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Treatment of Fibromyalgia Pain in Tibetan Medicine

April 13th, 2017 Posted in Articles, Tibetan Medicine Info

Written for The 4th Annual Symposium on Western & Tibetan Medicine, Stanford April 2017

Presented also at the 3rd International Confrence on Sowa Rigpa in Varanasi, India March 2018

Nashalla G. Nyinda Menpa, TMD Adjunct Professor Naropa University

Tibetan Medicine & Holistic Healing Clinic  © 2017

Fibromyalgia presents a myriad of pain symptoms therefore pinpointing treatment is challenging and varied. Based upon my experience working with Fibromyalgia patients, I assert that this condition primarily falls under the Tibetan medicine category of  “wind” or rLung disorder. If one consults the chapter on wind disease contained within the third volume of the classical four volume Tibetan medical treatises, a direct correlation emerges. The root causes of this condition rest within the causes and conditions of wind disorders.  Further, due to the chronic nature of this disorder, involvement of other bodily systems often produce further symptoms of imbalance which may fall under other humoral or elemental classification. By understanding the basic pathology and described symptomatology, the causes and conditions, locations in the body, and patient sensations a clear pathology is revealed. Treatment follows guidelines elaborated within the classical Tibetan medical texts. More specifically, wind disorders attacking muscles, tendons, ligaments or wind ‘running in the channels’ described here provides accurate descriptions of and treatment models for this modern affliction. In this paper, I identify which treatments within the Tibetan ‘Four Methods’ , consisting of diet, behavior, medicine and accessory therapy are beneficial for  Fibromyalgia patients. I present case study examples, techniques which produce beneficial results, and precautions for preventing future flare ups of pain.

The classical four volume Tibetan medical treatises are commonly referred to as the Four Tantras or rGyud bZhi. In this paper I will primarily stay within the Third Tantra, which focuses on pathology and detailed information on causes, conditions, classifications, typology for diseases as well as corresponding treatment. The chapter on wind disease groups a total of forty-eight rLung disorders. These are further broken down, twenty by type and twenty-eight by location.

In every wind disorder case, the nature of the wind has mixed with another disorders nature. Meaning it is either a conditioner or directly affected by another imbalance within the system. The term nature indicates the three principle energies of rLung, mKrispa and Badkan or wind, bile and phlegm. Some Tibetan physicians may describe wind as a neutral agent, mixing with hot or cold in consequence. All disease pattern and pathology are understood by looking upon the actions, locations and organization of the three primary energies, of wind, fire, earth and water respectively. Space is considered omnipresent within the other four elements and resulting humors. By relating the three to their associated bodily systems symptoms are classified and straightforward, even when mixed humors present. This clarity directly relates back to the first volume on medicine, the Root Tantra, where the cause of healthy and unhealthy body are introduced in detailed Tibetan anatomy and physiology theory. It is therefore stated, if you know the root, whatever grows and appears will be evident.

Translated often as humor, or dosha, each of the three has a direct relationship to the bodily systems known both in Tibetan and western anatomy and physiology; skeletal, muscular, cardiovascular, digestive, nervous, endocrine, lymph system, et cetera. In a very direct way, when wind mixes with other systems it can confused diagnosis as rooted in another humor. Yet it is vital to remember two factors. One because wind nature almost always mixes with other systems and spreads, increases, hardens, and intensifies disease this act of blending creates either a disturbed, excess or deficient amount of wind. This in turn will then travel down a wrong pathway, aggravating another system as it enters the location it is attacking. Two by knowing the Root Tantras introduction and explanation of the nature of wind, its characteristics and resulting symptoms it is clear which is a wind disorder, and which is the secondary humor involved.

We now turn our attention to the specific symptom presented in the wind chapter. As previously stated, disease is reliant upon wind to increase, spread and solidify a disorder. In this way when you control the wind, you control the disease. From the Tibetan medicine method of how pathology is created you have five possibilities in how disease enters and takes over a location of the organism. Disease must either 1. Spread on the skin, 2. Develop on the muscle, 3. Stick to bone or ligaments, 3. Run through the channels (nerves) 4. Land on a solid organ or 5. Fall into a vessel organ.

In fibromyalgia, symptomatology detailed in the wind chapter directly matches many of the documented general signs of basic rLung conditions. Wind or rLung itself is very pervasive, it enters though all five possible entrances or pathways. It primarily shows symptoms directly on skin, muscle, bone, ligament and runs though the channels. This you see in cases of fibromyalgia.

Generalized Symptoms of Wind Relating to Fibromyalgia from the rGyud bZhi:

  • Pain which moves and is un-stationary
  • Stiffness and joints which feel hard and difficult to move
  • Shivering and feeling of deep cold
  • Pain worse with movement (exercise can flare symptoms)
  • Feeling of squeezing or pressure or swelling even if no swelling or pressure is applied, or as if the body has been bound tightly
  • Stiff locked limbs held tight in extension or contraction, or muscle spasms such as restless leg syndrome
  • Feeling intense pain – as if the bones are broken or the muscles and tendons are tearing, or as if one has been badly beaten, or as if you are walking on hot thorns
  • Pains in the hips, waist, head aches
  • Insomnia
  • Desire to stretch, feeling constantly stiff
  • Symptoms worse in the morning despite sleeping a heavy fatigue
  • Dullness or foggy mind
  • Wind points are painful upon touch
  • Tingling, numbness and loss of sensation in extremities

Western Medical Symptoms of Fibromyalgia:

  • Chronic muscle pain, muscle spasms, tightness, restless leg or curled toes
  • A feeling of swelling (without actual swelling) in the hands and feet
  • A feeling of “being squeezed or bound”
  • Stiffness upon waking or after staying in one position for too long
  • Moderate to severe fatigue and decreased energy
  • Insomnia, sleep disturbances, or waking up feeling just as tired as when you went to sleep
  • Difficulty remembering, concentrating, and performing simple mental tasks (“brain fog”)
  • Abdominal pains, bloating, nausea, and constipation alternating with diarrhea
  • Chronic digestive disturbances
  • Tension or migraine headaches
  • Jaw and facial tenderness or TMJ
  • Sensitivity to one or more of the following: odors, noise, bright lights, medications, certain foods, and cold or hot
  • Feeling anxious, panicked, obsessive or depressed
  • Describe general feeling of “being plugged in” feel twitches in nerve system with no evidence in MRI scans
  • Numbness or tingling  all over, and non-stationary “roaming pain” or tingling in the face, arms, hands, legs, or feet
  • Heart palpitations
  • Increase in urinary urgency or frequency (irritable bladder)
  • Reduced tolerance for exercise and muscle pain after exercise
  • A feeling of swelling (without actual swelling) in the hands and feet

In the rGyud bZhi medical text there is an explanation of eight summarized symptoms of the twenty wind conditions categorized by type.

1. & 2. Stiff and Shrunken: རེངས་དང་འཁུམས་

3. Dryness: སྐམས་

4. Bloated: སྦོས་པ་

5. Paralyzed:  འཕྱེས་

6. Pain: གཟེར་

7. Mental / Emotional Instability: འཕྱོས་པ་

8. Cognitive Challenges: ལྐུགས་པ་

When we compare these manifestations of wind disorders from classical Tibetan medical text with the modern allopathic descriptions there is clear affirmation that fibromyalgia is related to a syndrome of wind. The twenty specific disorders by type underscore the following five specific wind diseases meeting a majority of criteria for matching fibromyalgia symptoms.

* ཤིང་རེངས་ Shing Rengs which translates as “Wood Like Stiffness

This is where the wind has combined with undigested earth and water, known as phlegm and has blocked the wind channels preventing wind from traveling through the proper channels which allow movement of the body. This makes the body stiff like wood, and often it is difficult or becomes nearly impossible for the torso or limbs to easily bend. If left untreated the stiffness progresses and the limbs can be more or less stationary.

Very frequently those patients whom I have seen with fibromyalgia have sluggish digestion which relates to the phlegm or Badkan humor being in excess and combining with wind.

  • བི་ཤ་ཙེ་ Bi Sha rTse which translates loosely as “Loss of Finger and Hand Functions

This wind disorder is characterized by hands and fingers losing their function and sensitivity, making movement difficult. Wind can attack the ligaments and tendons themselves. Initially there may be pain which one becomes accustomed to. The nerves in the hands are affected because the pathway is limited by the wind attacking the tendons and ligaments, the extensor and flexor muscles atrophy and the fingers can curl up with loss of function and feeling.

  • བརླ་རེངས་ brL Rengs best translated literally as “Stiff Thighs”.

This shares similar pathology as the first one we discussed, Wood Like Stiffness. Due to undigested substances the channels in the thighs become congested. The wind can no longer travel throughout the tissue, causing pain, swelling, coldness and a heavy feeling. The person will feel it is difficult to lift or move the thighs. This can easily be mistaken for a phlegm disorder due to the increase of flesh and fat to the area; and other limb problems often can appear as a phlegm issue. However it is clear this is due to a wind disorder when patients report simultaneously experiencing loss of appetite, stiffness of tendons and heaviness in the legs  culminating in diminished sensation of the legs. They describe they can feel they have an extremity, but without much sensation beyond that their legs are ‘just there’.

  • ཚེར་མ་སྟེ་ Tser Ma sTe disorder which is quite descriptive as “With Thorns

Also relating to nerve, tendon and ligament disorders, the wind is said to enter at the ankle area and attack the tendons and ligaments of the ankle. The feet will lose their functionality and have uncomfortable pain described as being stuck with thorns. The skin itself is also discolored pinkish showing inflammation.

  • རྐང་བརྩེ་ rang brTse is translated as “Walking on Top of Rocks

This disorder has some crossover for fibromyalgia pain as well. Feet will tingle, burn and have pain as if you’re walking on top of rocks. Some describe this as if there were thousands of tiny needles on the bottoms of the feet and it hurts to have any pressure applied to the feet. The soles of the feet themselves will appear darkish, or more brown and feel hot to the touch. The top of the foot and ankle may be pale and slightly swollen. Like other tricky wind pathology, the symptoms of heat and inflammation might make one think this is due to wind mixing with bile, when in fact this is due to Badkan mixing with rLung, or a Bad-rLung cause.

Next the wind chapter describes the twenty-eight specific locations affected by wind disorders. Looking at the list you can also surmise a connection to fibromyalgia issues. These twenty-eight are listed in the following manner.

  1. Skin ལྤགས་
  2. Muscle ཤ་ / ཤ་གནད་
  3. Fat ཚིལ་
  4. Nerves རྩ་
  5. Blood ཁྲག་
  6. Tendons & Ligaments ཆུ་བ་
  7. Bone རུས་པ་
  8. Joint ཚིགས་
  9. Bone Marrow རྐང་
  10. Reproductive Fluid ཁུ་བ་
  11. Heart སྙིང་
  12. Lungs གློ་བ་
  13. Liver མཆིན་
  14. Spleen མཆེར་
  15. Kidney མཁལ་
  16. Place of Digest ཟས་ (more specifically as the Duodenum ཕོ་བའི་ཟངས་ཚགས། རྒྱུ་སོར་བཅུ་གཉེས་མ།)
  17. Place of Undigested མ་ཞུའི་གནས་
  18. Post Digestive Place ཞུ་བའི་གནས་
  19. Gallbladder མཁྲིས་
  20. Rectum བཤང་
  21. Urine གཅིན་
  22. Womb མངལ་
  23. Head མགོ་
  24. Eyes མིག་
  25. Ears རྣ་བ་
  26. Nose སྣ་བ་
  27. Teeth སོ་
  28. Whole Body ལུས་ཀུན་

When you go into detailed explanations of these twenty-eight I pulled out those which relate to symptoms arising from wind that many fibromyalgia persons experience by location.

Wind spreading on the skin:

Skin is painful, sensitivity to touch, discomfort of anything touching skin, bumpy or rough to the tough, may have cracks, especially in winter.

Wind attacks / enters the muscles:

Muscles are swollen, skin covering affected muscle is rough, skin color changes, bumps, pimples or puss, can also be itchy red or yellow if involved with plasma heat disorders.

Wind attacks / enters the channels:

The affected channel becomes very visibly swollen, can protrude, appears swollen or puffy.

Wind attacks / enters the ligaments:

Various responses range from becoming very stiff in the limbs, diminished movement, loss of control or spastic, paralysis and often this will be centralized to the ligaments on the neck or limbs.

Wind enters the bones:

Tremendous pain and discomfort, muscle loss, diminished bodily strength with feeling weak and loss of healthy complexion. The skin and complexion dulls and they appear weakened.

Wind attacks the joints:

Joints become empty, spongy and soft, swell or can become puffy and swell (due to wind) and can lead the thoracic outlet and sternum to protrude and appear swollen, almost like a Robin’s breast. * This is my description and not in texts, this can lead to the disorder known as rLung da rGan.

Wind attacks the bone marrow:

Insomnia and difficulty sleeping is an issue. Patient describes feeling bound tightly, and this can dull the pain, you get relief when you press on wind points. (Corresponding to the rtsa dkar རྩ་དཀར་ or nervous system) It is my experience that this person shows general wind symptoms of sleep disturbance and malaise and does get relief when point and massage work is administered. However this person can easily have a ‘flare up’ if points are pressed too intently. I frequently see it affecting the three bones of the pelvis: the ilium, ischium and pubis with a dull ache helped by massage. It is my experience this is because the hip area is a location or ‘seat’ if you will, of the wind.

Wind Attacks the whole body:

Symptoms are similar to the general wind symptoms when it has spread or covered the whole body. General wind symptoms include the following aspects:

Pulse is floating and empty. Urine has appearance of water, thin and clear. Instability of mind which can be a feeling of mild uneasiness, distraction or total anxiety and panic. Frequent sighing, yawning, feeling light and ungrounded in ones body, dizziness, shivering, crackling or ringing in the ears. Sharp pains in the temple, chest and occiput area or moving non-stationary pain. If you push on a wind point it feels “open” and pain that worsens upon movement. Feeling constricted, stiffness, locked limbs in either extension or contraction. Bones feel “broken” muscles and tendons feel as if they were being torn. Experience of an achey body, as if you were beaten, body feels tightly bound. Feeling deep pain as if some pressure is pushing on the eyes. Can also appear a bulging of the eyes, pain in the hips or waist. Dry, rough or cracked tongue, bubbles in sputum. Rough and dry skin and cold hands and feet. Pores of the skin feel open and hairs stand on the end and have an appearance as if the hair had dew on the tips. Insomnia, body trembling, easy to startle. Desire to frequently stretch. Irritation and anger which arise quickly. Discomfort worsens in the early morning, at dusk or after eating. Bloating, gurgling sounds in the abdomen. Fluctuation in stools from dry to loose, seemly for no reason.

Methods of Treatment Explained

Having firmly linked and established the connection between wind rLung diseases and fibromyalgia symptoms the logical question becomes, what traditional Tibetan Medicine healing methods can benefit this affliction?

Tibetan Medicine has four methods of treatment. These are diet, behavior, medicine and external therapies. We always link the misbehaving humor or element to the correct antidote in these four methods. In addition I maintain a watchful eye and educational slant towards behaviors, diet and medicines. Even “natural” and alternative treatments which claim no side effect or the cure all may aggravate, increase the disorder, or create a secondary disorder through mismanaged or wrong treatment. It all comes back to relating to ones basic nature and the nature of the disorder.

I encourage people to work most closely within the first two treatment methods of diet and behavior. I believe these are the most important aspects for both recovering balance and management of conditions. The reason this is so fundamental as a treatment is the aspect that it is maintained primarily by the patient. The methodology is given by a qualified physician whom can identify what helps and what harms; yet the application is not necessarily dependent upon the physician. I believe firmly that if a physician of Tibetan Medicine gives proper direction and instruction they have done the most important service in the relationship between doctor and patient.

The analogy I return to over and over exemplifies the idea of instilling a commitment for your patient to become an active participant on their own healing journey. If going on a trip and you are told what to take to ensure you have all you need for a comfortable journey, alongside a good map, you may not need a guide every step of the way. This is not to be understated. What I have discovered in working to integrate western allopathic modalities and Tibetan Medicine approaches is the gift of correct diet and behavior should not be a side dish, but rather the main dish.

Always begin with dietary prescriptions because it nourishes all body systems. As a simple and direct approach, it has no side effects when applied correctly. For new, minor and psychological diseases, diet is the superior and effective treatment. Dietary treatment as the main priority is easy to accept because everyone has to eat. In a real sense food is medicine and medicine is food.

The third method focuses on natural medicines. The Tibetan pharmacopeia is vast and derived from various herbs, purified stones, minerals or animal substances. Again, here we return to the facts that these formulas are based on the five elements respective powers of hot and cold, qualities and characteristics which antidote the three humors and disease.

Qualities and Characteristics are essential in all aspects of the four treatment methods. This is due to the understanding that maintaining homeostasis is itself within a state of constant fluctuation. Movement is constant in the world and our bodies on a cellular microcosm level and a macrocosm level. Life stages, seasons, climates and in responses to foods, medicines and any dis-regulation of said elements and humors directly engage with a patient, their disorders balance or imbalance. Throughout the four treaties of Tibetan Medicine connections to the actions and reactions on both subtle and precise levels is indivisible in the methods of diagnosis, treatment and prevention. This relates to the very nature of our bodies elements, humoral balances and imbalances. Repeatedly we engage in this interdependence in every aspect of Tibetan Healing. I assert that this relationship of the body to its inner and out environment is the key to the systems unique success in helping disorders which are sometimes not well managed in allopathic or other alternative systems.

The fourth aspect of treatment within Tibetan Medicine relies upon external therapies. These methods are comprehensive. Treatment can include gDug (Compress) and Lums (Bath & Vapor) Therapies, gSer-Kap (Golden Needling, Metza known widely as moxibustion in Chinese Medicine, Me-Bum (Cupping Therapies), gTar-Ka drawing out bad blood techniques through bloodletting. My most often employed external therapy, sKu-mNye Massage and the hand on Therapies integrating various points or gsang for organs, bodily systems and the three principle energies of wind, bile and phlegm is the superior treatment for wind.

I describe this as four legs of a stool. Often in our western culture we have become accustomed symptoms arising, consulting a doctor and walking away with a prescription for the primary treatment. However as I began to compare western and Tibetan Medicine approaches, I clearly saw that if you only take medicine for symptoms and do not integrate other modalities or behavior modifications, how long can you stand on one leg?

Back to the analogy of packing a bag for a journey. If you use diet and behavior as your primary forms of treatment, not only do you have two legs to stand upon, but you can walk down the recommended road with correct tools and a map for your unique healthcare needs. Following and  establishing diet and behavior modifications is the main treatment. However, you may need to add medicine formulas into the protocol. Now you have a solid three legged stool for a treatment plan. If the case is more acute, critical or chronic, you add external therapies, the fourth leg of the stool. Each treatment modality adds strength and stability to the treatment plans. Maintaining diet and behavior as the primary legs upon which a patient must learn to navigate and take responsibility for their own healing journey with encouragement and correct guidance is the key to success.

Very serious illness needs a base on which to stabilize. In such cases, all four legs of the stool provide that support. As the patient heals, symptoms recede and the core strength of the organism functions better overall. Once this foundation of recovery and basic wellness arrives you begin to sometimes take away a leg, or ask the patient to stand on their own two feet if you will. In this case diet and behavior become the only needed tools in the bag and these two legs can be self sufficient in disease management.

With education about dietary concepts linking us to both the nature of a humor, its associated root poison, qualities, powers of effect, characteristics as well as antidotes we gain profound awareness into what aggravates us personally or worsens our condition. Food now becomes the primary medicine.

As holistic approaches are integrating into western allopathic treatments and medical schools are spending more time educating doctors on both nutrition and mind-body health, we are seeing better results and reduction in basic illnesses and the need for heavy prescriptions. It is my viewpoint that treatment should always begin from the basics of dietary healing. Improper diet and behavior create the majority of illness, thus if the antidote is applied in the correct manner diet alone can heal a great majority of illnesses.

With this understanding I believe the healing methods of Tibetan Medicine are totally self-sustaining. This integration of the theories into western treatment as an adjunct therapy is accomplished by using direct observation. Required is the basic comprehension of the theory of how these elements work in our body. This does necessitate some education of the patient. I view this as completely worth both time and effort.

I have found as patients experience a decrease in symptoms, they likewise increase their compliance to the protocols of diet and behavior. Understanding even in very rudimentary ways how ones own body and mind relate to disorders affecting them, which foods harm or help further creates greater compliance. Therefore as tractability to a corrective diet and behavior modifications brings increased symptom relief, commitment from the patient to additional protocols such as medicines and external therapies only serves to quickly increase the  desired stabilization and reversal of acute and chronic conditions.

I tell my patients, always think, what is my nature, what signs and symptoms show what humor is in excess (most common) or deficiency? What is the opposite antidote? What season are we in, how does that seem to affect my symptoms? What are the qualities of this season and how to balance that? Most importantly, what foods provide an antidote and how do I feel when I eat the foods on the yes list and or avoid the foods on the no list?

General Diet for Wind:

In general fresh, warm, nutritious and slightly oily or smooth foods which absorb easily are best for those who are suffering from the various disorders of wind. Onion, garlic, meats, bone broths, fish (no shellfish), boiled half milk – half water, cooked vegetables, aged cheeses, butters and aged meats, molasses, warm sake or tibetan alcohol called chang, (often a fermented grain) are of benefit.

Many cooking spices are medicines and can be used in both categories, as a food and a medicine. This is a simple way to treat wind conditions ongoing because spices are easy to add to food. Cardamom is excellent for wind attacking the hip bones and low back pain or nerve pain. Cumin, caraway, nutmeg, ginger, long pepper, black pepper, salt, curry spices, cinnamon, black salt, asafoetida all are excellent minor additions to daily diet which can help settle excessive wind while increasing circulation and bodily warmth.

General Behavior for Wind:

Akin to dietary guidelines, behavior as a treatment method is a constant in ones everyday life. Habitual tendencies which help or harm and awareness of the variance is equally vital to the process. This can fall under the category of how much sleep, how much exercise, how and what type of stress management or meditation is employed. Behavior is both simple and complex. Habits are profoundly related to our attachments and do tend to be difficult for people to both acknowledge and change. However, pain, unhappiness and feeling not your best can sometimes be a big motivation to change ones daily choices.

Those affected by wind disorders quite frankly need to de-stress. Ideally one suffering from a wind disorder should be in a peaceful, pleasant and simple locations which will not be excessively distracting to a mind prone to roam and overthink. It is said in the medical tantras “one should be in a warm, dark (not very brightly lit) place with a good friend or lover whom talks sweetly to them.” Because the cool nature of wind (unless combined with a heat situation) can attack the channels, nerves, ligaments and muscles it is vital to remain warmer, and adequately dressed. Sleep and rest are very important to the wind natured person, as it increases earth and water and can stabilize the movement and groundless aspects wind. Avoidance of diet and behaviors which increase or aggravate wind conditions can only be done with a focused mind. Therefore it is vital to help the patient feel clear, open and grounded enough to begin slowly to implement changes which improve their condition.

Though not expressly listed within Tibetan Medicine system, vagus nerve breathing is a promising new area to help fibromyalgia patients. However what is long known in both Tibetan Medicine and meditation is the reliance upon the breath. During meditation following and deepening the breath is an easy way to stabilize the mind and calm the wind. This is now known to decrease inflammatory responses. Breathing and meditation as a healing practice is becoming a popular area of research in the allopathic world. Studies verify the connection and benefits of vagus nerve stimulation, breath work and inflammation. Like food, breathing has to happen daily, and more so, moment to moment. By introducing basic meditation and placing emphasis on following the breath, calming the nervous system this is known to greatly benefits wind conditions such as fibromyalgia.

General Medicine for Wind:

Five classifications of medicines are used to treat wind. In the medical text there are many recipes and ingredient lists regarding these five. I will explain what these classification mean and some of the formulas and recipes which relate to the treatment of fibromyalgia.

  1. Decoctions Thang ཐང་ / Khu ba ཁུ་བ་ (broths) – 7 types
  2. Fermented grain & medicinal wine Chang ཆང་ – 5 types
  3. aDon འདོན་ ‘medicines to dig out disease’ – 4 types
  4. Powders phye ma ཕྱེ་མ་ – 1 type
  5. Medicated Butters sMan mar སྨན་མར་ – 5 types

Decoctions & Broths:

There are seven types of decoctions or broth recipes known for their power to suppress and heal wind disorders. Most notably bone broth from healthy animals which has been boiled for a long time is very nourishing. This has become widely popular in the last several years among the Paleo and gluten free diet movement. The specific bones said to be superior for the treatment of wind are ankle bones (calcaneus and talas), scapulas, and the sacrum. However any variety of bones can be healing. I usually encourage people to add garlic onions and various spices to their bone broth. I add also cumin, black pepper, ginger, a pinch of nutmeg and salt to my bone broth recipe for general wind disorders.

I frequently recommend to my wind patients to take bone broth. My instructions are to first scoop off any excess fats which rise to the top and place the liquid into ice cube trays or freeze into small amounts. When cooking vegetables use the cubes of spiced broth to cook vegetables for added nourishment. This can help avoid indigestion from oil if any phlegm condition is present or indigestion. Less heavy fat is especially important if the channels are sluggish and phlegm, disorders are combined with wind. I also advise weak patients to cook their grains in half water and half broth to help increase their appetite and provide warm easy to digest foods.

If one is vegetarian and just cannot bring themselves to take bone broth, that is ok. I suggest an alternative of barley miso soup used and spiced in the same way as bone broth. Sometimes I find people whom have been vegetarian for many years with a nature of wind as their basic constitution in extreme mental, emotion or physical distress due to wind aggravation. While they may need to temporarily eat some animal products until they recover, broth can sometimes be more manageable than meat. Bone broth is an ideal choice to ease into this situation. In this case bone broth provides deeper nourishment without having to eat the actual flesh of an animal, which can be equally distressing if used to cook beans, rice or vegetable instead of oils.

Fermented Grain Medicinal Wine:

Five specific recipes for fermented barley wines with herbs, molasses, butters, bones and spices are detailed in the texts. I will limit these to a simplified version based on my experience. I instruct those who posses a more basic wind nature, or may experiencing periods of feeling very high strung to take 1/2 TBS warm sake in about 1/4 cup hot boiled water alongside a formula for wind to increase the medicine’s potency and effect.

Medicines to Dig Out Disease:

These four cleansing formulas are themselves very interesting and contain five subsections in the chapter. The first four subsections are based on the substances within these formulas and the fifth details benefits.

In my experience I feel the third cleanser formula is superior for the treatment of fibromyalgia. It can alleviate symptoms of weakness, body aches, fatigue or brain fog. It is also said to be a good treatment for hot flashes in menopause and general wind. The recipe is as follows.

Ferment the barley first. Before adding any water or substances, open the lid to release the vapors. Mature the barley a few more days halfway covered. The fermented substance starts to appear like a mashed up strong smelling substance which produces its own liquid. Strain this liquid and add one year aged butter, molasses and some ginger. Cook this down until it all becomes liquid and melts. Cool to a comfortable temperature and drink this in the evenings.


This compound is formally known as Nutmeg Powder Compound རྫཱ་ཏི་ཕྱེ་མའི་སྦྱོར་བ་.

Contains fifteen ingredients, many basic spices which are staples of both Tibetan Medicine and cooking. Nutmeg, asafoetida, black salt, orange halite, rock salt, the three salts, cinnamon, pomegranate, cardamom, myrobalan, tinospora cordifolia,  garlic, white molasses. It is said this formula will suppress all wind of the upper, lower, inner (mental emotional) and outer (nerve, bone, ligament and tendons) and has a specific recipe on how to make this formula. But when looking at the ingredient list, it is clear many of these spices can just be also added to food.

Medicine Butters:

Of the five medicine butter recipes, I tend to use the butter called Pomegranate Medicine Butter  སེ་འབྲུ་སྨན་མར་ the most. It is pleasant to taste, increases digestive power and can open stuck channels due to chronic indigestion and weakness. It is praised for its power to suppress any type of wind disease. Especially useful in the winter months I use this to prevent wind from attacking muscles and resulting in muscle loss, which appears as if one is too thin and weak. It has  three parts. The main ingredient is pomegranate and one part, to that add one part coriander, one part ginger, one part chili pepper, one part long pepper, and three parts butter.

Medicinal butters are extremely therapeutic. I also make them with any number of kitchen spices which may be of benefit to wind. While there are traditionally five, new recipes with anti-wind herbs are perfectly fine.

General Treatment by External Therapy:

Enemas, massage, metza and compresses or horme treatment are all highly beneficial treatments for wind diseases. These methods all directly pacify wind by the poor of effect to antidote wind. The methods mentioned can be done either by peaceful or a more wrathful (strong) treatment.

The large intestine is a pathway of wind, and therefore butter enemas are used for when that particular pathway is more blocked. In the case of some neurological disorders atrophy of the sphincter muscle can be an issue and also relates to wind because the large intestine is a location or seat of wind, but the nerves which help the sphincter move are effected.

In my experience fibromyalgia patients respond best to massage which is neither vigorous or with extreme pressure. I use specific oils formulated for the benefit of wind disorders. The mechanism of action is to nourish the nerve system and decrease inflammation, increase the circulatory system and relax tendons, muscles and ligaments. When considering the symptoms and pain areas of fibromyalgia patents, it is especially important not to aggravate the body tissues and create a flare up of pain or inflammation.

Warmth applied as in horme and warm compresses to ligaments and muscles can ease tension and nerve pain. Warm compress of barley to soften the muscle can also be helpful before applying massage. So too is a warm compress of heated stones. Massage is touted as the “best treatment for wind” and this is very spot for the majority of fibromyalgia patients.

Horme is a gentle soft treatment which can release tension directly into the system by accessing the nervous system via  warm oily application to wind points or points of tension. I make horme with many of the same kitchen spices which I have previously listed to help wind. Nutmeg, caraway, salt, sesame, black pepper, long pepper etcetera, all will bring benefit as a horme oily compress. First warm the oil and then apply directly to the appropriate wind points.

Metza can be a more wrathful or strong treatment for wind and is usually more reserved for dire needs. It can be very helpful to clear mental fog and feeling cognitive challenges especially in the morning and after lunch due to a mixture of wind and phlegm. Warming metza not a full burn can also calm anxiety in general, as well as obsession around pain sensations from fibromyalgia that feels like “its all over and moves around the body” which can be disconcerting to some people. In general for fibromyalgia, any herbal oily horme compress is superior to metza in my experience unless heavily influenced by phlegm conditions.

Warm baths with  either the Five Nectar Bath, known as Dutsi Five Lums, or hot salty baths are both excellent external treatment for fibromyalgia. However, it is important not overheat the system as there is a low grade inflammatory situation happening, so the normal prescribed high temperatures of the bath series should be slightly modified. For an article on the five nectar bath, please refer back to the clinic website

In conclusion, fibromyalgia is classified as wind natured disorder. It can blend with either heat of bile and inflammation, or earth and water’s heavy, cool and sticky conditions of phlegm. In the Tibetan system it is managed through proper diet and behavior known to reduce and eliminate excess, deficiency or perverse levels of wind. Teaching patients which foods and behaviors harm and increase symptoms aids in restoring vitality. Engagement and inspiration to relate with basics of the Tibetan system is helpful in creating a relationship with patients willing to actively work towards management of their symptoms. The body and mind connection can be further enhanced with breathing and vagus nerve breathing during meditation to decrease inflammatory responses.


Gonpo, Yuthok Yonten 1982, 2002 rGyud bZhi — The Four Tantras, Tibet / China: bod lzongs mi dmangs dpe skrun khang

Nyinda, Nashalla G. Notes and translations of the rGyud bZhi