Dysmenorrhea, also known as menstrual abdominal pain, is a common condition among women. It is characterized by spasmodic pain in the lower abdomen during menstruation or around the time of menstruation, which may sometimes radiate to the lumbosacral region or be accompanied by a sensation of heaviness or pain in the vulva or anus. In severe cases, some individuals may experience systemic symptoms such as pallor, profuse cold sweats, cold hands and feet, as well as breast tenderness or swelling, nausea, vomiting, diarrhea, lower back ache, and headaches.
Types of Dysmenorrhea: Modern medicine classifies dysmenorrhea into primary and secondary dysmenorrhea. Primary dysmenorrhea, also known as functional dysmenorrhea, occurs in the absence of organic lesions in the reproductive organs and is most common among unmarried young women. It typically begins shortly after menarche and tends to lessen or disappear after marriage. Secondary dysmenorrhea results from organic lesions in the reproductive organs. It is more common in married women and is often accompanied by various gynecological conditions, such as:
① inflammation, salpingitis, oophoritis, and perimetritis;
② uterine fibroids;
③ uterine hypoplasia;
④ endometriosis;
⑤ endometrial shedding;
⑥ chronic pelvic inflammatory disease;
⑦ excessive uterine malposition;
⑧ endocrine disorders, etc.
In addition to the above primary and secondary dysmenorrhea, a type of dysmenorrhea caused by psychological factors is frequently encountered in clinical practice. This form of dysmenorrhea can occur in both unmarried and married women and is often triggered by psychological stress such as pressure from schoolwork and exams, a heavy workload, or family life.
The earliest recorded mention of dysmenorrhea appears in *The Essential Prescriptions from the Golden Cabinet: Pulse Patterns, Symptoms, and Treatments for Women*: “Leucorrhea, irregular menstruation, fullness and pain in the lower abdomen, occurring twice a month.” *Treatise on the Origins and Manifestations of Various Diseases* was the first to establish the “symptom of abdominal pain during menstruation,” stating: “Abdominal pain during menstruation in women results from overwork damaging blood and qi, leading to physical weakness; this allows wind-cold qi to invade the uterine meridians, thereby damaging the Chong and Ren meridians” .
Etiology and Pathogenesis: The onset of dysmenorrhea arises from multiple causes, including emotional stress, unhealthy lifestyle habits, or exposure to the Six Excesses. It is also influenced by constitutional factors and the specific physiological conditions occurring before, during, and after menstruation. The pathogenesis primarily involves the impact of pathogenic factors during menstruation, leading to blood stasis in the Chong (CV) and Ren (GV) meridians or cold coagulation within the meridians. This disrupts the smooth flow of qi and blood, obstructing the passage of menstrual blood through the uterus and resulting in “pain due to obstruction,” or pain caused by the Chong and Ren meridians and the uterus failing to receive proper nourishment. The pathological site involves the Chong and Ren meridians and the uterus; the pathological changes affect qi and blood; and the clinical manifestation is pain. The reason for its recurrence with the menstrual cycle is linked to changes in qi and blood within the Chong and Ren meridians during menstruation.
Classification, Manifestations, and Treatment
(1) Qi Stagnation and Blood Stasis Type: The patient is generally prone to depression; emotional distress during or around menstruation further depresses Liver qi. Depression leads to qi stagnation, which in turn causes blood stasis. Impaired qi movement in the Blood Sea (Xuehai) results in obstructed menstrual blood flow, manifesting as dysmenorrhea. Symptoms typically include distending pain in the lower abdomen 1–2 days before menstruation or during the menstrual period, with tenderness on palpation; this may be accompanied by distension in the chest, flanks, or breasts. Other manifestations may include scanty menstrual flow, irregular menstrual flow, dark purple menstrual blood with clots, pain that subsides after the expulsion of clots, and the disappearance of pain once menstruation ceases. The tongue may appear dark purple or have ecchymotic spots, and the pulse may be string-like or string-like and slippery. Treatment Principle for This Pattern: Regulate qi, resolve stasis, and relieve pain. The formula “Ge Xia Zhu Yu Tang” (Decoction for Expelling Stasis Below the Diaphragm) should be modified according to the specific symptoms.
(2) Cold Congestion in the Uterus Pattern: This is often caused by exposure to rain, wading through water, or swimming during menstruation; by excessive consumption of raw or cold foods just before menstruation, leading to internal cold injury; by excessive exposure to cold environments; or by living in damp environments. Wind, cold, and dampness invade the Chong and Ren meridians and the uterus, causing menstrual blood to stagnate and flow poorly; or it may result from a constitutional deficiency of yang with an excess of internal cold, leading to deficiency-cold in the Chong and Ren meridians and resulting in sluggish menstrual flow. Both conditions can cause blood stagnation, leading to accumulation and pain.
① Yang Deficiency with Internal Cold: Cold pain in the lower abdomen during or after menstruation, relieved by pressure or warmth; scanty menstrual flow with a dark, dull color; soreness and weakness in the lower back and legs; clear, copious urine; a deep pulse; and a white, moist tongue coating. The treatment principle is to warm the meridians, warm the uterus, and relieve pain. Apply the Warming the Meridians Decoction with modifications.
② Cold-Dampness Stagnation: Cold pain in the lower abdomen before or during menstruation; pain is relieved by warmth but worsened by pressure; scanty menstrual flow; dark-black menstrual blood with clots; or aversion to cold with body aches. White, greasy tongue coating; deep and tight pulse. The treatment principle is to warm the meridians, dispel cold, remove dampness, resolve blood stasis, and relieve pain. Apply the Lower Abdomen Blood-Stasis-Resolving Decoction with modifications, further adjusting the formula based on the physician’s clinical experience.
(3) Damp-Heat Descending Pattern: Chronic internal accumulation of damp-heat flows into the Chong and Ren meridians, obstructing qi and blood; or damp-heat pathogens are contracted during menstruation or postpartum, lingering in the Chong and Ren meridians or accumulating within the uterus. The damp-heat combines with menstrual blood, leading to dysmenorrhea. Symptoms include premenstrual lower abdominal pain that is tender to pressure, with a burning sensation, accompanied by distending pain in the lumbosacral region; or intermittent lower abdominal pain at other times that worsens with the onset of menstruation. There may be fluctuating low-grade fever; menstrual blood is dark red, thick, and clotted; vaginal discharge is yellow and viscous; urine is scanty and yellow; the tongue is red with a yellow, greasy coating; and the pulse is string-like and rapid or soft and rapid. The treatment principle focuses on clearing heat, eliminating dampness, resolving blood stasis, and relieving pain. Prescribe Modified Clear Heat and Regulate Blood Decoction.
(4) Qi and Blood Deficiency Type: This results from congenital deficiency of the spleen and stomach and insufficient source of transformation, or from severe or chronic illness leading to deficiency of both qi and blood. Deficiency of qi and blood in the Chong and Ren meridians causes the Blood Sea to become depleted after menstruation, resulting in inadequate nourishment of the Chong and Ren meridians and the uterine vessels. Combined with qi deficiency and blood stasis—which impedes circulation—this leads to dysmenorrhea. Symptoms include a dull ache in the lower abdomen 1–2 days after menstruation or during the menstrual period; a sensation of emptiness or heaviness in the lower abdomen and genital area, relieved by massage; soreness and weakness in the lower back and legs; a pale complexion; scanty menstruation that is pale in color and thin in consistency; mental fatigue and weakness; poor appetite and loose stools; a pale tongue; and a fine, weak pulse. The treatment principle focuses on tonifying qi, nourishing blood, and relieving pain. Use Shengyu Decoction with modifications, or Bazhen Decoction with modifications.
(5) Liver-Kidney Deficiency Type: This type is often caused by a constitutional weakness, inherent deficiency of the liver and kidneys, or damage to the liver and kidneys due to multiple childbirths and postpartum exertion, leading to deficiency of essence and blood, insufficiency of the Chong and Ren meridians, and inadequate nourishment of the uterine vessels. After menstruation, the deficiency of essence and blood becomes more pronounced, and the Chong and Ren meridians as well as the uterus fail to receive proper nourishment, resulting in dysmenorrhea. Symptoms include cold pain in the lower abdomen several days before or during menstruation, soreness in the lower back and weakness in the knees, dizziness and tinnitus, scanty menstrual flow with pale color, a pale tongue with a thin coating, and a fine, weak pulse. The treatment focuses on tonifying the kidneys, nourishing the liver, and relieving pain. The Tiao Gan Decoction (Regulating the Liver Decoction) is used with modifications based on the specific symptoms, and further adjustments are made according to the physician’s clinical experience.