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PMS (and PMDD) and Chinese Medicine 

Premenstrual syndrome (PMS) is the cyclic recurrence of a wide range of physical or emotional symptoms that typically occur about 5 to 11 days before a woman starts her monthly menstrual cycle. The symptoms usually stop when menstruation begins, or shortly thereafter. Premenstrual dysphoric disorder (PMDD) is a condition marked by severe depression symptoms, irritability, and tension before menstruation. These symptoms are more severe than those seen with PMS. 

Symptoms Main symptoms may be physical, psychological or emotional.

• Physical symptoms: Headache; migraine, backache, heart palpitations, breast tenderness, muscle spasms, swelling of ankles, feet and hands, abdominal pain, abdominal cramps or heaviness, abdominal fullness, feeling gaseous, constipation or diarrhea, nausea, bloating, fluid retention, weight gain, recurrent cold sores, acne flare-ups, decreased coordination, slow, sluggish, lethargic movement , food cravings, less tolerance for noises and lights, fatigue.
• Emotional and psychological changes: anxiety, panic attach, tension, anxiety, depression, irritability, hostility, aggressive behavior, confusion, difficulty concentrating, forgetfulness, poor judgment, decreased self-image, sex drive changes, or low self-esteem.

The symptoms of PMDD are similar to those of PMS, but they are generally much more severe and debilitating. Five or more of the following symptoms must be present:

• Disinterest in daily activities and relationships
• Fatigue or low energy
• Feeling of sadness or hopelessness, possible suicidal thoughts
• Feelings of tension or anxiety
• Feeling out of control
• Food cravings or binge eating
• Mood swings marked by teary periods
• Panic attack
• Persistent irritability or anger that affects other people, trouble concentrating
• Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain
• Sleep disturbances

Causes

PMS and PMDD is due to unbalanced hormonal fluctuations. Even though the exact mechanism is still not known, but it is believed that symptoms of PMS and PMDD occur because progesterone and estrogen, which are produced by the ovaries during menstrual cycle, cause the changes in brain chemicals such as Serotonin (related to depression and carbohydrate cravings), gamma-aminobutyric acid (GABA, related to anxiety and stress), endorphins (related to pain, mood, emotions), and norepinephrine (related to mood).

Conventional treatment

Regular aerobic exercise may help reduce the severity of PMS symptoms; Diet changes can help relieve symptoms such as low-salt diet and avoiding simple sugars, caffeine or alcohol; Nutritional supplements may be recommended such as Vitamin B6, calcium and magnesium; Aspirin, ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs) may be used to relieve pain such as headache, backache, menstrual cramping or breast tenderness; Birth control pills may decrease or increase PMS symptoms; Anti-anxiety drugs or antidepressants may be helpful; Diuretics may help women with severe fluid retention.

Chinese Medicine

Chinese Medicine has been successfully treating PMS and related symptoms for thousands of years. Both acupuncture and herbal medicine give excellent results to address the underlying energetic imbalance that gives rise to all of the symptoms associated with PMS and PMDD. The World Health Organization (WHO) recognizes acupuncture for effectively treating over 43 ailments including PMS in 1979. In 1997, the National Institute of Health (NIH) issued a consensus report that suggested acupuncture is effective in the treatment of menstrual cramps, and other symptoms associated with PMS. Acupuncture can address symptoms naturally, without medication, by restoring balance and harmony, both physically and emotionally. Since then, more and more PMS and PMDD sufferers in the western world are turning to acupuncture and Chinese medicinal herbs for the cure.  

Acupuncture research

The scientists wonder how acupuncture works in PMS patients. Numerous studies have shown that acupuncture regulates unbalanced hormone and stabilizes hormonal fluctuations such as:

• Follicle-stimulating hormone (FSH): FSH was higher in the PMS patients. Aupuncture decreases serum FSH.
• Estradiol 2 (E2): Some PMS symptoms are related to low E2 levels during the late luteal. Acupuncture increases serum E2 level.
• Increases the serum testosterone.
• Serotonin: Serotonin is a neurotransmitter involved in regulating moods, appetite, sleep cycles and various other bodily functions. Low levels of serotonin were present in women suffering from PMS and PMDD. The studies found that acupuncture stimulates the release of serotonin.
  
• Opioid peptides: One theory of PMS is proposed to result from excessive exposure to and/or withdrawal of brain opioid activity during the luteal phase. Acupuncture regulates opioid peptides such as endophins, enkephallins and dynorphins, which are closely involved in reducing the perception of pain and evolving a feeling of contentment. B-endorphin is a natural opiate produced in the body, triggers the productionof endorphins, Dynorphins are released in the spinal cord when electro-stimulation is applied to acupuncture points.
• Norepinephrine (NE): NE is a hormone released in response to stress and lack of NE cyclicity was observed in PMS patients. Acupuncture accelerates the synthesis and release norepinephrine
• GABA: GABA is an amino acid normally produced by the brain. When GABA levels are low, anxiety or panic attacks can occur. The studies show that acupuncture upregulates GABA expression
• Estrogen: Estrogen level is at lowest following ovulation, before menstruation begins, or in the two weeks before a woman has her period. Estrogen prevents serotonin from breaking down so quickly. The study shows that acupuncture stimulates estrogen production.

Etiology & clinical manifestations & treatment principles

PMS can be caused by a variety of reasons and the following are the most commonly seen in the clinical practice.  

qi Stagnation and blood stasis in the liver: symptoms: headache, breast tenderness, depression, irritability or abdominal pain. Treatment Principle: mediate liver, eliminate blood stasis, regulate qi and relieve pain.

yin deficiency in liver and kidney: symptoms:headache and dizziness, anxiety, insomnia, sweating, sore back a/or knees, numb in extremities, or ulceration in the mouth and tongue.  Treatment Principle: nourish kidney, tonify liver, clear heat and reduce fire.

Yang deficiency in spleen and kidney: symptoms: edema of face and extremities, body coldness or fatigue. Treatment Principle: strength spleen, nourish qi, warm yang and kidney.

Deficiency of qi and blood: symptoms: fever or cold, rash, fatigue, lack of energy, feeling lazy, easy to sweat. Treatment Principle; tonify spleen, supplement blood, nourish qi and solidify superficial body

Blood stasis and qi stagnation: symptoms: sore and pain in all over the body, especially low back & knee pain, painful menstruation, scanty period with dark color, purple tongue or petechia  with white, thin coat. Treatment Principle: stimulate blood circulation, soothe meridians, eliminate stasis and relieve pain. 

Acupuncture removes qi blockages, stimulates blood circulation, regulates yin-yang balance. It also provides deep relaxation that helps to calm the mind. Chinese herbs work together with acupuncture to nourishes blood and involved organs, and regulates the flow of qi and blood in the body. Together, they stimulate the body’s natural functions and encourage it to establish optimal balance. Acupuncture can be used alone or can be combined with herbal medicine, cupping or TuiNa, depending on each patient’s symptoms.  

The treatment of PMS with Chinese medicine requires at least 3 cycles, some may recover quicker and some might need longer treatment depending on individual situation and response to acupuncture or herbal medicine.

Morning Sickness and Acupuncture

Morning sickness is also called nausea gravidarum, nausea and vomiting of pregnancy, or pregnancy sickness. Usually, it is present in the early hours of the morning and reduces as the day progresses. The nausea can be mild or induce actual vomiting. In extreme cases that are known as hyperemesis gravidarium, morning sickness is so severe and long-lasting that it can cause weight loss, dehydration and even hospitalization.  

Acupuncture

Acupuncture is considered the most useful form of Chinese Medicine treatment for morning sickness. Various studies show acupuncture provides relief for those who suffer from morning sickness. BBC News Online reports that one Australian study shows acupuncture can ease nausea and vomiting for nearly 600 participants of expectant mothers. The study involved women who were less than 14 weeks pregnant with symptoms of nausea or vomiting. They were given weekly 20-minute sessions of acupuncture for four weeks. Dr. Smith, from the Women's and Children's Hospital and Adelaide University said: "We found that traditional acupuncture reduced nausea throughout the trial with dry retching being reduced from the second week”.  "Women now have an additional option to manage their morning sickness”. "I hope this exciting evidence that complementary therapy does work, will open up new opportunities for funding future research in women's health."  

Acupuncture studies on accupoint P6 

Various studies have documented the use of acupuncture to combat nausea and vomiting, with P6 (PC6), an acupoint located above the wrist on each arm, among the points most commonly tested. The results show the effectiveness of this acupoint on relieving morning sickness. The following are some of those studies. 

Effect of acupressure on nausea and vomiting during pregnancy

In this study, the treatment group comprised 26 women; 25 in the control arm and 24 women were assigned to the placebo arm. The study occurred over a 9-day period. During this time, the treatment group applied acupressure bands to P6 acupressure point on days 4-6 of the study with the placebo group receiving acupressure bands to a sham acupressure point, on the upper side of their wrists. RESULTS AND CONCLUSION: Acupressure would appear to be effective in symptom control, and alleviation and placebo effects in reducing the symptoms of nausea and vomiting during pregnancy. Can Gurkan O et al. Complementary Therapies in Clinical Practice, 14(1):46-52, 2008

Effect of acupressure on nausea and vomiting during pregnancy (NVP)

A randomized, placebo-controlled, pilot study involved 60 women. RESULTS: It is possible to reduce NVP significantly with acupressure at P6 as compared to acupressure at a placebo point or no treatment at all in healthy women with normal pregnancies. Relief from nausea appeared one day after starting treatment in both the P6 and placebo groups but lasted for only six days in the placebo group. The P6 group, however, experienced significantly less nausea after 14 days as compared to the other two groups. CONCLUSION: This study involved 60 healthy women with normal pregnancy and suffering from NVP. According to the results, in healthy women with normal pregnancy it is possible to reduce NVP significantly at P6 as compared to acupressure at a placebo point and to no treatment. Wemtoft E et al. J Reprod Med, 46(9):835-9, 2001 

Manual acupuncture reduces hyperemesis gravidarum

Researchers randomly assigned 33 women to acupuncture treatment at a specific point (P6) on the underside of the wrist, or to sham treatments at a different spot. After two days, all treatments were stopped for an additional two days to allow any effects to dissipate. Then the groups were reversed for two more days of treatment. Before treatment all women were vomiting. On day three, only seven out of seventeen women (41 percent) receiving active acupuncture were still vomiting compared with 12 out of 16 (75 percent) receiving sham treatment. After the active and sham groups were switched, more of the women receiving active treatment stopped vomiting. Women also reported experiencing less nausea. Carlsson CP et al. J Pain Symptom Manage, 20(4):273-79, 2000 

A double-blind cross-over study to evaluate the effectiveness of acupressure at pericardium 6 (P6) in the treatment of early morning sickness (EMS)

In this study, 23 patients were entered into a double-blind cross-over study to evaluate the use of P6 acupressure versus sham acupressure in the treatment of early morning sickness. Sixteen completed the study. P6 acupressure was significantly more effective than the sham acupressure in the relief of nausea as measured by daily visual analogue scales (P = 0.019). Two thirds of the patients preferred acupressure on P6 as compared to the sham point. Bayreuther J at al, Complementary Therapies in Medicine, 2 (2):70-76, 1994 

Morning sickness control in early pregnancy by Neiguan point acupressure

In this study, sixty women in early pregnancy were entered into a randomized, double-blind, cross-over, placebo-controlled trial. During a 12-day period, organized in four steps of 3 days each, the women were divided into two homogeneous groups to test the effectiveness of unilateral and bilateral acupressure. RESULTS: Use of acupressure resulted in a significantly lower frequency of morning sickness compared with placebo treatment. More than a 60% positive effect was found with unilateral and bilateral acupressure, compared with an approximately 30% positive effect of placebo acupressure. Changing from unilateral to bilateral pressure on the Neiguan point caused no significant statistical difference. No noteworthy side effects occurred. CONCLUSION: Acupressure on the Neiguan point relieves morning sickness. de Aloysio D et al. Obstetrics & Gynecology, 80(5):852-4, 1992 

Belfast experience with P6 acupuncture antiemesis

In a strictly controlled clinical situation, (postoperative sickness) where variables were reduced to a minimum, it was possible to demonstrate an effective prophylactic antiemetic action of P6 (Neiguan) acupuncture. Manual and electrical invasive (needling) stimulation of this point were equally effective. Non-invasive stimulation (transcutaneous electrical or pressure) was effective in the early postoperative period, but the effect did not last as long as for invasive acupuncture--although it was as good as standard antiemetics. Stimulation of a "dummy" acupuncture point was ineffective as was administration of the acupuncture after the emetic stimulus (opioid). This effect can be blocked by local anaesthesia at the P6 point. Acupressure on P6 is moderately effective in reducing morning sickness, but here there is more of a psychological element as pressure on a "dummy" point gives some alleviation of symptoms. Given in conjunction with standard antiemetics, P6 acupuncture is a useful adjuvant in reducing sickness after cancer chemotherapy. This effect can be prolonged for 24 hours by acupressure. Dundee J W. Ulster Medical Journal, 59(1):63-70, 1990 

Acupressure therapy for morning sickness

A prospective, controlled clinical trial examined the efficacy of acupressure therapy for morning sickness, using a two groups, random assignment, crossover design. Subjects in Group 1 (N = 8) used acupressure wristbands for five days, followed by five days without therapy. Subjects in Group 2 (N = 8) had no therapy for five days, followed by five days use of wristbands. The Multiple Affect Adjective Checklist and Sickness Impact Profile were used, and extent of nausea was assessed at baseline, day five, and day ten. Use of acupressure wristbands relieved morning sickness for 12 of 16 subjects. Acupressure therapy resulted in statistically significant reductions in anxiety, depression, behavioral dysfunction, and nausea. Limitations of the study and suggestions for future research are presented. Hyde E.  Journal of Nurse-Midwifery, 34(4):171-8, 1989

P6 acupressure reduces morning sickness 

A prospective study was designed to test the efficacy of pressure at the P6 (Neiguan) acupuncture point, in preventing morning sickness. Three groups of patients in early pregnancy recorded the severity and frequency of sickness over a period of 4 consecutive days following daily pressure at P6 point, pressure at a point near the right elbow and with no treatment. Troublesome sickness was significantly less in both the genuine (23/119) and dummy (41/112) pressure groups as compared with the control series (67/119). When the data are adversely 'weighted' to compensate for the lower incidence of fully completed returns in the active treatment groups, only the P6 group show a significant reduction in sickness. No side effects occurred in either group and while anticipation of benefit may offer a partial explanation for the findings, pressure at the Neiguan point appears to have a specific therapeutic effect. Dundee J W et al. Journal of the Royal Society of Medicine, 81(8):456-7, 1988. 

Etiology & Classifications & principle of treatment

In Chinese Medicine, when a woman becomes pregnant, the vital substances of her body such as the essence, blood and kidney qi are collected together to form the new life within her body. This change often causes an obstruction or stagnation in one of major meridians (Chongmai) that regulate the blood and qi of the body, which leads to rebellious stomach qi rising up and causing nausea. Because of this pathology, several patterns of disharmony can occur in the body, such as qi imbalance between liver and stomach, qi deficiency of spleen and stomach, phlegm/damp accumulation, or qi and yin deficiency.  

A single acupoint P6 is effective in relieving the symptoms of morning sickness in the various clinical studies. However, in clinic practice, multiple acupoints are commonly used according to individual situation and are much more effective than single acupoint. Depending on your specific presentation of symptoms, the Chinese Medicine practitioner will select the most effective points to relieve the nausea and vomiting.

Disharmony between Liver and Stomach

Sign and symptoms: vomit bitter fluids, stressful and hypochondriac fullness/pain

Principle of treatment: soothe liver, harmonize stomach and descend qi

Spleen Stomach deficiency

Sign and symptoms: vomit clear fluids, poor appetite and digestion, fatigue, loose stools and pale complexion

Principle of treatment: tonify stomach and spleen, descend stomach qi and regulate Chongmai

Phlegm-Damp accumulation

Sign and symptoms: vomit sputum-like or sticky fluids, sweet, sticky mouth, no appetite, palpitation chest/abdominal fullness or bloating

Principle of treatment: transform phlegm, resolve damp, harmonize stomach and spleen, and regulate Chongmai

qi and yin deficiency

Sign and symptoms: vomit with blood strips, low spirit, skinny, tired extremities, fever, thirsty, dry lips and tongue, scanty urine, constipation 

Principle of treatment: tonify qi, nourish yin, regulate stomach and stop vomiting 

Since the nature of morning sickness (nausea and vomiting), herbal medicine is rarely used. Acupuncture, acupressure, TuiNa, and some other Chinese medicine modalities can be used.

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