Dysmenorrhea and Menstrual Pain

Dysmenorrhea is painful menstruation that arises before, during or after menstruation. WHO (2003) reported that primary dysmenorrhoea, a painful condition, is one of the major indications for acupuncture in the field of gynaecological disorders. The beneficial effect of acupuncture on this condition has been repeatedly reported in controlled trials. Acupuncture relieves pain and also regulates the motility of the uterus to facilitate menstrual discharge and further alleviate the pain.

The following is an example of TCM treatment protocol that may help you understand how this disorder is diagnosed and treated with using acupuncture.

  • Etiology & Pathology:
    • Etiology:
    • Emotional Factors – strong emotions (depression, anger) may lead to stagnation of the LV Qi which may lead to a stagnation of Qi & Blood manifesting as painful menstruation.
    • Cold/Damp Exposure – contact with cold/damp environments (climates, climate controlled buildings, basements) a/or excessive consumption of cold/damp foods (fruit juices, ice cream) may lead to an accumulation of cold/damp in the abdomen which may lead to a stagnation of Qi & Blood manifesting as painful menstruation.
    • Existing Qi/Blood Deficiencies – symptoms may be exacerbated during menstruation leading to dysmenoorhea.
    • Existing LV/KD Deficiencies – constitutional weaknesses a/or in women who have had multiple child-births, thus depleting the KD Jing, worsened by the loss of Blood during menstruation.
      • Differentiation:
      • When pain is worse prior to a/or during menstruation, this indicates an excess condition:
      • Qi Stagnation
      • Blood Stagnation
      • Accumulation of Cold
      • When the pain is dull, this indicates a deficient condition:
      • LV/KD Deficiency
      • Blood Deficiency
        • Qi Stagnation – Excess Condition
        • Signs & Symptoms:
          • More distention than pain, bloating, breast tenderness is likely, stuffy chest, belching, irritability, short temper.
          • Tongue: Purplish possible, thin white coat
          • Pulse: Wiry
          • Treatment Principle:
            • Resolve Qi Stagnation
            • Treatment Points:
              • LV 2 – move LV Qi, LV 3 may be a better choice
              • CV 6 – tonify Qi, effect lower abdomen
              • CV 3 – help to move Qi in the lower abdomen
              • GB 34 – w/LV 2/LV 3, move LV/GB channel & abdomen w/CV 6
              • SP 8 – moves Qi and Blood (more for Qi), SP 10 (more for Blood)
              • SP 6 – direct Blood downwards
              • If sacral pain – UB 32
    • Blood Stagnation – Excess Condition
    • Signs & Symptoms:
      • Less distention, more pain w/stabbing qualities, no breast tenderness, abdominal pain worse w/pressure, blood clots.
      • Tongue: Purplish or purple spots which usually appear on the sides, very thin coat
      • Pulse: Deep, choppy can also be a little wiry
      • Treatment Principle:
        • Resolve Blood Stagnation
        • Treatment Points:
          • ST 29 – move Blood in the abdomen (also good for starting menstruation in patients who have cessation of menstruation)
          • CV 6 – move Qi in the abdomen
          • SP 6 – direct Blood downwards
          • SP 10 – move Blood and Qi
          • LV 3 – w/SP 6 move Qi in the lower abdomen
    • Accumulation of Cold – Excess Condition
    • Signs & Symptoms:
      • Pain that is better w/application of heat a/or pressure, scanty menstrual flow, dark blood w/clots that are smaller than the Blood Stagnation clots.
      • Tongue: White coat
      • Pulse: Deep, tight
      • Treatment Principle:
        • Disperse Cold
        • Resolve Stagnation
        • Treatment Points:
          • CV 4 – w/moxa, tonify Qi, warm & move abdomen
          • CV 8 – w/moxa, disperse cold
          • ST 28 – w/moxa, warm abdomen, resolve stagnation
          • ST 36 – tonify Qi & Blood
    • LV/KD Deficiency – Deficient Condition
    • Signs & Symptoms:
      • Dull a/or intermittent pain of the lower abdomen which arises during a/or after menstruation, pain is better w/pressure, sore back, dizziness, tinnitus (not as prevalent), sallow complexion, lassitude, chronic fatigue, light periods likely w/light red blood.
      • Tongue: Light red, thin white coat (if extremely deficient tongue may be flabby)
      • Pulse: Deep, fine or thin
      • Treatment Principle:
        • Tonify LV & KD
        • Move Qi in the Chong Mai and Ren Mai
        • Treatment Points:
    • Blood Deficiency – Deficient Condition
    • Signs & Symptoms:
      • Dull pain after menstruation, better w/pressure, dizziness, palpitations, scanty menstruation.
      • Tongue: Pale w/thin moss or slightly peeled (peeled section may appear pale as well)
      • Pulse: Empty, thin
      • Treatment Principle: