Introduction
Painful Period refers to abdominal pain during or before and after menstruation, usually affecting normal work and daily life. It is either primary dysmenorrhea (or functional dysmenorrhea) marked by no evident changes of the genitalia or secondary dysmenorrhea due to organic pathological changes of the genitalia. The clinical manifestations are mainly lower abdominal pain or lumbago before and after or during menstruation, even unbearable pain and regular occurrence with menstrual cycle. This disease pertains to abdominal pain during menstruation in TCM, usually caused by stagnation of liver qi, inhibition of blood flow or attack by cold during menstruation and unsmooth circulation of qi and blood; or by malnutrition of the uterine meridian due to asthenia of qi and blood as well as liver and kidney.
Syndrome Differentiation
1. Coagulation of Cold-Dampness
Cold pain in the lower abdomen before or during menstruation, rejection to pressure and preference for warmth, unsmooth and scanty menorrhea with purplish and blackish clot, accompanied by cold body and limbs, aching joints, whitish greasy tongue fur, deep and tense pulse.
2. Qi Stagnation and Blood Stasis
Distending pain in the lower abdomen before or during menstruation, unsmooth and scanty menorrhea with purplish and blackish clot, accompanied by distension in the chest, hypochondria and breast, purplish tongue or with ecchymoses, deep and taut pulse.
3. Insufficiency of Qi and Blood
Vague pain in the lower abdomen during or after menstruation, preference for pressure, light-colored and thin menorrhea, accompanied by pale complexion, lassitude, dizziness, light-colored tongue and thin and weak pulse.
4. Asthenia of Both the Liver and Kidney
Vague pain in the lower abdomen after menstruation, irregular menstruation, profuse or scanty menorrhea with light-red color and no blood clot, accompanied by aching and weakness of the loins and knees, restless sleep in the night, dizziness and tinnitus, reddish tongue with scanty fur and thin pulse.
Treatment
1. Body acupuncture
Prescription: Zhongji (CV 3), Ciliao (BL 32), Diji (SP 8) and Sanyinjiao (SP 6).
Modification: For coagulation of cold-dampness, Guanyuan (CV 4) and Shuidao (ST 28) are added with heavy and frequent moxibustion; for qi stagnation and blood stasis, Taichong (LR 3) and Xuehai (SP 10) are added; for insufficiency of qi and blood, Pishu (BL 20) and Zusanli (ST 36) are added; for asthenia of both the liver and kidney, Ganshu (BL 18), Shenshu (BL 23) and Taixi (KI 3) are added; for nausea and vomiting, Neiguan (PC 6) and Zhongwan (CV 12) are added.
Performance: The treatment begins 3 - 5 days before menstruation. Ciliao (BL 32) is needled 1.5 cun into the posterior sacral foramen obliquely toward the spinal column with reducing needling technique and repeated manipulation to enable warm sensation to transmit to the lower abdomen; for severe pain, electropuncture can be used. Zhongji (CV 3) is needled (urination is done first) obliquely downward to enable needling sensation to transmit to the lower region. Diji (SP 8) is needled with reducing needling technique. Sanyinjiao (SP 6) is needled obliquely upward to enable needling sensation to transmit to the upper region. For the treatment of coagulation of cold-dampness, reducing needling technique can be used and local acupoints are dealt with needle-warming moxibustion or moxaroll moxibustion; for qi stagnation and blood stasis, reducing needling technique is used and no moxibustion is applied; for insufficiency of qi and blood as well as asthenia of the liver and kidney, reinforcing needling technique is used with the addition of moxibustion.
2. Ear acupuncture
Prescription: Internal Genitalia (TF2), Subcortex (AT4), Sympathetic Nerve (AH6a), Endocrine (CO18), Liver (CO12) and Kidney (CO10).
Performance: Each time 2 - 4 acupoints are needled with medium and strong stimulation. Or Wangbuliuxingzi (Semen Vaccariae) is used for ear acupressure alternatively on both ears, 3 - 4 times a day. The treatment begins 3 days before menstruation to prevent relapse.