TCM holistic treatment for premenstrual syndrome PMS


Synopsis

Premenstrual Syndrome (PMS) is common but not a necessary part of having a period.

PMS in Western terms is due primarily to a hormone imbalance between estrogen and progesterone.

In Chinese Medicine the Liver plays a significant role, though the other organ systems are part of the picture too.

PMS can be treated with diet, herbal formulas, acupuncture, homeopathy, stress reduction, and exercise.

What is Premenstrual Syndrome?

Premenstrual syndrome (PMS) has a wide variety of signs and symptoms, including mood swings, tender breasts, food cravings, fatigue, irritability and depression. It is estimated that as many as 3 of each 4 menstruating women have undergone some kind of premenstrual syndrome.

Symptoms tend to recur in a predictable pattern. But the physical and psychological changes you encounter with premenstrual syndrome can change from just marginally noticeable all the way to extreme.

Premenstrual syndrome (PMS) is so ubiquitous that many People consider it to be normal. Symptoms are extensive, and may be both physical and mental-emotional. Still, you don't need to let these issues control your life. Remedies and lifestyle adjustments can help you reduce or manage the signs and symptoms of premenstrual syndrome.


What are PMS Symptoms?

According to Mayo Clinic, The list of possible Symptoms and signs for premenstrual syndrome is long, but most women only experience some of these issues.[1]

Behavioral signs and symptoms

• Tension or anxiety

• Depressed mood

• Crying spells

• Mood swings and irritability or anger

• Appetite changes and food cravings

• Trouble falling asleep (insomnia)

• Social withdrawal

• Poor concentration

• Change in libido


Physical symptoms include:

• Joint or muscle pain

• Headache

• Fatigue

• Weight gain associated with fluid retention

• Abdominal bloating

• Breast tenderness

• Acne flare-ups

• Constipation or diarrhea

• Alcohol intolerance


For many, the physical pain and psychological stress are severe enough to affect their daily lives. No matter the symptom severity, the symptoms generally disappear within four days of the beginning of the menstrual period for most women.


But a few women with premenstrual syndrome have disabling symptoms each month. This kind of PMS is known as premenstrual dysphoric disorder (PMDD). PMDD symptoms and signs include depression, mood swings, anger, stress, feeling overwhelmed, difficulty concentrating, irritability and tension. It may be common to experience PMS, but that does not mean it's an essential part of owning a period. These signs are messages into the body that something is out of equilibrium. You're not required to have PMS as part of having a menstrual cycle. It's a testament to our stressful lives that many people experience PMS. I would like to supply some context from a Chinese Medicine perspective for this very common issue. Let’s first see what Western medicine says about PMS.


The Western Perspective of PMS


Conventional Medicine view of PMS

According to the Medscape monograph on PMS, the real cause of PMS is unknown, although the report postulates several potential causes, including diminished serotonin, magnesium and calcium deficiencies, sensitivity to changes in hormone levels, and history of abuse.[2] They specifically state that estrogen excess, estrogen withdrawal, progesterone deficiency, pyridoxine (vitamin B6) deficiency, alteration of glucose metabolism, and fluid-electrolyte imbalances are older and erroneous theories. You will see below that I do not agree with a few of those decisions.


Functional Medicine view of PMS

Functional Medicine, though coming from a Western Perspective, goes beyond the limits of the traditional approach. According to Dr. Hyman, a prominent Functional Medicine physician, PMS is because of elevated estrogen and decreased progesterone, either in their overall quantities, or their levels relative to one another. A range of different issues may result in this sort of hormonal imbalance.[3]

The liver is responsible for taking additional hormones from the blood and altering them so that they can be eliminated in the bile. Things that interfere with liver metabolism or bile production can cause difficulties. A poor diet, exposure to toxic chemicals, stress, or alcohol can affect the liver and lead to estrogen to accumulate in the system.

The gallbladder takes the bile produced in the liver and secretes in the intestines. If the bile is not flowing well because of gallbladder problems it is the exact same situation as with poor liver metabolism. If there's constipation, the bile is not eliminated and the estrogen that the body is trying to eliminate gets reabsorbed from the intestines.

There is also a stress and adrenals connection. When we are under pressure the adrenals make cortisol, our main stress hormone. If the stress is ongoing and does not go away all of the cortisol may interfere with the hypothalamus and the pituitary. Both of these endocrine glands in the brain control plenty of hormone production, such as estrogen and progesterone. Since these hormones are made from cholesterol, creating a great deal of cortisol can reduce the amount of estrogen or progesterone being made. This is one of the effects of adrenal fatigue.


What is Chinese Medicine Perspective on PMS?


Liver Qi and Blood

The Liver (referring to the entire organ system rather than only the physical organ) in Chinese Medicine is a remarkably important organ system. It has several roles relating to Qi and Blood in the body. It's responsible for the smooth movement of Qi, and it stores and contains the Blood. Qi is needed to move the bloodstream, and thus the Liver is also partially in charge of transferring the Blood. Though the flow is ruled from the Heart, it's aided by the Qi of the Liver in providing Blood to all the several areas of the body.

The Liver is responsible for containing everyday stress and emotion, in order that loopholes don't always erupt and disturb the ability of a man to live in society. When the Liver is healthy, we have the ability to hold emotional outbursts in check until a time when permitting them out is appropriate.

Concerning menstruation, the Liver is accountable for moving Blood into the uterus during the second half of the cycle, in preparation for a potential pregnancy. If Blood is adequate, the Liver's capacity to store blood is wholesome, and the Liver Qi is strong, there'll be no signs of PMS.


Qi Stagnation and Deficiency

痛則不通,通則不痛 tòng zé bù tōng, tōng zé bù tòng: Should there be pain then there is not any free flow, if there is free flow then there's absolutely no pain. Since the Liver is responsible for the smooth flow of Qi when there's stagnation or lack (frequently both) it will result in pain, based on where the Qi gets trapped. This may account for a good deal of the pain which may happen, such as muscle pain, joint pain, back pain, breast tenderness, headache, in addition to feeling tight or rigid in one of these areas. A sign pain is brought on by Liver Qi problems is that exercise and stretching feel good and decrease the discomfort.

The stagnation of Qi from the digestive organs may create a host of problems. Because the Liver Qi assists the smooth movement of food when there's a lack food may get 'stuck', slowing down the digestion and resulting in nausea, bloating, and a sense of food sitting in the gut. There may be constipation, interspersed with bouts of nausea as the Qi builds up and attempts to move the stagnation.

If the Liver is deficient it will not be able to include the Emotions also. Since the Liver Qi is involved with moving blood into the uterus it's less Qi available for containment. This may result in moodiness and changing emotions, such as depression or anxiety.


Blood Deficiency

If there is not enough Blood once the second half of the Menstrual cycle arrives, other regions of the body will endure a lack of this very important substance as Blood is transferred to the uterus. Pain can also result from a deficiency of Blood and tends to be dull and achy. This describes a frequent type of headache in PMS. Issues with eyesight can happen as the eyes get less Blood than they require. Insomnia during this period is often because of an issue with Blood. If the person wakes up after sleeping 4 to 5 hours this indicates Heart Blood deficiency which can originate from the Liver.

Blood is created from a combination of Spleen and Kidney energies. The Spleen contributes nourishment from food, and the Kidney contributes essence in the Marrow. If both of these organ systems are deficient there can be difficulty creating Blood. Without enough blood being generated even when the Liver is performing well it will not have sufficient blood to disperse, and there'll be indications of Blood deficiency.

The Heart is also intimately connected with the Blood. The Blood homes the shen (our soul, or consciousness) as well as the emotions, each of which are connected to the Heart. When the Heart is agitated (with anxiety, worries, excessive thinking, etc.) it will need more blood to keep it calm. Over time this agitation increases the Blood; Blood (and then yin) deficiency will make more agitation, a downward spiral. The Heart could be the origin of the agitation, or it might be dealing with a deficiency of Blood because of a Liver deficiency. Agitation also leads to Heart Qi deficiency, and because the Heart rules within the flow without enough Qi the supply of Blood is going to be compromised.


Holistic Treatments for PMS

At present conventional medicine has few effective remedies to offer. A common first line strategy is to prescribe SSRIs (antidepressants). The monograph on Medscape also lists several alternative approaches, such as meditation or biofeedback methods, light therapy, massage, homeopathy, and herbal medicine.


Dr. Hyman, in his post On PMS, lists five things to do in order to treat PMS. The first is to eat well. Secondly, he lists a variety of nutritional supplements, including certain seeds, herbs, and probiotics. Third and fourth would be to exercise and reduce stress. Fifth is to include alternative therapies like acupuncture and homeopathy. Let us explore some of those options more fully.


Eating well is important. Food cravings during PMS tend to be due to some Spleen Qi deficiency. In this circumstance it's easier on the Spleen to eat smaller amounts more frequently. Eating 5-6 small meals during the day can help stabilize your blood sugar, energy, and blood generation. A deficient Spleen does better with food that is easily digested. This means food warm, moist, cooked foods. Eating raw or cold food, or drinking cold beverages, puts another burden on the digestion. All these things keep Qi from stagnating, helping to stop all of the issues described above.


Based on what is happening in the body, different herbs or supplements will be helpful. As an example, if there's some Liver Qi and Blood deficiency, together with water accumulation from a Spleen problem, this may cause symptoms such as cramping pain, bloating, diarrhea, and nausea. With confirmation from the heartbeat, the formulation Dang Gui Shao Yao San (Angelica and Peony Powder) could be appropriate. Or perhaps there together with the Liver Qi and Blood deficiency there's more dryness and yin deficiency, resulting in dry skin, insomnia, dizziness, and agitation, together with constipation and moodiness. Here it may be better to provide Wen Jing Tang (Warm the Menses Decoction). Each man is unique, so there isn't any one-size-fits-all solution.


Exercise is considered in popular culture as consistently useful, but Chinese Medicine views it differently. Exercise helps to move the Qi and blood in the body, and for that reason will alleviate symptoms due to stagnation. If the stagnation is coming out of a lack, exercise that's too extreme will deplete you, and over time things will get worse. Lots of individuals have a certain amount of blood lack; any exercise that forces the body to sweat will further deplete the blood, because perspiration is produced from Blood. It's great to move, but be careful of overdoing it.


Stress and anxiety is one of the defining issues of our time. Reducing Stress will make everything better, not just PMS. In Chinese Medicine stress primarily impacts the bronchial and the Heart, so treating these two organ systems is quite important. Helping the body let go of any previous injury, whether physical or psychological, is absolutely crucial; should you take your stress with you all of the time how can it go away? Developing body awareness, like by paying attention to the breath, is a fantastic way to help let go of anxiety. Massage, yoga, meditation, baths, decent business, all can be useful.


Acupuncture can be incredibly helpful with PMS. As a means of communicating directly with the body acupuncture may help free up stagnating Qi and bring awareness to patterns of held tension, whether from the muscles, the connective tissues, the nervous system, or the organs themselves. Acupuncture may also talk to the feelings, since body and mind are intimately connected.


Homeopathy is another terrific treatment approach. Though homeopathic remedies may be used on a more symptomatic level I would rather prescribe based on the entire person. This takes not only menstrual symptoms into consideration, but focuses on how that you move through life and react to all of life's stresses, in a physical, emotional, and psychological level. Prescribing a whole-person remedy could lead to profound changes.

Some things are easy to implement on your own, and with others it is helpful to have the advice of a trained practitioner.


References:

1. Mayo Clinic, Premenstrual Syndrome, https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/diagnosis-treatment/drc-20376787

2. Premenstrual Syndrome Updated: Sep 01, 2016  Megan A Moreno, MD, MEd, MPH; et al https://emedicine.medscape.com/article/953696-overview

3. How to eliminate PMS in 5 simple steps, Dr Mark Hyman, https://drhyman.com/blog/2010/09/17/how-to-eliminate-pms-in-5-simple-steps/

;