Ancient and Contemporary Famous Doctors’ Clinical Treasures

Gynecology, 2^nd Volume

Dan Shu Jian and Chen Zi Hua, authors

China Traditional Chinese Medicine Press, Beijing 1998

By Song Guang Ji (1920-  )

Zhe Jiang Chinese Medical Institute

Translated by Shirliey Fung

            When treating painful menses, it is first and foremost appropriate to emphasize abdominal pain, the most important symptom, according to the nature, degree, and location, and time of the pain. When determining the pattern differentiation, consider menstrual quantity, menstrual color, the nature of the menses, and the signs and symptoms of the entire body. When I am in clinic, I mostly keep to four main pattern types of treatment differentiation: cold coagulation and blood stasis, liver depression and qi stagnation, weak spleen blood deficiency, and debilitated liver and kidney.

1.      Cold coagulation and blood stasis: The main characteristic of this type of pain is that there is lower abdominal cold and pain one to two days before the menses or during the menses. The pain tends to be comparatively acute and severe and improves with heat. The color of the menstrual blood is dark red with clots or it can have the appearance of black bean juice. The quantity is scanty or its movement is not free-flowing. The syndrome is accompanied by cold limbs. The pulse is deep and wiry or slow, the tongue coat is white, and other signs of cold. To treat use Chuan Wu Wen Jing Tang (Experiential formula: zhi chuan wu, chao dang gui, jiao bai shao, chuan xiong, rou gui, wu yu, jiang ban xia, chao dang shen, du huo, wei ling xian) modified, mainly to warm and dissipate. If there are copious clots, add zhi mo yao, dan shen, ze lan, yi mu cao, and shi xiao san, etc.; if there is abdominal bloating and pain, add zhi xiang fu, xiao hui, ai ye; if there is damp, add cang zhu, fu ling; if there is kidney yang deficiency or a gynecological exam reveals that there is not good uterine growth and development, add lu jiao pian, zi shi yin, xian ling pi, ba ji rou, etc. Contemporary medicine’s endometrium-caused painful menses and endometriosis painful menses are for the most part this type. Frequently, its appearance is mainly of blood stasis, to treat the above appropriately, add a large quantity of invigorate the blood and course stasis herbs.

2.      Liver depression and qi stagnation: The main characteristic of this pattern is pre-menstrual or menstrual distention pain in the lower abdominal, ribside, and breast areas. When the distention is severe, there is pain; it is at times severe and, at times, the patient is recovered. The menses may also be delayed, etc. Use the formula Xiao Yao San, modified. If there is severe bloating add qing pi, ju ye, zhi qiao, ba yue zha, etc.; for heavy menstrual bleeding remove ling and zhu, and add jiao zhi, chao dan pi, chao tiao pin, ce bai tan, chao huai mi, da xiao ji tan, shi tan wan, etc.; for damaged yin add sheng di, mai dong, etc.; for simultaneous kidney deficiency add, wu zi yan zong wan. In contemporary medical studies, painful menses caused by inflammation of the uterus and endometrial inflammation is mainly because of liver heat causing damp and damp heat to stagnate in the uterine channel. To treat, one can prescribe modified qing jing dao zhi tang (experiential formula: chao dang gui, jiao bai shao, chai hu, guang yu jin, ji su san, ba yue zha, chuan lian zi, yan hu suo, hong teng). For uterine cancer, add tu bei mu, sheng mu li, xuan shen, hai zao, kun bu, xiao jin dan, and other herbs to soften hardness and dissipate that which is congealed.

3.      Weak spleen and blood deficiency: the characteristics of this type are pain that appears to be unremitting, empty pain that prefers pressure, menstrual flow that is pale and thin, and pain that appears during the menses or after. If one desires to move it, one must first fill it. To treat use ba zhen yi mu wan modified. For both heart and blood deficiency use gui pi tang modified; for qi and blood deficiency cold add rou gui, wu yu, gan jiang, fu pian, ai ye, etc.

4.      Debilitated liver and kidneys: with this type, one often sees faint post-menstrual lower abdominal pain, scanty quantity and light color, low-back and knee soreness and weakness, dizziness, tinnitus, etc. Use the formula: Fu Shi tiao gan tang modified. For those tending towards deficiency cold use Jing Yue you gui wan modified, tending towards yin deficiency use yi guan jian with er zhi wan, shan yao, yu rou, bai shao, etc., modified. If there is tuberculosis of the epithelial lining of the uterus, one can add huang bai, xia ku cao, huang qin, yu xian cao, huang lian, bai bu, yang ru, and other herbs to combat fatigue.

In general, if herbs are taken approximately three days before the menses and the herbs are continuously used for two to three cycles, one can expect to obtain results.