Articles

Premenstrual Syndrome (PMS)

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Premenstrual Syndrome (PMS)

Introduction

Premenstrual syndrome (PMS) is a set of mental and bodily symptoms that appears before menstruation, and subsides as menstruation begins. Between 7-14 days before menstruation, many women experience the following PMS symptoms: irritability, nervousness, hypersensitivity, edema, diarrhea, and breast tenderness. In traditional Chinese medicine, it belongs to the following subcategories of menstruation: fever, headache, bodily pain, diarrhea, edema, dizziness, perleche, rubella, breast tenderness, and mood swings.

Etiology/Pathogenesis

According to TCM, the development of PMS is due to the fact that leading up to menstruation, the blood in the female body floods into the reservoir of blood, resulting in a relative yin-blood insufficiency, an imbalance of yin and yang, and a disharmony of visceral organ functions. Yang believes that the onset of the condition is related to the individual's constitution, and that it is mainly triggered by an dysfunction of the liver, although quite often the kidney, the spleen, and the heart are also involved. (1) Chai, et al. believe that the condition is more closely related to the liver, and that treatment should emphasize regulating the liver. (2) Both Wang and Shu believe that pent-up emotions cause PMS: repressed emotions often lead to a depressed liver and stagnated qi, which in turn impair the spleen, giving rise to PMS. (3) , (4)

Primary Treatments with Chinese Medicinal Herbs

Jia Wei Xiao Yao Wan

Ingredients: Chai Hu (Bupleurum), Shao Yao (Dioscorea), Dang Gui (Dang Gui), Bai Zhu (White Atractylodes), Fu Ling (Hoelen), Dan Pi (Moutan), Shan Zhi (Gardenia), Bo He (Mentha), Zhi Gan Cao (processed Licorice)

Clinical Application:
Yin treated 45 cases of PMS due to stagnation of the liver-qi/interior heat with Jia Wei Xiao Yao San. The modified formula consisted of Dang Gui, Bai Shao, Chao Chai Hu, Fu Ling, Chao Bai Zhu, Xu Duan, Gou Teng, Dan Pi, Shan Zhi, Xiang Fu, Qing Pi, Chen Pi, and Jing Jie. A comparison group of 30 cases was treated with provera (4mg/day) and oryzanol (20mg each time, 3 times a day). The results: of the treatment group, 32 cases recovered, 6 significantly improved, 4 improved, with a total effective rate of 93.3% (compared to the comparison group's 53.3% (P

Other Treatments with Chinese Medicinal Herbs

Xiao Yao San

Huang treated 30 cases of dysmenorrhea and 38 cases of PMS with a modification of Xiao Yao San. The modified formula consisted of Xiang Fu, Chai Hu, Dang Gui, Bai Shao, Chuan Xiong, Bai Zhu, Fu Ling, and Mai Ya, used Shen Yue Ning to treat painful mensturation and PMS. One dose of the formula in water decoction was administered daily, starting 10 days before the menstrual cycle and ending when menstruation began. The treatment lasted 2-3 months. The results: of the dysmenorrhea patients, 6 recovered, 15 significantly improved, 7 improved, and 2 did not respond to the treatment; of the PMS patients, 7 recovered, 18 significantly improved, 10 improved, and 3 did not respond to the treatment. (5)

Shu Gan Jian Pi Tang

Li treated 58 cases of PMS with a formula called Shu Gan Jian Pi Tang (liver-soothing and spleen-invigorating formula). The formula consisted of Chai Hu, Yu Jin, Bai Shao, Qin Pi, Chen Pi, Chao Gu Ya, Mu Xiang, Dang Gui, Dang Shen, Chao Shan Yao, Bai Zhu, Fu Ling, and Gan Cao. Futhermore, modifications were made to suit individual patients' symptoms. One dose of the formula was administered daily, starting 10 days before the menstrual cycle and ending when menstruation began. The treatment lasted 2-3 menstrual cycles. The results: 43 cases recovered, 12 significantly improved, 3 did not respond to the treatment, with a total effectiveness rate of 94.8%. (6)

Zhu Yang Jie Yu Tang

Qian treated 32 cases of PMS with a formula called Zhu Yang Jie Yu Tang (yang-strengthening and depression-relieving formula). The formula consisted of Yin Yang Huo, Tu Si Zi, Ba Ji Tian, Lu Jiao Pian, Dang Gui, Chi Shao, Shan Yu Rou, Guang Yu Jin, Chai Hu, Qing Pi, and Chen Pi. One dose of the formula in water decoction was administered daily, starting 10 days before the menstrual cycle and ending when menstruation began. The treatment lasted 2-3 menstrual cycles. The results: 20 cases recovered, 7 significantly improved, 3 improved, and 2 did not respond to the treatment, with a total effective rate of 93.75%. (7)

Acupunture & Acupressure

You treated 56 cases of PMS with acupuncture. Acupoints were selected for treatment as follows: 1) PMS due to liver-qi stagnation: all patients were treated at Taichong (Liv 3), Taixi (K 3), Qihai (Ren 6), Ganshu (B 18), Sanzhong (Ren 17), and Sanyinjiao (Sp 6); in addition, patients with fever were treated at Dazhui (D 14), Quchi (LI 11), patients with headache were treated at Taiyang (Extra 2), and Baihui (Du 20), patients suffering from severe insomnia were treated at Shenmen (H 7), Neiguan (P 6), and patients with breast tenderness were treated at Rugen (S18), and Qimen (Liv 14). 2) PMS due to spleen and kidney-yang deficiencies: all patients were treated at Zusanli (S 36), Pishu (B 20), Shenshu (B 23), Taixi (K 3), Sanyinjiao (Sp 6), and Guanyuan (Ren 4; moxibustion). In addition, patients suffering from diarrhea were treated at Zhongwan (Ren 12), and Tianshu (St 25); patients with edema were treated at Shuifen (Ren 9), and Qihai (Ren 6; moxibustion).

The gauge 28-30, 50-65 millimeter filiform needles were used, and the needles were retained for 30 minutes after insertion. The reducing method was used for patients of liver-qi stagnation, while the universal reinforcing-reducing method was used for patients of spleen and kidney-yang deficiencies. In addition to needling, the acupoints Guanyuan and Qihai were also moxibusted for five minutes. The treatment started 10 days before the menstrual cycle and ended when menstruation began. One unit of treatment lasted 10 days. The results: out of a total of 36 patients of liver-qi, 9 cases recovered, 22 improved, and 5 did not respond to the treatment, with a total effective rate of 86.1%; out of a total of 20 patients of spleen and kidney-yang deficiencies, 6 recovered, 10 improved, and 4 did not respond to the treatment, with a total effective rate of 80.0%. (8)

Xu treated 50 cases of PMS with acupuncture. All patients received treatment at the acupoint Zhongji (Ren 3). In addition, patients suffering from dizziness and insomnia were also treated at Taiyang (Extra 2), Baihui (Du 20), and Shenmen (H 7); patients who lacked appetite were also treated at Zhongwan (Ren 12)and Zusanli (St 36); and patients suffering from distention in the lower abdomen were also treated at Guanyuan (Ren 4). The universal reinforcing-reducing method was used, and the needles were retained for 30 minutes. The treatment began 3-5 days before the menstrual cycle, and was discontinued during menstruation. One unit of treatment consisted of six daily sessions. The results: after 1-3 units of treatment, 42 cases recovered (25 recovered after one unit of treatment, 11 recovered after two units of treatments, and 6 recovered after three units of treatment), 6 improved, and 2 did not respond to the treatment, with a total effective rate of 84%. (9)

Other Treatments
Ran treated 37 cases of PMS by pressing a single vaccaria seed against selected auricular acupoints. All patients received treatment at auricular acupoints related to the pituitary gland, endocrine, ovary, uterus, and liver. In addition, patients with liver-qi stagnation were treated at auricular acupoints related to the root of the acoustic labyrinth, sympathy, and liver-yang; patients with liver and kidney-yin deficiencies were treated at points related to the kidney; patients with spleen and kidney-yang deficiencies were treated at points related to the kidney, adrenal glands, and the root of the acoustic labyrinth; patients with accompanying headache were treated at relevant occipital, vertex, frontal, and temporal points; patients with accompanying dizziness were treated at brain stem and vertigo points; and patients with accompanying vomiting were treated at stomach and sympathy points.

The method: a single vaccaria seed was placed in the center of a small piece of adhesive cloth, and then the adhesive cloth with the vaccaria seed in place was applied to the above auricular points; the patients were instructed to press the treated points 5-10 times a day, 3 minutes each time. The bilateral points were alternated in receiving the treatment every three days, and the entire treatment lasted 3 menstrual cycles. The results: out of a total of 18 patients with liver-qi stagnation, 11 recovered, 4 significantly improved, 2 improved, and 1 did not respond to the treatment, with a total effective rate of 94.4%; out of a total of 11 patients with liver and kidney-yin deficiencies, 3 cases recovered, 3 significantly improved, 2 improved, and 3 did not respond to the treatment, with a total effective rate of 72.7%; out of a total of 8 patients with spleen and kidney-yang deficiencies, 3 cases recovered, 3 significantly improved, 2 improved, with a total effective rate of 100%. (10)

References

  1. Yang Jian Bing. Shaanxi Journal of TCM, 1993. 14(6):255-256.
  2. Chai Li Na, et al. Journal of New TCM. 1988;20(7):15-16.
  3. Wang Wen Qing. Jilin Journal of TCM. 1988;(6):11.
  4. Shu Shang Yi. Yunan Journal of TCM. 1988;9(6):18-20.
  5. Huang Ling. Jiangxi Journal of TCM. 1999;30(1);30.
  6. Li Xia. Journal of Anhui College of TCM. 1999;18(4):41.
  7. Qian Jing. Jiangsu Journal of TCM. 1999;20(12):28.
  8. You Ya Fang. China Journal of Acupuncture. 1997;17(3):171.
  9. Xu Shi Ping. Xinjiang Journal of Traditional Chinese Medicine. 1993;(4):15.
  10. Ran Jin Li. China Journal of Acupuncture. 1997;17(7):434.