Significant Of Premenstrual Syndrome Syndrome Differentiation Dependent Therapy In The Modern Medication

Objective: The western modern medical treatment is able to clinically differentiate subtypes of the premenstrual syndrome (PMS). Although the first-line drug therapy in the modern western medicine offers effective anti-depression treatment, hitherto there is none subtype-specific drug therapy available for PMS. Moreover, these drug treatments produce various adverse reactions. Our former systemic study of the PMS rooted in the theory of traditional Chinese medicine found that PMS were clinically classified into two subtypes according their symptoms, namely, Liver-qi sthenic symptom complex, and Liver-qi negative symptom complex. The study also found that it was favorable to offer individualized drug therapy according to the subtype of PMS. Therefore, we hypothesized that efficacy of the drug therapy for PMS differs in the two subtypes by using first-line drug treatment. To test the hypothesis, we investigated the effectiveness of the treatment using fluoxetine hydrochloride for the two subtypes of PMS. This study attempt to provide the evidence that indicates the advantages of the traditional Chinese medicine for individualized treatment for PMS over the western medical drug therapy. While it is acknowledged that the modern medicine is capable to differentiate the subtype of PMS in diagnostic, but it offers no differentiated treatments. We argue that it is of importance to find specific drug treatment for the different subtypes of PMS for the future study.Methods: The patients firstly evaluated by using and the Daily Record of Severity of Problems (DRSP) . The selected patients were grouped into gentle, moderate, and severe according the severity of their PMS syndrome. The patients with PMS at moderate, severe level normally were with moderate drug intervention) . All the patients then evaluated and subgrouped as liver-qi sthenic symptom complex and liver-qi negative symptom complex by using and . Of all the seventy six patients diagnosed as PMS, twenty were grouped into liver-qi sthenic symptom complex; and twenty were assembled as liver-qi negative symptom complex. All the patients in these two groups suffered moderate to severe PMS. From fourteen days before the menstruation, a fourteen-day of fluoxetine hydrochloride (20 mg, once daily) was given to each patient in both in liver-qi sthenic symptom complex and liver-qi negative symptom complex group. The treatment will last two cycles of menstruations and each menstruate period was considered as one complete treatment cycle. The patients were asked to fill all aforementioned evaluation forms before and after each treatment cycle. The observing indicators: PMS symptoms (symptom score) , and serotonin (5-HT) concentration.Data analysis: All the data analysis use commercial statistical package (SPSS, USA). The paired t-test was used to examine effectiveness of before and after treatment of individual patient (mean±SD) . Independent sample t-test was used to compare the difference between two groups. For rank data, X~2 test was use to examine the effect of before and after treatment.Results: The study showed that total efficiency of fluoxetine in the treatment for PMS was 68.75%. The effectiveness of treatment was: Liver-qi sthenic symptom complex: the total efficiency was 41.67% by using DRSP symptom score. The dysphoria irritability symptoms: the total efficiency of 16.67%; consciously depressed symptoms, the total efficiency of 83.33%. Through the symptom score, PMS patients with liver-qi sthenic symptom complex symptoms of abdominal distention and pain, breast pain, depression (after angry) , fatigue, puffiness, lower enthusiasm for house-keeping, and inattention. Liver-qi negative symptom complex: DRSP symptom score, the total efficiency of 85%, the symptoms of irritability, the total efficiency of 10%, consciously depressed symptoms, the total efficiency of 95%. Through the symptom score: depression, and chest uneasy, sighing, headache, breast pain, swell in abdomen, loss of appetite, insomnia dreams, lethargy, puffiness and low enthusiasm for house-keeping; By comparing before and after treatment DRSP total score, emotional category, body type, social events symptoms score, fluoxetine hydrochlonde treatment of PMS with depression: Serotonin levels after treatment in the Liver-qi sthenic symptom complex is significantly lower than that before treatment (P <0.05 ) . The Liver-qi negative symptom complex group had a tendency to increase, but the difference was not statistically significant ( P> 0.05) .Conclusion : The study showed that the efficacy of treatment using fluoxetine hydrochlonde for Liver-qi sthenic symptom complex Liver-qi sthenic symptom complex is less satisfactory (total efficiency of 50%) than that for Liver-qi negative symptom complex (80% overall efficiency) . This study provided the support for the hypothesis that fluoxetine hydrochloride in the treatment of two subtype of PMS. We concluded that individualized treatment based on traditional Chinese medicine is favorable to the counterpart of modern western medicine in which drug therapy offered none subtype specific treatment. Although western modern medicine provides diagnostic differentiation, it does not offer subtype-specific drug therapy. The future study shall emphasize the need of differentiated, individual-specific treatment.