经前烦躁障碍症（PMDD）是育龄期女性常见疾病，以周期性情绪异常及躯体症状为特征，严重影响患者生活质量。文章基于“肝藏血”理论对PMDD病机及治疗策略进行探讨。提出PMDD的核心病机为月经周期中肝血下注冲任胞宫，导致肝血暂时性不足，进而引发肝气疏泄失常。肝血不足致使肝气亢逆或郁滞，表现为烦躁易怒、抑郁焦虑等情志异常，并伴随乳房胀痛、失眠等躯体症状。通过分析经前期、月经期、经后期三阶段肝血与肝气的动态变化，提出PMDD的周期性发病与肝血盈亏失衡密切相关。治疗上强调“未病先防”，主张在经前期补益肝血、调和肝气，辅以健脾补肾以增强生血功能，从而缓解肝失疏泄的病理状态。临床可选用疏肝理气、养血柔肝类方药（如逍遥散、当归芍药散等），并结合生活方式调整以减少肝血暗耗。

Premenstrual dysphoric disorder(PMDD) is a common disease among women of childbearing age,characterized by periodic emotional abnormalities and physical symptoms,which seriously affects the quality of life of patients. This article discusses the pathogenesis and treatment strategies of PMDD based on the theory of “liver storing blood”. The core pathogenesis of PMDD is that during the menstrual cycle,liver blood flows down to the Chong and Ren meridians in the uterus,resulting in temporary insufficiency of liver blood and subsequently causing abnormal circulation of liver qi. Insufficient liver blood leads to hyperactivity or stagnation of liver qi,manifested as abnormal emotions such as irritability,anger,depression and anxiety,accompanied by physical symptoms such as breast distension and pain and insomnia. By analyzing the dynamic changes of liver blood and liver qi in the three stages of premenstrual period,menstrual period and postmenstrual period,it is proposed that the periodic onset of PMDD is closely related to the imbalance of liver blood surplus and deficiency. In terms of treatment,it emphasizes “prevention before illness”,advocating tonifying liver blood and harmonizing liver qi before menstruation,supplemented by strengthening the spleen and tonifying the kidneys to enhance blood production function,thereby alleviating the pathological state of liver failure to regulate the flow of qi. Clinically,prescriptions and medicinals that soothe the liver and regulate qi,nourish blood and soothe the liver [such as Xiaoyao Powder（逍遥散）,Danggui Shaoyao Powder（当 归 芍 药 散）,etc.]can be selected,and lifestyle adjustments can be combined to reduce the hidden consumption of liver blood.