Pre-Menstrual+Syndrome+(PMS)

see also Premenstrual Dysphoric Disorder (Xue Ku)

//Western Diagnosis:// recurrent sns & sxs usually 1-2 weeks before menses

Etiology
1. imbalances in body biochemistry - estrogen and progesterone are related. if both are eliminated PMS symptoms will not occur. Serotonin is also involved, levels fall dramatically after menstruation. What are the correlates between estrogen & serotonin? If tryptophan [seritonin precursor] is taken away then PMS symptoms tend to become worse. 2. Estrogen & Progesterone fluctuations 3. excess aldosterone 4. changes in CHO metabolism

Signs & Symptoms
a. anxiety, tension, irritability, depression, mood swings, fatigue, HA, fluid retention, mastalgia, insomnia, food cravings b. broad range of sxs and timings: i. almost any sx can occur at any time regularly during cycle c. a few hours to 14 days before onset of menses d. usually cease within a few hours of onset of menses but may continue through and after
 * General**

a. high estrogen, low Progesterone b. anxiety, irritability, mood swings, nervous tension a. low prostaglandins, esp. PGE1 b. Carb cravings, inc appetite, HA, fatigue, dizziness, syncope, palpitations a. low estrogen, high progesterone b. depression, crying, forgetfulness, confusion, insomnia a. inc aldosterone b. also inc estrogen c. fluid retention, weight gain, abdominal bloating, breast tenderness
 * PMS-A [A=anxiety]**
 * PMS-C [C=carbohydrates]**
 * PMS-D [D=depression]**
 * PMS-H [H=hydration]**

Diagnosis
1. symptoms chart 2. may take a few months to totally sort out 3. urinary E

Treatment
1. stress reduction 2. hormonal manipulation: progesterone cream 3. diet ---increase complex carbohydrates ---low fat ---dec sat fat: arachidonic acid from animal fats stim PGF2 which dec P ---inc fiber to bind estrogen [very important] ---decrease salt, sugar, caffeine [caffiene is important to eliminate/cut down] 4. Evening primrose oil, black currant oil, flax oil ---increase PGE1 ---3-4 gm evening primrose oil daily 5. Magnesium 400 mg/d [particularly w/ cramping] 6. vitamin B6 100 mg TID 7. B complex 8. Treat liver 9. exercise

Others: Soy - phytoestrogen - not actuactly estrogen but similar substance that seems to affect the receptor sites of the cells. seem to be homeostatic depending on what the bodies levels are. some negative effects: binds thyroid receptors so active hormone is not being converted. [avoid if you have a thyroid problem]

Vitex agnus carta - studies are good on this. seems to change hypothalamic releasing factors (LH, FSH)

Black Cohosh (cimicifuga)

=
======================================================================================== //TCM Pathology//

Etiology and Pathogenesis
Heart Blood Deficiency Liver Qi Stagnation Upward Disturbance of Phlegm Fire

Liver Blood Deficiency Liver & Kidney Yin Deficiency Spleen & Kidney Yang Deficiency

=Differential Diagnosis= -Tao He Cheng Qi Tang -Xiao Chai Hu Tang -Acupuncture: LR-14 (Qi Men)
 * Heat entering the uterus**

-Bai He Di Huang Tang -Bai He Zhi Mu Tang
 * Bai He Disease**

Heart Blood Deficiency
Vexation, dementia, mental trance, or incoherence, sadness without reason before periods, pale red in color Lassitude, lower spirit, pale lusterless complexion, insomnia, forgetfulness, palpitation, disinclination to talk [Zhi Gan Cao (10g.), Xiao Mai (15-30g.), Da Zao (6g.)] + [Huang Qi (10g.), Fu Ling (10g.), Fu Shen (10g.), Dang Gui (10g.), Chuan Xiong (8g.), Zhi Gan Cao (6g.), Ban Xia Qu (8g.), Bai Zi Ren (10g.), Yuan Zhi (8g.), Wu Wei Zi (8g.), Ren Shen (8g.), Rou Gui (6g.), Suan Zao Ren (10g.)]
 * Tongue:** pale
 * Pulse:** Fine
 * Treatment Principles:** Nourish Blood, calm the spirit
 * Acupuncture Treatment: HT-7, SP-6, BL-15, BL-14**, PC-7, ST-36, BL-20, LR-3, LR-8
 * Herbal Treatment:** Gan Mai Da Zao Tang & Yang Xin Tang (Nourish the Heart Decoction)

Liver Qi Stagnation
Emotional changes before periods, restlessness, depression, irritability, clumsiness, aggressiveness, emotional strain, loses temper, anger, manic behavior, recovered after periods In the common days, disinclination to talk, chest/abdominal/breast/hypochondrium distending pain, poor appetite, vexation, headache, bitter taste, dryness of lips
 * Tongue:** red
 * Pulse:** wiry & rapid
 * Treatment Principles:** Soothe the liver, relieve stagnation
 * Acupuncture Treatment:** **LR-2, LR-3, BL-15, BL-18, PC-6**, HT-7, SP-6, LR-14
 * Herbal Treatment:** Dan Zhi Xiao Yao San

Upward Disturbance of Phlegm Fire
Agitation, incoherence, manic behavior, aggressiveness, excessive vaginal discharge, yellow in color, thick in quality Oppressive feeling of the chest, vexation, poor appetite, sleeplessness, dry stool, blood-shot eyes, red face, headache [Sheng Tie Luo (30g.), Dan Nan Xing (10g.), Bei Mu (10g.), Ju Hong (8g.), Fu Shen (10g.), Fu Ling (10g.), Gou Teng (10g.), Shi Chang Pu (10g.), Yuan Zhi (10g.), Zhu Sha (10g.), Tian Men Dong (10g.), Mai Men Dong (10g.), Xuan Shen (10g.), Dan Shen (10g.), Lian Qiao (10g.)]
 * Tongue:** red or crimson tongue; thick yellow greasy coat
 * Pulse:** wiry, slippery & rapid
 * Treatment Principles:** Clear Heat, expel phlegm
 * Acupuncture Treatment:** **ST-40, GV-26, GV-16, PC-6**, GV-14, HT-3, GV-24, LR-3, BL-20
 * Herbal Treatment:** Sheng Tie Luo Yin OR Wen Dan Tang

Liver Blood Deficiency
Depression & weeping before the period, slight abdominal & breast distention, scanty periods, tiredness, poor memory, poor sleep, slight dizziness, dull pale complexion
 * Tongue:** pale, possible on on sides
 * Pulse:** choppy or fine; possibly wiry on the left
 * Treatment Principles:** Nourish Liver blood, move liver qi
 * Acupuncture Treatment:** **CV-4, LU-7, KI-6, SP-6, ST-36, GB-34, PC-6, CV-6**
 * Herbal Treatment:** Xiao Yao Wan + Shu Di Huang, Gou Qi Zi OR Dui Shao Di Huang Tang

Liver & Kidney Yin Deficiency
Slight breast distention and irritability before the period & occasionally after it, sore back & knees, dizziness, blurred vision, poor memory, insomnia, dry eyes & throat, 5-palm heat
 * Tongue:** red tongue; no coat
 * Pulse:** fine, empty
 * Treatment Principles:** Nourish Liver and Kidney Yin, move liver qi
 * Acupuncture Treatment:** **LR-8, CV-4, SP-6, LR-3**
 * Herbal Treatment:** Yi Guan Jian

Liver & Kidney Yin Deficiency
Slight pre-menstrual tension w/ depression and weeping, slight abdominal and breat distention, tiredness, sore back, feeling cold, frequent pale urination, low sexual desire
 * Tongue:** pale tongue w/ teeth marks
 * Pulse:** deep, weak
 * Treatment Principles:** Tonify Yang, strengthen the kidneys
 * Acupuncture Treatment:** **BL-23, BL-20, CV-4, ST-36, SP-6, KI-3, LU-7, KI-6**
 * Herbal Treatment:** You Gui Wan



=
=================================================================================
 * IBIS:**

Definition:
A constellation of symptoms characterized by nervousness, irritability, emotional instability, depression, headaches, edema, mastalgia and food cravings, which arise in the 7-14 days before menses starts.

Etiology:
There are four types of PMS, each of which has distinct characteristics, and relationship to hormonal fluctuations: • PMS-A: anxiety: mood swings, nervous tension, irritability, anxiety; related to high estrogen, low progesterone. • PMS-C: craving: increased appetite, headache, fatigue, dizziness, fainting, palpitations; related to increased carbohydrate tolerance, decreased prostaglandin E1 in some. • PMS-D: depression: depression, crying, forgetfulness, confusion, insomnia; related to low estrogen, high progesterone, elevated adrenal androgens if hirsute. • PMS-H: hyperhydration: fluid retention, weight gain, swollen extremities, breast tenderness, abdominal bloating; related to excess aldosterone. Most PMS sufferers will experience symptoms from more than one group. The most common is group A. (Abraham per Pizzorno and Murray)

Somatic therapies:
• aerobic exercise program: sometimes helps • qigong • tai qi chuan

Nutrition:
therapeutic considerations: • General findings concerning the diets of PMS patients: - 63% higher in refined carbohydrates - 275% higher in refined sugar - 79% higher in dairy products - 78% higher in sodium - 53% lower in iron - 77% lower in magnesium - 52% lower in zinc (Marz, p. 427, 1997) • Treat the liver: The liver conjugates estrogens and is involved in estradiol and estrone production. • Work on digestion

eating principles: • Vegan diet of 75% complex carbohydrates, 15% protein, 10% fat • Increase consumption of complex carbohydrates to 70+% (Abraham, Guy. J. Repro. Med. 28:446-64, 1983) • Decrease consumption of saturated fats: especially red meats and dairy products. PMS patients in one study were found to eat 79% more dairy products than normals. For PMS-A, where there is an excess of estrogen, decrease any endogenous estrogens. Overweight patients must shed the extra pounds. (Marz, p. 427, 1997) • High fiber diet: increased fiber associated with increased binding and excretion of estrogens (Golden, B. N. Eng. J. Med. 307:11542-47, 1982) • Decrease caffeine (Rossignol, A. Am. J. Public Health 75(11):1335-37, 1985; Rossignol, A. Am J. Public Health 79:67-9, 1989.) • Decrease salt intake: to 3 g per day or less, especially for PMS-H. • Decrease sugar intake

therapeutic foods • Citrus peel, garlic, onions, legumes, kelp, apples, sesame seeds, brewer's yeast, alfalfa tablets • Liver-cleansing foods: beets, carrots, artichokes, lemons, parsnips, dandelion greens, watercress, burdock root • Dark green leafy vegetables: beet, radish, mustard, dandelion, collard greens, kale, spinach, chard • Foods rich in Magnesium, Calcium, Vitamin B-complex • Increase omega-3 and omega-6 fatty acids: vegetable, nut, seed oils, salmon, herring, mackerel, sardines, walnuts, flaxseed oil, evening primrose oil, black currant oil

» Stagnant Liver Qi or Stagnancy in the Liver channel: • Foods that invigorate Qi, soothe the Liver, sour foods, Dispersing foods, foods that open channels, and invigorate Xue (Blood) • Ginger, green onions, fennel, orange peel, spinach, walnuts, hawthorn berries, cinnamon (Ni, p. 152)

fresh juices: • Carrot (Walker, p. 146) • Carrot and spinach (Walker, p. 146) • Carrot, beet, and cucumber (Walker, p. 146) • Lemon juice in warm water (Shefi)

specific remedies: • Tea from ginger, green onions, fennel, black pepper and orange peel, boil for 10 minutes. Drink three times daily starting one week before premenstrual symptoms (Ni, p. 152) • Spinach soup boiled for 30 minutes (Ni, p. 152) • Tea from hawthorn berries and cinnamon (Ni, p. 152)

avoid: • Estrogenic foods: animal products, apples, cherries, olives, plums, carrots, yams, nightshade family (eggplant, peppers, tomatoes, potatoes, tobacco), peanuts, soy products, coconut, brown rice, barley, oats, wheat (See Materia Medica: Foods that contain estrogen-like sterols) • Animal fats stimulate the growth of certain intestinal bacteria, which can hydrolyze conjugated estrogens thus rendering them active again. (Marz, p. 427, 1997) • Arachidonic acid from animal fats is a precursor to PGF2, which is leuteolytic in women (decreases progesterone). (Dennefors, B., Sjogren, A., Hamberger, L. J. Clin. Endocrin. and Metab. 55:102-107, 1982) • Meat, alcohol, spicy foods, fried foods, fatty foods, rich foods, salt, salty foods, sugar and sweet foods, chocolate, cold and raw foods in excess, excess fruit, shellfish, coffee, black tea, cola drinks, caffeine, dairy products, processed and refined foods • Cabbage, cauliflower, broccoli, brussel sprouts, kale, sweet potatoes, turnips

Botanicals
• Angelica sinensis • Borago officinalis: oil from seeds influences prostaglandin synthesis (NCNM Botanicals) • Chamaelirium luteum (Helonias): sense of weight; congestion of pelvic contents with irritability (Felter, p. 404) • Linum usitatissimum (flax seed): oil from seeds influences prostaglandin synthesis (NCNM Botanicals) • Oenothera biennis: oil from seeds influences prostaglandin synthesis (NCNM Botanicals) • Ribes nigra: oil from seeds influences prostaglandin synthesis (NCNM Botanicals) • Selenicereus grandiflorus: for nervous menstrual headache (Felter, p. 254) • Scutellaria laterifolia: eases premenstrual tension (NCNM Botanicals) • Silybum marianum: improves liver function ; helps liver conjugate and metabolize estrogen (NCNM Botanicals) • Taraxacum officinale: improves liver function ; helps liver conjugate and metabolize estrogen; diuretic (NCNM Botanicals) • Trifolium pratense: anti-spasmodic with phytosterol activity; alterative (NCNM Botanicals) • Viburnum prunifolium: uterine sedative and tonic (Felter, p. 694) • Vitex agnus castus: premenstrual syndrome based on hyperfolliculinism; acne and premenstrual herpes labialis (Weiss, p. 318)

Chinese Formulae
• Bupleurum and Cyperus C. (Chai Hu Shu Gan San); Shu Gan Wan (patent); Nuphar 14 (patent): Liver Qi Stagnation: bloating, poor digestion, breast distention (Bupleurum: Yeung, p. 54; Dharmananda, 1986, p. 226; Bensky and Barolet, p. 146; Shu Gan: Zhu, p. 215; Nuphar: Dharmananda, 1990, p. 87) • Bupleurum and Peony F. (Dan Zhi Xiao Yao San or Jia Wei Xiao Yao San); Xiao Yao Wan (patent); Tang Kuei 18 (patent): Liver Qi Stagnation due to Xue Xu (Blood Deficiency) creating Heat (Bupleurum: Hsu, 1980, p. 87; Yeung, p. 72; Dharmananda, 1986, p. 177; Bensky and Barolet, p. 148; Xiao Yao: Zhu, p. 227; Tang Kuei: Dharmananda, 1990, p. 25) • Cinnamon and Hoelen C. (Gui Zhi Fu Ling Wan): Xue Yu (Blood Stasis): abdominal bloating, pain before or with menses (Hsu, 1980, p. 423; Yeung, p. 113; Bensky and Barolet, p. 322) • Ginseng and Astragalus C. (Bu Zhong Yi Qi Tang) plus quick-fried ginger (pao jiang) and coptis (huang lian): Spleen Qi Xu (Deficiency): fatigue, premenstrual diarrhea (Bensky and Barolet, p. 241) • Wu Chi Pai Feng Wan (patent): Qi Xu (Deficiency) with Xue Xu (Blood Deficiency) (Zhu, p. 247) • Bu Xue Tiao Jing Pian (patent): Xue Xu (Blood Deficiency): headache, insomnia, emotional distress (Zhu, p. 254) • Bamboo and Ginseng C.: Gall Bladder Phlegm: absent-mindedness, insomnia (Hsu, 1980, p. 90; Dharmananda, 1986, p. 247) • Ginseng and Zizyphus F. (Tian Wang Bu Xin Dan); Ding Xin Wan (patent): Shen Disturbance with Heart Xue Xu (Blood Deficiency):insomnia, restlessness, forgetfulness (Ginseng and Zizyphus: Hsu, 1980, p. 270; Yeung, p. 231; Dharmananda, 1986, p. 244; Bensky and Barolet, p. 378; Ding Xin: Zhu, p. 326) • Licorice and Jujube C. (Gan Mai Da Zao Tang): Shen Disturbance: absentmindedness, moodiness, crying spells, restless sleep (Hsu, 1980, p. 347; Yeung, p. 102; Dharmananda, 1986, p. 110; Bensky and Barolet, p. 383)

Acupuncture
after assessing the person and palpating, consider these patterns: Liver Qi Stagnation in pelvis, chest, throat; Spleen Qi Xu (Deficiency); Xue Xu (Blood Deficiency); Shen Disturbance with Heart Xue Xu (Blood Deficiency); dysfunction of the Chong Mai (Penetrating Vessel) and/or Ren Mai (Conception Vessel); emotional frustration from individual and cultural factors

» therapeutic note: see also conditions which may be aspects of premenstrual syndrome, such as "anger", "anxiety", "depression", "fear", "constipation", "fibrocystic breasts", "headache: nonvascular", "hypoglycemia" and "pituitary dysfunction", esp. if one seems especially predominant

» illustrative combinations: • Lv-3 and LI-4: open the Four Gates; regulate Qi and Xue (Blood) circulation; remove Obstruction of the channels; release bodily tension; relax clenching of jaws; free constraint; calm the mind; relieve mental cloudiness; provide sedative and analgesic effect to calm the nervous system; pacify Liver Yang (Finkelstein, p. 7; Flaws, 1989, p. 76); • GV-4 and GV-20: strengthen the Du Mai (Governing Vessel) and support the Ren Mai (Conception Vessel) and Chong Mai (Penetrating Vessel) (Finkelstein, p. 78) • yin tang and Ht-7 (-): calm Shen; allay dream-disturbed sleep • Lu-7, St-36, LI-4 and LI-11: use Metal to restrain Wood and control the Liver by strengthening the Large Intestine and clearing and descending the Lung Qi; particularly useful "in patients who have a dark, dull complexion, a thick stolid body, a habitually negative, accusatory demeanor" (Flaws, 1991, p. 159) • UB-18 and UB-19 (+): promote Qi flow • Lv-14 and Lv-3 (-): disperse Liver Qi Stagnation specifically in the Lower Warmer; smooth and restore balance in the Liver; regulate the circulation of the Xue (Blood); descend Rebellious Qi; relieve (abdominal) distention; stop (abdominal) pain (Flaws, 1989, p. 70; Finkelstein, p. 75) • Sp-6 assists Lv-3 in "harmonizing the Liver and harmonizing Wood and Earth" (Flaws, 1991, p. 157) • Lv-14 and GB-25: pacify the Liver and relieve Liver Qi Depression (Flaws, 1989, p. 70) • Lv-3 and UB-18: remove Liver Depression (Finkelstein, p. 73) • Lv-2 and Lv-14: remove Obstruction of the Liver and Liver Qi Depression (Finkelstein, p. 72) • Sp-10, Sp-6 and Lv-2: disperse Qi Stagnation and Xue Yu (Blood Stasis) (Flaws, 1989, p. 88) • UB-17 and UB-18: nourish Xue (Blood) and remove Obstructions of Liver and Xue Yu (Blood Stasis) (Finkelstein, p. 41); • UB-17 and Sp-6: activate Xue (Blood) circulation in Liver and remove blocks in Liver (Finkelstein, p. 41) • CV-17, St-18 and St-34: relieve breast distension (Flaws, 1991, p. 157) • SI-1 and tai yang for swollen breasts (Shanghai, p. 241) • SI-3 and breast ashi (tender) point (-) disperse congestion in the breast; often can apply ion-pumping cords, usually with black clip at breast and red clip at SI-1 (Flaws, 1991, p. 158) • St-30, GB-22 <-> Sp-21 area and SI-11 are "essential" points for treating breast problems; St-15 <-> St-16 area along with PC-6 and Sp-4, to effect the Chong Mai (Penetrating Vessel), are secondary points; palpation, of course confirms the points' appropriateness (Matsumoto) • UB-17 and UB-19: form si hua (the "four flowers") to build Xue (Blood) (Finkelstein, p. 41); • Sp-10 and UB-17: replenish the Xue (Blood) (Finkelstein, p. 29); • Sp-10, Sp-6 and LI-11: manufacture Xue (Blood) and nourish the Liver to strengthen Spleen (Finkelstein, p. 29); • Lv-14 and GB-34: disperse Liver Qi Stagnation affecting the Middle Warmer (Finkelstein, p. 76) • St-36 and Sp-6 (+): strengthen Spleen/Stomach; tonify digestion and Qi; nourish Xue (Blood); calms the Shen • yi shu, GV-"5.5" or GV-6 (inferior to T11 or T12) or associated hua tuo jia ji (-), "lumbar eye", left Kd-15 <-> Kd-16, left St-21 <-> Sp-16 (needle or magnet south pole down), "kidney supporter point" (needle or magnet north pole down), Sp-6 or Sp-8, and St-2 (sinus focal infection point), as indicated by palpation, for blood sugar imbalance; may apply direct moxa or with Tiger Warmer at GV-"5.5" or GV-6 and "lumbar eye" until midthoracic or calf point reactivity resolves (Matsumoto) • GB-41 and St-44: to rectify lower abdominal distention (Ellis, et al, 1988, p. 324; Shanghai, p. 275) • St-30, Sp-8 and Lv-8: harmonize Xue (Blood) and dispel effused blood, esp. with menstrual problems (Finkelstein, p. 17) • Sp-8 and Sp-10: regulate menses (Ellis, et al, 1988, p. 154) • St-29 and UB-32: induce flow of blood in the uterus (Finkelstein, p. 17) • St-25, Kd-5 for menstrual disorder (Finkelstein, p. 16); • St-29 and St-25: clear Heat and regulate menses (Finkelstein, p. 17; Flaws, 1989, p. 83) • Sp-10 and GB-34: clear Heat in the Xue (Blood), strengthen the Spleen and regulate the menses (Flaws, 1989, p. 76) • St-25, Kd-10 and Sp-6: regulate menses; treat dysmenorrhea and irregularity (Finkelstein, p. 16) • UB-23 and GV-4 (+ and D): strengthen Kidney Yang • CV-15, CV-16, CV-19, Kd-13, Sp-6, Kd-11, UB-47/52, GB-37, GB-5, UB-60 and CV-10: influence the pituitary (Worsley, 1975, p. B-20; McWilliams, et al, Lesson 31, p. 258) • Kd-13, UB-67, Kd-7, GB-37, Sp-6, Kd-2, GV-4 and Lv-3 influence the ovaries (Worsley, 1975, p. B-20; McWilliams, et al, Lesson 31, p. 258) • UB-31, Sp-6 and GB-3: have strong hormonal action on women (Finkelstein, p. 46)

Homeopathy
• Bovista: spasm in chest; painful bearing down in genitals; diarrhea, pain as if bruised; weary in loins, belly, and thighs, preventing going upstairs; leukorrhea is acrid, corrosive, green, thick, slimy, tough • Calcarea carbonica: sensitive to frights and amorous dreams; headache; chills and nocturnal colicky pain; aching of back and hips; pain in armpits; pain and swelling of breasts; leukorrhea • Calcarea phosphorica: insatiable sexual desire (nymphomania), followed by a copious flow; headache for 3-7 days before; griping and rumbling in bowels • Cuprum: violent, unbearable cramps in the abdomen; extending to the chest, causes nausea/vomiting; may have convulsions of limbs and piercing shrieks • Folliculinum: history of birth control pills and/or estrogen replacement therapy, esp. bad reaction, i.e., estrogen poisoning; tendency to put others' needs before her own, and then become resentful later; woman has lost touch with her own inner rhythms and her reference has become external rather than internal; often best used in a single dose, or repeated every two weeks, possibly at new and full moons • Lachesis: nervous distress; desires open air; vertigo, nosebleed; pains in the left ovary; spasms of the chest; eructations; diarrhea with violent straining; colic, leukorrhea: copious, green, stiffens linen; pain in the back with abdominal cramps and throbbing headache • Lycopodium: sad, chilly, bloated abdomen; melancholy; delirium with weeping; coldness and heaviness of feet/legs; flatulence; ill humor; headache; severe backache; nausea; faintness • Natrum muriaticum: anxious, sad, irritable; nausea, sweetish eructations in morning; headache; eyes heavy; palpitation; disposition to faint; expectoration of bloody saliva; cutting, tearing, burning in vagina; leukorrhea; lassitude and trembling; toothache. • Pulsatilla: leukorrhea; desire to urinate; water running from mouth; vomiting; asthma; abdomen swells, stitches in the side; vertigo and eructations; chills; convulsions • Sepia: sadness, toothaches; violent pressure in the forehead; nosebleeds; soreness of limbs; colicky pains day before menses; restless sleep, with frequent starting and screaming; hours before pressure in the abdomen becomes a violent pain in the umbilical region, > menses • Sulphur: moroseness/apprehension with uterine pain; menses two days late; constipation and distended abdomen; suppressed with congestion to other parts; nosebleed; itching of vulva; cramp in splenic region; toothache, heartburn, night sweats • Veratrum album: nymphomania before menses from unsatisfied passion or mental causes; headache, vertigo, bleeding of nose, night sweats • Zincum metallicum: boring pain in the left ovarian region > from pressure, entirely relieved by menstrual flow; boring, burning felt between menstrual periods; > excessive flow; heaviness and weakness of lower extremities; pain so severe in limbs she cannot keep them still

Subtle Support
• Re (Garner, p. 64)

• notes: A, A#, B, C, C#, D, E, F, G, G#

• chords: A minor, C minor, D minor, D# minor, tonic (Gimbel, p. 116)

Mind/Body
• Rejection of feminine role. (Rossi, p. 295) • Associated with anxiety and stress. (Harrison, p. 14) • Unresolved issues around femininity, sexuality, or conception. (Harrison, p. 14) • Allowing confusion to reign; giving power to outside influences; rejection of feminine processes. (Hay, 1984, p. 180)

Chinese psychophysiology: • Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores and cleanses the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); has an intimate relationship with the genitals and Lower Warmer; and reflects emotional harmony and movement. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Xu (Deficiency) signs include frigidity; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry eyes, skin, and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down. » Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216) » Mental signs of Liver channel disorders include irritability; difficulty developing ideas; depression; and lack of energy. (Seem, p. 28)

• Heart ~ Xin houses the Shen (Spirit) and reveals itself through the brightness in the eyes; governs Fire and Heat; rules the Xue (Blood) and its vessels and directs the circulation; opens into the tongue and controls speech; and relates to the integration of the organs and the personality. » Healthy expressions are warmth, vitality, excitement, inner peace, love, and joy. » Heart Xu (Deficiency) signs include sadness; absence of laughter; depression; fear; anxiety; shortness of breath (Seem, p. 28); cold feeling in the chest and limbs; palpitations; cold sweat; inability to speak; memory failure; and restless sleep. Chronic Yin Xu (Deficiency) predisposes to Empty Fire, acute and chronic. » Heart Shi (Excess) signs include false or facile laughter; sobbing; agitated spirit; insomnia (Seem, p. 28); frightful dreams; anxiety; tongue feels numb and heavy; heavy chest; hot sweat; and orange-colored urine. » The Heart is the Emperor of the bodily realm so that when the Heart is disturbed all the other organs will be disrupted.

• Spleen ~ Pi governs digestion; transforms food into Qi and Xue (Blood); governs the Xue (Blood); governs the Xue (Blood) and holds it in the vessels; resolves Dampness and Phlegm; and relates to the ability to assimilate, stabilize, and feel centered and balanced. » Healthy expressions are fairness, openness, deep thinking, and reminiscence. » Spleen Xu (Deficiency) signs include slightness (deficient "form"); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; pale lips; loose stools; muscular weakness; and, indirectly, obesity. » The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen and may lead to Xue Yu (Blood Stasis). This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise and excess consumption of sweet and Cold foods will also deplete the Spleen.

Integrative Therapies
The signs of premenstrual syndrome can start 1 to 14 days prior to your menstrual period. Common signs and symptoms are depression, irritability, anxiety, and mood swings. Other symptoms include breast tenderness, bloating, and either constipation or diarrhea. Some women experience headaches, swelling of the joints, and intense cravings for sweets or salty foods.

PMS is related to an imbalance in the hormone levels of estrogen and progesterone. If your symptoms are not related to the menstrual cycle, please see your physician.

THE FOLLOWING SUPPLEMENTS CAN BE TAKEN UNTIL SYMPTOMS IMPROVE: 1. Vitamin B-complex – 50 milligrams once a day. 2. Additional vitamin B6 – 100 milligrams once a day, taken 10 days before the menstrual period. 3. Calcium and magnesium supplement – 500 milligrams of each per day. 4. Vitamin E – 600 Units per day. 5. Beta-carotene – 50,000 to 100,000 Units per day. Pregnant women (or women who may become pregnant) should not take more than 15,000 Units of Beta-carotene a day. 6. It is important to include certain essential oils in your diet. Take either 1 to 2 tablespoons a day of Flaxseed oil or 2 capsules a day of Evening Primrose or Borage oil.

THE PROPER DIET FOR PMS WILL INCLUDE THE FOLLOWING: 1. Avoid or cut down on caffeine such as in coffee, tea, sodas, and chocolate. 2. Avoid sugar and sweets such as candy and pastries. 3. Decrease the fats in your diet such as dairy products, fried foods, and red meats. Estro-gens, used as fattening agents, have been found in commercial red meats, so as much as possible, eat organic meat, fish, or chicken. 4. Increase your consumption of fresh vegetables, and eat at least 1 cup per day. Eat at least 2 pieces of fruit and 1 cup of whole grains, such as oatmeal or brown rice, per day. 5. Some women find that eating small meals, often, can greatly help in relieving symptoms.

HERBS USED FOR PMS: 1. Licorice – Make a tea of 1 teaspoon dried Licorice Root per cup of water. Simmer for 5 minutes. Steep 10 minutes. Drink at least 3 cups per day. Licorice can also be used as a tincture, which is a liquid herbal extract. Take 30 drops 3 times a day. You can also use 2 capsules of the dried herb 3 times a day.

2. Milk Thistle – Chew 1 tablespoon of seeds until soft enough to swallow once a day or take 2 capsules twice a day. You can also grind the seeds in a blender before chewing.

3. Use a combination of the following herbal tinctures: • Angelica sinensis, also called Tang Kuei • Dioscorea, or Wild Yam • Blue Cohosh Use 60 drops of this mixture in a little water 3 times a day. It can also be taken in tea form.

HOMEOPATHY: • Sepia 30C: Useful for depression, irritability, or for indifference to family members or close friends. Symptoms are worse before the period. Dissolve 3 pellets under the tongue once a day. • Pulsatilla 12C: For extreme mood changes and weepiness. Dissolve 3 pellets under the tongue twice a day while the sypmtoms are present. Note: A wide range of homeopathic medicines can be helpful for women experiencing premenstrual syndrome. Consultation with a health care professional trained in homeopathic prescribing will usually be the best way to select the correct medicine.

ANOTHER USEFUL MEASURE IS: • Regular physical exercise throughout the month for 30 minutes, at least 3 times a week.