Pre Menstrual Syndrome


Introduction

Any disorder that comes regularly around menses.

 

  • Fever
  • Breast Tenderness
  • Headaches
  • Body Aching
  • Diarrhea
  • Epistaxis & Hematemesis (nosebleed & vomit blood)
  • Cankers
  • Hives
  • Dizziness
  • Edema
  • Emotional Disorders

 

Fever

Diagnosis

  • Acute, each occurrence any 1-2 days before-during-after period
  • LR KI Yin deficiency → 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

  • LR KI Yin deficiency - around period Yin/Blood get used for Uterus ? heat.
  • Heat in Blood (LR heat) – during menses – need more Qi to make period happen & this generates heat.
  • Qi (blood) deficiency - Ying & Wei are not harmonized, before fever there probably be chills – then fever & chills alternate.
  • Blood stag. – usually mixed w/ ext. patho. invasion, & already have Blood Stasis in Uterus – disharmony of Ying & Wei, - stag. leads to heat.

Pathogenesis Differentiation & Treatment

  1. LR KI Yin deficiency
    • tidal fever during last few days of bleeding, scanty blood
    • Plus – Yin deficiency sym. T-red-scanty coat  P-thin-rapid
    • P/T – nourish Yin – clear ? heat
    • Rx – 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
    • P/T – clear heat – cool blood to reduce fever
    • Rx – Qing Jing Tang
  3. Qi (blood) deficiency
    • low fever during last few days of bleeding, could be spontaneous sweat, Heavy flow, pale-thin
    • Plus – Sp Qi & blood ? sym.
    • P/T – nourish SP Qi to harmonize Ying – nourish blood, to reduce fever.
    • Rx – Bu Zhong Yi Qi Tang
  4. Blood stag.
    • fever comes before or during bleeding, dark-purple blood w/ clots & Pain
    • P/T – promote circ. – remove Blood Stasis to reduce fever
    • Rx – Tao Hong Si Wu Tang  or  Xue Fu Zhu Yu Tang

 

Breast Tenderness

Diagnosis

  • Around period breasts (KI) feel tender, sore, distended, or have itchy pain in the nipples (LR)

Etiology

  1. LR Qi stag. – LR effects nipple – if the LR attacks the ST the breasts are effected. Qi is not able to flow smoothly.
  2. LR KI Yin deficiency - breasts are effected during menses, blood is deficiency - collaterals then lack nourishment & this leads to stag.

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.

Pathogenesis Differentiation & Treatment

  1. LR Qi stag.
    • pre-menstrual tenderness, itchy, distended
    • Plus – LR Qi stag. sym.
    • P/T – sooth LR to relieve stag.
    • Rx – Chai Hu Shu Gan San  or  Xiao Yao San
  2. LR KI Yin deficiency - tenderness in last few days of bleeding
    • Plus – LR KI Yin ? Heat sym.
    • P/T – nourish LR KI Yin
    • Rx – Yi Guan Jian

 

Headaches

Diagnosis

  • When period is finished the headache will go away.

Etiology

  • All Zang-fu Qi/essence go up to nourish head
  • All Yang meridians & LR go to head
  • When clear Qi/essence cannot raise to head ? headache
  1. Blood deficiency - cannot nourish head, when blood is needed to start menses headachecomes
  2. LR Fire – pre-menstrual headache, Chong is full of blood & LR has heat, this drives Qi upward.
  3. Blood Stasis – pain during bleeding, cold or trauma causes Stasis. Turbid Qi cannot go down – instead it goes up & interferes w/ ascending clear Qi.

Differentiation

  • ext. patho. invasion – the headaches do not happen at a regular time around menses.

Pathogenesis Differentiation & Treatment

  1. Blood deficiency
    • dull headache during last days of bleeding, dizziness, scanty menses, LR blood deficiency top of head.
    • Plus – Blood deficiency sym. T-pale-thin  P-thin-uneven
    • P/T – nourish Qi & blood to relieve pain
    • Rx – Ba Zhen Tang w/ gou qi zi & he shou wu
  2. LR Fire
    • pre-menstrual or starting period headaches, more severe, temporal/behind eyes/vertex, dizziness.
    • Plus – LR Fire sym. T-red  P-rapid-wiry
    • P/T – clear LR fire & nourish LR Yin to sooth LR, expel Wind
    • Rx – Qi Ju Di Huang Wan
  3. Blood Stasis 
    • trauma or chronic illness causes fixed stabbing pain in head.
    • P/T – promote circ. – remove Stasis to relieve pain
    • Rx – Tong Qiao Huo Xue Tang  (common headache formula)

 

Body Ache

Diagnosis

  • Body aching around menses.

Etiology

  1. Blood deficiency -  aching last few days of bleeding, body simply lacks nourishment.
  2. Blood Stasis – pre-menstrual body pains when stagnation blocks meridians.

Pathogenesis Differentiation & Treatment

  1. Blood ?
    • last few days of bleeding ? numbness/pain/weakness in limbs (mostly lower), scanty bleeding
    • Plus – Blood deficiency sym. T-pale-thin
    • P-thin-uneven
    • P/T – nourish & harmonize blood to lube tendons/muscles
    • Rx – Dang Gui Bu Xue Tang
  2. Blood Stasis
    • pre-menstrual aches/pain in low back/knees, cycle may be delayed (generally)
    • P/T – move & nourish Blood, warm up meridians to relieve pain.
    • Rx – Chen Tong Tang

 

Diarrhea

Diagnosis

  • Significant soft/loose or watery stool around the menses that stops when period ceases. Not necessarily related to diet. SP deficiency is the most common pattern.

WM

  • women w/ Uterus retroflexion have more pressure on the bowels when endometrial lining grows.

Differentiation

  • 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

  1. SP Qi deficiency - controls blood, T&T of fluids, SP has to work hard to make blood for menses, when weak it has trouble w/ T&T → diarrhea.
  2. KI Qi deficiency - controls gates, menses need KI Qi to transform Essence into blood, the gates are weak, & it is also difficult to steam water to the BL → more water → diarrhea.

Pathogenesis Differentiation & Treatment

  1. SP Qi deficiency
    • pre/during/last days = soft stools, heavy-pale-thin bleeding.
    • Plus – SP Qi deficiency sym.  T-pale white coat  P-soft
    • P/T – strengthen SP Qi – transform Damp
    • Rx – Shen Ling Bai Du San
      Tong Xie Yao Tang (Wood overact on Earth)
  2. KI Qi deficiency
    • during/last days = diarrhea (can be 5 am), thin-pale bleeding.
    • Plus – KI Qi deficiency sym.
    • P/T – nourish KI Qi
    • Rx – Si Shen Wan

 

Epistaxis & Hematemesis (nosebleed & vomit blood)

Diagnosis

  • Nosebleeds &/or Hematemesis regularly pre/during menses. Stops when period ceases.

Etiology

  1. LR Fire –  Stagnated LR causes fire, LR supplies Blood to Chong Mai, Fire causes Chong to rise causing bleeding.
  2. ST Heat – diet – spicy food, alcohol etc. causes Heat to rise w/ Chong Mai.
  3. KI LU Yin ? - ? Fire ? Chong travels upward w/ KI meridian, pushes blood out of vessels.

Pathogenesis Differentiation & Treatment

  1. LR Fire
    • Epi/Hema pre/during menses, bright-red early lg. amt. of menstrual blood.
    • Plus – LR Qi stag. – LR Fire sym.
    • P/T – sooth LR – clear LR Heat – cool blood
    • Rx – Qing Gan Ying Jing Tang
  2. ST Heat
    • similar to LR Fire sym. + bleeding upper gums.
    • Plus – ST heat sym ? bad breath, thirst  P-forceful
    • P/T – purge ST Fire
    • Rx – San Huang Si Wu Tang
  3. KI LU Yin ?
    • Epi/hema during/last days of menses, bright-red scanty early menses.
    • Plus – KI LU Yin ? sym
    • P/T – nourish KI LU Yin
    • Rx – Shun Jing Tan + Niu Xi

 

Cankers

Diagnosis

  • Cankers around menses, Mouth → ST, Tongue → HT. Heat related – frequently around period.

Differentiation

  • Behcet's Syn. – autoimmune ulcers in eyes/mouth/genitals, not related to menses.

Etiology

  1. ST Heat
    1. heat goes up w/ Chong meridian (ST/Chong Mai have a relation)
    2. Yin deficiency → hyper HT Fire – worry a lot, a lot of ↑ emotions – injures HT Yin, around period have even more
  2. Yin deficiency sym. because of bleeding → more HT Yin deficiency Fire goes up.

Pathogenesis Differentiation & Treatment

  1. ST Heat
    1. during cycle painful ulcers appear, bad breath, heavy-deep-red menstrual bleeding.
    2. Plus – ST Heat sym.
    3. P/T – clear ST Fire – purge Fire
    4. Rx – Qing Wei San  or  Liang Ge San (cool diaphragm)
  2. HT Yin deficiency → hyper HT Fire
    1. around menses – tip of tongue ulcerated & painful, scanty early menstruation.
    2. Plus – HT Yin ? sym. (mental restlessness, malar flush)
    3. P/T – nourish Yin – descend Fire
    4. Rx – Zhi Bai Di Huang Wan

 

Hives

Diagnosis

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

Etiology

  1. Blood deficiency - produces internal Wind – during menses blood is more deficiency, itchyness & eruptions occur.
  2. External Wind – Qi & Blood are used in great quantity for menstruation, if person had preexisting Heat patterns ? mix w/ Wind/Heat.

Pathogenesis Differentiation & Treatment

  1. Blood deficiency
    1. whole body can be itchy, when scratched hives will appear, worse @ night, delayed scanty menstruation.
    2. Plus – Blood ? sym. (dry skin, blurry vision)  T-pale, thin
    3. P/T – nourish Blood – expel Wind
    4. Rx – Dang Gui Yin Zi
  2. Wind/Heat
    1. 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.
    2. Plus – Heat sym. (maybe exterior sym.)
    3. P/T – nourish blood – clear Heat – cool blood – expel Wind
    4. Rx – Xiao Feng San

 

Dizziness

Diagnosis

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

Differentiation

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

Etiology

  1. Blood deficiency - long term bleeding or SP deficiency - cannot produce enough blood, during menses blood goes down to lower Jiao ? not enough can go up to head.
  2. Yin deficiency → hyper LR Yang – Yin deficiency in lower Jiao causes relative Yang ↑ , Yang rises causing Wind (dizziness).
  3. SP deficiency - produces Phlegm-Damp – this blocks the meridians & impairs clear Yang to rise to head for nourishment (Qi helps clear Yang to rise, i.e. SP Qi deficiency, Qi is used to move menses in Lower Jiao).

Pathogenesis Differentiation & Treatment

  1. Blood deficiency
    • during/post menses dizziness, maybe delayed period.
    • Plus – LR HT Blood deficiency sym.  T-pale, thin  P-weak
    • P/T – nourish HT SP for Qi/Blood
    • Rx – Gui Pi Tang + gou qi zi, he shou wu
  2. Yin deficiency → hyper LR Yang
    • during menses dizziness, tinnitus, scanty-bright-red blood, T-red-scant yellow coat  P-thin wiry rapid
    • Plus – LR Heat sym. (irritable, anger, thirst)
    • P/T – nourish Yin – subdue Yang
    • Rx – Tian Ma Gou Teng Tang  (dizzy wind soup)
  3. SP deficiency
    • produces Phlegm-Damp – pre/during menses dizziness & heavy head, vaginal leukorrhea, T-white greasy coat  P-soft (damp) slippery (phlegm)
    • Plus – SP deficiency/phlegm-damp sym. (fullness in chest, nausea, soft stools edema.
    • P/T – strengthen SP – trans. damp – eliminate Phlegm
    • Rx – Ban Xia Bai Zhu Tian Ma Tang

 

Edema

Diagnosis

  • Around period face &/or limbs get puffy/swollen.
    • ↑ - LR Qi stag., pre-menses, quick-return pitting.
    • deficiency- SP KI, mostly in morning, during/after menses, pitting.

Differentiation

  • check kidney/renal function (WM).

Etiology

  1. SP KI deficiency - cannot control T&T or the gates.
  2. Qi/Blood stag. – Qi cannot move water transformation in Lower Jiao (abd. bloating)

Pathogenesis Differentiation & Treatment

  1. SP KI Yang deficiency
    • pitting during/post menses, more in morning (face), delayed scanty purple-pale blood, cold signs.
    • Plus – SP KI Yang → sym. (except urine will be scanty)
    • P/T – nourish SP – warm KI – induce diuresis
    • Rx – Ling Gui Zhu Gan Tang
  2. Qi/Blood stag.
    • pre menses edema, abd. bloating, fatigue, delayed-dark-clotted blood, Dysmenorrhea.
    • Plus – LR Qi stag. sym.
    • P/T – regulate LR Qi – promote blood circ.
    • Rx – Ba Wu Tong  + fu ling, zi lan

 

Emotional Disorders

Diagnosis

  • Around period feel very irritable, angry, sad, depressed, violent mania, anxiety &/or insomnia. Recede after menses stop.

Differentiate

  • Heat invading the Blood – effects the LR HT, causes delirium at night w/ fever.

Etiology

  1. HT Blood deficiency - during menses HT gets weak (Shen)
  2. LR Qi stag. → Fire – pre-menses – Chong goes upward because of the Heat. Fire rising also effects HT Shen.
  3. Phlegm-Fire – LR Heat / SP Phlegm accumulates pre-menses, Heat goes upward along Chong & effects Shen.

Pathogenesis Differentiation & Treatment

  1. HT Blood deficiency
    • during menses – anxiety, lack of concentration, slow mental function, sadness, talk to themselves, delayed-scanty-pale blood.
    • Plus – fatigue, insomnia, palpitation, Blood deficiency sym. T-pale thin coat
    • P/T – nourish Blood – calm Shen
    • Rx – Yang Xin Tang  + long gu, mu li
      Gan Mai Da Zao Tang (mild strength for sadness)
  2. LR Qi stag. → Fire – pre-menses – irritable, anxiety, anger, violent, heavy-red-early periods.
    • Plus – LR Qi stag. sym.
    • P/T – clear LR Heat – sooth LR – calm Shen
    • Rx – 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
    • P/T – clear Phlegm-Heat to calm Shen
    • Rx – Wen Dan Tang  (er chen tang cousin w/ heat herbs)