Dysmenorrhea is the term for painful cramps occuring in the lower abdomen prior to or during menstruation. Although minor pain is normal during menstruation, excess pain is not. This condition is a very common problem amongst young women in their early 20’s-30’s. Approximately 50% of menstruating women have dysmenorrhea. Dysmenorrhea is characterized by spasmodic pain with or without radiating pain to the vagina, anus and lower back. It is often accompanied with low back pain, frequent urination, or a feeling of defecation. For about 10% of the women with dysmenorrhea, the pain is so severe that they are debilitated for three or more days. If not treated, dysmenorrhea can develop into more serious conditions which may affect the patient’s physical, mental and emotional health.
In Chinese medicine, to treat dysmenorrhea, it is important to always remember to find the root cause. According to Zhang Jing-Yue, "There are both deficiency and excess pattern in dysmenorrhea." Thus, it may be more difficult to differentiate the root problem. It is better to pattern diagnose and differentiate the deficiency or excess symptoms when the patient is not menstruating.
In treating dysmenorrhea, we always want to treat the acute symptoms first. Once those symptoms are relieved, then we can treat the root cause. For example, abdominal cramps during menstration is an acute symptom. The patient’s physical condition is the underlying root cause. When the patient is menstruating, we treat the acute symptoms and afterwards, we treat the underlying problem and prevent the recurrence of pain in the next cycle. Generally speaking, there are four typical patterns:
Qi Stagnation and Blood Stasis
Qi stagnation usually results from mental depression, excessive worrying, or too many obsessive thoughts, all of which can impede the normal flow of qi and blood. Qi stagnation causes sluggishness in blood circulation which can cause blood stasis. The pain usually occurs before and during the period and is accompanied with bloating in the lower abdomen. The period is scanty, with purplish clumps. Usually the pulse is wiry and the tongue purple.
Gui Zhi Fu Ling Wan or Xue Fu Zhu Yu Wan are both good formulas to use as they activate blood, remove stasis, regulate Qi and relieve pain. If the bloating is severe, adding Qing Pi or Xiang Fu will be useful.
Damp Cold Stagnation
Patients with this condition have usually sustained cold injury to their lower jiao and the coldness is retained in the uterus. These patients may be careless with their diet during their cycle and drink too many cold beverages or eat too many cold foods. Bathing or swimming in cold water or living in a wet damp environment can also introduce cold damp evil into the body. Patients with this pattern usually suffer pain in the lower abdomen with aversion to coldness during the period. With more severe cases, the pain can radiate to the back. The symptoms are usually relieved by warm compress. The tongue is greasy and the pulse is wiry and deep.
Wen Jing Tang or Xiao Fu Zhu Yu Tang can be used to disperse the blood stasis and warm the channels.
Damp Heat Stagnation
This condition develops from consuming excessive amounts of rich, fatty, spicy and sweet foods. Patients with this condition usually have bitterness in the mouth, fullness in the intercostal region, scanty dark urine, and thick odorous vaginal discharge during menses. During the period, the patient will have stabbing pain in the lower abdomen which is worse with pressure and heat.
Long Dan Xie Gan Tang can be used to treat this pattern as it eliminates damp heat.
Qi and Blood Deficiency
Patients with this pattern were either born with a weak constitution or has had a serious illness. With both qi and blood deficiency, blood circulation is sluggish causing blood stasis and pain. Usually the pain in the lower abdomen develops at the end of the menstrual period or after the period is over. The pain is usually relieved with pressure. Patients with this pattern have light and thin bleeding during their period, sallow complexion and often fatigued. Their tongue is pale with a thin white coat, with a thin weak pulse. Ba Zhen Wan can be used to replenish blood and qi.
Although these are the most typical patterns associated with Dysmenorrhea, these are not the only possible patterns. It is important to heed Dr. Bing Yin Lee’s advice to focus on the person and find the root cause for the individual patient. Do not pigeon hole her into one of these four patterns. It is essential to focus on the acute symptoms first and then the root cause. Patients must see results for their acute symptoms, or you may never get a chance to address the root cause.