DysmenorrheaDysmenorrhea ((tong jing tong jing 痛经痛经 ))

Shuguang hospital affiliated to shaShuguang hospital affiliated to shanghai TCM universitynghai TCM university

Doctor: zhang qin huaDoctor: zhang qin hua

IntroductionIntroduction ClassificationClassification PathogenesisPathogenesis DiagnosisDiagnosis Main points of syndrome differentiationMain points of syndrome differentiation Examples :Treatments on the types of Examples :Treatments on the types of

syndrome differentiationsyndrome differentiation

contentscontents

IntroductionIntroduction

What is What is 痛经（痛经（ tong jing)tong jing) ？？

Definition:Definition: refers to painful menstrual period, characrefers to painful menstrual period, charac

terized by cramping lower abdominal paiterized by cramping lower abdominal pain radiating to the back and legs, often accn radiating to the back and legs, often accompanied by GI & neurological symptoms ompanied by GI & neurological symptoms （（ nausea, vomiting, diarrhea)nausea, vomiting, diarrhea)

Affects approximately 50% of womenAffects approximately 50% of women about 5-10% have severe dysmenorrhea afabout 5-10% have severe dysmenorrhea af

fecting daily activities.fecting daily activities.

IntroductionIntroduction

ClassificationClassification

Primary or idiopathicPrimary or idiopathic without pelvic pathology.without pelvic pathology.

SecondarySecondary underlying pelvic pathologyunderlying pelvic pathology

Primary Spasmodic Primary Spasmodic DysmenorrheaDysmenorrhea

Commonest in teens/early twentiesCommonest in teens/early twenties Usually appear 1-2 yrs Usually appear 1-2 yrs afterafter menarche menarche

ovulatory cycles are established.ovulatory cycles are established. No abnormal findings except some tenderneNo abnormal findings except some tenderne

ss.ss. Main physiological basis is increased endomMain physiological basis is increased endom

etrial etrial prostaglandinprostaglandin productions. productions. The pain may lessen as the woman gets oldeThe pain may lessen as the woman gets olde

r.or after giving birth. r.or after giving birth.

Secondary DysmenorrheaSecondary Dysmenorrhea

secondary to pathologysecondary to pathology Usually occurs many years after Usually occurs many years after mmenarche.enarche. Pain may begin before bleeding and last for Pain may begin before bleeding and last for

entire duration or entire duration or persist continuously upto persist continuously upto few days after the cessation of bleeding.few days after the cessation of bleeding.

30s and 40s women30s and 40s women

Underlying pathology in secondary dysmenorrhea

1.1. Endometriosis/Adenomyosis.Endometriosis/Adenomyosis.

2.2. Fibroid uterusFibroid uterus

3.3. Congenital uterine anomalies- bicornuate, Congenital uterine anomalies- bicornuate, septate etc.septate etc.

4.4. Cervical stenosis.Cervical stenosis.

5.5. Pelvic inflammatory disease.Pelvic inflammatory disease.

Shall we consider all the pain with vaginal bleeding as dysmenorrhea

?

Differential DiagnosisDifferential Diagnosis

pregnancy complications like abortions & epregnancy complications like abortions & ectopic pregnancyctopic pregnancy

rupture of corpus luteumrupture of corpus luteum torsion of ovarian cysttorsion of ovarian cyst urinary stonesurinary stones AppendicitisAppendicitis colitis and acute gastroenteritis colitis and acute gastroenteritis

Symptoms of DysmenorrheaSymptoms of Dysmenorrhea

Cramps or pain in the lower abdomen or Cramps or pain in the lower abdomen or lower back lower back

Pulling feeling in the inner thighs Pulling feeling in the inner thighs Diarrhea Diarrhea Nausea Nausea Vomiting Vomiting Headache Headache Dizziness Dizziness

ExaminationExamination

Vaginal exam not essential in Vaginal exam not essential in young female with Primary young female with Primary dysmenorrheadysmenorrhea

Vagina – septumVagina – septum cervical - moving tendernesscervical - moving tenderness Uterus- size / mobility/ Uterus- size / mobility/

position/tendernessposition/tenderness Adnexa –tenderness/ Adnexa –tenderness/

enlargementenlargement

InvestigationsInvestigations

Transabdominal ultrasound with full Transabdominal ultrasound with full bladderbladder

Transvaginal ultrasound –increased Transvaginal ultrasound –increased sensitivitysensitivity

Laparoscopy –gold standard for Laparoscopy –gold standard for endometriosisendometriosis

Risks versus benefitsRisks versus benefits

TCM pathologic factorTCM pathologic factor

Emotional factors

six exogenous

malnutrition of uterus

congenital defect

consumption

of Q i& blood

QIBLOOD

Sad, anger, liver depression

Cold, heat, dampness

serious disease and prolonged illness liver and kidney

multiparity and excessive sexual life

TCM PathogenesisTCM Pathogenesis

stheniasthenia 　　 (( 实）实） Bu tong er tong Bu tong er tong 不通而痛不通而痛

Qi stagnation and blood stasis into uterusQi stagnation and blood stasis into uterus

Asthenia (Asthenia ( 虚） 虚） Bu rong er tong Bu rong er tong 不荣而痛不荣而痛

Malnutrition of the uterus and meridian Malnutrition of the uterus and meridian

Syndrome differentiationSyndrome differentiation

How to revealing the nature of dysmenorrhea?How to revealing the nature of dysmenorrhea? PainPain

the timethe time LocationLocation DegreeDegree

MensesMenses the quantitythe quantity ColorColor TextureTexture

ComplicationsComplications tongue and pulse conditions. tongue and pulse conditions.

Sthenia:Sthenia: before and during the mens before and during the mens unpressable and violent paiunpressable and violent pai

nn Asthenia:Asthenia:

After the menstruation After the menstruation dull pain with preference of dull pain with preference of

pressurepressure Cold:Cold:

pain alleviated with warmtpain alleviated with warmthh

colic or cold paincolic or cold pain Heat:Heat:

pain worsened with warmth pain worsened with warmth burning pain burning pain

Syndrome differentiationSyndrome differentiation

Blood stasis:Blood stasis: pain severer than distensionpain severer than distension pain alleviate after the remopain alleviate after the remo

val of blood clotval of blood clot Pain is fixed and stingPain is fixed and sting

Qi stagnation:Qi stagnation: distension severer than pain distension severer than pain With breast tendernessWith breast tenderness

liver disorders:liver disorders: pain in the sides of abdomepain in the sides of abdome

nn kidney disorders:kidney disorders:

pain involving the loinspain involving the loins

Therapeutic principle Therapeutic principle

key:regulating Qi and blood in the thoroughkey:regulating Qi and blood in the thoroughfare and conception vessels fare and conception vessels regulating Qiregulating Qi activating bloodactivating blood dissipating colddissipating cold Clearing away heatClearing away heat supplementing asthenia supplementing asthenia purging sthenia purging sthenia

Two step principlesTwo step principles

Firstly : during the menstruationFirstly : during the menstruation regulating the blood to stop the painregulating the blood to stop the pain treat branch (biao treat branch (biao 标）标）

Secondly : at other timeSecondly : at other time syndrome differentiationsyndrome differentiation treat roottreat root （（ ben ben 本）本）

Syndrome ofSyndrome of 　　 dysmenorrheadysmenorrhea

qi stagnation and blood stasisqi stagnation and blood stasis coagulation of cold in uteruscoagulation of cold in uterus

Coagulation of cold and dampnessCoagulation of cold and dampness intern-cold caused by Yang asthenia intern-cold caused by Yang asthenia

liver and kidney asthenia liver and kidney asthenia Qi and blood asthenia Qi and blood asthenia

ExamplesExamples from ”Zhu nansun” clinical examples of gynecology from ”Zhu nansun” clinical examples of gynecology 14 jan Miss Huang, 22 year-old, soldier.unmarried14 jan Miss Huang, 22 year-old, soldier.unmarried Main symptoms: Main symptoms:

The 3rd day of the mensesThe 3rd day of the menses severe lower abdominal pain since the menses cosevere lower abdominal pain since the menses co

mesmes prolonged period ,scanty menorrhea ,with blood cprolonged period ,scanty menorrhea ,with blood c

lotslots accompanied with backpainaccompanied with backpain Tongue: thin and white fur,Tongue: thin and white fur, Pulse: deep, thready and a little taut. Pulse: deep, thready and a little taut.

Syndrome analyseSyndrome analyse The 3rd day of the menses — The 3rd day of the menses — treat branchtreat branch severe lower abdominal pain since the menses comessevere lower abdominal pain since the menses comesstheniasthenia prolonged period ,scanty menorrhea ,with blood clotsprolonged period ,scanty menorrhea ,with blood clotsQi and blood stagnation or cold coagulationQi and blood stagnation or cold coagulation accompanied with backpainaccompanied with backpainAsthenia –kidney ‘s yang asthenia Asthenia –kidney ‘s yang asthenia Tongue: thin and white fur,Tongue: thin and white fur,Cold or qi stagnationCold or qi stagnation Pulse: deep, thready and a little taut. Pulse: deep, thready and a little taut. Cold and qi stagnationCold and qi stagnation

answeranswer

Syndrome differentiation: Syndrome differentiation: asthenicasthenic uterine cold, uterine cold, Qi stagnationQi stagnation in Chong an in Chong an

d Ren vessels(d Ren vessels( 胞宫胞宫虚寒虚寒，冲任，冲任气滞气滞 )) Treatment: warm meridians and regulating QiTreatment: warm meridians and regulating Qi Drug: Drug:

Aiye6 Aiye6 Xiangfu9 Xiangfu9 Danggui6 Danggui6 Xuduan9 Xuduan9 B Baishao6aishao6

Shoudi9 Shoudi9 Muxiang4.5Muxiang4.5 Wuyao6Wuyao6 Chuanlianzi9 Chuanlianzi9 Huangqi9Huangqi9

Rougui2.4Rougui2.4

prognosisprognosis One month lateOne month late

patient felt the pain obviously illeviated, and less bpatient felt the pain obviously illeviated, and less blood clots, more volume of menses.lood clots, more volume of menses.

Treatment: Soothing the liver to regulate qi nourishTreatment: Soothing the liver to regulate qi nourishing blood and warming the middleing blood and warming the middle

Drug: Drug: Xiangfu9 Yujin9 Danshen9 Aiye9 WuyaXiangfu9 Yujin9 Danshen9 Aiye9 Wuya

o6o6Chuanlianzi9 Zhike4.5 Shoudi9 Chenpi6 WuChuanlianzi9 Zhike4.5 Shoudi9 Chenpi6 Wu

zhuyu6zhuyu6Baishao6Baishao6

After the treatment , dysmenorrhea disappeared ,aAfter the treatment , dysmenorrhea disappeared ,and the period became regular.nd the period became regular.

summarizesummarize

Dr. Zhu said:“ When treating dysmenorrhea, doctDr. Zhu said:“ When treating dysmenorrhea, doctors should not only pain attention to the syndrome ors should not only pain attention to the syndrome differentiation, but also differentiation, but also the proper momentthe proper moment. In thi. In this case, because there is Qi stagnation and blood stas case, because there is Qi stagnation and blood stasis in the patient, we should give drugs at the first sis in the patient, we should give drugs at the first of the menses, especially patient felt severe lower aof the menses, especially patient felt severe lower abdominal pain ,scanty menorrhea, with blood clots.bdominal pain ,scanty menorrhea, with blood clots. We usually use “Shanzha, Zhike, Danggui, Ruxia We usually use “Shanzha, Zhike, Danggui, Ruxiang, Moyao” to dissipate the stagnation ,smooth the ng, Moyao” to dissipate the stagnation ,smooth the menstruation, then the pain will disappear.”menstruation, then the pain will disappear.”

ExamplesExamples from ”Zhu nansun” clinical examples of Gynfrom ”Zhu nansun” clinical examples of Gyn Miss Wang, 23 year-old, doctorMiss Wang, 23 year-old, doctor Main symptoms: Main symptoms:

Dysmenorrhea since the 1st, in recent years,aggressivDysmenorrhea since the 1st, in recent years,aggressive paine pain

advanced menorrhea, normal quantity, with clots,advanced menorrhea, normal quantity, with clots, there was signs before the menstruation there was signs before the menstruation distending pain in the chest, hypochondria and breastdistending pain in the chest, hypochondria and breast

ss poor appetite, fatigue , backpain ,leucorrheapoor appetite, fatigue , backpain ,leucorrhea when the menses came ,severe lower abdominal pain when the menses came ,severe lower abdominal pain

lead to vomiting and diarrhea, even to comalead to vomiting and diarrhea, even to coma Tongue: white and thin furTongue: white and thin fur Pulse: thready and taut.Pulse: thready and taut.

analyseanalyse advanced menorrhea, with clotsadvanced menorrhea, with clots

Qi asthenia Qi asthenia ， ， blood stasis blood stasis distending pain in the chest, hypochondria and bdistending pain in the chest, hypochondria and b

reastsreasts Liver depression and qi stagnationLiver depression and qi stagnation

poor appetite, fatigue , backpain ,leucorrheapoor appetite, fatigue , backpain ,leucorrhea Liver ‘s qi affect the Spleen’s functionLiver ‘s qi affect the Spleen’s function Dampness invased the belt vessel because of the spleDampness invased the belt vessel because of the sple

en’s weeknessen’s weekness severe lower abdominal pain lead to vomiting ansevere lower abdominal pain lead to vomiting an

d diarrhea, even to comad diarrhea, even to coma Liver ‘s qi rising ,spleen’s qi descendingLiver ‘s qi rising ,spleen’s qi descending

Tongue: white and thin furTongue: white and thin fur Pulse: thready and taut.Pulse: thready and taut.

answeranswer

Syndrome differentiation: Syndrome differentiation: liver depression and asthenia of spleen, weliver depression and asthenia of spleen, we

ekness of Belt vesselekness of Belt vessel Treatment:Treatment:

Before the menstruation, when patient felt Before the menstruation, when patient felt the signsthe signs soothing liver and harmonizing stomachsoothing liver and harmonizing stomach

In the middle of mensesIn the middle of menses invigorating spleen and tightening up the Belt invigorating spleen and tightening up the Belt

vesselvessel

Drug: Before the menstruationDrug: Before the menstruation Xiangfu9 Xiangfu9 Yujin6Yujin6 Danggui6 Danggui6 BaishBaish

ao6 ao6 Yanhusuo6Yanhusuo6 Wuyao9 Wuyao9 Chuanlianzi6 Chuanlianzi6 Ruxiang6 Ruxiang6 Moyao6 Moyao6 Sugeng6 Muxiang Sugeng6 Muxiang4.5 4.5 Shanzha9Shanzha9

Drug: in the middle of mensesDrug: in the middle of menses Baishu6 Chenpi6 Fuling9 HuangBaishu6 Chenpi6 Fuling9 Huang

qi9qi9 Danggui6 Danggui6 Yiyiren12 Yiyiren12 Ebaipi9 Ebaipi9 Haipiaoxiao9 Haipiaoxiao9 Xianhecao9 Xianhecao9 Diyutan12 HuDiyutan12 Huangbai6angbai6

summarizesummarize

PS: Dr. Zhu said:” in the case of liver deprePS: Dr. Zhu said:” in the case of liver depression , we should treat dysmenorrhea when ssion , we should treat dysmenorrhea when signs appears, by using drugs of soothing livsigns appears, by using drugs of soothing liver and regulating Qi” er and regulating Qi”

Syndrome of Syndrome of qi stagnation and blood stasisqi stagnation and blood stasis

Main symptoms: Main symptoms: unpressable lower abdominal pain or distention pain befunpressable lower abdominal pain or distention pain bef

ore or during menstruationore or during menstruation profuse or scanty menstruation ,dripping and unsmooth profuse or scanty menstruation ,dripping and unsmooth

menorrhea, purplish and blacking color menses with blomenorrhea, purplish and blacking color menses with blood clotsod clots

distending pain in the chest, hypochondria and breastsdistending pain in the chest, hypochondria and breasts purplish tongue or with ecchymosis on the edgepurplish tongue or with ecchymosis on the edge deep and taut pulse.deep and taut pulse.

Therapeutic methods:Therapeutic methods: Soothing the liver to regulate Qi and resolving stasis to stSoothing the liver to regulate Qi and resolving stasis to st

op pain.op pain. Prescription: Prescription:

Modified Xuefu Zhuyu TangModified Xuefu Zhuyu Tang

exampleexample from ”Qian bo xuan” clinical examples of gynecolfrom ”Qian bo xuan” clinical examples of gynecol

ogyogy 23 /2 Miss Jin, 21 year-old23 /2 Miss Jin, 21 year-old

unmarried ,LMP: 3 febunmarried ,LMP: 3 feb Main symptoms: Main symptoms:

dysmenorrhea for six yearsdysmenorrhea for six years lower abdominal pain before menseslower abdominal pain before menses accompanied with stomach painaccompanied with stomach pain felt cold in abdomen with preference of pressurefelt cold in abdomen with preference of pressure Tongue: white and thin furTongue: white and thin fur Pulse: thready and slipperyPulse: thready and slippery

analyseanalyse

lower abdominal pain before menseslower abdominal pain before menses sethniasethnia

accompanied with stomach painaccompanied with stomach pain Qi stagnation(liver)Qi stagnation(liver)

felt cold in abdomen with preference of prfelt cold in abdomen with preference of pressureessure Asthenia of spleen yang(why not kidney)Asthenia of spleen yang(why not kidney)

Tongue: white and thin furTongue: white and thin fur Pulse: thready and slipperyPulse: thready and slippery

answeranswer

Syndrome differentiation: Syndrome differentiation: coagulation of cold and Qi stagnation; disharmony bcoagulation of cold and Qi stagnation; disharmony b

etween liver and stomachetween liver and stomach Treatment:Treatment:

Warming meridians and dissipate coldness; harmonWarming meridians and dissipate coldness; harmonizing liver and spleenizing liver and spleen

Drug: Drug: Danggui9 Danggui9 Chuanxiong4.5 Chuanxiong4.5 Chishao9 Chishao9 Baishao9Baishao9 RR

ougui3 ougui3 Wuzhuyu3 Wuzhuyu3 Gouji12 Gouji12 Wuyao6 Wuyao6 Qingpi6 Qingpi6 ChCh

enpi6 enpi6 Banxia6 Muxiang6Banxia6 Muxiang6 xiaohuixiangxiaohuixiang

Syndrome of Syndrome of coagulation of cold dampnesscoagulation of cold dampness

Main symptoms: Main symptoms: unpressabe lower abdominal pain, cold pain before or durunpressabe lower abdominal pain, cold pain before or dur

ing menstruationing menstruation alleviation of pain with warmthalleviation of pain with warmth scanty menorrhea with purplish color menses and clot or lscanty menorrhea with purplish color menses and clot or l

ike juice of black soybeanike juice of black soybean cold sensation in the body and aversion to cold ,loose stoolcold sensation in the body and aversion to cold ,loose stool light purplish tongue with white and moist or white and grlight purplish tongue with white and moist or white and gr

easy fureasy fur deep and tense pulse.deep and tense pulse.

Therapeutic methods:Therapeutic methods: Warming meridians to disperse cold and draining dampneWarming meridians to disperse cold and draining dampne

ss to eliminate stagnation.ss to eliminate stagnation. Prescription: Prescription:

Modified Modified Shaofu Zhuyu Tang Shaofu Zhuyu Tang

exampleexample from ”Qian box uan” clinical examples of gynecologyfrom ”Qian box uan” clinical examples of gynecology 6.25 Miss lin ,20 year-old, unmarried LMP: 6.15 6.25 Miss lin ,20 year-old, unmarried LMP: 6.15 Main symptoms: Main symptoms:

Dysmenorrhea for 4 years. Less volume of menses with light Dysmenorrhea for 4 years. Less volume of menses with light color.color.

lower abdominal pain appeared 2 days before the menses; at lower abdominal pain appeared 2 days before the menses; at the first day of menstruation, lower abdominal pain became the first day of menstruation, lower abdominal pain became more seriousmore serious

accompanied with cold limbs , palpitation , dizziness , alleviaccompanied with cold limbs , palpitation , dizziness , alleviated with warmth. ated with warmth.

LMP: 6.15 , scanty menses purplish color with clots, serious lLMP: 6.15 , scanty menses purplish color with clots, serious lower abdominal pain even to faint, constipation ower abdominal pain even to faint, constipation

Tongue : white fur , exfoliate fur in the middle of the tongueTongue : white fur , exfoliate fur in the middle of the tongue Pulse: deep and taut. Pulse: deep and taut.

Less volume of menses with light color.Less volume of menses with light color. Asthenia of qi and blood Asthenia of qi and blood

accompanied with cold limbs , palpitation , accompanied with cold limbs , palpitation , dizziness , alleviated with warmth. dizziness , alleviated with warmth. Cold and blood deficiency( heart and spleen)Cold and blood deficiency( heart and spleen)

scanty menses purplish color with clots, seriscanty menses purplish color with clots, serious lower abdominal pain even to faint, conous lower abdominal pain even to faint, constipation stipation Blood stasis (cold and qi asthenia)Blood stasis (cold and qi asthenia)

Tongue : white furTongue : white fur Pulse: deep and thready. Pulse: deep and thready.

Syndrome differentiation:Syndrome differentiation: Qi and blood astheniaQi and blood asthenia

Treatment:Treatment: Warming and nourishing Qi and bloodWarming and nourishing Qi and blood

Drug:Drug: Chinese patent drug :Shiquandabu WanChinese patent drug :Shiquandabu Wan siwutang+sijunzi tang +rougui huangqisiwutang+sijunzi tang +rougui huangqi

prognosisprognosis

2 w After treatment , the patient felt all kinds of sy2 w After treatment , the patient felt all kinds of symptoms alleviated. mptoms alleviated. Tongue: white and thin fur, Pulse : thready and dTongue: white and thin fur, Pulse : thready and d

eep .Now the menses was coming.eep .Now the menses was coming. Treatment: nourishing blood and regulating Qi,; Treatment: nourishing blood and regulating Qi,;

warming meridians and dissipating stagnation warming meridians and dissipating stagnation

Drug: Drug: Danggui9 Danggui9 Chuanxiong6 Chuanxiong6 Danshen9 Danshen9 Xiangfu6 Xiangfu6

Zelan9 Wuyu3 Zelan9 Wuyu3 Guizhi4.5 Yanhusuo9 Guizhi4.5 Yanhusuo9 Heidou12Heidou12And Chinese patent drug:And Chinese patent drug: Hupo San 6g/every nightHupo San 6g/every nightHuposan: Sanleng30 Eshu30 Chishao30 LHuposan: Sanleng30 Eshu30 Chishao30 L

iujinu30 Mudanpi30iujinu30 Mudanpi30Shoudihuang30 Danggui30 Guangui30 WuyShoudihuang30 Danggui30 Guangui30 Wuy

ao30 Yanhusuo30ao30 Yanhusuo30

8.3 After this period treatment8.3 After this period treatment LMP:7.27,the pain and poor appetite disappeared ,juLMP:7.27,the pain and poor appetite disappeared ,ju

st felt distending in the abdomen. The volume of mest felt distending in the abdomen. The volume of menses became large, but still accompanied with headnses became large, but still accompanied with headache, backpainache, backpain

white thin fur, Pulse: deep and slippery, white thin fur, Pulse: deep and slippery, Syndrome differentiation:Syndrome differentiation:

blood asthenia and stagnation of Qi and bloodblood asthenia and stagnation of Qi and blood Treatment: Treatment:

nourishing blood and regulating Qi to regulate mensnourishing blood and regulating Qi to regulate menstruation and dissipate stagnation.truation and dissipate stagnation.

Drug: Drug: Chinese patent drug: Bazhen Yimu Wan+Hupo SanChinese patent drug: Bazhen Yimu Wan+Hupo San

Syndrome of Syndrome of Qi and blood astheniaQi and blood asthenia

Main symptoms: Main symptoms: Dull pain or continuous pain or prolapsing sensDull pain or continuous pain or prolapsing sens

ation in the lower abdomen during or after meation in the lower abdomen during or after menstruation, alleviation with pressure, profuse onstruation, alleviation with pressure, profuse or scanty menses with light color and thin texturr scanty menses with light color and thin texture but without clot, pale complexion, dizziness, e but without clot, pale complexion, dizziness, palpitation , lassitude, light-colored tongue witpalpitation , lassitude, light-colored tongue with tooth print and thin fur as well as thin pulse.h tooth print and thin fur as well as thin pulse.

Therapeutic methods: Therapeutic methods: Strengthening the spleen and nourishing Qi ,inStrengthening the spleen and nourishing Qi ,in

vigorating blood and stopping bleeding.vigorating blood and stopping bleeding. Prescription:Prescription:

Modified Bazhen TangModified Bazhen Tang

exampleexample

7.22 Miss Teng ,27 year-old, unmarried7.22 Miss Teng ,27 year-old, unmarried Main symptoms: Main symptoms:

Dysmenorrhea for six years; delayed menDysmenorrhea for six years; delayed menorrhea with a few blood clots,; dull abdomorrhea with a few blood clots,; dull abdominal pain during the menstruation accompinal pain during the menstruation accompanied with backpain, hot sensation in palanied with backpain, hot sensation in palms; Tongue: red tongue with teeth print, ms; Tongue: red tongue with teeth print, white furwhite fur

Syndrome differentiation: liver and kidney Syndrome differentiation: liver and kidney asthenia asthenia

Drug: Drug: Danggui9 Huainiuxi9 Shengdi9 Danggui9 Huainiuxi9 Shengdi9

Chishao9 Chishao9 Nuzhengzi4.5 Nuzhengzi4.5

Xuduan9Xuduan9 Gouji9 Gouji9 Fuling12 Fuling12 Zexie9 Danpi9 Zexie9 Danpi9

Syndrome of Syndrome of liver and kidney asthenialiver and kidney asthenia

Main symptoms: Main symptoms: Scanty menses with dull light color but witScanty menses with dull light color but wit

hout blood clot, dull pain in the lower abdhout blood clot, dull pain in the lower abdomen after menstruation, aching sensatioomen after menstruation, aching sensation in the lions and knees, dizziness and tinn in the lions and knees, dizziness and tinnitus, light-red tongue with thin fur, deep nitus, light-red tongue with thin fur, deep and thin pulse.and thin pulse.

Analyse:Analyse:

Therapeutic methods: Therapeutic methods: Nourishing blood and regulating the liver, reNourishing blood and regulating the liver, re

plenishing the kidney and enriching essenceplenishing the kidney and enriching essence Prescription: Prescription:

Modified TiaoGan TangModified TiaoGan Tang Shanyao15 ejiao 9 danggui9(wine) baishaShanyao15 ejiao 9 danggui9(wine) baisha

o9(wine) shayurou9 baji3 gancao3 so9(wine) shayurou9 baji3 gancao3 sangjisheng15angjisheng15

Duzhong15 gouji15 shoudi12 shayuanziDuzhong15 gouji15 shoudi12 shayuanzi1515

Relief Relief tipstips ExerciseExercise

Exercising most days of the week can make you feel better.Exercising most days of the week can make you feel better. Aerobic workouts, such as walking, jogging, biking, or swiAerobic workouts, such as walking, jogging, biking, or swi

mming, help produce chemicals that block pain. mming, help produce chemicals that block pain. Apply heatApply heat

A warm bath or a heating pad or hot water bottle on your aA warm bath or a heating pad or hot water bottle on your abdomen can be soothing. bdomen can be soothing.

SleepSleep Make sure you get enough sleep before and during your peMake sure you get enough sleep before and during your pe

riod. This can help you cope with any discomfort. riod. This can help you cope with any discomfort. RelaxRelax

Meditate or practice yoga. Relaxation techniques can help Meditate or practice yoga. Relaxation techniques can help you cope with pain. you cope with pain.

Food treatFood treat

Mutton soup:Mutton soup: Danggui 60g raw jinger 5 huangqi30gDanggui 60g raw jinger 5 huangqi30g Mutton 500gMutton 500g Reinforce qi and blood,regulating menses stop painReinforce qi and blood,regulating menses stop pain

Hawkthorn soup:Hawkthorn soup: Shanzha(hawkthorn)30g brown sugar 60g guizhi5gShanzha(hawkthorn)30g brown sugar 60g guizhi5g Activing blood and disperse stasis,stop painActiving blood and disperse stasis,stop pain

Brown sugar soupBrown sugar soup Brown sugar 30g ganjiang 30g dazao 30gBrown sugar 30g ganjiang 30g dazao 30g Warming meridian disperse cold stop painWarming meridian disperse cold stop pain

External therapyExternal therapy

Navel stuffing with baiyao Navel stuffing with baiyao Baiyao 20g, make paste use white wine anBaiyao 20g, make paste use white wine an

d stuffing into navel ,fasten with adhesive d stuffing into navel ,fasten with adhesive plaster, iron on it with the hot-water bag ,tplaster, iron on it with the hot-water bag ,twice a day,10-15min avery time. wice a day,10-15min avery time.

Drug-wine massageDrug-wine massage Yunnan baiyao wine ,daub on the guanyuYunnan baiyao wine ,daub on the guanyu

an an 、、 qihai acupointqihai acupoint ， ， and massage untiand massage until you feel hot.l you feel hot.

Foot bath Foot bath Yimucao 20g xiangfu 20g ruxiang 20g moyYimucao 20g xiangfu 20g ruxiang 20g moy

ao 20g xiakucao 20g ao 20g xiakucao 20g take decoction2000ml and make foot bath take decoction2000ml and make foot bath

erery day ,15-20minerery day ,15-20min

External therapyExternal therapy

清 ·王清任 wang qing ren qing dynasty ( 公元 1768 - 1831年 ) 。

Zhu yu tangZhu yu tang

Xue fu zhu yu tangXue fu zhu yu tang Ge xia zhu yu tangGe xia zhu yu tang

Qi stagnation and blood stasisQi stagnation and blood stasis Shao fu zhu yu tangShao fu zhu yu tang

Cold lodging into uterus or low energizer Cold lodging into uterus or low energizer

Warm uterus :Warm uterus : huixiang aiye rougui paojiang fuzi wuyu huixiang aiye rougui paojiang fuzi wuyu

Clear heatClear heat Danpi chishao shengdi huangqin shanzhi huangbai Danpi chishao shengdi huangqin shanzhi huangbai

zhimuzhimu Disperse stasisDisperse stasis ：：

chishao sanleng ezhu honghua Taoren danpi chishao sanleng ezhu honghua Taoren danpi dibiechong shuizhi shengpuhuang wulingzhi dibiechong shuizhi shengpuhuang wulingzhi

Active qi:Active qi: Zhixiangfu chuanxiong zhike qingpi yanhusuo chaiZhixiangfu chuanxiong zhike qingpi yanhusuo chai

hu hu Stop painStop pain

Quanxie wugong xuejie Ruxiang moyao Quanxie wugong xuejie Ruxiang moyao

rebalance yourselfrebalance yourself

TCM’s treatment fTCM’s treatment focuse on th body, nocuse on th body, not on the dieaseot on the diease

Aim to rebalance the yAim to rebalance the yin and yang of the bodin and yang of the body y