Painful+Periods+(Dysmenorrhea)

//Western Diagnosis// //cyclic pain associated with menses during ovulatory cycles//

primary (functional)
1. without demonstrable lesion affecting reproductive structures 2. from uterine contractions and ischemia probably from PGF2

secondary (acquired)
1. sx with demonstrable lesion 2. endometriosis, narrow cervical os, PID

Signs & Symptoms
1. lower abdominal pain 2. crampy or colicky 3. may be dull constant ache 4. may radiate to low back or legs 5. often starts day before or during menses 6. usually dec after 2 days 7. HA, N, V, C, D, urinary frequency 8. PMS sx

Diagnosis
1. rule out 2o 2. clinical

Treatment
1. tx cause if secondary 2. like PMS 3. Avoid saturated fats [animal products]== 4. tryptophan a possibility

=
================================================ //TCM Pathology//

**Etiology & Pathogenesis**
Qi Stagnation & Blood Stasis Accumulation of cold in the uterus Downward flow of damp-heat Qi & Blood deficiency Liver & Kidney deficiency
 * Excess **
 * Deficiency **

**Differential Diagnosis**
Ruptured tubal pregnancy Abdominal pain in internal medicine & surgical diseases

**Pattern Differentiation**
Pain occurs before or during menstrual period: Pain occurs after the menstrual period: Colicky pain, burning pain, prickly pain & distending pain aggravated by pressure: Dull pain alleviated by pressure: Cold pain in the lower abdomen alleviated by warmth: Distention is more severe than the pain: Pain is more severe than the distention: Pain is n the bilateral sides of the lower abdomen: Pain radiates to the lumbar and sacral regions:

**Treatment Principles:**
Regulate Qi & Blood in Chong & Ren meridians Treatment should reflect the different natures (cold, heat, deficiency or excess) of the disease

**Commonly used herbs:**
Cold Pain: Ai Ye, Xiao Hui Xiang, Pao Jiang, Rou Gui, Wu Yao, Wu Zhu Yu Qi Stagnation: Xiang Fu, Chuan Lian Zi, Yan Hu Suo, Pian Jiag Huang, Mu Xiang, Zhi Ke, Bing Lang Blood Stasis: Chuan Xiong, Ru Xiang, Mo Yao, Xue Jie, San Qi, Yan Hu Suo, Pu Huang, Tao Ren, Wu Ling Zi, Dang Gui Heat: Chuan Lian Zi, Chi Shao, Dan Shen, Mu Dan Pi, Sheng Di Huang

**External herbs:**
Ding Xiang, Rou Gui, Xiang Fu, Wu Zhu Yu, Ru Xiang, Mo Yao 1:1 ratio, dry powdered herbs in teabag placed over area from CV-2 to CV-6

**Auricular Acupuncture**
Uterus, Endocrine, Sympathetic, Kidney

**Capsule**
Yun Nan Bai Yao San Qi Powder/Pill

** TCM Pattern Differentiation ** ** Stagnation of Qi & Blood ** Distending or colicky pain with tenderness in the lower abdomen 1-2 ays prior to or during the menstrual period, aggravated by pressure, scanty or sluggish discharge of dark-purple menstrual blood with clots, pain usually relieved after passing of blood clots, irritability or emotional depression, distending pain in the chest, costal region & breasts **Tongue:** dark purplish, ecchymosis **Pulse:** Wiry or wiry, slippery **Treatment Principles:** Move Qi, eliminate blood stasis & relieve pain **Acupuncture Treatment:** **CV-6, LR-3, SP-6, SP-10, ST-29**, SP-8, KI-13, LI-4 **Herbal Treatment:** Ge Xia Zhu Yu Tang (Drive out Blood Stasis below the Diaphragm) [Dang Gui (10g.), Chuan Xiong (10g.), Ci Shao (10g.), Tao Ren (10g.), Hong Hua (10g.), Zhi Ke (6g.), Yan Hu Suo (10g.), Wu Ling Zhi (10g.), Mu Dan Pi (10g.), Wu Yao (8g.), Xiang Fu (8g.), Gan Cao (6g.)]

** Interior Cold due to Yang Deficiency ** During or after periods, persistent cold pain in the lower abdomen, relieved by palpation or heat, scanty pale red menstrual flow, sore & weak loins & knees, clear & profuse urine **Tongue:** pale tongue; moist thin white coat **Pulse:** Deep, fine, slow **Treatment Principles:** Warm uterus & Chong, Ren to relieve pain **Acupuncture Treatment:** **CV-4, SP-6, BL-23, GV-4, SP-8**, ST-29, KI-7 **Herbal Treatment:** Wen Jing Tang (The Essential of Golden Cabinet) [Wu Zu Yu (8g.), Gui Zhi (10g.), Dang Gui (10g.), Chuan Xiong (10g.), E Jiao (10g.), Mai Men Dong (10g.), Mu Dan Pi (10g.), Bai Shao (10g.), Gan Cao (6g.), Ren Shen(10g.), Ban Xia(10g.), Sheng Jiang (10g.)]

** Accumulation & Stagnation of Cold Dampness ** Cold or Colicky pain with tenderness in the lower abdomen before or during the menstrual period, relieved by heat, aggravated by exposure to cold, scanty dark-purplish menstrual flow with clots, aversion to cold, desire to lie with limbs curled up, cold limbs, purplish blue lips **Tongue:** greasy white coat **Pulse:** deep, tight **Treatment Principles:** Warm uterus, expel cold dampness, invigorate blood, relieve pain **Acupuncture Treatment:** **CV-2, ST-28, SP-8, SP-9**, SP-6, BL-32, ST-29, KI-14 **Herbal Treatment:** Shao Fu Zhu Yu Tang (Eliminate Stasis in the Lower Abdomen Decoction) [used for cold & blood stasis] [Xiao Hiu Xiang (8g.), Gan Jiang (8g.), Rou Gui (8g.), Yan Hu Suo (10g.), Mo Yao (10g.), Pu Huan (10g.), Wu Ling Zhi (10g.), Dang Gui (10g.), Chuan Xiong (10g.), Chi Shao Yao (10g.)]

** Downward Flow of Damp-Heat ** Burning pain in the lower abdomen before & during period, aggravated by pressure, dark purplish, thick viscous menstrual blood with possible clots, distending pain in the lumbar and sacral regions, or dull pain in the lower abdomen on non-period days that is aggravated during periods w/ yellow, viscous and foul leucorrhea, low-grade fever, sticky mouth, bitter taste, poor appetite, scanty & dark urine, difficult defecation **Tongue:** red tongue; thick greasy yellow coat **Pulse:** slippery rapid or soggy rapid **Treatment Principles:** Clear heat, expel dampness, eliminate blood stasis and relieve pain **Acupuncture Treatment:** **SP-6, Sp-9, CV-3, LI-1, GB-34, ST-28**, LI-4, SP-8, SP-10 Herbal Treatment: Qing Re Tiao Xue Tang (Clear Heat Regulate Blood Decoction) [Mu Dan Pi (10g.), Sheng Di Huang (10g.), Huang Lian (6g.), Dang Gui (10g.), Bai Shao (10g.), Chuan Xiong (10g.), Hong Hua (10g.), Tao Ren (10g.), E Zhu (10g.), Xiang Fu (10g.), Yan Hu Suo(10g.)] **Modifications:** Phlegm Heat in the pelvic cavity: + Bai Jiang Cao, Hong Teng, Pu Gong Yin, Yi Yi Ren

** Deficiency of Qi & Blood ** Dull pain in the lower abdomen at the beginning, during or at the end of the period, relieved by pressure or massage, with a possible dragging sensation in the lower abdomen and vulva, scanty pale red & thin menstrual flow. Pale complexion, palpitations, shortness of breath, fatigue, insomnia, poor appetite, loose stool **Tongue:** pale tongue; thin white coat **Pulse:** fine, weak **Treatment Principles:** Supplement Qi, nourish blood and relieve pain **Acupuncture Treatment:** **CV-6, ST-36, SP-6, BL-17, BL-20**, LR-8 **Herbal Treatment:** Sheng Yu Tang (Sage-like Healing Decoction) [Ren Shen (10g.), Huang Qi (10g.), Dang Gui (10g.), Chuan Xiong (10g.), Shu Di Huang (10g.), Sheng Di Huang (10g.)]

** Deficiency of Both Liver & Kidney ** Dull pain in the lower abdomen during one or two days before or after the menstrual period, sore lumbar & sacral regions, pale red scanty & thin menstrual flow, dizziness, tinnitus, blurred vision, sore loins & knees, bearing-down sensation & cold lower abdomen, tidal heat **Tongue:** thin white or thin yellow coat **Pulse:** deep fine or fine weak **Treatment Principles**: Nourish Kidney and Liver, and regulate the menstruation to stop pain **Acupuncture Treatment:** **BL-23, BL-18, CV-4, ST-36, SP-6, KI-6, LR-3, KI-3** **Herbal Treatment:** Tiao Gan Tang (Regulate Liver Decoction) [Dang Gui (10g.), Bai Shao (12g.), Ba Ji Tian (12g.), Shan Zhu Yu (10g.), Shan Yao (12g.), E Jiao (10g.), Gan Cao(6g.)]

** Functional Dysmenorrhea ** //Formula 1:// Promote blood circulation primary, adjunctively, warming the uterus will help not only in relieving the cold sensation, but also in enhancing the flow of qi and blood Pu Huang (12g.), Wu Ling Zhi (12g.), Dang Gui (9g.), Dan Shen (12g.), Rou Gui (3g.)

//Formula 2:// For membraneous dysmenorrheal: Promote the flow of qi and blood & remove blood stasis Pu Huang (15g.), Wu Ling Zhi (12g.), Shan Zha (12g.), Qing Pi (4.5g.), Xue Jie (6g.) Modifications: Internal heat: + Bai Jiang Cao (30g.), Zhi Da Huang (6g.) Internal cold: + Xiao Hui Xiang (9g.), Pao Jiang (3g.)

Acupuncture: SP-6, SP-10, CV-4 Auricular Acupuncture: Uterus, Kidney, Ovary, Endocrine

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 * IBIS:**

Definition:
Painful menstruation.

Etiology:
Dysmenorrhea can be primary (functional) or secondary (acquired). • Primary dysmenorrhea occurs in ovulatory cycles without any identified pathology in the genital tract. often, however, the woman's liver may be hypofunctioning; she is constipated (estrogens can be reabsorbed from the bowel if the stools do not evacuate frequently); and she is hormonally imbalanced with too high an estrogen level in relation to her progesterone levels. • Secondary dysmenorrhea is recognized by painful periods due to an identifiable cause (e.g. endometriosis, uterine fibroids, PID, adhesions). The majority of dysmenorrhea patients also have premenstrual syndrome, and the two syndromes often merge in terms of signs and symptoms.

Somatic therapies:
• aerobic exercise: preventive (only helpful for some women) • qigong (see exercise dysmenorrhea) • tai qi chuan

Nutrition:
eating principles: • Alter the diet to include a high percentage of complex carbohydrates and low fat intake, especially from arachidonic acid sources, which is the substrate for prostaglandin. (Marz, p. 430, 1997) • Vegan diet of 75% complex carbohydrates, 15% protein, 10% fat • High fiber diet

therapeutic foods: • Increase foods rich in Sodium, Iron, Calcium and Magnesium • Increase omega-3 and omega-6 fatty acids: vegetable, nut, seed oils, salmon, herring, mackerel, sardines, walnuts, flaxseed oil, evening primrose oil, black currant oil » for Liver Xue Xu (Blood Deficiency): • Increase foods that nourish Xue (Blood) and tonify the Spleen and Stomach; bland foods • Blackberries, beets, blueberries, parsley, raspberries

specific remedies: • Irregular menstruation: boil 3 oz. raw brown sugar, 3 oz. dried dates and 1/2 oz. ginger in l pt of water until reduced to half. Drink once per day (Butt and Bloomfield, p. 148) • Cook 60 g black soybeans, 2 unshelled eggs and 120 g rice wine over low Heat; peel eggs after cooking and then cook eggs again; add rice wine. Eat the eggs and drink the hot soup to relieve pain. (Lu, p. 150) • Boil 50 g fresh parsley in 3 cups water until the water is reduced to l cup; crack 1 egg into the boiling water and add some seasoning. Eat to relieve pain. (Lu, p. 151)

fresh juices: • Carrot juice (Walker, p. 146) • Carrot and spinach juice (Walker, p. 146) • Carrot, beet, and cucumber (Walker, p. 146)

therapeutic foods for Stagnant Liver Qi or Stagnancy in the Liver channel type: • Foods that invigorate the Qi, Liver foods, sour foods, Dispersing foods, foods that open channels • Foods rich in Vitamin B-complex and Calcium • Foods rich in Magnesium

therapeutic foods for Cold in Uterus or Meridians type : • Warming or Heating foods, foods that open the channels, Liver foods

specific remedies: • Boil 30 g dried ginger in water along with 30 g brown sugar and 30 g seeded red dates and drink (Lu, p. 150) • Prepare 24 gr fresh ginger, 30 g red dates, and 9 g red pepper. Cut the ginger and pepper as you would in normal cooking; boil the 3 ingredients in 3 glasses water until the water is reduced by half. Drink hot to relieve pain (Lu, p. 150) • Boil 5 g cinnamon twigs, 15 g hawthorne fruits, and 30 gr brown sugar in 3 glasses water until water is reduced by half; add brown sugar and continue to boil for a few seconds. Drink hot to relieve pain (Lu, p. 151)

avoid: • Coffee, caffeine, food intolerances

Botanicals
• Achillea millefolium: anti-spasmodic uterine sedative (Nissim, p. 22) • Angelica archangelica, sinesis: anti-spasmodic, emmenagogue (Nissim, p. 22; Mitchell, p. 78) • Caulophyllum thalictroides (toxic): anti-spasmodic, emmenagogue indicated for delayed menses, uterine and cervical spasms, amenorrhea, dysmenorrhea, ovaralgia, ovaritis; specifically indicated for uterine pain with weight, fullness, congestion and uterine debility secondary to chronic inflammation (Nissim, p. 23; Felter, p. 282) • Cimicifuga racemosa: anti-spasmodic and ideal utero-ovarian tonic for dense, heavy uterine pain; uterine atony, deranged menses and heavy bleeding (Nissim, p. 22; Felter, pp. 466-468) • Dioscorea villosa: anti-spasmodic and progesterone precursor (Anderson Geller) • Helonias dioica: uterine tonic; weak, relaxed pelvic tissue with sense of weight and congestion; gastric disturbance due to pelvic relaxation and strong, sticky leukorrhea (Mitchell, p. 78; Felter, pp. 404-405) • Humulus lupulus: anti-spasmodic, nervine (Felter, pp. 103, 407) • Leonurus cardiaca: anti-spasmodic, emmenagogue; restless, irritable, pelvic and lumbar pain, bearing down pain (Felter, p. 443; Mitchell, p. 78) • Lobelia inflata (toxic): for spastic contractions with muscular rigidity; relieves spasms of cervix and relaxes perineum (Felter, pp. 455, 460) • Piscidia erythrina (toxic): pain • Salvia officinalis: stimulating emmenagogue, general hormonal tonic; abundant menstrual flow, cramps worse with heat, flushed, thirsty, constipated women with dark urine and yellow-coated tongue (Nissim, pp. 24-25) • Senecio aureus (toxic): uterine tonic indicated for dysmenorrhea, meno- and metrorrhagia with bearing-down pains, sense of pelvic weight and vascular engorgement (Felter, pp. 625-626) • Viburnum prunifolium: strong anti-spasmodic and uterine/smooth muscle sedative, cramps, dysmenorrhea (Felter, p. 694; Stansbury) • Zingiber officinalis: stimulating emmenagogue and digestive, cramps better with heat and scant dark blood (Nissim, p. 24; Weed, p. 7)

consider: (Stansbury) • Alchemilla vulgaris • Aletris farinosa • Matricaria chamomilla • Ribes nigrum • Rubus idaeus • Scutellaria lateriflora • Tanacetum vulgare • Taraxacum officinale • Valeriana officinalis

Chinese Formulae
» note: Any Xue (Blood)-moving formula should be given no later in the menstrual cycle than three days before the flow begins, to avoid causing excessive bleeding. • Peony and Licorice C. (Shao Yao Gan Cao Tang): Any spasmodic pain: may be used acutely (Hsu, 1980, p. 108; Dharmananda, 1986, p. 109; Bensky and Barolet, p. 252) • Corydalis 5 (patent); Yan Hu Su Zhi Tong Pian (Corydalis Yanhusus Analgesic Tablets) (patent): For dull pain: may be used acutely (Corydalis 5: Dharmananda, 1990, p. 44; Yan Hu Su: Zhu, p. 232; Fratkin, p. 128) • Yun Nan Bai Yao (patent): with heavy bleeding/clotting. (Zhu, p. 243) • Bupleurum and Peony F. (Dan Zhi Xiao Yao San or Jia Wei Xiao Yao San); Lindera 15 (patent): Liver Qi Stagnation with Xue Xu (Blood Deficiency): dysmenorrhea with premenstrual syndrome, irritability (Bupleurum: Hsu, 1980, p. 87; Yeung, p. 72; Dharmananda, 1986, p. 177; Bensky and Barolet, p. 148; Lindera: Dharmananda, 1990, p. 49) • Tiao Gan Tang: Liver and Kidney Yin Xu (Deficiency): mild pain after menses ends; low back soreness; scanty thin flow, patient may feel flushed (Yeung, p. 232) • Cinnamon and Persica C.; Fu Ke Zhong Zi Wan (patent): Xue Yu (Blood Stasis) (Cinnamon: Hsu, 1980, p. 573; Dharmananda, 1986, p. 325; Fu Ke: Zhu, p. 253) • Cinnamon and Hoelen F. (Gui Zhi Fu Ling Wan): Xue Yu (Blood Stasis): strong constitution, including teen-age menstrual complaints (Hsu, 1980, p. 423; Yeung, p. 113; Bensky and Barolet, p. 322) • Cinnamon and Bulrush (Shao Fu Zhu Yu Tang): Xue Yu (Blood Stasis): abdominal pain with no lumps; pain begins before or during menses, patient feels cold, especially in lower abdomen; better with heat, worse with pressure; menstrual flow dark with clotting; scanty flow, slight aversion to cold (Dharmananda, 1986, p. 327; Yeung, p. 195; Bensky and Barolet, p. 316). • Tang Kuei and Carthamus F.; Nuphar 14 (patent): Xue Yu (Blood Stasis) with Heat: constipation (Tang Kuei: Hsu, 1980, p. 438; Dharmananda, 1986, p. 325; Nuphar: Dharmananda, 1990, p. 87) • Tang Kuei 18 (patent); Ji Xue Teng Qin Gao Pian (patent): Xue Xu (Blood Deficiency) with Xue Yu (Blood Stasis) (Tang Kuei 18: Dharmananda, 1990, p. 25; Ji Xue Teng: Zhu, p. 103) • Tang Kuei and Peony F. (Dang Gui Shao Yao San): Liver Invading Spleen: continuous cramping pain that is not very severe, slight edema primarily of the lower limbs (Tang Kuei: Hsu, 1980, p. 585; Yeung, p. 77; Dharmananda, 1986, p. 177; Bensky and Barolet, p. 251) • Sheng Yu Tang: Qi and Xue (Blood) Xu (Deficiency): constant ache in the lower abdomen either during or just after menstruation, better with pressure; scanty and pale menstrual flow; pale complexion, lethargy (Bensky and Barolet, p. 249). • Bu Xue Tiao Jing Pian (patent); Wu Chi Pai Feng Wan (patent): Xue Xu (Blood Deficiency): weak constitution, low back pain (Bu Xue: Zhu, p. 254; Wu Chi: Fratkin, p. 184) • Tang Kuei and Evodia C. (Wen Jing Tang): Chong Mo and Ren Mo Xu (Deficiency) and Coldness: weak and cold patient, dry mouth and throat, increased body temperature in the evening, irregular menstrual flow (Hsu, 1980, p. 588; Yeung, p. 242; Dharmananda, 1986, p. 323; Bensky and Barolet, p. 324)

Acupuncture
after assessing the person and palpating, consider these patterns: Qi Stagnation; Xue Yu (Blood Stasis), esp. in Uterus; Cold Accumulation; Liver Xue Xu (Blood Deficiency); Liver Qi Stagnation; Kidney Xu (Deficiency); Qi Xu (Deficiency) and Xue Xu (Blood Deficiency); Shi (Excess) of the Ren Mai (Conception Vessel) and/or the Chong Mai (Penetrating Vessel); dysfunction of the Dai Mai (Girdle Vessel); Xu (Deficiency) of the Yang Qiao Mai (Yang Motility Vessel) and/or Shi (Excess) of the Yin Qiao Mai (Yin Motility Vessel); Liver Invading Spleen; Cold in the Liver; Heat

» illustrative combinations: • GB-41 and TW-5: open the Dai Mai (Girdle Vessel) which regulates the pelvis and menstruation and for which dysmenorrhea is a symptom of dysfunction; specifically treats temporal headache associated with menstrual cycle • Lu-7 and Kd-6: open the Ren Mai (Conception Vessel) which nourishes the Uterus and regulates menstruation; usually indicated by head and neck pain, abdominal distension, vaginal discharge and other symptoms of congestion; menstrual disorders are usually a part of Shi (Excess) effecting the Ren Mai (Conception Vessel) • Sp-4 and PC-6: open the Chong Mai (Penetrating Vessel) for which menstrual disorders are a symptom of Shi (Excess) and reproductive disorders are a general symptom of dysfunction • UB-62 and SI-3: open the Yang Qiao Mai (Yang Motility Vessel) which transports Yang and for which gynecological problems are a Xu (Deficiency) symptom • Kd-6 and Lu-7: open the Yin Qiao Mai (Yin Motility Vessel) which transports Yin and for which gynecological problems are a Shi (Excess) symptom • CV-4 and Sp-6; also consider: St-29, CV-7, St-36, UB-23 and/or CV-6 for dysmenorrhea (Shanghai, p. 671) • GB-41, Sp-6 and CV-3 for difficult menstruation (Shanghai, p. 279) • Sp-6, LI-4, CV-4 and CV-6 for dysmenorrhea (Liu, p. 394) • CV-4, CV-3, St-27, St-28, Sp-10 and Sp-6 for dysmenorrhea (Lee and Cheung, p. 331) • UB-18, UB-20 and UB-26 for dysmenorrhea (Shanghai, p. 213) • shi qi zhui xia, CV-3, Sp-6 and Kd-3 for dysmenorrhea (Shanghai, p. 213) • UB-31, UB-32, UB-33 and/or UB-34; Sp-6 and thread CV-4 to CV-3 for dysmenorrhea (Shanghai, p. 217) • Lv-8, Lu-7, Sp-6 and Kd-3; UB-62, GB-35, LI-4 and St-28; Lv-14 and Kd-15; UB-31, UB-32, UB-33 and UB-34; GV-12 for dysmenorrhea (Mann, p. 146) • St-25, CV-7 and CV-4 for dysmenorrhea (Shanghai, p. 183) • CV-6, CV-3 and Sp-6 for dysmenorrhea (Shanghai, p. 184) • GB-41, Sp-6 and CV-3 for difficult menstruation (Shanghai, p. 279) • CV-6, CV-3, Sp-8, GB-34 and Lv-2 (retain 30 - 60 mins. with manipulation every 5 - 10 mins.) for dysmenorrhea due to Qi Stagnation (Qiu and Su, p. 4) • CV-4, Sp-6, St-29 and CV-6 for dysmenorrhea due to Qi Stagnation and effused Blood (Lee and Cheung, p. 331) • CV-6, St-29, Sp-10 and Sp-6 (-) for dysmenorrhea due to Xue Yu (Blood Stasis); also consider Lv-2 with Heat (Qiu and Su, p. 4) • GV-4, GV-8, St-28 and St-36 (= and D) for dysmenorrhea due to Cold Accumulation (Qiu and Su, p. 5) • CV-4, Sp-6, St-36 and UB-23 for dysmenorrhea due to Qi Xu (Deficiency) with Coldness (Lee and Cheung, p. 331) • UB-18, UB-23, CV-4, St-36 and Kd-3 (+) for dysmenorrhea due to Liver and Kidney Xu (Deficiency) (Qiu and Su, p. 7) • PC-6, Sp-6, CV-3 and Lv-3 Retained one hour) for dysmenorrhea arising from Stagnation of Qi and Xue (Blood) from Obstruction of Liver Qi due to mental depression (Qiu and Su, p. 7) • Lv-14, Lv-3, CV-6 and Sp-6 for painful menstruation due to Stagnant Liver Qi with Xue Yu (Blood Stasis) (Jirui and Wang, p. 271) • UB-32 and St-29: induce flow of Xue (Blood) in the Uterus (Finkelstein, p. 17) • Sp-8 and St-29 (-): move Xue (Blood); clear contributing Qi Stagnation; transform Damp and warm Cold in Lower Warmer • Sp-8 and LI-4 for painful menstruation and abdominal pain (Finkelstein, p. 29) • Kd-5 and St-25: treat menstrual disorders (Finkelstein, p. 53) • Sp-10 and Sp-1 stop menstrual pain (Finkelstein, p. 30) • Sp-6, CV-6, LI-4, GB-29, yao yan, UB-18, Sp-8, CV-2, UB-31 to UB-34, and the hua tuo jia ji of T11 to S4 for pain associated with Qi Stagnation and Xue Yu (Blood Stasis) (Shanghai, p. 671) • St-25 and St-29: clear Heat and regulate menses (Finkelstein, p. 17) • St-28 and GB-26 (+ and D): relieve pain below umbilicus (So, 1987, p. 255) • St-30, Sp-8 and Lv-8: harmonize Xue (Blood) and dispel effused blood, esp. with menstrual problems (Finkelstein, p. 17) • CV-3 and Sp-6: regulate the Qi function of the Lower Warmer and the function of the genital organs - Sp-6 sends Qi up; CV-3 sends it deep (Finkelstein, p. 84) • CV-15, CV-16, CV-19, Kd-13, Sp-6, Kd-11, UB-47/52, GB-37, GB-5, UB-60 and CV-10: influence the pituitary (Worsley, 1975, p. B-20; McWilliams, et al, Lesson 31, p. 258) • Kd-13, UB-67, Kd-7, GB-37, Sp-6, Kd-2, GV-4 and Lv-3: influence the ovaries (Worsley, 1975, p. B-20; McWilliams, et al, Lesson 31, p. 258) • UB-31, Sp-6 and GB-3: has strong hormonal action on women (Finkelstein, p. 46)

Homeopathy
• Belladonna: congestion with heaviness in vulva; pains come on and leave suddenly; vagina hot, dry and pains cut horizontally through pelvis; spasmodic at climacteric with cerebral congestion, < touch, motion, noise, lying down, summer sun, > standing, erect, warm room • Caulophyllum thalictroides: spasmodic, intermittent, paroxysmal, erratic; pains flying to other parts of the body; bearing down sensation; hysterical convulsions with dysmenorrhea since puberty • Cimicifuga racemosa: pains flying from hip to hip; sharp, labor-like, shooting down thigh; headache before menses; menses profuse, dark, coagulated, offensive; > warmth, eating • Cocculus indicus: dark clots, headache and nausea as if sea sick; pains as if sharp stones rubbing together in abdomen; distended abdomen due to flatus; profound weakness, unable to stand; esp. in light-haired, sensitive and romantic females; time passes too quickly • Colocynthis: left-sided ovarian pain; boring pain extends from umbilicus to genitals; restlessness; patient doubled in pain, > hard pressure and warmth. • Folliculinum: history of birth control pills and/or estrogen replacement therapy, esp. bad reaction, i.e., estrogen poisoning; tendency to put others' needs before her own, and then become resentful later; woman has lost touch with her own inner rhythms and her reference has become external rather than internal; often best used in a single dose, or repeated every two weeks, possibly at new and full moons • Lac Humanum: history of difficult mother-daughter relationship; issues of nourishment • Magnesia phosphorica: neuralgic and crampy pain preceding menses, > warmth, bending double, pressure, friction, < motion, right side, cold, touch, night; use 12X in hot water (Boericke) • Pulsatilla: dark and delayed menses; more severe the pain, more chilly the patient gets; nausea and downward pressure; changeable pains; with diarrhea; from getting feet wet • Viburnum opulus: sudden uterine pain with backache; cramps extending down thighs; menses late, scanty, and lasts a few hours, < lying on affected side, at night, > open air, resting • Xanthoxylum americanum: burning, paralyzing pain down thighs, esp. left side; profuse, early menses, thick, almost black; headache over left eye and occiput day before menses; women of nervous, delicate temperament, emaciated

Subtle Support
• notes: A, A#, B, C, C#, D, E, F, G, G#

• chords: A minor, C minor, D minor, D# minor, tonic (Gimbel, p. 116)

Mind/Body
• Unresolved issues around femininity, sexuality, or conception. (Harrison, p. 14) • May be a form of self-punishment. (Rossi and Cheek, p. 297) • Female problems represent a rejection of the feminine principle; denial of the self; rejecting femininity. (Hay, 1984, p. 165) • Anger at mate; sexual guilt; need for punishment. (Hay, 1984, p. 187) • Menstrual cramps represent fear, tension, gripping, holding on, guilt, rejection of femininity, or belief that genitals are sinful or dirty. (Hay, 1984, p. 160, 174) • Women who have painful periods often find it painful to be a woman, a protest against this self-surrender. (Dethlefsen, p. 185)

Chinese psychophysiology: • Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores and cleanses the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); controls the muscles especially their contractility; has an intimate relationship with the genitals and Lower Warmer; and reflects emotional harmony and movement. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Xu (Deficiency) signs include impotence; frigidity; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry skin and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down. Liver Xue Xu (Blood Deficiency) predisposes to Xue Yu (Blood Stasis) and Xue (Blood) Heat. Liver Yin Xu (Deficiency) predisposes to the Shi (Excess) conditions of Liver Wind, Liver Yang Rising, and Liver Fire Blazing. » Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216) Xue Yu (Blood Stasis) often begins with Qi Stagnation. » Liver Shi (Excess) signs include discontent; anger; pain in lumbar region and genitals (Seem, p. 28); muscular tension; excessive sex drive; insomnia; moodiness; excitability; genital diseases; red, tearing eyes; compulsive energy; and bitter taste in the mouth. Chronically suppressed anger can implode and give rise to Fire in the Liver and Gall Bladder with symptoms of irritability, bitter taste, headaches, etc. Liver Shi (Excess) can also spill over and "invade" the Spleen.

• Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging, particularly the internal aspects of the reproductive organs; houses the Zhi (Will); expresses ambition and focus; governs Water to regulate body fluids; and displays the stresses of aging and chronic degenerative processes. » Healthy expressions are gentleness, groundedness, and endurance. » Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; and abundant sweating (Seem, p. 28); chronic fatigue; fearfulness; apathy; discouragement; and scatteredness. » Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).

Integrative Therapies
Dysmenorrhea includes Menstrual Cramps and Painful Periods

Menstrual cramps are pains in the back, abdomen, pelvis, or upper thighs that occur just before or after the menstrual period. The severity of the pain can range from mild discomfort to an excruciating intensity.

Menstrual cramps are often associated with a hormonal imbalance, a high fat diet, lack of calcium or magnesium, stress, or a history of being sexually abused. The pain is produced by a change in hormone levels that occurs during menstruation and causes contractions in the uterus.

There may also be a more serious underlying cause. If the pain is severe, if the severity or duration of the pain becomes worse than it has been previously, or bowel movements are painful, consult a physician.

Many women have found that their cramps stop or diminish when they switch from using tampons to using pads. Having an IUD removed may also eliminate a source of menstrual pain and tension.

THE FOLLOWING SUPPLEMENTS CAN BE TAKEN UNTIL SYMPTOMS IMPROVE: 1. Vitamin B-complex – 50 milligrams twice a day. 2. Folic acid – 2 milligrams per day. 3. Calcium – 1,200 milligrams per day. The best sources are calcium citrate, calcium from oyster shells, or calcium amino acid chelate. 4. Magnesium – 400 to 800 milligrams per day. 5. Bromelain (an enzyme from pineapples) – 500 milligrams, 3 times per day between meals on days when symptoms are present.

REGARDING THE PROPER DIET FOR MENSTRUAL CRAMPS: Throughout the month: 1. Reduce the use of fats such as butter, margarine, cheeses, and meat. 2. Decrease or eliminate consumption of caffeine, found mostly in coffee, black tea, sodas, chocolate, and some over-the-counter medications. Read the product labels. 3. As much as possible, avoid sugar foods such as candy, cake, and cookies and refined carbohydrates such as white flour products. 4. Drink at least 8 cups of liquid a day in the form of water, diluted fruit and vegetable juices, soups, and herb teas. 5. Overeating or being overweight can often worsen menstrual cramps. Eating light meals on the 3 days previous to the menstrual period and throughout it may, in these cases, greatly relieve cramping.

HERBS USED FOR MENSTRUAL CRAMPS: The following 3 herbs are used in combination, starting about 2 days before the cramps usually appear: Cramp Bark, Wild Yam, and Black Cohosh. Simmer 1/2 ounce of each in 3 pints of boiling water for 15 minutes. You can grate and add a small piece of Ginger Root, and you can also add honey and lemon for taste. Cool and drink 1 cup at least 3 to 6 times a day. If these herbs are used as a tincture, which is a liquid herbal extract, take 1/2 teaspoon of each 3 to 6 times a day.

PHYSICAL THERAPY MEASURES FOR MENSTRUAL CRAMPS ARE AS FOLLOWS: 1. To ease cramps and pain, place a hot water bottle or heating pad on your abdomen or back. 2. Rub castor oil on your abdomen and cover with plastic and a warm towel on top. Rest in this way for 1 1/2 hours once a day. 3. Regular exercise can be helpful in preventing cramps. Try taking a brisk walk, jogging, swimming, or doing your favorite sport 4 times a week on regular basis. 4. Acupuncture has been very helpful in dealing with menstrual cramps and the problems that underlie this condition. Look for a licensed practitioner in your area. 5. Pay special attention to keeping warm. Use extra blankets, sweaters, and thermal under-wear if necessary. 6. Be sure to get adequate rest. 7. Deeply massage the muscles of your lower back. You can receive a massage about 3 days before your period is due or just before you expect the cramps.

HOMEOPATHY: • Magnesia phos. 30c: Dissolve 3 pellets under the tongue every hour until cramps are relieved. Note: A wide range of homeopathic medicines can be helpful for women with painful periods. Consultation with a health care professional trained in homeopathic prescribing will usually be the best way to select the correct medicine.