By Jiang Liu, Diplomate of Oriental Medicine
AR Licensed Acupuncturist and Herbalist
Acupuncture & Chinese Medicine Clinic
2024 Arkansas Valley Dr., Suite 402
Little Rock, AR 72212


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

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 hormones 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.