Conditions Women's health and fertility Sleep, stress and mood

PMS and PMDD

For the week or two before your period that feels like someone else's life: irritability, tears, bloating, sore breasts, cravings, poor sleep. We work alongside your physician and any mental health care you already have.

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Read through

BothWesternClassical

Two lenses, one plan

Wood 木 is the phase it is most often read through. Here the classical lens leads: differential pattern diagnosis decides the treatment, with the Western picture as context.

The Western lensAnatomy, physiology, biomechanics

Sensitivity to the cycle

In PMS and PMDD, hormone levels are usually normal; the brain is thought to respond more strongly to the normal rise and fall of progesterone and its byproducts, with serotonin involved in mood.

Track two cycles: Diagnosis rests on symptoms that clearly appear after ovulation and lift with the bleed. A daily symptom log is the most useful tool you can bring.
Other conditions: Depression, anxiety, thyroid problems and perimenopause can look like PMS or make it worse, which is why your physician's view matters.

The classical lensChannels, patterns, the five phases

The Liver before the bleed

The Liver stores blood and keeps qi moving. In the days before the period, blood gathers toward the uterus and the Liver has less to soften it, so any tendency toward constraint becomes loud.

Breasts and sides: The Liver channel passes through the breast and along the sides of the ribs, which is why tenderness there is read as a Liver sign.
When it turns hot: Anger that flares, a bitter taste and poor sleep are read as constraint becoming fire, which needs cooling as well as moving.

Patterns we often see

Liver qi constraint gān qì yù jié 肝氣鬱結
Liver constraint with Spleen deficiency gān yù pí xū 肝鬱脾虛
Heart and Liver fire xīn gān huǒ wàng 心肝火旺
Blood deficiency xuè xū 血虛

Patterns are examples of how this is often read, never a diagnosis. Yours is read at your visit.

How we work: one plan

Luteal-phase acupuncture, calming scalp acupuncture lines when mood leads, cupping across the upper back, a formula for each half of the cycle, and food advice for the premenstrual week. Any antidepressant or hormonal treatment stays as prescribed, and herbs are checked against it.

What PMS and PMDD are

Premenstrual syndrome is a cluster of physical and emotional symptoms that appear after ovulation and ease once the period starts: breast tenderness, bloating, headaches, cravings, fatigue, irritability, low mood and broken sleep. PMDD is the severe form, where mood changes such as despair, rage or anxiety take over for part of every month. The pattern is thought to involve sensitivity to normal hormonal shifts rather than abnormal hormone levels. Conventional care includes lifestyle measures, hormonal contraception and certain antidepressants.

Reading the monthly report card

The classical view treats the premenstrual week as a monthly report on how freely qi is moving. As the cycle builds toward the bleed, the Chong vessel fills, and constrained Liver qi has nowhere to go. It pushes into the breasts and sides, into the belly as bloating and loose stools, and up into the head as irritability and headaches. When blood is thin underneath, the mood turns tearful and fragile. When heat builds, it becomes anger, insomnia, mouth ulcers or acne along the jaw. When constraint has begun to turn hot, a practitioner might consider Jia Wei Xiao Yao San (Augmented Free and Easy Wanderer); when blood is thin and the mood fragile, a nourishing formula instead.

How we work with it

Visits are timed to the second half of your cycle, with acupuncture to free the Liver and calm the spirit, calming scalp acupuncture lines when mood leads, and cupping across the upper back. A formula is chosen for your pattern and often changes between the two halves of the month. We ask you to rate your worst symptoms each day across one or two cycles so we can see what shifts.

Formulas here illustrate how pattern diagnosis shapes treatment. They are not recommendations; a practitioner selects and adjusts formulas for the individual.

Questions people ask

Can acupuncture help PMS?

Acupuncture and herbal medicine are studied for premenstrual symptoms, and research is ongoing. Many people find the week before the period becomes easier to live with. We treat the pattern that builds each month, and we adjust as your symptoms change.

Is PMDD more than bad PMS?

Yes. PMDD is a recognized condition in which mood symptoms before the period are severe enough to disrupt work and relationships. It deserves care from your physician or a mental health professional, and we work alongside them. If you ever have thoughts of harming yourself, call or text 988 or go to an emergency room.

I take an antidepressant. Can I still have herbs?

Possibly, but only after a careful review. Some herbs interact with antidepressants, so every formula is checked against your medications, and we never ask you to change a prescription.

Does what I eat in the second half of my cycle matter?

In this reading, yes. Cold, sweet and greasy food tends to weigh on the Spleen just when the Liver is pressing on it, and alcohol feeds heat. Advice is matched to your pattern rather than a fixed list.

From the journal

PMS and PMDD in Chinese MedicineIrritability, breast tenderness, poor sleep, then relief once bleeding starts: how Chinese medicine reads PMS and PMDD through Liver, Blood, Kidney and Heart patterns.

This is general wellness information, not medical advice.

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