TCM Diagnosis of Premenstrual Syndrome (PMS)
Premenstrual syndrome (PMS) is a diagnosis of Western Medicine, although Traditional Chinese Medicine (TCM) uses this name, but its methods on diagnosis and treatment are different.
PMS usually presents a group of symptoms that involve emotional, nervous, vascular and endocrine disturbances. PMS symptoms occur within 7~14 day before menstruation, and then fade out gradually when menstruation comes. The occurrence is regular and cyclical along with periods. There is no gynecological test for PMS diagnosis.
TCM physicians not only concern about the premenstrual phase for PMS individuals, they also try to discover any irregular manifestation during the whole menstrual cycle. The consultation procedure is known as syndrome differentiation. Physicians rely on four examination skills to collect the clinical date, other influential factors such as medical history, age, constitution and living habits are taken into account too. The information is used to analysis the location, pathological nature and prognosis of a condition. Generally, a syndrome pattern (a group of symptoms and signs) is concluded as diagnosis.
Individuals present with absent-mindedness, restlessness, sadness, insomnia, listlessness, a dull facial color, forgetfulness, palpitations, fatigue, reluctant to speak. There may also have delayed periods with scanty and thin menses flow. On examination, the tongue is pale; the pulse is thready.
Individuals present with irritability, restlessness, dizziness, stuffiness in the chest and rib sides, poor appetite, throat dryness, a bitter taste in the mouth, and even early periods with heavy and dark red menses flow. On examination, the tongue is red with yellowish fur; the pulse is taut and rapid.
Individuals present with anxiety, restlessness, incoherent speech, headache, insomnia, chest oppression, poor appetite and constipation. On examination, the tongue is red with yellowish thick greasy fur; the pulse is rolling, rapid and forceful.
Individuals present with itchy and pain nipples, or distending pain in the breasts, the pain is worse when touched or pressed, and may find lumps or nodules too. There are also irritability, a tendency to sigh, stuffiness in the chest and rib sides, distending pain in the lower abdomen, non-smooth menses flow that is dark red color or clotted. On examination, the tongue is dark red color and coated by thin white fur; the pulse is taut.
Individuals present with itchy painful nipples, or distending pain in the breasts; in severe cases, the pain is so unbearable that can’t be covered clothing. Other accompanied symptoms include chest tightness, poor appetite, excess throat discharges, excessive sticky vaginal discharges, and scanty thin menses. On examination, the tongue is bulky and pale with greasy and white fur; the pulse is slow and rolling.
Individuals present with dull headache, dizziness, paleness, heart palpitations, insomnia, mental fatigue and general weakness. Individuals may have scanty and light menses. On examination, the tongue is pale and coated with white thin fur; the pulse is thready.
Individuals present with distending pain in the forehead, even may have dragging pain on the head crown sometimes. They also experienced dizziness, irritability, throat dryness, and a bitter taste in the mouth; menses flow is scanty and is bright red in color. On examination, the tongue is red with yellow fur; the pulse is taut or thready and taut.
Individuals present with severe headache, stabbing or throbbing pain fixed in one location. There may have pain in the lower abdomen that is worse when pressed; non-smooth menses flow that is scanty and dark purple or clotted. On examination, the tongue is dark red and may have purple spots; the pulse is thready and hesitant, or taut and hesitant.
Individuals present with distending pain or heaviness in the head, dizziness, obesity, poor appetite, nausea, chest and abdominal distention, general weakness, drowsiness, and frequent belching. Individuals may also have excessive sticky vaginal discharges and the menses are light and scanty. On examination, the tongue is bulky and pale with white greasy fur; the pulse is rolling.
Individuals present with puffy face and limbs, gastric distention, poor appetite, loose stools, bloating, mental fatigue, limb heaviness, scanty urine, or the presence of excessive light menses. On examination, the tongue is pale and covered by a white or greasy fur; the pulse is slow.
Individuals present with puffy face and limbs (in particular the lower limbs), dizziness, ear ringing, soreness in the lumbar and knee regions, cold feeling in lumbar and abdomen, poor appetite, and loose stools. Individuals may also have excessive thin menses. On examination, the tongue is pale and bulky, and the coating is white and glossy; the pulse is deep and weak.
Individuals present with general puffiness, gastric and rib cage distention, or distending pain in the lower abdomen. Some individuals may have non-smooth and scanty menses flow that is dark red or clotted. On examination, the tongue is pale and covered by thin white fur; the pulse is taut and rolling.
Individuals present with sores or painful ulcers in the oral cavity, dryness in the mouth and throat, vexing heat in the chest, palms and soles, a thin physique, disturbed sleep, scanty and yellowish urine. On examination, the tongue is red particularly on the tip and is covered by a thin yellowish fur; the pulse is thready and rapid.
Individuals present with painful oral ulcers on the tongue or in the oral cavity, hot bad breath, thirst with preference for cold drinks, good appetite, constipation and yellowish urine. On examination, the tongue is red and covered by a thick yellow fur; the pulse is rolling and rapid.
Lumpy skin rashes that are pale color, very itchy and worse at night. Other usual symptoms include skin dryness, a lusterless and pale complexion, restlessness, and poor sleep. There may have delayed periods, and the menses are scant and light red. On examination, the tongue is pale; the pulse is thready.
Red raised rashes that are very itchy and worse with warm temperatures. Other usual symptoms include mouth dryness, thirst, constipation and yellowish urine. On examination, the tongue is red with yellowish fur; the pulse is floating and rapid.
1. Mood Swings
Mood swings in premenstrual phase is mainly associated with liver qi stagnation. The stagnated qi can easily transform into fire and make the flowing blood become over-heated, when the over-heated blood accumulates along the Liver Meridian and irritates the orifices in the head, emotional problems will occur such as irritability, sadness, depressed, and insomnia. In some cases, it is associated with over-thinking damaged spleen functioning, this leads to a decline in the production of nutrient essence, there will be inadequate blood and qi nourishing heart and spirit, or even making the body create phlegm. When the phlegm and fire further combined and up-flared in the head region, emotional problems occur too. The common disharmony patterns for mood swings in premenstrual phase are below:
Heart blood deficiency
Individuals present with absent-mindedness, restlessness, sadness, insomnia, listlessness, a dull facial color, forgetfulness, palpitations, fatigue, reluctant to speak. There may also have delayed periods with scanty and thin menses flow. On examination, the tongue is pale; the pulse is thready.
Fire accumulated in liver meridian
Individuals present with irritability, restlessness, dizziness, stuffiness in the chest and rib sides, poor appetite, throat dryness, a bitter taste in the mouth, and even early periods with heavy and dark red menses flow. On examination, the tongue is red with yellowish fur; the pulse is taut and rapid.
Phlegm and fire stirring upward
Individuals present with anxiety, restlessness, incoherent speech, headache, insomnia, chest oppression, poor appetite and constipation. On examination, the tongue is red with yellowish thick greasy fur; the pulse is rolling, rapid and forceful.
2. Breast Tenderness
The Stomach Meridian runs through the nipples and the Liver Meridian runs along the breasts. During the premenstrual phase, the body's blood and qi (vital energy) tend to gather in the Thoroughfare Vessel, which leads to a relative lack of supply in the other meridians. When disturbances such as qi stagnation occurs in the liver or dampness and phlegm obstruct the Stomach Meridian, the breasts can easily be affected. The common disharmony patterns for PMS breast tenderness are below:
Liver qi stagnation
Individuals present with itchy and pain nipples, or distending pain in the breasts, the pain is worse when touched or pressed, and may find lumps or nodules too. There are also irritability, a tendency to sigh, stuffiness in the chest and rib sides, distending pain in the lower abdomen, non-smooth menses flow that is dark red color or clotted. On examination, the tongue is dark red color and coated by thin white fur; the pulse is taut.
Stomach deficiency and phlegm accumulation
Individuals present with itchy painful nipples, or distending pain in the breasts; in severe cases, the pain is so unbearable that can’t be covered clothing. Other accompanied symptoms include chest tightness, poor appetite, excess throat discharges, excessive sticky vaginal discharges, and scanty thin menses. On examination, the tongue is bulky and pale with greasy and white fur; the pulse is slow and rolling.
3. Headache
Headache in premenstrual phase happens when the abundant qi (vital energy) in the Thoroughfare Vessel brings accumulated evils such as phlegm or fire evils upwards and disturbs orifices in the head region. In other cases, the symptom is caused by deficiencies of fundamental substances like blood, qi or essence, which lead to inadequate nourishment of the orifices. The common disharmony patterns for PMS headache are below:
Deficiency of blood and qi
Individuals present with dull headache, dizziness, paleness, heart palpitations, insomnia, mental fatigue and general weakness. Individuals may have scanty and light menses. On examination, the tongue is pale and coated with white thin fur; the pulse is thready.
Yin deficiency and hyperactive liver
Individuals present with distending pain in the forehead, even may have dragging pain on the head crown sometimes. They also experienced dizziness, irritability, throat dryness, and a bitter taste in the mouth; menses flow is scanty and is bright red in color. On examination, the tongue is red with yellow fur; the pulse is taut or thready and taut.
Blood stasis obstruction
Individuals present with severe headache, stabbing or throbbing pain fixed in one location. There may have pain in the lower abdomen that is worse when pressed; non-smooth menses flow that is scanty and dark purple or clotted. On examination, the tongue is dark red and may have purple spots; the pulse is thready and hesitant, or taut and hesitant.
Phlegm and dampness obstructed in middle burner
Individuals present with distending pain or heaviness in the head, dizziness, obesity, poor appetite, nausea, chest and abdominal distention, general weakness, drowsiness, and frequent belching. Individuals may also have excessive sticky vaginal discharges and the menses are light and scanty. On examination, the tongue is bulky and pale with white greasy fur; the pulse is rolling.
4. Puffiness
According to TCM theory, spleen and kidney systems work together to regulate body fluid production and distribution throughout the body. Overwork, stress and improper diet are the usual causes for spleen and kidney dysfunctions. In the premenstrual period, when these organs are further overloaded, the body fluid metabolism will be disturbed, leading to signs like puffiness. In addition, liver qi stagnation causes blood and qi (vital energy) flows to be sluggish, which can cause ineffective body fluid distribution too. In TCM experiences, puffiness usually occurs in middle age women and menopause. The common disharmony patterns for PMS puffiness are below:
Spleen deficiency
Individuals present with puffy face and limbs, gastric distention, poor appetite, loose stools, bloating, mental fatigue, limb heaviness, scanty urine, or the presence of excessive light menses. On examination, the tongue is pale and covered by a white or greasy fur; the pulse is slow.
Kidney deficiency
Individuals present with puffy face and limbs (in particular the lower limbs), dizziness, ear ringing, soreness in the lumbar and knee regions, cold feeling in lumbar and abdomen, poor appetite, and loose stools. Individuals may also have excessive thin menses. On examination, the tongue is pale and bulky, and the coating is white and glossy; the pulse is deep and weak.
Qi stagnation
Individuals present with general puffiness, gastric and rib cage distention, or distending pain in the lower abdomen. Some individuals may have non-smooth and scanty menses flow that is dark red or clotted. On examination, the tongue is pale and covered by thin white fur; the pulse is taut and rolling.
5. Mouth Sores
TCM believes unhealthy living habits such as overwork and improper sleeping patterns tend to exhaust excessive yin fluids and create virtual fire inside the body. This virtual fire can easily lead to heart disharmony and causes mouth sores. In other cases, over-consumption of greasy, deep-fried and spicy foods will cause an over-heated stomach, in which mouth sores is a symptom of this condition. For some women, these heat syndromes can easily be triggered during the premenstrual period as yin elements are further consumed. The common disharmony patterns for PMS mouth sores are below:
Virtual fire burns mouth
Individuals present with sores or painful ulcers in the oral cavity, dryness in the mouth and throat, vexing heat in the chest, palms and soles, a thin physique, disturbed sleep, scanty and yellowish urine. On examination, the tongue is red particularly on the tip and is covered by a thin yellowish fur; the pulse is thready and rapid.
Heat accumulated in stomach
Individuals present with painful oral ulcers on the tongue or in the oral cavity, hot bad breath, thirst with preference for cold drinks, good appetite, constipation and yellowish urine. On examination, the tongue is red and covered by a thick yellow fur; the pulse is rolling and rapid.
6. Hives (nettle rash / urticaria)
It is common to have hives as a main complaint in PMS. Hives (urticaria) refer to a skin reaction that develops red and itchy rashes on the body surface. The skin rashes vary in sizes, they appear and fade repeatedly as the reaction runs its course. In TCM, skin attacked by wind evils becomes itchy. Hives may arise from wind evils coming from either endogenous or exogenous sources. Exogenous wind comes from an environmental invasion while endogenous wind can be due to exhaustion of yin fluids that cause dryness of the blood and generate wind evils internally. The common disharmony patterns for PMS hives are below:
Blood deficiency
Lumpy skin rashes that are pale color, very itchy and worse at night. Other usual symptoms include skin dryness, a lusterless and pale complexion, restlessness, and poor sleep. There may have delayed periods, and the menses are scant and light red. On examination, the tongue is pale; the pulse is thready.
Wind-heat accumulated in skin
Red raised rashes that are very itchy and worse with warm temperatures. Other usual symptoms include mouth dryness, thirst, constipation and yellowish urine. On examination, the tongue is red with yellowish fur; the pulse is floating and rapid.
According to TCM experiences, PMS symptoms vary greatly from person to person, and even period to period. Therefore, the above syndrome patterns may not appear alone, PMS individuals often present in a mixed form. Nevertheless, liver disharmony is always involved, it is likely to combine with one or two other disharmony patterns in each case. That is way a thorough consultation by experienced physician is needed, this ensures accurate diagnosis and desirable results.
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