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Dysmenorrhea is the occurrence of painful cramps during menstruation.

More than half of girls and women suffer from dysmenorrhea (cramps*), a dull or throbbing pain that centers in the lower mid-abdomen and radiates to the lower back. This can occur before, during or after menstruation. Though menstruating women of any age can experience cramps, it occurs most typically in young women two to three years after the onset of menstruation. While the pain may be only mild for some women, others experience severe discomfort that can significantly interfere with everyday activities for several days each month. The pain is often accompanied by headache, dizziness, vomiting, nausea, diarrhea or constipation.

Dysmenorrhea is called "primary" when there is no specific abnormality, and "secondary" when the pain is caused by an underlying gynecological problem. A doctor should perform a thorough pelvic exam* and take a patient history to rule out* an underlying condition that could cause cramps.

In Chinese medicine, menstrual pain, like other forms of pain, is caused by one or more of the following diagnostic patterns: cold congealing in the uterus, liver-kidney deficiency, dual deficiency of qi and blood, and qi stagnation and blood stasis, as listed in Fig. 17-12. Therefore, the treatment commonly involves tonifying the kidney, tonifying the spleen, regulating the liver, regulating qi and blood and regulating the thoroughfare and conception vessels.

Fig. 17-12 Four basic patterns of dysmenorrhea

Differentiating the patterns of menstrual pain depends on analyzing the timing, nature, location, intensity, color, volume and quality of the menstrual discharge, and "reading" the tongue, pulse, and associated symptoms. Generally speaking, menstrual pain before the period indicates an excess pattern, whereas menstrual pain after the period indicates a deficiency pattern. Aversion to pressure on the abdomen indicates an excess pattern, and feeling relief with pressure indicates a deficiency pattern. Sticky menses with dark-red color indicates an excess pattern. Feeling relief after passing menstrual blood clots indicates a blood stasis pattern. Abdominal pain with hypochondriac distention indicates a qi stagnation pattern. Thin menses of a pale-red color, and experiencing pain after the period indicates a qi and blood deficiency pattern. Experiencing cold abdominal pain, and passing small, dark blood clots indicates a cold pattern. Thin menses of a pale-red color, and experiencing back soreness indicates a kidney-liver deficiency pattern.

Pattern of qi stagnation and blood stasis in dysmenorrhea is marked by moving or stabbing pain in the lower abdomen with or without mass formation, unsmooth and scanty purple or dark color menstrual discharge, purple tongue or purple-spotted tongue, and string-like choppy pulse.*

The therapeutic principle for this pattern is to activate blood, resolve stasis, and move qi to relieve pain*. Ge xia zhu yu tang (Source: Correction of Errors in Medical Classics) can be selected for this pattern and its ingredients are:

Decoct the above herbs in water for oral administration.

Pattern of cold congealing in the uterus is marked by cold and pain in the lower abdomen, refusal of pressure and alleviated by warmth, dysmenorrhea or delayed periods with dark menstrual discharge, white tongue coating and sunken tight pulse.

The therapeutic principle for this pattern is to warm the uterus to relieve pain*. Modified shao fu zhu yu tang (Source: Correction of Errors in Medical Classics) can be applied to this pattern and its ingredients are:

Decoct the above herbs in water for oral administration.

Pattern of dual deficiency of qi and blood in this condition is marked by vague pain in the lower abdomen during or after menstruation, alleviated by pressure; pale-colored and thin menstrual flow, listlessness, lack of strength, shortness of breath, pale or sallow complexion, or dizziness, or dimmed vision, pale lips and nails, or palpitation, or insomnia, pale tongue and weak pulse. The therapeutic principle for this pattern is to tonify qi and replenish blood*. Bazhen tang (Decoction of Eight Precious Ingredients) is the most selected formula for this pattern, and its ingredients are:

Add 2 slices of shengjiang (Rhizoma Zingiberis Recens) and 3 pieces of dazao (Fructus Ziziphi Jujubae) into the above ingredients and decoct all the herbs in water for oral application.

Liver-kidney deficiency pattern in this condition is marked by vague pain in the lower abdomen after menstruation, irregular menstruation, profuse or scanty menstrual discharge with pale-colored and thin menstrual flow and no blood clot, accompanied by soreness and weakness of the loins and knees, dizziness and tinnitus, reddish tongue with scanty fur, and thin pulse. The therapeutic principle for this pattern is to enrich the kidney and nourish the liver* and tiao gan tang can be selected. The ingredients of the formula are:

Decoct the above herbs in water for oral administration.