Case Study: Treating PMDD with Chinese Medicine

A 44-year-old female patient, I will call her Sara, came to me with a diagnosis of PMDD (Pre-menstrual Dysphoric Disorder).   PMDD is a major depressive disorder that coincides with a woman’s menstrual cycle.  Symptoms usual begin two weeks prior to menses and are similar but more intense than PMS (Pre-menstrual Syndrome).  Most women have some symptoms and/or moodiness prior to menses however the  depression associated with PMDD is severe enough to push some women to suicide. 

When Sara arrived in my office she was not functioning in her daily life.   She could not work or leave her home three weeks out of the month.  As  a small business owner this had a very negative effect on her business and her financial situation.  She rated her stress level as “severe”.  She was skeptical but desperate and willing to try an alternative, holistic approach. 

Sara was diagnosed with PMDD at age 41, in addition to her debilitating depression her physical symptoms included “intense” headaches, painful breast and pain at specific points on her spine.  She reported feeling that her muscles were weak.   Her energy levels fluctuated from low to high, she did not sleep, and had frequent colds with a clear nasal discharge.  She was also “always” constipated.  She had managed with medications since her diagnosis but now the medications were no longer working.

A full history revealed a series of emotionally intense life events beginning as a small child and moving into early adulthood.  At 37 she was  diagnosed with  Bi-Polar Disorder and had taken Lithium and Wellbutrin regularly since that time.  She also used Zoloft as needed to help with sleep. 

Sara sat and spoke calmly but she had a marked constant tremor in her hands, and intermittent twitches in her spine that caused her head to jerk slightly.  I have seen this combination of symptoms before in people taking multiple psychotropic drugs to stabilize mood.  These are considered side-effects of these medications but they occur in people who also have the TCM diagnosis of Blood Defiency with Internal Wind. 

From the TCM (Traditional Chinese Medicine) perspective Bi-Polar Disorder results when an intense emotional shock produces great fear.  This intense fear creates imbalances in the body which show up as problems in digestive function, insomnia, fatigue, and numerous other symptoms.  

For TCM practitioners these symptoms signal the body’s function is in decline and needs to be corrected or conditions will worsen.  Over time insomnia unresolved will produce anxiety and then mania developes.  As the same time sleeplessness creates an ever deepening fatigue and from that Depression develops.  The body and the emotions teeter-totter back and forth between hyper and hypo functioning but can not find balance.  Everybody with a Bi-Polar diagnosis has this switching between high and low to some extent, for Sara it was very severe and needed medication.

Sadly, though Sara's medication stabilized her emotions, the underlying imbalances were not addressed and four years after she was diagnosed as Bi-Polar, she developed PMDD.  

The Chinese Medical Approach

Often PMDD is the first major diagnosis a woman receives and nobody explains that in the Western medical system the terms "disorder" or "syndrome" means we recognize your symptoms, but we can not locate the organic cause and therefore there is no treatment.   

Any women suffering with PMDD should understand you do not have an untreatable disease, you have a syndrome a predictable pattern of disfunction.   From a Traditional Chinese Medicine perspective the underlying causes of these dysfunction are well understood and easily treated by a well-trained practitioner.  

Note for TCM practitioners:  Overtime one imbalance had created another and then another in an interlocking cascade. Her Chinese diagnosis was:  Liver and Spleen Disharmony; Liver Qi and Blood Stagnation, Heart Blood Deficiency with Heat Harassing the Heart, Liver Blood Deficiency with Internal Wind, Spleen Yang/Qi Deficiency with Cold Damp Accumulating,  there was also Deficiency of  Lung Qi, Wei Qi, and both Kidney Yin and Yang Deficiency.  

In TCM when each disfunction, or imbalance, contributes to and is caused by two or more of the other patterns this is called a "knotted" disease.  A "knotted" disease requires a holistic approach because if only one or two imbalances are treated it is like pulling on only one string in a knot; the knot only tightens.  

Western medicine does work well with knotted diseases, or syndromes,  because biomedicine is not a system-based holistic,  approach. Using alternative herbal and dietary approaches can create improvement for a time, but after a while the positive effect wears off. 

TCM is the system that can address all the various symptoms while also addressing the root cause. 

This is what happened during Sara's treatment. 

Sara received acupuncture twice a week for two months.  She also took a Chinese Herbal Formula I wrote specifically for her.  Her Formula consisted of seventeen herbs and was designed to treat all her dysfunctions simultaneously with a focus on relieving her PMDD symptoms.   After her first acupuncture treatment Sara reported a marked shift in her mood and some improvement in her other symptoms.   

By her third acupuncture treatment Sara was on Day 6 of  her Menstrual Cycle and reported a change in her menstrual blood flow. Normally heavy on either Day 1 or Day 2, this cycle her flow was more even across all the days.  She also reported improvement in all her symptoms ranging  from "some" to "much" improvement. Sara reported her mental and emotional state was improved over the norm for the first week of her cycle. This improvement was due solely to acupuncture as Sara had not yet started her chinese herbal formula. 

Sara started her custom herbal formula and six days later, on Day 12 of her cycle, the trembling in her hands was improved and the twitching in her spine was completely resolved.  Sara happily reported her “wit and humor” were returning. Her energy had also improved and she had slept without the use of medication on a few occasions. 

On Day 16 of her menstrual cycle, about 16 days after beginning  treatment, Sara entered her PMDD zone time when her Depression affected her the most.   Sara did have some symptoms but reported she could function with effort which was an improvement.  Sara also reported sleeping through the night for the first time in “forever”.  Sara again said she felt much improved immediately after her acupuncture treatment. 

On Day 21 Sara reported she felt “perfect”, then on Day 22 PMS symptoms started.  PMS not PMDD, physical symptoms were not as severe and Sara was fatigued and moody but not depressed.   Sara  finished out her 28  day cycle without returning to her most severe symptoms.  

One month later, on Day 21 of her menstrual cycle Sara described herself as 75% operational.  Her energy was good, digestion fine, sleep varied. Her PMS symptoms were light, she had no depression.  Sara “knocked on wood” after expressing how good she felt. 

Day 28 - Sara was excited. She had done well “all week”. She could not believe she was back to work!  She had worked 8am - 5pm all week but noticed she fatigued easily. She also slept through the night, at times, without any sleep aids. Her headaches now responded to Advil. 

After two months of treatment with acupuncture and Chinese Herbal Medicine Sara was no longer experiencing debilitating PMDD and had resumed normal activities.  We continued treatment at reduced levels to allow her body to continue to repair.  During this phase of treatment lifestyle changes and stress management strategies were added to consolidate her improved health.   

One year later Sara gets acupuncture twice a month and knows she can add herbs back into her health regime at times of high stress if needed.  She has been able to start a new business and recently began dating.  She remains on her Bi-Polar medication.

For further information on PMDD and PMDD and Acupunture

Effects and treatment methods of acupuncture and herbal medicine for premenstrual syndrome/premenstrual dysphoric disorder: systematic review - National Institute of Health

PMDD is Not Just Normal Moodiness - Pysch Central