Dysmenorrhea is one of the common gynecological disorders, and there are three types of dysmenorrhea that are not easily treated. We hereby present our personal clinical experience and typical cases for public reference.
I. Dysmenorrhea with hanging yin
Dysmenorrhea of the hanging yin is described in “Ye Tian Shi Women’s Medicine” and “Xiao Shan Zhu Lin Si Women’s Medicine”. This disease is characterized by painful traction in the pubic area, less abdomen and breast area with frequent attacks. The disease, analyzed from the site and nature of its onset, is closely associated with the liver, and is caused by liver stagnation, liver stagnation and fire, blood deficiency and liver stasis in the meridians. And it has periodic attacks. Dysregulation of Qi and blood in the liver is often associated with kidney deficiency. As Yin deficiency cannot nourish Liver wood, Liver depression and Qi stagnation, and easy to turn into fire, are common in clinical practice; Yin deficiency mixed with Yang deficiency and Liver depression and Qi stagnation are also seen. Therefore, the treatment is mostly based on regulating the liver and resolving blood stasis, and after menstruation, the kidneys should be tonified.
(A) Heat-related evidence
Before and during menstruation, pain in the vagina, breast and abdomen, or traction pain, most of the periods are overdue, occasionally behind, the amount of menstruation is more or less, purple-red with small blood clots, chest tightness and irritability, headache and insomnia, the pulse is thin and stringy with a number, the tongue is red, treatment should be given to clear the liver and relieve depression to regulate menstruation, with self-order neem soup (attached) with the addition and reduction of treatment.
Case example: Qiu, female, 35 years old. The patient has premenstrual and menstrual pain in the vagina, breast and abdomen, which has become more acute in recent years; her menstrual period is late, with small blood clots in a small amount and purple color; premenstrual chest tightness and irritability, poor sleep, irritable fever and thirst, dizziness and waist; thin and stringent pulse, red tongue with yellowish greasy coating. Gynecological examination: no abnormality was seen. She had taken Danjiania Yiyao San and Jinlingzi San, which were not effective. The reason for this is the deficiency of kidney yin, liver depression and qi stagnation, one side of the fire dry offending the rushing veins, liver meridian, one side of the rushing blood stagnation and stasis, stasis obstruction and menstruation is not smooth, so that the qi and fire can not be flat drain. Treatment should be cleared liver fire in the pre-menstrual period, smooth menstruation in the period, to make the blood downstream, and then nourish the kidney yin in the post-menstrual period.
In the present period, into the self-defined Chuan Neem soup plus Ze Lan Tang to increase the damage. Prescription: Neem 10g, Zeilan 10g, Angelica 10g, Radix Paeoniae 10g, Salviae Miltiorrhizae 10g, Radix Aconiti 10g, Centipede 2, Dried Dragon 10g, Fructus Aromaticus 9g, Tribulus terrestris 10g, Salviae Miltiorrhizae 10g, Yimu Cao 15g. After taking five doses, the menstrual flow was more than before and the pain in hanging yin was greatly reduced. After the menstruation was cleared, she was given Radix Paeoniae Dihuang Tang to regulate. In the future, we will take self-ordered Chuan Neem soup before menstruation and advise to be pleasant and nourishing to match. After 3 months of treatment, the pain of hanging yin was basically controlled.
(II) Cold evidence
Before and during menstruation, painful traction in the vagina, breast and abdomen. The menstrual period is late, the volume of menstruation is small, dark with blood clots, chest tightness or irritability, waist i frequent urination, cold form or cold feeling in the abdomen, thin string pulse, white greasy tongue coating. Treatment should be to warm the yang and regulate the liver, with Chuan neem soup combined with orange nucleus pill, or combined with ai wu nuan gong pill into the retreat.
Case example: Don, female, 40 years old. She has been suffering from painful dysmenorrhea in the hanging yin for more than a year. The menstruation was normal in the past, but after the onset of the disease, the cycle was slightly delayed, the volume of menstruation was acceptable, dark red with small blood clots, and there was severe pain before and during menstruation in the lesser abdomen and anterior and posterior yin.
The abdomen is distended, the waist and buttocks are painful, the chest is stuffy and irritable, the body is cold, especially in winter, the pulse is thin and stringent, and the tongue is white and greasy. He is usually silent and depressed, which indicates that the disease belongs to Yang deficiency and liver depression. The treatment should be to warm yang and relieve depression by combining Chuan Neem Tang with Ai Shen Nuan Gong Wan. The prescription is Chai Hu 5 grams, Xiang Shen 10 grams, Angelica Sinensis 10 grams, Red Peony 10 grams, Yuan Hu Suo 10 grams, Neem 10 grams, Orange Kernel 10 grams, Wu Yu 3 grams, Cinnamon 3 grams, Chuan Jian Pork 10 grams, Roasted Licorice 5 grams, Du Zhong 10 grams. Before and during menstruation, take the above, and after menstruation, take Quan Lu Wan and Zhuan Yao Wan. As the method of treatment for more than 2 months and healed.
(With] Neem soup: 10g of neem, 3g of cumin, 10g of yuan hu, 5g of roasted lactuca (each), 5g of green peel (each), 10g of suluzi, 10g of angelica, 10g of red peony, 10g of white tribulus terrestris, 10g of made aromatic herb, 3g of roasted centipede.
Membranous dysmenorrhea
Membranous dysmenorrhea refers to dysmenorrhea caused by enhanced contraction or uncoordinated contraction of the uterus when the endometrium is discharged in one piece. Its clinical manifestations: pain occurs on the second day of menstruation, paroxysmal intense pain, dropping of rotten flesh-like blood clots, sometimes the clots are quite large and flaky, the menstrual volume is high, easily confused with miscarriage. Blood stasis and fatty film clotting, often due to deficiency of kidney yang, or spleen and stomach yang, liver qi can not be released, resulting in liver depression and qi stagnation, affecting the flushing. In the menstrual period, the treatment should be based on removing blood stasis and removing membranes, using our experimental formula for removing membranes (attached). However, it must be combined with the treatment of kidney and spleen Yang Qi weakness, even with warm tonic.
(I) Evidence of Yang deficiency and stagnation
Late menstruation, severe pain on the 2nd to 3rd day of menstruation, blood clots like rotten meat, large amount and purple color. Waist i frequent urination, cold pain in the abdomen, heat and pressure, chest tightness and annoyance, poor nasality, thin string pulse, slightly red tongue, or accompanied by headache and epistaxis, breast swelling and pain, irritable heat and thirst, insomnia and yellow urine. The treatment should be to benefit the kidney and promote yang, expel blood stasis and remove membrane.
Case example: Zhang, female, 26 years old. She has been suffering from severe pain in the abdomen during menstruation for two years. She has severe cold pain in the abdomen on the third day of menstruation, with more lining pieces (rotten flesh-like lumps) coming out, more menstrual flow, accompanied by lumbar i, cold form, dizziness, chest tightness, irritability, premenstrual breast swelling and pain. The tongue is light red, the coating is yellowish white and greasy, and the pulse is thin and stringent. This is a case of Yang deficiency and liver depression with stagnation. The treatment is to remove stagnation, remove blood stasis and warm the kidney to help Yang.
Prescription: Radix Angelicae Sinensis 10g, Radix Paeoniae Alba 10g, Rhizoma Curcumae 10g, Fructus Schisandrae 10g, Radix Achyranthes Bidentatae 10g, Radix Aconiti 10g, Radix Aconiti 9g, Radix Aconiti 6g, Radix Cinnamomum 3g, Radix Fenugreek 10g, Radix Trigonellae 10g, Radix et Rhizoma Icariensis 15g, after taking five doses. The abdominal pain was relieved, the flesh-like clot was reduced, and the menstrual period was reduced from 10 days to 6 days with the continuation of the above. After the menstruation was cleared, the kidneys were benefited to nourish the liver and calm the mind, and Chuanjiandihuang, Baji, Cuscuta and Dog’s spine were added to Guixia Shao Dihuang Tang. The usual use of Xian Ling Spleen, Xian Mao, the genus of deer horn, and at the same time with compound angelica injection. In the future, every time to premenstrual period, on the basis of warming kidney yang, adding nourishing heart and regulating liver products, such as helianthus bark, wide Yujin, roasted Yuan Zhi, Tribulus terrestris, green calyx plum, etc.; when menstruation comes, continue to take the above. So treated for half a year, menstrual decidualization less and small. Abdominal pain is basically controlled.
(B) Qi deficiency and stagnation evidence
Menstrual period varies, menstruation 2 to 3 days off membrane abdominal pain, the amount of red color. Lack of facial color, thinness, fatigue, fatigue, abdominal gangrene, loose stools, premenstrual chest tightness and irritability, breast distension, thin pulse, thin coating. The treatment should be to strengthen the spleen and benefit the qi, expel the blood stasis and release the membrane, and the formula should be taken as Jiu Yuan Decoction or Xiang Sha Liu Jun Tang combined with the release of membrane.
Case example: Sun, female, 25 years old. The patient has been suffering from abdominal pain during menstruation for more than three years, her menstrual cycle is slightly overdue, her menstrual volume is excessive, her color is red, a large piece of endothelium is peeling off, and she has severe abdominal pain. She is thin and weak, fatigued, has poor appetite, loose stools during menstruation, irritable and irritable before menstruation, chest tightness or breast distension, thin and stringent pulse, and light red tongue. The evidence belongs to spleen deficiency, liver depression, internal obstruction of stagnation. The treatment before menstruation should be to benefit Qi, strengthen the spleen and remove stasis in the liver.
Prescription: Radix Angelicae Sinensis 10g, Radix Paeoniae Alba 10g, Radix Codonopsis Pilosulae 10g, Rhizoma Atractylodis Macrocephalae 10g, Poria Cocos 10g, Pericarpium Citri Reticulatae 6g, Radix Bupleurum Chinense 5g, Rhizoma Gastrodiae 10g, Radix Magnoliae Sinensis 6g, Radix Dampsi 10g, Rhizoma Chuanji 10g, Fructus Crataegi 10g. 10 grams, and 10 grams of Radix Codonopsis pilosulae. Astragalus injection was also administered both before and after menstruation. The patient had fewer and smaller rotten flesh-like clots and abdominal pain had been relieved at the next menstrual period. After continuous injection of Astragalus injection for three months, the rotten flesh-like clots disappeared during menstruation and the dysmenorrhea was cured.
[Attachment] Decidualization: one part of cinnamon, five lingzhi, three parts of each of trigon and curcuma, take the appropriate amount of each in the above proportion and research finely, put the capsule for backup.
Third, abdominal pain in the intermenstrual period
Abdominal pain in the middle of two periods, regular episodes, short one day, long 3 to 5 days. Modern medicine calls this abdominal pain during ovulation. The disease mostly occurs in the two less abdominal or side, many patients and chronic adnexitis related. The mechanism belongs to the range of qi stagnation and blood stasis with dampness, and pain if it does not pass. The treatment should be to dredge the liver to resolve blood stasis, dampness and clear the ligaments, such as pain in the abdomen, favoring one side, chest tightness and irritability, occasional breast distension, increased leucorrhea, viscous and slippery quality like egg white, waist i, thin and slippery pulse, dark tongue or purple stasis points, the formula is taken from the Golden Bell Seeds San, Gui Zhi Fu Ling Wan. If complicating pelvic inflammatory disease, use 10 grams each of angelica and red peony, 15 grams each of septoria, red vine and coix seed, 5 grams of mucuna pruriens, 6 grams of roasted tulsi (each), 10 grams each of yanhuosuo, sumac and hawthorn (this is the author’s customary formula). If the pain is severe due to tuberculous adnexitis, it is necessary to add sizzling centipede, dragon, whole scorpion and other insects to move and analgesic products.
Case example: Wu, female, 35 years old. She has had intermenstrual abdominal pain for three years with regular episodes. In the past, menstruation was normal. She had been taking Prosperity Pill, Orange Kernel Pill and Yueju Pill, but the effect was not satisfactory. When she came to our hospital, it was ten days after menstruation, she had pain in her left abdomen, and when the pain was severe, it was mainly in her left abdomen, like needles, and it lasted for three days. When the pain was severe, the pain was mainly in the left hypochondrium, like pins and needles. With chest tightness and irritability, fine string pulse, reddish tongue with purple spots, and greasy moss. The evidence belongs to the intersection of stasis and turbidity, paralysis blocking the meridians of the lesser abdomen, although there is qi stagnation, in fact, stasis of blood is the main. The treatment should be clearing and clearing the ligaments and at the same time to benefit dampness.
The prescription, angelica 10 grams, 10 grams of red peony, 9 grams of fragrant herbs, 10 grams of yanhuosuo, 10 grams of golden bell, 10 grams of orange kernel, 10 grams of hawthorn, 15 grams of sorrel, 6 grams of roasted milk (each), 10 grams of coix seed, 10 grams of poria, 10 grams of suzuki, take five doses of medicine, pain relief, and continue to take the original formula to reduce its amount and take it. The next menstrual net, turn to take nourishing kidney liver drink (i.e. Liu Wei Di Huang Wan combined with Free Run Wan), between periods and then take the above. The pain was basically controlled after 3 months of treatment.
The above treatment method is just an example. When the evidence should be in accordance with the characteristics of the pathogenesis of different symptoms, flexible prescription selection of drugs, do not stick to it.