Dysmenorrhea (painful periods)

 WM

Painful periods.  Primary dysmenorrhea usually start with the first period of a womans life and is thought to be the result of excessive prostaglandin production.  It is often associated with nausea, vomiting, and faintness.  Secondary dysmenorrhea usually effects older patients and the pain precedes menstruation.  It is thought to be caused by pelvic inflammatory disease, endometriosis, fibroids, and the presence of an IUD (intrauterine device).

 OM

Dysmenorrhea refers to the pain appearing in the lower abdomen and lower back before, after or during menstruation. The pain, sometimes intolerable, occurring during the cycle of menses is known as painful menstruation.

Dysmenorrhea is principally ascribed to the impeded flow of qi and blood in the uterus. Deficiency or stagnation of qi and blood may cause unsmooth flow of menstruation. Dysmenorrhea is clinically classified into deficiency and excess type.

Etiology and Pathogenesis

a) Excess syndrome: It is due to stagnation of the liver qi, which fails to carry the free flow of blood. The impaired flow of blood causes disharmony between the Chong and Ren Meridians and stagnation of blood in the uterus, resulting in pain. Another cause is the affection of external cold or intake of old drinks during menstrual periods, which hurts the lower jiao, and makes the cold retain in the uterus. Finally there appears retarded menstruation with pain.

b) Deficiency syndrome: In circumstances of qi and blood deficiency due to either weak body - build or chronic disease, menstruation drains up the sea of blood and deprives the uterus from nourishment, then pain occurs.

Differentiation

a) Stagnation: Main manifestations: Pain in the lower abdomen, usually starting before menstruation, retarded and scanty and dark purple menses with clots, distending pain in the lower abdomen, alleviated by passing out the clots, distension in the hypochondriac region and breast, purplish tongue with purple spots on its edge, deep and string - taut pulse; pain and cold feeling in the lower abdomen referring to the waist and back, alleviated by warmth, scanty dark red menses with clots, sticky and white tongue coating, deep string - taut pulse.

Analysis: The depressed liver qi gives rise to the distending pain in the lower abdomen, hypochondriac region and breast, and scanty and impeded menses. Qi stagnation inevitably leads to blood stasis, so the menses appears dark purple with clots. The release of clots helps to weed out a little stagnation, alleviating the pain. Purplish tongue with purple spots on its edge, deep and string - taut pulse are signs of qi stagnation and blood stasis. When the cold and damp retain in the uterus and surround the blood, there present impeded scanty menses with clots and pain in the lower abdomen. Since the uterus connects with the kidney, severe pain refers to the waist and back. Warmth alleviates the pain for it accelerates the flow of blood. White tongue coating, deep and string - taut pulse are signs of collection of internal cold and damp.

b) Deficiency: Main manifestations: Dull pain appearing by the end of or after menstruation, alleviated by warmth and pressure, pink, scanty and thin menses, thready and weak pulse accompanied by aversion to cold, cold extremities, pale complexion, palpitation and dizziness.

Analysis: When qi and blood is insufficient the sea of blood is not able to provide enough nutrients to the uterus. This is the cause of dull pain, which can be alleviated by pressure and warmth. Deficiency of both qi and blood also gives ground to scanty pink and thin menses. Severe deficiency of qi and blood causes the failure of the heart and head to be nourished, leading to palpitation, dizziness and pale complexion. The weakened yang qi after a chronic disease is the cause of aversion to cold and cold extremities. Thready and weak pulse indicates deficiency of both qi and blood.

Qi and Blood stagnation

P/T – regulate Qi, promote circulation of blood, remove Stasis

Acupuncture – sedate, moxa, foot Jueyin,

LR3, LR8, SP6, RN6
hypochondriac/chest/breast distension/pain: TH5, TH6, BL18
severe low abdominal pain: BL32
nausea, vomiting: MH6, ST36

Damp/Cold stagnation

P/T – disperse Cold, eliminate Damp, warm Jing

Acupuncture

RN3 & ST28 (water problems, needle and moxa), SP6, SP8
Kidney deficiency: BL23, RN4
bodyaches: BL11, BL23

Liver Qi stagnation with Low Jiao Damp/Heat

P/T – clear Heat and Damp, regulate Liver Qi

Acupuncture

LR3 & SP6, RN3 & BL32
Low abdominal burning: LR8
Fire: LR2 (more large clots)

Qi and Blood deficiency

 Acupuncture

RN6, BL20, SP6, ST36, Zi Gong
deficient Cold: RN4, ST30, moxa

Alternative Treatment Methods

auricular- internal reproductive organs, sympathetic, KI, LR, SP
7 star- medium stimulation, lower abdominal area
injection- Dang Gui 0.5ml, Hong Hua 0.1ml