Compiled by Joseph Brady MSTCM, L.Ac., Dipl. OM

Contact: taichiproj@earthlink.net | joe.brady@faculty.ccmu.edu

1529 York Street, Denver, CO 80206

Acknowledgements

Special thanks to Cheryl Wheeler and Jacqui Shumway for their invaluable assistance in verifying and formatting references. Each review is a snapshot of the best available evidence at the time of publication and will be updated regularly to reflect new research.

Author’s Note on AI Use

Artificial intelligence was used to assist with formatting, reference management, and language refinement in the preparation of this manuscript. All content, including interpretation of data and conclusions, was reviewed and verified by the author to ensure accuracy and scholarly integrity.

Acupuncture and Traditional Chinese Medicine for Premenstrual Syndrome: A  Review of Evidence

Premenstrual Syndrome (PMS) encompasses a wide array of recurrent physical and psychological symptoms experienced by women during the luteal phase of the menstrual cycle. These symptoms significantly impair quality of life and affect up to 30% of reproductive-aged women. While conventional treatments exist—such as selective serotonin reuptake inhibitors (SSRIs) and hormonal therapies—many women seek complementary therapies, especially Traditional Chinese Medicine (TCM) approaches such as acupuncture, herbal medicine, and acupressure. This review synthesizes current evidence from systematic reviews and clinical trials on the efficacy, safety, and biological plausibility of TCM interventions for PMS.

Evidence from Systematic Reviews

A Cochrane systematic review analyzed five randomized controlled trials (RCTs) involving 277 women, comparing acupuncture or acupressure to sham controls or no treatment. The review concluded that acupuncture significantly improved both mood and physical PMS symptoms, as measured by the Daily Record of Severity of Problems scale (mean difference [MD] for mood: -9.03, 95% CI: -10.71 to -7.35; physical symptoms MD: -9.11, 95% CI: -10.82 to -7.40) (Armour et al., 2018). Acupressure also demonstrated benefit in reducing moderate to severe PMS symptoms (risk ratio 0.64, 95% CI: 0.52 to 0.79).

Another systematic review applied network pharmacology to assess TCM herbal therapies and identified Xiaoyao San and Chaihu Shugan San as the most commonly used formulas. These prescriptions modulate neurotransmitters, hormones, and inflammatory pathways to alleviate PMS symptoms (Qu et al., 2022). Additionally, a review of herbal and nutritional supplements for PMS found 53% of included RCTs to be of high methodological quality, with notable heterogeneity but consistent positive effects (Sultana et al., 2022).

Safety data across TCM modalities indicate favorable profiles. Acupuncture showed no significant increase in adverse events compared to control (risk ratio 1.74, 95% CI: 0.39 to 7.76) (Armour et al., 2018), and herbal therapies reported only mild side effects in four RCTs (Sultana et al., 2022). Auricular acupoint therapy also showed minimal adverse effects (Cao et al., 2023).

Evidence from Clinical Trials

Among notable trials, a recent RCT evaluating ShuYu capsules, a modified herbal formula, demonstrated efficacy for both emotional and physical symptoms of premenstrual dysphoric disorder (PMDD). The intervention worked by modulating allopregnanolone-GABAA receptor pathways, suggesting a plausible neuroendocrine mechanism (Geng et al., 2024).

Another RCT on smartphone-based mindfulness training, though not TCM, supports integrative approaches by demonstrating significant symptom reduction in PMS with a large effect size (Asadi et al., 2022). This highlights the potential for combining mindfulness with TCM therapies.

Furthermore, a meta-analysis found that acupuncture performed at specific times in the menstrual cycle yielded higher efficacy compared to both sham acupuncture and standard medication. Frequently used acupoints included SP6, LR3, and RN4 (Evidence-Based Complementary and Alternative Medicine, 2019).

Quality of Evidence and Conclusions

Overall, while the direction of effect across studies consistently favors TCM interventions, the quality of evidence ranges from low to moderate due to small sample sizes, methodological limitations, and heterogeneity. Nevertheless, the safety profile is favorable, and the mechanistic plausibility of herbal and acupuncture interventions supports further research.

In conclusion, acupuncture and TCM therapies show promise for managing PMS, especially for patients seeking alternatives to conventional treatments. High-quality, large-scale pragmatic trials comparing these modalities to SSRIs and hormonal therapies are warranted to strengthen the evidence base and guide clinical decision-making.

References

Armour, M., Ee, C., Hao, J., Wilson, T. M., Yao, S. S., & Smith, C. (2018). Acupuncture and acupressure for premenstrual syndrome. Cochrane Database of Systematic Reviews, 8(8), CD005290. https://doi.org/10.1002/14651858.CD005290.pub2.

Asadi, D. M., Tajrishi, K. Z., & Gharaei, B. (2022). Mindfulness training intervention with the Persian version of the mindfulness training mobile app for premenstrual syndrome: A randomized controlled trial. Frontiers in Psychiatry, 13, 922360. https://doi.org/10.3389/fpsyt.2022.922360

Cao, M., Ye, F. Y., Yan, X., Ho, M., Cheung, D. S. T., & Lee, J. J. (2023). Effectiveness of auricular acupoint therapy targeting menstrual pain for primary dysmenorrhea: A systematic review and meta-analysis. Worldviews on Evidence-Based Nursing, 20(3), 194–203. https://doi.org/10.1111/wvn.12636

Evidence-Based Complementary and Alternative Medicine. (2019). Acupuncture for premenstrual syndrome at different intervention time: A systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2019, 6246285. https://doi.org/10.1155/2019/6246285

Geng, X., Wang, X., Liu, K., et al. (2024). ShuYu capsule alleviates emotional and physical symptoms of premenstrual dysphoric disorder: Impact on ALLO decline and GABAA receptor δ subunit in the PAG area. Phytomedicine, 126, 155549. https://doi.org/10.1016/j.phymed.2024.155549

Qu, S. B., Qiao, M., Wang, J., et al. (2022). Network pharmacology and data mining approach reveal the medication rule of traditional Chinese medicine in the treatment of premenstrual syndrome/premenstrual dysphoric disorder. Frontiers in Pharmacology, 13, 811030. https://doi.org/10.3389/fphar.2022.811030

Sultana, A., Heyat, B. B., Rahman, K., et al. (2022). A systematic review and meta-analysis of premenstrual syndrome with special emphasis on herbal medicine and nutritional supplements. Pharmaceuticals, 15(11), 1371. https://doi.org/10.3390/ph15111371