PMS

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

1. LR KI Yin ↓ – around period Yin/Blood get used for Uterus → heat.
2. Heat in Blood (LR heat) – during menses – need more Qi to make period happen & this generates heat.
3. Qi (blood) ↓ – Ying & Wei are not harmonized, before fever there probably be chills – then fever & chills alternate.
4. 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

1. 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

2. 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

3. 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

4. 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

1. LR Qi stag. – LReffects nipple – if the LR attacks the ST the breasts are effected.  Qi is not able to flow smoothly.
2. 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

1. 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

2. 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 headache comes

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

1. Blood↓ –  aching last few days of bleeding, body simply lacks nourishment.
2. 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

1. 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.
2. 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

1. LR Fire –  Stagnated LR causes fire, LR supplies Blood to Chong Mai, Fire causes Chong to rise causing bleeding.
2. ST Heat – diet – spicy food, alcohol etc. causes Heat to rise w/ Chong Mai.
3. 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

1. ST Heat– 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 during cycle painful ulcers appear, bad breath, heavy-deep-red menstrual bleeding. Plus – ST Heat sym. P/T – clear ST Fire – purge Fire Rx – Qing Wei San  or  Liang Ge San (cool diaphragm)

HT Yin ↓ → hyper HT Fire around menses – tip of tongue ulcerated & painful, scanty early menstruation. Plus – HT Yin ↓ sym. (mental restlessness, malar flush) P/T – nourish Yin – descend Fire Rx – Zhi Bai Di Huang Wan

Hives

Diagnosis

Itchy skin, raised eruptions around periods.

Main Pathogen = Wind → exterior or interior (blood ↓)

Etiology

1. Blood ↓ – produces internal Wind – during menses blood is more ↓ , itchyness & eruptions occur.
2. 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 ↓ whole body can be itchy, when scratched hives will appear, worse @ night, delayed scanty menstruation. Plus – Blood ↓ sym. (dry skin, blurry vision)  T-pale, thin P/T – nourish Blood – expel Wind Rx – Dang Gui Yin Zi

Wind/Heat

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. Plus Heat sym. (maybe exterior sym.) P/T nourish blood clear Heat cool blood expel Wind 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

1. 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.
2. Yin ↓ → hyper LR Yang – Yin ↓ in lower Jiao causes relative Yang ↑ , Yang rises causing Wind (dizziness).
3. 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

1. SP KI ↓ – can’t control T&T or the gates.
2. Qi/Blood stag. – Qi can’t move water transformation in Lower Jiao (abd. bloating)

Pathogenesis Differentiation & Treatment

1. 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

2. 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

1. HT Blood ↓ – during menses HT gets weak (Shen)
2. LR Qi stag. → Fire – pre-menses – Chong goes upward because of the Heat.  Fire rising also effects HT Shen.
3. Phlegm-Fire – LR Heat / SP Phlegm accumulates pre-menses, Heat goes upward along Chong & effects Shen.

Pathogenesis Differentiation & Treatment

1. 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)

2. 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

3. 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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