Premenstrual syndrome is the constellation of symptoms that appear in the days prior to the onset of a menstrual period.  Symptoms include anxiety, irritability, fatigue, depression, headache, breast pain, abdominal bloating, and fluid retention.  Numerous hormonal changes have been implicated in PMS.  Depending on the predominant symptoms, researchers have subdivided the condition into four general types: anxiety, food craving, depression and fluid retention.  This system of classification makes it much easier to prescribe herbs, as it divides the condition in a way similar to the herbal energetics methods used in traditional medicine. 

Most cases involve progesterone deficiency or estrogen excess.  I usually start with a trial of chaste tree berry tincture (Vitex agnus-castus), which helps increase progesterone via an effect on the pituitary hormone prolactin.  Often this is enough, and it is inexpensive and easy to administer.

 Native American women would chew evening primrose seeds to relieve PMS (Duke, 1997).  The benefit may result from gamma-linoleic acid (GLA), the fatty acid abundant in the seeds that helps the body make needed hormones. 

Nai-shing uses a base combination of the TCM herbs bupleurum root, scute root, cyperus rhizome (xiang fu or C.  rotundus), blue citrus peel (qing pi or C.  reticulata) and white peony root.  Other herbs are added according to signs and symptoms.  For example, with fluid retention, she adds small amounts of diuretic herbs such as dandelion leaf, leonorus herb (yi mu cao or L.  heterophyllus), or water plantain (ze xie or Alisma plantago-aquatica), to her base formula. 

In cases with anxiety symptoms, you can use scullcap herb tincture or kava root to control those symptoms.  Because chaste tree berry and the TCM combinations seem to work through different biochemical mechanisms, using one or the other, or sometimes both in combination can usually solve even the most severe PMS problems. As always, healthy diet and healthy lifestyle are essential for proper hormonal balance.

Research Highlights

• A randomized controlled double blind clinical trial of 100 women measured the effects of chaste tree berry (30 drops twice per day) on breast pain preceding menstruation.  Intensity of breast pain diminished more quickly in the treated group (Halaska et.  al., 1998).  An earlier study showed reduction in water retention (Amann, 1979).

• In a series of animal experiments, a Japanese researcher showed that the six-herb combination called dang gui and white peony powder increased progesterone secretion.  When the formula ingredients were analyzed in groups, dang gui root, water plantain (ze xie or Alisma plantago-aquatica), and white peony root increased progesterone accumulation in the blood, while the combination of poria mushroom and white atractylodes decreased these levels.  The formula as a whole favored progesterone production and reduced one of the estrogens called estradiol (Usuki, 1988).  This formula is traditionally used to reduce cramping pain and swelling in the abdomen and uterus, and to prevent miscarriage.