Pre Menstrual Syndrome

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 ↓ → 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 ↓ - 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) ↓ - 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

LR KI Yin ↓ 
• tidal fever during last few days of bleeding, scanty blood
• Plus – Yin ↓ sym.  T-red-scanty coat  P-thin-rapid
• P/T – nourish Yin – clear ? heat
• Rx – Liang Di Tang
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
Qi (blood) ↓
• 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
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

LR Qi stag. – LR effects nipple – if the LR attacks the ST the breasts are effected.  Qi is not able to flow smoothly.
LR KI Yin ↓ - breasts are effected during menses, blood is ↓ - 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

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
LR KI Yin ↓ - 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 can’t raise to head ? headache

1. Blood ↓ - can’t 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 can’t 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

Blood ↓
• dull headache during last days of bleeding, dizziness, scanty menses, LR blood ↓ top of head.
• Plus – Blood ↓ 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
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
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 Aching

Diagnosis

 

Body aching around menses.

Etiology

 
Blood ↓ -  aching last few days of bleeding, body simply lacks nourishment.

• Blood Stasis – pre-menstrual body pains when stagnation blocks meridians.

Pathogenesis Differentiation & Treatment

 
Blood ?

• last few days of bleeding ? numbness/pain/weakness in limbs (mostly lower), scanty bleeding
• Plus – Blood ↓ sym.  T-pale-thin  
• P-thin-uneven
• P/T – nourish & harmonize blood to lube tendons/muscles
• Rx – Dang Gui Bu Xue Tang
• 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 ↓ is the most common pattern.

WM

 

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

Differentiate

 

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

 
SP Qi ↓ - 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.

• KI Qi ↓ - 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

 
SP Qi ↓

• pre/during/last days = soft stools, heavy-pale-thin bleeding.
• Plus – SP Qi ↓ 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)
• KI Qi ↓
  • during/last days = diarrhea (can be 5 am), thin-pale bleeding.
  • Plus – KI Qi ↓ 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

 
LR Fire –  Stagnated LR causes fire, LR supplies Blood to Chong Mai, Fire causes Chong to rise causing bleeding.

• ST Heat – diet – spicy food, alcohol etc. causes Heat to rise w/ Chong Mai.
• KI LU Yin ? - ? Fire ? Chong travels upward w/ KI meridian, pushes blood out of vessels.

Pathogenesis Differentiation & Treatment

 
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
• 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
• 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.

Differentiate

 

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

Etiology

 
ST Heat

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

Pathogenesis Differentiation & Treatment

 
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)
• HT Yin ↓ → 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 ↓)

Etiology

 
Blood ↓ - produces internal Wind – during menses blood is more ↓ , itchyness & eruptions occur.

• External Wind – Qi & Blood are used in great quantity for menstruation, if person had preexisting Heat patterns ? mix w/ Wind/Heat.

Pathogenesis Differentiation & Treatment

 
Blood ↓

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
• 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.

Differentiate

 

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

 
Blood ↓ - long term bleeding or SP ↓ - can’t produce enough blood, during menses blood goes down to lower Jiao ? not enough can go up to head.

• Yin ↓ → hyper LR Yang – Yin ↓ in lower Jiao causes relative Yang ↑ , Yang rises causing Wind (dizziness).
• SP ↓ - 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 ↓, Qi is used to move menses in Lower Jiao).

Pathogenesis Differentiation & Treatment

 
Blood ↓

• during/post menses dizziness, maybe delayed period.
• Plus – LR HT Blood ↓ sym.  T-pale, thin  P-weak
• P/T – nourish HT SP for Qi/Blood
• Rx – Gui Pi Tang + gou qi zi, he shou wu
• Yin ↓ → 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)
• SP ↓ 
  • produces Phlegm-Damp – pre/during menses dizziness & heavy head, vaginal leukorrhea, T-white greasy coat  P-soft (damp) slippery (phlegm)
  • Plus – SP ↓/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.
• ↓ - SP KI, mostly in morning, during/after menses, pitting.

Differentiate

 

check kidney/renal function (WM).

Etiology

 
SP KI ↓ - can’t control T&T or the gates.

• Qi/Blood stag. – Qi can’t move water transformation in Lower Jiao (abd. bloating)

Pathogenesis Differentiation & Treatment

 
SP KI Yang ↓

• 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
• 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

 
HT Blood ↓ - during menses HT gets weak (Shen)

• LR Qi stag. → Fire – pre-menses – Chong goes upward because of the Heat.  Fire rising also effects HT Shen.
• Phlegm-Fire – LR Heat / SP Phlegm accumulates pre-menses, Heat goes upward along Chong & effects Shen.

Pathogenesis Differentiation & Treatment

 
HT Blood ↓

• during menses – anxiety, lack of concentration, slow mental function, sadness, talk to themselves, delayed-scanty-pale blood.
• Plus – fatigue, insomnia, palpitation, Blood ↓ 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)
• 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
• 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) 

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