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Dysmenorrhea

Dysmenorrhea is characterized by periodic lower abdominal pain radiating to the lumbus and sacrum and occurs during, before of after the menstrual period.

Etiology and Pathogenesis

According to the ancient statement "pain ensues wherever obstruction is present," the chief mechanism of dysmenorrhea is the stagnation of qi and blood and the obstruction of the Bao meridian, resulting from the dysfunction of the Zang-fu organs.

Based on its pathogenesis, dysmenorrhea may be classified into five clinical types: stagnation of qi and blood; retention of cold-dampness; deficiency of blood and qi; accumulation of heat-dampness; and impairment of the kidneys and liver.

Diagnosis and Differential Diagnosis

Abdominal pain of other origins which appears or is aggravated during the menstrual period should be distinguished from this disorder. A detailed history and a thorough physical examination including the gynecological examination are necessary for the differentiation.

Syndrome Differentiation and Treatment

Whether the disorder is attributed to cold or heat, asthenia or sthenia syndrome may be identified by the different times of occurrence and the characteristics of the abdominal pain. Those abdominal pains occurring in the premenstrual or menstrual period and characterized by a stabbing sensation may indicate a sthenia-syndrome; while those occurring in the postmenstrual period, relievable by pressure and dull, aching in character may suggest an asthenia-syndrome. A colicky or cold pain relievable by warmth shows a cold-syndrome, while a stabbing pain relievable by cold indicates a heat-syndrome. A pain more predominant than distension and alleviated by discharge of blood clots reveals a case with blood stasis, while a distension more predominant than pain indicates a case with qi stagnation.

Syndrome Differentiation

A. Dysmenorrhea due to stagnation of qi and blood

Manifestations: Distending pain (distension predominantly) over the lower abdomen in premenstrual or menstrual period which is sometimes relieved after discharge of blood clots, irregular menstrual cycle, oligomenorrhea with dark purplish menses containing blood clots, emotional upset, distending pain over the chest, hypochondrium and breasts, dark purplish tongue with petechiae and white, greasy coating and wiry and unsmooth pulse.

Therapeutic principles: Regulate qi, activate blood circulation, eliminate blood stasis, and relieve pain.

Prescription: The Modified Decoction for Removing Blood Stasis Under the Diaphragm

Radix Angelicae Sinensis 10 g
Rhizoma Chuanxiong 10 g
Radix Paeoniae Rubra 10 g
Radix Paeoniae Alba 10 g
Semen Persicae 10 g
Flos Carthami 10 g
Fructus Aurantii 12 g
Rhizoma Corydalis 10 g
Faeces Trogopterori 10 g
Rhizoma Cyperi Praeparata 10 g
Pulvis Resina Draconis (taken with the decoction) 3 g
Folium Citri Reticulatae 10 g
Semen Citri Reticulatae 10 g
Radix Glycyrrhizae Praeparata 6 g

In addition, the Pill of Lignum Aquilariae Resinatum, Cortex Cinnamomi, Corydalis and Succinum may also be taken, 6 grams twice daily.

B. Dysmenorrhea due to retention of cold-dampness

Manifestations: Cold pain and tenderness of the lower abdomen during menstrual period, delayed menstrual cycle, difficult menstruation with dark purplish menses containing blood clots or distending pain over the abdomen, coldness of extremities, vomiting, clammy sweating, white, greasy tongue coating and deep and slow pulse.

Therapeutic principles: Warm the meridians, expel cold, and relieve pain.

Prescription: Decoction for Removing Blood Stasis in Lower Abdomen

Fructus Foeniculi (fried) 10 g
Rhizoma Zingiberis (dried) 6 g
Cortex Cinnamomi 6 g
Fructus Evodiae 6 g
Radix Angelicae Sinensis (fried with wine) 10 g
Rhizoma Chuanxiong 10 g
Pollen Typhae (wrapped in cloth) 10 g
Faeces Trogopterori 10 g
Pulvis Rhizoma Corydalis 3 g
Myrrha Praeparata 10 g

Remarks: The Pill of Zingiberis, Cortex Cinnamomi, Aconiti Praeparata and Succinum may be given as a supplement, 6 grams twice daily. For cases with asthenia-cold syndrome manifested as delayed menstrual cycles, menorrhagia with light-colored menses, lower abdominal pain during postmenstrual period or at the end of menstrual period, pale tongue with thin, white coating and deep, slow and weak pulse, use the Modified Decoction for Warming Meridians to expel cold, warm the uterus, benefit qi, nourish blood and regulate the Chong meridian. The prescription is as follows:

Folium Artemisiae Argyi (fried) 6 g
Ramulus Cinnamomi 10 g
Fructus Evodiae 6 g
Radix Angelicae Sinensis 10 g
Radix Paeoniae Alba (fried) 15 g
Rhizoma Chuanxiong 10 g
Radix Codonopsis Pilosulae 15 g
Rhizoma Pinelliae 10 g
Colla Corii Asini 10 g
Radix Glycyrrhizae Praeparata 6 g
Rhizoma Zingiberis Recens 6 g

C. Dysmenorrhea due to accumulation of heat-dampness

Manifestations: Lower abdominal distending pain and tenderness before the menstrual period, lumbago or hot feeling over the lower abdomen, intermittent low fever, leucorrhagia with yellow and odorous discharge, menstrual cycle preceded by dark red and viscous menses containing clots, oliguria with yellow urine, red tongue with yellow, greasy coating and wiry and rapid pulse.

Therapeutic principles: Clear away heat, eliminate dampness and blood stasis, and arrest pain.

Prescription: The Modification of Powder for Regulating the Liver and Spleen with Toosendan Powder

Radix Bupleuri 10 g
Fructus Aurantii Immaturus 10 g
Radix Paeoniae Rubra 10 g
Radix Glycyrrhizae 6 g
Fructus Toosendan 10 g
Rhizoma Corydalis 10 g
Herba Patriniae 15 g
Myrrha Praeparata 10 g
Radix et Rhizoma Rhei (decocted later) 6 g
Herba Verbenae 15 g
Cortex Moutan Radicis 10 g
Rhizoma Dioscoreae Bulbiferae 10 g
Radix Saussureae Lappae 6 g

Remarks: For cases with marked heat-toxin syndrome manifested as severe abdominal pain, leucorrhagia with yellow and odorous discharge, add Caulis Sargentodoxae (15 g) and Rhizoma Smilacis Glabrae (15 g).

D. Dysmenorrhea due to deficiency of qi and blood

Manifestations: Dull abdominal pain occurring at the end of, or after, the menstrual period and relievable by pressure, oligomenorrhea with pink and watery menses, pale complexion, fatigue, palpitations, shortness of breath, pale tongue with thin coating and thready and weak pulse.

Therapeutic principles: Tonify blood and qi, regulate menstruation, and relieve pain.

Prescription: The Modification of the Decoction of Four Drugs with Codonopsis Pilosulae and Astragali

Radix Codonopsis Pilosulae 30 g
Radix Astragali Praeparata 15 g
Radix Angelicae Sinensis 10 g
Radix Paeoniae Alba (fried) 15 g
Radix Rehmanniae Praeparata 15 g
Rhizoma Chuanxiong 10 g
Fructus Amomi 6 g
Radix Glycyrrhizae Praeparata 6 g
Malt 30 g

Remarks: For cases with blood deficiency as the predominant syndrome accompanied by cold-syndrome that manifests itself as dizziness and palpitations, use the Decoction of Four Drugs with Colla Corii Asini and Artemisiae Argyi composed of Radix Angelicae Sinensis, Radix Rehmanniae Praeparata, Rhizoma Chuanxiong, Radix Paeoniae Alba, Colla Corii Asini, Folium Artemisiae Argyi and Rhizoma Zingiberis to warm the meridians and uterus, expel cold and nourish blood. Furthermore, the Decoction of Paeoniae Alba and Glycyrrhizae is an effective prescription for analgesic purposes.

E. Dysmenorrhea due to impairment of the liver and kidneys

Manifestations: Lower abdominal pain after the menstrual period, soreness and weakness of limbs, severe lumbago, dizziness, tinnitus, irregular menstrual cycle, oligomenorrhea with light-colored menses, reddish tongue and deep and thready or wiry and weak pulse.

Therapeutic principles: Tonify the liver and kidneys, benefit blood and essence, regulate menstruation and relieve pain.

Prescription: The Modified Decoction for Regulating the Liver

Rhizoma Dioscoreae 15 g
Colla Corii Asini 10 g
Radix Angelicae Sinensis 10 g
Radix Paeoniae Alba 15 g
Fructus Corni 10 g
Radix Morindae Officinalis 10 g
Radix Glycyrrhizae Praeparata 6 g
Placenta Hominis 10 g

Remarks: For cases with distending pain over the chest and hypochondrium, add Radix Curcumae (10 g), Rhizoma Cyperi (10 g) and Fructus Aurantii (10 g). For cases of pelvic tuberculous infection with flushed cheeks and hectic fever, add Cortex Lycii Radicis (10 g), Carapax Trionycis Praeparata (15 g), Herba Artemisiae Annuae (10 g) and Radix Stemonae (15 g), and omit Morindae Officinalis. For cases with insomnia and poor memory, add Semen Ziziphi Spinosae (15 g), Fructus Schisandrae (10 g) and Caulis Polygoni Multiflori (15 g).

Copyright 1995 Hopkins Technology


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