Case from Dr. He Ren’s Clinical Experience Essentials, published 1998, p460

Dysmenorrhea

Case:  Pan MouMou, female, aged 25.  1^st visit 12/30/1975.

During her period the lower abdomen is painful and she feels extremely nauseous.  Her complexion lacks luster and there is a scanty amount of bleeding.  A regulate and move Qi method is used to treat the patient:  Dang Gui 12g, Yan Hu Suo 12g, Bai shao 12g, Chuan Zhu Zi 9g, Xiao Qing Pi 6g, Yi mu Cao 15g, Zi Su Ye 9g, Guang Mu Xiang 9g, Sheng Pu Huang 9g, Wu ling zhi 9g, zhi xiang fu 12g.  5 packs.

12/30 (sic)—Next exam:  Jiu Zhi Xiang Fu Wan 360g (take once in morning and once in afternoon, 9g each).  and Xiao Yao Wan, 180g (take one each day at mid-day, 9g). 

Discussion of case:

During a woman’s period, or possibly before or after her period, there may be low back and abdominal aches and pains.  Perhaps the pain is seizing and difficult to bear and flares up along with the cycle.  This is called “Dysmenorrhea”.  Note that painful areas are not always the same—pain may be right in the middle of the lower abdomen, on both sides, or just on one side.  Frequently, when the pain is severe, it radiates to the low back, thighs, and ribsides. 

When the period flows, the lower abdomen around the naval may be mildly distended and uncomfortable.  This is not a dysmenorrhea pattern and does not require treatment.

Dysmenorrhea could be caused by excess or vacuity.  Vacuity patterns are due to Qi and Blood vacuity and weakness.  The uterine vessel loses nourishment so blood flow is not strong.  Excess patterns are due to Qi stagnation and Blood stasis.  Qi stagnation does not diffuse and so stasis stops the interior and blood flow becomes obstructed.  It is possible that Cold and Damp congeal and stagnate due to the woman being caught in the rain, exposure to water, or perhaps because she ate raw, cold food.  Then the Blood and Cold bind, and the blood flow is not smooth.

Even if the disease causes are different, they are all governed by Qi & blood obstruction and stagnation, and so the emphasis should be placed on unblocking and freeing.  Hence, with vacuity cases, supplement and free; with excess cases, move and free.  For Qi and Blood weak vacuity, diffuse, supplement and nourish Qi and Blood, and regulate and rectify the Chong & Ren; for Qi Stagnation and Blood Stasis, diffuse and rectify Qi, move stasis and stop pain; for Cold Damp congealing stasis, diffuse and warm the channels, and disperse Cold.  Carefully examine the results of the treatment.  

In the case example, during the period the lower abdomen is painful.  There is extreme nausea and there is a liver Qi area bind and the liver has lost it’s ability to course and drain.  She has heavy Stomach counterflow and thus the Stomach is not harmonized  subdued.  Qi and Blood are plentiful, but the Qi is stagnant, and therefore the movement of blood is not smooth and the period is scanty.  This pattern belongs to Qi Stagnation and Blood Stasis.  Use Dang Gui, Bai Shao to harmonize Blood, Xiang Fu, chuan Lian Zi, Yan Hu Suo, Mu Xiang, Qing Pi to course the liver and rectify Qi to stop pain; Sheng Pu Huang, Wu Ling Zhi, and Yi Mu Cao to quicken Blood & transform Stasis. Use Qi mechanism to course and free blood flow and transform stasis, and she will recover.  Continue to use Zhi Xiang Fu Wan and Xiao Yao Wan to course the liver, rectify the Qi, quicken the blood, stop pain and regulate the menses.