Primary dysmenorrhea is recurrent menstrual pain (cramps) not due to other diseases in the reproductive tract. It occurs before, during or after menstruation. The pain is mild to unbearable, felt in the lower abdomen, back or thighs.
Etiology and Pathology
1) “Blockage results in pain” (bu tong ze tong, 不通则痛):
Cold food or climatic cold pathogen, or cold dampness can cause uterine blood coldness and further result in uterine blood stasis.
Stress leads to liver qi stagnation which gives rise to blood stasis in Chong and Ren Channels, eventually creating uterine blood stasis.
2) “Undernourishment leads to pain” (bu rong ze tong, 不荣则痛):
Kidney or blood deficiency can make the uterus “empty”.
Weak constitution or chronic diseases contributes to uterine blood insufficiency.
Diagnosis
Established by finding above mentioned symptoms and ruling out other uterine diseases by medicinal doctors.
Syndrome Patterns and Treatment
1) Uterine Cold and DampSymptoms: before or during the period, lower abdominal cold pain, worsened by pressure, pain extending to lower back, reduced by warmth, scanty menstruation, clots; thin tongue coating, deep/tense pulse
Treatment Principle: warm channels and uterus, disperse cold, remove blood stasis, stop the pain
Channels and Acupuncture Points: Ren channel, Spleen channel; acupuncture plus moxa
zhong ji / Ren3: on Ren channel, connecting to the uterus; moxa for regulating Chong and Ren channels, warming channels and stop the pain
shui dao/ST28: on stomach channel, Chong channel, reinforced by stomach channel; reinforce zhong ji/Ren3 to warm uterine and stop the pain
di ji/SP8: Spleen cleft, tonify spleen, resolve damp, regulate blood and stop the pain.
If pain is severe, add ci liao/UB32, gui lai/ST29
If abdominal pain extends to the lower back, add ming men/Du4, Shen shu/UB23
2) Liver Qi StagnationSymptoms: before or during the period, lower abdominal distending pain; scanty period, clots; chest/hypochondriac/breast distending pain, dull pale tongue, deep wiry pulse
Treatment Principle: activate qi and blood, stop the pain
Channels and Acupuncture points:
Ren channel, liver channel
qi hai / Ren 6: on Ren channel, connect to uterine, regulate qi and activate blood, regulate C/R;
Tai chong/ LV3: source point of the liver, soothe liver, regulate Qi/blood;
San yin jiao/SP6: assist qi hai/Ren 6 to regulate qi/blood
If abdominal distension, add Tian shu/ST25, qi xue/KI13, di ji/SP8
If hypochondriac pain, add yang ling quan/GB34, guang ming /GB37
If chest distress, add nei guan/PC 6
3) Liver and Kidney Yin Deficiency Symptoms: during or after a period, dull pain, reduced by pressure, scanty period with thin and light colour; dizziness, pale complexion; pale tongue, deep thin weak pulse
Treatment Principle: nourish kidney and liver, stop the pain
Channels and Acupuncture points:
Ren channel, kidney channel, back shu points
Gan shu/UB18: nourish kidney and liver, regulate Chong and Ren
Shen shu/UB23: nourish kidney and liver, regulate Chong and Ren
Zhao Hai / KI 6: nourish kidney and liver, regulate Chong and Ren
Guan yuan / Ren4: replenish essence blood, nourish kidney and liver, nourish Chong and Ren
San yin jiao/SP6: tonify spleen and stomach to reinforce blood and qi
If dizziness, add xuan zhong / GB39, tai xi / KI3
If abdominal pain is severe, add da he /KI12, qi xue /KI13
Other treatment:
Ear Acupuncture: uterus, endocrine, sympathetic, kidney
Moderate level of stimulation, 2-3 points each time, retain needle 20 minutes
Note: Acupuncture treatment for dysmenorrhea is effective for patients with functional disorders. The best time for treating dysmenorrhea of excess syndrome is about a week before the period, while the best chance for deficiency syndrome is about a week after. Chinese herbs are a much better option for dysmenorrhea or deficiency syndrome.
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