rajyan AP: 

Dosh ke sath  saam niraam aur  aavran aur aavak ka vichar bahut jaroori hota hai

[16/10, 7:17 PM] Prathamesh Karpe Vd. AP: 

Apatarpana, Paachan, rukshana, anulomana till niraama stage is achieved

[16/10, 7:18 PM] Prathamesh Karpe Vd. AP: 

Then snehana karma for proper brimhana can be started in form of either siddha sneha paana or anuvasana basti chikitsa.

[16/10, 7:18 PM] Prathamesh Karpe Vd. AP: 

Symptomatic treatment should be avoided initially.

[16/10, 7:22 PM] pawan madan Dr:

 Agree sir

Yess.....aavaran is most imp..

[16/10, 7:24 PM] Prathamesh Karpe Vd. AP: 

Any diagnostic test for FM?

[16/10, 7:24 PM] Dr. Surendra A. Soni: 

Agni consideration is our first step....!👍

Here dhatwagni correction and dhatuposhan should be targated...

[16/10, 7:25 PM] pawan madan Dr:

 There can be differentvsampraptis in different pts of fibromyalgia

In mod....diagnosed by exclusion method....but still cases of fibromyalgia and chronic fatigue syndrope ovarlap...

[16/10, 7:26 PM] Prathamesh Karpe Vd. AP: 

how you can differentiate both?

[16/10, 7:28 PM] pawan madan Dr:

Usually they are differntitated based on history, aggravating factors and the tendor.points on the body....

[16/10, 7:29 PM] Prathamesh Karpe Vd. AP: 

In my practice patients who comes with multiple joint pain or fatigue or tiredness,  i first stop all rasavaha srotodushtikara nidana and starts aama paachana. 

Pain subsided with in a day in 60% of cases by scale of 8/10.

[16/10, 7:29 PM] Prathamesh Karpe Vd. AP: 

In 40% of cases patient told that they didnt had control over their mind and break pathya.

So their recovery period extends from week to month.

[16/10, 7:30 PM] pawan madan Dr: 

True

[16/10, 7:31 PM] ‪+91 94223 57002‬: 

What r general causes u encounter in these pt

[16/10, 7:31 PM] Prathamesh Karpe Vd. AP: 

In any disease if we focus on hetu viparita chikitsa,  results obtained are faster with few medicines n less procedures.

[16/10, 7:32 PM] ‪+91 94223 57002‬:

Stopping nidan stops further progress but what abt already vitiated doshas so it aloso needs some time to subside.

[16/10, 7:32 PM] Dr. Surendra A. Soni: 

Most correct way....

[16/10, 7:33 PM] ‪+91 94223 57002‬:

Either by shodhana aampachana etc depending on bahudoshawastha.

[16/10, 7:37 PM] Prathamesh Karpe Vd. AP: 

I didnt diagnosed them as FM. 

their day starts with 1 bottle of water, breakfast with bread, butter or fermented items like uppam or idli or dosa, fruit jam,  cornflakes with milk or sometime eggs with milk or milk shake(so called  healthy diet)

After going to workplace again tea n samosa or bhaajipaav or batatawada. 

Lunch fish 4 times a day or eggs, pickels, leafy vegetables,  curry prepared in goa are made sour by tamarind n cocum. 

Similar stuff for dinner

Evening milktea with buiscuits containing salt. 

After dinner fruits(guru) or sweet dish. 

This all above hetu r dominant in guru, abhishyandi, ati snigdha, vidahi, guna.

Once you treat saama avastha,  treating doshas becomes more easier.

Otherwise unnecessary procedures like snehana, basti sometimes worsens the disease.

[16/10, 7:41 PM] pawan madan Dr:

I also.find same.history....

[16/10, 7:42 PM] Prathamesh Karpe Vd. AP: 

Explaining pathya n making them follow is little tough but NOT IMPOSSIBLE. 

that is the main role of bhishak i guess

[16/10, 7:43 PM] pawan madan Dr: 

right...par jab pt karnaa chahe....

[16/10, 7:44 PM] Prathamesh Karpe Vd. AP: 

By god's grace 90% of my patient follows my advise fully.

[16/10, 7:46 PM] ‪+91 94223 57002‬: 

Is it easy to control chintyanam cha ...।..ati......in rasavaha srtrotodushti hetu.

[16/10, 7:47 PM] santosh Chavhan dr:

Klama can be considered as symptoms of Grahanidosh manifested into Amlapitta. Amlapitta bhishak mohakar vyadhi. Mamsavrita can't be considered since no symptoms like " pipalika Eva abhidaranam " . Regarding Vata kshay symptoms doesn't matching with above mentioned FM symptoms but if you considered further classification of Vatavyadhi ; it can be classified into two karma hanijanya and Karma vriddhijanya . E.g. Apatantrak  Dhanurstambh vriddhijanya and Pakshghat karmahanijanya (Ref Vaidya Antarkar shastri)  Concisely considered  under Vatavyadhi. But my limited knowledge of modern medicine B 12 deficiency leads into Fibromyalgia like symptoms including cognitive functions impairment

 Post related to Fibromyalgia.

[16/10, 7:50 PM] Dr. Surendra A. Soni: 

Perfect....

Rasvah srotodushti...

Possibility of other dhatu too... especially majja... in the presence of psychiatric symptoms...

That i assumed in my first post milder form of Dhatukshya... may be all together or scatteredly as per nidan... ras is first and foremost...

[16/10, 7:54 PM] Prathamesh Karpe Vd. AP: 

Excessive thinking or stress decreases as soon as he/she gets relief from the disease. 

In few cases meditation or counselling or stress relieving techniques may be required.

[16/10, 7:54 PM] Dr. Surendra A. Soni:  

[16/10, 7:55 PM] Pawan rajyan AP: 

I am raschikitsak hardly use  panchkarma follow some points as mention above dosh, saam aam , aavran aavrak and got good results in vaat vyadies and in autoimmune disords of all types . 

[16/10, 7:57 PM] Prathamesh Karpe Vd. AP: 

Many ayurvedic doctors do not focus on pathya, they focus on medicines without focussing on hetus, hence we face problems like slow result or delayed results etc.

[16/10, 7:57 PM] Dr. Surendra A. Soni: 

Perfect...

[17/10, 2:58 PM] Upendr dixit Prof. Goa:

 I think Rasadushti  (Saama Rasa)  and Saama Vata need to be considered. Signs and symptoms of Dhatukshsya may be due to Rasadushti and Srotorodha, which obstruct the nourishment of Dhatus. Of course dominance of Vata may be a precipitating factor. 

Then again all signs and symptoms are not observed in all the patients. And Samprapti and Nidana of each patient will have to be decided on individual basis, taking into consideration the Hetu.

[17/10, 6:42 PM] Dr. Surendra A. Soni: Perfect....

Thanks Sir.

KAY-SAMPRADAY

16/10, 7:27 PM] Dr:

Treat the depression first.

Shodhana based on dosha.  Encourage for exercise + regular abhyanga, and then vatahara Rx.

[16/10, 7:29 PM] Sukhvir Verma J. KC:

I had tried basti dhara abhyang shiodhara balya chikitsa medhya Rasayan but couldn't not succeeded completely in fibromyalgia.

[16/10, 7:31 PM] Dr. Surendra A. Soni: 

Once antidepressant given for a long time... definitely results are uncertain...

[16/10, 7:32 PM]Dr: 

A set of anti depressants should be continuously prescribed alongside other therapies for 4-6 months time. I have used mentat, manasamitra vatakam, brahmi ghrita, kalyanaka ghrita with some success.

[16/10, 7:35 PM] Shantanu Das Prof KC: 

In Fibromyalgia:

Balya bata samaka nd samyak paachan very helpful.....

Mostly....Br vatagankusa nd....agntundi vati.....very helpful.....followed by samyak pachana......

[16/10, 8:06 PM] Raghuram Dr Banguluru: 

Regular oral intake of *Guggulu tiktakam Ghrita* has given good results...can be tried in the form of *shamana or brimhana Sneha*...

[16/10, 8:17 PM] Daya Shnkrji Sir: 

Its treatment should be done acoording aamvata.

[16/10, 9:37 PM] Dr. Surendra A. Soni:

Saaratva and basic prakriti are different. Prakriti cannot be changed while Saaratva does change at certain level because it indicates nutritional status. 

As ek doshaja prakriti is rare..so dvidoshaja including vat may be taken..in FM.

[16/10, 9:41 PM] Dr: 

any research study done to conclude FM is more common in vataja ot vata associated prakrti?

 FM and obesity are directly related. 

Depression is 25%more common in obese people than non obese.  

Obesity or bulkiness is both a feature to hint saarata and prakrti.

[16/10, 10:18 PM] Dr. Surendra A. Soni: 

I also want to know this.

Still involvement of vat is possible...

Medasaaratva should be differentiated from sthoulya...

Pathological sthoulya may involve any saar...

[16/10, 10:40 PM] Dr: 

I don't deny Vata involvement in FM. Vata is definitely involved.

[16/10, 10:44 PM] Dr. Surendra A. Soni: 

Thanks

Actually it's a Rasvah srotodushti initiative headed by vat with चिंत्यानाम् अतिचिंतनात् । 

May involve other dhatus too as per specific nidan indulged.

[16/10, 11:43 PM] Pankaj Chhayani dr ndyad: 

As there is cardinal symptom is pain , we can say it is vata dominant... I think Pippali should be given along with Medhya rasayana...

[17/10, 12:29 AM] Tapan Vaidya ADI AP: असृज: कंडरा सीरा:।

[17/10, 9:14 AM] Anita Gaytri Dr. DG: 

Sir, i think it should be maamsa saaratva from sthoulya. Medasaar purusha is not obese. Maamsa saara purusha is obese. As per charaka samhita- vimaana sthaana.
And we can differentiate maamsa saara from sthoulya in the following manner that maamsa saara person has shubh maamsopchita...that means he is not having any problem with that bulk of maamsa on him. And sthoulya has difficulties(ati sweda, difficulty in walking, shrama shwaasa etc.) due to that maamsa. My thinking.

[17/10, 10:01 AM] Dr. Surendra A. Soni: 

This is again a question.

Upto the occurrence of sthoulya with chal-sfik etc and physical as well as mental sings and symptoms we can assume the condition of Medasaaratva that may  convert into sthoulya / atishtoulya. Pre existing medasthiti may not be denied... i think...! 

Yes agree with you that mans-saratva are prone to develop sthoulya...!

[17/10, 11:53 AM] Anita Gaytri Dr. DG: Thanks.

[17/10, 12:42 PM] Anupma Patra AIMS AYU: 

sir, i think ur diagnosis is right . In old vaata vyadhi that to in vata prakriti people we usually never got response unless repeated snehan ,swedan and snehavirechan in between. Simple vata samak medicine usually never give much response unless internal snehapaan. As per charak samhita 

यद्यनेन सदोषत्वत् कर्मणा न प्रशाम्यति

मृदुभि स्नेह संयुक्तै औषधे त्वां विशोधयेत्। (ch.chi.28/83)

Again in old age group and after one year it comes under yapya. So repeated treatment needed.

[17/10, 4:11 PM] Vd. Jui Shahane: 

@ Soni sir....FM ....i think presents symptoms of Saam Vayu. Major role is of vitiated Vat as compared to other Dosha. So treatment can be
1.  Langhan 
2. Abhyang (any vataghn oil like Balashwagandhadi, or          Dhanwantaram), Swedan & at least a course of Yog basti 
 only after langhan is completed . 
3. Nasya (pratimarsh) can b started from 1st day. 
4. Sitz bath in plain hot water 10-15 min as it is very useful to Katipradesh. 
5. Snigdh, laghu bhojan. 
6. Other factors like exercise, good daily habits...as discussed by all.....r very necessary.

Mansa saar....seen in players like Lawn tennis....they hv weight very much more than average persons....bt their bodies look strong...i.e.neither thin nor obese....& they hv a very high potential to bear physical stress...this is mansa sarata....

So mansa sarta is physiological condition while sthoulya is pathological.

I m also of the opinion that medo sarata can turn into sthoulya. Bt gurujans will guide better.

[17/10, 6:41 PM] Dr. Surendra A. Soni: Thanks Madam

..............................................................................................................................

Above discussion held on 'Ayurveda Peetha"(initiated by Prof. S.N. Ojha) & 'Kay-sampraday' two Famous Whatsapp group of  well known Vaidyas from all over the India. 

Compiled & edited by

Dr.Surendra A. Soni

M.D.,PhD (KC)

Associate Professor

Dept. of Kaya-chikitsa

Govt. Ayurveda College

Vadodara Gujarat, India.

EMAIL: surendraasoni@gmail.com

Mobile No. +91 9408441150