A bilingual physician’s diagnostic map of the four patterns behind the week most women dread
By Dr. Cristina Fang · 方筱華醫師 · Innerglow 創辦人 · Tainan × Bay Area
In This Article · 14 min read
When two frameworks look at the same cycle — Abraham’s PMS-A through PMS-H, meet Fu Qing-Zhu’s Four Patterns
The Four Patterns, mapped to their Western cousins
Pattern 1 · Liver Qi Stagnation (肝鬱氣滞)
Pattern 2 · Qi & Blood Deficiency (氣血兩虛)
Pattern 3 · Blood Stasis (血瘀)
Pattern 4 · Phlegm-Damp Accumulation (痰濕)
The two frameworks at one glance
What this framework is — and what it isn’t
The Innerglow approach
In 1983, an endocrinologist named Guy Abraham proposed something Western medicine had been resisting for forty years — that pre-menstrual syndrome was not one condition, but four. He called them PMS-A, PMS-C, PMS-D, and PMS-H, and he argued that the same generic recommendation could not possibly serve all four. His paper was largely ignored for the next two decades. Most women’s health protocols continued to treat PMS as a single, vaguely hormonal complaint best managed with a contraceptive pill, an SSRI, or — in the wellness-medicine register that arrived later — magnesium and chasteberry.
Three centuries earlier, working in late-Ming-era China, a physician named Fù Qīng-Zhǔ (傅青主) had already mapped a more sophisticated version of the same insight. His Treatise on Women’s Diseases (《傅青主女科》) — finally published in 1827, more than a hundred years after his death — described the premenstrual week not as a syndrome but as a diagnostic window: a recurring, predictable interval in which the body reveals its dominant constitutional pattern more clearly than at any other point in the cycle. The patterns he named — Liver Qi stagnation, Qi and Blood deficiency, Blood stasis, Phlegm-Damp accumulation — are the same four most TCM physicians use today. The vocabulary outlasted the dynasty.
What Abraham and Fù Qīng-Zhǔ each understood, three hundred years apart, is that the answer to “why does the same advice help my friend and not me?” is rarely a question of compliance. It is a question of which version of PMS each woman actually has — and whether the advice happens to address her version, or fight it. This piece walks through both maps and shows where they meet.
This piece is part of The Innerglow Approach — the five-organ-system framework for women’s health and aesthetic medicine. PMS sits primarily within the Liver and Spleen systems, mapped here through both lenses.
When Two Frameworks Look at the Same Body
Modern Western medicine has refined Abraham’s typology — adding PMDD as the severe-end variant, layering in HPA-axis dysregulation and insulin-resistance overlays, integrating the gut-hormone axis as understanding of estrogen metabolism has matured. The four-type framework remains useful because it is symptom-anchored: a woman can locate herself in it without lab work.
Type
Dominant symptoms
Suspected mechanism
PMS-A (Anxiety)
Anxiety, irritability, mood lability
Estrogen excess relative to progesterone; sympathetic dominance
PMS-C (Cravings)
Carbohydrate cravings, fatigue, headaches
Reactive hypoglycemia, prostaglandin imbalance
PMS-D (Depression)
Withdrawal, low mood, weepiness
Progesterone-relative imbalance, low serotonin
PMS-H (Hyperhydration)
Bloating, breast tenderness, weight gain
Aldosterone-driven sodium and water retention
Functional medicine adds two further dimensions that overlap with Abraham’s framework — chronic stress flattening the cortisol curve and disrupting the GnRH-FSH-LH cascade, and insulin resistance manifesting as carbohydrate cravings and luteal-phase fluid retention rather than as classical metabolic syndrome.
So the answer to “is my PMS just hormonal?” depends on which Western lens is in use — the classical Abraham view, the modern endocrine view, or the metabolic-functional view. Each captures something real. None of them are wrong. What none of them do is read the body as a system in motion: a temporal sequence of pressure, depletion, obstruction, or waterlogging that begins seven to ten days before bleeding and resolves only when the cycle restarts.
That reading is what TCM has been doing for eighteen centuries. A 2019 systematic review and meta-analysis of nineteen randomized trials, indexed in PubMed Central, found that acupuncture for PMS produced statistically significant symptom-burden reductions across mood-domain and physical-domain measures, with the strongest effects when treatment was timed to the luteal phase — a finding that mirrors what classical pattern-based protocols have always specified (Liu et al., 2019, PMC). The four TCM patterns most relevant to PMS — Liver Qi Stagnation, Qi & Blood Deficiency, Blood Stasis, and Phlegm-Damp Accumulation — are organizing categories that map a constellation of symptoms onto an underlying physiological state. The two frameworks are not in opposition. They are looking at the same body and noticing different things — Western medicine tracks hormone levels, neurotransmitters, and metabolic markers; TCM tracks the quality and direction of physiological function. The clinical value of speaking both is correlation: when a woman with PMS-A also presents the tongue, pulse, and shoulder pattern of Liver Qi Stagnation, neither framework is decorative. They are confirmatory.
The Four Patterns, Mapped to Their Western Cousins
Each TCM pattern has a closest-fit Abraham/functional correlate. The match is not 1:1 — there is overlap, and many women carry features of more than one pattern — but mapping them this way makes the comparison legible to a Western-trained reader, and gives the bilingual physician a common ground to stand on.
The Four Patterns · At a Glance
Pattern 01
肝鬱氣滞 Liver Qi Stagnation
Western cousin: PMS-A
Felt-quality: pressure. Irritability building 7–10 days pre-menses. The high-output woman who cannot slow down.
Pattern 02
氣血兩虛 Qi & Blood Deficiency
Western cousin: PMS-C
Felt-quality: depletion. Premenstrual fatigue, dizziness, foggy thinking. The endurance runner whose period has gone irregular.
Pattern 03
血瘀 Blood Stasis
Western cousin: PMS-D + endo spectrum
Felt-quality: obstruction. Sharp fixed-location pain, dark clotted blood, worse with pressure. The endometriosis patient.
Pattern 04
痰濕 Phlegm-Damp
Western cousin: PMS-H + PCOS spectrum
Felt-quality: waterlogging. Premenstrual swelling that won’t shift, sticky sweat, carb cravings. The PCOS or insulin-resistant constitution.
Closest Western correlate: PMS-A (Anxiety) layered with HPA-axis dysregulation.
The biomedical reading: Sustained sympathetic nervous-system activation combined with impaired hepatic clearance of estrogen metabolites. The TCM “Liver” is not a metaphor — it physically processes hormones. When chronic stress impairs Phase II hepatic detoxification, estrogen metabolites recirculate and exacerbate the luteal-phase symptom load.
The pattern signature: Irritability that builds seven to ten days before menses. Breast tenderness — sometimes severe. Distending pain in the chest or upper abdomen. Sighing. Headaches at the temples. Premenstrual neck and shoulder tension that the woman herself often does not register until Friday. The dominant felt-quality is pressure.
Who shows it: The woman who pushes through her PMS week. Cannot slow down. Does not notice her shoulders are at her ears until something — a yoga class, a partner’s offhand comment — forces the awareness. The same Liver-Qi pattern that drives her premenstrual week is the one that drives the aging of her face from the inside, in a way I described in detail in the prior article on the three aging constitutions — the two surfaces are reading the same constitutional terrain.
Closest Western correlate: PMS-C (Cravings) overlapping with adrenal insufficiency and functional anemia.
The biomedical reading: Reduced erythrocyte mass and an exhausted HPA axis. Often correlates with low ferritin (under 50 ng/mL), suboptimal B12, and a chronically depleted adrenal reserve. The body has too few raw materials to mount a normal luteal-phase response, and the symptom load is the body announcing the shortage.
The pattern signature: Fatigue that worsens premenstrually. A heavy sensation in the limbs. Dizziness on standing. Scant menstrual flow finishing in two or three days. Pale lips. Foggy thinking. The dominant felt-quality is depletion.
Who shows it: The endurance runner whose period has become irregular. The new mother whose cycle returned but whose energy did not. The forty-seven-year-old whose decade of “clean eating” has tipped quietly into nutritional deficiency. The pattern is not visible on a standard panel — it is visible at the threshold of standard panels, in the suboptimal range that most clinicians categorize as “still normal.”
Pattern 3 · Blood Stasis ｜血瘀 — Xuè Yū
Closest Western correlate: Pain-spectrum PMS, endometriosis-spectrum disease, prostaglandin overproduction. (Abraham’s original four-type framework did not cleanly accommodate the pain-dominant variant — a gap subsequent endocrinology has had to fill.)
The biomedical reading: Impaired uterine microcirculation combined with prostaglandin-mediated inflammatory response. Often present in women with diagnosed endometriosis, adenomyosis, or fibroids — but also in otherwise structurally healthy women whose luteal phase is marked by excessive PGF2α production.
The pattern signature: Sharp, fixed-location pelvic pain that worsens in the days before bleeding. Dark or purplish menstrual blood with clots. Pain that is worse with pressure, not relieved by warmth. Pain that radiates to the lower back. The dominant felt-quality is obstruction.
Who shows it: Women with diagnosed endometriosis or adenomyosis. Women whose periods became more painful after a C-section, IUD insertion, or D&C. Women who clot heavily. The pattern responds well to TCM treatment but slowly — Blood Stasis took years to build and takes months, not cycles, to clear.
Pattern 4 · Phlegm-Damp Accumulation ｜痰濕 — Tán Shī
Closest Western correlate: PMS-H (Hyperhydration) layered with insulin resistance and the PCOS spectrum.
The biomedical reading: Insulin resistance combined with chronic low-grade inflammation and impaired lymphatic drainage. Common in women with PCOS, metabolic syndrome, or chronic post-prandial bloating. The “Phlegm” of TCM is functional, not literal — the term describes pathological fluid metabolism, not respiratory mucus.
The pattern signature: Premenstrual weight gain that does not budge for a week after the period ends. Swollen ankles and fingers. A sensation of heaviness in the head and limbs. Sticky sweat. Intense carbohydrate cravings. Copious cervical mucus mid-cycle. The dominant felt-quality is waterlogging.
Who shows it: Women with PCOS or borderline insulin resistance. The “I eat well and exercise but my body won’t release weight” cohort. Women with chronic sinus congestion that worsens premenstrually. The pattern is responsive but requires both metabolic and TCM-level intervention — addressing one without the other repeatedly fails.
The Two Frameworks at One Glance
Dimension
Liver Qi Stagnation
Qi & Blood Deficiency
Blood Stasis
Phlegm-Damp
Closest Abraham type
PMS-A
PMS-C
(pain-spectrum, post-Abraham)
PMS-H
Dominant felt-quality
Pressure / irritability
Depletion / fatigue
Obstruction / sharp pain
Waterlogging / heaviness
Period flow
Variable, often delayed
Scant, short, pale
Heavy with clots, dark
Variable, often w/ mucus
Mood profile
Snappy, easily set off
Weepy, low motivation
Withdrawn from pain
Foggy, sluggish, apathetic
Physical hallmark
Breast tenderness, headaches
Pale lips, dizziness
Fixed pelvic pain
Premenstrual weight gain
Western correlate
Sympathetic overactivation, hepatic congestion
Anemia / adrenal fatigue
Endometriosis, prostaglandin excess
Insulin resistance, PCOS
What worsens it
Stress, alcohol, suppressed emotion
Overwork, undersleeping, undereating
Cold, prolonged sitting
Refined carbohydrates, dairy
TCM treatment direction
Move Qi, soothe Liver
Tonify Qi & Blood
Invigorate Blood, break stasis
Resolve Phlegm, transform Damp
The clinical implication is the one Abraham and Fù Qīng-Zhǔ both understood: a treatment that works elegantly for Pattern 1 will do nothing for Pattern 4, and may actively worsen Pattern 2. This is why generic advice — whether from a gynecologist, a wellness influencer, or a friend who swears by chasteberry — disappoints so often. The pattern decides the treatment. That principle is true in both medical systems. What changes is the precision with which each system can name the pattern.
What This Framework Is and Isn’t
This is not a diagnostic the reader is expected to make alone. Pattern identification combines the woman’s self-observation with face, tongue, and pulse readings a physician performs in the room. What the reader can do — and what this article exists to enable — is recognize which felt-quality dominates her PMS week. Pressure, depletion, obstruction, or waterlogging are not interchangeable. Most women, asked the question for the first time, can answer it within a sentence.
A few qualifications worth naming:
This framework is for women in the perimenopausal arc — roughly thirty-two to fifty-two — who track their cycle with reasonable specificity and have tried at least one conventional approach (the pill, an SSRI, magnesium, chasteberry) without lasting resolution. It is not designed for acute symptom relief in a single cycle. The TCM approach to PMS is restorative — it expects three menstrual cycles for full assessment of response, with measurable change typically beginning in cycle two.
Most women carry a dominant pattern with a secondary layer. Pure Pattern-1 or Pure Pattern-3 presentations exist, but the more common picture is a Liver-Qi-driven woman who has been depleted enough by years of overwork to also show Pattern 2, or a Phlegm-Damp constitution that has, under chronic stress, layered Pattern 1 on top. The clinical work is in reading the interplay.
The frameworks are complementary, not competitive. The most useful work I have done in my women’s health practice has been with patients who arrive having already done the Western workup — labs, hormone panels, GI testing — and who are looking for the next layer of resolution. Pattern diagnosis fills in what bloodwork cannot reach: the quality of how the body is functioning across the trajectory of a cycle. The two reads, taken together, are nearly always more useful than either alone.
The Innerglow Approach
In my practice — Tainan-based for in-person work, with a growing cohort of patients across Taiwan, the Bay Area, and beyond — the first conversation is structured around pattern identification rather than symptom inventory. We look at cycle-tracking data, recent labs (ferritin, vitamin D, fasting insulin, AM cortisol where available), sleep architecture if wearable data exists, and a focused history that maps the quality of the PMS week — pressure, depletion, obstruction, or waterlogging — onto one of the four patterns and, where the data supports it, the Western correlate. This work sits inside the broader five-system Innerglow approach — the constitutional framework that organizes pattern-based women’s health and aesthetic medicine across cycle, sleep, fertility, and skin.
For local patients, treatment combines acupuncture (typically six to eight sessions across two cycles), pattern-specific Chinese herbal formulas — discussed in the context of any prescription medications already in the regimen — and two or three targeted lifestyle adjustments. Never a long restrictive list. Always the highest-leverage two or three for that constitution.
For patients who cannot access in-person care, the educational layer of this work now lives inside Innerglow Circle — a private members’ community where the pattern-identification frameworks, constitutional self-assessment tools, monthly live office hours, and the full library of clinical PDFs are available to members. The Circle is the bridge — between the physician’s mind and the reader’s body, between the article and the protocol, between Tainan and the Bay Area women whose practice is not yet open to them.
The principle is the same in either format: pattern first, protocol second.
The Bottom Line
PMS is not one condition. Both Abraham in 1983 and Fù Qīng-Zhǔ three centuries earlier understood this — Western medicine through symptom typology, TCM through pattern recognition built on a far longer clinical record. The two systems are not in opposition. They are looking at the same body and noticing different things, and a physician fluent in both can offer something neither alone can.
Recognizing which pattern is dominant in your case is, for many women, the first time the body becomes intelligible rather than rebellious. Once the pattern is named, the work becomes clear, finite, and measurable. That is the invitation of this practice — and of the Circle that surrounds it.
Continue Your Innerglow Journey
A Bilingual Physician’s Guide to Your Cycle
Get the free four-pattern self-screening companion — a printable framework to identify which version of PMS you actually have, plus the lifestyle adjustments that match each constitutional type.
The full PMS Pattern Self-Assessment — the four-pattern self-screening questionnaire, pattern-specific lifestyle recalibrations, and a private monthly office-hour where members bring their own cycle questions — lives inside Innerglow Circle, a private members’ community for women learning pattern-based women’s health from a bilingual physician.
Inside the Circle, women working through the four PMS patterns find each other in dedicated cohorts (Liver Qi · Qi-Blood · Blood Stasis · Phlegm-Damp), with monthly live office hours, member-only audio teachings, and the full library of clinical PDFs.
The Circle is now open to founding members — free through May and June. When the paid tier opens July 1, the first 30 founding members lock in $29/month for life. Circle members are also the first to know when the Bay Area practice activates.
Dr. Cristina Fang 方筱華醫師 is a Taiwan-licensed TCM Physician specializing in women’s health and facial acupuncture. Through Bay Area Innerglow, she brings two decades of clinical practice in pattern-based women’s medicine, constitutional diagnosis, and medical aesthetic acupuncture to a readership of women who want both clinical precision and integrity from their wellness practice. She is also the founder of TCM Medical English, an educational platform serving the Taiwan healthcare community.
For healthcare professionals working with English-speaking patients, the bilingual TCM glossary used in this article appears in detail at medicalenglish.kaik.io.
Educational content. Not a substitute for individualized medical care. The clinical work described reflects Dr. Fang’s active Taiwan practice; the Bay Area practice opens in a future phase, with Innerglow Circle members notified first. Consult your own physician before changing any treatment plan.
