PREMENSTRUAL SYNDROME: AN AYURVEDIC PERSPECTIVE AND A REVIEW OF HERBAL INTERVENTIONS
Background: Premenstrual syndrome (PMS) is a cyclical disorder of physical, psychological and behavioural symptoms in the luteal phase that impairs daily functioning in many women of reproductive age. Conventional treatment with selective serotonin reuptake inhibitors and hormonal agents is effective but not acceptable to all women, and complementary approaches are widely used. PMS is not described as a single entity in the classical Ayurvedic texts, but its features can be interpreted through the concepts of Dosha, Manas and menstrual-cycle physiology. Objective: To present an Ayurvedic interpretation of PMS, relate it to current understanding of its pathophysiology, and review the clinical evidence for herbs used in Ayurveda and for associated diet, lifestyle and yoga interventions. Methods: Classical texts (Charaka Samhita, Sushruta Samhita and Kashyapa Samhita) were reviewed for concepts relevant to cyclical premenstrual symptoms and for Rajaswala paricharya. PubMed was searched for guidelines, systematic reviews, meta-analyses, randomised trials, protocols and case reports on PMS, herbal medicine, Ayurveda and yoga. A retracted meta-analysis identified during the search was excluded. Findings were synthesised narratively. Results: PMS can be understood in Ayurveda as a cyclical, Vata-led disturbance of all three Doshas, with Pitta and Kapha patterns and involvement of the mind. Meta-analyses support saffron (Kumkuma) and suggest benefit from herbal medicines and supplements in general, while systematic reviews of curcumin (from Haridra) are favourable but limited. Evidence for Ashwagandha in PMS is largely indirect, and a placebo-controlled trial of Brahmi (Bacopa monnieri) with cognitive behavioural therapy is in progress. Systematic reviews of yoga and mindfulness-based practices report improvements in physical and psychological symptoms, but trial quality is moderate. Conclusion: Ayurveda offers a plausible framework for individualised PMS care combining herbs, diet, conduct and yoga. Rigorous, prospectively diagnosed trials of standardised Ayurvedic interventions are required.