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 

Wiring Your Brain For Happiness

Recently science has proven that what you think actually creates the physical shape of your brain. Scientist now know that as a the brain fires off a neural sequence repeatedly over time, the brain cells involved wire together so the sequence can run more efficently.  The upside is this process of hard wiring in the brain helps the brain conduct routine business more efficiently, however the down side is that most people are not actively choosing how their brain, their life, is getting wired to operate. 

An example of an active use of this principle would be an athlete, or a piano player, who enhances his performance by visualizing the sequence he needs to perform.  The necessary brain wiring, or neural sequence, becomes stronger by thinking though the performance because the same neural pathways used to visualize it are used to perform it.

Given that the same thing happens with ALL your thoughts and feelings actively making choices about what you focus on starts to make a lot of sense.  If you are constantly stressed and overwhelmed your brain becomes wired to be very good at being stressed and overwhelmed.  It will then trigger the stress sequence in your body at the first thought of trouble, real or imagined.  

If you began thinking negative critical thoughts about yourself in puberty (and who didn't!) every day those thoughts have run through your mind unchallenged they have become more entrenched and more real.  Ever notice how that Critical Voice in your head speaks with absolute authority, those negative thoughts are deeply reinfored.  

Thousands of years ago the Sages of India knew this was how humans operated and their teachings are full of references to  “mental grooves”,  “patterned thinking” and "conditioned exsistance".  Liberation from this mindless, repeating of sequenced thoughts, behaviors, and/or actions is what meditation is meant to do. 

Beyond the science that supports the existance of "mental grooves", there is a  study out of China  that now shows the oldest brain exercise, meditation, remains the best for maintaining a positive outlook, off-setting stress, and keeping your brain “young” . 

Meditation not only can bring a person to a state of calm, it promotes a more positive outlook.  As time is spent in a calm, positive, state this is what becomes wired into the brain.  Each time you meditate your ability to mindfully, willfully, shake-off life's stresses and return to a state of ease grows stronger.

If you would like to give it a try, check out the free audio down loads of mediations at UCLA’s Mindfulness Research Center.   I recommend you start with the 5 minute Breathing Meditation or the 3 minute Loving Kindness Meditation.  

If sitting quietly watching your own breath sounds like science-fiction consider acupuncture treatment or yoga as a starting point.  If those options are not realistic, please read my post on practicing Gratitude and use that to get yourself moving in a positive direction. 

Or simple set the intention that you want a calm, more positive mind, and know that every mindful breath you take while holding that thought is a step in that direction. 

Acupuncture Proven Effective

Creating a study to properly measure the effectiveness of acupuncture has proven difficult because the gold standard, the double-blind random controlled study, was designed to test pharmaceuticals against a placebo/sugar pill.

There simply is no good way to "fake" an acupuncture treatment.  And even if sham acupuncture could be devised it would be impossible for the person administering the treatment to be "blind" to the knowledge of whether they were giving real acupuncture or sham acupuncture.

However, the tide is turning and different ways of approaching the need to scientifically prove the effectiveness of acupuncture are being found.  In a Georgetown University study, neuropeptide y (NPY) a protein associated with stress, was measured before and after acupuncture treatment.  Findings concluded an immediate and long lasting reduction in the protein measured.

The study is significant because once duplicated, acupuncture will be "scientifically" proven as a treatment for stress.  Since stress is a recognized precursor for so many more serious ailments there is hope that this scientific finding will open the door for a wider acceptance and use of this valuable therapy.

In the meantime, the US Military after performing it's own vigorous studies has recognized publicly the value of acupuncture and  introduced the therapy into both Veteran's Hospitals and combat settings.

Chinese Herbs versus Supplements

The medicinal herbs used in Chinese medicine are categorized as supplements by the Food and Drug Administration, and their production and distribution is overseen by this agency. Herbs are in this category because they, like supplements, are considered safe when taken as directed; so both are equally safe.

About ten years ago, “Bah Humbug!!” lost steam as an argument against alternative traditional medicine when statistics showed that people were spending billions of dollars for this kind of care. Now, Western medicine has begun to admit that there are things they don’t treat well, such as chronic pain, chronic diseases and disease prevention.

For some M.D.'s pharmaceutical grade supplements became the way to address these areas of shortcoming, however, the docs and others who recommend supplements still use a western approach. They still treat symptoms, not the root cause, and they still use a 'one size fits all' approach.  The result is people often take fists-full of expensive supplements with mediocre results.

A custom herbal formula is a customized supplement designed to treat both the symptoms and the root. It is designed specifically for the individual, and because of this, people should expect to feel an improvement within a week. One formula to treat your personal laundry list of issues.

Chinese herbs are safe, effective and have no side-effects.

Western doctors who warn against Chinese herbs do so because they do not understand how a medical system based on sticks 'n twigs, and roots 'n berries can work so well without side effects.