Case Study: PMDD Treated in Collaboration with Local Acupuncturist

Donna - A Case of PMDD

Donna was an elite athlete as a youth with all the discipline, physical and mental strength that comes with competing at the national/international level.  She competed between the ages of 11 – 22.  Her cycles began at 11-12 years of age and she reported they were difficult and painful from the start.

When she contacted me she had been suffering and diagnosed with PMDD for about 25 years; she had first noticed issues in her mid-teens to early-twenties.  She had never found anything that lessened her symptoms despite trying many medical treatments and they had been worsening as the years passed.  

Donna had a history of chronic TMJ from her early teens and had a severe Kidney infection while in 4th grade. At 34 years old she had been diagnosed with sciatica and told she had arthritis in an extra vertebrae in her back.  At 49 years of age she was hospitalized with anemia, severe iron deficiency and a viral infection in her heart.  At this point she realized her years of pushing through the PMDD were done and she took a break from the daily routine that had worn her down.

Donna’s weight yo-yoed over the years, and she seemed to get progressively heavier since the chronic back pain.

 When she contacted me Donna was 51 years old, 5’9” and 275 pounds.  She took no medications and only a few supplements.  She diligently saw an acupuncturist and had taken herbs he prescribed but after several years her symptoms were not improving and they seemed to be unable to find the right remedy.

Donna’s true nature was one of great awareness and perseverance so she carried on looking for a solution. She finally found me online and asked if I would work in tandem with her local acupuncturist as she was too distant to see me in my office.

Her intake form revealed a daily struggle with fatigue, excessive hunger, both falling asleep and staying asleep.  Her other symptoms included palpitations while at rest, moderately thick white phlegm, urgent daytime urination, frequent urination during her menses, water retention, bowel movements that varied from loose to constipated, night sweats and digestive issues that included, belching, bloating, gas.

She described herself as having “one good week” out of the month, the week after her period.  That week the above issues would decrease in intensity to levels where she could function and get things done.  The two weeks prior to her menses her symptoms listed above would intensify and her emotional state would careen from intense rage to severe depression and anxiety.  The physical pain in her breasts and back would become severe.

Her actual week of menses was a peak pain experience with intense cramping, intermittent heavy bleeding and the passing of large clots.  Donna would take 16 Extra Strength Advil daily during her menses to manage the pain.  As her physical state reached unbearable levels, her emotional/mental state dropped into a dark, deep sense of hopelessness.


Traditional Chinese Medicine Perspective

In TCM (Traditional Chinese Medicine) we diagnose patterns of dysfunction using our own peculiar professional language.  It is a Systems approach meaning the natural scientist and physicians who developed it were focused on understanding how loss of function or balance in one part of the body would affect the whole system.   TCM is a Holistic medical approach with possibly 4000 years of use and definitely 2000 years of clinical records.

As I’ve written elsewhere a chronic, severe and complex case like this falls into the category of a Knotty or Knotted Disease.  This is because a pattern or dysfunction or disharmony in one body system will always over time push other physical systems out of balance.  As the body cascades deeper into dysfunction it attempts to self correct but when too many systems are not functioning well and the body’s attempts only make things worse.

Recently science has proven the Mind/Body connection as fact, however in Chinese Medicine there has never been a separation between the Body/Mind or Spirit.  Therefore from my perspective the intense emotional/mental states in PMDD are not only unavoidable they are to be expected given the state of the body.

 With all the information gathered during our Facetime “office visit” and a photograph of her tongue I was able to create a Chinese diagnosis for Donna.  Her local acupuncturist was open to my input so I was also able suggest a slight shift in his treatment approach.

TCM Diagnosis was severe deficiency of the Vital Substances: Qi, Blood, Yin and Yang, with Damp Accumulation, and Blood Stagnation. 

For TCM practitioners: If you find all the vital substances are deficient you will need to address the following patterns: Liver Qi Stagnation, Spleen Qi Deficiency, Lung Qi Deficiency, Heart Qi and Blood Deficiency, and Kd Yin and Yang Deficiency.  

In this case as with other chronic Knotted Diseases every phase of the Shen/Ko system is out of balance and needs correction, and since each imbalance creates a pathological influence, (in Western terms a co-morbid condition), some degree of damp, heat, damp-heat, food stagnation, qi stagnation or blood stasis will be present and should be addressed.

Each person with PMDD is unique so the Shen/Ko imbalances will be present with different degrees of severity. The same is true of the co-morbid pathological influences.  All this must be analyzed prioritized and addressed – SIMULTANIOUSLY.  This is the nature of a Knotted Disease you cannot pull on one string (ie. address one pattern or symptom) and then pull on the next one because that will never untie the knot.

Donna’s Treatment and Outcome

I wrote Donna a customized formula that addressed all her issues simultaneously and conferred with her local acupuncturist on a treatment plan.  I want to stress the importance of the acupuncture treatments.  It is having both these tools working together that gets the fastest results.


First Cycle - Donna started her herbs on Day 1 of her menses and on Day 9 reported that beginning on Day 4 she felt a lessening of her symptoms though the back pain remained severe.

By Day 5 all symptoms continued to lessen, she had no breast pain and back pain was improved as well.  Day 7 – The final day of her blood flow she reported all symptoms were mild and there was still no breast pain.

On the firsts days of her cycle Donna had panic attacks as usual.  They stopped on Day 3 and overall she noticed she was more calm. Also her hunger was less extreme and, she reported she had none of her usual brown discharge.  Also her night sweats had also become mild and she was no longer getting up to urinate at night.  

“Can this be happening?” she asked me.  She was afraid to get her hopes up.

Second Cycle - Donna reported that all signs and symptom had improved and she felt able to recognize herself in the mirror again.  She confessed she was hesitant to say things were better for fear she would jinx it.  She expressed great hope and relief that she seemed to be really improving.

Donna takes detailed notes and laid out her menstrual cycle as follows.

Day 1 minimal cramps; Day 2 Severe cramps and fatigue; all other symptoms present but muted.  From Day 3 on her symptoms and pain remained moderate.   

In general she felt her mental health was greatly improved. She had enough energy to make plans and to do more on a daily basis.  Donna reported sleep continued to be challenging.

TCM Practitioner notes:  Donna’s tongue showed that qi and blood were returning however this increased the stagnation issue.  This is why acupuncture is so important it can address this piece of the puzzle and make more rapid adjustments.  I advised Donna that she and her local practitioner could establish which days of her cycle were the most critical for treatment.

3rd Cycle – When I asked how she was doing Donna replied, “I feel f***in’ Good!”  She was on Day 4 of her cycle and she had taken an average of 4 Advil a day. This was a great reduction from her old 16 Advil a day.

Symptoms were present but much less intense.  She felt like she had relatively normal PMS  and was having more normal levels of menstrual discomfort.

Donna described a few days scattered through the month when she rated her symptoms moderate to severe.  Her emotional issues were rated as severe on 3 days for anger/rage, 4 days for anxiety,  and 3 days for the ravenous hunger.

We discussed that deconstructing mental/emotional/behavioral habits that had developed over 25 years of just pushing through and surviving would be her next level of healing.  

Donna, always proactive, had stayed close to the cleanse diet she finished before starting the herbs.  We discussed how to rotate foods to allow variety.  She also was meditating daily and doing positive visualizations of herself enjoying life without PMDD.

As we ended our session Donna said, “Wow. This really is happening. I’m really feeling better.”

Moving forward from this point I will revise Donna’s formula to better address the anger, anxiety, and intense hunger issues and she will continue with acupuncture and her dedicated work to her own healing.


Moving Forward - Donna plans to start a blog to share her PMDD life experience with others. You can find her and at the link below.

To All that Suffer - There is help.  You need a well-trained Chinese Herbalist and Acupuncturist.









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