A Story About a Patient

Treating fibromyalgia is like untying a bundle of knots. First, you need to identify the first knot, and then where it started getting tangled with others. Sometimes untying the first knot unravels the rest and treatment goes very fast, and sometimes you need to untie each one individually. This process can take months, up to a few years to complete, but sometimes goes much faster.

This is the story of one where we started to untie the first knot and they all came undone.

There are many ideas of how to treat fibromyalgia. This is the method we use at Khoo Wellness, which has been used to extremely good results in China and has had no exposure in the States until we opened our center. For HIPAA compliance, I am leaving out name and any identifiers, including medications by this patient, but I can say that this patient is a male in his mid-40s, and was on several medications prescribed for treatment of his diagnosed fibromyalgia. In addition to fibromyalgia, he had been diagnosed with hypothyroidism, and has suffered from both for more than 6 years. You can probably guess his symptoms- amongst a few were heavy brain fog, chronic joint pain, migraines, insomnia, tinnitus, and constipation.

Rather than looking at this as just “fibromyalgia,” we looked for the underlying contributing factors (the knots tied together). He took our diagnostic tool, the Quiz, and then we confirmed the accuracy through consultation session. This patient had four primary contributing factors: lymphatic dysregulation, gut dysbiosis, nitric oxide dysregulation associated with elevated cortisol, and mitochondrial myopathy, with the primary contributing factor (nitric oxide dysregulation) being accurately predicted by the diagnostic quiz.

What does that all mean? To vastly simplify it, elevated cortisol levels impacted the liver’s ability to multitask because it had to metabolize cortisol out of the blood. The kidneys were impacted by the adrenal plexus creating all of these hormones, becoming a contributing factor in the hypothyroidism. This caused a disruption in the homeostasis of the gut biome, leading to an immune reaction to gram negative bacteria. The inflammation from this, and the collateral damage from what is essentially a gut war, caused one particular winner: nitric oxide synthase, which is an enzyme that puts out lots of nitric oxide. This all happened at the same time that he sat for long periods of time and did not move. Nitric oxide spiked, but was unable to flow freely, and autoregulatory systems started to cascade out of control throughout his body.

Ok, to really, really simplify it, he had a kinked a hose and then added a ton of water pressure.

So how do you treat that? For him, it is a five stage process. We began to address lymphatic flow and gut microbiota through herbal therapy and medical qigong exercises, while addressing nitric oxide distribution through acupuncture several times per week. He reported increased stool regularity and pain changes within a few days, and managed to shoot through the first stage incredibly fast, within a week.

For the second stage we began treating the distribution of nitric oxide to improve energy metabolism and ease oxidative nerve damage. He used a combination of herbal formulas, acupuncture and qigong breathing exercises. He reported feeling more energetic, pain reduction, sound sleep, and a lighter sensation in the body. We then progressed to stage three addressing nitric oxide and cortisol dysregulation using acupuncture and one more change in herbal formulas.

We had to get the nitric oxide under control, and unkink the lymphatic system. This started taking pressure off the liver, and sleep began to normalize, inflammation and joint pain started reducing, and his gut was no longer pumping out massive doses of nitric oxide, nor did it have to spend tons of energy cleaning up after inflammatory responses both inside and on the surface.

This is an exemplary patient in that he followed the recommended treatment protocol exactly, and I think it reflected in his recovery time. He is shooting through protocols faster than expected. He has now reached the tipping point where we have turned the tide in the battle and are now able to start cleaning up the organ damage from the years of fibromyalgia and get all of those autoregulatory systems back to functioning properly again. I couldn’t be more excited for him.

A couple of questions might pop up here, such as what herbal formulas are he taking for such great results, or why is acupuncture working for him when it might not have helped someone else.

First, acupuncture is useful in treatment in some types of fibromyalgia, and there is a distinct difference in acupuncture for temporary relief of symptoms and proper treatment. If you have had a less than stellar experience with acupuncture and wrote it all off, it might not have been for your unique pain, or it may have been administered incorrectly. It’s like trying fish for the first time and not liking it. You might actually love fish, but not like the preparation.

His herbal protocols are very specific to his stage, and in some cases to him. One of the formulas he is on, and is actually one that is beneficial to all of the eight types of fibromyalgia, we call Fibrokalm. Just below is a little bit about it.

So this is a long story! I expect it to have a very happy ending.

Herbal Formula FibroKalm Pharmacology

A. Increases melatonin: Melatonin is a pineal hormone that plays a central part in regulating bodily rhythms. The melatonin signal forms part of the system that regulates the sleep–wake cycle which is considered to be related to jet lag. FibroKalm can bring the serum melatonin level back to normal.

B. Effects on nitric oxide(NO)/cGMP pathway: NO/cGMP pathway plays a critical role in corticostriatal long-term depression. Paeoniflorin (an active ingredient in FibroKalm) can inhibit NO/cGMP pathway to reduce depressive-like behavior.

C. Effects on dopamine: Dopamine is a catecholamine neurotransmitter with roles in pain perception and natural analgesia. There is also strong evidence for a role of dopamine in restless leg syndrome, which is a condition found frequently in patients with fibromyalgia. Fibrokalm can significantly increase the dopamine (DA)level and decrease the DOPAC level, with a marked elevation of A/DOPAC ratio in the striatuin.

D. Effects on cortisol: Changed patterns of serum cortisol levels have been observed in connection with abnormal ACTH levels, clinical depression, psychological stress, and physiological stressors. Xiao Yao San can reduce serum cortisol. The mechanism is that FibroKalm regulates cortisol release via hypothalamic–pituitary–adrenal axis (HPA or HTPA axis).

E. Noradrenaline (NA): Most people with Fibromyalgia have low NA levels. FibroKalm can significantly elevate the level of NA and decrease the level of 3, 4-dihydroxyphenylacetic acid(DOPAC)in rat hypothalamus.

F. Increases cGMP: cGMP is a signaling compound playing an important role in mammalian sleep regulation and timing of physical activity over the 24 hours of a day. FibroKalm can increase the cGMP in the blood to help adjust to time changes.

G. Effects on Monoamine Neurotransmitters: Monoamine Neurotransmitters are related to psychiatric disorders. FibroKalm elevated significantly the level of noradrenaline (NA) and decreased the level of 3, 4-dihydroxyphenylacetic acid(DOPAC)in rat hypothalamtis. It also increased the dopamine (DA)level and decreased the DOPAC level, with a marked elevation of A/DOPAC ratio in the striatuin. It can also increase dropped melatonin back to normal.


For all of you reference junkies, here is a treasure trove about this and more, particularly the herbal pharmacology:


  • Kim, Young C., et al. “Ginsenosides Rb 1 and Rg 3 protect cultured rat cortical cells from glutamate-induced neurodegeneration.” Journal of neuroscience research 53.4 (1998): 426-432.
  • Tian, Jingwei, et al. “Neuroprotective effect of 20 (S)-ginsenoside Rg 3 on cerebral ischemia in rats.” Neuroscience letters 374.2 (2005): 92-97.
  • Kim, Do Hoon, et al. “Inhibition of stressinduced plasma corticosterone levels by ginsenosides in mice: involvement of nitric oxide.” Neuroreport 9.10 (1998): 2261-2264.
  • Sho-Saiko-To (Xiao-Chai-Hu-Tang) and Crude Saikosaponins Inhibit Hepatitis B Virus in a Stable HBV-Producing Cell Line
  • Chang, Jung-San, et al. “Sho-saiko-to (Xiao-Chai-Hu-Tang) and crude saikosaponins inhibit hepatitis B virus in a stable HBV-producing cell line.” The American journal of Chinese medicine 35.02 (2007): 341-351.
  • Activation of murine peritoneal macrophages by intraperitoneal administration of a traditional chinese herbal medicine, xiao-chai-hu-tang (Japanese name: Shosaiko-To)
  • Kumazawa, Yoshio, et al. “Activation of murine peritoneal macrophages by intraperitoneal administration of a traditional Chinese herbal medicine, xiao-chai-hu-tang (Japanese name: shosaiko-to).” International journal of immunopharmacology 10.4 (1988): 395-403.
  • Effects of a Blended Chinese Medicine, Xiao-Chai-Hu-Tang, on Lewis Lung Carcinoma Growth and Inhibition of Lung Metastasis, with Special Reference to Macrophage Activation
  • ITO, Hitoshi, and Keishiro SHIMURA. “Effects of a blended Chinese medicine, Xiao-Chai-Hu-Tang, on Lewis lung carcinoma growth and inhibition of lung metastasis, with special reference to macrophage activation.” The Japanese Journal of Pharmacology 41.3 (1986): 307-314.
  • Youhong, Xie. “Clinical Observation on 56 Cases of Fibromyalgia Syndrome Treated with the Method for Soothing the Liver and Strengthening the Spleen.”Journal of Traditional Chinese Medicine 5 (2005): 019.
  • Bo, Ji, Chen Jiaxu, and Lu Zhaolin. “Influence of Xiaoyao Powder on Human Nerve-Endocrine-Immune System.” JOURNAL-BEIJING UNIVERSITY OF TRADITIONAL CHINESE MEDICINE 26.6 (2003): 68-71.
  • Treatment of chronic liver injury in mice by oral administration of xiao-chai-hu-tang
  • Tajiri, H., et al. “Effect of sho-saiko-to (xiao-chai-hu-tang) on HBeAg clearance in children with chronic hepatitis B virus infection and with sustained liver disease.” The American journal of Chinese medicine 19.02 (1991): 121-129.
  • Role of b-lymphocytes in the immunopharmacological effects of a traditional Chinese medicine, xiao-chai-hu-tang (shosaiko-to)
  • Matsuura, Kazuko, et al. “Role of B-lymphocytes in the immunopharmacological effects of a traditional Chinese medicine, xiao-chai-hu-tang (shosaiko-to).” International journal of immunopharmacology 15.2 (1993): 237-243.
  • Induction of interferon after administration of a traditional chinese medicine, xiao-chai-hu-tang (shosaiko-to) Kawakita, Takuya, et al. “Induction of interferon after administration of a traditional Chinese medicine, xiao-chai-hu-tang (shosaiko-to).” International journal of immunopharmacology 12.5 (1990): 515-521.
  • 李炳照等主编.实用中医方剂双解与临床[M].北京:科学技术文献出版社,2008538. 
  • 魏睦新,王刚. 方剂一本通[M].北京:科学技术文献出版社,2009. 
  • 李炳照等主编.实用中医方剂双解与临床[M].北京:科学技术文献出版社,2008535. 
  • 李经纬等主编.中医大词典——2[M].北京:人民卫生出版社,200456. 
  • 李炳照等主编.实用中医方剂双解与临床[M].北京:科学技术文献出版社,2008535-536. 

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s