Menstrual Pain (Dysmenorhea)

WESTERN MEDICINE: Dysmenorrhea is a painful menstruation occurring shortly after the onset of menarche (primary dysmenorrhea) or later in life (acquired or secondary dysmenorrhea).

The etiology of primary dysmenorrhea is unknown. It occurs only with ovulatory cycling. Secondary or acquired dysmenorrhea is invariably associated with organic pelvic disease including pelvic inflammation, strictures of the cervix, abnormal position of the uterus, endometriosis, and uterine and ovarian tumors. Both primary and secondary dysmenorrhea may be aggravated by psychic and emotional factors. 

SYMPTOMS AND SIGNS: Pain appears 24 or 48 hr. before menstrual flow and persists for a variable time. The pain of primary dysmenorrhea is either sharp and cramplike or a steady, dull aching pain referred to the legs and suprapubic area and accompanied by a bearing-down sensation. Abdominal distention, painful breasts, nausea and vomiting, premenstrual tension, depression, and irritability may be associated complaints. In secondary dysmenorrhea, pain is usually a dull, nagging, bearing-down type which spreads to the back and lower thighs. Symptoms tend to increase in severity and to persist through the menstrual period.

ETIOLOGY AND PATHOLOGY: The major reason for dysmenorrhea is due to the abnormal or obstructed circulation of Qi and blood. Bu Tong Ze Tong (All pains are due to certain obstruction) is a well known saying in Chinese medicine. The following etiological factors are the most commonly seen in clinical practice: 

(1). Qi stagnation and blood stasis due to depression, worry, melancholy and anger, or invasion of cold or drinking cold liquids during menstruation. 

(2). Damp-cold obstruction due to walking in rain, or swimming, cold drinks, or sitting on wet areas during menstruation period. 

(3). Qi and blood deficiency. 

(4). Liver and kidney deficiency. 

DIFFERENTIATIONS: 

1. Dysmenorrhea due to Qi stagnation and Blood Stasis:

Indications: Lower abdomen pain or distention before or during menstruation, scanty menstrual flow with dark color or clots, release feeling after clots come out; pain or distention at breast or hypochondriac regions, dark purplish tongue, or with petechia on the sides of tongue, deep and wiry pulse. 

Treatment & Formulas: Regulate and promote the circulation of Qi and blood so as to stop the pain. 

Products:

• Xiao Yao San (Dang Gui and Bupleurum Decoction, Item No. 2195): This is a Qi regulating and harmonizing formula. It also can be combined with Gui Zhi Fu ling Wan or Tao He Cheng Qi Tang to promote the circulation of both Qi and blood. 
• Jia Wei Xiao Yao San (Bupleurum and Peony Decoction, Item No. 2068): This is used for Qi stagnation plus interior heat due to the stagnation. 
• Gui Zhi Fu Ling Wan (Cinnamon and Poria Decoction, Item No. 2157): It is very good formula to resolve or disperse the stagnant blood and improve the blood circulation, especially good for lower burner. lf there is also Qi stagnation, it can be combined with Xiao yao San or Jiao Wei Xiao Yao San. 
• Tao He Cheng Qi Tang (Persica and Rhubarb Decoction, Item No. 2165): This is a strong formula to clear the stagnated blood in lower burner (uterus, large intestine... ). 

2. Dysmenorrhea due to the Stagnation of Damp Cold:

Indications: Lower abdominal pain or distention before or during menstruation, or pain referred to the legs and suprapubic areas, or referred to lumbar release after hot pressing, scanty menstrual flow dark color or clots, aversion to cold, loose stool, white and greasy tongue coating, deep and tight pulse.

Treatment & Formulas: Warm the meridian promote the circulation, eliminate the damp factors so as to stop the pain. 

Products:

• Wen Jing Tang (Warm the Menses Decoction Item No. 2227): This is very a popular and widely used formula for women diseases due to the damp cold at lower burner. It is applied broadly to  menstrual irregularity, dysmenorrhea, menopausal disorders, leukorrhea, infertility, or eczema.
• Sheng Hua Tang (Dang Gui and Ginseng Decoction, Item No. 2077): It has a warming and regulating function. So it is used for dysmenorrhea due to the damp cold and blood stagnation, especially for women after childbirth. 

3. Dysmenorrhea due to Qi and Blood Deficiency:

Indications: Steady dull aching lower abdominal pain during or after menstruation, release by pressing the painful area, pale and loose quality of menstruation, pale complexion, lassitude, pale tongue, thin coating, thready and weak pulse. 

Treatment & Formulas: Tonify both Qi and blood. 

Products:

• Dang Gui Shao Yao San (Dang Gui and Peony Decoction, Item No. 2233): This is a popularly used formula for dysmenorrhea, irregular menstruation, anemia before or after childbirth, habitual miscarriage. Its function is to tonify both Qi and blood by promoting the function of the spleen and stomach, as well as the liver. 
• Ba Zhen Tang (Eight Treasue Decoction, Item No. 2010): This is a tonic formula for both Qi and blood. 
• Ren Shen Yang Rong Tang (Ginseng and Rehmannia Decoction, Item No. 2007): Also a strong Qi and blood tonic formula. 
• Gui Pi Tang (Ginseng and Longan Decoction, Item No. 2261): This tonifies the Qi and blood by promoting the function of spleen and heart.
• Xiong Gui Jiao Ai Tang (Dang Gui and Gelation Decoction, Item No. 2100): It is good for blood deficiency with interior coldness.

4. Dysmenorrhea due to the Liver and Kidney Deficiency:

Indications: Lower abdominal dull pain after menstruation, scanty and pale menstrual flow, dizziness, tinnitus, soreness or pain at lumbar region, slight red tongue, thin coating, deep and thready pulse. 

Treatment & Formulas: Tonify the liver and kidney. 

Products: 

• Huan Shao Dan (Lycium Decoction, Item No. 2264): This is a tonic formula, especially for the kidney. 
• Liu Wei Di Huang Wan (Rehmannia Six Decoction, Item No. 2051): This is a Yin tonic for the kidney. 
• Ba Wei Di Huang Wan (Rehmannia Eight Decoction, Item No. 2011): This is both a Yin and a Yang tonic for the kidney.