7.menstrual Diseases 4 Dysmenorrhea

7.
Menstrual Diseases
Section 4. Dysmenorrhea
( Tong Jing , 痛经）
与分析
4.1 Etiology & Pathogenesis
4.2 Diagnosis & Differential Diagnosis
4.3 Pattern Differentiation and

Treatments
4.4 Acupuncture and Moxibustion

Treatment
2
Section 4. Dysmenorrhea 与分析
4.5 Chinese Patent Medicines
4.6 Prognosis
4.7 Prevention and Self-Care
4.8 Case Study
3
Dysmenorrhea , or painful
menstruation , refers to lower
abdominal pain , or lower back pain ,
which occurs during or around the
menstrual period . It may be mild , or
severe enough to cause fainting .
4
4.1 Etiology & Pathogenesis
The major causes of Dysmenorrhea ?

Qi stagnation and blood stasis,
cold congealing and blood stasis,
damp-heat and blood stasis
obstruction, deficiency of qi and
blood, kidney qi deficiency.
5
Qi stagnation and blood stasis? What can cause 集
6
cold congealing and blood stasis?
What can cause 集
7
damp-heat and blood stasis obstruction?
What can cause 集
8
deficiency of qi and blood? What can cause 集
9
kidney qi deficiency? What can cause 集
10
Differential Diagnosis 集与分析
Dysmenorrhea should be distinguished

from threatened miscarriage
11
Threatened miscarriage may be
accompanied with abdominal pain and
vaginal bleeding . As above , the blood
or urine HCG test is positive , and
there may be ultrasound evidence of a
gestational sac or fetal heart beat.
Differential Diagnosis
12

from Acute appendicitis
13
Appendicitis may occur at any time
including during the menstrual
period . It presents with a strong lower
abdominal pain , accompanied by
nausea and vomiting or diarrhea . A
physical examination shows obvious
tenderness and rebound tenderness in
the right lower quadrant of the
abdomen i . e . tenderness in the
McBurney point .
14
Blood tests reveal an elevated white
blood cell count , especially
neutrophilic cells . White blood cell
count is usually normal in cases of
simple dysmenorrhea , and there is no
tenderness in the McBurney point .
15

from Acute gastroenteritis
16
Gastroenteritis may occur during
menstruation , with symptoms of colic ,
nausea , vomiting , anorexia , diarrhea ,
or melena . This disease does not
happen periodically , and is usually
associated with an intake of
contaminated food .
17
Essentials of Pattern Differentiation 集与分
析
Time of pain onset
The pain of dysmenorrhea may occur

before the menstrual flow starts , but is
alleviated by the onset of the flow . Or it
may occur at the beginning of the flow ,
gradually reducing as the period finishes .
Less commonly it may occur towards the
end of the period or even after it .
18
析
 Generally , pain which occurs before or

at the beginning of the period is an excess
pattern or a deficiency pattern mixed with
excess . Postmenstrual pain belongs to a
deficiency pattern .
19
析
Pain location
Pain in the center of lower abdomen

indicates blood stasis or blood deficiency .
Pain in bilateral lower abdomen usually
arises from qi stagnation . Pain in the
lumbosacral region is usually due to kidney
deficiency .
20
析
Nature of the pain
Aversion to pressure indicates an excess

pattern whereas preference for pressure
indicates a deficiency pattern . Pain
aggravated by heat belongs to a heat
pattern , while pain alleviated by heat
indicates a cold pattern .
21
析
Nature of the pain
An abdominal sensation that is
preominately distending suggests qi
stagnation whereas a sensation that is
predominately painful indicates blood
stasis . A stabbing pain or persistent pulling
pain indicates blood stasis . Gripping pain
is caused by cold - stasis obstruction .
22
析
Paroxysmal and severe pain results from qi

stagnation with blood stasis . A dull or
bearing - down pain indicates qi and blood
deficiency . Dysmenorrhea often manifests in
an excess pattern rather than a deficiency
pattern . One must carefully analyze all the
symptoms to correctly identify the essence of
disease .
23
Treatment Principles 集与分析
The principle " in acute conditions , treat

the branch ; in moderate conditions , treat
the root " should be employed according to
the condition of disease . Severe pain
during the menstrual period should be
managed by regulating the blood and
relieving the pain, i.e. giving priority to the
branch symptoms .
24
Treatment Principles 集与分析
 In the case of mild pain , or application of

treatments between the periods , the
constitutional condition should be considered .
Methods of soothing the liver , rectifying qi ,
replenishing the kidney , fortifying the spleen ,
and nourishing qi and blood should be applied ,
so that qi - blood harmony and a free menstrual
flow are achieved .
25
Pattern Differentiation and Treatments 集
与分析
Dysmenorrhea
1. Qi stagnation and blood stasis
[ Main Manifestations ]
Lower abdominal pain before or

during menstruation , with aversion to
pressure .
26
Dysmenorrhea
与分析
[ Other Signs and Symptoms ]
 A scanty or unsmooth menstrual flow ,

which is purplish or dark red in color with
clots . Lower abdominal pain is relieved by
the discharge of clots ; breast distension ,
chest tightness , or belching .
27
Dysmenorrhea
与分析
 [ Tongue and Pulse ]
A dark or purple tongue or one with

petechia or ecchymosis and a wiry
pulse
28
[ Treatment Principles ]
Rectify qi and move stagnation ,
resolve stasis and relieve pain
[ Formula ]
 G é Xi à Zh ú Y ü T ä ng ( Expelling
Stasis Below the Diaphragm Decoction
29
与分析
Dysmenorrhea
2. Cold coagulation and blood stasis
Cold pain in the lower abdomen

before or during menstruation with an
aversion to pressure , and alleviated
by heat .
31
Dysmenorrhea
与分析
[ Other Signs and Symptoms ]
Occasional delayed menstrual period ,

with scanty dark blood flow mixed with
clots ; bluish - white complexion , cold
limbs with fear of cold .
32
与分析
Dysmenorrhea
 [ Tongue and Pulse ]
Dark tongue with white coating

and a deep tight pulse .
33
Warm channels and dissipate cold ,

resolve stasis and relieve pain .
34
[ Formula ]
Sh à o F ù Zh ů Y ů T ä ng ( Lesser
Abdomen Stasis - Expelling Decoction
35
与分析
Dysmenorrhea
3. Damp - heat obstruction
Distending pain in the lower abdomen before

or during menstruation with a scorching
sensation , pain referring to the lumbosacral
region . Pain may also occur between periods
and get worse just before the menstrual
37
period .
与分析
Dysmenorrhea
Heavy or prolonged menstrual flow which is

dark red in color and thick in nature or mixed
with a large amount of mucus ; profuse
leucorrhea , which is yellow , thick , and
odorous ; a fluctuant mild fever , dark urine .
38
与分析
Dysmenorrhea
[ Tongue and Pulse ]
Red tongue with a yellow , greasy

coating and a rapid , slippery pulse or a
rapid , wiry pulse.
39
Clear heat and remove dampness ,

resolve stasis and relieve pain
40
[ Formula ]
Qing R è Ti á o Xu è T ä ng ( Heat -
Clearing Blood - Regulating Decoction)
plus h ó ng t é ng ( Caulis Sargentodoxae
), b à i ji à ng c ã o ( Herba Patriniae )
and y ì y ï r é n ( Semen Coicis ).
41
与分析
Dysmenorrhea
4. Deficiency of both qi and blood
Dull pain in the lower abdomen

during or after menstruation , with
preference for pressure . There
may be a bearing - down sensation
in the abdominal and genital region
43
.
与分析
Dysmenorrhea
 Scanty menstrual blood , which is light

red in color and clear and thin in nature ;
a lusterless complexion , dizziness ,
palpitations , mental fatigue and a lack of
strength .
44
与分析
Dysmenorrhea
Pale tongue , thready forceless pulse
45
Dysmenorrhea
Boost qi and nourish blood ; regulate
menstruation and relieve pain
[ Formula ]
Sheng Yu Tang ( Sage Cure Decoction , 圣

愈汤） minus sheng di huang ( Radix
Rehmanniae ), plus bái shá o ( Radix
Paeoniae Alba ), xiang f ù( Rhizoma Cyperi )
and yu á n h ú( Rhizoma Corydalis).
46
与分析
Dysmenorrhea
5. Kidney qi deficiency
Constant lower abdominal pain

during menstruation , or 1-2 days post
menstruation .
48
与分析
Dysmenorrhea
An aching pain in the lumbosacral region

and weak legs ; scanty , dark , thin
menstrual flow ; dizziness and tinnitus , a
dull complexion , poor memory and
insomnia , copious clear urine .
49
与分析
Dysmenorrhea
A light red tongue with thin coating

and a deep , thready pulse .
50
Supplement the kidney and replenish
the essence , nourish the blood and
relieve pain
[ Formula ]
Yi Shen Tiao Jing Tang ( Kidney -

Boosting Menstruation - Regulating
Decoction ).
51
[DIETARY THERAPY]
 Adding certain foods and liquids to

the diet around the time of
menstruation can be helpful.
53
[DIETARY THERAPY]
 A decoction can be made by boiling

in plenty of water ,60g of brown
sugar ,10 red jujubes and 6g of ginger .
A cup of this decoction is drunk once
daily for 3-5 days before
menstruation .
54
[DIETARY THERAPY]
 Another decoction uses 10 g of g ä n ji ä

ng ,30 g of à i y è and 30 g of y ì yi r é n . Yi yi
r é nis added after the other ingredients are
decocted , to make a porridge . This porridge
has the effect of warming the channels and
dissipating cold , resolving stasis , eliminating
dampness and moistening the skin . It is
indicated for dysmenorrhea due to cold
congealing and blood stasis .
55
[DIETARY THERAPY]
 Yue ji hua ( Flos Rosae Chinensis ，月季

花） and mei gui hua ( Flos Rosae Rugosae
，玫瑰花） : A tea brewed with these two
flowers and taken over a long period of time
can move qi and activate blood, and also
moisten the skin . It is indicated for
dysmenorrhea due to qi stagnation and blood
stasis .
56
[DIETARY THERAPY]
 D ä ng Gui Y á ng Rou Sheng Ji ä ng T ä

ng ( Chinese Angelica , Mutton and Fresh
Ginger Decoction ，当归羊肉生姜汤） :
This stew is made using dang gui 10 g ,
mutton 100g, sheng jiang 10 g , and is eaten
before menstruation for 5-7 consecutive
days . This recipe can nourish the blood and
relieve pain .
57
[DIETARY THERAPY]
Another tonic decoction is made by boiling

50g of sh ä n zh ä,50g of sunflower seed and
100 g of brown sugar and taken for 3-5 days
before menstruation . It can supplement the
middle jiao and boost qi , fortify the spleen
and stomach , and activate the blood . It is
indicated for dysmenorrhea due to deficiency
of both qi and blood .
58
[ Prevention And Self - Care ]
 It is important to remember certain

healthy practices during the menstrual
and postpartum time , to prevent
dysmenorrhea . Patients should keep
warm during menstruation and avoid
exposure to external cold . Cold ,
greasy , raw foods or medicinals
should be avoided .
59
[ Prevention And Self - Care ]
 A calm and pleasant mental mood ,

and avoidance of stress maintains
smooth qi movement and menstrual
flow will be fluent .
 These precautions help to alleviate
period pain and to promote early
recovery of dysmenorrhea .
60
[ CASE STUDY ]
Jennet , age 34, married , English

Chief Complaint : Lower abdominal
pain during menstruation for over ten
years .
Present History: The patient had her
menarche at age 15. She experienced a
colicky pain in the lower abdomen
every first day of her menstruation .
The pain severely affected her daily
work and life .
61
[ CASE STUDY ]
Though the pain was slightly alleviated

by using hot compresses , it could only
be stopped by injections of pain
killers . Her menstrual cycle was
normal with a heavy menstrual flow ,
which lasted for 7-8 days . The
menstrual color was dark with blood
clots .
62
[ CASE STUDY ]
Her last menstrual period started on

January 18",1989. Normally , she had
poor appetite , cold limbs , loose stools
and a bearing - down sensation of
abdomen and rectum before
menstruation .
63
[ CASE STUDY ]
History of Past Illness: She was

diagnosed as having endometriosis in
England two years ago , and a
chocolate cyst on her left ovary was
removed surgically . Dysmenorrhea
was relieved afterwards , but had
worsened again recently .
64
[ CASE STUDY ]
Menstrual History: Menarche began at

15, with a menstruation cycle of 7-8/28-
33 days . The blood flow was dark , with
clots .
Obstetrical History: She has been

married for four years and has a normal
sexual life without the use of
contraceptives . She had never been
pregnant .
65
[ CASE STUDY ]
Physical Examination: The patient

appeared emaciated and pale , had a
light red and dark tongue , and a deep ,
slow , moderate pulse .
66
[ CASE STUDY ]
Gynecological Examination: The patient

had a normal vulva , an unobstructed
vagina , a smooth cervix , and a
retroverted fixed uterus of a normal
size . Nodules the size of a bean were
palpated in the posterior uterine walls
with slight tenderness and normal
adnexa .
67
[ CASE STUDY ]
TCM Diagnosis
Dysmenorthea due to cold

congealing and blood stasis .
68
[ CASE STUDY ]
Pattern Differentiation
The patient was a female of child -
bearing age , who had dysmenorrhea for
over ten years . During the long course of
the disease , severe pain and a
menstruation of dark blood color with
clots all indicated blood stasis , which
was located in chong and ren mai and the
uterus , causing unsmooth qi and blood
circulation .
69
[ CASE STUDY ]
This had consequently resulted in
dysmenorrhea . The weather in
England was cold and damp. Cold -
dampness binding with the menstrual
blood lead to blood stasis in chong and
ren mai and the uterus . New blood
was unable to flow in the vessels ,
causing excessive menses and
prolonged periods .
70
[ CASE STUDY ]
The stasis obstructed the uterus vessels
and collaterals so that it was difficult to
conceive . Anorexia and loose stools
arose from the cold pathogen attacking
the stomach and middle - yang .
Sinking of the spleen qi resulted in the
obvious bearing - down sensation of
the lower abdomen and the anus .
71
[ CASE STUDY ]
In line with the condition of tongue
and pulse , dysmenorrhea in the pattern
of cold congealing and blood stasis
was diagnosed .
72
[ CASE STUDY ]
Treatment Principles
Warm the channels and dissipate

cold , activate the blood and resolve
stasis
73
[ CASE STUDY ]
Formula
Sh à o F ù Zh ú Y ù T ä ng
( Lesser Abdomen Stasis -
Expelling Decoction)
74

7.menstrual Diseases 4 Dysmenorrhea

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7.

4.2 Diagnosis & Differential Diagnosis

4.3 Pattern Differentiation and

4.4 Acupuncture and Moxibustion

4.5 Chinese Patent Medicines

4.7 Prevention and Self-Care

4.8 Case Study

4.1 Etiology & Pathogenesis

The major causes of Dysmenorrhea ?

Dysmenorrhea should be distinguished

Dysmenorrhea should be distinguished

Dysmenorrhea should be distinguished

The pain of dysmenorrhea may occur

 Generally , pain which occurs before or

Pain in the center of lower abdomen

Aversion to pressure indicates an excess

Paroxysmal and severe pain results from qi

The principle " in acute conditions , treat

 In the case of mild pain , or application of

Lower abdominal pain before or

 A scanty or unsmooth menstrual flow ,

A dark or purple tongue or one with

Cold pain in the lower abdomen

Occasional delayed menstrual period ,

Dark tongue with white coating

Warm channels and dissipate cold ,

Distending pain in the lower abdomen before

Heavy or prolonged menstrual flow which is

Red tongue with a yellow , greasy

Clear heat and remove dampness ,

Dull pain in the lower abdomen

 Scanty menstrual blood , which is light

Pale tongue , thready forceless pulse

Sheng Yu Tang ( Sage Cure Decoction , 圣

Constant lower abdominal pain

An aching pain in the lumbosacral region

A light red tongue with thin coating

Yi Shen Tiao Jing Tang ( Kidney -

 Adding certain foods and liquids to

 A decoction can be made by boiling

 Another decoction uses 10 g of g ä n ji ä

 Yue ji hua ( Flos Rosae Chinensis ，月季

 D ä ng Gui Y á ng Rou Sheng Ji ä ng T ä

Another tonic decoction is made by boiling

 It is important to remember certain

 A calm and pleasant mental mood ,

Jennet , age 34, married , English

Though the pain was slightly alleviated

Her last menstrual period started on

History of Past Illness: She was

Menstrual History: Menarche began at

Obstetrical History: She has been

Physical Examination: The patient

Gynecological Examination: The patient

Dysmenorthea due to cold

Warm the channels and dissipate

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