How TCM Views Premenstrual Syndrome (PMS)

How TCM Views the Development of Premenstrual Syndrome

From a TCM viewpoint, PMS is not complicated.

Every month, a woman's essence (acquired and congenital) will gradually be enriched to a particular level by the kidneys; the kidneys will then produce a substance called tian gui. Under the action of this substance and guided by the liver, the Conception Vessel becomes exuberant and flushed with abundant qi (vital energy) and blood. When the excessive qi and blood in the vessels become overflowing, they drift into the uterus and become menses. This is considered a normal healthy process.

Emotional strain, improper diet and overwork are common incidences of modern life. TCM believes that these unhealthy lifestyle habits will eventually produce functional disorders of organs. Anger, frustration and anxiety can easily interfere with the flow of blood and qi, which gives rise to a state called "stagnation of liver-qi." This becomes the most important factor for developing PMS. Excessive consumption of cold and greasy foods damages the spleen and leads to the formation of phlegm and dampness evils. Overwork not only exhausts kidney essence, but also flares up the fire inside the heart and liver. In general, these factors also contribute to the stagnation of liver-qi and kidney-yin deficiency, which are the predisposing conditions necessary for PMS to occur.

The Liver Meridian (blue) and the Stomach Meridian (red) run through the breast, chest and abdomen. Development of PMS from a TCM perspective.

Prior to menstruation, the body's blood is programmed to flush the Conception and Thoroughfare Vessels. In general before menstruation, the uneven blood distribution inside the body deteriorates kidney and liver functions as well as that of other organs. Accumulated evils (mainly led by fire evils) take advantage of the situation to cause various pathological changes, which are responsible for the symptoms observed in PMS. After menstruation, when the body's blood redistributes and the organs resume their normal functions, the body regains its power to check the excessive evils and the PMS symptoms gradually disappear. PMS is cyclical in nature as the process starts again when the Conception and Thoroughfare Vessels become flushed with blood before the next menses.

As mentioned, symptoms of PMS vary from woman to woman and cycle to cycle. The more debilitating symptoms are differentiated according to major complaints and associated syndrome patterns.

Table (1) summarizes commonly seen PMS complaints and their associated deficiency patterns from a TCM perspective.

Major Complaints TCM Deficiency Patterns Mood swings Heart-blood deficiency Fire accumulation in the liver meridian Phlegm and fire harassing upwards Breast tenderness Liver-qi stagnation Stomach deficiency and phlegm stagnation Headache Blood and qi deficiency Yin deficiency and hyperactive liver Blood stasis obstruction Phlegm and dampness obstruction in the middle burner Edema Spleen deficiency Kidney deficiency Qi stagnation Oral sores Hyperactive fire and yin deficiency Heat accumulation in the stomach Skin rash Blood deficiency Wind-heat accumulation