CHINESE HERBS AND ACUPUNCTURE TREATMENT FOR PRIMARY DYSMENNORHEA


2. TREATMENT METHOD

Repletion Pattern
In repletion pattern of cold congealing blood stasis, use Wen Jing Tang with the addition of herbs that invigorate the blood, transform stasis, and a small amount of herbs that move qi: wu zhu yu 3g, dang gui 12g, bai shao 12g, chuan xiong 12g, tai zi shen 10g, gui zhi 15g, e jiao 10g, dan pi 15g, xiang fu 15g, pu huang 15g (in filter bag), wu ling zhi 15g (in filter bag), xiao hui xiang 15g, gan jiang 10g.

In repletion pattern of qi stagnation and blood stasis, use modified Xiao Yao Wan with Wen Jing Tang.  Take out tonifying herbs that obstruct qi in Wen Jing Tang: wu zhu yu 3g, dang gui 12g, bai shao 12g, chuan xiong 12g, gui zhi 15g, dan pi 15g, xiang fu 15g, pu huang 15g (in filter bag), wu ling zhi 15g (in filter bag), zhi qiao 15g, tao ren 10g, hong hua 10g, wu yao 10g.

Acupuncture points include the following: zhong ji (CV3), ci liao (UB32), di ji (SP8), gui lai (ST29), tai chong (LV3), zi gong xue (MCA18).  Use draining method.  If cold is severe use moxa, and if qi stagnation is severe add qi hai (Ren 6)

Deficiency Pattern
In qi and blood deficiency pattern, use Ba Zhen Tang with Wen Jing Tang modified: dang gui 10g, bai shao 12g, shu di 20g, tai zi shen 20g, bai zhu 12g, fu ling 12g, zhi gan cao 6g, zhi huang qi 20g, wu zhu yu 3g, gui zhi 15g, dan pi 15g, xiang fu 15g, zhi qiao 15g, chuan xiong 12g, gui zhi 10g.

In kidney qi deficiency pattern, use Wen Jing Tang and add herbs that tonify the kidney qi: wu zhu yu 3g, dang gui 12g, bai shao 12g, chuan xiong 12g, tai zi shen 10g, gui zhi 15g, e jiao 10g, dan pi 15g, xiang fu 15g, pu huang 10g (in filter bag), wu ling zhi 10g (in filter bag), xiao hui xiang 10g, zhi huang qi 20g, ba ji tian 20g, du zhong 15g, xu duan 15g.
 
Acupuncture points include the following: guan yuan (CV4), qi hai (CV6), zu san li (ST36), san yin jiao (SP6).  If there is kidney deficiency combine with shen shu (UB23), and tai xi (KI3).  Use tonification technique; can use moxibustion.

The herbal decoctions should be taken seven days before menses, and continue until the menstrual flow stops.  Acupuncture and moxibustion treatment should be done daily starting seven days before menses.  The needles should be left in place for 20 minutes.  Acupuncture treatment should be stopped when menses arrives.  Each menstrual cycle is one treatment course, and three treatment courses should be done in total.


5.  MEDICAL CASE

Ms. Mou was twenty-two years old when she came in for her first visit on March 20, 2005.  She had lower abdominal pain with her menses for more than 8 years.  The pain was sometimes mild and other times severe, and began 1 to 2 days before the menstrual flow.  There were one or two days during the period in which the pain was more severe.  The amount of blood was normal, the color was dusky pale, and there were blood clots.  The gynecology exam did not show any organic pathology of the reproductive organ.  When the pain was mild, she would take hot brown sugar water and yuan hu analgesic tablets, and place a hot compress on the lower abdomen to alleviate the pain.  When it was severe, she would be restless, tossing and turning.  Her facial complexion was pale and white; her lower abdomen was cool and did not like pressure.  She must take an over-the-counter analgesic to help.  The tongue was dusky with a thin white coat.  The pulse was sunken and choppy.  The diagnosis was cold congealing blood stasis.  The treatment was to warm the channel, break up the cold, and warm the uterus to stop pain.  The formula was modified Wen Jing Tang: wu zhu yu 10g, dang gui 10g, bai shao 12g, chuan xiong 6g, tai zi shen 15g, gui zhi 10g, sheng jiang 3 slices, ai ye 6g, xiang fu 10g, pu huang 10g (in filter bag), wu ling zhi 10g (in filter bag).  The patient was advised to avoid cold and raw foods, and acrid and spicy foods.  She was also advised to regulate her emotions, avoid wind and cold, and pay attention to rest.  Acupuncture treatments used the following points: zhong ji (CV3), ci liao (UB32), di ji (SP8), gui lai (ST29), and tai chong (LV3).  There was complete recovery after 3 courses of treatment and no reoccurrences after one year. 

6.  DISCUSSION

Abdominal pain that occurs when menses arrives often is due to overexertion and damage of qi and blood, reception of wind-cold that reside in the uterine vessel, and damage of the chong and ren vessels.  The main pathology of primary dysmenorrhea is that “there are both internal and external causes, and that the chong and ren vessels are blocked”.  Within Wen Jing Tang, wu zhu yu and gui zhi warm the menses, support the yang in order to dispel the cold, open up the blood vessels in order to stop the pain; dang gui, chuan xiong and dan pi invigorate the blood and transform stasis, nourish the blood and regulate the menses; bai shao together with gan cao, sour and sweet, are used to relax the urgency and stop the pain.  The formula as a whole warms the menses, scatters cold, dispels stasis and nourishes blood.  Acupuncture treatment employs zhong ji (CV3), a ren channel point, to unblock and regulate the chong and ren vessels, dispel cold and move qi.  Ci liao (UB32) has the empirical effect of treating and unblocking the menses.  Di ji (SP8) is the spleen channel’s xi-cleft point.  It can regulate the spleen channel and stop pain.  Guan yuan (CV4) and qi hai (CV6) are points on the ren channel used to warm the lower jiao and warm and nourish the chong and ren vessels.  San yin jiao (SP6) is the intersecting point of the liver, spleen and kidney channels, used to regulate the qi and blood.  Zu san li (ST36) is the stomach channel he-sea point.  It tonifies the stomach qi to support the source of generation and transformation of qi and blood.  Chinese herbs along with acupuncture treatments can satisfactorily treat primary dysmenorrhea. 


REFERENCE

中药配合针刺治疗原发性痛经38例
Chinese Herbs and Acupuncture Treatment for Primary Dysmenorrhea Example 38

孟 君, 杨杨
Authors: Meng Jun, Yang Jing

实用中医药杂志
Journal of Practical Traditional Chinese Medicine
2007, May, Volume 23, Number 5