Dysmenorrhea and Chinese Medicine

Dysmenorrhea ( painful menstruation) is a menstrual condition characterized by severe and frequent menstrual cramps and pain associated with menstruation. The following are the most common symptoms of dysmenorrhea. However, each individual may experience symptoms differently. Symptoms may include cramping in the lower abdomen, pain in the lower abdomen, low back pain, pain radiating down the legs, nausea, vomiting, diarrhea, fatigue, weakness, fainting, and headaches. The symptoms of dysmenorrhea may resemble other conditions or medical problems.

Dysmenorrhea may be classified as primary or secondary.

Primary dysmenorrhea – Primary dysmenorrhea is menstrual pain associated with ovular cycles in the absence of pathological findings. From the beginning and usually lifelong; manifestation is severe and frequent menstrual cramping caused by severe and abnormal uterine contractions. Pain generally develops one or two years after the first menarche and may progressive get worse with time. In general, women with primary dysmenorrhea experience abnormal uterine contractions as a result of a chemical imbalance in the body (particularly prostaglandin and arachidonic acid — both chemicals which control the contractions of the uterus).

secondary dysmenorrhea – due to some organic cause and usually of later onset; painful menstrual periods caused by another medical condition present in the body (i.e., pelvic inflammatory disease, endometriosis). Secondary dysmenorrhea is caused by other medical condition. Most often endometriosis is the root problem. This is a condition in which tissue that looks and acts like endometrial tissue becomes implanted outside the uterus, usually on other reproductive organs inside the pelvis or in the abdominal cavity – often resulting in internal bleeding, infection, and pelvic pain. Other possible causes of secondary dysmenorrhea include pelvic inflammatory disease (PID), uterine fibroids, abnormal pregnancy, infection, tumors, or polyps in the pelvic cavity.
While any woman can develop dysmenorrhea, the following women may be at an increased risk for the condition: women who smoke, women who drink alcohol during menses (alcohol tends to prolong menstrual pain), women who are overweight, women who started menstruating before the age of 11.

Traditional Chinese Medicine Overview
Dysmenorrhea (Tong Jing) The pathology of dysmenorrhea is the impairment of Qi and Blood. The main organs involved are the Liver, Kidney and Spleen. The main channels involved are the Ren and the Chong. Patients with Deficient patterns will experience more pain after the period. The pain will have a dull quality that is better with pressure. Patients with excess patterns will have more severe pain before and during her period. The pain is severe and worse with pressure; it is important to point out that differential diagnosis of dysmenorrheal in Chinese Medicine is more complicated and will include both deficient and excess patterns. Although point prescription depends on a patient, these are some general points used for dysmenorrhea: Ren3, 4, 6, St25(qi), St28(damp), St29 (stasis), Ub32, Ki13, Ki14, Shi Qi Zhui (17th vertebrae point, located below Lumber 5), Pc6, Li4, St36.
TCM Pattern Differentiation
Dysmenorrhea may present as one of these patterns or in combination. Other pattern maybe displaying depending on the individual.

Excess Patterns: More severe pain at the beginning of the period.
Coagulation of Cold-Damp: most common.
Liver Qi Stagnation and Blood Stagnation
Descent of Damp-Heat: uncommon, possibly related to PID (Pelvic Inflammatory Disorder).
Vacuity Patterns: More severe pain following period.
Yang Deficiency with Internal Cold: Kidney and Spleen.
Liver and Kidney Deficiency: Liver (blood), Kidney (essence and qi).
Qi and Blood Deficiency: Mostly Liver and Spleen but can also relate to Lung Heat. Origin may relate to loss of nourishment to the Ren and Chong.