Dysmenorrhea (painful period)

Diagnosis For Dysmenorrhea

– recurring pain in lower abdomen 1-2 days before, during, or after period. Pain can radiate to whole abdomen, lower back, and anal/genital area (Endometriosis can have a feeling of downward pulling on the anus).

The pain generally diminishes after period ends. The pain can be stabbing, burning, squeezing, dull, down-bearing, and in severe cases can cause nausea, vomiting, cold sweating, and fainting.

This seems to happen mostly in younger women.

Differential Diagnosis of Dysmenorrhea

– Appendicitis (pain only in right side, severe when pressed and let go), Ulcers (usually in epigastrium), Ovarian cysts and Uterine fibroids (milder pain), Inflammatory bowel diseases and reproductive and intestinal Cancers (constant dull pain), all of these can happen at any time within the cycle.

Etiology (causes) of Dysmenorrhea :

1. Qi and Blood Stagnation - Liver, emotional upset/stress stagnates Qi blood stasis. Sea of Blood stagnates and causes pain.

2. Cold in Uterus – common in young women (swimming, Yang , living enviro., cold foods), cold invades lower abdomen, Yang can also cause cold in Ren/Chong. Mostly Cold/Damp or Yang .

3. Damp/Heat – inflammations, cold turns to heat, surgery, abortions etc cause Damp/Heat in lower Jiao, Ren/Chong and Uterus stagnate blocked flow pain.

4. Qi and Blood - after surgery, illness, constitution, all can cause stagnation pain.

5. Liver and Kidney - births, sex, abortions essence/blood not enough blood in Ren/Chong pain after menses (lack of lubrication idea).

1. or - PMS is more , pain after period starts is . 2. How severe is the pain 3. General condition – angry, Qi , Blood , leukorrhea (damp), etc. 4. In Qi or Blood level / in Liver or Kidney -if pain in lower abdomen radiates to sides = Liver -if pain radiates to lower back = Kidney -if pain is fixed = blood stasis -if pain moves (not fixed) = Qi stagnation. 5. Eight-principle diagnosis

Principle of Treatment of Dysmenorrhea: – regulate REN/Chong – Qi and Blood, combine root/branch (pain first)- choose herbs according to type of pain symptoms

Chinese Medicine Differentiation and Treatment for Dysmenorrhea

Qi and Blood stagnation – 1 or 2 days before or during 1stday of menses – lower abdominal distension pain, pressure makes worse, generally scanty blood flow, start/stop flow, dark-purple colour w/ clots, when clots pass the pain is relieved (or when menses stop). Plus – Liver Qi Stagnation sym. (PMS) T-dark-red P-wiry

Principle of Treatment:– regulate Qi, move stasis to relieve pain

Herbal Medicine Formula:– Ge Xia Zhu Yu Tang (below diaphragm).

Cold in Uterus – a) Cold (Yang ) painful during or after, pressure and warmth helps, scanty dull-dark red blood. Plus – Kidney Yang sym. T-pale, moist white coat P-deep

Principle of Treatment: – warm Chong/Ren/Uterus to regulate blood and relieve pain

Herbal Medicine Formula: Wen Jing Tang - b) Cold/Damp block lower Jiao causing lower abdomen cold pain – few days before or during, pain gets worse w/ pressure – better w/ warmth, scanty very-dark blood w/ clots. Plus - cold sym. w/ aching all over T-white coat P-tense

Principle of Treatment: – expel cold, eliminate Damp, warm meridians to relieve pain

Herbal Medicine Formula:– Shao Fu Zhu Yu Tang + eliminate damp (cang zhu, fu ling)

Damp/Heat – in lower Jiao causes distension pain before or during menses, pressure makes worse, hot sensations, yellow smelly vaginal leukorrhea, dark-red thick blood w/ clots, maybe more blood. Plus – Damp/Heat sym. T-red, yellow greasy coat P-wiry-rapid

Principle of Treatment: – clear heat – eliminate damp to relieve pain

Herbal Medicine Formula: Qing Re Tiao Xue Tang

Qi and Blood - dull pain during or after period, pressure helps, scanty pale thin blood. Plus – Qi/Blood sym. T-pale P-thin

Principle of Treatment: – nourish Qi and Blood

Herbal Medicine Formula: Ba Zhen Tang

Liver and Kidney - dull softer pain during or after period, dull-dark scanty thin blood Plus – Liver Kidney sym. T-pale P-weak

Principle of Treatment:– nourish Liver Kidney to relieve pain

 
Herbal Medicine Formula: Tiao Gan Tang (regulate Liver w/ Kidney herbs)