Tilo Medical and Acupuncture

PMS

Experiences Treating PMS

abstracted & translated by

Bob Flaws, Lic. Ac., Dipl. Ac. & C.H., FNAAOM, FRCHM

Keywords: Chinese medicine, Chinese herbal medicine, gynecology, PMS

Premenstrual syndrome or PMS is a variable combination of up to 200 different medically recognized conditions which recur during the luteal phase of the menstrual cycle each month. Different women have different of these signs and symptoms as well as varying degrees of intensity and duration of each sign or symptom. In issue #4, 2003 of Shan Xi Zhong Yi (Shanxi Chinese Medicine) , Wu Xue-hua, adjunct professor of Chinese medicine and a practitioner at the First Affiliated Hospital of the Shantou University College of Medicine in Guangdong, published two case histories of her treatment of PMS. These case histories appeared on page 29 of that journal and a summary is given below.

Case 1: Premenstrual asthma

The patient was a 23 year-old female who was first seen by Dr. Wu on Jan. 3, 1999. For the past three years, the woman had experienced nasal congestion, chest oppression, dyspnea, and asthmatic breathing with inability to lie flat beginning four days before each menstruation. Once her menses came, these symptoms spontaneously remitted. Normally, she did not have any panting, wheezing, or coughing. She had been receiving medical treatment for the past half year which was not effective. In fact, in the last three months, the panting and coughing had been occurring eight days before menstruation. When severe, the young woman felt like her throat was obstructed. When she coughed, she was able to hack up a large amount of sticky, white phlegm. Her head was also faintly painful, she feared cold, and her extremities were chilled. During these episodes, her lips were also slightly blue-green. The woman's tongue was pale with white, slimy fur, and her pulse was slippery.

Based on the above signs, symptoms, and history, the patient's Chinese medical pattern was categorized as lung defensive not securing with phlegm depression, congestion, and stagnation. Therefore, the treatment principles were to secure the exterior and boost the qi, diffuse the lungs, stabilize panting, and wash away phlegm. The formula used was Yu Ping Ding Chuan Tang (Jade Windscreen Stabilize Panting Decoction): Radix Astragali Membranacei ( Huang Qi ), 30g, Radix Ledebouriellae Divaricatae ( Fang Feng ), stir-fried Rhizoma Atractylodis Macrocephalae ( Bai Zhu ), Semen Pruni Armeniacae ( Xing Ren ), Flos Inulae Racemosae ( Kuan Dong Hua ), processed Rhizoma Pinelliae Ternatae ( Ban Xia ), and Fructus Trichosanthis Kirlowii ( Gua Lou ), 10g each, Semen Ginkgonis Bilobae ( Bai Guo ), 9g, Cortex Radicis Mori Albi ( Sang Bai Pi ), 15g, and Fructus Perillae Frutescentis ( Zi Su Zi ) and Radix Glycyrrhizae Uralensis ( Gan Cao ), 6g each. One packet of these medicinals was decocted in water and administered per day beginning nine days before th expected onset of menstruation. This formula was administered for three menstrual cycles with minor modifications and, after, 33 packets, the patient was labeled cured. In addition, the patient was advised not to catch cold and to eat two walnuts per day to supplement her kidneys.

According to Dr. Wu, premenstrual asthma is commonly seen in young and middle-aged women and is commonly accompanied by fear of cold, chilled limbs, and, if severe, inability to lie flat. In younger women, i.e. adolescents, kidney vacuity is usually the main cause. Therefore, treatment in such cases should supplement the kidneys. In middle-aged women, the main cause of this condition is liver depression. Hence treatment in these cases should course the liver. In the above case, the root was a lung defensive qi vacuity. As the qi and blood became gradually exuberant during the premenstruum, this led to depression of qi internally and mutual binding of phlegm and dampness which congested in and obstructed the lungs. The lung qi did not downbear, and hence there was panting respiration and inability to lie down flat. Within this formula, the ingredients of Yu PingFeng San (Jade Windscreen Powder) secure the exterior and supplement the lung and defensive qi, while the ingredients of Ding Chuan Tang (Stabilize Panting Decoction) diffuse the lungs and level panting, drain the qi congested in the lungs and wash away the phlegm. When these two formulas are combined, they are called Yu Ping Ding Chuan Tang .

Case 2: Premenstrual headache

The patient was a 43 year-old female who was initially seen by Dr. Wu on Aug. 2, 1998. For the past two years, this woman experienced a headache which came and went before each menstruation. It was most severe on the left side and was accompanied by sharp, piercing pain. When the pain was severe, the woman had to take Western pain medications to relieve it. This patient's menstrual period was normal. However, its color was dark red and it contained clots. There was also lower abdominal distention, fullness, and pain. In particular, the sharp, piercing pain was located at the left point Tai Yang (M-HN-9). Other premenstrual symptoms included vexation, agitation, and easy anger. This patient's tongue was normal with thin, white fur. However, her pulse was bowstring and choppy.

Based on these signs and symptoms, Dr. Wu categorized this woman's Chinese medical pattern as stasis obstructing the network vessels headache. Therefore, the treatment principles were to quicken the blood and transform stasis, regulate the qi and free the flow of the network vessels. The medicinals used consisted of: Semen Pruni Persicae ( Tao Ren ), Herba Leonuri Heterophylli ( Yi Mu Cao ), and Radix Ligustici Wallichii ( Chuan Xiong ), 15g each, Radix Achyranmthis Bidentatae ( Niu Xi ), Radix Bupleuri ( Chai Hu ), Radix Rubrus Paeoniae Lactiflorae ( Chi shao ), Flos Carthami Tinctorii ( Hong Hua ), Radix Albus Paeoniae Lactiflorae ( Bai Shao ), Radix Angelicae Dahuricae ( Bai Zhi ), Fructus Viticis ( Man Jing Zi ), and Rhizoma Cyperi Rotundi ( Xiang Fu ), 12g each, and Radix Glycyrrhizae Uralensis ( Gan Cao ), 6g. In addition, Dr. Wu performed acupuncture at Shen Shu (Bl 23), Zu San Li (St 36), San Yin Jiao (Sp 6), and Qi Hai (CV 6) with even supplementing-even draining technique. Zu Lin Qi (GB 41), Xing Jian (Liv 2), Tai Bai (Sp 3), and a shi points were needled with draining technique. Qi Hai and the a shi points were also treated with moxibustion. Three packets of medicinals were administered as well as three acupuncture treatments, the woman's menstruation came on, and her menstrual blood was freely and smoothly flowing. However, it did contain clots. The headache and abdominal pain were less. Therefore, Dr. Wu prescribed two more packets of medicinals. Then she removed Qi Hai and needled 20 more times while also prescribing Xiao Yao Wan (Rambling Pills) and Ba Zhen Yi Mu Wan (Eight Pearls Leonurus Pills) to regulate and rectify. The next time the menses came, the headache was even less. Dr. Wu prescribed three packets of the above medicinals and acupuncture for half a month. At that point, the headache was completely cured and her condition was brought under control. Continuous use of the above methods were employed for an unspecified amount of time, and there was no recurrence of the headache.

According to Dr. Wu, in the case of premenstrual headaches, the disease is located in the qi and blood. Therefore, the treatment of this condition heavily depends on the regulation and rectification of the qi and blood. In the above formula, Tao Ren, Hong Hua, Chi Shao, Niu Xi , and Yi Mu Cao quicken the blood and transform stasis, while Chai Hu and Xiang Fu regulate and rectify the qi mechanism. Huang Qi, Dang Shen , and Bai Zhu supplement the qi, and Dang Gui, Bai Shao , and Shu Di nourish the blood. (Some of these last ingredients were probably unspecified additions in the above case.)

Discussion

In general, Dr. Wu is of the opinion that the two main mechanisms of PMS are 1) liver depression qi stagnation and 2) kidney water insufficiency. The nipples, chest and rib-sides, and lower abdomen are traversed by the liver channel and its network vessels and the chong and ren home to the liver and kidneys. Any signs and symptoms in any of these areas may be due to accumulation and depression in the liver channel. If kidney water is insufficient, then liver wood loses its sprinkling and nourishment. Thus it will tend to counterflow horizontally and attack spleen earth. In that case, spleen earth's movement and transformation lose their duty and the finest essence of water and grains is not transformed. Instead, these spill over as dampness, and, when dampness accumulates, it may produce phlegm. Thus there is premenstrual breast pain, headache, loose stools, and/or edema. Premenstrually, the sea of blood is full and exuberant, but kidney water and yin blood may be left relatively insufficient. The viscera and bowel function loses its balance and fire may become depressed and accumulate internally. After the menses come like a flood, this depressed and accumulated fire obtains coursing and discharge and kidney yin is able to recuperate itself. Thus all the premenstrual signs and symptoms gradually subside. This is why Dr. Wu thinks that the main treatment methods for PMS are to regulate the liver and boost the kidneys.

For more information on the Chinese medical treatment of PMS, see Bob Flaws' A Handbook of Menstrual Diseases in Chinese Medicine available from Blue Poppy Press.