Transcript Treating Dysmenorrhea with Chinese Medicine Dr. Jeffrey(Ji

Dysmenorrhea Treatment with
Chinese Medicine
Dr. Jeffrey(Ji Fei) Wang DOM, L.Ac & CH
Wang’s Acupuncture & Herbal Clinic
704-968-0351
www.Ballantyneacupuncture.com
Dysmenorrhea Treatment with Chinese Medicine
Overview in Western Medicine
• 1.Signs and symptoms
• 2.Causes and mechanism
• 3.Screening and diagnosis
• 4.Complications
• 5.Treatment
Dysmenorrhea Treatment with Chinese medicine
• 1.Concept
• 2. Causes and Mechanisms
• 3. Clinical manifestations
• 4. Diagnosis and Differential diagnosis
• 5.Patterns and Treatments
Overview in Western Medicine
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Dysmenorrhea is simply the medical term for menstrual cramps, that dull or throbbing
pain in the lower abdomen many women experience just before and during their
menstrual periods. For some female, it can be severe enough to interfere with
everyday activities for a few days every month.
Dysmenorrhea occurs in conjunction with the menstrual cycle. For many sufferers, it
occurs during menstruation, though it can occur at other times in a woman's cycle, as
well, such as during ovulation.
Dysmenorrhea can be primary or secondary.
Primary dysmenorrhea involves no physical abnormality and usually begins within
three years after you begin menstruating.
Primary dysmenorhea is the term used to describe pain related to menstruation, but
not related to any pelvic disorder or injury. The pain of primary dysmenorrhea is often
identified as waves of lower abdominal pain or cramping, which may be associated
with the contractions of the uterus during menstruation. The abdominal pain of
primary dysmenorrhea in some cases can be accompanied by leg cramps or back
ache, nausea, vomiting, and bowel problems such as diarrhea or constipation, as
well. Additionally, daughters of mothers who suffered primary dysmenorrhea
frequently suffer from primary dysmenorrhea themselves.
Secondary dysmenorrhea involves an underlying physical cause, such as
endometriosis or uterine fibroids.
Secondary dysmenorrhea refers to pain related to menstruation and caused by
pelvic inflammation or lesions from disease, surgical scarring, injuries to the
reproductive tract, and sometimes implanted types of birth control (IUDs). While the
pain of primary dysmenorrhea is often symmetrical, begins just before the onset of
menstrual bleeding, and lasts only one or two days, the pain of secondary
dysmenorrhea is often concentrated around the area effected by the lesions, begins
several days before bleeding, and lasts for several days after the onset of bleeding.
Signs and symptoms
• Most women experience menstrual cramps at some time in their
lives. Cramps become problem when they're severe enough to keep
you from going about your day-to-day routine.
• Signs and symptoms of dysmenorrhea, whether primary or
secondary, may include:
• Dull or throbbing pain in the lower abdomen
• Pain that radiates to the lower back and thighs
• Less common signs and symptoms include:
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Nausea and vomiting
Loose stools
Sweating
Dizziness
Causes and mechanism
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For primary dysmenorrhea: No one knows for sure, but many experts believe that
prostaglandins cause menstrual cramps.
To create a nourishing environment for a fertilized egg, the female sex hormone estrogen causes
the uterine lining (endometrium) to thicken every month. Soon after, a follicle — a tiny sac in the
ovary that contains a single egg (ovum) — ruptures and releases its egg (ovulation). If the egg
becomes fertilized by contact with a sperm on its way to the uterus, the egg implants in the lining
of the uterus. However, most often the unfertilized egg passes through the uterus and out of the
body. Shortly thereafter, the uterus releases the lining, and the menstrual flow begins.
To help expel its lining, the uterus contracts. Prostaglandins, hormone-like substances involved in
pain and inflammation, trigger the uterine muscle contractions.
For Secondary dysmenorrhea: The following are main causes for secondary dysmenorrhea.
They include:
Endometriosis. In this painful condition, the type of tissue that lines the uterus becomes
implanted outside the uterus, most commonly on the fallopian tubes, ovaries or the tissue lining
the pelvis.
Pelvic inflammatory disease (PID). This infection of the female reproductive organs is usually
caused by sexually transmitted bacteria.
Use of an intrauterine device (IUD). These small, plastic, T-shaped birth control devices are
inserted into the uterus. They may cause increased cramping, particularly during the first few
months after insertion.
Uterine fibroids and uterine polyps. These noncancerous tumors and growths protrude from the
lining of the uterus.
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Risk factors
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Early onset of puberty (age 11 or younger)
A family history of painful periods
Screening and diagnosis
• Review the medical history
• Perform a physical examination, including a pelvic exam. During the
pelvic exam, the doctor will check for any abnormalities in the
reproductive organs and look for indications of infection.
• Diagnostic tests: To rule out other causes of the symptoms or to
identify the cause of secondary dysmenorrhea, which include:
Imaging tests. Noninvasive tests that enable the doctor to look for
abnormalities inside the pelvic cavity include ultrasound,
computerized tomography (CT) and magnetic resonance imaging
(MRI).
Laparoscopy. This surgical procedure involves the doctor viewing
the pelvic cavity by making tiny incisions in the abdomen and
inserting a fiber-optic tube with a small camera lens.
Hysteroscopy. In this procedure, the doctor inserts an instrument
through the vagina and the cervical canal to examine the cervical
canal and the inside of the uterus.
Complications
• The complications of secondary dysmenorrhea depend
on the underlying cause.
• Ectopic pregnancy
• Infertility
For instance, pelvic inflammatory disease can scar your
fallopian tubes and compromise reproductive health. The
scarring can lead to an ectopic pregnancy, in which the
fertilized egg stays in the fallopian tube rather than
traveling through the tube to implant in your uterus, or it
implants somewhere else outside your uterus.
Endometriosis, another possible cause of secondary
dysmenorrhea, can lead to impaired fertility.
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Treatment
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For primary dysmenorrhea: While there is no cure for primary
dysmenorrhea, many steps can be taken to reduce or eliminate symptoms.
an over-the-counter nonsteroidal anti-inflammatory drug (NSAID), such as
aspirin, ibuprofen (Advil, Motrin, others) or naproxen (Aleve).
Some over-the-counter remedies are designed especially for combating the
pain of primary dysmenorrhea, and contain a combination of pain-killing
agents and diuretics to stop pain and reverse bloating and water retention.
For those with especially painful, heavy or long periods, prescription pain
killers, muscle relaxants, or hormonal therapies may be used to alleviate
symptoms or normalize the menstrual cycle;
For severe cramping, low-dose oral contraceptives to prevent ovulation,
which may reduce the production of prostaglandins and therefore the
severity of the cramps.
Other possible remedies include heat application, dietary modification, and
exercise. Some patients report that herbal remedies help to decrease their
symptoms, as well, although it is recommended that patients check with
their health care provider before beginning any such products.
For secondary dysmenorrhea, Depending on the cause, treatment could
include antibiotics to treat infection or surgery to remove fibroids or polyps.
Many women suffer from mild cramping and discomfort at the time of their
menstrual periods. However, for others, the pain can be intense and
disruptive.
Dysmenorrhea Treatment with Chinese Medicine
• Dysmenorrhea refers to the pain that occurs around or during
the menses. Commonly seen. It occurs periodically / regularly
per month. Primary dysmenorrhea starts w/ the first menses.
Secondary dysmenorrhea occurs later or post surgery /
abortion May diagnose if occurs X 2.
• Common sx’s – abdominal pain, lower back pain, fainting, N/V.
The abdominal pain is dt excess or def. in the sudden change
of qi & blood in the chong or ren during the period. In Chinese
medicine, dysmenorrhea like other forms of pain is the symptom of a
deeper problem.
The location of the disease is in the Chong & Ren & Uterus; It is
caused by abnormal changes of qi & blood which manifests as
pain in the lower abdomen.
Causes and machenisms
• Stagnation of Qi and Blood: Emotional Factors - strong emotions
(depression, anger) may lead to stagnation of the LV Qi which may
lead to a stagnation of Qi & Blood manifesting as painful
menstruation.
• Cold(Damp) in Chong/Ren/Uterus: contact with cold(damp)
environments (climates, climate controlled buildings, basements)
a/or excessive consumption of cold/damp foods (fruit juices, ice
cream) may lead to an accumulation of cold/damp in the Chong/Ren
and Uterus which may lead to a stagnation of Qi & Blood
manifesting as painful menstruation.
• Damp-heat in Lower Jiao: contact with damp-heat during menses
period or consuming too much damp-heat food, etc.
• Existing Qi/Blood Deficiencies: def.of sp and st. or chronic disease.
symptoms may be exacerbated during menstruation leading to
dysmenorrhea.
• Existing LV/KD Deficiencies - constitutional weaknesses a/or in
women who have had multiple child-births, thus depleting the KD
Jing, worsened by the loss of Blood during menstruation.
Diagnosis and differentiation
Key points for diagnosis:
1. cramping, dull or throbbing pain in the lower abdomen just before or during or after their menstrual
periods. It relates with menstrual cycle.
2. Accompanied with other symptoms: lower back pain, nausea, vomiting, sweating, etc.
The Key points for differentiation:
Pain/ conditions of menses/ accompanied symptoms, tongue, pulse/ constitution
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Pain symptoms:
The nature of the pain: throbbing/shooting/sharp/stabbing/dislike pressure--- Excess
dull/empty/aching/hollow/ prefer pressure---Deficiency
The time of the pain: Prior/or during--- Excess; after or during---Deficiency
The location of the pain: Central/Sides/Back/etc
The degree of the pain: Severe---Excess; mild---Deficiency
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Conditions of menses: Cycle, amount, color, quality
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Accompanied signs and sym.+ tongue and pulse conditions
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Constitutions
Diagnosis and differentiation
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Differentiation of the Pain: time, location, nature, intensity to the interview, along w/ condition of
the menses, T & P,+ accompanying sx’s.
Key Points:
Time –
if before the menses – excess
If after the menses – deficiency
If during the menses – either
Location –
If both sides of lower abd – Liver
If central / middle lower abdomen – indicates blood stasis or Kidney def.
Nature or Character/and Intensity –
Excess: severest, stabbing, fixed, distention, dislike pressure
Def: dull, hollow, empty, bearing down sensation, prefer pressure
Heat / Burning – blood heat
Cold pain / prefer warmth – Cold – may be def or excess.
General treatment Principle:
Regulate Qi & Blood
Regulate Chong & Ren
During the Bleeding Period:
Regulate Qi & Blood
Stop Pain
Other time of the month:
Treat the Root
Regulate Chong & Ren
Best time to treat to stop pain is 1 week to 10 days prior to onset of menses**
Treatment Principle
• General treatment Principle:
• Regulate Qi & Blood
• Regulate Chong & Ren
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During the Bleeding Period:
Regulate Qi & Blood
Stop Pain
Other time of the month:
Treat the Root
Regulate Chong & Ren
• Best time to treat to stop pain is 1 week prior to onset of
menses**
Patterns and treatment
1.Qi Stagnation w/ Blood Stasis
2. Cold in the Uterus
1) Yang Deficiency
2) Damp-Cold accumulation
3.Damp-heat Accumulate in the Chong & Ren
4.Qi & Blood Deficiency
5.Kidney & Liver Deficiency
Patterns and treatment 1.Qi Stagnation w/ Blood Stasis
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Liver qi stag. causes obstruction of chong & ren leading to painful periods.
Dt strong emotions Occurs prior to onset of menses, May occur up to 1
week prior menses.
Amount: Normal, scanty, un-smooth flow. Color; Purple Quality: w/ clots
Abdominal pain & distention, dislike pressure,w/ breast distention/ pain.Pain
relieved w/ discharge of clots; Pain disappears at end of period
T/P:Normal or Slightly purple, may have dark spots/ ecchymosis Wiry or
wiry & rolling
Move the Qi, Soothe the Liver Invigorate the Blood Relieve the pain
Pts: LIV 3, SP 6, SP 8 SP10, Ren 6, UB 17
Tao Hong Si Wu Tang or Ge Xia Zhu Yu Tang or Xue Fu Zhu Yu Tang
+ 5 herbs Chai Hu Zhi Ke Nui Xi Jie Jeng Gan Cao
+ Modify w/Shi Xiao San – sudden smile powder Pu HunagWu Ling Zhi
Modifications:If increased heat sx’s – fresh red blood+ Mu Dan Pi & Zhi Zi
If have bearing down sensation in genitalia (sx of endometriosis)+ Chai Hu*
or Xiang Fu, Chuang Lian
If lower abd pain w N/V dt LIV OA ST+ Huang Lian & Wu Zhu Yu
2. Cold in the Uterus
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Yang Deficiency or Damp-Cold accumulation Dt outside on cold, rainy days, eat too much raw,
cold food, C-D accumulates in Chong & ren
1) yang qi def. failing to promote circulation of qi & blood in chong & ren leading to pain. Occurs at
end of menses or during
Amount; Scanty Color; Slightly light or dim Abdominal w/ cold sensation, likes warmth & pressure,
likes hot water bottle.W/ soreness/weakness of low back/knees Poly urine
T/P Pale, Moist Pale body or normal White, greasy coat Deep, Weak Warm the Channels Warm the
Uterus Relieve the Pain
Pts: UB 23, DU 3, DU 4Ren 4, Ren 6, SP 6, SP 8, KI 6Omit SP 6
Ai Fu Nuan Gong Wan Artemisia-Cyperus Warming the Uterus Pill Ai Ye Xiang Fu‘Si Wu Tang’Shu
di Huang Bai Shao Dang Gui Chuan Xiong+ Huang Qi Rou Gui Xuan Duan Wu Zhu Yu Indicated
for Dysmenorrhea & delayed menses
2) Cold accumulation: Occurs prior or during mensesAmount; ScantyColor; Dark, dim Quality; w/
clots - small, dark Lower abdominal pain – centralW/ cold sensation Prefers warmth / dislikes
pressure
T/P Deep, Tense
Warm the Channels Eliminate Dampness Remove Blood stasis, Relieve Pain
Pts: SP 6, SP 9, Ren 3 ST 29, ST 28, SP 8, DU4
Shao Fu Zhu Yu TangLower (Abdominal Eliminating Stasis Decoction) Cang Zhu Xiang fu
1st 2 herbs for damp Fu Ling Mo yao Invigorate blood Ru Xiang Remove stasis Dang Gui Chuan
Xiong Wu Ling Zhi Pu Huang Yan Hu Suo Rou Gui* Xiao Hui Xiang * Warm the channels Chi
Shao Yao Expel cold Gan Jiang
*Modifications:If exterior cold w severe pain+ Fu Zi
3. Damp-heat Accumulate in the Chong & Ren
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D-H accumulates in chong & ren dt living in a Damp, humid area, post
surgery D-H attacks, D-H constitution. D-H flow into chong & ren, flows into
uterus & fighting w/ qi & blood
 pain. Occurs prior or during menses Color: Fresh red Quality: Sticky w
clots Lower abdominal pain w heat or burning sensation, LBPPain may
occur mid cycle, increases w period Yellow Leukorrhea
 T/P:Red Yellow, greasy coatWiry, Rapid or Moderate, rapid
 Clear Heat, Eliminate Damp Remove Blood Stasis Relieve Pain
Pts:SP 6, SP 9, UB23, UB 22, LI 11,SP 10, Ren 3, ST28, LIV 3, LIV 8,SP 4, LU
7 & KI 6
Dan Bai Si Ni Miao San Mu Dan Pi Huang Bai Chai Hu Bai Shao Yao Zhi Ke
Gan Cao‘Si Ni San’for pain dt qi stag.(Huang Bai)Cang Zhu Niu XiYi Yi
Ren‘Si Miao San’cl D-H Hong Teng Bai Jiang Lian Qiao Clear heat, detoxify
Chuan Xiong Chi Shao Yao Invigorate blood Remove stasis
Modifications:If Distention abd/costal/breast area+ Chuang Lian Zi, Xiang Fu
& Yan Hu Suo
4. Qi & Blood Deficiency
• Physical overwork or chronic disease consume qi & blood;
especially SP. The menses consumes more qi & blood failing to
nourish chng & ren & failing to nourish the uterus causing pain.
Pain occurs during the menses or at the end Amount: Scanty Color:
Pale Quality: Thin ;Abdominal pain that is dull, empty, hollow, Prefer
pressure Dragging sensation in lower abdomen w lassitude,
tiredness, poor appetite, diarrhea
T/P:Pale Thready, Weak
Tonify Qi Nourish Blood Relieve Pain
Pts: Ren 4, Ren 6, ST 36, SP 10,UB 20, UB 17, UB 32, UB 54
Ba Zhen Tang* – best choiceComposed of Shen Qi Si Wu Tang and
Sheng Yu Tang minus bai shao yao+ Sheng di Huang+ herbs to
move qi Xiang Fu Yan Hu Suo
Modifications:If breast distention/ pain/ costal dt blood def causing
liver qi stag.+ Ju Ye or Ju He
If w dizziness, vertigo, palpitations+ Shan Zao Ren, Ji Xue Teng
If LBP and knees sore+ Chuan Xiong, Xu Duan, Shan Ji Sheng
Also for:Scanty menses, Amenorrhea
5. Kidney & Liver Deficiency
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Over sex / too many pregnancies consume yin & blood, essence so fail to nourish
chong & ren, fail to nourish the uterus leading to pain.*commonly seen patterns
• Occurs towards the end or after menses Amount: Scanty Color: Pale Quality: Thin
Dull, hollow abdominal pain, relieved by pressure / massage Soreness/ weakness low
back / knees+ Yin def Sx’s, Essence def Sx’s:tinnitus, blurred vision, tidal fever,
T/P: Pale (essence def) or Red (yin def.)Thin, may be yellowish Thready, weak
Tonify Kidney & Liver Relieve Pain
Pts: Ren 4, Ren 6, UB 18, UB 23 ST 36, UB 32, UB 54
Tiao Gan Tang*(Regulating the Liver Decoction) Dang Gui
) Tonify blood &Bai
Shao Yao ) Nourish yin Shan Zhu Yu – tonify KI & LIV
Huai Shan Yao – Strengthen Spleen E Jiao – Nourish yin, Tonify blood Ba Ji Tian –
Tonify KI Gan Cao
Or Yi Guan Jian Sha Shen Gou Qi Zi Shu di Huang Mai men Dong Dang Gui Chuan
Lian Zi
Modifications:If sore low back+ Xu Duan & Du Zhong
If Distention/ pain sides of lower abdomen / costal area++ Xiang Fu, Chuang Liang
Zi, Yu Jin
If breast distention, breast cysts+ Ju Ye, Ju He