Premenstrual Syndrome & Hysteria

“The cause is clearly Windy Vapors
ascending from the Womb upwards” (Culpeper)

Hysteria

Hysteria is a traditional classification where the body, mind and nerves are affected by the ‘Uterus’ [hormones]. It was associated with hyper-emotionalism, dramatic behavior, over-excitement, amnesia, sometimes leading to mania or psychosis. Physical symptoms such as Globus Hystericus (sense of a lump in the throat), Palpitations or abdominal swelling may also occur.

According to some writers, the actual Uterus was believed to rise up into the abdomen, just as it can also fall (prolapse). However, this ‘movement’ is referring to the energetic movement upwards where the Womb (via the hormones) affects the Head, Mind and Spirit. This is similar to the Chinese concept of Qi stagnation, or more correctly, improper flow of Qi.

As the Qi rose up to the Head, it would often affect the breathing or give a sensation of a blockage in the Throat. This is similar to the “Plum-Stone Qi” of TCM which is likewise associated with Qi blockage.

As it was associated with the Uterus, it was specific to women. In cases where a man had similar symptoms it is regarded as another disease and may have been classed with Epilepsy, for example.

Premenstrual Syndrome (PMS)

PMS refers to the symptoms which some women have, typically in the days or week leading up to the beginning of menstruation. Symptoms may be Mental-Emotional, or Physical:

• Mental-Emotional: sadness, depression, anxiety, irritability, anger, mania
• Physical: breast distention, menstrual cramping, abdominal distention, bloating

Symptoms that may accompany:

• moodiness, hyper-emotionalism, crying, anger, mania
• cramping, abdominal distention or pain, breast tenderness
• loss of appetite, nausea, despises food
• weakness of the Heart, palpitations, fainting
• choking feeling

These symptoms are due to disharmony in the progesterone-estrogen balance, the time between ovulation and menstruation being largely governed by progesterone.

In Traditional Medicine this falls within the category of ‘Hysteria’, that is, from the Greek husterikos, ‘of the Womb’.
Hysteria was often described as a ‘Rising of the Womb’. Later anatomists scoffed at this idea as the Uterus is bound tightly with ligaments. But its highly likely the original intention was a rising of ‘Vital Spirit (Qi)’ from the Uterus. In other words, the energetic effect of the Uterus on the Mind and Body, similar to the Qi Stagnation of TCM. In any case, the recognition of this being related to the Uterus, and therefore the hormones, was classically known.

Treatment:

Treatment generally aims to regulate Qi and relieve Qi stagnation, as well as promoting or regulating menstruation. In cases with marked deficiency, tonics are indicated.

It was long recognised that there was a peculiar relation between the Uterus and could scents. Strong foul scents applied to the nose, with sweet, aromatic scents applied to the pubis, or even as a fumigation directly to the vagina, was used to “draw down” the uterus. Based on this concept, foul and strong smelling scents, especially Asafetida and related gums, were regularly used for Uterine diseases including Hysteria.

A Database Review from Taiwan:

A huge review of all prescriptions written for PMS in Taiwan between 1998-2011 (a total of 14, 312, prescriptions), revealed:

• Dan Zhi Xiao Yao San (Jia Wei Xiao Yao San) was by far the most common used (37.5% of all prescriptions) and was most common core formula prescribed (with modification).
• Dan Zhi Xiao Yao San was commonly combined with Cyperus rotundus (most common addition)
• Dan Zhi Xiao Yao San was also commonly used with Chinese Motherwort (Yi Mu Cao)

See the Research below.

Other Chinese Formulas

Special Formula

Uterine Fury

“Madness of the Womb”

It is worth making brief mention of what was called Uterine Fury, or Madness of the Womb.

“Womb Fury is a sort of Madness, arising from a vehement and unbridled desire of Carnal embracement which desire disthrones the Rational Faculty so far, that the patient utters wanton and lascivious Speeches, in all places, and companies, and having cast off all Modesty, madly seeks after Carnal Copulation, and invites men to have to do with her in that way”. (The Practice of Physick, 1663)

This clearly demonstrates the idea of the hormones being affected by lack of sex when there is a strong desire for sex. And this therefore was recognised as another way the Uterus could affect the Mind and Spirit. It was said to come from “an abundance of seed”, but could be translated today as “an abundance of hormones”.

“Some hold, That the Seed being corrupted, acquires a malignant quality, which causes these grievous symptoms”

Causes were said to be either a “youthful age”, Sanguine (Blood) constitution, or Bile or Melancholy.

From a TCM perspective, long term Qi stagnation creates Heat in the Liver, and as the Heat rises, yelling, abusing, violence and a loss of control can manifest.

Treatment:

“in the first place, Blood must be often drawn … And if the Patients monthly Courses be stopped, the inferior Veins (in the legs) are afterwards to be opened”. (The Practice of Physick, 1663)

“if the Patient cannot so conveniently be married, or the condition of her life will not bear that estate, some advise that the Genital Parts should be by a cunning Midwife so handled and rubbed, as to cause an Evacuation of the over-abounding Sperm’. (The Practice of Physick, 1663)

The above clearly shows the idea of causing orgasm to relieve the overexcited state and relieve Qi constraint.

Research:

AGNUS CASTUS
–Vitex agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials.
–Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review.
–The treatment of premenstrual syndrome with preparations of Vitex agnus castus: a systematic review and meta-analysis.
–Efficacy and safety of Vitex agnus-castus extract for treatment of premenstrual syndrome in Japanese patients: a prospective, open-label study.
–Use of Vitex agnus-castus in migrainous women with premenstrual syndrome: an open-label clinical observation.
–Evaluating therapeutic effect in symptoms of moderate-to-severe premenstrual syndrome with Vitex agnus castus (BNO 1095) in Chinese women.
OTHER HERBS
–Effect of Melissa officinalis capsule on the mental health of female adolescents with premenstrual syndrome: a clinical trial study.
–Effect of Melissa officinalis Capsule on the Intensity of Premenstrual Syndrome Symptoms in High School Girl Students.
–The efficacy of Hypericum perforatum (St John’s wort) for the treatment of premenstrual syndrome: a randomized, double-blind, placebo-controlled trial.
–Efficacy of Chamomile in the Treatment of Premenstrual Syndrome: A Systematic Review.
–Curcumin attenuates severity of premenstrual syndrome symptoms: A randomized, double-blind, placebo-controlled trial.
–A randomized, placebo-controlled trial of Ginkgo biloba L. in treatment of premenstrual syndrome.
–Effects of Zataria Multi-Flora, Shirazi thyme, on the Severity of Premenstrual Syndrome.
GENERAL
–A Systematic Review and Meta-Analysis of Premenstrual Syndrome with Special Emphasis on Herbal Medicine and Nutritional Supplements.
–Understanding premenstrual syndrome from a Chinese medicine perspective.
–Identifying Chinese herbal medicine for premenstrual syndrome: implications from a nationwide database.
–A controlled trial of Chinese herbal medicine for premenstrual syndrome.
–Herbal treatments for alleviating premenstrual symptoms: a systematic review.
–The effectiveness and safety of Iranian herbal medicines for treatment of premenstrual syndrome: A systematic review.
–Effects and treatment methods of acupuncture and herbal medicine for premenstrual syndrome/premenstrual dysphoric disorder: systematic review.
–Efficacy of acupuncture in management of premenstrual syndrome: a systematic review.
–[Treatment of premenstrual syndrome with Chinese medicine formula, baixiangdan capsule: implications for neuron viability and GABA(A) receptor modulation in rat cortex].