Diagnosis of Premenstrual Syndrome (PMS) from a Chinese Medicine Perspective

TCM Diagnosis of Premenstrual Syndrome (PMS)

Both Western and Chinese medicine have similar diagnoses for Premenstrual Syndrome (PMS) according to different emotional and/or physical symptoms occurring before or after the menstrual period.

However, TCM employs a holistic approach, as it is common for individuals with PMS to have accompanying menstrual or gynecological problems. Physicians are not only concerned about the premenstrual phase, they also try to discover any irregular manifestations during the whole menstrual cycle as well. Symptoms and signs of PMS are elicted during the examination using the four diagnostic techniques, and then they are grouped together to form a particular syndrome pattern. This consultation procedure is known as syndrome differentiation.

1. Mood Swings

This is mainly caused by liver-qi stagnation, which inhibits the spleen from transforming food into nutrient essence, leading to an inadequate supply of blood and qi (vital energy). When this affects the heart and spirit, they malfunction. In some cases, severe liver-qi stagnation makes the body create fire evils or phlegm. These evils easily accumulate in and obstruct the Liver Meridian or they can accumulate in head region orifices causing emotional problems.

Deficiency Pattern Symptoms Heart-blood deficiency Absent-mindedness, restlessness, sadness, insomnia, fatigue, inert facial expression, heart palpitations or a fearful throbbing sensation, delayed menses with scanty and thin flow. The tongue is pale; the pulse is thready. Fire accumulation in the liver meridian Irritability, vexation or depression, oppression in the chest and rib sides, dizziness, poor appetite, headache, throat dryness, a bitter taste in the mouth. The tongue is red with yellowish fur; the pulse is taut and rapid. Phlegm and fire harassing upwards Mania, restlessness, incoherent speech, headache, insomnia, vexation, red face, bloodshot eyes, chest oppression and poor appetite. The tongue is red with yellowish thick greasy fur; the pulse is rolling, rapid and surging.
2. Breast Tenderness

The Stomach Meridian runs through the nipple and the Liver Meridian runs along the breast. During the premenstrual period, the body's blood and qi (vital energy) tend to gather in the Thoroughfare Vessel and lead to a relative lack of supply in the other meridians. When stagnation or obstruction occurs in the Stomach and Liver Meridians, the breasts will be affected.

Deficiency Pattern Symptoms Liver-qi stagnation Itchy nipples, distending or swelling pain in the breasts. In severe cases, the discomfort is worse when touched or pressed. Accompanying lumps or nodules may be present. The individual usually presents with irritability, depression, a tendency to sigh, a suffocating feeling and oppression in the chest and ribs. The tongue is coated by thin white fur; the pulse is taut. Stomach deficiency and phlegm stagnation Itchy nipples, tender, swollen or painful breasts. The individual usually has feelings of chest tightness, poor appetite, food cravings, excessive sticky vaginal discharge and scanty menses. The tongue is bulky and pale with greasy and white fur; the pulse is slow and rolling.
3. Headache

This happens when the abundant qi (vital energy) in the Thoroughfare Vessel brings accumulated evils such as phlegm or fire evils upwards and disturbs the head region. In other cases, the symptom is caused by deficiencies of fundamental substances like blood, qi (vital energy) or essence, which lead to inadequate nourishment of the head.

Deficiency Pattern Symptoms Phlegm and dampness obstruction in the middle burner Headache, dizziness, obesity, chest oppression, pale complexion and nausea. Individuals may have excessive sticky vaginal discharge and the menses are light and scanty. The tongue is bulky and pale with white greasy fur; the pulse is rolling. Blood stasis obstruction Severe headache, stabbing pain fixed in one location. Individuals may have pain in the lower abdomen that is worse when pressed. The menses are dark purple with clots. The tongue is dark red and there may be bruised spots on the tip; the pulse is fine and taut or hesitant and taut. Deficiencies of blood and qi Continuous headache, dizziness, pale complexion, shortness of breath, heart palpitations, insomnia, lethargy and general weakness. Individuals usually have scanty and light menses. The tongue is pale and coated with white thin fur; the pulse is thready and weak. Yin deficiency and hyperactive liver Headache or pulling pain on the crown of the head, dizziness, irritability, easily annoyed, throat dryness, a bitter taste in the mouth, soreness and weakness in the lumbar and knee regions and vexing heat in the palms and soles. Individuals may have scanty menses, but, they are bright red in color. The tongue is red with little fur; the pulse is taut and thready and rapid.
4. Edema

According to TCM theory, the spleen and kidneys work together to control water metabolism. Overwork, stress and improper diet are the usual causes for spleen and kidney dysfunction. In the premenstrual period, these organs are already overloaded, thus excessive water can easily accumulate in the body. Additionally, liver-qi stagnation causes the body's blood and qi (vital energy) flows to be sluggish, and therefore, distribution of water inside the body is affected.

Deficiency Pattern Symptoms Spleen deficiency Puffy face and limbs, poor appetite, loose stools, bloating, sleepiness, limb heaviness, scanty urine, or the presence of excessive menses. The tongue is pale red and covered by a white fur; the pulse is slow and hesitant. Kidney deficiency Puffy face and limbs (in particular the lower limbs), dizziness, ear ringing, discomfort in the lumbar and knee regions, limbs coldness or diarrhea. Individuals may have delayed and thin menses. The tongue is pale and covered by a white fur; the pulse is deep and slow. Qi stagnation Puffy face and limbs and distending pain in the lower abdomen. Individuals can have non-smooth and scanty menses. The tongue is pale red and covered by thin white fur; the pulse is taut and rolling.
5. Oral Sores

TCM believes unhealthy lifestyle habits such as overwork and improper sleeping patterns tend to exhaust excessive yin fluids and create virtual fire inside the body. This virtual fire leads to heart disharmony and causes oral ulcers. In other cases, over-consumption of greasy, deep-fried and spicy foods will cause an over-heated stomach, in which oral ulcers are 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.

Deficiency Pattern Symptoms Hyperactive fire and yin deficiency Sores or ulcers in the oral cavity, dryness in the mouth and throat, vexing heat in the chest, palms and soles, disturbed sleep and scanty and yellowish urine. The tongue is red, particularly on the tip and is covered by a thin yellowish fur. The pulse is thready and rapid. Heat accumulation in the stomach Painful oral ulcers, bad breath, thirst with preference for cold drinks, good appetite, constipation and yellowish urine. The tongue is red covered by a thick yellow fur; the pulse is rolling and rapid.
6. Skin Rash

In TCM, skin attacked by wind evils becomes itchy. Individuals may have skin eruptions as a main complaint in PMS. This 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 create wind evils internally.

Deficiency Pattern Symptoms Blood deficiency Lumpy skin rash that is very itchy and worse at night. Other general symptoms are skin dryness, a lusterless and pale complexion, fatigue, heart palpitations and dizziness. The menses are scant and light red. The tongue is pale; the pulse is thready. Wind-heat accumulation in the skin Red raised rash that is very itchy and worse with warm temperatures. Other general symptoms are mouth dryness, thirst, vexation, constipation and dark-yellowish urine. The tongue is red with yellowish fur; the pulse is floating and rapid.
According to TCM experiences, PMS symptoms vary greatly frome person to person. The above typical syndrome patterns may not appear alone. In general, there is usually liver disharmony accompanied by one or two other disharmony patterns in each case. Therefore, an experienced physician is needed to ensure an accurate diagnosis.