Xiao Yao San & PMS

abstracted & translated by
Bob Flaws, L.Ac., FNAAOM (USA), FRCHM (UK)

Keywords: Chinese medicine, Chinese herbal medicine, gynecology, premenstrual syndrome (PMS), Xiao Yao San

On page 103 of issue #2, 2007 of the Zhe Jiang Zhong Yi Za Zhi (Zhejiang Journal of Chinese Medicine), Meng Ying-fang published an article titled “Modified Xiao Yao San in the Treatment of Perimenstrual Syndrome.” This article was a cohort study using Xiao Yao San with additions and subtractions for PMS. A summary of this article is presented below.

Cohort description:

There were 86 women enrolled in this study, all of whom met the diagnostic criteria for PMS. These patients ranged in age from 18-45 years old. The menstrual cycle was normal in 40 of these cases, late in 20 cases, early in 14 cases, and sometimes early, sometimes late, no fixed schedule in 12 cases. The condition had lasted within one year in 38 cases, for more than one year in 30 cases, and for more than two years in 20 cases. There was marked psycho-emotional discomfort in 40 cases and no obvious psycho-emotional discomfort in 46 cases. Thirty cases had accompanying breast lumps. However, there were no cases of breast cancer. Thirty-five cases had accompanying premenstrual edema. Patients with heart, liver, or kidney disease were excluded from this study.

Treatment method:

Modified Xiao Yao San consisted of:

Chai Hu (Radix Bupleuri)
stir-fried Bai Zhu (Rhizoma Atractylodis Macrocephalae)
Bai Shao (Radix Alba Paeoniae)
Fu Ling (Poria)
Xiang Fu (Rhizoma Cyperi)
Xu Duan (Radix Dipsaci)
He Huan Pi (Cortex Albiziae), 15g each
Dang Gui (Radix Angelicae Sinensis), 12g
Yi Mu Cao (Herba Leonuri)
stir-fried Suan Zao Ren (Semen Zizyphi Spinosae), 20g each
Gan Cao (Radix Glycyrrhizae), 9g

Further modifications were made on a case by case basis following each patient’s specific signs and symptoms. One packet of these medicinals was decocted in water two times and administered per day in two divided doses, morning and evening. Treatment was begun 5-7 days before the expected onset of menstruation and stopped after the menstruation was finished. In those cases where the menstruation came sometimes early and sometimes late, the medicinals were administered during the days the menses should normally have come. Three menstrual cycles equaled one course of treatment, and outcomes were analyzed after one course. During the study, patients were counseled not to eat acrid, peppery, uncooked, or chilled things and to control their salt and coffee intake. They were also told to try to keep their emotions relaxed and under control.

Study outcomes:

Cure was defined as complete disappearance of the symptoms with no recurrence on follow-up after one year. Improvement meant that the symptoms decreased, there was no disturbance to work or studies, or, if all the symptoms disappeared, there was a recurrence within a half year. No effect meant that there was no obvious improvement in symptoms after one course of treatment. Based on these criteria, 40 cases were cured, 38 cases improved, and only eight cases got no effect. Therefore, the total effectiveness rate was 90.70%. Readers should note that these medicinals were only given during the premenstruum and the menses themselves, not throughout the entire cycle. This is standard in the treatment of PMS in China when patients are treated with bulk-dispensed, water-based decoctions. Readers should also note the relatively high doses of medicinals in the formula.

Copyright © Blue Poppy Press, 2007. All rights reserved.