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Expert Advice-Treatment of Premenstrual Syndrome in Traditional Chinese Medicine(TCM):

Solving the Premenstrual Syndrome Mystery with 

Chinese Medicine

Many Western-trained doctors are at a loss when it comes to treating PMS. Premenstrual syndrome (PMS) includes a long list of possible symptoms and combinations of symptoms, and most of these symptoms are subjective – they can’t be measured or analyzed under a microscope. Therefore, a lot of doctors think of PMS as a mystery, and a few even dismiss it as an imaginary condition. Premenstrual syndrome, also called premenstrual tension, affects about one-third to one-half of women between the ages of 30 and 40. The emotional and physical symptoms include distention and pain in the breasts, headache, dizziness or fainting, restlessness, insomnia, a feeling of distention or pain under the rib cage, restless sleep, fatigue, depression, crying, forgetfulness, confusion, irritability, anxiety, nervous tension, and abdominal bloating. Typically, these symptoms will occur or intensify during the 7 to 14 days prior to menstruation, and last for 5 to 10 days. Most women experience their symptoms before the onset of menstruation, while some experience them during the period. After the period, most women are back to normal. If a woman has these symptoms only infrequently, it is not considered to be PMS – PMS is recurrent and cyclical with every period.

PMS in Conventional Medicine and Chinese Medicine
Six years ago, one of my patients went to her regular doctor, a family practitioner. She was experiencing headaches, joint pain, breast distention, abdominal distention, numbness of her hands and feet, and increased tendency to catch a cold. These symptoms had appeared regularly, seven to ten days before her period, every month for the past three years. The doctor made all possible examinations. He could not find anything wrong. She said to her doctor, "it might be PMS." "What!" her doctor responded. Then she was back home with an ibuprofen prescription.

Although the term premenstrual syndrome has been used in conventional medicine since 1931, there has been no definitive explanation of the mechanisms involved in PMS, and no "PMS drug" has yet been developed. Conventional medical treatment of PMS is symptom-based, usually prescribing a particular drug for one or two of the most troublesome symptoms, but tending to ignore the whole picture as it is expressed in the individual woman. This tendency to a one-symptom, one-drug connection means that one or two symptoms may be suppressed, but the syndrome is neglected as a whole. Following is a partial list of PMS symptoms, with the drugs that are commonly prescribed to treat each symptom. All of the drugs listed have side effects.

SYMPTOM

DRUG

Irritability, Stress, Nervousness

Buspirone or Alprazolam

Depression

Fluoxetine or Prozac

Breast Discomfort

Bromocriptine (Parlodel)

Fluid Retention & Bloating

Diuretic such as Spironolactone

Premenstrual Pain

Mefenamic (Ponstel)

Joint Pain & Headaches

Nonsteroidal Anti-inflammatory Drugs

Multiple PMS Symptoms

Progesterone Therapy

Blocked Ovarian Function

Lupron or Synarel

In traditional Chinese medicine, groups of symptoms, or syndromes, are typically classified into patterns that involve the internal organs and/or energy pathways (meridians) of the body. Three organ systems are principally involved in the PMS pathology analysis: Liver, Heart, and Spleen. Chinese medical theory explains the mechanisms involved as follows: emotional disturbances attack or stress the Liver (which is identified with the Wood element). Wood generates Fire, which is the element associated with the Heart. Fluids are exhausted by Heart Fire, which leads to Heart Blood deficiency. The Heart is then too weak to store the Spirit properly. Spleen deficiency generates phlegm and Phlegm Heat harasses the Heart. Working with these Liver/Heart/Spleen mechanisms, Chinese medicine identifies three primary patterns that include all the major PMS symptoms: Liver Qi Stagnation pattern; Heart Blood Deficiency pattern; and Phlegm-Heat Harassment pattern. Many of the typical PMS symptoms occur in all three patterns, but specific symptoms, as well as specific tongue appearances and pulse readings, are used to differentiate the patterns. For example, a thousand years of observation and clinical practice in China have shown that: heavy and early periods are associated with Liver Qi stagnation; scanty and late periods are associated with Heart Blood Deficiency; and heavy vaginal discharge is associated with Phlegm Heat Harassment. Studies show that over 150 physical and behavioral symptoms are associated with PMS. Dozens of these symptoms fit into the Chinese medicine pattern-differentiated model, and have been treated successfully with acupuncture and herbal medicine for a thousand years.

PMS Patterns and Treatments in Chinese Medicine
Acupuncture has been widely and successfully used to treat PMS. The three main patterns of PMS in traditional Chinese medicine are presented below, with their differentiating symptoms and the leading herbs and herbal formulas that are commonly prescribed for each pattern. The herb, angelica (Dang Gui) has been widely used by Chinese and Japanese women for centuries. It is well-known for regulating menstrual cycles, eliminating the discomfort of premenstrual syndrome, and relieving menstrual cramps. Even though angelica is widely prescribed, there are more refined combinations of herbs and acupuncture points that are tailored to each pattern.

Liver Qi Stagnation Pattern: Emotional stress contributes to the Liver Qi Stagnation pattern of PMS. Clinical manifestations include: depression and melancholy before the period; propensity to outbursts of anger; moodiness; irritability; anxiety; a feeling of fullness or congestion in the chest; a feeling of distention or pain under the rib cage; muttering to oneself; headache with anxiety; heavy, early periods; thin tongue coating; and a wiry pulse. Many of these symptoms increase before the period and return to normal after the period. Buplerum (Chai Hu) is the leading herb to relieve depression and regulate the Liver Qi. Mood Smooth (Jia Wei Xiao Yao San) and Buplerum Formula (Chai Hu Shu Gan San) are time-tested formulas for this pattern.

Buplerum Formula (Chai Hu Shu Gan San)

Buplerum (Chai Hu)

White Peony (Bai Shao)

Aurantium Fruit (Zhi Ke)

Cnidium (Chuan Qiong)

Cyperus Tuber (Xiang Fu)

Licorice (Gan Cao)

Tangerine Peel (Chen Pi)

Heart Blood Deficiency Pattern: Chronic illness or excessive menstrual blood loss contributes to Heart Blood Deficiency pattern of PMS. Clinical symptoms include: emotional upset with periods; speaking incoherently; sadness; fatigue; sluggishness; heart palpitations; insomnia; poor memory; inert facial expression; dull-pale complexion; scanty and light periods with light red flow; pale tongue body with a white tongue coating; and a thin pulse. Biota seed (Bai Zi Ren) and jujubee (Suan Zao Ren) are two important Heart tonic herbs. Heart Yin Tonic (Tian Wan Bu Xin Dan) and Heart Tonic (Yang Xin Tang) are classical formulas for nourishing the Heart and calming the Spirit.

Heart Yin Tonic (Tian Wang Bu Xin Dan)

Biota seed (Bai Zi Ren)

Jujubee (Suan Zao Ren)

Asparagus (Tian Dong)

Lilyturf Root (Mai Dong)

Angelica (Dang Gui)

Schizandra (Wu Wei Zi)

Rehmannia (Di Huang)

Ginseng (Ren Shen)

Figwort (Xuan Shen)

Codonopsis (Dan Shen)

Platycodon (Jie Geng)

Polygala (Yuan Zhi)

Phlegm-Heat Harassment Pattern: Habitual consumption of hot, spicy or greasy foods or chronic emotional trauma contributes to the Phlegm-Heat pattern of PMS. Symptoms include: anxiety; headache; insomnia before the period; agitation; incoherent speech; red face, bloodshot eyes; a feeling of oppression in the chest; angry outbursts; poor appetite; constipation; red tongue body with a yellow-sticky tongue coating; and a wiry-slippery-rapid pulse. Again, many of these symptoms intensify before the period and return to normal after the period. Pinellia tuber (Ban Xia) is the top herb for resolving phlegm and harmonizing the spleen and stomach. Bamboo shavings (Zhu Ru) are the leading herbs for expelling phlegm from the body and alleviating anxiety. Warming Gallbladder Decoction (Wen Dan Tang) is a leading herbal combination for this pattern.

Warming Gallbladder Decoction (Wen Dan Tang)

Pinellia Tuber (Ban Xia)

Bamboo Shavings (Zhu Ru)

Aurantium Fruit (Zhi Shi)

Tangerine Peel (Chen Pi)

Licorice (Gan Cao)

Poria (Fu Ling)

Rhubarb (Dai Huang)

Acori Graminei (Chang Pu)

Curcuma (Yu Jin)

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