PMS - Pre Menstrual Syndrome and Traditional Chinese Medicine

PMS is any disorder that comes regularly around menses.

Click on the links below for more info… Fever Breast Tenderness Headaches Body Aching Diarrhea Cankers Hives Dizziness Edema Emotional Disorders

Fever

Diagnosis Acute, each occurrence any 1-2 days before-during-after period LR Kidney Yin end of cycle manifestations Once period is finished – fever should be gone Is there an external pathogenic invasion history Regularly for at least 3 months consecutively Differentiate – ovulation, temperature goes up but no feverish feeling comes with this.

 

Etiology (causes) of PMS:

1. LR Kidney Yin - around period Yin/Blood get used for Uterus heat.

2. Heat in Blood (LR heat) – during menses – need more Qi to make period happen and this generates heat.

3. Qi (blood) - Ying and Wei are not harmonized, before fever there probably be chills – then fever and chills alternate.

4. Blood stag. – usually mixed w/ ext. patho. invasion, and already have Blood Stasis in Uterus – disharmony of Ying and Wei, - Stagnation leads to heat.

 

Chinese Medicine Differentiation and Treatment of PMS

1. Liver Kidney Yin - tidal fever during last few days of bleeding, scanty blood Plus – Yin sym. T-red-scanty coat P-thin-rapid

Principle of Treatment: – nourish Yin – clear heat

Herbal Medicine Formula: Liang Di Tang

 

2. Heat in Blood – pre-menstrual high fever, red complexion, heavy periods, can have early periods. Plus – hot sym. T-red P-rapid

Principle of Treatment: – clear heat – cool blood to reduce fever

Herbal Medicine Formula: Qing Jing Tang

 

3. Qi (blood) - low fever during last few days of bleeding, could be spontaneous sweat, Heavy flow, pale-thin Plus – Spleen Qi and blood sym.

Principle of Treatment: – nourish Spleen Qi to harmonize Ying – nourish blood, to reduce fever.

Herbal Medicine Formula: Bu Zhong Yi Qi Tang

 

4. Blood Stagnation – fever comes before or during bleeding, dark-purple blood w/ clots and Pain

Principle of Treatment: – promote circ. – remove Blood Stasis to reduce fever

Herbal Medicine Formula: Tao Hong Si Wu Tang or Xue Fu Zhu Yu Tang

 

Breast Tenderness

Diagnosis of Breast Tenderness: Tenderness around period breasts (KI) feel tender, sore, distended, or have itchy pain in the nipples (LR)

Etiology (causes) of Breast Tenderness:

1. LR Qi stag. – Liver effects nipple – if the Liver attacks the Stomach the breasts are effected. Qi is not able to flow smoothly.

2. LR Kidney Yin - breasts are effected during menses, blood is - collaterals then lack nourishment and this leads to stagnation

 

Differentiation - Tumor – generally has inverted nipple, breast skin looks like an orange peel, Areola border is not clear. Cyst – can be big or small – change w/ cycle hormone levels, can have many, they are fluid filled sacs.

 

Chinese Medicine Differentiation and Treatment of Breast Tenderness

1. Liver Qi Stagnation – pre-menstrual tenderness, itchy, distended Plus – Liver Qi Stagnation sym.

Principle of Treatment: – sooth Liver to relieve Stagnation

Herbal Medicine Formula: Chai Hu Shu Gan San or Xiao Yao San

 

2. Liver Kidney Yin - tenderness in last few days of bleeding Plus – Liver Kidney Yin Heat sym.

Principle of Treatment: – nourish Liver Kidney Yin

Herbal Medicine Formula: Yi Guan Jian

 

 

Headaches Before Period

Diagnosis of PMS Headaches:

When period is finished the headache will go away. Etiology (causes): All Zang-fu Qi/essence go up to nourish head All Yang meridians and Liver go to head When clear Qi/essence can’t raise to head headache

1. Blood - can’t nourish head, when blood is needed to start menses headache comes

2. LR Fire – pre-menstrual headache, Chong is full of blood and Liver has heat, this drives Qi upward.

3. Blood Stasis – pain during bleeding, cold or trauma causes Stasis. Turbid Qi can’t go down – instead it goes up and interferes w/ ascending clear Qi. Differentiation – ext. patho. invasion – the headaches do not happen at a regular time around menses.

 

Chinese Medicine Differentiation and Treatment of PMS Headaches:

Blood dull headache during last days of bleeding, dizziness, scanty menses, Liver blood top of head. Plus – Blood sym. T-pale-thin P-thin-uneven

Principle of Treatment: – nourish Qi and blood to relieve pain

Herbal Medicine Formula: Ba Zhen Tang w/ gou qi zi and he shou wu

 

LR Fire pre-menstrual or starting period headaches, more severe, temporal/behind eyes/vertex, dizziness. Plus – Liver Fire sym. T-red P-rapid-wiry

Principle of Treatment: – clear Liver fire and nourish Liver Yin to sooth LR, expel Wind

Herbal Medicine Formula: Qi Ju Di Huang Wan

 

Blood Stasis trauma or chronic illness causes fixed stabbing pain in head. P/T – promote circ. – remove Stasis to relieve pain

Herbal Medicine Formula: Tong Qiao Huo Xue Tang (common headache formula)

 

 

Body Aching

Diagnosis of Body Aches PMS -

Body aching around menses.

Etiology (causes) of Body Aches:

1. Blood - aching last few days of bleeding, body simply lacks nourishment.

2. Blood Stasis – pre-menstrual body pains when stagnation blocks meridians.

 

Chinese Medicine Differentiation and Treatment of PMS Body Aches:

Blood last few days of bleeding numbness/pain/weakness in limbs (mostly lower), scanty bleeding Plus – Blood sym. T-pale-thin P-thin-uneven 

Principle of Treatment– nourish and harmonize blood to lube tendons/muscles

Herbal Medicine Formula: Dang Gui Bu Xue Tang

 

Blood Stasis pre-menstrual aches/pain in low back/knees, cycle may be delayed (generally)

Principle of Treatment: – move and nourish Blood, warm up meridians to relieve pain.

Herbal Medicine Formula: Chen Tong Tang

 

 

Diarrhea

Diagnosis of Diarrhea Before Period:

Significant soft/loose or watery stool around the menses that stops when period ceases. Not necessarily related to diet. Spleen is the most common pattern. WM – women w/ Uterus retroflexion have more pressure on the bowels when endometrial lining grows. Differentiate – Chronic diarrhea can occur at any time but may get worse around menses. Poor diet may cause diarrhea anytime. External Pathogenic invasion can also cause acute diarrhea.

Etiology (causes) of PMS Diarrhea:

1. SP Qi - controls blood, TandT of fluids, Spleen has to work hard to make blood for menses, when weak it has trouble w/ TandT diarrhea.

2. KI Qi - controls gates, menses need Kidney Qi to transform Essence into blood, the gates are weak, and it is also difficult to steam water to the Bladder more water diarrhea.

 

 

Chinese Medicine Differentiation and Treatment

 

Spleen Qi Deficiency pre/during/last days = soft stools, heavy-pale-thin bleeding. Plus – Spleen Qi sym. T-pale white coat P-soft

Principle of Treatment: – strengthen Spleen Qi – transform Damp

Herbal Medicine Formula: Shen Ling Bai Du San, Tong Xie Yao Tang (Wood overact on Earth)

 

Kidney Qi Deficiency during/last days = diarrhea (can be Plus– Kidney Qi sym.

Principle of Treatment – nourish Kidney Qi

Herbal Medicine Formula: Si Shen Wan

 

 

Epistaxis and Hematemesis

(nosebleed and vomit blood) Nosebleeds Diagnosis Nosebleeds and/or Hematemesis regularly pre/during menses. Stops when period ceases.

 

Etiology (causes):

1. Liver Fire – Stagnated Liver causes fire, Liver supplies Blood to Chong Mai, Fire causes Chong to rise causing bleeding.

2. Stomach Heat – diet – spicy food, alcohol etc. causes Heat to rise w/ Chong Mai.

3. Kidney Lung Yin - Fire Chong travels upward w/ Kidney meridian, pushes blood out of vessels.

 

Chinese Medicine Differentiation and Treatment

LR Fire Epi/Hema pre/during menses, bright-red early lg. amt. of menstrual blood. Plus – Liver Qi Stagnation – Liver Fire sym.

Principle of Treatment: – sooth Liver – clear Liver Heat – cool blood

Herbal Medicine Formula: Qing Gan Ying Jing Tang

 

ST Heat similar to Liver Fire sym. with  bleeding upper gums. and – Stomach heat sym bad breath, thirst P-forceful

Principle of Treatment: – purge Stomach Fire

Herbal Medicine Formula: San Huang Si Wu Tang

 

KI Lung Yin Epi/hema during/last days of menses, bright-red scanty early menses. Plus – Kidney Lung Yin sym

Principle of Treatment: – nourish Kidney Lung Yin

Herbal Medicine Formula: Shun Jing Tan + Niu Xi

 

 

Cankers

Diagnosis Cankers around menses, Mouth ST, Tongue HT. Heat related – frequently around period. Differentiate – Behcet’s Syn. – autoimmune ulcers in eyes/mouth/genitals, not related to menses.

Etiology (causes):

1. ST Heat – heat goes up w/ Chong meridian (ST/Chong Mai have a relation)

2. Yin hyper Heart Fire – worry a lot, a lot of emotions – injures Heart Yin, around period have even more Yin sym. because of bleeding more Heart Yin Fire goes up.

 

Chinese Medicine Differentiation and Treatment

ST Heat during cycle painful ulcers appear, bad breath, heavy-deep-red menstrual bleeding. Plus – Stomach Heat sym.

Principle of Treatment: – clear Stomach Fire – purge Fire

Herbal Medicine Formula: Qing Wei San or Liang Ge San (cool diaphragm)

 

HT Yin hyper Heart Fire around menses – tip of tongue ulcerated and painful, scanty early menstruation. Plus – Heart Yin sym. (mental restlessness, malar flush)

Principle of Treatment: – nourish Yin – descend Fire

Herbal Medicine Formula: Zhi Bai Di Huang Wan

 

 

Hives

Diagnosis Itchy skin, raised eruptions around periods. Main Pathogen = Wind exterior or interior (blood )

 

Etiology (causes):

1. Blood - produces internal Wind – during menses blood is more , itchyness and eruptions occur.

2. External Wind – Qi and Blood are used in great quantity for menstruation, if person had preexisting Heat patterns mix w/ Wind/Heat.

 

Chinese Medicine Differentiation and Treatment

Blood whole body can be itchy, when scratched hives will appear, worse @ night, delayed scanty menstruation. Plus – Blood sym. (dry skin, blurry vision) T-pale, thin

Principle of Treatment: – nourish Blood – expel Wind 

Herbal Medicine Formula: Dang Gui Yin Zi

 

Wind/Heat big patches of red elevated hives, when scratched you can see clear red lines on the persons skin, severe itchiness, heat makes it worse, early-heavy menstruation. Plus – Heat sym. (maybe exterior sym.)

Principle of Treatment: – nourish blood – clear Heat – cool blood – expel Wind

Herbal Medicine Formula: Xiao Feng San

 

 

Dizziness

Diagnosis Regular dizziness and/or blurred vision around period, severe cases can have spinning and tinnitus.

 

Differentiate – Meniere’s syndrome – inner ear fluid causing tinnitus and dizziness (balance) when eyes are open, also may have cold limbs. Also general dizziness will occur at anytime within the cycle.

 

Etiology (causes):

1. Blood - long term bleeding or Spleen - can’t produce enough blood, during menses blood goes down to lower Jiao not enough can go up to head.

2. Yin hyper LR Yang – Yin in lower Jiao causes relative Yang , Yang rises causing Wind (dizziness).

3. SP - produces Phlegm-Damp – this blocks the meridians and impairs clear Yang to rise to head for nourishment (Qi helps clear Yang to rise, i.e. Spleen Qi , Qi is used to move menses in Lower Jiao).

 

Chinese Medicine Differentiation and Treatment

Blood during/post menses dizziness, maybe delayed period. Plus – Liver Heart Blood sym. T-pale, thin P-weak

Principle of Treatment: – nourish Heart Spleen for Qi/Blood

Herbal Medicine Formula: Gui Pi Tang + gou qi zi, he shou wu

 

Yin hyper Liver Yang during menses dizziness, tinnitus, scanty-bright-red blood, T-red-scant yellow coat P-thin wiry rapid Plus – Liver Heat sym. (irritable, anger, thirst)

Principle of Treatment: – nourish Yin – subdue Yang

Herbal Medicine Formula: Tian Ma Gou Teng Tang (dizzy wind soup)

 

SP produces Phlegm-Damp – pre/during menses dizziness and heavy head, vaginal leukorrhea, T-white greasy coat P-soft (damp) slippery (phlegm) Plus – Spleen /phlegm-damp sym. (fullness in chest, nausea, soft stools edema.

Principle of Treatment: – strengthen Spleen – trans. damp – eliminate Phlegm

Herbal Medicine Formula: Ban Xia Bai Zhu Tian Ma Tang

 

 

Edema

Diagnosis Around period face and/or limbs get puffy/swollen. - Liver Qi Stagnation, pre-menses, quick-return pitting. - Spleen KI, mostly in morning, during/after menses, pitting. Differentiate – check kidney/renal function (WM).

 

Etiology (causes):

1. SP KI - can’t control TandT or the gates.

2. Qi/Blood stag. – Qi can’t move water transformation in Lower Jiao (abd. bloating)

 

Chinese Medicine Differentiation and Treatment

1. Spleen Kidney Yang - pitting during/post menses, more in morning (face), delayed scanty purple-pale blood, cold signs. Plus – Spleen Kidney Yang sym. (except urine will be scanty)

Principle of Treatment: – nourish Spleen – warm Kidney – induce diuresis

Herbal Medicine Formula: Ling Gui Zhu Gan Tang

 

2. Qi/Blood Stagnation – pre menses edema, abd. bloating, fatigue, delayed-dark-clotted blood, Dysmenorrhea. Plus – Liver Qi Stagnation sym.

Principle of Treatment – regulate Liver Qi – promote blood circ.

Herbal Medicine Formula: Ba Wu Tong + fu ling, zi lan

 

 

Emotional Disorders

Diagnosis Around period feel very irritable, angry, sad, depressed, violent mania, anxiety and/or insomnia. Recede after menses stop. Differentiate – Heat invading the Blood – effects the Liver HT, causes delirium at night w/ fever.

Etiology (causes):

1. HT Blood - during menses Heart gets weak (Shen)

2. LR Qi Stagnation Fire – pre-menses – Chong goes upward because of the Heat. Fire rising also effects Heart Shen.

3. Phlegm-Fire – Liver Heat / Spleen Phlegm accumulates pre-menses, Heat goes upward along Chong and effects Shen.

 

Chinese Medicine Differentiation and Treatment

1. Heart Blood - during menses – anxiety, lack of concentration, slow mental function, sadness, talk to themselves, delayed-scanty-pale blood. Plus – fatigue, insomnia, palpitation, Blood sym. T-pale thin coat

Principle of Treatment: – nourish Blood – calm Shen

Herbal Medicine Formula: Yang Xin Tang + long gu, mu li, Gan Mai Da Zao Tang (mild strength for sadness)

 

2. Liver Qi Stagnation Fire – pre-menses – irritable, anxiety, anger, violent, heavy-red-early periods. Plus – Liver Qi Stagnation sym.

Principle of Treatment: – clear Liver Heat – sooth Liver – calm Shen

Herbal Medicine Formula: Dan Zhi Xiao Yao San

 

3. Phlegm-Fire – during menses – violent, irritable, lg. amt. yellow smelly-sticky leukorrhea. Plus – Phlegm-Heat sym. (fullness in chest, nausea, + heat) T- red P- slippery rapid wiry

Principle of Treatment: – clear Phlegm-Heat to calm Shen

Herbal Medicine Formula: Wen Dan Tang (er chen tang cousin w/ heat herbs)