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Medicine

Western medicine defines Premenstrual Syndrome (PMS) as a collection of cyclical physical and mental symptoms in women, but traditional Chinese medicine (TCM) thinking does not consider it as a single distinct disorder. According to the view of traditional Chinese medicine, a focus on individual symptoms around the menstrual period predominates. Descriptions of specific symptoms which are associated with menstrual periods such as “oedema during menstruation”, “premenstrual breast distension”, “headache during

menstruation” and “premenstrual emotional changes” can be found in various Chinese medical publications (SiTu & Yang 2000). TCM defines and discusses menstrual related disorders that are symptom-based rather than proceeding along a syndrome perspective as modern western medicine. The description of these disorders is similar to those “older medical writings” of western society that did not distinguish between premenstrual and menstrual complaints (Richardson 1995)

Today, some gynecologists in Chinese medicine classify all these symptom disorders collectively as ‘Peri-menstrual Disorders’, a term that first appeared in 1980 (Hubei college of TCM 1980). Typical descriptions of peri-menstrual disorders, Xia (1994) refer to a series of menstrually related disorders that are cyclical and recurrent, and in which a symptom/range of symptoms appears a few days before and/or during menstruation, may continue until the cessation of

menstruation, and disappears or reduces to a negligible level after commencement of menstruation. Since the definition of ‘Peri-menstrual Disorders’ in Chinese medicine relates to the cyclical timing of symptoms before, during and after menstruation, some other conditions that are associated with disorders other than PMS, e.g. period pain, endometriosis, chronic pelvic infection, and general blood deficiency may also be included. While TCM advocates no significant difference in the treatment process of these disorders, confusion may arise among western and modern Chinese scientific views and reports regarding the exact nature of the condition being considered.

Some gynecologists in Chinese medicine continue to categorize these disorders according to individual symptoms, following many classic texts, such as The Gynecology of TCM (Luo 1986) and The Gynecology of TCM (Ma 1997). Both proposed 11 different disorders that are symptom-based, i.e. ‘Breast distension during menstruation’, ‘Feverish sensation during menstruation’, ‘Headache during menstruation’, ‘General bone-ache during menstruation’, ‘Diarrhoea during menstruation’, ‘Haematemesis during menstruation’, ‘Oral ulcer during menstruation’, ‘Rashes during menstruation’, ‘Dizziness during menstruation’, ‘Oedema during menstruation’ and ‘Emotional changes during menstruation’ .

The above definitions of the disorder relate in particular to the cyclical timing of symptoms, without characterizing its special timing (premenstrual phase) of menstruation and severity level. Thus, the Chinese medicine definition is less specific, more inclusive and may potentially confuse understanding.

Therefore most research of premenstrual disorders in Chinese medicine in recent years and in some recently published gynaecology books in fact adopt the definition of PMS from western medicine and only those symptoms which appear before and during menstruation are considered. Sun and Guo (2004), Zhou Z (2003) and Wang B (2002), follow the western view of definition and refer to PMS as a group of cyclic changes that include somatic, psychological and behavioral disturbances which appear recurrently in the late luteal phase (days 24-28) of the menstrual cycle. These disturbances must be severe enough to cause pain or distress in the woman’s mind and/or body and adversely affect the woman’s daily life and work. These symptoms must also resolve naturally after menstruation. In a TCM gynecological textbook, the Women Diseases - TCM Clinical Diagnosis and Treatment (SiTu and Yang 2000), premenstrual tension syndrome refers to the physical, psychological and behavioural changes during the 7-10 days before menstruation. These symptoms may affect the woman’s normal life and work, and disappear naturally after menstruation. These defining characteristics are based on western medicines.

Both premenstrual syndrome and premenstrual tension syndrome have been used synonymously to describe this disorder in many Chinese medical articles and text books regardless whether or not nervous tension is a common

3.2 History of Premenstrual Disorders in the Chinese Tradition

The earliest records and discussions of symptoms during premenstrual and menstrual phases in Chinese classics date back to the Ming Dynasty (1368-1644AD). In The Appendix of Dan-Xi’s Experiential Methods(Fang 1536), the author indicated that to diagnose cases of ‘feverish sensations’ in women’s diseases, one should ascertain whether the feverish sensations occurred during menstruation or also at other times. In the Qing Dynasty (1644-1911AD), as many as 22 premenstrual symptoms were listed in the Ye Tian-Shi’sGynaecological Records(Liu 1921). Most of the symptoms discussed in Master Ye’s book were somatic problems such as oedema, feverish sensations, hypochondriacal pain, diarrhoea, body aches, abdominal cramps, and reduced appetite, except one which was manic or ‘delirious speaking’.

The description and discussion on disorders during menstruation in TCM classics are grouped under different symptoms.

3.2.1 Feverish Sensation and Menstruation

The Elementary Course for Medicine (Li 1624), proposed that the feverish sensations and cramps during menstruation were common disorders among women, and when feverish sensations occur before menstruation these are due

to Blood deficiency with stagnation, and feverish sensations after menstruation is due to Blood deficiency with Heat.

In the Golden Mirror of Medicine (Wu 1742), fever/feverish sensations during menstruation were considered to be due to Heat in the Blood, whilst

fever/feverish sensations after menstruation were due to a deficiency. If the feverish sensations happened continually, it was believed to be caused by pathogens, and if they only happened in the afternoon, it was believed to be the result of Yin deficiency.

3.2.2 General Body-ache and Menstruation

The Standards of Diagnosis and Treatment: Gynecology (Wang 1602) recorded that general body-ache was one of the symptoms which indicated that

menstruation was imminent.

The Complete Book of Ye’s Obstetrics and Gynecology (Ye 1913), pointed out clearly that the general bone-ache in the first 2-3 days of menstruation was likely caused by a Cold pathogen entering the bone.

The Golden Mirror of Medicine (Wu 1742) proposed that diagnosis of bone-ache during menstruation should be ascertained if it was caused by deficiency/excess and Wei/Ying. Wu believed that bone-ache happened with sweating but no swelling was regarded as due to insufficiency of Wei Qi

(Protective Qi); if there was swelling but no sweating then it was believed to be due to the excess of Ying Qi (Nourishing Qi).

3.2.3 Diarrhoea and Menstruation

In the Fu Qing Zhu’s Obstetrics and Gynecology (Fu 1826), Master Fu

suggested that women suffering from diarrhoea three days before menstruation was a indication of Spleen deficiency and not as some other practitioners believed to be caused by excess of Blood.

In the Complete Book of Ye’s Obstetrics and Gynecology (Ye 1913), Master Ye described early morning diarrhoea during menstruation as a sign of Kidney deficiency.

Both The Supplementary and Explanatory Notes of Chen Su-an’s Gynecology

(Chen Ming Dynasty, 1368-1644) and Golden Mirror of Medicine (Wu 1742) claimed that diarrhoea during menstruation was caused by Spleen deficiency.

3.2.4 Oedema and Menstruation

In the Complete Book of Ye’s Obstetrics and Gynecology (Ye 1913), Master Ye explained that general oedema/swelling of the body during menstruation is

caused by a weakened Spleen that fails to transport and transform water which is then retained in the body resulting in swelling.

3.2.5 Headache and Menstruation

Zhang’s Treatise on General Medicine (Zhang Lu 1695) considers that headache, distension, palpitation, reduced appetite and dull skin during every menstruation resulted from the Phlegm-Dampness which are pathological products of impaired water metabolism.

3.2.6 Abdominal Cramps and Menstruation

Golden Mirror of Medicine (Wu 1742) stated that abdominal pain before menstruation was due to Qi and Blood stasis, whilst weakness of Qi and Blood may lead to abdominal pain after menstruation.

3.2.7 Emotional Changes and Menstruation

The Supplementary and Explanatory Notes ofChen Su-an’s Gynecology (Chen Ming Dynasty1368-1644) explained that emotional changes during

menstruation were the result of the deficiency of Blood in the body giving rise to internal Heat and manifesting as emotional changes. The woman required to

be treated with Blood-cooling herbs to clear the Heat while diaphoretic herbs should be avoided because water would be lost from the body.

3.2.8 Dizziness and Menstruation

In The Supplementary and Explanatory Notes ofChen Su-an’s Gynecology

(Chen Ming Dynasty 1368-1644), the pathogenesis of dizziness during

menstruation is discussed. It is considered that the heavy headed sensation was due to the sinking of Yang Qi, and blurring of vision was caused by the lack of

Jing and Blood.

3.2.9 Other Symptoms

In addition to the above, the Classified Treatise on Obstetrics and Gynecology

(Xiao 1689) recorded additional symptoms which included body-ache, feverish sensation, blurring of vision, and diarrhoea during menstruation. The Excerpt of Chen’s Obstetrics and Gynecology (Chen 1850) also mentions hoarseness of voice and blurring of vision during menstruation.

3.2.10 Summary

While the Hippocrates described these menstrual symptoms as uterine gaseous distension and associated the etiology of the condition to the accumulation of black bile in the uterus (Ricci 1950, cited in Richardson 1995), most of the descriptions and discussions of all disorders during menstruation in TCM classics claim that these peri-menstrual disorders are caused by the malfunctioning of Zang-fu, Qi or Blood, such as Liver stagnation, Spleen deficiency, Blood deficiency, and Kidney deficiency, but some conditions may also be related to excess Heat, Cold pathogen and/or Wind-Coldness. Also, the latest recommended treatment method of PMS suggests thatmedications be given to treat specific symptoms and that treatment be individualized to target the most troublesome symptoms in each patient (Dickerson 2003). Interestingly, this strategy has a similar initiative to the historic TCM treatment.