Dysmenorrhea and Premenstrual Tension
By Dr. Hong-Yen Hsu
More than 80% of the female population experiences discomfort in various forms before menstruation, such as aching of the lower abdomen and lower back with the accompaniment of headaches, vomiting, and generalized fatigue which affects daily activities. This syndrome is known as dysmenorrhea. It is divided into functional dysmenorrhea and organic dysmenorrhea. The former is caused by psychogenic factors and hyperprostaglandin. It often occurs in the first year after the first menstruation and each time may continue for two to three days. The problem may be due to the enlargement of a carcinoma, intracarcinomatous hemorrhage, congestion, or inflammation which can cause hyperprostaglandin and result in violent aching. The condition is usually found two years after the first menstruation. If premenstrual tension occurs seven to ten days before menstruation, it is characterized by mammary distention, mastalgia, edema, headache and uneasiness. For these disorders, herbal therapy is quite effective. Herbal therapy attaches importance to the individual's deficiency or sufficiency conformation in defining problems. For deficiency conformations, warm-natured, stagnant Blood-dispersing herbs like Tangkuei and Peony Formula are prescribed. For excess conformations, formulas containing moutan and persica are used such as Cinnamon and Persica Formula or Persica and Rhubarb Combination. If aching is strong, Peony and licorice Combination is taken in together with the above formulas. For premenstrual tension, Bupleurum and Paeonia Formula is commonly used.
In Traditional Chinese Medicine, the lower abdominal pain that occurs at the time of menstruation is known as emmenic aching. If there is abdominal aching with tenderness before or after menstruation, there is usually a excess conformation. If after menstruation the individual is relieved by pressing on the lower abdomen, the problem belongs to a deficiency conformation. If the mense comes after the due date and there is a cold pain in the abdomen that is relieved by warmth, it belongs to a cold conformation. If the mense comes before the due date, and the abdomen has feverish pain, it belongs to a heat conformation. With regard to the nature of the aching; contracting pain belongs to cold, and strangling and intermittent pain belongs to excess conformations. Distention as well as aching is due to qi stagnation. Stabbing pain is due to Blood. Mild and lingering pain belongs to deficiency. Distention and burning pain belongs to heat. Pain with a droping sensation belongs to qi deficiency. Clinically, we must refer to other symptoms in order to make correct diagnoses.
Treatment for the conditions mentioned above is as follows:
1. Blood Deficiency
This condition is characterized by dull pain in the lower abdomen, during or after menstruation, which becomes milder upon pressing; the mense being thin and scanty and the individual of a pale complexion, or chloroitic, with pale lips, moderate-weak pulse, pink tongue and/or no thin fur on the tongue. Ginseng and Tang-kuei Ten Combination or Ginseng and Longan Combination are commonly used to replenish qi and enrich Blood.
2. Blood Stagnation
Characterized by abdominal ache before or at the beginning of menstruation: pain being of a stabbing form or with tenderness; the mense dark red and scanty; the pain relieved following discharge of blood clots; a submerged-hash pulse; and dark red tongue. A Cinnamon and Persica Formula plus Bulrush and Pteropus Formula is commonly used. If the patient is of strong physique and constipated, then Persica and Rhubarb Combination may be substituted.
3. Kidney Deficiency
Characterized by lower abdominal pain after menstruation, lower back achiness and forcelessness, pale colored mense, limbic adynamia, submerged-weak pulse, pink tongue and thin tongue fur. Rehmannia Eight Formula is used to nourish the Kidneys.
4. Qi Stagnation
Characterized by distentive pain in the lower abdomen and lower back before or during menstruation, which involves ribs and breasts at the climax of the distention, a scanty mense at no fixed intervals, a stringy pulse and yellowish fur on the tongue. Tang-kuei and Bupleurum Formula is commonly used to regulate qi and move stagnation. If the patient is irascibile and exhibits neurotic symptoms and premenstrual tension before menstruation, Bupleurum and Paeonia Formula should be used.
Characterized by lower abdominal strangling pain before or during menstruation, cool sensation, fondness of hot fomentations, a scanty mense that is dark red, a submerged-string pulse and white thin fur on the tongue. Tang-kuei and Evodia Combination is commonly used for warming the mense and dispersing cold. If the patient has severe chills, Tang-kuei, Evodia and Ginger Combination should be selected.
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