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Fibromyalgia

Fibromyalgia Protocol Stage 4: Circulation, Prostaglandins & Repair

May 19, 2026
✦ Fibromyalgia Protocol ✦

Stage Four: Circulation & Repair

Addressing sharp and stabbing pain by restoring healthy prostaglandin levels, improving circulation, and moving toward lasting remission.

By Brehan Crawford, MAcOM, LAc  ·  Crawford Wellness

Stage 4 Products  Join Our Community 
Watch: Fibromyalgia Stage Four

Fibromyalgia Protocol Series:  Stage 0  ·  Stage 1  ·  Stage 2  ·  Stage 3  ·  Stage 4  ·  Movement

The final layer: getting the blood where it needs to go.

Sharp or stabbing pains are the result of elevated prostaglandin levels  a special type of hormone your body creates at specific sites of tissue damage and inflammation. We often talk about inflammation as a bad thing, but it's actually a blessing that our bodies can create it. When the inflammatory cascade completes itself properly, it's how we heal. If our bodies couldn't become inflamed after a wound or infection, we'd crumble like a rotten piece of old furniture.

Unfortunately, that process doesn't always go as planned. Prostaglandins should be kept within a healthy range, but in fibromyalgia they're frequently elevated beyond it  triggering excessive pain at sites of old injury. Women with fibromyalgia also often have incredibly painful periods for the same reason.

If you've already been practicing the foot soak in Stage 1 and Stage 3, you've got a head start. For some people, the stabbing pain of Stage 4 is so mild they don't need to do anything at all other than get regular exercise or occasionally use a topical remedy. For others, the sharp pains are the most severe kind — and deeper work at this stage is required.

"Freedom from fibromyalgia pain is called remission — not cure. Remission can be and often is permanent. But it would be disingenuous of me to claim that will be the case for everyone."

— Brehan Crawford, MAcOM, LAc

Nutrition for Stage 4

Eat the Rainbow — and Earn a Treat

Eating a moderate, balanced diet of mostly cooked foods has helped your body recover from chronic infections, regulate its microbiome, and relax its autonomic nervous system. For Stage 4, we're going to emphasize the importance of richly colored fruits and vegetables — and a treat I'll get to in a moment.

Research: Vitamin E & Prostaglandins

Vitamin E is essential for keeping prostaglandins — specifically the pain-regulating prostaglandin E2 — in a healthy range. A randomized controlled trial demonstrated that vitamin E supplementation reduces menstrual cramps. Dietary sources include nuts, seeds, spinach, avocado, bell peppers, beet greens, and pumpkin. By eating richly colored fruits and vegetables, you're also consuming a high level of dietary antioxidants associated with healthier inflammatory cascades and better cardiovascular function.

Your Stage 4 Treat: Dark Chocolate

It's been a lot of hard work to get here — and you deserve a reward. The flavonol content of dark chocolate has been shown in a randomized, double-blinded controlled trial to improve vascular function. It's also a powerful way to increase nitric oxide, the signaling gas responsible for vasodilation and pain perception. A couple of squares a day of a low-sugar, high-potency dark chocolate at this point in your progress is a nice way to keep the blood flowing.

Traditionally, chocolate is said to be a rich food that can increase dampness — so take it in moderation. If your signs of dampness return, take a break or use a little MicroGuard to help digestion.

Exercise — Gentle Return to Movement

Getting Up and Moving Again

Now that you've completed Stages 1 through 3, it's time to contemplate getting up and moving again. Sedentary lifestyles are not good for our health, but they're a common coping mechanism fibromyalgia patients adopt because pain becomes so much worse with fatigue or post-exertional malaise. Almost any kind of exercise can get your blood moving — and for the sharp, stabbing pain of Stage 4, regular mild activity as tolerated throughout the day is the most important thing to do.

Hourly Movement

Set an alarm every hour to do five minutes of stretching or short walks. Frequent, gentle movement throughout the day beats one intense session.

Mind-Body Practices

Yoga, Taiji, and Qigong are well-studied for reducing fibromyalgia pain. Clinically, we see these make the most difference with the least rebound pain in Stage 4.

Breathing Exercise — Pulse to Feet

1. Lie down in a comfortable position. Breathe normally for a moment — don't force your breath.

2. Notice where you feel your heartbeat. For most of us, it's in the chest, neck, or head.

3. Take a deep breath in and sigh to relax. Now place your body awareness into the soles of your feet and palms of your hands.

4. Continue deep inhales and deep, relaxing sighing exhales — while keeping your awareness in your hands and feet.

5. After a few minutes, you'll likely start to notice your heartbeat has arrived where you've kept your attention. If your mind wanders, bring it back to your hands, feet, and breath.

6. Once you feel your pulse in your feet, take a few more breaths there. If you're sleepy, take a short nap. If you can't get it the first time, try during the foot soak — and keep practicing.

Botanical Medicines

The Stage 4 Protocol: Tea, Foot Soak, Topicals, and a Treat

1. Bu Zhong Yi Qi Tang Tea (Tonify the Middle)

This formula originates from 1830, when physician Wang Qingren developed it to treat patients with circulatory and neurological damage following stroke. It's still used for that purpose in Chinese hospitals today — giving us a significant reservoir of research into its pharmacology.

✦   Astragalus — A nitric oxide donor (what Chinese medicine calls a "Qi tonic"). Boosts energy and function across multiple body systems dependent on NO. Famous for increasing white blood cell count and speeding wound healing. Especially useful for patients who frequently catch new colds or have been hit multiple times with viruses like SARS-CoV-2.

✦   Dong Quai (Tang Kuai) — The most famous herb in Chinese medicine for women's health. Modern research shows it to be a powerful COX-2 inhibitor, suppressing excess prostaglandin formation — which is specifically what we're addressing here. It typically comes without the harmful side effects of NSAIDs and is safe for long-term use.

Important Caution

Astragalus is not appropriate to take during active infections or where excess dampness is present — which is why those situations were addressed in earlier stages. If you catch a cold while taking this formula, stop and return to Stage 1 until you're well again.

Dosage: 1–2 bags per day, brewed and sipped throughout the day.

2. Tibetan Foot Soak

Returning for its blood-moving properties. Tibetan Saffron is an incredibly rare plant with powerful capacities to enhance blood flow, reduce pain, and reduce unhealthy levels of vascular inflammation. While usually known as a fragrant cooking spice, in the foot soak it's employed specifically for its vascular benefits.

Dosage: 1 bag steeped in boiled water, cooled to 115°F or below. Soak 30–45 minutes. Try the pulse-to-feet breathing exercise during your soak for a combined effect.

3. Topical Pain Relief: Evil Bone Water or Corydalis Balm

You have a choice of two favorites for anytime topical pain relief:

✦   Evil Bone Water (Zheng Gu Shui) — A powerful remix of the classic traumatology formula. Best if your stabbing pains are severe, or if you have lots of easy bruising or painful joints. Contains menthol and camphor — FDA-approved for topical pain relief — but the aroma isn't for everyone.

✦   Corydalis Balm — More gentle in action with a milder scent. Good if you like to massage topicals into a large area of your body. Works via your body's innate opioid pathways without the addiction risk.

Usage: Apply as needed to areas of sharp or stabbing pain.

4. Medicinal Hot Chocolate

I want you to be able to enjoy dark chocolate without building up any dampness you worked so hard to get rid of in Stages 1 and 2. This is a high-quality hot chocolate mix made from high-flavonol dark cocoa and includes some of the highest quality medicinal mushrooms from one of the most reputable companies in the industry. The mushrooms have their own tremendous benefits — and I'm happy to report from my own experience that this mix sits very well and is easy to digest for most people.

Browse Stage 4 Products 

Remission, Not Cure — and What to Do if Pain Returns

For many people, Stage 4 will be the final round of therapy required. But life throws wild cards, and it's best to be prepared. Freedom from fibromyalgia pain is called remission — not cure. Remission can be and often is permanent, which is wonderful. But it would be disingenuous to claim that will be the case for everyone.

The most common causes of relapse I see in clinic are exhaustion, prolonged episodes of heightened stress, and new infections or immune system activation. Catching a new virus — or reactivation of an old one like Epstein-Barr — can trigger a relapse.

If Pain Returns — Quick Guide

✦   Wandering or heavy pain only → A one-time repeat of Stage 1 is usually all that's necessary

✦   Other types of pain → Review the appropriate stage video and treat accordingly

✦   Flares from medical treatments, surgery, or vaccination → Usually less severe than from a new virus. Discuss concerns with your doctor in advance.

✦   Above all → Treat yourself gently. Be kind and compassionate. Accept your limitations. Our nature as generous caregivers who want to take care of others often leads us to overextend ourselves and deplete the reserves our bodies need to stay pain-free.

"It's been a lot of hard work to get where you are. The inflammatory cascade isn't something to fight — it's something to complete. When circulation is restored and prostaglandins are in range, your body can finally finish what it started."

— Brehan Crawford

Continue Your Journey

Movement Protocol & Community Support

Review the detailed self-massage and movement exercises for all stages, and connect with our clinical community for ongoing support.

Movement Protocol   Join Community

Full Series:  Stage 0  ·  Stage 1  ·  Stage 2  ·  Stage 3  ·  Stage 4  ·  Movement

This content is for educational purposes only and does not constitute medical advice. Please consult with your physician before beginning any new exercise program, dietary changes, or supplementation plan. This post contains affiliate links — if you purchase through our link, we may receive a commission at no additional cost to you. Individual results vary and are not guaranteed.  ·  Join the Community  ·  © Crawford Wellness · crawford-wellness.com


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