I. Concept of primary dysmenorrhea.
Dysmenorrhea is cyclic lower abdominal pain that occurs during and around the menstrual period, often before and during the menstrual period, and occasionally within a few days after the menstrual period. Primary dysmenorrhea is defined as dysmenorrhea without obvious lesions in the reproductive organs. Primary dysmenorrhea occurs within 1-2 years after menarche. Although primary dysmenorrhea mainly affects young women, it can persist into the 40s. Dysmenorrhea belongs to the category of “abdominal pain during menstruation” in Chinese medicine. Primary dysmenorrhea can be caused by uterine hypoplasia, uterine flexion, cervical stenosis, endometrial tubular shedding (membranous dysmenorrhea), poor posture and physical factors, allergic reactions and psychological factors.
II. Symptoms of dysmenorrhea
Most of the primary dysmenorrhea occurs in the beginning hours of menstruation, mostly spasmodic colic, which lasts 0.5-2 hours and then changes to moderate paroxysmal pain, lasting about 12-24 hours, gradually improving after the outflow of menstrual blood, and some need bed rest for 2-3 days or painkillers to relieve. The site of pain is mostly in the lower abdomen, and in severe cases, it can be radiated to the lumbosacral region or the inner femur. Some patients are accompanied by nausea, vomiting, diarrhea, dizziness, headache, fatigue and other systemic symptoms, and occasionally fainting or fainting. Primary dysmenorrhea often disappears on its own with age or after marriage or childbirth.
Treatment of primary dysmenorrhea
1.Modern medical treatment methods:
a. Suppression of ovulation: If you are willing to control fertility, oral contraceptive tablets (compound norethindrone tablets or compound methandienone tablets) are the preferred drugs for the treatment of primary dysmenorrhea. With the application of oral contraceptives, more than 90% of the symptoms can be relieved, probably due to the inhibition of endometrial growth, the decrease in menstrual flow, and the decrease in the amount of prostaglandins below normal levels leading to a weakened uterine activity. Since the drug has to be administered continuously throughout the menstrual cycle, and the effect occurs only during menstruation, it takes more than six months after stopping the drug before pregnancy can occur, so it is generally less acceptable to patients unless they need concurrent contraception.
b. Prostaglandin synthetase inhibitors: The most common drugs taken clinically, such as fenbid, anti-inflammatory pain, etc., which can inhibit prostaglandin synthesis, so that the uterine tension and contractility decline, to achieve the purpose of treating dysmenorrhea. The most common drugs are Fenbuterol and anti-inflammatory pain, which can inhibit prostaglandin synthesis and decrease uterine tension and contraction to treat dysmenorrhea. Side effects: There are gastrointestinal reactions and central nervous system symptoms, rarely causing bronchospasm and temporary renal impairment.
c. Calcium channel blockers: interfere with the passage of calcium ions through the cell membrane and prevent the release of calcium ions from the cells, thereby inhibiting uterine contractions. Commonly used nifedipine 10mg, 3 times/day, sublingual in case of pain. The main side effects are decrease in blood pressure, tachycardia, headache and facial flushing.
2.Treatment by Chinese medicine
Modern medicine generally uses painkillers, sedatives and antispasmodics for symptomatic treatment, which can provide immediate pain relief, but the pain remains the next time. Hormones are also used to inhibit ovulation, but they are not in line with female physiology. Prostaglandin synthase inhibitors such as anti-inflammatory pain are used to relieve pain, but have certain side effects. The role of Chinese medicine in the treatment of primary dysmenorrhea is certain, and if patients adhere to the medication and treat both the symptoms and the root cause, they can mostly achieve significant results.
Chinese medicine believes that the occurrence of dysmenorrhea is related to the vegetative body and the special physiological environment during and before and after menstruation. During the non-menstrual period, the Qi and blood of Chong Ren are calm, and the pathogenic factors cannot cause stagnation or deficiency of Chong Ren and uterus, so pain does not occur, but during the menstrual period or late menstrual period, the sea of blood is full and overflowing, and the Qi and blood of uterus is in temporary deficiency after the menstruation, and the Qi and blood changes rapidly, so the pathogenic factors take advantage of the deficiency and make the Qi and blood run poorly, and the circulation of the menstrual blood of uterus is obstructed, so that “it is painful if it does not pass “The mechanism includes cold, heat, heat and pain. The mechanism is cold, heat, deficiency and actual, with the actual evidence being the most common. Common types of symptoms: Qi stagnation and blood stasis, cold stagnation and blood stasis, dampness, heat and stasis, Qi and blood weakness, liver and kidney deficiency, etc.
The treatment of dysmenorrhea is carried out in two stages: “treating the symptoms of dysmenorrhea” and “treating the symptoms of dysmenorrhea”, mainly in the pre-menstrual period, with the method of moving Qi and blood to relieve pain, and emphasizing that it is advisable to start taking medicine 3-7 days before menstruation until it is clean. But treating the symptoms is only a stopgap measure, the key is to treat the root cause, only the root cause, in order to achieve the purpose of the cure. Therefore, during the non-menstrual period, focus on treating the root cause, promoting the recovery of the function of the internal organs, combined with the vegetative condition, identify the cause, or regulate the liver, or benefit the kidney, or support the spleen, or treat the heart. Generally speaking, it is necessary to adhere to the treatment for 3-6 months in order to consolidate the efficacy.
Fourth, prevention and conditioning
1, the woman to blood as the foundation, the liver as the innate, so should give the necessary mental comfort and menstrual knowledge, especially for the menstrual flow soon after the girls, patiently give general medical health knowledge guidance, explain is a physiological phenomenon of the development of girls maturing, may appear some physiological reactions as the abdominal cramps, slight lumbar acidity are normal categories, when the menstrual blood outflow is smooth, the symptoms will disappear naturally.
2, pay attention to menstrual hygiene, forbidden to have intercourse, bathing, swimming, wading and strenuous exercise, avoid overwork.
3, eat less cold, raw and cold or stimulating food, living and living should be normal.
4.Dietary regimen
a. Sugar and vinegar Yimou cream: 30g of brown sugar, 15g of rice vinegar, 15g of Yimou grass, 10g of sand, decoct the above medicine in appropriate amount of water, remove the residue and extract the juice, take in 2 times. It is suitable for blood stasis evidence.
b. Turmeric and eggs: 21g of turmeric, 2 eggs, 1 cup of sweet wine. After boiling the eggs, peel off the shells, boil them with turmeric, take the eggs with one cup of sweet wine, and eat 2-3 times during menstruation. Suitable for mixed evidence of deficiency and reality.