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Expert Advice-Treatment of Dysmenorrhea in Traditional Chinese Medicine(TCM):

Dysmenorrhea and Pain Control

Dysmenorrhea refers to cyclical abdominal pain which is experienced during or before menstruation. It occurs most typically in young women two to three years after the onset of menstruation. Menstrual pain will take the form of cramping, lower abdominal pain, lower back pain or a pulling sensation in the inner thighs. Pain is often accompanied by headaches, dizziness, vomiting, nausea, diarrhea or constipation. This is a common health problem for women all over the world.

Lisa is a nurse who works for Allina in a conventional medicine clinic. She has been affected by menstrual pain most of her adult life, and has had to skip three days of work every month for the last fifteen years. Over the years she has tried all kinds of prescription pain killers and over-the counter pain relievers. Finally, a doctor recommended that she see an acupuncturist. She was skeptical at the beginning, but she came to see me on one of her "miserable" days, and experienced relief from the very first acupuncture treatment. I recommended that she have two treatments every month before her menstruation. Three month’s acupuncture treatments and an herbal formula, StagnationEASE (Xue Fu Zhu Yu Tang), turned her from a skeptic to a firm believer.

Conventional medicine uses the term "primary dysmenorrhea" for pelvic pain that is the normal result of having a period, and the term "secondary dysmenorrhea" for pain during menstruation which is caused by an abnormal condition such as endometriosis, fibroids, or pelvic inflammatory disease. Ibuprofen or Naproxen are two of the over-the-counter pain relievers for menstrual pain which are commonly recommended by doctors. Birth-control pills and some stronger prescription medications also reduce menstrual pain, but with these there can be unwanted side effects. The way conventional medicine manages menstrual pain is to block the formation of prostaglandins, a substance that is produced abundantly by the body during menstruation.

In Chinese medicine, menstrual pain, like other forms of pain, is caused by one or more of the following diagnostic patterns: blockage of Qi and Blood; deficiency of Qi and Blood; retention of Heat, Dampness or Wind; or imbalance of Kidney and Liver. The goal of treatment (both herbal and acupuncture) is to tonify the deficiencies, open the blockage, remove the excesses and regulate the internal organs.

Dysmenorrhea and Pain Management in Chinese Medicine
In Chinese medicine, pain is the symptom 0f a deeper problem. The root cause of pain can be either an Excess (Shi) pattern or a Deficiency (Xu) pattern. The blockage of Qi and Blood, or the retention of Heat, Dampness or Wind, are Excess patterns. Deficiency of Qi and Blood, or imbalance of Kidney and Liver are Deficiency patterns. Blockage of Qi and Blood causes pain; imbalances of the internal organs cause pain; blockage of the meridians causes pain. Figuring out the source of the pain is the key to diagnosis and treatment. Non-fixed pain is attributed to a Wind pattern. "Chilly" pain is associated with a Cold pattern. Heavy and swollen pain is associated with a Dampness pattern. Sharp pain is associated with a Blood Stasis pattern. Stomach pain and back pain are attributed to retention of Cold in the Middle. Dull pain is associated with a Blood Deficiency pattern. Pain with redness, swelling and heat is associated with a Heat pattern. Joint pain with leg soreness is attributed to Kidney Deficiency. Chinese medicine practitioners use acupuncture and herbal medicine to relieve pain through one or a few of the following strategies: expelling Wind; dissipating Cold; eliminating Dampness; moving Qi; invigorating Blood; nourishing the Blood; clearing the Heat; tonifying the Kidneys.

Differentiating the patterns of menstrual pain depends on analyzing the timing, nature, location, intensity, color, volume and quality of the menstrual cycle and discharge, and "reading" the tongue, pulse, and associated symptoms. Generally speaking, menstrual pain before the period indicates an Excess pattern, whereas menstrual pain after the period indicates a Deficiency pattern. Aversion to pressure on the abdomen indicates an Excess pattern, and feeling relief when pressure is applied to the abdomen indicates a Deficiency pattern. Sticky menses with dark-red color indicates an Excess pattern. Feeling relief after passing menstrual blood clots indicates a Blood Stasis pattern. Abdominal pain with hypochondriac distention indicates a Qi Stagnation pattern. Thin menses of a pale-red color, and experiencing pain after the period indicates a Qi and Blood Deficiency pattern. Experiencing "cold" abdominal pain, and passing small, dark blood clots indicates a Cold pattern. Thin menses of a pale-red color, and experiencing back soreness indicates a Kidney-Liver Deficiency pattern.

Treatment of Dysmenorrhea with Herbal Medicine
Dysmenorrhea is effectively treated with Chinese herbal medicine and acupuncture. The most important of the herbal menstrual pain relievers, angelica (Dang Gui) and corydalis tuber (Yan Hu Suo), are either used in a single herb form or in combination with other herbs in a formula. Following are the most typical patterns of dysmenorrhea with the herbs most commonly prescribed to treat them:
  1. Qi Stagnation and Blood Stasis Pattern: Abdominal pain before and during menstruation; menses of a purple or dark color, with small volume and blood clots; decreased pain after passing blood clots; purplish spots on the tongue; and a wiry-choppy-strong pulse. Herbs used: aurantium fruit (Zhi Ke), lindera root (Wu Yao), and cyperus tuber (Xiang Fu) are used to regulate the Qi. Cnidium (Chuan Qiong), persica seed (Tao Ren), and safflower (Hong Hua) are used to invigorate the Blood. One of the popular herbal formulas is BlockageEASE (Ge Xia Zhu Yu Tang).

  2. Deficiency Cold Pattern: Abdominal pain during or after menstruation; feeling better when pressure and/or warmth are applied to the abdomen; pale, watery menses with small volume; soreness of the lower back and legs; long-drawn-out urination with a thin stream; a white tongue coating, and a deep pulse. Herbs used: Cinnamon bark (Rou Gui) and evodia bark (Wu Zhu Yu) are two herbs that warm the pelvic area (uterus). One of the widely used herbal formulas is "Warming Menses Formula" (Wen Jing Tang).

  3. Cold Dampness Pattern: Abdominal pain before or during periods; application of warmth reduces pain; dark-colored menses with blood clots; aversion to cold; cold limbs; white or white-sticky tongue coating; and a wiry-tight or wiry-slippery pulse. Herbs used: Cinnamon bark (Rou Gui), fennel seed (Xiao Hui Xiang), and dry ginger (Gan Jiang) are three major "warm property" herbs that can remove Dampness from the system. StagnationEASE (Shao Fu Zhu Yu Tang) is a popular formula for this pattern.

  4. Damp Heat Pattern: Abdominal pain before menstruation; aversion to heat; soreness and distention of the lower back; a feeling of heat in the abdomen or a low grade fever; menses that are sticky, with a dark red color and blood clots; a burning sensation when the menses flow out; yellow and sticky vaginal discharge; scant urine; a red tongue body, with a yellow-sticky tongue coating; and a wiry-rapid or slippery-rapid pulse. Herbs used: Coptis (Huang Lian),and peony bark (Mu Dan Pi) are two leading herbs for clearing Damp Heat. "Heat-Clearing Blood-Regulating Decoction" (Qing Re Tiao Xue Tang) is a very standard formula for this pattern of dysmenorrhea.

  5. Qi Blood Deficiency Pattern: Abdominal pain after menstruation; dull abdominal pain; menses that are thin, with a pale color and small volume; tiredness; loose stools; pale complexion; pale tongue body; and a thin-weak pulse. Herbs used: Ginseng (Ren Shen), astragalus (Huang Qi), angelica (Dang Gui), and rehmannia (Di Huang) are the leading Qi and Blood tonic herbs. "Chi Blood Tonic" (Ba Zhen Tang) is a time-tested formula for the Qi Blood Deficiency pattern of disease.

  6. Kidney Liver Deficiency Pattern: Dull abdominal pain after menstruation; sore back; menses that are pale, with small volume; dizziness; ringing in the ears (tinnitus); poor memory; insomnia; a flushed face; hot flashes; a dark-red tongue body; and a deep-thin pulse. Herbs used: Angelica (Dang Gui) and white peony root (Bai Shao) nourish the Blood and Liver. Cornus fruit (Shan Zhu Yu) is a Kidney and Liver tonic. "Liver Tonic" (Tiao Gan Tang) is recommended.

Treatment of Dysmenorrhea with Acupuncture
Besides using herbal formulas to treat dysmenorrhea, acupuncture is another viable way to treat menstrual pain. Acupuncture can open the blockage of Qi and Blood, balance the internal organs, and clear the blockage of meridians. Scientific studies find the following mechanisms for pain relief: acupuncture stimulates the production of endorphins, blocks the transmission of pain signals, and increases adrenocorticotropic hormone. In order to test these historical and modern claims about the effectiveness of acupuncture in treating dysmenorrhea, a clinical trial was organized at the Gynecology Clinic of the Kaiser-Permanente Medical Center in Oakland, California. Forty-three women with primary dysmenorrhea were followed for one year. Patients were randomly assigned into one of four different groups: the Real Acupuncture Group (RA); the Placebo Acupuncture Group (PA); the Standard Control Group (SC); and the Visitation Control Group (VC) with the following treatments: appropriate acupuncture treatment was provided to the RA Group; Random Point acupuncture treatment was provided to the PA Group; no acupuncture or medical intervention was provided to the SC Group; non-acupuncture visits with physicians were provided to the VC Group. The following results were demonstrated: 10 of 11 (90.9%) showed improvement in the RA Group; 4 of 11 (36.4%) showed improvement in the PA Group; 2 of 11 (18.2%) showed improvement in the SC Group; and 1 of 10 (10%) showed improvement in the VC Group. There was reduction of analgesic medication used by the women in RA Group, but no change or increased use of medication in other groups.

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