Dysmenorrhea

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 ) Excess syndrome : 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 syndrome : 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 .

Treatment

a ) Excess syndrome :

Method : Acupuncture is given with the reducing method . Points of the Ren and Foot - Taiyin Meridians are selected as the principal points . Both acupuncture and moxibustion are used in case of cold syndromes to adjust qi activities , invigorate blood flow and restore the functions of meridians .

Prescription : Zhongji ( Ren 3 ) , Ciliao ( B 32 ) , Hegu ( Li4 , Xuehai ( Sp 10 ) , Diji ( Sp 8 ) , Taichong ( Liv 3 ) . Supplementary points : Distending pain in the lower abdomen : Siman ( K 14 ) , Shuidao ( S 28 ) .

Pain with cold feeling in the lower abdomen : Guilai ( S 29 ) , Daju ( S 27 ) .

Explanation : Zhongji ( Ren 3 ) serves to regulate the qi in the Chong and Ren Meridians . When it is applied together with Xuehai ( Sp 10 ) , Diji ( Sp 8 ) , the Xi - ( Cleft ) Point of the Spleen Meridian , may invigorate blood flow and menstruation . Taichong ( Liv 3 ) , the Yuan - ( Primary ) Point of the Liver Meridian can free the stagnated liver qi , paired with Hegu ( Li4 ) can regulate qi and blood flow and eliminate pain . Ciliao ( B 32 ) is an empirical point for dysmenorrhea . For distending pain in the lower abdomen it is used together with Siman ( K 14 ) , Shuidao ( S 28 ) to regulate the Chong and Ren Meridians and remove blood stasis and pain . Moxibustion applied to Guilai ( S 29 ) and Daju ( S 27 ) warms up the related meridians and eliminates pain in the lower abdomen . The above points used together are to promote the flow of qi , remove blood stasis , warm up meridians and dissipate cold . Thus dysmenorrhea gets cured when the Chong and Ren Meridians are well adjusted .

b ) Deficiency syndrome :

Method : Points of the Ren , Spleen and Kidney Meridians are selected as the principal points . Acupuncture is given with the reinforcing method and moxibustion to regulate qi and blood , warm up and nourish the Chong and Ren Meridians .

Prescription : Guanyuan ( Ren 4 ) , Pishu ( B 20 ) , Shenshu ( B 23 ) , Zusanii ( S 36 ) , Sanyinjiao ( Sp 6 ) .

Explanation : Guanyuan ( Ren 4 ) is an intersecting point of the three foot - yin meridians . When moxibustion is applied to it and Shenshu ( B 23 ) , it may warm up the lower jiao , benefit essence , blood and finally the Chong and Ren Meridians . Pishu ( B 20 ) , Zusanii ( S 36 ) and Sanyinjiao ( Sp 6 ) grouped together can tonify the spleen and stomach , and benefit qi and blood . Dysmenorrhea is naturally removed when the uterus is nourished by abundant qi and blood , and the balanced equilibrium of the Chong and Ren Meridians .

Remarks

This disorder often involves in pathological changes of the genitalia , and relates to endocrinal and neuropsychiatrical factors . If dysmenorrhea is secondary , treatment should be given to the primary cause