2014 - the year everything changed

Raw herbs - the first lot

I found some old blog posts I thought were worth reposting because they explain the problems I faced during my marriage to Martin in the year before his death (he died in December 2014 as described in my first blog post). I was struggling with sleep, of course, and had to increase the doses of my sleep aids. I used quetiapine but had reached unsustainable levels (100-200 mg) that caused severe restless legs (akathisia). I had also used pregabalin on and off for seven years when the ‘sleep psychologist’ Dr Selsick in London asked me to go up to 200 mg per night. I felt completely out of it and physically numb. Sex, which was already problematic, was now out of the question altogether. I started to question the drug’s place in my life and ended up tapering off. When I did, several things improved: I no longer had to pee ten to thirty times a night. I now only went 2-5 times. I no longer suffered from palpitations and when I also cut down on quetiapine (used as a sleep aid), I was able to come off verapamil (a calcium channel blocker). I gradually grew back all the hair I’d lost. According to my husband, I was also less aggressive. But things were still not alright in the sleep department and the below diaries outline my concerns and the eventual move over to Traditional Chinese herbs (TCM). 

At the time, I suspected I had hypermobile Ehlers-Danlos syndrome but I didn’t understand how severely it can affect you and thought my main illness was fibromyalgia. I wasn’t diagnosed with hEDS until 2018. As for the herbs, there was a lot of trial and error because many of them increased restlessness and I had to try and understand what exactly I was treating on a deeper level. For instance, I had a lot of trouble with herbs that raise the energy, and many of them were grassy (e.g. Chai Hu, Yin Chen Hao), provoked diarrhoea or just dispersed Qi too much. I should never have stopped using herbs but decoctions aren’t easy to deal with and life just happened. I became overconfident about my ability to sleep and thought I could sleep without them. I could not, and bad things followed… Please be aware that I am not professionally trained in TCM so the articles only reflect my self studies. I feel I must return to them now that I have come off quetiapine as well. My assistant is a somewhat demented ChatGPT that cannot remember who I am from one day to the next, or what my issues are even though I explained them the day before. It’s not very consistent in its advice, either. Given the additional constraints and the lack of genuine empathy, I certainly can’t imagine having an AI partner, hahaha.

A herbal decoction on the stove 

31.1 2014

An update might be in order. The other day I was supposed to have an appointment with my GP, but there was a mix up so I ended up with a doctor I've never seen before. As soon as we got to the problems with insomnia he froze, the way male doctors almost always do. With a judgmental tone of voice he said, all these hypnotics you're taking will cause addiction as well as tolerance. As if I haven't heard the same thing a million times before, it's straight out of the textbook. There is a witch hunt going on regarding the addictive nature of hypnotics, which is unfair and even untrue in a lot of cases. I would be so very happy to quit them but I'm not seeing any evidence of being able to sleep without medication. In the autumn I tried a few times, but quickly wore out. Some people can exist alongside sleep deprivation. I really cannot.

When I quit the last of the anti-histamine all I had left that didn't cause all this physical agitation was the hypnotics. I soon started to sag because they really aren't working very well for me anymore. I got very depressed and tearful. Since I quit the pregabalin (Lyrica) my libido has also been zero, and that distresses me a great deal. I don't know if that's an after effect from the Pregabalin, the result of a lack of quality sleep, or a perimenopausal symptom. I've been on a vaginal HRT cream now for a week but so far I'm not seeing any benefits. The sleep deprivation was getting so bad as I kept waking up during the night and didn't get more than 6 - 7 hrs per night, that I decided to give Mirtazapine another go. I thought it possible that it was only causing problems in conjunction with other medications, namely Pregabalin. I admit that this summer I might occasionally, but very rarely, have taken up to three psycho active medications as well as some hypnotics in order to get some much needed sleep. That was definitely not the norm! It was therefore not very surprising that Mirtazapine is still causing severe agitation. The first night was alright and I got some deep rest, but the second night I was kicking my legs, feeling my heartbeat, having to empty my bladder a lot, and feeling generally agitated for a few hours until I fell into comatose sleep. Once was asleep, I wasn't bothered by hot flushes or anything else, and that was a relief. That was on only 7.5 mg.

The following night I tried 3.85 mg (halved and taken at slightly different times just before switching lights off), but still felt somewhat restless [this was akathisia but I didn’t know it then]. The past three days I've been walking around like a zombie, as the somnolence this drug is causing just wouldn't clear. That is, after I'd managed to drag myself out of bed, which was almost impossible. The drowsiness and dullness is a bit less debilitating now after last nights super low dose, and I feel fairly okay. I'm relieved to have had some good rest inspite of it all. Mirtazapine seemed a lot more effective as a sleeping drug than I ever experienced in the past -  however, apparently this comes with a high price. I was offered the same solution by a psychiatrist way back in time, but 30 mg didn't do the trick at the time and I felt extremely detached from my normal self during the two months I kept trying to cope on it.

I can only conclude that with age (47.5), hormonal fluctuations and changes in metabolism, I have become over sensitive to these insidious drugs. They seem to be doing some very bad things to my body and so I can't risk taking even small amounts, even when it helps me sleep. I also suspect that the effects are reverberating and causing mental agitation. I seem quite bitchy when I'm on them. In other words, I'm getting the side-effects that are listed as unusual. The listings of side-effects are useless, since they don't take into account that problems can come with age. I'm pretty stunned by it all. I never used to be sensitive to drugs. It's possible that this medication is the answer for other women with insomnia caused by menopause, so it's possibly worth a try. Just please be vigilant regarding any surplus agitation or other insidious issues that might occur. In my case it seems to be an ongoing problem that doesn't go away over time (see previous blog posts).

The more exhausted I get from lack of restorative sleep, the less I feel like even trying to manage without the hypnotics. I feel less and less motivated to even try and do experiments. In this regard I'm back to square one. It doesn't exactly help that the doctor at the insomnia clinic isn't responding to my inquiries about what to do next. They ought to know how serious this can be (on a bad day I really lose my will to live). Just today I got a reply back from the reception regarding my latest cry of despair: they can pass it onto someone else since the consultant is on leave and I've already been waiting for so long! I really wish I could kick the pills but at the moment it's not a realistic solution. On the other hand it's perfectly possible that they are also causing problems, namely more insomnia. I don't know how I could drag myself up by the hair in the Munchenhausen way - that's assuming it's even possible to begin with. This is a terrible trap. I can only take a day at a time and try not to panic.

WIRED AND TIRED

It's time for an update. I have been meaning to write about the war I've had to endure in regard to my glasses, but it will have to wait. I have so little time for these things. I suffer from chronic stress just from the fact that I can't keep up with even the few things I need to do every day - that's some ‘work’ related stuff (such as writing posts for my art blog), 20 minutes of exercise, some meditation, cooking a meal (because it’s my job), sometimes going out for a walk, and trying to keep the house tidy. I fail miserably at managing the house, as it's the last thing on the list. The house is just way too big and is itself also in a deplorable condition that matches my own, so keeping it neat is a totally and utterly overwhelming task. We bought a small bag less vacuum cleaner with some of my grant money to make it easier for me to get it up the stairs, but it doesn't work! Oh the endless frustration... It gets clogged up after five minutes and is a real pain to clean. The rest of the time I spend waiting for sleep or trying to wake up, as well as watching films and TV shows for relaxation.

I have come to the conclusion that there really must be something very wrong with the physical aspect of my brain, and have therefore abandoned the doctor's rather formulaic recommendation for cognitive behavioural therapy. I gave it a lot of thought. I'm especially shocked that they would suggest sleep deprivation (a part of the CBT treatment) as a cure for someone with my condition (i.e. with a serious tendency of getting very wired, more so the more sleep deprived). It's like saying, oh why don't you try suicide as a way of alleviating your issues?! I found later that this consultant, Dr Selsick, is a psychologist (actually I'm not sure what exactly but something of the sort) with a special interest in insomnia and psychiatric disorders (see here), and of course I didn't want to see yet another one! None of the dozen psychologists and psychotherapists I've seen in Finland were ever able to help me in any way. Quite frankly I thought his suggestion was an insult, though I also understand (or try to, anyway) that they have their formulaic procedures and he didn't know that much about me to begin with - I'm not confident my GP has been able to get the message across very well. (Sure I would be welcome to go there for another appointment if I could afford it).

At the clinic at the London hospital of integrated medicine, the consultant didn't listen to me, just repeated some standard blurb about treatment options and misquoted me in his letter to the GP. I would have thought there would be some kind of collaboration with the fibromyalgia clinic, as the hospital is supposed to offer an integrated service. I didn't feel that he understood much about fibromyalgia and chronic fatigue in general (Ehlers Danlos Syndrome wasn't mentioned during the visit). He didn't seem to think that comorbid insomnia is that common, but I'm now very sure that's exactly what my problem is even if it means I'm a minority. I've heard rumours that people with CFS/ME as well as FM may be suffering from inflammations in the brain and over activation of microglia. Of course a lot of people with comorbid insomnia may gain from CBT because they have racing thoughts as well, but I don't - there are no thought patterns to fix, at night all is calm! I'm not in pain either, just a bit uncomfortable as always. So something is clearly going on outside of my thought processes or emotional states.

This doctor didn't even pick up on the fact that I was probably suffering from chemical sensitivity, which is so common with these conditions - he just suggested more drugs. I had to read that ridiculous self-help book by Colin Espie he asked me to buy, but without consulting me, they kept insisting to invite me to intensive CBT sessions in London. I guess it's all they can do for me but frankly it's not good enough, and they are not going about it in a respectful way. "Integrated" my arse. Needless to say I've been feeling upset and powerless, going over a complaint in my mind - if something is keeping me awake at night and causing additional stress in the daytime, it would be my frustration with not being heard. This relentless frustration is of course yet another symptom of an over sensitised brain (which affects the psyche, of course). Of course, I don't agonise over this on most nights, as I'm able to push it aside.

I'm scheduled for a sleep study in June, and hope that if I have a means of going, it will at least show something physical. The consultant claimed it will probably show nothing at all and was only interested in whether I might have periodic limbic movements (restless legs) that keep me awake. Does he really know nothing about chronic fatigue?? I'm quite terrified of the whole thing and have to be very mindful about how I prepare for it. It means I have to make sure I'm getting some kind of quality sleep before I go there, so that I don't suddenly crash out of severe exhaustion and fail to sleep at all. I have to try and simulate a normal night at home, and it's not going to be easy, and if I can't take any medication I will most likely be more than just a little exhausted the following day.

Because of the chemical sensitivity I now suffer from in regards to medication, I also seem to respond more easily to the sedation. I have thus been able to cut down on my consumption a great deal. However, normal sleeping pills don't give me a "reasonable" night and so my only option was to go back to Quetiapine, which is the strongest non-addictive sedative you can get through the NHS. Mirtazapine is quite sedative too but I have to take quite a bit in order to sleep through the night, and my body just can't handle that - the side effects are horrendous. Meanwhile with Quetiapine, I can manage on fairly small amounts, but of course tolerance is creeping up. I sometimes combine the two for variety's sake but it's not working too well. Normally I have to take about 50 mg Quetiapine at night and then a small amount of some Benzodiazepine (at the moment Diazepam or Temazepam). I get physical agitation from some of the drugs, but usually go to sleep within 2 hours and stay in a weird state of physical heaviness which is difficult to get out of when I start to wake up after a good amount of hours. I think in fact the tranquillisers (especially zopiclone) help counteract some of the restlessness. If I have to get up to pee (which I do a lot on these medicines, especially Mirtazapine), I'm able to go back to sleep. With the Quetiapine already in the body, the benzo then seems to kick me over the threshold.

If I were to take more drugs, I'd wake up every so often with a sense of extreme stress. If I take only half a tablet quetiapine (12.5 mg) in the morning, it can cause my heart to race for a few hours, and the sleep is thus very disturbed. That's just how bad these medicines are for me. On a normal night I may get a reasonable amount of sleep and it's of reasonable quality so that I can function during the day. I feel pretty grotty and low, and my heart is racing a bit during the day but I rather be that way than be over-stimulated and strained from sleep deprivation. I have tried all other alternatives and combinations but I don't seem to get a sufficient amount of deep sleep so feel very worn out. That's if I get a few hours of some kind of sleep at all. Without medicines I'm just not sleeping, I just lie there until after a few hours I just can't take it anymore. CFS already make you unable to recover from exhaustion, imagine just what it's like when you also don't sleep.

The medication makes my heart race but I have found that this isn't the reason I'm not sleeping. My routine at night is a good one. After dinner we meditate for half an hour, and then I receive a back rub from my husband. I then lie on the bed of nails in front of our TV/computer while watching stuff for a couple of hours. After this, I light a candle and turn on some soft light in the bedroom. We snuggle for a bit. By this time, my pulse has usually gone down and I feel perfectly calm. Sleep still wouldn't come unless I had taken my medication. I sometimes read a bit, as getting up to do something in accordance with CBT-i would wake me up more, making me wired. Getting up really doesn't work! In fact, when I've tried to manage on almost no medication or none at all, I've just wanted to get up to take care of chores or work or something else. I have no interest in sleeping, as I don't feel sleepy in spite of having a long day behind me. I'm in a state of wakefulness and can't seem to turn it off. I have to force myself not to do this because if I do, I have no chance of the semblance of a "normal" day the next day.

On days when we've been out and about, my sleep is much worse. On Saturday we had to go and attend a party at a gallery, and I also talked in front of an audience about some work I had there. It didn't go that well as I'm unable to manage my nerves, and this stresses me further. We also had an appointment for the optician because the occupational lenses they've made for me were still not working. I had however brought the wrong glasses! This is a symptom of my lack of attention. I got very upset from this since the optician is far away and we've had to go in for sake of my glasses about ten times in the past five months. The weather was bad so waiting around for the opening of a show at the gallery in the evening wasn't very pleasurable. I felt so tired from a short night and quite down in the dumps about the glasses that we still have to sort out another day. During the opening I tried very hard to be sociable and exhausted myself very thoroughly in the process.

The night following the outing my sleep was quite disturbed in spite of the heavy sedation, and the following day I crashed both mentally and physically. I slept better on Sunday night after a day's rest, but had nightmares of needing to throw up that spoke of feeling overwhelmed and too full of difficult emotions. On the third night I had a hard time going to sleep because of having slept a lot the night before, but got good sleep in the end and felt a great deal more refreshed. I bet the fourth night is going to be horrid, because after a while I'm "too rested" to sleep at all, even with the drugs, and will no doubt suffer more from the side-effects. I was also out one night at a birthday party in a very noisy community hall which clearly caused me a lot of stress, and couldn't sleep after that on a normal amount of medication. My conclusion is  that it's good to tire myself out as long as the day isn't stressful as well (which is easier said than done).

I am worried about how much I will be able to push myself in social situations in the future... the situation is getting harder and harder to manage. 

Here's the bit about me that in all fairness is not so great from a psychiatric point of view right now. I have only recently started to feel these things are a real problem. The kind of low I experienced frightens me, as I've had it twice in the past two weeks, and it's so forceful. I feel like a complete failure in every conceivable way. My art, which I feel isn't progressing well enough, doesn't seem to be much appreciated by others so my life's work is just pointless. In spite of my efforts I feel that I'm unable to connect really well with women around here, and keep blaming myself for failure. People confuse me and wear me out. Perhaps it's all in my imagination but these kind of issues get magnified when I’m wired and tired. My efforts are of course out of proportion in relation to my genuine abilities, and so I also place a great deal of value on these efforts. The significance I place on my efforts is thus also out of proportion. On top of all this I have now started to have great fears of losing control over my body and mind. I feel that I might just suddenly have a massive nervous breakdown of sorts, or that I will die from sleep deprivation (for instance kill myself because of going insane). Or I might just say something really bad. I don't know how I'm going to manage the sleep situation in the future. I can't keep taking these drugs that stress my body so much.

You might think CBT could in fact be useful in managing all these negative thoughts and feelings, but I'm already trying not to give in to them. I have a life time of self-exploration behind me. I don't believe there is much else I can do - after all, telling myself I can manage is silly when I already know I manage as well as humanly possible. I have been trying to hold onto hope and other positive feelings but it's in all honesty dissipating. The meditation I started in late January was quite hopeful (I was able to imagine being healed) and I felt healing going on for a while as a consequence, but it now feels stifled. I felt more balanced for a while, but no longer as good. I think going into deeper brain waves in the meditation is just as hard as it is during the sleep, and so I maybe I just need more of it and maybe as a friend said, for years rather than months. It's of course also possible that the meditation is bringing up deep-seated fears that I just have to deal with - I’m not sure. I'm not in a good place at the moment, and very much at the mercy of this condition.

I have to hang in there somehow until I've been to the sleep study, but who knows what I'll do afterwards. I will have to make sure I am off the drugs on the night of my sleep study (that is, I must taper off as much as possible before I go there, especially the benzos). Even if they find that I'm not sleeping nor going into deep sleep I doubt there is anything they can do about it.

I will try and get hold of low dose Naltrexone which they won't give on the NHS (but the cost is an issue right now, as we have no money to spare). It could be helpful and possibly harmless though. With the help of friend I'm trying flower remedies to fix any personality disorder that might still be adding to the insomnia but I'm feeling there's very little left to fix on that level. Most of my issues (hopelessness and fear of rejection) are a result of the illness and not the other way around (but we'll see, of course). I should also meditate three times a day at least, but it's so hard to manage this with the few hours I have during the day. I wish there was a way of trying medical marijuana, since it is said to calm down the nervous system with a minimum of adverse effects.

I found this guide to insomnia, "Treating insomnia in 10 minutes" by my consultant in London. It  repeats more or less what the book says. They are trying to find a formula that they can use en masse, but it's full of contradictions. It's actually pretty horrid as it offend’s the patient’s intelligence while also attempting to force them into a mould. And - it's for healthy people!! Would they ask any person with a chronic illness to keep getting up in the middle of the night and spend time in an icy cold room, or to not do anything non-sleep related in the bed they are tied to? How about poor single people who have to live in a bedsit? Why is sex in bed acceptable and not meditation? This "revolutionary" idea about improving the "sleep bed connection" is a highly contrived and pretty ridiculous one and it will most certainly not work for anyone who has to spend a lot of time in bed because they are ill.

———

27.5.14

I'm getting more confirmation that conditions such as fibromyalgia and ME/CFS are entirely neurological and have very little to do with the psyche - at least once they are established. One can never disregard the possibility that psychological issues have contributed to the condition, and that they may co-exist with the illnesses. However, physiological stress is an unconscious reaction to difficult and threatening situations, and cannot be cured through any kind of psychotherapy or other form of talking therapy that attempts to rectify mental and emotional imbalances. I want to make sure that this is not taken as an attack on psychotherapeutic practices, as most people suffer from psychological imbalances of some kind and may gain from talk-based therapies. It might help people deal with their symptoms and in cases of chronic illness, to gain acceptance of their fate. Nonetheless there are still a majority of powerful medical authorities out there who want to psychologise these kind of illnesses and do not offer any other form of treatment. When I went through a work assessment years ago I was offered CBT but cried, pleading the authorities that I needed therapy for my poor body, not my mind or psyche! Of course there was none to be had. They were going to send me to a mental hospital for evaluation but I protested and managed to get them to send me to one that deals with physiological illnesses. I didn’t have the fibromyalgia diagnosis at the time and it was scoffed at, just as my hypermobility was scoffed at. But at least I had the lumbar kyphosis to show for. Not that it really mattered to them, either, but, oh well. I was granted a permanent pension in the end even if it was based on ‘anxiety and depression’ rather than my physical malaise.

Practitioners also tend to put all patients with chronic illnesses in one convenient bag, without paying attention to individual differences. And believe me - the individual differences regarding symptoms and ability to deal with the illness at hand are huge. Many of them jump on everything you say and twist your words to suit their narrow-minded treatment plan. This in itself is incredibly stressful. Luckily there is a lot of research going into studying the brain and its anomalies at the moment, and it's certainly not "all in your head".

"Limbic kindling is a condition where either repeated neurological exposure to a sub-threshold stimulus (i.e. one that does not produce problems), or a short-term high intensity stimulus (e.g. brain trauma), eventually leads to a persistent hypersensitivity to that stimulus. /... / The limbic system regulates the autonomic nervous and endocrine systems and the emotions, memory and even smell. Is it ‘on fire’ in ME/CFS?"

(Read more on Health Rising).

In my own life, I have only encountered huge difficulties while looking for help with the persistent insomnia. I had my own way of surviving all my other symptoms and didn't really feel dependent on doctors. Of course help would have been welcome but I soon got the idea that there wasn't really any to be had. In the case of the insomnia I have been desperate for help as I need medication to cope. My life is literally at stake (or my ability to function at the very best), but I have only negative experiences to report. I feel very much a victim of the tendency amongst medical practitioners to blame imaginary ‘maladaptive’ behavioural patterns. After years of soul searching, I am confident that the fact that I am finding it increasingly difficult to manage my emotional self is merely a symptom of my illness and the stress around it. I didn't use to mull over injustices and hold grudges. I had a kind of social anxiety that came from shyness and a lack of confidence, but as I've improved my social skills, it has merely been replaced by a different kind of anxiety that is triggered by overwhelm. I don't feel able to manage complicated situations because I am too tired and even the tiniest emotional, mental or physical challenge is stressful. Now it is as if I perceive any semblance of adversity as a threat. It means that noisy environments are just as much a threat as a lack of a financially secure future and confusing people whose motifs I don't understand. People are the hardest to deal with, because they are hard to avoid and you just never know what to expect from them so you can't really foresee what level of stress may arise.

Some people in my past have chosen to cause me stress and grievance. They are petty and mean spirited people. Some of the worst experiences I have had were with the social services I was dependent on in a small town in Finland. I was humiliated on a regular basis. Just a very simple example is when I asked for a cheap vacuum cleaner and was told I could just as well wipe off the floors by hand. I wast even allowed to have a clean home - how as a disabled person would I clean the floors without a vacuum cleaner?! The least they could have done would be to pay for someone to come and clean my home, yet that's not even what I asked for. Still it was worse, much worse than this. I wrote all about it in a blog but it's in Swedish (however, you're welcome to translate it through Google if you're interested). At the time my stress levels were incredibly high, and that as well as negative dating experiences set me back so much I am no doubt a lot more ill now than I needed to be.

I have come to a point where the drugs that help me sleep are making me so ill I simply have to come off them. However, now I really am anxious as I have to face the possibility that it I will not survive it. I meet ill people who sleep two to four hours a night, and survive it - they don't feel they have a life but they are still standing. They are still here. I know this would not be possible for me. Perhaps I use too much mental and physical energy during the day? I don't know - all I know is even one short night makes the following day into a very arduous affair. Not only that, the following night my nervous system is even more agitated and so the possibility of sleep is even more remote. In other words, the better I have slept one night, the better I'm likely to sleep the next, and vice versa. Why is this so hard for the experts to understand? Since I am not able to make an appointment and go and see the insomnia consultant and get my concerns out of my system, the concerns are instead eating me up from the inside out. However, I try and take matters in my own hands and try not to fret over all the things I ought to do in the near future, all those things for which I feel I have to be prepared and reasonably well rested. Thus I'm cutting the quetiapine in half each night and hoping for the best. Last night I slept, but not enough, and I feel very strained, weak and woozy, and find it quite difficult to concentrate on writing this article.

Patients suffering from fibromyalgia often report unrefreshing sleep. A study conducted in 1975 by Moldovsky et al. showed that the delta wave activity of these patients in stages 3 and 4 sleep were often interrupted by alpha waves. They later showed that depriving the body of delta wave sleep activity also induced musculoskeletal pain and fatigue. (Wikipedia)

I am becoming increasingly certain that the best potential cure for this kind of condition is the reprogramming of the brain (however I cannot vouch for everybody, I can only talk from my own perspective and what seems right for me). Basically you need to access the unconscious part of your body and recondition the nervous system to respond to life in more constructive ways. It is not your mind, but your nervous system, that needs to be reconditioned to stop perceiving life as a threat. Of course there are other things such as diet and exercise that have a positive effect on your body's ability to restore balance, but I think we need to get to the very core of the problem. Dr Myhill and others have suggested that failing mitochondria is the problem. You can watch a webinar here > 

However,  I'm personally more interested in the autonomic nervous system. I also recently read that an estimated 90% of all illnesses are said to stem from stress, and this is an instinctual gut reaction that requires no involvement from the conscious mind. This means that during chronic stress the autonomic nervous system begins to go haywire while it is trying to decide whether to fight, to run, or to shut down the system altogether ("play dead"). Over time, if this stress is not released, negative responses to stimuli become automated so that the tolerance to life's challenges becomes lower... and lower. Chemical and other sensitivities may also occur. No amount of talking sense to yourself is going to help, because the problem is not on the level of the conscious mind.

This is where I am at. My body is luckily quite sturdy and I can still exercise, and so my overall symptoms are still reasonably easy to manage. Yet I do worry that this break down of the nervous system is gradually wearing everything else out as well. The nervous system is connected to everything in your body, and this holistic phenomenon is of course difficult for the over-specialised doctors to comprehend. I thought I was getting better when my stressful relocation was further behind me, but unfortunately things aren't really improving. I can tell from the way I respond to all sorts of trivial issues in daily life (mostly to do with other people).

These are the things I feel I can do for myself:

• Avoidance. By avoiding stressful situations as much as possible, I hope to give my brain the idea that life isn't all about stress, threats and challenges. This requires vigilance, as one has to foresee the possibility of a stressful reaction in all kinds of life situations (social encounters in real life or on the internet, supermarkets, visits to art galleries, visits to the optician or the doctor, and so on, and so on...). This also includes the art of pacing, that is not to overdo an outing or any kind of work by the computer, in the house, or elsewhere. For me, it means limiting the time I spend making art (as the process is often quite stressful and tends to consume me for hours on end). It may also mean not visiting my home country even if money was to present itself.
• Meditation. I have been meditating once a day for about half an hour since late January, but believe I should be doing it three times a day. In the beginning it was quite powerful, as I was able to imagine and probably produce a state of receptiveness to healing energies. It felt as if a lot was happening on an energetic level. I believe the energy is there for us to draw in, though it's not always easy and you have to do it consciously. You can pass it onto other people or yourself. You need to be able to feel compassion towards yourself though. You need to have a positive intention and the imagination that allows you to believe in good health (or at least better health), as well as the intuition that allows you to do it in a way that works for you. I call these my three eyes (I's). My meditation is nowadays calm and uneventful but I feel that it is giving my brain some breathing space, and I focus my good intention on giving the nervous system a break from stress.  I'm no good at visualisations such as imagining energy and pain gateways, but there are other ways of inducing well being. Meditation has recently been shown to reduce activity in brain centres involved with anxiety and depression.
• Practicing Qigong. I learnt a 10-20 min program on a weekend course for Zhineng Qigong, and it's especially beneficial to ill people. While meditation is a way of accessing deeper brain waves (delta waves would be ideal as that is the equivalent of deep sleep), Qigong and Tai Chi smoothen your ethereal body and so is more about your physical being. Alternatively you can do Yoga if that suits you and your body. I admit I haven't practiced for ages but I should do if I aim to focus on recovery this summer.
• Keep on using the bed of nails every night after a lovely back rub from my husband. Both are soothing the nervous system a great deal, but I also believe that inducing pleasure (endorphins) is essential to retraining the body's responses. It needs to remember what it feels like to be in a good state of health.
• Keep on exercising. I'm able to do a bit of aerobic as well as anaerobic exercise every day, and this and a healthy life style in general is the cornerstone of my life. I just ought to start out the day with the exercise and not wait until I'm all stiffened up.

• Remembering to take deep breaths as often as possible during the day, and hold them for as long as possible. Lung capacity and oxygen intake need to increase!
• Keep on managing negative thoughts by trying to maintain a hopeful and constructive outlook on life while knowing that some things cannot be fixed and therefore must be accepted and integrated into one's being. I keep on telling myself that my corporeal existence will improve as my stress responses diminish.
• Keep on forgiving people. I didn't use to think I had to forgive people nor did I necessarily even believe in the process. However, multiple disappointments with people over a fairly short period of time showed me that I needed to actively engage in such a process. People are ignorant and will hurt you. Being a bit more accepting of the way people are can only be helpful when you're trying to manage your stress levels. 

There is also a method called neurosomatic therapy that you can look into. It doesn't seem that original, it pretty much seems to combine elements of different kinds of massage and physiotherapies (so all of it is familiar to me). It could be a good thing for those who have become completely immobile, as the kind of help you get is often quite one-sided. To be fair I think that my daily back rub, exercise routine and other habits, as well as what I've learnt throughout my life, more or less cover the ground. The above is what I can do for myself without having to pay a lot of money. All of this will have to come to forefront while I try and get my sleep onto better rails. Let's just hope for the best. The catch is, I won't be doing any of it if I don't sleep, yet I have to do it with the hope of improving the sleep.

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3.7.2014

As I have now seem to have been been peri-menopausal/menopausal for about a year, I have gradually started to experience some significant changes. They are not just the ones most commonly sited. One has to dig deep to find really interesting information about this time in one's life, and how it relates to stress related chronic illness.

The most significant ones were that I became intolerant to medication and started experiencing even more disrupted sleep in spite of still taking medication to manage it. My health started declining quite rapidly in many ways, and though it's not clear whether it's all due to lowering levels of sex hormones, it does seem likely. My back pain has increased a great deal so that walking on flat surfaces has become very difficult. Of course, this was already expected since there is bound to be increasing wear and tear in my buggered spine. It's very worrying - but I hope to see a consultant soon and hopefully get some help (though it's possible they won't do anything about this). I've also been a great deal more tired and can only undertake one task per day. That is, a household task, or creating some art, or going somewhere for an outing. Small efforts leave me exhausted but may also help me sleep a bit better as long as I don't suffer from stress. I experienced increasingly hotter feet at night (a problem I've had for a long time) though in all honesty it was worse as a result of taking medication. I also have more problems with cognition, hair loss, red and oily skin, and started to experience some vaginal atrophy (i.e. I was itchy, which aggravated the vulvodynia). My periods also became more frequent, i.e. my cycle was 21 days.

I resisted the idea of HRT (hormone replacement therapy) because on the surface, the side-effects looked just like any other that medication cause, and I didn't quite understand why you should disrupt the cause of nature. I didn't know much about the benefits and the ones commonly sited didn't impress me that much. I started out taking oestrogen cream that you apply locally, and that did help with the itches. It has no side-effects. I also had to start applying clobetasone (euomovate) cream on the outside of the vagina because of temporary itches that probably came about due to my vulvodynia. However, after three months I read an interview with a compatriot who has written books about how she's tackled her chronic fatigue (ME), and one thing she mentioned was taking oestrogen and progesteron. She's not menopausal - I'm guessing she's around 30 - 35. However, these hormones had a massive effect on her well being. The theory is that in stress related illnesses the levels of the stress hormone cortisol become depleted, and this in turn depletes the sex hormones. It makes you wonder if this could also be one reason for the low libido many fibromyalgia and ME sufferers experience (not to mention people who are just stressed in general). She also said that progesteron helped her with her massive hair loss! Of course I pricked my ears, since my hair loss has been terrible for years but really got going now over the past year or two. Three years ago I still had fairly nice, curly hair, and now there's almost none left and what is there is just wiry, limp and not very curly. That really affects how I feel about myself - add to that four kilos overweight and a tired and wrinkly face... well, my self-confidence is worse than it used to be. I have read that HRT can cause hair loss but decided to take the chance, at once, before ALL my hair is gone.

As I dug deeper I found some evidence that HRT can indeed help with fibromyalgia symptoms. In fact, some women start to experience fibromyalgia symptoms as they become peri-menopausal (even before the age of 40), and have experienced relief as soon as they started on the HRT. You should of course take both oestrogen as well as progesteron unless counter indicated. This means that HRT could also be beneficial for younger women with a chronic stress related illness who aren't yet menopausal.

Another interesting theory is that progesteron especially can help with back pain in the form of sciatica. It helps create tissue and some of this is an increase in myeline, that is the protective membrane around our nerves. This layer of protection becomes damaged when under stress - I have personally experienced long term stress so bad that I felt as if my nervous system was completely "raw". I really think the myeline was very damaged and gradually got better as my situation improved. However, the illness can still be causing serious harm to the hormonal balance. On top of that, menopause seems to start depleting the body of myeline and this starts the furthest away from the brain. Of course I'm interested in keeping the nerves of my lower back as happy as possible. Not only that, it gives me the idea that this could be beneficial to the entire nervous system! If you have problems with the spine and don't exercise very much because of fatigue, it's also worth considering that HRT can protect you from osteoporosis. It is also noteworthy, that progesterone is a sedative!

I have now been on HRT for a bit over two weeks, taking oestrogen at first, and then the progesteron about two weeks into the treatment. The beginning was difficult because I experienced severe abdominal cramps - they were period cramps of a kind I've never really had before. I had to take paracetamol which gave some relief. I also had to make sure I took the tablet with my dinner, because it caused IBS symptoms when taken on an empty stomach. I also felt very dizzy and weak on the first day and rushed to the doctor to check whether carrying on with these side-effects was a good idea or not. Doctor thought I should try and hang in there, as the symptoms were likely to settle gradually over time (this they don't tell you in the leaflet). He didn't think that taking HRT in any other form than pills would be helpful at all - and it makes sense. Of course I didn't want to go around with these kind of symptoms for the recommended three months! The dizziness subsided over the following days but I still experience cramps that go on for about 12 - 14 hours. The severity varies though and seems dependent on the day in the cycle as well as IBS symptoms (I'm trying to make very sure I don't upset my tummy outside of this treatment). However, I also wonder if perhaps the fact that it hurts is the body adjusting to something it really needs. The HRT is supposed to level out my period cycle so that it goes back to 28 days, and perhaps this is also a reason why the cramps are so bad. I'm thinking they might well dissipate as the body adjusts to all of this. There's also been an increase in vulvodynia pain, muscle pain and oily skin (my pillow case is quickly soaked in grease), but I hope it settles.

When I started on the oestrogen and the progesteron respectively, I also experienced some significant sex dreams. In the last one energy was coming from the womb. This gave me some hope that my body is a bit more tuned into sex! After all, my libido has gone downhills in recent years and it certainly seemed as though in the past year, it was quite a lot dependent on hormonal levels (in other words with a few peaks here and there but mostly flatland). Just three days into the progesteron treatment, which I had been the most excited about, I had some rather strange and powerful experiences in this area..! Yess!

My sleep quality seemed to improve a bit when I started the HRT. Of course it's difficult to tell because it could be coincidental, but I seemed to wake up a bit less frequently on many nights. 

I have also discovered a Chinese herb combo that seems to help me stay asleep for longer. On most nights, I sleep continuously for 6-7 hours, sometimes having a quick pee or two in the middle but being able to go back to sleep afterwards. It's also good for menopausal symptoms and lack of libido, and one of the main ingredients, Radix Rehmanniae, comes highly recommended for chronic fatigue. The combo is called Tian Wang Bu Xin Dan, aka Emperor's tea pills. I will talk more about this later. You can try pills or buy it in a 100 g pack (cheaper!). You have to figure out whether you fit the personality type and pattern of illness first, though. I think this one seems especially beneficial to stress related insomnia and fibromyalgia (read more about Chinese medicine and fibromyalgia), but there are also other combos. There is one especially recommended for menopause and insomnia, called Liu Wei Di Huang Wan, but I don't know if you can take it while on HRT since it contains natural oestrogen (I would think it doesn't matter).

I think generally speaking the risks are somewhat exaggerated and the chances of getting cancer because of the HRT are fairly slim. It's quite obvious to me, that if all the potential good effects come into being, it is definitely worth the risk. At the moment I'm way too preoccupied with my declining health in other areas to worry about some potential cancer risk in the future. I shall continue my research. In spite of declining health and the feeling my life is soon about to be over, I feel somewhat empowered because I've learnt a lot about my illness recently as research has progressed, and feel that more treatment options are becoming to light.

5.7.14

Often I hear people say they tried this... then this... then something else - I believe it was like that for me too though I never had much money to spend on a lot of treatments. I think I'm really getting the idea now that in order to benefit from treatments you have to do them at the right time, in the right order, and often simultaneously. One has to create synergy between the treatments, for maximum effect. I think this applies the more complicated your imbalances are on all levels of your being. The reason I'm seeing some improvement may very well be that I've found a way to unfold the healing process in a way that at least makes some kind of sense. It doesn't mean what I did before (for instance ate well, took supplements, exercised and even meditated for a few months) was in vain, only that it wasn't enough to rectify the balance so that I would actually start sleeping again. 

I've done more research into Chinese herbs, but frankly it's time consuming and rather frustrating at times. I've made a lot of progress though, and have been updating the article at the same time. It's  hard to figure out what could potentially be useful. Many of us in the present day have mixed illness patterns. Here's a list of Chinese herbs recommended specifically for fibromyalgia, but I wouldn't start taking them randomly. Most of them won't work if you only address one aspect of your illness. You need to target a complex array of interactions, and create synergy.

I've also become aware of just how indoctrinated we are with the Western mentality of not paying respect to symptoms but just shooting the messenger. Even the best of us jump on the bandwagon of quick and easy relief of symptoms (though in all honesty, that's okay too, in acute cases). For instance, people with low blood pressure are told to just eat enormous amounts of salt. Simples! A study I saw just concluded that it cured most of the subjects. What does that tell doctors? It gives me the feeling I can just have all the salt I want. But of course extreme amounts of salt isn't good for the internal balance - it can damage the lining of your stomach, cause osteoporosis and kidney stone. You have to be clever. I feel like eating good quality sea salt and so I do, knowing that I only get very little from processed foods. I like to add my own salt. But of course I'm being intuitive and am not going to let the usage escalate. And in any case, hypotension is a sign of imbalance. One has to map the whole territory, not just take down the signposts and say there is no territory to  begin with. The use of simplistic logic is prevalent in the West. I'm sure many Chinese are just as simple minded and take pills to rectify issues without changing their life style, but at least they are better informed than we are.

The first thing I ordered before I knew much about Chinese herbs was Sophoros Flavescens root (Ku Shen), which I made into a vile tasting tea. Many people with chronic fatigue and some with fibromyalgia take it as a supplement called Oxymatrine. You can read about it here. Dr Myhill's report is here. ("Patients with CFS/ME are not good at dealing with viral infections, they do not eradicate them efficiently and this viral DNA gets in the way of cell metabolism causing a low grade chronic inflammation which means cells malfunction."). It's anti-inflammatory and supposed to clear phlegm. I drank this tea once a day for four days but got rather bad side-effects. The yellow, greasy coating on my tongue cleared and this prompted me to carry on taking it. However, I became dizzy and then came down with a very bad headache, as well as feeling queasy and weak, unable to think, and bit nauseous. In the beginning I had palpitations and didn't sleep well. Some coating on my tongue came back but isn't as bad as it used to be (not yet, anyway).

I still haven't quite recovered from this shock to my system three days ago - I still feel tired and have a slight headache. I wish I hadn't been so persistent! Apparently you're supposed to gradually build up the dosage, and I probably totally overdosed (not everyone is sensitive, though). I hope it still did some good in the midst of all this. Of course this could be a healing crisis but one never knows. It made me feel as if my inner organs were all very tired, and I have in fact slept quite well after the first night. Last night I went to bed a bit earlier than normal and only took 1/4 of a Quetiapine (that's about 6 mg only), and one teaspoon of the sleep combo (Tian Wang Bu Xin Dan). I slept well for six hours, then took about 1/3 of a teaspoon of the combo and slept for another three hours (lightly at first, then a bit more soundly). So in a way, this heaviness (an anti-wound up state) in my body feels quite welcome...

I'm deliberating whether I should start taking some in the daytime too, for maximum healing effect. This combo is obviously doing me a world of good, but I don't feel I can still sleep without anything at all. I'm taking it easy though, giving my body time to adjust. The formula could take up to a month or more to be fully effective. All this sleep is doing wonders to me, and in spite of the incident with the Ku Shen, I feel a lot better and am also getting up two hours earlier in the morning. And I've even lost a couple of kilos, just like that! I also find it easier to breathe. I suspect the sleeping pills were suppressing my breathing but in the end it doesn't matter whether I feel better for not taking them or whether the Chinese herbs have cleared a blockage, or both.

I have not yet been able to address the damp heat discussed in the previous article, as I've gone over it for days, trying to work out what would be the best solution. I hope to order the herbs soon.

What I've been doing so far:

- all the usual, i.e. avoiding stress as much as possible, eating healthy food and some basic vitamins, daily exercise, a good walk at least once a week, lying on my bed of nails at night, receiving a massage from my husband every evening, and meditating for 30 mins in the evening.

- a year ago I was still on heavy medication that was only patching up the damage on the surface. I took 25mg x 6 Quetiapine as well as a lot of benzo and non-benzo in order to sleep. I had bad palpitations so was also on a heart medication called Verapamil for 6 months. I gave up the Quetiapine and that helped me clear some of the palpitations so that I could give up the heart medicine. I tried other ways of managing my insomnia including Mirtazapine and anti-histamine, but realised after a few months that I was medically intolerant to all these chemical concoctions. Since then it's been a terrible journey, trying to get some sleep while feeling more and more tired and creaky. You can read about it in older blog posts. Somehow in this process I managed to cut down on all the medication. I went back to Quetiapine in the spring as it seemed the least worst, but now responded to small doses. Throughout spring I've managed on 30 - 40 mg Quetiapine taken in two parts during the night, as well as some benzo/non-benzo which I tried to alternate for maximum effect. Since being on the Chinese combo I have cut down even more. 

- HRT (Elleste Duet) for a month now. It was hard for a month but I 'm feeling rejuvenated from it nonetheless. Perhaps this lay the foundation for change. [I only used this for a month]

- Tian Wang Bu Xin Dan Chinese herb sleep remedy for about three weeks, gradually building it up while cutting down on the other medications very slowly so as not to create shock to the system. I'm not worried about giving it up for any other reason than that I don't want to rely solely on the herb combo and then find that I'm still not able to go to sleep. I want to give the combo plenty of time to work on the imbalances that have given rise to the insomnia in the first place. I may also have to supplement with Huang Lian in order to address digestive issues that could be keeping me from falling asleep. I feel weakness in the digestive area and really want to try some herbs to try and resolve damp heat, as soon as possible. I'm now taking just half a Quetiapine at night to fall asleep, that's a mere 12.5 mg. I also take about two teaspoons of the Chinese formula, and when I wake up again after 5-6 hours, I take another half tea spoon.

- incidentally, I was offered healing free of charge and have now received three sessions. I also receive some advice about Bach flower remedies and a chance to try them for free.

- I went through a deep, emotional issue about rejection that has been defining my life, just two weeks ago. It was a tidal wave. As terrible as it was to be confronting someone I know, I think it was all useful to my state of mind in the end.

- a short course of Sophoros Flavescens which cleared my tongue from the worst gunk.

That's all for now, though in all honesty it's quite a lot of stuff. When I have money to spend I will get the kefir culture and see what that does when it populates the body with good bacteria and hopefully boosts the immune system. I also consider getting one more Chinese herb, but don't know which one yet - possibly one for the digestive issues if I can find something that seems compatible with the sleep formula. I might start to take the present one in the day time too, for maximum effect. If I start feeling more energetic I will probably take up my Qi Gong practice again (it addresses a different aspect of one's being than what meditation does).

"We found that the terminology relating to sleep-related symptoms in the TCM classification was much more detailed than those used in the Western diagnostic systems. The insomnia symptoms mentioned in theDiagnostic and Statistical Manual of Mental Disorders Fourth Edition [23] and the WHO International Classification of Diseases 10th Edition [23] include difficulty falling asleep, difficulty maintaining sleep, nonrefreshing sleep, and nonrestorative sleep. Although excessive dreaming, awakening with a start and restless sleep were common complaints in individuals with insomnia, they were not utilized in the Western diagnostic systems. Half asleep, going to sleep late at night, insomnia with vexation, and difficulty falling asleep with vexation were seldom mentioned in the Western literature. At present, no scientific investigation on these individual sleep symptoms has been performed; hence future studies are needed to determine their clinical significance" 

(Classification of Insomnia Using the Traditional Chinese Medicine System: A Systematic Review)

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9.7 2014

NOTE: This article evolved over a time period of a few weeks, so the contents will display an increasing degree of understanding of Traditional Chinese Medicine (TCM), a very complex system that is no easy nut to crack, and I knew absolutely nothing when I started unravelling this mystery. This means that at no point in the article is the information complete. However, you may follow the development of my growing insight in order to inspire your own. In order to get the whole picture, you must also read the updates that follow this article. It might appear that I'm suggesting that fibromyalgia is a heat disease, but as you read on I will show you that it's not so simple. The remedy I started out with ended up not being the best for me, however I will also explain why it did work to some extent and why it's not the best solution.

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I believe I've come across something very useful in treating comorbid insomnia when induced by stress and fibromyalgia, especially when coupled with other measures. I'm going to offer my understanding of this remedy because I wish to inspire people to try Chinese herbs. As you can see from previous blog posts I suffer from very sever insomnia and had pretty much given up hope of ever having any kind of life, if any life at all. My insomnia seemed pretty terminal.

I am not a health professional and cannot guarantee it will help everyone, but I'm pretty sure there is no harm in trying it. This is my attempt to help you self-diagnose. If you try this herb without consulting a professional, it is of course at your own risk. I am not a health professional, so all experimentation is at your own risk! Herbs are medicines, so you can expect adverse reactions if you take the ones that aren't indicated for your specific condition. In this article, I try and stick with herbs that are probably fairly safe to try  - if you are extremely ill, you will obviously be less tolerant to adverse reactions.

The reason I feel I have to offer a synthesis and "interpretation" is that Chinese medicine is extremely complicated and it can be difficult to plough through the information available on the internet or in books. It's hard to know where to start. I don't really know that much about Chinese medicine per se but I do understand symbolism (my art is symbolic) and also at least to some extent the kind of logic the Chinese have employed in putting together a combination of herbs. I studied world religions, cultures and even the Chinese language in the past (on a Master's level). I have a special interest in Taoism, which is deeply connected to Chinese medicine.

Each combo has to match a person's personality and pattern of illness, so the question here is to determine whether a specific remedy matches a certain profile. I always wanted to see a Chinese herbalist but either didn't have access to one or simply couldn't afford it. There is a local herbalist who charges £100 for the initial consultation - and that's just the first one. Of course you probably get a proper diagnosis as well as a customised combination of herbs, but some of us disabled people don't have the money to put into this. The lingo on the internet is usually quite difficult since everyone has their own way of understanding Chinese medicine. I'm sure herbalists also prefer that you go and see someone and don't take matters in your own hands, however this wasn't an option in my case. This is not a scientific treatise, just a compilation of facts found readily all over the internet, all with the aim of clarifying some hazy concepts and providing a more complete picture. If my intention had been a scientific paper, I would have had a different approach.

It all started because I was inspired to look up a Chinese herb (Ku Shen or Sophoros Flavescens) mentioned in the case of ME and insomnia - I found that it is often taken for chronic fatigue. It can promote hair growth and has anti-inflammatory and anti-cancer properties, and it might promote sleep indirectly. It can have dodgy side-effects, though. The research did however give me names of herb combos more directly recommended for insomnia. The one that stood out is called Tian Wang Bu Xin Dan, aka Emperor's Tea Pills or Emperor of Heaven's Pill to Tonify the Heart. (Note that the last word Dan is often substituted by Pian or Wan. Another variation on an ending on some herb formulas is Teng/Tang).

"'Adaptogens'" are a group of herbs that seem custom-made for our stressed out times. By definition, adaptogens are 'non-specific,' so rather than targeting one particular symptom or part of the body, like much of Western medication, they increase your resistance overall against physical, chemical and biological stressors. They're non-habit forming, even when taken over long periods of time and, most importantly, they are normalizing -- they create balance in the body without negatively influencing any particular body system at the expense of another." (Dr Patricia Fitzgerald)

One has to understand that the Chinese descriptions of diagnosis and matching remedy are a combination of metaphor and fact - often fact is clad in a metaphorical language. Also when they talk about physical organs they are really talking about the energy field, however it doesn't mean they are ignoring the physicality of it all. I would say that we're looking at two sides of a coin. I believe that energy and matter are two sides of one coin, as is in this case also symbol and reality. It's also not important whether the disease has come about due to external,  internal or behavioural factors - the simple fact of incurred imbalance remains. From this point of view, mental clutter and racing thoughts that prevent people from sleeping is just a symptom, not a cause. Insomnia is also just a symptom. While CBT could be useful in many cases of insomnia (positive thoughts have a positive effect on the whole organism), it doesn't address physiological imbalances and a distressed spirit (shen) with depleted energy reserves (qi/chi). Spirit here denotes all of the mind, soul and spirit in an esoteric sense. If you have a severe physiological and energetic imbalance, you will probably not be cured by positive thoughts alone.

Western doctors are very fond of either offering loads of pills or condemning the use of pills, but don't offer much of an option. One doctor preached to me when I came to the UK and thought I was just looking for the answer in a pill - but honestly, where else should I look? In the end, herbal medicines have always been around for a reason. I used to think herbs weren't strong enough, but now I think it could just be a question of finding the right ones and the right combinations. Taking just one or two herbs is probably a non-starter when you have a serious illness because it's only addressing a few aspects of your condition and doesn't necessarily help create synergetic balance. The more ill you are, the more there is a need for a holistic approach, but ironically, that's usually when you get the most specialised medicines.

The consultant in London said to me Chinese acupuncture hasn't been proven useful in cases of insomnia. To be fair, acupuncture never helped me with anything, however I do believe the treatments weren't skilled and insightful enough, nor were they coupled with other remedies. I believe it could potentially be effective when teamed with herbs and self-help/life style changes. I think that even in an integrated hospital like the one I went to for my insomnia they are very narrow-minded and don't offer a selection of complementary and individualised treatments that address all aspects of one's being. To give acupuncture to try and induce insomnia without addressing underlying conditions is bound to fail, but would be a very typical Western approach. They stare at insomnia as if it was an isolated phenomenon. I can personally also recommend meditation, Tai Chi and Qi Gong (all address different energies) as calming exercises, but it's not enough when your imbalances are severe.

TIAN WANG BU XIN DAN (HEART, KIDNEY AND LIVER)

This particular combination of herbs, Tian Wang Bu Xin Dan (thyan whung boo shin dun), is recommended in many cases of fibromyalgia. The basic principle is that a body, that is being ravaged by stress and inflammation, will display excess heat and therefore needs to cool down. This is explained as the prevalence of an excess of yang energy (the male principle). Consequently it's necessary to strengthen yin, the feminine principle. Yin is deficient especially in many immune disorders and cases of fibromyalgia. Yin is also the realm of sleep, whereas yang stands for wakefulness. Too much yang energy keeps you awake.

You need to remember that the Chinese use the name of organs symbolically - by diagnosing and addressing an energetic imbalance the physical aspects of the body will heal. There are clearly many imbalances that can give rise to insomnia.

This ancient formula that was said to have been revealed in a dream by heavenly beings ("heavenly emperors") is the classical remedy for the symptoms of "heart and kidney yin deficiency," that shows up in a lack of "communication" between the two. This often comes about due to emotional shock and trauma. A few signs of kidney energy weakness are low back ache, tiredness and fatigue, and a burst of energy at about 11 pm in the evening. If the heat regulating kidneys don't work well, the heart will overheat - this is an imbalance common in modern industrialised society.

"The kidneys reflect the water element, and the heart reflects the fire element. Thus, when we say there is disharmony between the heart and kidneys, we are saying there is an imbalance between fire (yang) and water (yin). This also leads to yang not giving way to yin. To return the organs and elements to balance, you need to strengthen the kidneys and sedate the heart: Water needs to overcome fire." (Dr Mark Wiley)

If one has trouble going to sleep and generally has problems with feeling overwhelmed and extremely fatigued, it could be a case of liver qi (energy) stagnation or damp heat/phlegm. When the qi of the liver is stuck, symptoms of frustration, irritability, depression, anxiety, fullness in the chest, menstrual disorders, and indigestion can occur. This problem is often connected with the IBS that people with fibromyalgia experience. This excess condition can also arise in a person who has experienced long-term depression or frustrations, creating a vicious cycle of cause and effect. With Liver Chi stagnation, sleep becomes restless, with intense dreams and even nightmares, and a tendency to wake up too early in the morning. Liver-spleen disharmony often results in fibromyalgia - in simple terms, it means that there have been an excess of negative emotions and too much mental activity, as well as a lot of worrying. For a more in-depth diagnosis, please see this table. Another diagnosis for the remedy that you might come across is "Qi and Yin deficiency with Liver Fire", but in this case there should be additions made if you use a ready made formula (read more further down).

The Heart energy is directly connected to the brain. Spleen-Heart deficiency is sometimes said to be a major reason behind typical fibromyalgia symptoms of fatigue, depression, brain fog and poor concentration. The heart is not nourished by the spleen, which gives rise to insomnia. With "heat disturbing the heart", "heart blood deficiency" and/or "heart and kidney in disharmony", people find it difficult to fall asleep an/or to stay asleep.

Insomnia is in traditional Chinese terms often seen to occur because the heart is so troubled that a person's spirit isn't able to return to the heart during the night. The heart is the energy centre that consolidates spiritual and earthly energies. In many cultures, it is thought to be the seat of the soul. We know that deep sleep is disturbed in conditions such as fibromyalgia, but what isn't always clear to Western people is that deep sleep is a spiritual state. So perhaps, if you aren't able to reach a state of deep sleep, on the one hand your body will not restore itself well, but on the other hand the connection between body and spirit, i.e. mind, soul and spirit, will also all suffer. This would then no doubt perpetuate the restlessness and disconnect that caused the insomnia in the first place.

"According to TCM theory, insomnia is associated with agitation of the shen (the spirit/mind). Shen is a form of qi. It is the “lightest”, least substantial, and least stable form of qi. Shen plays a role in the higher mental functions associated with the intellect and the spiritual aspects of consciousness. Shen is light and subtle, therefore it must be anchored by the yin aspect of qi (jing) and the blood or else it is possible it could “float away”. The shen must be calm at night and is housed by the heart during sleep. If this is disturbed it will result in disturbed sleep and insomnia.

The Heart and shen have a special interdependent relationship. The heart is the residence of the shen and during sleep the heart houses the shen. In Chinese medicine, sleep is seen as one's yang energy moving inward to be enfolded by yin. Insomnia therefore, is a dysfunction in the interchange of yang entering yin." (Chris de Tecco)

INDICATIONS

I believe the first question on the check list for this remedy could be as follows - do you suffer from a stress related illness that may have disrupted the natural balance between yin and yang in favour of yang? Is your yin energy so weak that insomnia has occurred?

At least this is somewhere to start unraveling the syndrome. Generally speaking, symptoms of excessive yang will show up as stress and anger. Physiologically there will be problems with the stress hormones cortisol and adrenaline. Whether there is inflammation can be hard to determine though there are usually signs for those who know how to read them. As recently suggested by research, fibromyalgia could be connected to an inflammation of the brain. Sometimes low fever is present, but not always. In any case, for this remedy, there should only be a reasonably mild problem with excess fire. In other cases, other remedies may be more suitable.

You should also display many of the following psychological and physical symptoms that should not be that hard to determine:

Restlessness, emotional distress, irritability, anxiety, worry, vexation and even nervous breakdowns; palpitations and a sense that it's hard to breathe; forgetfulness, inability to concentrate and staying in the here and now; even a sense of being a bit "ADHD" or having been diagnosed as having it; difficulty staying asleep, suffering from excessive dreaming (i.e. too much dream sleep and not enough deep sleep), waking up too early, and feeling tired. One may have warm and moist palms and soles as well as general night sweats, dry throat and mouth, dry stools, and even mouth and tongue ulcers - the tongue is red, dry and cracked with slight furry coating and one feels thirsty a lot. One's pulse is thready and rapid.

I personally suffer from all of the above except for my propensity for diarrhoea rather than constipation. This could be an indication of excess "dampness" or damp heat which could in turn point to liver qi stagnation and/or the invasion of damp heat in in the digestive organs.  As you will see later, I found herbs to supplement with. I've suffered from hot, sweaty feet for a long time, as well as painful tongue fissures. I do usually have thick white or yellow coating on my tongue so there may be more issues to address with a different remedy (possibly another symptom of "damp heat"). There should be a remedy for better digestion that might be useful in this case.

Recently I've had issues with palpitations, though some of it has been down to medications (namely Quetiapine for sleep). The kind of dryness of the mouth I've experienced all my life is a sort of stickiness/sliminess, which should indicate damp heat or phlegm/heat. I have always felt some of the discomfort in my mouth is due to the IBS. I'm always thirsty, which is another symptom of fibromyalgia. My pulse  has always been too rapid. In Indian Ayurvedic terms I'm a Pitta/Vata personality, thus displaying a lot of symbolic fire and air. This is supported by my Western Astrological chart, which also displays a lot of water and lacks grounding elements that would normally slow you down and counteract the effects of stress. The element in my Chinese horoscope is fire. I dislike dry, hot climates. Looking at these type of systems and inclinations could be helpful in determining your underlying propensities, but of course it doesn't fit in with everyone's belief system.

I sometimes feel cold because my heat regulation is off. I think it's even worse as the damp heat on my soles is cooled down by the cold air in this draughty old house, so I wear woolly (especially alpaca) socks a lot. I would say this tendency to feel too cold has increased over the years.

Medical indications for Tian Wang Bu Xin Dan include coronary heart disease, angina, fibromyalgia, ME/Chronic Fatigue, viral myocarditis, hypertension, hyperthyroidism, neurasthenia, mental instability, attention deficit disorder, insomnia, impotence/low libido, and hepatitis.

This formula clears heat, reduces inflammation, regulate hormones (the hypothalamic-pituitary-adrenal axis or "the kidney network" according to the Chinese), regulates blood pressure and blood sugar, and also acts as a sedative. All the ingredients come up time and time again if you search for remedies for fibromyalgia, stress, menopausal symptoms and insomnia. However, it is clearly contraindicated for people who are very pale and deficient in Yang energy, so especially people with ME should probably be reasonably clear about their diagnosis before taking this particular formula.

INGREDIENTS AND DOSAGE

For instance -  Radix Rehmanniae (Sheng Di Huang/Shu Di Huang) is highly recommended in cases of chronic illness. It has been shown to reduce inflammation and swelling and increase plasma levels of adrenocortical hormones. These hormones are involved in all of the following processes: proper glucose metabolism, regulation of blood pressure, insulin release for blood sugar maintenance, immune function, inflammatory response, and controlling blood volume (source). It's useful in cases of anemia, it tonifies the heart, and it can lower cholesterol levels and blood pressure. Shizandra berries (Wu Wei Zi) seem to increase the ability to fight disease and endure stress. It can protect you from the damage from nonspecific stimuli and stress. It can enhance the libido. It's a complex herb with many properties. I have taken it before, but didn't notice any obvious improvement while only taking small amounts on its own. Ziziphi Spinozae (Jujube seeds) (Suan Zao Ren) is one of the most common herbs for insomnia in China. It's a sedative and particularly helpful in supporting liver qi stagnation mentioned above, and is sometimes prescribed on its own. This is a remedy often recommended for people with fibromyalgia and also comes in a very commonly prescribed combination for insomnia and irritability called Suan Zao Ren Tang Wan - like The Emperor's tea pills, this is especially recommended for insomnia related to menopause and fibromyalgia. In an experimental rat model, Suan zao ren tang was shown to increase non-rapid eye movement sleep (in other words deep sleep), and the mechanism was thought to be mediated through the stimulation of GABA and serotonin receptors. (Jujube fruit, i.e. Chinese red dates, are highly recommended for insomnia and poor digestion but is not part of this formula). Post scriptum - these herbs treat signs of heat in the body and may not be suitable for people with chronic fatigue. Please read on for more information!

Some claim there are no contraindications, some say diabetes and fever/flu symptoms. It may not be advised to take this if you are taking the heart medicine Warfarin, Heparin or Aspirin. In other words, some people may feel more comfortable consulting a herbalist.

Now we get to the dosage. I started out by buying a box of 192 pills for about £7.80, but was dismayed to see that I would have to take 8 pills three times a day and so the box would only last a few days. Because of this, I only took it before going to bed, which you can do if you suffer from insomnia. I started out with just four pills, and then gradually increased it. You can take up to 12 pills for insomnia.

When I started the Emperor's tea pills, sleep was immediately less disrupted and deeper. When I woke up after 6-7 hours, I would take some more sleep medicine and four more herbal pills and get about one more hour of sleep. I hope I just might gradually become more rested and balanced and eventually require less sleep too. 

I only found one place in the UK, activeherb.co.uk, that sells this formula as a powder, and unfortunately it's only 100 gms. The cost for this herb went down by about 40% nonetheless. On the website it says to take two teaspoons three times a day. I figured a teaspoon must equal 8 pills... well in fact it seems somewhat more potent than the pills. Last night I took what I thought would equal 12 pills, i.e. three small teaspoons. I couldn't get out of bed when I woke up! This formula contains ginseng root (ren shen), which enhances qi and strengthens the digestion (apparently it's good for chronic diarrhoea). I think you should probably start out slowly and gradually increase the dose. You could eventually take a small teaspoon three times a day as a course of treatment for a few months for lasting benefit, or take 1-3 small teaspoons at night. Since it's a sedative, I felt unsure about taking it in the daytime, but eventually resolved to take half a teaspoon in the afternoon - it only relaxes me a bit and presumably keeps the herbs in my system. You can take this remedy indefinitely. Though you should see some results almost instantly, you should also give the herbs time to help balance your body (at least a month). 

If this isn't right for you, then other remedies may be. Please consult this article for a more in depth self-diagnosis and read on...

FURTHER INTO THE TERRITORY...

POTENTIAL REMEDIES FOR FIBROMYALGIA- INDUCED INSOMNIA

There are many Chinese remedies for insomnia depending on your constitution and profile. The indications are just a few that I picked up here and there.  An Shen Bu Xin Pian (Wan) (worry, vivid dreaming, palpitations, racing thoughts) and An Mien Pian (racing thoughts, anxiety, mental fatigue) and Gui Pi Tang (Pian, Wan) (poor diet and digestion, sleeping on and off, night sweats, loss of appetite, mentally overworked, anemia with pale tongue and thready pulse) and Te Xiao Zao Ren An Mian Pian (Wan) (depression, tachycardia, anxiety, high blood pressure, dissatisfaction with life) and Chai Hu Long Gu Mu Li Pian (mental illness, bipolar disorder, anxiety, fullness in the chest, fearfulness). Long Dan Xie Gan Tang (fibromyalgia, difficulty falling asleep, vivid dreaming, red tongue and eyes, anger), and Tian Ma Gou Teng Wan (numbness, dizziness, headaches), Gan Mai Da Zao Pian (sorrow, involuntary movements,  frequent yawning) and  finally the most prescribed of them all Suan Sao Ren Tang Wan (for long term use and complete inability to sleep due to nervous exhaustion, somnolence, worrying, with thin and wiry pulse with normal or red tongue without coating, menopause). These are all formulas similar to Tian Wang Bu Xin Dan, but there are variations depending on illness pattern and availability seems to be a bit of a problem in this country.

Types of sleep patterns can be seen in this table. To understand heat and dampness, please consult this page.

It appears that these are some of the common formulas recommended for fibromyalgia-induced insomnia:

1) Tian Wang Bu Xin Dan. Take one of these in cases of worry, nervousness and a red tongue and face, If there is phlegm-heat - add at least huang lian (Rhizoma coptidis). To anchor Yang, Mu Li (Concha Ostrea) can be added - it is beneficial to the digestion, the immune system and is also a sedative. It's possible to add Huo Xiang Zheng Qi Wan in case one develops diarrhoea and bloating during the course of the treatment.

 2) An shen Bu Xin Dan is simpler and probably gentler than Tian Wang - and contains the sedative Polygonum Vine instead of Poria. There seem to be many variations on the market. This one frankly seems a bit too simple but does seem safe for those who worry about complicated interactions. It doesn't contain the sedatives Jujube seeds (Suan Zao Ren) nor Poria (Fu Ling), and so I would hesitate to use it for really severe insomnia.

3) Gui Pi Tang in cases of a weak spleen (the spleen in Chinese terms helps turn food and drink into energy), for the treatment of over-analyzing, heart-spleen impairment caused by overexertion, forgetfulness, and palpitation, depression, mental exhaustion and lack of energy, emotional withdrawal, hypotension. If you suffer from diarrhoea, you should make sure it contains Bai Zhu (Atractylodis) and Suan Zao Ren for improved sleep. You can take this formula containing Ginseng for increased energy. Read more about Gui Pi Tang here. In cases of severe insomnia, you could add Schizandra (Wu Wei Zi) and Polygonum (Ye Jiao Teng). You can look up the additions in this table.

4) Suan Zao Ren Tang - for inability to sleep (see above). This formula clears heat in the liver and heart and calms the spirit.

An individualised modification depending on one's pattern of is also recommended - for instance again for damp heat, Huang Lian, or Bai Zi Ren (playtcladus) for general weakness, irritability, forgetfulness, constipation (avoid Bai Zi Ren if you have diarrhoea). It also treats a weak abdomen and general fatigue and weakness. Another common addition in Asia is Ye Jiao Teng/He Shao Wu/Shou Wu Teng (Polygonum Vine) which seems like a good idea for cases of severe exhaustion. It's prescribed for weakness, nervous exhaustion, soreness, hair loss, numbness and to clear meridians and calm the system - it helps you sleep longer and deeper and isn't even expensive. It's said to promote longevity. It can be used on its own for insomnia. The only drawback is that long term use can cause liver problems, and it's not always recommended if you have loose stools. The two (Bai Zi Ren) and (Ye Jiao Teng) are recommended along with Dang Gui (Angelica or Donquai) when there's "blood deficiency" caused by overthinking, overworking, stress and bad eating habits. You could also take Suan Zao Ren Tang along with Gui Pi Tang, the sleep remedy above, to support a deficient spleen energy (see more about the spleen further down in this article). For a lack of energy (qi deficiency) add Ren Shen (ginseng) and Huang Qi (Astragali, good for fatigue and diarrhoea). IMPORTANT NOTICE! Since writing this article I have issued a warning against this remedy here.

5) Xiao Yao San / Xia Yao Wan ("free and easy wanderer" or "rambling powder" or "happy pill") is a liver tonic for fibromyalgia, chronic fatigue and depression when there isn't that much heat. This is a formula highly recommended for conditions arisen from emotional problems and excess. "The prescription xiaoyaosan may have the same effectiveness as antidepressants at the end point of the treatment with fewer side effects" (source). This remedy could also be combined with anti depressants (source). The tongue should be pink with thin white or yellow coating, and the pulse wiry and deficient, or tight and deficient. It's suitable if you have diarrhoea alternating with constipation, as well as a lack of appetite and cold extremities. It can treat perimenopausal symptoms and relieve pain. Indications are: Hypochondriac pain, depression syndrome, low-grade fever, impotence, male breasts, nodules of breast, hair loss, fertility problems, and others due to liver depression, anemia, and spleen deficiency. Specific manifestations include wandering flank pain and fullness, lack of appetite, no desire to eat, belching or nausea and vomiting; mental depression and fatigue, abdominal bloating and fullness, alternating periods of chills and fever, irritability, dull flank pain, and dizziness (source). It's also useful in food allergies, chronic hay fever, and hypoglycaemia.

This is a classic formula with great promise for fibromyalgia patients to which additions can be made depending on the illness pattern. These range from Rehmanniae (Di Huang) to Polygonum (Ye Jiao Teng) to Ziziphys (Suan Zao Ren) when sleep is impaired. Read more here. Make sure the formula contains ginger, or take it with some a tea made from boiling ginger.

Initially I could only find a version that contained Zhi Zi - this is not suitable for those with chronic diarrhoea as it's mainly for clearing heat and thus treats constipation. Also note that Zhi Zi (Gardenia) lowers the blood pressure, and is effective in stopping bleeding and treating insomnia, delirium and urinary tract infections. It can negate the effects of hypertension medications. If you don't have constipation you really need to be careful not to buy the version that contains Zhi Zi! Note that Xiao Jiao Wan also comes with the prefix Jia Wei - , in which case it's meant for severe menopausal symptoms and PMS.

6) Wen Dan Tang (Pian) (often combined with Huang Lian), is good for insomnia coupled with general anxiety disorder, fearfulness, timidness and gnawing hunger, over eating and a coated tongue.

7) Long Dan Xie Gan Tang clears liver heat (one of the signs is hypertension), but you would have to add fu shen (Radix podia) for deep sleep (see below). If one is able to get hold of them, one could add long gu (Os draconis), and mu li (Concha ostrea) when liver qi is stagnated due to emotional excess - these are in fact also sedatives. This formula contains gentian, which has been used to treat hair loss due to liver fire, however is too harsh on people with deficient yin and deficient cold in spleen and stomach (in other words I would be careful with it). In Chinese terms you would be looking out for these symptoms: Excessive fire in the liver and gall bladder attacking the head, eyes and ears along the corresponding meridians or stagnation of qi in the liver and gall bladder impairing the meridians. Damp-heat in the liver and gall bladder flowing along their meridians down to the genital organs. Sings of accumulation of damp-heat. All this would manifest as a red tongue with thick yellowish fur, taut and rapid pulse, swelling or itching in the genital organs, painful urination, bitter taste in the mouth, red, swelling pain the eyes, swollen ear, with deafness, headache, etc. It seems a bit hefty for sure.

A simpler formula called Wu Ling San (Wu Ling Shen) is said to be excellent in promoting deep sleep and fighting fatigue (while also believed to have antiradical and antioxidant properties) - the main ingredient is a fungus that promotes deep sleep, Fu Ling (indicated for greasy tongue, diarrhoea, forgetfulness, insomnia), which is also part of the Tian Wang Bu Xin Dan formula. It seems similar to Ye Jiao Teng (Polygonum vine) mentioned above. Note that it promotes urination, so if this is a problem to you should consider getting something else, or getting Fu Ling on its own.

For more details and options, please consult this article. Find out more about the top ten herbal formulas in this article. They are all good as a base, which can be modified to suit the individual.

The above additions are but a few, as each pattern may require a very specific approach. Note that some fibromyalgia and ME patients may experience overall deficiency patterns and so should avoid medicines that treat extremes. Here is another good article to help you find a formula to treat fibromyalgia. Here is a specialised article that covers many aspects of the illness and suggests additional remedies for those who are able to pin point their problem. 

In other words, there are three herbs that are quite strongly sedative and help induce deep sleep: Suan Zao Ren (Jujuba), Fu Ling (Poria) and Ye Jiao Teng (Polygonum). Dan Shen (Salvia root) is also calming and treats palpitations. Fu Ling seems especially beneficial when there is diarrhoea. For a complex problem as fibromyalgia I wouldn't take a single herb for insomnia, though you could take 1-3 or a simple formula just to get to sleep. These herbs do also have other medicinal properties that will work on your system. You have to go by the assumption that the whole system needs dealing with and that these synergetic herb formulas may work. 

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THE QUESTION OF IBS AND HOW IT AFFECTS THE SLEEP

It seems that damp heat complicates many cases of fibromyalgia, though it's not the main culprit. This is in line with my own conclusions. It appears that it can travel around the body, and the heat can also rise and make the upper body dry and hot. Read more about phlegm here. Although typical, damp heat isn't the only possible problem.

In addition to several formulas they recommend Huang Lian for problems with damp heat (that may have become phlegm) - it should clear damp heat in the spleen (a frequent problem with fibromyalgia). There's a somewhat radical anti-inflammatory formula, Huang Lian Jie Du Tang, that contains Huang Lian and Zhi Zi (soothes irritability) for clearing damp heat in cases of "intense fire toxin". Some of the indications are: chronic fatigue, vexation, disordered speech, a red tongue with yellow fur and rapid, forceful pulse, dry mouth and throat as well as diarrhoea with a burning anus. This is not to be taken long term. Contraindicated for those without coating on their tongues and a weak constitution (extreme spleen deficiency and chronic fatigue), i.e. who don't display signs of excess yang energy/heat. Zhi Zi is a sedative but could be a problem if there are loose stools. It seems best not to take this formula if you're very fatigued and feel unsure of what exactly ails you.

This is an article that helps you find a remedy for IBS. Stomach problems are often connected to insomnia and should therefore be dealt with. There are 69 conditions associated with diarrhea, difficulty falling asleep, difficulty sleeping and difficulty staying asleep - check them out here.

Diarrhoea is often a sign of the damp heat discussed above, though there seem to be many more variations on the theme. From the classification table for insomnia (connected to this study) you can see how many different reasons there are for insomnia according to TCM. This is really how it is for me: Difficulty falling asleep, excessive dreaming, difficulty staying asleep, insomnia with vexation, restless sleep, unrefreshing sleep, insomnia, shallow sleep. According to the table, these issues would be a sign of "stomach disharmony". I suffer from some of these symptoms at least to some degree: Vexation, belching, dizziness, dry mouth, dry throat, feverish sensations in the palms, soles, and chest, night sweating, gastric stuffiness, stuffiness and pain in stomach and abdomen, sore knees, backache, hot flashes, constipation, flusteredness, poor appetite, oppression in the chest, stuffiness in stomach and abdomen, sloppy stool, tinnitus.

As hard as it is to determine these things (not least since many symptoms are made worse by Western medications), the stomach issue really is quite obvious in my own case, and though there is obvious imbalance elsewhere in the body too, this may well be the main issue. It appears this is usually connected to a weakened spleen energy as well as stuck liver energy, so it makes sense to try and find a remedy that deals with these issues, before expecting any definite improvement.

Another possible diagnosis is "hyperactivity of fire due to yin deficiency" (which can be a partial diagnosis). In this pattern, which shows deficiency of yin rather than excess yang, you can have a rapid pulse. It means that you could easily misdiagnose yourself as having an excess pattern when it's really a deficiency pattern (but this is getting complicated and may be best not dwelled on too much). Read more about treatment options for a disturbed liver here. Diagnose yourself in accordance with this list.

One might for instance take Ge Gen Huang Qin Huang Lian Tang - it contains Huang Lian (which I discussed above) as well as Kudzu, which is used for muscle tensions in fibromyalgia, for chronic migraines, high bloodpressure and as a natural HRT. It is not suited for those who are very pale and feeble, because of Huang Lian, as it clears heat (while also draining damp), and is often used for hypertension. I think it should also be alright to take the two main ingredients separately, if money is an issue.

Another remedy is the gentler Shen Ling Bai Zhu, which augments Qi and strengthens spleen (see next chapter) in a big way while clearing out damp (typical problems with fibromyalgia and diarrhoea) - pale or pale red tongue with white and maybe greasy coating, as well as thready or even and deficient pulse. This formula also contains Ginseng (Ren Shen) and the sedative Fu Ling and Jobi seeds (Yi Yi). It suits people with anaemia and coughs and is good during convalescens. Main usage and indications are indigestion, distention and fullness in chest, borborygmus, diarrhea, myasthenia of limbs, sallow complexion, emaciation, pale tongue with white greasy coating, and feeble moderate pulse. In the case of loss of appetite, add Chao Mai Ya (Fried Barley Sprout, Malt), Shen Qu (Medicated Leaven), and Jiao Shan Zha (Chinese Hawthom fruit, charred) (source).

QI AND YIN DEFICIENCY AND THE IMPORTANCE OF THE SPLEEN

Bu Zhong Yi Qi Tang is a general tonic containing Ginseng for spleen qi deficiency and pallor. It supports the immune system, fights chronic fatigue and fever even when the fever is low grade or subjective, as often in the case of FM and ME (a sign of deficient Qi), stimulates the central nervous system, fights hair loss and low libido, and also supports the digestion (including chronic diarrhoea) and insomnia. It can be used for people with diabetes, AIDS and those who have had cancer treatments as well as those with fibromyalgia and ME. It raises Yang, so is not right for those with substantial signs of heat in the upper body. It is useful when a weakened spleen energy (often due to worry and other distressing thoughts) has lead to dampness and an inability to control the muscles (which may be invaded by dampness). Prolonged diarrhoea, yellow and thin stools (sometimes with pus and blood), a dropping sensation of the anus and abdomen, and even organ prolapse, are signs of Qi deficiency of the spleen and stomach making qi sink and fail in rising upwards. A pale tongue and a weak, empty and flooding pulse are signs of Qi deficiency. (main source).

This formula can be used during the phase in fibromyalgia when severe chronic fatigues sets in (tiredness which is worse in the morning, muscle fatigue and aches, shortness of breath, weak voice, spontaneous daytime sweating, loose stools, bloating, tiredness after meals, abdominal distention and fullness, pale complexion, depression, palpitation).

Indications are, among other things: fatigue, aversion to cold, diarrhoea, diarrhoea and constipation alternating, haemorrhoids, loss of voice, shortness of breath, maybe cough, maybe lower back pain, slight thirst with preference for warm drinks, pale tongue with whitish fur, weak and slow pulse, night sweats, tendency to curl up, visual disturbances, dizziness, organ prolapse, slight fever or feverish sensation. It appears to be a gentle formula for those who are very weak, but one should probably gradually build up the dosage if one has any worries that it could be upsetting to a weakened system. Note that this remedy isn't strong enough in case of severe insomnia if the insomnia has to be dealt with at once, so additions may have to be made. Buy it here.

These are some interesting thoughts regarding the value of treating the digestive system in cases of insomnia:

"In a study translated by Bob Flaws, the Chinese herbal formula Bu Zhong Yi Qi Tang was used to treat forty-six patients. All of those included in the study were seen as out-patients. Eight had trouble falling asleep along with sometimes waking during the night, thirty-five had varying degrees of insomnia and insufficient night-time sleep, and three patients had all-night-long insomnia. The patients suffered from insomnia for the length of from ten days to six years. The patients all had some degree of Qi deficiency. One course of treatment was one month. Forty-five of the forty-six patients all experienced marked improvement in their sleep. The night-time sleep for the patients lengthened by from one to seven hours for thirty-five of the participants. After waking, none of the patients experienced any headaches, dizziness, or other adverse reactions. Three months after stopping the herbal formula, only one patient had a relapse. [4] Bob Flaws notes in his discussion of the study that in clinic, most practitioners use heart-nourishing, spirit-quieting herbs, however he states that the therapeutic effects are not good. He recommends that Qi-supplementing formulas, such as Bu Zhong Yi Qi Tang, should not be overlooked. (Jeri Petz, Jade Acupuncture clinic)"

There are other similar formulas such as Ba Zhen Wan / Ba Zhen Yi Mu (especially good for anemia and heavy menstruation), Tao Hong Si Wu Wan (endometriosis), Jin Gui Shen Qi Wan (fatigue, low libido, diabetes II), Shen Ling Bai Zhu Wan (see above - Qi deficiency of the spleen and stomach concomitant with dampness, fatigue, poor appetite, dyspepsia, vomiting or diarrhea, chest distress and epigastric fullness, pale tongue with whitish and greasy fur, feeble and moderate pulse, osteoporosis) and Liu Wei Di Huang (menopause, fatigue, hypertension, diabetes). Read more here.

This is a view of how stress and burnout gives rise to a complex series of problems. All this gives rise to Qi (energy) deficiency which in turn causes Yin deficiency. This is something that this remedy can treat:

"First, there is abnormal upsurging of Qi, causing symptoms in the upper regions of the body. This is a characteristic of Yin Deficiency and may include malar flush, facial skin conditions, headache, fever, irritability, anxiousness, etc. It could also manifest as shortness of breath because the Kidneys are unable to grasp and bring down the Qi of the Lungs. There would be a large and surging pulse and incessant thirst. Incessant thirst is a symptom of Yin Deficiency, but the large and surging pulse may be a sign of Heat."

"When the original or Righteous Qi of the Spleen and Stomach are injured /due to emotional excess or poor diet/, its weakened state does not allow for nourishment of the organs and extremities of the body. Food and drink then become a further stress and burden on the body. Without nourishment, the body struggles to function, but it does so by consuming its own inner resources, running on adrenal energy rather than food energy. This auto-consumptive condition is called Yin Deficiency and leads to burnout. It occurs as a result of over-stimulation of the sympathetic nervous system controlled by the adrenals, which are part of Kidney Qi, and it is said that Fire as a result of Yin Deficiency emanates from the Lower Burner. The stress to act and function during burnout is not part of the normal function of the body, but must be inspired as a result of the mind which is governed by the Heart in TCM. Thus the Yin Deficiency Fire that results from malabsorption in the Spleen and Stomach is said to emanate from the Heart, not directly, but by its minister, the Pericardium, which has a branch that communicates with the Lower Warmer (a clue as to why some texts used to call the Pericardium “Circulation-Sex”). When Yin Deficiency Fire rises, it further vanquishes the original Qi of the Spleen and Stomach, and instead of the Qi of the Spleen rising as it should, it descends into the Kidneys causing Kidney Yin Deficiency.

Thus, deficiency of the Spleen can be seen to be the root of Yin Deficiency and therefore to nourish Yin, one must supplement the Spleen." (Michael Tierra)

(Check recommended additions to the remedy here). 

Spleen deficiency can lead to chronic illness, but chronic illness can also damage the spleen! The spleen is also responsible for damp in the body, and damp is said to often be a main problem with fibromyalgia.

"The spleen is the principle organ for the production of qi and blood in the body and serves a vital function in this capacity. When the spleen is functioning well a person has a good appetite, strong digestion, and vibrant energy. When this function is weak you will see issues such as bloating, reflux, fatigue, diarrhea, poor appetite and/or malnutrition.

Another transformative function of the spleen relates to the resolution of dampness in the body. Dampness /.../ refers to an internal issue which can result in sluggish energy, poor digestive functions, may solidify into fibroids/cysts/tumors and can cause many other issues. Within this function the spleen helps remove this dampness from the meridians and all organs of the body. A weakness in this function may lead to conditions such as edema, diarrhea and other fluid retention issues. /.../ (Spleen) Yang deficiencies are much deeper than qi deficiencies and are often involved with people experiencing serious or chronic illnesses. Symptoms of spleen yang deficiency are similar to that of qi deficiency along with more signs of cold in the body, cold limbs, chilliness, edema, etc."

(Chad Dupuis)

In these explanations, we can see that yin and yang deficiencies don't always automatically imply an excess pattern of its opposite principle, though in simpler terms this is normally the case (i.e. yin deficiency leads to too much yang and vice versa). 

The detoxification of the liver and expulsion of pathogens would seem essential in the treatment of fibromyalgia and ME, and it can be done with a variety of Chinese herbal formulas. Liver/Spleen disorders manifest mainly in the nervous system, digestive system, and female reproductive system whereas the Chinese Spleen is associated with all of the organs, glands, and bodily functions which are directly responsible for digestion (with the exception of the stomach). When this system breaks down, literally hundreds of diseases and symptoms can result, from ulcers to menstrual problems to cancer. (source). In fact, most humans have some issues with this duo due to the stresses of modern life, as well as the consumption of alcohol, tobacco and drugs. The spleen also has to be supported if there is a lack of energy, since, according to the Chinese system, it is responsible for turning drink and food into energy. In fact it appears that one must treat these issues in order to successfully treat the comborbid insomnia, especially in cases of fibromyalgia and ME.

The ingredient Chai Hu is generally recommended for activating qi and can be found in most of these formulas. Some good formulas to take in order to support and heal the whole digestive system are: 

1) Chai Hu Shu Gan Wan, a broad formula for mixed excess and deficiency patterns connected to a great deal of stress - this formula disperses stagnated liver qi and can be taken to start the healing process (stress, mood disorders, hypertension, chronic gastritis, gastric ulcer, inter coastal neuralgia, IBS, PMS). 

2) Xiao Chai Hu Tang (Minor Bupleurum Formula) supports the body's own strength and helps expel pathogens. (fever and chills, chest and rib-sides fullness and discomfort, a bitter taste in the mouth and dry throat, reduced appetite, nausea, vomiting, and irritability). This formula was used together with Bu Zhong Yi Qi Tang in a study about treating Chronic Fatigue. They are similar, yet seem to support each other too. Like Bu Zhong -, this formula has a slightly calming effect without containing any of the usual sedatives.

3) Xiao Yao San (Free and Easy Wanderer) (see description above)

4) Liu Wei Di Huang Wan (Rehmannia formula) (dizziness, faint vision, tinnitus, tiredness, sweat or low fever, low libido, menopause, diabetes, insomnia, weak and painful lower back and legs).

4) Bu Zhong Yi Qi Tang (see description above) - more focused on the spleen and thus good for weakness and diarrhoea.

A word of warning: There is possibly a danger in feeding the body energising ingredients that can be found in some of the formulas when it's so depleted of energy that it can't use them efficiently. It could reinforce the pathogens (an experience many people have when they get treatments). In this case it would be best to find a good practitioner who knows what they are doing and are able to guide the patient through the process. By checking the herbs one can also come to one's own conclusions as descriptions are provided on sites like americandragon.com.

For an overview of the various reasons people have insomnia and some suggested remedies, go here. For evidence and remedies in the treatment of chronic fatigue with TCM, go here. To see what kind of pattern is often present in cases of chronic fatigue, please go here.

CONCLUSIONS

My longwinded research has taken me through the heart and kidney energies down to the spleen and liver. I have come to the conclusion that I probably suffer from damp heat, yin deficiency and lack of qi mainly in the digestive area, and a bit of heat (excess) in the upper body - this is of course a general view that may have many variations. I believe my liver and spleen have suffered from stress and worry, and treating them should be a matter of priority. In general this is a typical fibromyalgia profile. It appears that it's easy to misdiagnose oneself as being "too yang" (easily wired) because there is not enough yin energy when in fact the problem is more complicated than that.

While at first it seemed I could continue taking Tian Wang Bu Xin Dan, as it seems to be one of the most complex of the sleep remedies for fibromaylgia, maybe supplemented with Huang Lian (possibly in the form of Huang Lian Jie Du Tang) in order to also clear damp heat, it all seems a bit too hefty and too focused on clearing the yang, i.e. attacking heat.

Towards the end of this expose I found that you could add Huo Xiang Zheng Qi Wan in case you develops diarrhoea and bloating during the course of the treatment. Though often used for colds, the formula does look reasonable. However, treating a side-effect when you have a serious underlying condition with complicated imbalances doesn't sound like a good idea.

I also found that you could add these two in cases of chronic insomnia: An Shen Ding Zhi Wan (Ziziphus & Polygala Formula) which is absolutely packed with all the most important sedatives (Fu Shen, Fu Ling, Yuan Zhi, Suan Zao Ren, Ye Jiao Teng). You could also add Jin Gui Suan Zao Ren Tang. Unfortunately, I have not yet found these formulas in Europe. Availability is clearly a big problem, especially if you want to avoid wasting your money. The reason An Sheng Ding Zhi Qi Wan doesn't seem to be on the European market (though you could possibly get it from the US) could be that it contains Long Chi, powdered mammal bone, and Mu Li, powdered oyster shell. I have been looking for Mu Li but cannot find it, and simply have to assume that it has been banned because of being a kind of animal derivative. Also, as a non-practitioner you can't buy from wholesalers.

I may switch to a gentler and simpler formula for the sleep which should be more or less as effective as the one above, minus the settling and calming animal derivatives. This could possibly Suan Zao Ren Tang that doesn't address constipation and heat as much as Tian Wang - , and really shouldn't be that difficult on the digestion (it doesn't address constipation the way Tian Wang - does). Its two main ingredients (Suan Zao Ren and Fu Ling) are heavily sleep inducing. Fu Ling and Zhi Mu are especially useful for insomnia and irritability due to Liver Yin Deficiency (post scriptum: I have issued a warning against Zhi Mu in Part II of this article!). One might add the herb Ye Jiao Teng (Polygonum) as well. You can tell from the An Shen Ding Zhi formula above that combining the most common sedatives is fine. Another addition for improved sleep could be Wu Ling San, which is recommended if you suffer from diarrhoea, but the worrying bit is it promotes urination which you may not always need. You could also only take Fu Ling, the sedative fungus, on its own. (Please see Part II for clarifications regarding these formulas and their suitability in cases of chronic fatigue).

Gui Pi Tang is a strong contender for the sleep issues. The sedatives in this remedy are Fu Ling and Suan Zao Ren (Jujube seed), Da Zao (Jujube fruit) and Yuan Qi (Polygala) - the latter is contraindicated for ulcers and yin deficiency with heat signs. It now seems clear to me that I should also focus on clearing the liver and strengthening the qi of the spleen/stomach. Bu Zhong Yi Qi Tang  bears a resemblance to Gui Pi Tang. I feel that many people with chronic fatigue syndrome would benefit from taking either. Bu Zhong-  mainly lacks the Jujube seeds (Suan Zao Ren) or Polygala (Yuan Zhi) - the latter is a good sedative and indicated for Qi deficiency (contraindicated for those with Yin Deficiency with Heat signs). Bu Zhong Yi Qi Tang is used for a wide variety of complaints and should be a gentle way to start the process. It appears that some practitioners are in favour of using this remedy to indirectly treat insomnia, especially when supplemented with remedies that support sleep. Shen Ling Bai Zhu also seems like a good contender for clearing stomach issues, and is also somewhat sedative.

The liver clearing Xiao Yao Wan (without Zhi Zi!) (with additional sedatives for insomnia and other imbalances), as described above, also sounds excellent. It contains Fu Ling, the sedative fungus, as well as Bai Zhu, which fights diarrhoea. It contains Peony (Bai Shao) and Angelica (Dang Gui - Donquai) which along with Poria (Fu Ling) have been found useful in treating sleep disturbances in cases of CFS. I would think Xiao Yao Wan would be very useful for a great deal of people who suffer from symptoms that ultimately originate from stress and unhealthy living - in the present day, that's most people! You can find suggested additions to this remedy here. Post scriptum - having now spoken to ActiveHerb, I have discovered that there are in fact many versions of this remedy, so please stay in tune for more information!

The trick is to find the right herbs to combine, not to get as many as possible as that could potentially be confusing to the body. The point has been made that trying to treat oneself with diet alone is probably not going to be successful if the condition didn't arise from a poor diet in the first place. My own experience has told me that this may very well be true. A more complex approach is needed. Having said that, these are some foods that are useful in supporting the healing of a deficient digestive system (namely the spleen).

Of course the sceptic in me thinks it's possible that the remedies don't have the balancing effect they claim to have and that I'm only getting benefits from the sedative effect. The Emperor's tea pills haven't put me to sleep, but since my sleep quality and the length have improved a great deal, it's definitely doing something good. This is not to say this is necessarily the best remedy, but at least it was a start. I'm still taking small amounts of Quetiapine to induce sleep. I feel that I have to allow the herbs to work over time and not cut out the ordinary medicines too soon, while also realising they could be in conflict as the herbs are doing on thing and the ordinary medicines another. I had been able to cut down on the benzodiazepines to a point where the amount was absolutely negligible.

I'm not cured just yet but already greatly improved, probably thanks to improved inner balance but especially thanks to the simple fact that I'm sleeping  better. I wouldn't have been able to conduct all this research had I not had this sleep to begin with. This remedy is far superior to any of the Western herbal remedies that only relax you a little bit. My GP was thrilled when I told him about my experience but many Western doctors would of course be horrified. I have to say though that I much prefer the gentle holistic approach of the Chinese to the Western way of attacking a problem with guns and weapons. This can be quite effective when dealing with acute illnesses, but as I'm sure most people would agree, it's not always so great when illnesses have become chronic and symptoms are complex and less specific.

I feel excited by my progress, and have worked hard on figuring all this out because I want people to realise that there are remedies out there - it's a question of finding the right ones and understanding how they work. The Western approach can be too single minded and brutal, and a chronic illness will respond much better to a gentle approach that takes multiple problems into consideration. I sincerely hope the information I have dug out will inspire people to self-diagnose and seek treatments. Though it would be great to work with a good Chinese physician, many of us don't have that luxury. Finding your own solutions can also be empowering.

I am also one month into the HRT and feeling that it's helping me a great deal as well - previously, it was like having a machine run without oil. Please see my previous blog post on this treatment. If greater balance can be achieved through Chinese Herbs, it's quite possible that the HRT will eventually become redundant. Since the contents of this article is no doubt hard to take in, I don't mind answering questions related to the contents. Please note that I have written this to spread information, thus you can use this article for personal use, but it shouldn't be considered as a definite scientific paper.

Read about my decisions, progress and discoveries in my next blog posts! You can find PART II

PART II

First I have to admit I've been feeling way over my head with all this and am somewhat terrified of the responsibility of putting my research up on the internet. Yet I have also felt I have no choice but to go on finding solutions. I hope that by reading my musings others will also learn and understand, or at least feel inspired.

As I was running out of the Emperor's tea pills, i.e. Tian Wang Bu Xin Dan, I was in a hurry to order some more herbs to try. I had come to the conclusion that Tian Wang - was really treating heat and constipation and that I should find an alternative sleep remedy. I was concentrating quite a bit on treating the spleen qi with one of the spleen and liver cleansers, and didn't pay enough attention to the possible adverse effects of the sleep remedy I decided to go for. I really assumed the formula I chose was safe because it's the most common of all sleep remedies in China, and I did in fact have to dig quite deep in order to find some evidence of side effects.

I decided to order Bu Zhong Yi Qi Tang to support the digestion, i.e the spleen qi, and thus treat the diarrhoea as well as problems with chronic fatigue. Although I am diagnosed with fibromyalgia, my main issue is fatigue and diarrhoea (deficient spleen and, presumably, overall qi deficiency), so I lean towards treating it as you would treat chronic fatigue syndrome. This also seemed like a priority as it appears that digestive malfunction with a deficient spleen could be linked to the inability to go to sleep. I also ordered the sleep remedies Suan Zao Ren Tang with Jujube seeds as the main ingredient, and Ye Jiao Teng (polygonum multiform). That's because I couldn't get hold of Gui Pi Tang and didn't realise that all I had to do was ask the company Activeherb. I was also trying to save money by getting at least two sedatives in one formula. I had no reason to suspect there to be any great problem with any of the herbs.

After I'd taken the sleep remedies I felt very much awake. I could hear my heart pounding even harder than usual, and had some hissing sound in my head (the Maracas effect...). I assumed this was all due to Bu Zhong -. I had to take quite a bit of Quetiapine and benzo in order to get to sleep, and when I woke up after six hours I wasn't able to go back to sleep when I took some more herbal sleep remedy (the new stuff). This ran counter to my experience with Tian Wang - . 

The next day I took two smaller doses of Bu Zhong - in the day time (just half a spoon rather than two twice in the day), but still had issues at night. In fact I had something that bordered on a head ache, hissing sounds in my head, and some palpitations. Again I had to take more Quetiapine than usual, a small amount of a Benzo, to sleep. I also resolved to take the trusted Tian Wang -  of which I had a little left. When I woke up after six hours or so I took some more Tian Wang - and then had some good sleep in the late morning.

So what on earth was going on? At first I suspected the fungus Fu Ling (Poria). It's one of the main ingredients in Suan Zao Ren Tang but only a minor ingredient in Tian Wang - . After all, the process using Tian Wang Bu Xin Dan hasn't exactly been smooth as I've had stomach trouble and feebleness, and still couldn't go to sleep without a bit of help from Western medicines. However, the quality of my sleep had so greatly improved I was very puzzled as to what exactly was working. It was clear that it was clearing too much heat and thus creating stomach issues, as frequently reported on the internet (though in all honesty I think it also cleared some issues with heat). But which ingredients or combination of ingredients were helping me sleep so much better?

Upon digging deeper I found that two of the other main ingredients in Suan Zao Ren Tang can sometimes cause side-effects. One of them are the Jujube seeds (Suan Zao Ren).

SUAN ZAO REN

SUAN ZAO REN

Use caution in cases of severe diarrhea.

Use caution in cases of Heat from Excess.

Use caution in cases of insomnia due to Excess Heat or Hot Phlegm.

Use caution for those with an Exterior condition.

Use caution during pregnancy.

(americandragon.com)

This is an extract from chineseherbshealing.com:

"Suan Zao Ren, seeds taken from the ripe jujube fruit, can help the patients get rid of the torture of insomnia and thereby give them a good night’s sleep, recover the heartbeat of patients who are suffering from arrhythmias, and make neurasthenia patients energetic again. As you can see now, this herb offers tons of health benefits. But this is exactly the reason more and more people ignore its side effects and abuse it.

1) Aggravating pathogenic heat. According to Shen Nong Ben Cao Jing Shu (Commentary on ‘Shen Nong’s Classic of the Materia Medica), it shouldn’t be used in the patients who are with excess heat pathogen in channels of liver, gallbladder, and spleen because of its astringent nature.

2) Causing diarrhea. According to Ben Cao Qiu Zhen (Facts of Materia Medica), people who have gastrointestinal dysfunction should avoid excessive consumption of it since it can lubricate the intestinal tract.

3) Causing allergy. Its decoction can occasionally result in allergic reactions, such as nettle rash (hives), generalized pruritus, chills, fever, joint pain, and the like.

4) Causing numbness in the lips. The triterpenoids contained can cause numbness, clogging feeling in throat, drooling, stiff tongue, heart rhythm disorders, and a series of other adverse reactions.

5) Causing excessive stomach acid. Excessive consumption will aggravate the condition of hyperacidity because of its acidic property."

The other sedative ingredient apart from Fu Ling is Zhi Mu (Anemarrhenae) and it sure looks like a bad idea in cases of fibromyalgia and chronic fatigue. I suspect it's the main culprit. You can see it is contraindicated rather than to be used only with caution in many cases of fatigue, It's basically tearing down what I'm trying to build up with Bu Zhong - . It's not part of the Tian Wang - formula, which could explain why I tolerated it better in some ways. Tian Wang - does contain Suan Zao Ren (Jujube seeds) but I don't think the side effects are quite so bad, nor are they the reason Tian Wang - upsets my tummy so much.

ZHI MU

Contraindicated in those with diarrhea.

Contraindicated in those with Cold from Spleen Deficiency.

Contraindicated in those with impotence coupled with quick arousal and quick ejaculation.

Contraindicated in those with a weak Spleen.

Contraindicated in those with inability to digest food.

Contraindicated in those with Stomach Deficiency with no thought of eating.

Contraindicated in those with Kidney Yang Deficiency.

(americandragon.com)

I have not even seen this many contraindications for the herbs I've been looking at for clearing the liver and spleen and so on. Suan Zao Ren, i.e. Jujube seeds, is the second ingredient in Tian Wang -, which could account for some of my discomfort during the course of treatment even if it and other herbs were helping me sleep better. I find no evidence whatsoever that Fu Ling would be a culprit. Its only drawback seems to be that it promotes urination, and should be used with caution in cases of yin deficiency (that's when there's too much heat in the body/yang energy, which in fact is usually not the case with chronic fatigue though some heat can be present).

Suan Zao Ren Tang also contains one more doubtful herb, Chuan Xiong - some people should be careful. It is contraindicated for people with Yin Deficiency Fire with with a red tongue and a dry mouth as well as headaches due to Qi deficiency.

There is another herb often indicated as an addition for insomnia if you take Bu Zhong Yi Qi Tang, and that's Bai Zi Ren. I had discounted this option because it's counter indicated in cases of loose stool and phlegm disorder. I'm worried it would aggravate diarrhoea. However, it looks like almost all the other can do that too. In the end it could be a question of choosing the least bad option.

The following night I took a third dose (two teaspoons) of Bu Zhong- as well as all the other sleep remedies apart from the combo Suan Zao Ren Tang . There was only a little bit of a Maracas effect and only very little palpitation (it was probably due to Tian Wang - and the Western drugs), and my tummy was calmer too. I got sleepy but couldn't go to sleep without some Western medications. To say "sleepy" is maybe a bit inaccurate as it's a kind of strange whoozy/sleepy feeling in the head (probably an indication I really have serious trouble going to sleep). Once asleep, things were as normal and I got seven fairly good hours. I felt a lot better on the inside than I have for a long time - sort of soft and pleasant in the digestive region. I did feel very tired in the day time, though. It was all a bit much.

I do have great hopes for Bu Zhong Yi Qi Tang as I'm having no adverse effects from it - in fact it firmed up my stools at once! It also has a calming effect and just gives me a good feeling overall. However, during this process I also need to sleep. How very hard it has prevent to be to find anything that goes with a propensity for diarrhoea! 

The good news is that if I respond so strongly to Zhi Mu, it must surely mean it's hitting my weakest spot, which means I was indeed right all along about suffering from spleen deficiency. It's noteworthy that I didn't only experience gastric discomfort, but also a headache and palpitations. In other words, it doesn't only attack my real physical digestive system but is poisonous to me in some other sneaky way too.

In this study of the chronic fatigue syndrome, Bu Zhong Yi Qi Tang was used alongside with Suan Zao Ren and Sophoros in cases of insomnia (not Bai Zi Ren as suggested elsewhere). Sophoros is Ku Shen, the vile tasting root I took for four days - I believe it cleared some liver stagnation. It's an article that clarifies one course of treatment. The dreaded Zhi Mu is recommended in cases of "deficiency heat", so my own negative experience would indicate that getting the additions wrong can at least in some cases cause a lot of upset to the system (of course all herbs have some drawbacks, some more extreme than others). On the other hand, I would think that many herbs that I discussed in the previous article are reasonably safe for tired people to try (though this is just a lay person's point of view). The herbs I was discussed come up in this list of suggested additions in case of dampness and yin deficiency (vacuity):

"If there is concomitant dampness, I would add Sclerotium Poriae Cocos (Fu Ling) and Rhizoma Pinelliae Ternatae (Ban Xia) /.../. If there is yin vacuity, I would probably choose between Fructus Lycii Chinensis (Gou Qi Zi), Fructus Ligustri Lucidi (Nu Zhen Zi), Fructus Schisandrae Chinensis (Wu Wei Zi), cooked Radix Rehmanniae (Shu Di/Sheng di Huang), and processed Radix Polygoni Multiflori (He Shou Wu/Ye Jiao Teng)" (Bob Flaws)

Fu Ling and Ban Xia should be useful when there is diarrhoea, i.e. dampness or even phlegm. You might however draw a simple conclusion that you suffer from yin vacuity because you're flushed and suffer from night sweats and hot feet and have other heat signs (possibly due to peri-menopause), however as stated in the previous article it's not uncommon to have both signs of heat and damp when you suffer from fibromyalgia. This makes everything very complicated and is the reason why medicines like Tian Wang - aren't so great (it treats heat, not much damp). Gou Zhi Zi (Lychee) and Nu Zhen Zi and to some extent also He Shou Wu/Ye Jiao Teng are contraindicated if you have diarrhoea. Shu Di/Shen di Huang is a herb that contrary to my expectation I now see is contraindicated for Qi deficiency, diarrhoea and abdominal pain (which would most certainly match my own profile). Since it's the main ingredient in Tian Wang - it's no wonder the formula can cause gastric problems. On the other hand Wu Wei Zi (Schizandra berries) should not be a problem if you have diarrhoea and should be great for almost anybody who suffers from stress, a low libido and more. However, if one is uncertain about having any signs of heat in the body at all, and have a weak constitution, then it might be better to avoid it.

"The fact is, pulses and tongues will often reflect only one pattern or side of the condition, and you have to rely on the other signs and symptoms to get a full picture of the other patterns involved. For example, you could find a fast, thin pulse, which indicates yin deficiency, but at the same time you might find overall symptoms that indicate dampness such as fullness in the abdomen or loose stools. Your end diagnosis requires that you integrate the pulse with these other symptoms.

The tongue is actually a little bit easier to read, since it often reflects more than one pattern. In the case of phlegm heat damaging yin, for example, the tongue will be greasy and yellow, with red peeled patches. But this doesn't always happen. Sometimes you have a greasy tongue coat, but have to rely on symptoms such as night sweats and warm palms and soles to recognize that there is yin deficiency as well as dampness." (Yong Ping Jiang)

Some herbs that have come up in relation to fibromyalgia are Yi Yi Ren, Fu Ling, Bai Zhu and Shan Yao. This is how you could combine them according to americandragon.com:

Yi Yi Ren Strengthens the Spleen, drains Dampness and transforms Phlegm.

With Fu Ling, for Spleen Deficiency with Excess Dampness and edema.

With Fu Ling and Bai Zhu, for Spleen Deficiency diarrhea.

With Fu Ling, Bai zhu and Shan Yao, for Spleen and Stomach Deficiency with loose stools and reduced appetite.

One just has to try and synthesise the available advice. It's advisable to check contraindications of all the herbs you intend to try. It's easy to ignore things we don't fully understand but we have to do our best and not experiment with anything that is really obscure. It's best to stick with common herbs and formulas. You can check the ingredients at americandragon.com in the "treatment protocols" section. It's geeky but useful. The chances of making mistakes as a layperson trying to self-diagnose are obviously substantial, however with persistence it just might be possible to find a satisfactory solution. After all, almost every time you try a potent drug prescribed by a Western doctor you run the risk of having a lot of bad side-effects that are often widely accepted by the scientific community - this is not a dissimilar situation. You have to use your own judgment. If nothing else, it is surely good to go to see a Chinese practitioner with some insight in your back pocket.

The benefits I've had so far from all these trials are: improved quality and length of sleep, improved breathing i.e. the shortness of breath and feeling of not being able to fill my lungs with air have disappeared (these are symptoms of illness/blockage). I'm also a lot less thirsty and my lips are less cracked and I seem to be less prone to gastric sensitivity. The coating on my tongue has diminished dramatically. And finally, I'm experiencing improved emotional stability - I feel a lot less "raw" and on edge and feel that my nervous system is doing a lot better than before. I feel that in spite of the drawbacks, Tian Wang - also did some good in my system, possibly clearing some heat. A word of warning: I would not take it if there were no heat signs at all! I don't think that in its readily available form, this is suitable for most serious cases of ME, for instance.

There are a couple of excellent herbs for insomnia in Tian Wang Bu Xin Dan that don't come up in other common formulas for insomnia that I have dealt with. These are Shi Chang Pu (sweet flag) which rejuvenates the brain and nervous system as well as treating a deficient spleen with digestive disorder while resolving dampness, and Bai Zi Ren (Arbor Vitae) which can potentially be a bit hard on the digestion but does treat insomnia. Along with Suan Zao Ren, Fu Ling, Dang Gui and Wu Wei Zi (Schizandra) and a herb that guides the other herb (Jie Jeng), these are no doubt helping me sleep while also helping to heal the body. I'm assuming I could do without the rest, which mainly treat heat and constipation. What appear to treat yin deficiency (vacuity) as suggested by Bob Flaws above are Wu Wei Zi (Schizandra) and di Huang/Shu Di (Rehmanniae). 

Tian Wang - has some of the main sedatives in common with Gui Pi Tang, but the rest of the sedative herbs in Gui Pi Tang don't seem quite as interesting as the ones in Tian Wang -. It is however recommended for insomnia that arises from a disquiet heart (restless sleep, worry, fatigue, heart palpitations, shortness of breath) and some of the herbs are the same as in Bu Zhong -. I'm a bit concerned about one ingredient, Long Yan Rou (Arillus), which treats insomnia but isn't always recommended if there is a serious lack of energy (also phlegm with qi stagnation, phlegm in middle burner i.e. the digestive tract, yang constitution). Another commonly available formula is An Shen Bu Xin wan, which contains the interesting herb Shi Chang Pu, but it also contains the herb Nu Zhen Zi which again is contraindicated in cases of diarrhoea.

In this article, you can find some suggestions for ready made formulas to treat chronic fatigue as manifested in four organs respectively. Here on americandragon.com you can see what formulas are recommended for which illness pattern coupled with insomnia, but it requires a great deal of knowledge to be able to understand the implications. In the end there appears to be a whole host of formulas, but accessibility for the layperson will be a problem.

For instance, Huang Lian Wen Dan Tang which contains Huang Lian (which I discussed in my previous article) appears to help qi to descend as well as treating diarrhoea. It looks useful to many people with fibromyalgia. (For insomnia, palpitations and irritability due to Phlegm Heat leading to disharmony between the Gallbladder and Stomach with a stifling sensation in the chest and restlessness). Huang Lian is mostly used in rather severe cases of diarrhoea. This interesting formula, Yang Xin Tang, for nervous exhaustion and chronic fatigue contains many familiar herbs. 

Although there are suggestions all around the internet for taking additions to counteract the digestive trouble that can arise from taking Tian Wang - , it is also contraindicated for people with a weak spleen and stomach on americandragon.com. I also noticed that you should be careful with alcohol while taking it (I had a bad night after two glasses of wine though I waited a few hours before taking Tian Wang - along with Quetiapine). Of course it's counterintuitive to try and treat a side-effect, especially when the side-effect tells you as much as the symptoms themselves.

For financial reasons I can't buy a lot of single herbs even if I could get hold of them. Therefore I think I will have to stick with just two more for insomnia that are often seen together, Suan Zao Ren (inspite of its potential drawbacks it seems reasonably safe) and Fu Ling. They both treat insomnia and Fu Ling has the added benefit of treating diarrhoea and damp in general, as well as supporting the immune system. It's to be used with some caution when there's a lack of energy, and shouldn't be taken long term. These should go well with Bu Zhong Yi Qi Tang and hopefully be sufficient to help me sleep. I will take Bu Zhong- three times a day (3x2 tsp), and the sleep remedies as an addition at night. This is all for the moment but I will continue pondering more options.

POST SCRIPTUM:

I have now found that using Bu Zhong Yi Qi Tang along with Suan Zao Ren and Fu Ling isn't working so great. I have also found that ActiveHerb can custom make formulas (as approved by their practitioner), and will therefore consider trying a mixture that has all the nice herbs from Tian Wang Bu Xin Dan (the Emperor's Tea Pills), but excluding the ones with heat clearing properties. I was indeed onto something there and am glad I didn't see a practitioner who might have given me the usual remedies. One of the best suggestions for customised formulas in cases of fibromyalgia that I have come across to date seems to be this list using Xiao Jiao San as a base - feel welcome to draw your own conclusions. Stay tuned for updates!

I have come to the conclusion that I shouldn't continue using the Chinese herbal formula Tian Wang Bu Xin Dan. When I started to use it three times a day (2-3 teaspoons at night and 1/2 a teaspoon morning and afternoon), I experienced an increased need to pee coupled with increased palpitations (especially at night), increased diarrhoea, abdominal distension and a feeling of weakness, queasiness, and some irritability/hostility. I can now see that I don't display sufficient amounts of heat to warrant the use of this combo, and perhaps it's increasing damp heat to some extent. The good news, however, is that the sleep inducing herbs really are working and so I will switch to another formula. I haven't yet found a formula that addresses diarrhoea rather than constipation, but if I can't find one I will just take an ordinary formula and add something for this ailment.

You could take these herbs the way you take Western medicines, and they would probably still be working to give you improved sleep. However, in order to treat the underlying imbalances you do have to take a customised combination of herbs. I have come to realise just how complicated an illness fibromyalgia is. I do also now believe that this is possible to treat it this way, and that one can achieve significant improvement of the syndrome in many cases.  Finding and working with a good practitioner of Chinese medicine comes at a very high price, however, and for many of us it's simply not possible. I will continue working on my sleep issues as avoiding the normal sleeping pills and still getting some reasonable sleep is a priority, but in the meantime I will think some more about the kind of formula that could be useful in treating my specific condition. The quality of my sleep has vastly improved already and I do believe the herbs have also acted in a positive way on my system, so I'm eager to continue on this path.

At the moment I'm particularly interested in Bu Zhong Yi Qi Tang to treat diarrhoea and increase energy, as well as Suan Zao Ren Wan for sleep. It might be possible to add Ye Jiao Teng (Polygonum Vine) and Wu Wei Zi (Schizandra).  As I have trouble finding a cheap version of Xiao Yao San for clearing the liver and treating the spleen, with the right ingredients, (I only found this one), I may start with these. These remedies would cover the herbs that I find especially interesting. More about this later.

——

You do have to make a decoction out of raw herbs so this photo is just for a laugh

Late July 2014

It's interesting how things seem to be falling into place at the moment. I would venture to say that things are going in a nice direction, though it's a long road to travel. I think sometimes there comes a time when you've reached the end of your time of suffering and things start to unravel... at least a bit! If you haven't read my previous posts, you should probably give it a go in order to understand what I'm talking about here. 

I was running out of Tian Wang- (The Emperor's tea pills, my original remedy for sleep) and realising that it's not ideal for my constitution, I tried the Jujube Seeds, Poria fungus and Polygonum vine (Suan Zao Ren, Fu Ling and Ye Jiao Teng) separately, but without much luck. I was deliberating what to do about my very acute need to sleep and found out that I could order a custom made combo of Tian Wang- in which the herbs that were acting badly on my digestion were left out. 

I had to go on a demanding trip for a few days and worried quite a lot about the sleep. While I was away, I tried to order the modified Tian Wang- in the morning but failed and didn't have time to sort it all out before I had to go out for the day. Believe it or not, but as I was strolling around High Wycombe, I came across a Chinese herb- and acupuncture shop called Dr China. I probably would never have considered going in had I not done all this experimentation on Chinese herbs. I'm easily intimidated and worry a lot about getting into situations where I have no authority to contest what is said to me and have to pay money I don't have. As it happened, I decided to go in anyway and ask whether they had Tian Wang- for sale. They did, but we got talking about it. They said it's much better to make a tea out of dried herbs than to take pills or concentrated powder. It was possible to get a custom made herbal combo, which you paid for by the day (£6). There was a young Chinese lady who interpreted an older Chinese lady doctor whose English wasn't so great. They asked me some questions and conceded that Tian Wang- may not be right for me. I explained that I was also taking Bu Zhong- in order to rectify deeper issues, the root of the problem. The doctor said they could make me a course of treatment that would last me a week, and that it could rectify my problems with the sleep. It was of course also possible to get acupuncture but I didn't have money nor would I have been able to come back. I deliberated with my husband and decided to get a few days worth of herbs in order to get me through the wedding. The reason I made this choice was that I hadn't been able to find the perfect ready made formula.

The doctor took my pulse and looked at my tongue. She said that at first when I came in it might have seemed that I was Yin deficient, however this was clearly not the case. In this case my tongue should have been red (damn I haven't quite gotten to tongue diagnoses yet!). She said that it's too much Yang rising to my head that's keeping me awake, and that insomnia is the reason I'm so tired (in other words not general Qi deficiency). There was also a problem with phlegm and heat which aggravate the problem on all levels of my system. In that instant I knew what she was saying - in fact it confirmed my own research except for the fact that I hadn't quite gotten my head around the Yin and Yang balance. If you have too much Yang it doesn't automatically imply there is a lack of Yin, and vice versa. I realised that I've been right all along - my main problem is too much stress, but it hasn't completely depleted me.

This suddenly made perfect sense and made me think it might in fact be a very good idea to try the course of treatment she was suggesting. She said that the herbs I have are taking me in the wrong direction.  As I am not tired because of Yin deficiency, it does in fact mean I have a lot of energy to work with (if you're not Yin or Yang deficient then you are surely not Qi (energy) deficient either, which surely would be a much more difficult situation to rectify). In fact this was great news! Of course, I was already feeling a lot better from my own experimentations as I had surely gotten some of it right, and increasingly felt that I would indeed feel really pretty good if only I could sleep (deep inside I have believed this all along). It was also clear that although I wasn't completely off the mark when I chose to take Bu Zhong-, it's not quite right because it treats Qi deficiency. Tian Wang- on the other hand treats Yin deficiency. However, they have no doubt both treated some of the liver, spleen and kidney related

I got my herbs (we were very impressed by the sheer volume of it all, and the number of herbs in it) and made them into a strong and vile decoction, which I took twice a day. It didn't make me sleep and I had a lot of trouble getting through the weekend, especially as I was sleeping at a friend's house (we were attending a wedding in England). At night I had to take all my herbs from home as well as the ordinary sleeping pills. The weird thing is though that I had a lot more energy than expected. I managed to get through the whole weekend without feeling particularly drained and strained (just tired in a more normal way and feeling that having a sit down and a rest actually helped, and just felt better on the inside overall) - and I even managed to enjoy myself! Really it was quite miraculous. My tongue is also looking better.

When I got home I was able to identify most of the herbs this doctor had put in the mix, and found that all but two were familiar from my research. The two unfamiliar ones are indicated for damp heat. I feel confident that this formula is right for me though I was still not sleeping (I expect it will probably take a while to fix such a persistent symptom as I suspect the nervous system doesn't give in very easily).

I called the shop and asked if I can take other herbs and pills during the course of treatment in order to get better sleep. The doctor sounded a little bit surprised that I hadn't slept better but said it was ok, I could take anything I wanted while I let these herbs work their magic on my system. I thus resolved to get the modified Tian Wang- since it seemed so helpful for the immediate sleep issues. It will be delivered in 1-2 days. She said just not to take too much of it. In a week or so I am to call them back and send them a picture of my tongue, and then we'll see where to go from there. It's possible to receive a new mixture by post. I feel very strongly that I can get better.

INTERESTING NEWS

I saw this article about the "Gu" phenomenon, which struck a cord. Basically "gu" are traditionally parasites that break down the body, but according to the article you can translate this to mean any viruses or external influences that cause a progressive break down of the system that leaves it depleted. It's interesting to check out the list of herbs that fight the gu, because many of them are familiar from formulas that support FM and ME. These break downs are very serious, and the fact that so many are experiencing them is a very serious implication of society today. When you start trying to reverse this process, you must be very persistent and not give up when there are healing crises, because there are bound to be many along the way. As I said before, if there is very little Qi then you could also experience an inability to drive out the pathogens. This makes the process even more difficult, but I still believe there is a way if you go about it systematically. I rather put my faith into a system that has been perfected over several thousands of years than any newfangled therapies that come along. Though I'm sure over time there will be new and effective treatments, I honestly haven't come across anything very convincing with a comprehensive and affordable approach. The more I've looked into the wondrous world of Chinese herbs, the more I think they are actually very potent if used in the right way. It's all so comprehensive. According to the Chinese, everything has a reason for being and is connected to everything else, so there are no chance symptoms that are unrelated to one another. I find this very comforting. There is also a lot of research that indicates their usefulness in the treatment of chronic conditions, though in all fairness the research is still in its infancy.

I have exhausted every last bit of our financial resources, because we have so very little to start with. I had to experiment with the herbs on my own in order to understand what is going on and why, but it has been costly. My husband is very worried about the finances and is telling me to quit all this if it's not fixing my insomnia. I insist that it may take some time and I simply can't give up now that I got this far. The Western drugs make me feel so ill I am really in a hurry to get rid of them. I have experienced improvements, but it's not an easy road to travel. At the moment I just feel very tired and somewhat depressed due to the difficulty in getting decent sleep and working out what to do next when money is so scarce. At the moment I don't have the stamina to do a lot of research - I feel somewhat mentally exhausted after so much research and a difficult trip that I'd been preparing for all summer. I need to take it easy and get my mind off all of this a bit.

I received the modified Tian Wang-, that is with all the heat clearing herbs removed. It didn't work very well and I have not had the deeper and longer sleep I had in the beginning of this journey. (That is not to say it wouldn't work wondrously on someone with mild insomnia, because they do often make me feel drowsy for a while and clearly have at least some kind of effect on the quality of my sleep). 

The formula that I decided on goes as follows (the company will work out the proportions for you):

Suan Zao Ren

Wu Wei Zi

-  Dang Gui [unsuitable for diarrhoea]

Gan Cao

- Shi Chang Pu

Jie Geng

Yuan Zhi

Fu Shen (or Fu Ling) 

Dan Shen

Xuan Shen

- Ren Shen [very stimulating]

Who is to say what is really going on? It could be that the changes are temporarily aggravating the insomnia. I've taken the herbs from Dr. China for ten days now. I spoke to the doctor today but her assistant who speaks better English isn't there on Mondays so I will have to make a more detailed call tomorrow. I have faith in this doctor but of course my husband's cynicism about people who need to make their businesses viable by selling you lots of stuff is difficult to ignore. I know what he means but sometimes you just have to put your trust in someone in order to get some help. Based on my impression as well as my analysis of the herbs she gave me I'm confident that she's trying the right ones. I've just had very persistent insomnia for so many years (not to mention years of using drugs that only suppress the symptoms and cause bodily distress), and I honestly don't have unrealistic expectations of being cured in an instant. 

However, it's clear that I much rather be guided by someone with 25 years of experience, and feel that I have found a reasonably viable and affordable solution. All the knowledge I've gathered is still useful to me, for instance in clarifying what is going on with other people where Western medicine is unable to see a connection between disparate symptoms, and knowing where to look for more answers. For instance, I have a friend who suffers from hyperthyroidism, anemia and restless legs, and while doctors don't believe these symptoms are interrelated, it's a very classic pattern of illness from a Chinese point of view. I quickly saw some solutions for her though ideally she should of course see a practitioner. Her case, which seems to centre around the heart and kidney with blood problems, also helps me understand my husband, who also has issues with these. He suffers from hypertension, arrhythmia, restless legs and kidney stones. It's probable (in simplistic terms) that blood stasis has caused his heart problems which in term are responsible for his kidney stones - but I have yet to look into all this a bit more. For the moment I gave him the rest of the Rehmannia based formula Liu Wei Di Huang which I had ordered for myself in the very beginning of my journey, only to try and see if it does something for him. Liu Wei Di Huang should also be quite, if not even more, useful to my friend. Another formula that is also recommended in these kind of cases is in fact our old friend Tian Wang Bu Xin Dan, but I now know it's too harsh if you don't suffer from yin deficiency.

I think that my initial experimentations with Tian Wang- proved that something can help me have longer and deeper sleep. The four-day trial with Ku Shen (Sophoros Flavescens) proved that herbs can effectively clear some issues since that horrible thick yellow coating on my tongue almost disappeared, leaving a thinner white coat (it was possibly a sign of liver stagnation). And lastly, the courses of actual treatment of the underlying issues using Bu Zhong- and the herbal mix from Dr China have proved that the remaining coating on my tongue can continue to disappear, that some herbs can firm up my loose stools, that I can have more energy from using the right herbs in spite of the persistent insomnia, and that I can feel better and less drained and strained overall. I've even had moments of almost feeling a bit sleepy. Recently I have also started to feel as though someone opened the windows to my body and let in a fresh summer's breeze. I feel the body is possibly having a bit of a difficult time dealing with a surge of new energy while also accommodating the nervous system and brain to the need for rest and sleep and that it could take some time for things to fall into place (call me stubborn but I'm still optimistic about this prospect). I actually think that's quite a lot of improvements in just two months and that I'm not being overly optimistic, though it's also clear that I can't afford waiting much longer for more substantial results. I hope to get another course of treatment from Dr China but if that doesn't help, I really don't know what to do next. 

I also decided to give the original Tian Wang- with the heat clearing herbs one more go as a straightforward sleeping pill, though it's quite possible I don't respond to it so well anymore because of changes in the body. I simply have to get some reasonable sleep at the moment. I asked that they add Huang Lian, which counteracts the tendency for stomach issues. I haven't removed any herbs this time because I'm unsure which ones or which combinations have been helpful. 

My best advice at the moment if you are desperate to try something for your sleep, is either to try Gui Pi Tang 2 tsp/3 times a day or to give Tian Wang Bu Xin Dan a go. The former is safe for those who have IBS but I haven't felt confident to try it because of my good experience of Tian Wang-. The combinations I've tried to recreate match Gui Pi Tang to some extent but simply haven't been as effective on the insomnia itself. There is no harm in trying either, though one should not be taking Tian Wang- for too long in case of adverse effects (i.e. if you don't suffer from Yin deficiency).

Well, there is one more thing I'm looking into at the moment, and that is auriculotherapy. That is finding the right pressure points in your ear and pressing on them for as long as possible (ideally 20 mins). See the image above that I created for points that work on stress - try just a few major ones to start with. I've also heard that you can get magnets and stickers to stick on there so you don't have to press yourself or see an acupuncturist. 

A BREAKTHORUGH AND A SETBACK

9.9.14

I'm now expecting to receive my fourth course of treatment from Dr China. It's a bumpy ride, not least because I'm having serious trouble paying for this and it means being without other essentials in life. Because of this, I haven't been able to buy the kefir starter to see if that might help my digestion. I had a stomach virus for quite some time - about ten days - and could really have used some probiotics like that. Fortunately I had some organic miso with healthy bacteria at home, and that helped a bit. Remember never to heat  these products too much. Organic miso is fantastic as you can just mix some with cold water and add just enough hot water to make it pleasant to drink. It doesn't seem so expensive when you consider that it's also a nutritious meal, and it keeps for a very long time if you keep it in a sandwich bag in the fridge.

With the second lot of herbs, the doctor wanted to treat the damp condition of my body - damp (a Yin condition) being one of the climatological imbalances your body can get into, and very common in today's world. It gave me some abdominal pains for a few days, something which they felt was not abnormal when you're trying to treat other aspects of a complex condition. 

After two weeks of treatment, I didn't have money for the next one so I had to wait for over a week. In the meantime, I was taking some random herbs at night, namely the version of Tian Wang Bu Xin Dan that had the diarrhoea provoking herbs removed. During this time, I had palpitations for several days (not related to the temporary insomnia herbs, I don't think, but clearly related to the process at large as draining damp probably provoked the heat). After a few nights I switched to taking only the original powdered Tian Wang Bu Xin Dan with two modifications that I had gotten some time ago. The modifications were that there was Fu Shen instead of Fu Ling, although part of the same fungus the former is more sedative, and the addition of Huang Lian. During my research, I had found that this addition would help counteract the loose stools that some of us would get from the formula as it clears heat (this had been mentioned in several places). The drying herb Huang Lian seems very effective in treating diarrhoea (that is, damp condition).

Somewhat surprisingly, I suddenly responded really well to this formula. There was clearly some connection between the damp clearing course of treatment that went before, and this sudden  response to a Yang clearing formula with the addition of a drying herb. If you first predominantly treat the damp, presumably this may increase heat (palpitations), so by then taking some heat clearing herbs with a bit of a damp clearing herb added, I was able to find a better balance for a while. The palpitations calmed down, I had some heavier sleep, firm stools and a lot less frequent peeing during the night for a couple of days. My tongue suddenly got clearer from white coating. It was a glimpse of some balance!!

I'm sorry this is disgusting but it needs to be shown in the name of science. I'm sorry I don't have a photo from when I started on the herbs this summer, before the really bad thick yellowish coating cleared thanks to the very drying herb Ku Shen (Sophoros Flavescens aka Oxymatrine).

When I started on the next lot of herbs, which were intended to support the Yin, things went back to more "normal" again. This must be quite a seesawing process as damp and heat are opposites. While I was then suffering from the stomach bug less than a week into the treatment, my tongue got more coated again, though the coating was smoother than before. I'm not trying to read too much into all this, as I'm sure the journey isn't straightforward. I should probably also have asked doctor if I should take the herbs during my acute illness, but was too tired and too optimistic that it wouldn't last too long. I don't think I lost anything to loss of fluids though so I'm sure it did something good in the background. After all, I slept a lot... it could have been thanks to the herbs and not just because I was ill?

I also think formulas like Tian Wang Bu Xin Dan, the very first formula I ever tried that I wrote about extensively, sometimes works well in my kind of cases, sometimes not so well, depending on where the body is at. As I've been taking it again while waiting for the new lot of herbs, I would say it's still a fantastic formula that always helps support the sleep quality, but one must be cautious with the fact that it doesn't treat damp, only heat (over time it thus aggravates the damp condition in people with diarrhoea). Adding Huang Lian to the original mix means that the damp is being treated at the same time, and it really helps in firming up my stools though I also think it's all a bit confusing to the tummy. It is not a long term solution, though. I'm just glad I have this in-between treatments, though my approach may be a bit unorthodox. I don't see it doing any harm. Why it works so well is no doubt because it's treating both damp and heat, both of which I suffer from, however I do feel that it's a good idea to try other treatments as well so as to approach the problem in a more many faceted way. I would really recommend people try this course of action if they are clear they suffer from damp heat, even just to see that Chinese herbs really do help, and then get in touch with a real practitioner if things are going well. Clearing damp was one of the most helpful things in my case and I wonder that doctor didn't continue on that road for a little longer. 

The sign that something is going on at the moment is that I've been feeling very sluggish, as though there was lead rather than blood in my veins. It feels hard to move the body a lot of the time. I've been sleeping loads in the past few weeks, on most nights about 9.5 hours in total. It's like I'm on under drive rather than over drive a lot of the time, or the two all at once (i.e. not somewhere comfortably in the middle). Though it sounds like a case of combined excess and deficiency, it could also simply be that the nervous system is going through some serious change while relearning how to wind down, and all this really seems positive to me. I'm sure it will all settle down to something more normal in the end.

The heaviness seems to come on mostly in the morning when I get almost comatose sleep, and makes it extra hard for me to get up and get going. I do find it quite difficult to do my condition justice on the phone - it's just very hard to explain what is going on and answer questions accurately, especially at it's going through the assistant. It's possible that the doctor jumped onto something different a bit too soon. On the other hand, it's also possible that the stomach bug screwed things up. Or then perhaps everything is going just fine in spite of side effects and some funny reactions. Apart from the sluggishness I have been feeling more nervous, anxious and depressed than usual, and so the next lot of herbs is going to address the anxiety. Palpitations, arrhythmia (which I had a bit of too), feeling jittery and suffering from tongue fissures are all signs of too much Yang (heat).

I lost some of my interest in researching all this stuff as I feel that it's simply too much to learn and understand - at least for the time being, though I may get excited again. I've just been feeling out of sorts, and mentally low and lacking in motivation. I did, however, start to collect images of Chinese herbs on Pinterest. This collection is meant to showcase the best photos from all over the internet so that you can identify what the doctor has given you (of course, in many cases I'm just guessing what it looks like straight out of the shop rather than in the factory, as some pictures can be misleading in this respect). I needed to be able to see at least approximately what I got in order to feel more confident about the whole process.

I do find these herbs very exciting still, I mean look at them..! but I just don't have quite the right incentive to carry on learning at the rate I was learning this summer. Let's see what happens next.

THE EMOITONAL SELF SEEMS TO BE IMPROVING

17.10.14

With the previous lot of herbs, Dr wanted to treat my anxiety first and then stomach problems. In the first four bags, there was a herb that clears damp and heat in the gallbladder and liver, as well as Longan fruit (Long Yan Rou). My anxiety did dissipate and I have been feeling a lot calmer and more normal since then - more stress resistant, in fact. I have hardly any palpitations. The depression, which could have been a symptom of energy clearance in the liver and gallbladder, has also improved. The sluggishness I'd experienced for so long also dissipated. At first my bowel movements were erratic and I almost had a bit of constipation, but then it got back to more normal again. The stools were a bit firmer than usual and I often had a need to go at night as well as after getting up.

For a night or two I didn't sleep well at all (waking up every two hours) and had serious misgivings about the treatment, but then matters improved in spite of the fact that I no longer felt sluggish and heavy, and prone to sleep because of it. Towards the end of the treatment, that is for about three nights, I slept unusually well. On the last night I took slightly less Western medication than normal and slept solidly for six hours, getting up to pee a few times but hardly waking up. Of course, six hours is not sufficient so I have been taking 1 mg Diazepam in order to get a couple more hours sleep. All this sleeping has of course changed my schedule for the worse so I'm not able to even consider sleeping until about 3 am. 

Here are the most recent tongue shots. I'm a bit dismayed that there isn't a great difference though. Things got a bit worse for a while when I had the stomach bug, which you can see in the middle picture. In any case it does look like areas are starting to clear. 

I didn't want to be taking my own herbs for too long after the last treatment as I didn't feel comfortable with them (as they mostly treat heat), so I tried to get the next treatment as soon as possible. I was also a bit dismayed that it was mostly the same herbs as in the last three bags, they really weren't very interesting looking ones... But perhaps she felt a bit like I did that good things were just starting to happen when the last lot ran out. Also, she's now trying to treat the Liver/Gallbladder meridians which could take a while to clear. Well, I just have to trust her. I've had a sort of funny sense of openness and fresh air in the solar plexus, a very cold nose one day that I thought was leading to a cold, and a strange sensation in my head. I'm assuming these are all due to changes in my energies. 

Yesterday, before I got the new shipment, I took a few calming herbs that I still had at home: Ashwagandha, Fu Ling and Schisandra berries. After a few hours I felt very tired and had to rest for a couple of hours. At least I respond to all this a lot better than I used to. I felt grumpy and a bit angry afterwards, though my heart was incredibly calm, and wonder just how much that has to do with Liver clearance (since such emotions arise due to imbalance and stagnation of the Liver).

I'm also thinking that I should cut down on foods that cause phlegm in order to help the damp clearing process along. Many of these are foods I normally find odd to eat and don't even like very much, but have been eating because alternatives are so expensive and I find it difficult to think what else to eat on a tight budget. At the moment food wise we're just hankering along trying to get cheap outgoing food in the supermarket, because my treatments cost us so much money. I don't have the energy and focus to think of new dishes.

The most important to cut down on are diary products, very greasy foods, spicy food, ordinary vinegar, as well as alcohol (especially beer and red wine). Include bitter and sour tastes if you suffer from damp heat. One is supposed to avoid mushrooms but honestly - how difficult should you make your life? There is a fairly decent mushroom pate that is reasonably priced and go well on sourdough bread - I'm thinking to try and stick with these kinds of foods for a while and eat less ordinary bread with cheese. I like soya products but many of them are very expensive. I might exchange the yoghurt for soya, or try and find a yoghurt with probiotics that isn't too pricey. Generally speaking cold and uncooked food and drinks aren't recommended though. Read more about what to eat here.

Here is an illuminating lecture on diagnosing by looking at body types and tongues.

A HEALING CRISIS?

At least I think that's what it was. I started on the new lot of herbs and saw little improvement for a couple of days, things were just the same. Then suddenly, I had a weird experience. On Saturday morning while still trying to sleep, I felt extremely anxious and insecure. It was a feeling of having the rug pulled from underneath. It wasn't a nightmare, because I felt it while I was awake and it kept me from falling asleep (this I find quite interesting...). I took some extra Diazepam in order to get some anyway. I put it all down to having had a bit of wine and some extra medicine the night before. I was trying very desperately to change my sleeping schedule, which was getting absurd because of my tendency to get really drowsy towards the late morning. I did this by taking advantage of the fact I had to get up quite early on a couple of mornings, as well as by taking a tad more medicine at night. The clock was also changing backwards so I needed to use this opportunity. 

Anyhow, the experience was repeated the next night. I didn't have alcohol in the evening and the amount of medication was quite normal. It came on as soon as I went to sleep at night, and carried on for about four hours before dissipating. There is nothing in my life at the moment to cause such extreme real life distress, which were more akin to the kind of anxiety I felt when I broke up with a boyfriend and had to move from a place that really felt like home, or when my cat died traumatically. The morning was spent with restless sleep, and the following night was also restless though a lot better. During the worst crisis I also had a very distressed tummy, with strange aches and pains, and a need to go to the toilet very often (it was sort of reluctant, sticky and burning). My tongue was more coated than normal. I decided that all this could be a sign of clearance. There could be emotional reactions stemming back to my early childhood when I lost a sense of emotional security and started to clam up. It's interesting that the feelings were keeping me awake, which could suggest a connection with my chronic insomnia. There could be toxins released thanks to a release of stagnated energy, appearing as coating on the tongue and sticky stools. Sadly, there was no real sense of relief after this but I still don't want to discount that something might have improved.

My heart was also starting to race, gradually increasing with each day, and harder to cope with - I feel quite stressed. I feel close to angry and bitter outbursts all the time. I have slept quite badly in chunks of 2-3 hours since the weekend, and can't wait to receive some herbs that treat the problems with heat (=palpitations). Longan fruit seems to have been excellent for this and I'm toying with the idea of buying some or the calming sleep formula Gui Pi Tang to have at home... but it's risky since I don't want to take anything during treatments that doctor hasn't prescribed for a reason. I'm a bit upset that doctor wasn't dealing with that this time around, perhaps she thought it was safe to only give me one herb that clears some heat in the liver. This is not easy to cope with, when you have seen better days. My husband finds it hard to believe matters are improving when I can only manage better sleep while taking herbs, but I still believe in the process. In any case, it's all I've got.

It's confession time. Having discovered "converted" to Chinese Medicine, I am now quite unable to think positive thoughts about the materialism of Western Medicine. I think of it almost as someone who has been through a religious salvation in favour of a different denomination, though I say this tongue in cheek.... sometimes you just have an inner knowing, a conviction. That is not to say that none of the Western stuff is of any use whatsoever (after all, the HRT therapy still seems like a good idea), but mostly it focuses on secondary issues as it deals with the analysis of symptoms and their material manifestation. With all the fancy and impressive terminology, and sometimes quite sophisticated ways of measurement, in the end it really explains and treats very little. With all its airs and graces, is it maybe a bit of a case of the Emperor's new clothes?

Since so little makes any real sense to the doctors, problems are often conveniently dismissed as "just in the head". It's a typical male attitude if you're stuck in traditional male thinking. WM sort of addresses the map rather than the territory itself. Mapping the territory is important, but the map isn't the territory! WM is good at dealing with acute problems and holding symptoms at bay for a while, but then what? Sometimes it can point to a cause such as a virus or some bacteria, or a physical accident, or a congenital disposition... this can help the doctors understand why certain symptoms occur and know what to address in their biological warfare against external pathogens and occurrences that disrupt the physical side of human beings. However, as far as I can tell, that's more or less where it ends. The whole concept of some elusive energy that governs the physical body is still a very hazy concept within Western medicine. The only reason acupuncture is somewhat accepted is that it demonstrates such mysteriously good results - it certainly isn't for the concept behind it.

Complicated illnesses such as MS, FM, ME, Parkinson's and many, many more are still poorly understood and poorly treated. If you only get part of the picture, you can only treat part of the syndrome. In complex cases, this just isn't good enough. All of the body's functions are interconnected - I find people believe it in theory, but as it is very hard for the modern mentality to truly grasp it, it doesn't always lead to an effective approach on a practical level. In order to address all the "bits" of your body in a way that gradually readdresses balance, you have to have a clear idea of the underlying structure and how it all interconnects. 

I always thought structure was everything - and I'm not talking about physical structures as much as energetic ones. Once you understand how reality is constructed in terms of patterns, you have the key to understanding a whole lot of pathologies. This is why I was interested in ontology while at University. I wanted to understand how Asian philosophies and some esoteric Western world views describe the fabric of reality, and it certainly made a lot of sense to me. I was particularly enamoured with the idea of the dualism and fundamental paradox of our existence (Yin and Yang). Once I had grasped this concept, it was like a philosopher's stone that allowed me to write a whole bunch of exams without reading more than a couple of pages from my exam books (efficient, economical thinking and acting saved a lot of energy which I had little of to begin with). I knew that either directly or indirectly, this is what everyone is trying to resolve through their research. I got out of University with flying colours.

The point is, it doesn't matter if the structures are expressed symbolically, because what you need to grasp is the principle. Westerners think of Chinese medicine as unscientific, but that's just because the terminology isn't as glamorous and awe-inspiring to the point where only doctors can really understand it. The Chinese spent centuries observing the body and its functions, and interestingly came to the conclusion that it mirrors the rest of nature perfectly. Now there's a shock to the contemporary establishment, who rarely concerns itself with the welfare of Nature in the first place (of course all countries fail at this, as too many people think selfishly). There may be new diseases, but the underlying principles are still the same. Nature doesn't change in this respect.

Therefore, when you hear that you suffer from damp heat, it really helps to think of it as a climatological occurrence. From my own research, I've come to the conclusion that damp heat is what ails most people with fibromyalgia, even to the point where I would suggest that if this isn't a main  problem then you may not have fibromyalgia but something else (for instance, ME seems to be more about Qi deficiency though there are many other issues as well). Brain fog, diarrhoea, greasy skin, an uncomfortable restless ache in the muscles, sometimes a propensity for catching colds and feeling cold, getting worse in damp climates and better in dry ones - well it all points to damp invading multiple organs, including the brain. 

This is a description of possible problems associated with FM - the article points to just how complicated the illness is. The more complex your syndrome, the more important it is to see one or several well trained practitioners. The author suggests that no one Western therapy is useful in treating FM and that evidence of the effectiveness of commonly used therapies is scanty (that is, all apart from exercise). It's also clear the Western medications aggravate the syndrome, but personally I don't find this doctor's prescriptions of herbs appealing.

FM begins often following an infectious, or other medical disease, which can lead to retained pathogenic factors. It may also result from trauma, blood loss, chronic stress or chronic diseases. Stress, trauma and retained pathogenic factors result in obstruction and often, also, secondary unstable Yang (Yin-Fire, Empty-Heat, Wind etc.) which can manifests as facilitated sympathetic nervous system and may depress the parasympathetic system. Autonomic nervous dysfunction (and unstable Yang) often manifests with increased pulse rate that tends to be variable (frequent changes in; rate strength and quality with little stimulation /.../ The main pathogenic factor seen clinically is Dampness, often with underlying deficiency. Transformative Heat and Yin Fire/unstable Yang are common complicating factors. The severity of the muscle aches is often related to the level of pathogenic Dampness or Phlegm. With time Blood stasis and more severe and fixed pain can develop.

/.../ 

Spleen/pancreas weakness is said also to result in deficiency of Blood, which then may weaken the Liver ("fail to lubricate") and may result in Liver Qi stagnation/congestion. The Liver then may fail to nourish the sinews; muscles/sinews develop tension and weakness. Liver Qi stagnation may result in variable and poorly localised pains, and leave the patient susceptible to emotional stress and aggravation. Because Qi (or Phlegm/Dampness) stagnation is said to slow circulation, Blood stasis and or transformative Heat may develop. When Qi stagnation becomes severe and rebels swelling (usually not substantial or changing) may develop. Heat may congeal fluids, which become Phlegm. When Phlegm and Blood join, muscles may become fibrotic and loose flexibility; possibly permanently. With Qi stagnation the patient’s symptoms may frequently change. (Source)

In order to embrace the possibility that Chinese medicine can do anything for you at all, I think it really helps to at least more or less understand how it works. You also have to commit to it fully as no therapy is ever a quick fix. Chinese medicine is able to explain and treat pretty much everything as long as organs aren't terminally damaged, and therefore also has a very calming effect on someone who is afflicted with weird symptoms - I find dealing with WM and it's "nitpicking" and obsession over random, isolated details whose internal relationships are poorly understood extremely stressful, which means it also indirectly aggravates my symptoms. WM is also very good at fear mongering - had you noticed how terrifying it is to look things up on the internet? Of course Chinese medicine is not always successful in its treatments if the problems are sufficiently severe or a person refuses to follow life style advice or keep up with the treatments. Sometimes food allergies prevent people from taking herbs. However, provided there is a sufficient amount of time, TCM can usually at least alleviate suffering because it knows what to address. It is a very positive system in that the more you understand how the body works, the more amazed you might be that you're not as ill as you could be. At least that has been the case for me. It has given me real optimism about my chances of getting well, or at least improving, because I now have an idea of what needs to be done and how it can work.

According to this system, you don't just take some random medication or a few fashionable herbs and supplements based on general recommendations, and hope for the best... instead, you address the issues on the level of the territory, while looking at the particular climatological circumstances that define you individually. Of course many popular herbs that are hailed in the West are good for you generally speaking, but they may not be absolutely right for your pattern, nor do they work efficiently without the synergetic support of other herbs. There's so much hit and miss within the Western sphere. It's like going out to shoot some animal to eat and hoping that you'll kill something by shooting in random directions (sorry for the violent picture but it's the only one I could think of - after all, the Western approach is usually pretty aggressive).

This is very, very important: people spend loads and loads of money on a few herbs from a health food store they think might be good for them. Even worse, they take one at a time, thinking they won't know what worked if they take several. Unfortunately, this approach will never work! One herb is not going to help. In Chinese medicine, you would normally take around twelve herbs for fibromyalgia (sometimes even more), and the choice of herbs is an exact science! That is to say, there are many routes to the same result, and therefore differences of practice and opinion, but the problem needs to be well mapped in order to be treated correctly. Also don't forget that the herbs are highly concentrated, it's not just a bit of tinted water! I just read somewhere that in Japan, they give people much smaller doses and so there's a much lower incidence of people being cured compared to China and Taiwan. In the West medical companies sometimes extract an active ingredient from a herb (e.g. Digitalis), but that's completely missing the point of the amazing therapeutic qualities these herbs possess. Every aspect of the herb interacts with the body in synergistic and intricate ways, which is why side effects are rare. It's always about using nature rather than working with it. This is a patriarchal and arrogant mentality I can no longer support.

At the heart of Taoist thinking is the idea of compassion for all living things. In the West, we see an illness as evil that needs to be quenched. However, an illness is a messenger and your body is trying very hard to rectify the problem. Be kind to your body, and look at the illness with compassion. I know it's hard to do when a virus invades you or a tumour starts spreading, but what it is really telling you is that your body wasn't strong enough to ward off the threat. The TCM approach to illness is a diplomatic one, it's about patiently negotiating with various forces in order to restore harmony and the status of the self as the true power centre of existence. This is a form of empowerment of the individual, rather than an opportunity to take their power away. It's not about suppressing the evil forces or fighting them off through control and arrogant supremacy. According to Tao, all aspects of life are ultimately equal. Confucianism and Legalism have influenced the course of Chinese medicine a great deal too, and in this case it's more about the moral values and co-existing as a social being.

In other words, it's all about the kind of herbs, the number of herbs, the level of concentration of the herbs, and the synergy of the herbs.

I would venture to say that we don't even realise just how indoctrinated we are with Western thinking. Most of us believe that a diagnosis will give us all the answers. We think that a name will tell us what it looks like on the inside, and that everyone with the same diagnosis needs to be treated the same. We then assume doctors have, or will soon have, a treatment that will cure that bit in us that is out of whack. This is not always true! Take cancer for instance - as we know, Western doctors treat all cancer patients pretty much the same. In Chinese medicine you treat each patient differently depending on whether the cause for their symptoms is damp, heat, Blood or Qi stagnation, or any number of other conditions and combinations thereof. If you don't address these underlying issues, you are more likely to have recurring symptoms.

Illnesses do not always have the same causes, though there may be some typical patterns that lead to certain kinds of ailments. So if I say that fibromyalgia tends to show up a pattern of damp heat, it's a useful generalisation, but it can only remain a generalisation. This problem can show up with any number of other issues around the body and the nervous system, and they must all be taken into consideration for successful treatment. Sometimes people are asymptomatic, yet their tongues tells a whole other story. The signs on the tongue are warning signs for trouble to come, if not prevented. It is in fact absolutely amazing to be able to follow your own healing process by looking at your tongue. It's empowering, to say the least. Within Western medicine we are often trying to pin point very elusive symptoms that are hard to describe because there is seldom a consensus about the terminology to use. This is not the case in TCM, where in fact symptoms are very aptly described. It means the doctor knows which questions to ask.

The beauty of these therapeutical herbs is that they address the physiology as well as the life force (energy production) - that's because they are of nature, and therefore a mirror of our bodies! Energy and matter are two sides of one thing. Acupuncture, when skilfully applied, is clearly beneficial too, but you can't normally have it very often and it is really only treating one form of Qi. This can be a limited approach to a complex illness that has disrupted your organs. It depends what the illness is, and how complicated - for instance, fertility problems are often treated with acupuncture rather than herbs though herbs should be useful too. Some structural issues and consequent pain, for instance sciatica, can be relieved through acupuncture, and so on. If people are reasonably healthy, they will respond to this kind of treatment a lot easier than people with very clogged up energies. Attempting to penetrate substantial accumulations of stagnation and readdressing a balance that is truly out of whack through acupuncture can remain futile. I would be vary of this before starting acupuncture alone.

I had some acupuncture a long time ago, but gave up after a couple of months because I saw no improvement whatsoever. Thinking back, I'm not at all surprised as the energy stagnations were substantial and probably pretty impenetrable. I now know that it would have required a different kind of commitment and I blame the practitioner for not attempting to explain this to me. All he said was that he could fix my stomach pain. Expensive it was, too. I probably would have been more impressed had I been simultaneously given herbs - now I believe herbs are actually more useful in the case of many faceted syndromes. The great thing about herbs is that you take them twice every day, and so you are treating your body on a constant basis (not leaving too long between treatments, of course). It's reasonably economical, if all you have to do is intermittently show your tongue to the practitioner (as your body changes all the time, the practitioner has to regularly check on you).

If you can't have acupuncture at the same time, there are other simple things you can do such as eating well and avoiding foods that aggravate your condition, exercise daily, practice Qi Gong/Tai Chi/Yoga and meditation, and maybe lie on the bed of nails every day too. Avoiding stress is naturally also important, and if necessary, you can take Western medicines alongside the herbal treatments. I also receive daily massages from my helpful husband, and this no doubt helps clear toxins as well as energise stagnated energies and stabilise rampant ones. I have recently found that I can now affect and calm down the racing heart through meditation and massage, which is pretty obvious progress.

THE DOWNSIDE OF CHINESE MEDICINE, AND A BIT OF A CRISIS WITH YIN CHEN HAO (wormwood/Artemisia)

Yes, I have indeed discovered a down side. Although Chinese medicine treats every patient with an individual set of herbs, it falls into the same trap as Western medicine in treating people on a conveyer belt. Chinese medicine is effective and quick. Apparently in China, the number of patients treated in clinics over the course of one day is even more terrible than here. I thought having only 20 minutes with a doctor in Finland was terrible, but then I come here and I get only 8 minutes! In China, there is little need for long discussions in order to understand what ails people, and so it's even less. 

What happened to me was that the palpitations I reported about in my last blog got so bad I decided to call Dr China. After all, they had asked me to call if I had any questions, and though I realised they couldn't actually do anything about it over the phone, maybe they could at least tell me if this was a normal reaction and whether I should really continue with the lot of herbs I was on at the time. The anxiety I experienced was odd, as it kept shape shifting. It wasn't really social anxiety as much as a sense of insecurity. It didn't bother me too much in the day time, except that it was accompanied with palpitations that were occasionally quite bad. I felt very stressed for a few days. During the night I would sleep restlessly and feel the need to take more Western medicine than usual just to be able to get enough sleep. The anxiety that was coming out in my sleep did gradually dissipate over the course of some nights, but while I was still taking the Chinese herbs I felt really bloated, puffy, grotty and shattered when I woke up even when I had in theory slept quite a lot. This weekend I felt sort of really sad and down hearted, but it was more of a feeling in my tummy than in my heart. My tongue was awfully gunky and not improved at all except that there's a thin layer of damp on the sides that clears when I eat. It exposes a long line of fairly red tongue all along the edges and a red patch at the back. I'll talk about this later.

So I called. Unfortunately, the assistant wasn't there, only the doctor who speaks poor English. She didn't know who I was and sounded very stressed. I tried to explain that I was feeling anxious but she didn't seem to realise I was someone she had been treating for three months already. She snapped that she was busy and could I please call in two days time when the assistant was there. As I hung up, I started to cry. I was really vulnerable and just needed to feel that I was being taken care of. Although I knew what I enrolled in when I started to follow up on the treatments from Dr China and made an effort to detach myself from it emotionally (I wasn't paying for surplus attention), I ended up still investing some emotions in this process. I realised that it's something you simply can't avoid when you're starting to have emotional reactions during the course of treatment. I do get that the doctor was busy on her own in the shop. She probably finds it hard to catch names on the phone and to hear what people are saying, because as a foreigner I have the same problem. However, she could have replied in a kinder way and this was simply not professional behaviour as we expect it here in the West. It also begs the question as to whether she's really been following my case or just prescribing something in the moment. Though it may not matter so much to them what the history is, it does matter to me that they are aware of the process.

So I was sitting there crying and thinking what the hell to do next. It occurred to me, that doctor had given me Longan fruit last time I was suffering from anxiety, so I called my husband who was in Aberystwyth to go and see if he could obtain some from a new Chinese herbalist that has recently opened over there. Unfortunately it was closed. As I talked to my husband about all this we agreed that the relationship with Dr China is no longer working for me and that I should find someone else to work with whom I can see from time to time. I have therefore decided to try the new herbalist in Aberystwyth, as it's not so difficult for me to go there. I have been sceptical because she has only recently been qualified, but who knows, perhaps she has a fresh and more enthusiastic take on things. It strikes me as being a less stressful and busy environment than the shopping mall in High Wycombe! It could also be a bit cheaper, not least if we can pick up the herbs ourselves.

Unfortunately this practitioner has gone to China for another three weeks so in the meantime I will be taking my own mixture. I decided to place an order from Activeherb and try and custom make it a little, based on some ideas I've gotten from analysing the herbs Dr China has given me. I was in a hurry, of course, so I hope I thought of all the aspects of the treatment. I decided that I was going to use Gui Pi Tang as a base and add a few things. This formula is directed towards the Spleen and I believe I also need to treat the Liver. The company approved of the formula I suggested. 

This is the recipe (the numbers denote the percentages):

Here comes the geeky bit though I'll keep it short: Basically the idea is to take quite a lot of Longan fruit (Long Yan Rou) as it has a major calming effect on the palpitations (heat). I also asked that they would substitute Fu Ling, the sedative mushroom Poria Cocos, with Fu Shen, which is even more sedative. I then decided that Chai Hu could be useful not least in the Liver/Gallbladder as it dries as well as helps Qi circulate, as well as two drying herbs that would act on the damp and enter the large intestine and Liver meridians. I had been given Mimosa bark (He Huan Pi) once along with Longan so I thought this seemed like a good idea for the time being. Orange peel (Chen Pi) has also proven very useful in drying my damp intestines. Another good herb for treating diarrhoea and distention is Mu Xiang which is already part of the formula, but doesn't enter the Liver. The other herbs (namely Bai Zhu, Yuan Zhi, Huang Qi) are ones I have been given regularly too. I am not convinced that this formula is quite the right one in the long run but we'll see how it goes. It's so focused on the Spleen that I worry that we're not dealing sufficiently with the problems of the Liver. However, it was the only solution I could think of off a hip and would obviously prefer to talk to someone who can take me by the hand so that I won't get stuck. Chai Hu is a pungent and neutral herb /.../ dispersing the Liver-Qi. It can be used to treat hypochondriac pain and distension, emotional disturbance, irritability and depression. It has no direct function in removing Dampness unlike the other two herbs. (Source) There are also a couple of things I have at home that I can supplement with if needed. One is of course Schizandra (Wu Wei Zi) which has been present in all the treatments so far, and the other is Turmeric. Turmeric (Yu Jin) is great for Liver Qi stagnation with heat signs, and it also invigorates the blood and supports the gallbladder. Read more about Liver related issues here. One thing to realise is that sour foods is good for damp heat in the Liver, so please drink a glass of lukewarm lemon juice in the morning! Squeeze half a lemon into some cold water and add a little bit of hot water.

These are the ingredients for Jia Wei Gui Pi Tang, which is quite similar to my recipe. It has Chai Hu added to Gui Pi Tang as well.  However, it contains the Liver "chilling" ingredient is Gardenia (Zhi Zi). It clears both heat and damp in the liver, but it's not recommended for those with diarrhoea.

So now the question is, what on Earth was going on with the last lot of herbs I had received from Dr China? She gave me very similar herbs twice, which means that I was taking a heck of a lot of the main herb in this formulas, i.e. Artemisia (Yin Chen Hao). Well, the interesting thing is that I woke up on Sunday two weeks ago feeling quite depressed and thinking, this Artemisia isn't right and Dr China isn't doing the right thing for me. Why I would feel that way is a complete mystery to me! I'm not supposed to know enough about these things to make that kind of judgment. So when I opened the following shipment from Dr China and discovered some more Artemisia, I was really shocked! I was also disappointed that's all there was apart from some of the regular herbs that calm the Shen.  I just didn't feel right about it. I also checked formulas online but came to the conclusion that Artemisia should be a good thing for clearing the Liver and Gallbladder - I had no reason to think otherwise.

This is an overview of the kind of trouble I suffer from (along with most other fibromyalgia sufferers, no doubt) - Artemisia treats damp heat in the Liver/Gallbladder.

DAMP HEAT IN THE LIVER/GALLBLADDER (gan dan shi re): primary symptoms are discomfort, stuffiness, or pain in chest, epigastric, or subcostal region; abdominal distention; nausea; bitter or unpleasant taste in mouth; no appetite; restlessness; easily angered; dark urination. Secondary symptoms include alternating heat/cold sensations; thick and colored vaginal discharge; itching or swollen genitalia; obstructed bowel movements; jaundice and yellow eyes. The tongue typically presents with a reddish body and a greasy yellow coating; the pulse tends to be wiry and rapid.

Representative Herbs: gentiana (longdancao), capillaris (yinchen), gardenia (zhizi), scute (huangqin), rhubarb (dahuang), indigo (qingdai), akebia (mutong), alisma (zexie), plantago leaves (cheqiancao), hoelen (fuling), coix (yiyiren), talc (huashi), bupleurum (chaihu), curcuma (yujin). (itmonline)

It is to be noted that some of these herbs are contraindicated for damp condition, for instance Gardenia (Zhi Zi) in cases of diarrhoea. This is a Western overview of Artemisia (Yin Chen):

Yin chen is used to treat liver disease (hepatitis), gallstones, and high cholesterol. It is also used to stimulate the flow of bile from the gallbladder. Yin chen is used for brain damage in newborns (kernicterus) caused by bile pigments in the blood (jaundice), fever and chills, bitter taste in the mouth, chest tightness, flank pain, dizziness, nausea, and loss of appetite. In addition, it is used for headache, constipation, painful urination, itching, tumors, mucus in the nose and throat, joint pain(rheumatism), painful menstrual periods, malaria, and muscle spasms. In Chinese and Japanese herbal combinations, yin chen is used for jaundice with fever, painful urination, constipation, and stomach bloating. Yin chen can cause nausea, bloating, dizziness, and heart problems. Yin chen may cause an allergic reaction in people who are sensitive to the Asteraceae/Compositae family. Members of this family include ragweed, chrysanthemums, marigolds, daisies, and many others.  (WebMD)

If this was an intuition, it could mean two things - I was either subconsciously fearing the kind of emotional healing crisis this could bring by stirring up things of the past, or it simply wasn't right for me. My husband once had this kind of emotional reaction from taking St John's Worth and who knows what it all meant? He was feeling normal as soon as he stopped taking it. After the disastrous call to the Chinese shop I decided to bravely finish it all off just in case it was a question of a healing crisis. Now I have suffered from a lot of depression and anxiety for a few weeks (not just heart problems as suggested above) and quite looking forward to getting out of it. I have been able to deal with it with an objective frame of mind so I've stayed on top of it, but it hasn't been pleasant. It's quite possible that we're talking about a combination of side-effects and healing, though. Of course it's possible that what I thought of as intuition was just a symptom of my general state of mind (depressive) and doubts about the doctor's choices this time. To be honest, I find no reasonably indication that Artemisia should be a problem, so am bent towards thinking it just set difficult energy blocks in motion.

It is the author’s experience that FM patients are often sensitive and do not tolerate strong, spicy, hot or cold formulas. They tend to develop side-effects (even with so called individually appropriate formulas) and are often non-compliant. A mild approach to herbal formula design may be preferable. The most difficult aspect is to decide between elimination of pathogenic factors, tonification and/or harmonization. Although following traditional theory one usually eliminates pathogenic factors before tonifying, this is not always the best clinical approach in FM patients. (Source)

As I was saying, my tongue looks pretty awful but the coating on the edges is thin and loose and as soon as I eat something or wash my teeth (not my tongue) it reveals a red edge all around and a patch at the back. This corresponds with the Liver. What that seems to indicate to me is that damp has indeed been dispersed in the Liver but it has also encouraged some Yin deficiency. This is surely (at least partly) why I've had such palpitations, a feeling that my lungs are dry (it's a bit hard to breathe) and hair that is even dryer and more hay like on top of the greasy scalp, than normal. 

This article by a distinguished practitioner discusses the issues of damp heat and how it is in fact a case of hot dampness rather than damp heat, therefore it is to be considered a damp condition.

Damp-Heat is particularly important as a pathogenic factor because it itself can become a cause of disease. In fact, not only Dampness obstructs the Qi mechanism leading to more Dampness, but Heat also dries up the fluids and condenses them into more Dampness. Furthermore, the Heat part of Damp-Heat (especially if predominant) may also injure Yin. (Maciocia Online)

Well then. We'll just have to wait and see how it goes. I still have no doubts whatsoever that this is the way to go, and I'm hellbent on proving that my insomnia can be cured through these treatments. It's just a question of finding someone to work with who will be communicative about the process. Of course I realise that you can go and see a Western Chinese Practitioner if you want more attention, however I really want to stick with the real thing and also have no intention of paying a lot of money just for a bit more sympathy.

According to Five Element theory, anger and other related emotions such as resentment, unfulfilled desires, frustration, etc. are attributed to the Liver. The relationship between an organ and its corresponding emotion is reciprocal. The Liver for instance, is responsible for the free and smooth flow of Qi, which has a deep relationship with a person's emotional state. Conversely, anger, repressed emotions, etc. affect the Liver organ itself, and disrupt the smooth flow of Qi in the body.

If Liver is functioning well, and its Qi is flowing smoothly, the emotional state will be happy, and "relaxed" or "free and easy". Emotions will be freely expressed. When Liver Qi does not freely flow, stagnation of Qi occurs, and affects the emotional state. This causes anger and irritability. Over a long period of time, stagnation of Liver Qi impairs circulation of Qi and can cause emotional states of constant low level anger, depression, and resentment. These may be transferred to and appear in the physical body, such as the chest, breasts in women, hypochondriac region, epigastric region, or throat. Stagnation of Liver Qi, therefore, produces feelings of tightness in the chest and hypochondriac region, often with frequent sighing, pain and swelling of the breasts, tension in the stomach, the sensation of a lump in the throat.

Liver Qi may "rebel" upward and cause Liver Yang to rise. Symptoms include irritability, headaches, and the propensity to lose one's temper. (Sacred Lotus)

I WAS FLYING!

I have a friend who has severe chemical sensitivity and a whole host of other problems that cause immobility and fatigue. He went to see a well known TCM practitioner for a whole year in the beginning of his illness and ended up "very ill and poisoned". I don't know any more details than that as I only spoke to his wife about it in an e-mail. It's very disheartening to hear this kind of thing - in fact it makes me incredibly sad. Of course it's perfectly possible that someone with extreme sensitivities or a propensity for sensitivity that is just about to erupt is going to have issues with some of the herbs, or have problems in spite of herbs. Or maybe he really was given the wrong thing. I don't have the full story and people sometimes twist things to fit their agenda, so it's useless to speculate, but I suspect his is a freak case and not something to take to heart.

I personally don't have any worries since I consider my basic constitution relatively sound. However I won't discount that there are people with a weak consitution who could have some reactions they are unable to handle and who would be better off not doing any kind of experimentation on their own. They might also be better off going to see a practitioner who takes time with them. I am simply trying to find ways that I can afford, and am hellbent on proving that this is a way out of my miserable situation that also keeps me firmly rooted in poverty. I have decided I am not going to be a sad victim and passive receiver of some arbitrary help, but as active and proactive as I possibly can be. It's up to you if you want to follow my example, but at the very least I hope to provide some hope and inspiration for all of you out there who are suffering and maybe even needlessly so. I no longer want to feel stuck with an illness no one has actually proved is incurable. Western medicine certainly can't do anything for you.

When I started on my modified Gui Pi Tang, my heart stopped racing all of a sudden after my meditation in the evening. What a relief it was. My lungs and hair feel less dry. I had a calm night after that but didn't sleep so well as I woke up after four hours and found it hard to get back to sleep. The following day I added Schisandra and Turmeric to my herbs. I took these three times a day as recommended for powders (2 tsp x 3), which frankly is quite a lot. Then I had a very strange experience. 

While I was meditating in the evening, I started to imagine that I was doing some kind of Tai Chi that evolved into a dance. I felt I was pushing against the air around me. It was a strong, physical sensation. I then decided that I could probably also fly. I imagined flying like we do in dreams. Sometimes flapping my arms, sometimes just floating through the air, sometimes descending vertically towards the Earth. The only reason this fantasy worked was because of the physical sensation of resistance from the air around me. It was very peculiar. I slept reasonably well that night (the second night after being on the modified Gui Pi Tang), in two chunks of five and three hours.

I felt drowsy and willing to go back to sleep when I woke up. I had a bit of a raised temperature, slightly racing heart, and my eyes were puffy and dry and it felt as though something was obstructing my vision (these could be symptoms of fire in the Liver). I felt as if my body really has been to space and back. I feel drowsy and there's this weird sensation inside, not dissimilar to what I had in that meditation - it's especially in the solar plexus and probably connected to the Liver and possibly the other organs in the middle Jiao. I have no idea what it means but I embrace it as a positive change in my energy field. I want to make a record of it because I think it's significant. On the third night I slept all the way through, and found it very hard to get out of bed. When I finally did, I felt puffed up with red eyes, and weird but almost wonderful for having had so much real rest if I hadn't felt a bit dizzy and headachy (could be signs of liver heat). My tongue looked a lot better - a bit less gunky and less red, too. I will take a picture sometime soon.

I've been wrecking my brain thinking what else I should be taking in order to support the clearing of fire in the Liver, and really regret I decided not to include Huang Lian to my recent mix after all. I was afraid it would firm the stools up too much, and to be fair, I couldn't possibly know that they would be as loose as they are today. However, it's a herb that is recommended for clearing Liver fire, and in any case it may be a good thing to have at hand when you have terrible diarrhoea.  I feel quite confident about this particular herb, but it's also true that one has to be very careful not to aggravate one's damp condition when clearing heat. You can see just how complicated it is from this article.

When treating Heat syndromes, it is important to know the pitfalls of using herbs that clear Heat so as to avoid potential side-effects. Generally speaking cold herbs, and especially bitter-cold herbs, can easily injure the Yang and produce Dampness, so they should not be used for too long and at a large dosage. Bitter-cold herbs may also easily injure the Stomach and may cause stomach cramps and pain, so a proper dosage and a proper course should be arranged carefully. Also, patients with a weak constitution, or suffering from Cold in the Middle Burner, or weakness of the stomach and intestines, should not use cold herbs in too great a quantity or for too long.

I wondered if I could get it separately from the internet, along with some Chinese barley (Yi Yi Ren) which also treats damp and heat, but it's very expensive.

If Heat stays in the Liver and its meridian, the symptoms of the patient will include irritability, red and dry eyes, hypochondriac pain and distension, dream-disturbed sleep, insomnia, headache, dizziness and tinnitus. The tongue body is red or red on the border and the coating is yellow. The pulse is wiry, rapid and forceful. Herbs which are bitter and cold and enter the Liver and Heart meridians, such as Huang Lian Rhizoma Coptidis, Long Dan Cao Radix Gentianae Longdancao and Xia Ku Cao Spica Prunellae Vulgaris, are selected.

I think we can safely assume the heat is not only in the Liver when you have a complicated condition, however if that's what you want to address, Huang Lian does seem like a good option. It also treats heat in the heart and firms up the stools. I have a strong feeling there's a lot going on in my Liver at the moment, not least judging by all the difficult emotions I'm going through. I have also looked into other options such as Gentian and Gardenia, but they come with a lot of potential hazards. The former can be toxic and the latter can aggravate diarrhoea. I've had a very favourable reaction to Huang Lian so I trust.

Spring 2015
I used TCM herbs for several years and about a year after the introduction to it,
I was able to give up Western sleep drugs altogether. 
Unfortunately the situation changed when I was burnt out after 
my mum’s death from pancreatic cancer in 2017.

Summer 2025 after seven years of unsuitable drugs including oestrogen and opioids, 
all the while unable to tolerate any herbs or supplements at all.

75 days post-opioid, still in withdrawal
End of March 2026

Some TCM herbs.
I thought them incredibly beautiful.