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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 4  |  Issue : 1  |  Page : 33-36

Ayurvedic management of fibromyalgia with severe depression: A case report


1 Department of Panchakarma, Shri Dhanvantari Ayurvedic Medical College and Research Center, Mathura, Uttar Pradesh, India
2 Department of Panchakarma, All India institute of Ayurveda, New Delhi, India

Date of Submission15-Sep-2020
Date of Acceptance13-May-2021
Date of Web Publication17-Jun-2021

Correspondence Address:
Dr. Ram Lakhan Meena
Assistant Professor, Department of Panchakarma, Shri Dhanvantari Ayurvedic Medical College and Research Center, Mathura, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacr.jacr_70_20

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  Abstract 


Fibromyalgia (FM) syndrome is a musculoskeletal condition characterized by widespread musculoskeletal pain with many clinical presentations. Its prevalence is estimated at around 2% in the general population. Various pharmacological interventions are of little efficacy and its prognosis is also poor. Some treatments are available to control the symptoms, but no complete cure has been documented for this syndrome. Certain Panchakarma procedures and internal Ayurvedic medicines have been proved to be beneficial in the management of FM. The present report deals with a case of FM managed by Panchakarma treatment. The Ayurvedic diagnosis of Mamsagata vata was made and Panchakarma procedures such as Abhyanga (~therapeutic massage), Bashpa swedana (~sudation), and Basti (~therapeutic enema) along with Shirodhara were done followed by internal medicines. Assessment criteria was based on the scoring of FM Impact Questionnaire. Encouraging results were found in physical signs of FM.

Keywords: Fibromyalgia, Mamsagata vata, Panchakarma, Vata vyadhi


How to cite this article:
Meena RL, Bhatted SK. Ayurvedic management of fibromyalgia with severe depression: A case report. J Ayurveda Case Rep 2021;4:33-6

How to cite this URL:
Meena RL, Bhatted SK. Ayurvedic management of fibromyalgia with severe depression: A case report. J Ayurveda Case Rep [serial online] 2021 [cited 2021 Jul 26];4:33-6. Available from: http://www.ayucare.org/text.asp?2021/4/1/33/318662




  Introduction Top


Fibromyalgia (FM) is a or musculoskeletal condition characterized by chronic widespread musculoskeletal pain and tenderness including associated neuropsychological symptoms including fatigue, unrefreshing sleep, cognitive dysfunction, anxiety, and depression.[1] Patients with FM have an increased prevalence of other disorders including chronic fatigue syndrome, temporomandibular disorders such as pain in jaw, chronic headaches, irritable bowel syndrome, painful bladder syndrome, and other pelvic pain syndromes. Its prevalence is estimated at around 2% in the general population and it is far more common in women than in men with a ratio of 9:1.[2] Central nervous system sensitization is a major pathophysiological aspect of FM, while various external stimuli like infection, trauma, and stress may contribute to development of the syndrome.[3] There are no direct references regarding FM in Ayurveda. However on the basis of clinical presentation of disease, the condition may be correlated Mamsagata vata.[4] Further analysis of the symptomatology indicates the involvement of Mamsa dhatu in association with Asthi and Sandhi. In modern system of medicine, drugs that have both analgesic and antidepressant/anxiolytic effects, such as duloxetine or milnacipran, may be the best first choice.[5] On the basis of the factors involved in the Samprapti dominated with severe pain, Snehana, Swedana, and Erandamuladi basti are thought to be effective in relieving the pain and other associated symptoms and Shirodhara to relieve the psychological stress which is also one of the important factors involved in FM.


  Case Report Top


A 51-year-old male patient resident of New Delhi, medical practitioner (MBBS) by profession visited the department of Panchakarma with complaints of pain at multiple joints with swelling, generalized muscular pain, especially over the nape of neck, right arm, and right leg, fatigue, and constipation. He also presented with depression, hopelessness, sleeplessness, and impaired memory. All these problems were gradually developed, progressive, and recurrent for the last 12 years, for which he was taking nonsteroidal anti-inflammatory drugs. On examination, vital parameters (blood pressure, pulse rate, respiratory rate) were within normal limits. He was a non-smoker, non-alcoholic, and not having an allergy to any drug or food item. The condition was diagnosed to be “FM syndrome” based on the “2010 American College of Rheumatology diagnostic criteria”.


  Timeline Top


Timeline of Panchakarma therapies and oral medication is placed in [Table 1] and [Table 2].
Table 1: Panchakarma treatment administered

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Table 2: Internal medicines administered

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  Follow up and outcome Top


FM Impact Questionnaire (FIQ) was used to assess the effect of therapy.[6] Before starting treatment, the FIQ score was 65.4, indicating that the patient has been suffering from severe FM syndrome. After completion of treatment, the FIQ score got reduced to 32.3. This reduction in FIQ score shows that the patient got moderate relief with the treatment prescribed [Graph 1]. Improvement was observed in physical impairment, difficulty in doing work, pain, fatigue, and stiffness. Constipation was relieved and heaviness in the body was also reduced. General condition got improved markedly.




  Discussion Top


The clinical presentation of FM indicates toward Mamsagata vata described in Ayurveda with predominant symptoms such as Danda mushti hata (~severe pain), Gaurava (~heaviness), and Saruk shrama (~excessive fatigue with pain).[4] Virechana (~therapeutic purgation), Niruha basti (~decoction enema), and Vata shamana (~pacifying Vata dosha) treatments such as Snehana (~internal and external oleation) and Swedana (~sudation) along with oral medicines were advised in the treatment of Mamsagata vata.[7]

The aggravation of Vata dosha and accumulation of Ama (~toxins) are the primary causes of FM. Initially, Koshta shuddhi (~cleansing of bowel with laxatives) was done with Gandharvahastadi eranda taila which acts as a Vata anulomaka.[8] Shirodhara with Ksheerbala taila was done for the management of depressive features, headache, and sleeplessness. Shirodhara is a traditional procedure of pouring medicated oil on the forehead from a specific height for a period continuously with allowing the oil to run through the scalp and into the hair. Head is considered as Uttamanga and Ashraya for all the Indriyas (~control and regulation of both sensory and motor and mental functions) and contains Mastulunga (~brain). On the other hand, one of the important functions of Vata is Tantra yantra dhara (~regulator of all physiological activities in general and neurological activities in particular). Shirodhara may regulate the functions of Mana and Indriya along with regulation of Vata, which are the major causative factors involved in the pathogenesis and progress of the disease FM and depression. It may normalize the function of the central nervous system by relaxing the nervous system.[9] When oil is poured on the forehead, it may induce the somato-autonomic reflex through thermo sensors or pressure sensors of the skin or hair follicles and provides a relaxing effect on mind.[10]

Ksheerbala taila is prepared from Bala (Sida cordifolia L.), Tila taila (Sesame oil), and milk. Bala is known for its Balya (~increases body strength), Brimhana (~nourishing), and Vatahara (~alleviating Vata) action. Tila taila is the best Vatahara and milk is known for its Brimhana and Prasadana (~soothing) action. Hence as a whole, Ksheerbala taila is best Vatahara, Brimhana, and Prasadana in action which induces better sleep.[11] The therapeutic effect may be due to diffusion of oil drugs through the fine pores present over forehead in similar way as seen by the procedure such as Abhyanga, Snana, Udvartana, and Parisheka. Moreover, possibility is there to produce a certain amount of absorption by application of substances on the skin. Abhyanga (~therapeutic massage) with Dhanvantara taila followed by Bashpa swedana was done to relieve pain, fatigue, and body ache as Dhanvantara taila is especially indicated in Vata disorders.[12]

Erandamuladi basti is both Lekhana and Vatahara in nature, which helps in reducing Kapha and removal of Avarana, thus reducing symptoms such as heaviness and stiffness. Anti-inflammatory, antioxidant, central analgesic, and bone regeneration activities are found in Eranda (Ricinus communis L.) which is the main content of the Erandamuladi niruha basti.[13] Eranda is best in pacifying Vata dosha. Gugglutiktaka ghrita is having Tikta rasa and Ushna virya favors normal functioning of Dhatvagni (~metabolic stage), facilitating increased nutrition to the Asthi dhatu (~bony tissue).[14] Ghṛita (~ghee) is Vata-pittashamaka (~reduces Vata and Pitta doṣha), Balya (~increases body strength), Agnivardhaka (~increases appetite as well as metabolism), Madhura, and Sheeta virya (~cold in potency). Thus, it pacifies Vata dosha and reduces the pain.

Mode of action of internal medicine

Rasna is a major ingredient of Rasnasaptaka kwatha which is best for Vata dosha. It is used to treat swelling and painful afflictions due to having Shothahara (~anti-inflammatory) and Vedana shamaka (~analgesic) properties.[15] Simhanada guggulu has Vata-kapha shamaka, Amapachaka, and Sroto shodhaka properties, which helps in cleaning of Srotas and regulation of movement Vata.[16] Ashwagandha is a potent Rasayana (~rejuvenative drug) due to its multiple pharmacological actions such as anti-stress, neuroprotective, antitumor, anti-arthritic, analgesic, and anti-inflammatory. It is useful for different types of diseases such as  Parkinsonism More Details, dementia, memory loss, and stress-induced diseases. It is one of the best nervine tonics of Ayurveda.[17] Musta churna (Cyperus rotundus L.) has Katu (~pungent), Tikta (~bitter) and Kashaya (~astringent) taste with Laghu (~light) and Ruksha (~dry) properties and it provide Katu taste after digestion. It is Kapha-pitta hara (~reduces Kapha and Pitta dosha), Deepana (~increases digestive fire), Pachana (~digests undigested material), Jwara hara (~antipyretic), Atisara ghana (~antidiarrheal), and Kandu hara (~anti-itching). Musta is used extensively in the management of fevers, diarrhea, thirst, inflammation, tastelessness, indigestion, and obesity.[18] Guduchi is Tikta, in Rasa, and Madhura vipaka which helps in Pitta shamana and is immune modulatory antioxidant.[19]


  Conclusion Top


Panchakarma treatment particularly Abhyanga with Dhanvantara taila, Swedana with Dashamoola kwatha, and Erandmuladi basti was found to be useful in the management of FM that effectively address symptoms such as pain, tenderness, stiffness, constipation, headache, and fatigue. Shirodhara with Ksheerabala taila helped to overcome psychological manifestations such as anxiety and insomnia. The results observed in this case infer that Ayurveda approaches are beneficial in managing pathologies like FM. However, establishing the exact mode of action to convince conventional scientists is difficult.

Declaration of patient consent

Authors certify that they have obtained patient consent form, where the patient/caregiver has given his/her consent for reporting the case along with the images and other clinical information in the journal. The patient/caregiver understands that his/her name and initials will not be published and due efforts will be made to conceal his/her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and symptom severity. Arthritis Care Res 2010;62:600-10.  Back to cited text no. 6
    
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Acharya YT, editor. Commentary Ayurveda Dipika of Chakrapanidatta on Charaka Samhita of Agnivesha, Chikitsa Sthana. Ch. 27., Ver. 93. Varanasi: Chaukhamba Surbharti Prakashana; 2017. p. 621.  Back to cited text no. 7
    
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Acharya YT, editor. Commentary Ayurveda Dipika of Chakrapanidatta on Charaka Samhita of Agnivesha, Sutra Sthana. Ch. 25., Ver. 40. Varanasi: Chaukhamba Surbharti Prakashana; 2016. p. 131-2.  Back to cited text no. 8
    
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Ogiso T, Shiraki T, Okajima K, Tanino T, Iwaki M, Wada T. Transfollicular drug delivery: Penetration of drugs through human scalp skin and comparison of penetration between scalp and abdominal skins in vitro. J Drug Target 2002;10:369-78.  Back to cited text no. 10
    
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Nishteswar K, Vidhyanath R, editors. Sahasrayogam, Taila Prakarana. Ch. 3. Varanasi: Chowkhamba Sanskrit Series Office; 2017. p. 110.  Back to cited text no. 11
    
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Shastri HS, editor. Commentary Sarvangasundara of Arunadutta on Astangahrdaya of Vagbhata, Chikitsa Sthana. Ch. 21., Ver. 47-51. Varanasi: Chaukhambha Surbharti Prakashana; 2017. p. 726.  Back to cited text no. 12
    
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Damayanthie Fernando KP, Thakar AB, Shukla VD. Clinical efficacy of Eranda Muladi Yapana Basti in the management of Kati Graha (lumbar spondylosis). Ayu 2013;34:36-41.  Back to cited text no. 13
    
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Shastri HS, editor. Commentary Sarvangasundara of Arunadutta on Astangahrdaya of Vagbhata; Chikitsa Sthana. Ch. 21., Ver. 58-61. Varanasi: Chaukhambha Surbharti Prakashana; 2017. p. 726-7.  Back to cited text no. 14
    
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Mishra SN, editor. Hindi Commentary of Kaviraj Govind Das Sen on Bhaisajya Ratnavali. Vol. 1., Ch. 29., Ver. 23. Varanasi: Chaukhambha Surbharti Prakashana; 2017. p. 598.  Back to cited text no. 15
    
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