3. PREMENSTRUAL SYNDROME (Premenstruai Tension Syndrome) GENERAL CONSIDERATION
      Premenstrual syndrome is a recurrent (monthly) variable cluster of troublesome symptoms and signs that develop during the 7 to 14 days before onset of menses. The disorder may be characterized by irritability, emotional liability, hypo- or hyperreactivity, headache, palpitations, cyclic acneiform rash, mastalgia and edema of the extremities. Manifestations subside when menstruation occurs. Emotional nulliparous women 30 to 40 years of age are most commonly affected. Cyclic physiologic disturbances account for the symptoms. Recent studies suggest that renin augmentation of the latter portion of the menstrual cycle activates the angiotensin system, resulting in release of norepinephrine and aldosterone. Premenstrual syndrome is believed to be a result of the action of increased biogenic amines and fluid and electrolyte disturbances. Prostaglandin may be responsible for the troublesome effects.
     No gross endocrine or other physical dysfunction distinguishes the patient with
premenstrual tension syndrome. Brief elevated serum prolactin has been reported in
some patients.
     Dread of an impending period or concern regarding pregnancy, elimination and
femininity often are related concerns. Atypical pelvic pain and primary dysmenorrhea
may be the associated problems.
     In traditional Chinese medicine, the disease is called "Di Shar Mong," due to
hepatic Qi or liver stasis.
CLINICAL MANIFESTATIONS
     Anxiety, agitation, insomnia, inability to concentrate, and a feeling of inadequacy are reported. Patients complain of mastalgia, nausea and vomiting, and diarrhea or constipation. Depression may colour the woman's affect, or she may be contentious and aggressive. Peculiar drives or unusual appetites are commonplace.
     The emotional build-up parallels weight gain (edema) of up to 3 or 4 kg. The
general and pelvic examinations are not otherwise specific. A prompt weight loss by diuresis follows the onset of the period. Laboratory findings such as serum prolactin may be elevated.
DIAGNOSIS
     ? Emotional nulliparous women 30 to 40 years of age.
     ? Recurrent variable cluster of troublesome symptoms and signs that develop
during the 7 to 14 days before onset of menses,
     ? Brief elevated serum prolactin has been reported in some patients.
TREATMENT
I. Treatment in Western medicine.
     Sympathetic understanding, reassurance, simple analgesics, thiazide diuretics, judicious use of sedatives, sodium restriction and support stockings may provide
relief for many patients with premenstrual syndrome. Psychotherapy alone is relatively ineffective. Behavior modification is sometimes of value in treating patients whose mothers have had a similar illness pattern.
     Suppression of ovulation by oral contraceptive may give relief. High doses of
progestins are sometimes beneficial, but this therapy is not often practical. Prostaglandin drugs may give relief.
     Spironolactone, an aldosterone blocking agent, 25mg orally 2 times daily for 7 to 10 days prior to and through the menses, has been reported to be effective and
well tolerated. Other diuretics and potassium supplements must be avoided with
spironolactone administration.
II. Treatment in traditional Chinese medicine.
     1. Herb therapy
     For "liver stasis." There may appear various symptoms, such as fullness or
burning pain of the hypochondrium, chest distress, mental depression or anxiety,
feeling a lump in the throat, occasional epigastric distension and pain, hiccup
regurgitation of acid, suppressed appetite, occasional abdominal distension and pain, diarrhea, stringy pulse. The principle of the treatment is to clear the liver with Dan Ge Xiao Yao San Jia Jian.
      Constituents:
      Chinese angelica  20g
      Root of herbaceous peony  30g
      Chinese thorowax  10g
      Tuckahoe  12g
      Large-headed atractylodes  15g
      Nutgrass plagsedge  15g
      Root-tuber of aromatic turmeric  12g
      Root-bark of peony  15g
      Capejasmine  15g
      Fruit of citron or trifoliate orange  15g
      Fruit of harwthorn  15g
      Medicated leaven  15g
      Malt 30g
      Decoction and dosage: All the above herbs make a dose and six to ten doses are prescribed with one dose daily. Each dose is simmered twice and then the broth of each mixed, half of the mixed broth each time, twice a day.
      For hepatic fire. It is caused by disharmony of the hepatic Qi. The symptoms
are irritability, fullness, distension and pain of the chest and hypochondrium,
distension and pain of hypogastrium, breast pain, irregular menstruation, headache
and dizziness, restlessness. In severe cases, mania may appear with stringy rapid and forceful pulse, redness of the tip and edges of the tongue with yellowish coating. The principle of the treatment is to purge the live fire with Lun Dan Xie Gan Tang Jia Jian.
      Constituents:
      Rough gentian  15g
      Cape jasmine  12g
      Skullcap  12g
      Chinese thorowax  15g
     Oriental water plantain  15g
     Chinese angelica  15g
     Fresh and dried root of rehmannia 20g
     Root-bark of peony 12g
     Cape jasmine  12g
     Root of herbaceous peony 30g
     Motherwort  20g
     Fruit of glossy privet 30g
     Decoction and dosage is the same.
     For impairment of liver and kidney. The pathologic changes in which the Yin
(vital essence) fluid of the body, liver and kidney are simultaneously impaired. The main symptoms are dizziness, feeling of distension of the head, blurred vision,
tinnitus, hot palms and soles, insomnia, soreness of the waist and knee, breast pain,
irritability, stringy, faint and rapid pulse, or faint and weak pulse. The principle of treatment is to nourish the Yin fluid with Yi Guan Jian Jia Jian.
      Constituents:
      Tuber of dwarf lilyturb  30g
      Fresh or dried root of rehmannia  30g
      Beishashen  15g
      Chinese angelica  30g
      Chinaberry fruit  12g
      Fruit of Chinese wolfberry 15g
      Root of Zhejiang figwort  20g
      Root of herbaceous peony  30g
      Chuanxiong 15g
      Fruit of glossy privet  30g
      Yerbadetajo  30g
      Root-bark of peony  12g
      Cape jasmi