Yan Lu, L.Ac.
Clinical Case Study #4
Treatment of dysmenorrhea with Acupuncture and Chinese Herbs- A Case Study
ABSTRACT
Background Treatment of dysmenorrhea with pharmaceutical medicine is effective, but
may not prevent recurrence
Object To present a case that demonstrates the effectiveness of acupuncture and
Chinese herbs for dysmenorrhea
Result reliving symptoms of dysmenorrhea in a 28 year-old women using
acupuncture and Chinese herbs after 7 weeks of treatments
Conclusion The positive results in this case indicates that acupuncture and Chinese
herbs may be a viable treatment option in treating dysmenorrhea
BACKGROUND
Biomedicine Perspective
Dysmenorrhea can be divided into primary dysmenorrhea and secondary dysmenorrhea.
Primary dysmenorrhea is menstrual pain associated with ovular cycles without pathologic
findings. The pain usually begins within 1-2 years after the menarche and become more
severe with time. The frequency of cases increases up to age 20 and then decreases with
age and markedly with parity. 50 to 75 percent of women are affected at some time, and
5-6 percent has incapacitating pain. Primary dysmenorrhea is low abdomen pain which is
crampy or colicky or dull ache and radiate to the back or inner thighs. The pain may start
before or with menses, last 1 or more days and may be associated with nausea, diarrhea,
headache, and flushing. The pain is produced by uterine vasoconstriction, anoxia, and
sustained contractions mediated by prostaglandins. The pelvic examination is normal
between menses; examination during menses may produce discomfort, but there are no
pathologic findings. Nonsteroidal anti-inflammatory drugs (ibuprofen, ketoprofen,
mefenamic acid, naproxen) are generally helpful. A drug may be more effective if started
24 to 48 hours before and continued 1 or 2 days after menses begins. If pain continues to
interfere with daily life, suppression of ovulation with low dose estrogen-progesterone
oral contraceptives is advised. But when patients want to get pregnant and stop birthcontrol
pills, dysmenorrhea may come back. NSAIDs cannot prevent recurrence of
dysmenorrhea, too. Secondary dysmenorrhea is menstrual pain for which an organic
cause exists. The common causes are endometrosis and pelvic inflammation. Other
causes include submucous myoma, IUD use, cervical stenosis with obstruction, or blind
uterine horn. (1)
Traditional Chinese Medicine Perspective
Dysmenorrhea in Chinese medicine can be caused by many reasons such as excess or
deficient conditions. The excess conditions may include the following: Qi and blood
stagnations can cause this disease. Depression over period of time can cause liver qi
stagnation, which can cause blood stasis leading to obstruction of flowing of qi and
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blood, thus cause this disease. Coldness retention in the uterus is another pathogen.
Walking in the rain without a cover, swim in cold water, eating too much cold food
during menses, or living in damp-cold environment can lead to retention of coldness in
the uterus and Chong and Ren channels causing obstruction of flowing of qi and blood;
congenital yang deficiency with yin coldness-excess cause deficient coldness in the
Chong and Ren channels leading to blood stasis and dysmenorrhea. Lower jiao dampheat
disturb qi and blood can also cause dysmenorrhea. The above reasons are mainly
excess conditions that can cause dysmenorrhea (except deficient coldness).
The following reasons are deficient conditions. Deficiency of qi and blood due to
deficiency of spleen and stomach or after severe illness leads to malnourishment of uterus
and Chong and Ren channels, in addition to deficient qi will also cause blood stasis, thus
dysmenorrhea occurs. Liver and kidney deficiency due to congenital condition or overindulgence
in sex activity or giving birth many times cause deficiency of essence and
blood, leading to malnourishment of uterus, Chong and Ren channels, thus
dysmenorrhea.
The formula treatment of dysmenorrhea for qi and blood stasis include ge xia zhu yu
tang, chai hu su gan san, xiao yao san, jing ling zi san, shi xiao san. Formula for coldness
retention include shao fu zhu yu tang, wen jing tang. Formula for damp-heat include qing
jing san, qing re tiao xue tang, dan zhi xiao yao wan, long dan xie gan tang. Formula for
qi and blood deficiency include ba zhen tang, sheng yu tang, wu ji bai feng wan. Formula
for liver and kidney deficiency include tiao gan tang.
Acupuncture points for excess conditions including qi and blood stasis, coldness
retention, and damp-heat retention include CV3, BL32, LI4, SP10, SP8, LIV3, KID14
and ST28. Acupoints for deficient condition include CV4, BL20, BL23, ST36, SP6, PC6
and Sp4. (2)
Research
Wu described treating 40 women with severe dysmanorrhea with Chinese herbal
formula-Tongjing Power and obtained satisfactory result. Tonjing Power consists of 15g
each of dan shen, chi shao, pu huang, wu ling zhi, and 10g each of yan hu suo, chuan
xiong, gui zhi. The patients took Tongjing Power 30g tid three days before onset of
menstruation for 6 days during each cycle, and 3 menstrual cycles constituted a complete
course of treatment. To assess the effectiveness of the treatment, Wu use the methods of
observing clinical symptom changing, checking the blood flow parameter of uterine arties
by Doppler flow imaging and assay of hemorheologic data. Of the 40 patients treated
with Tongjing, 12 showed marked improvement, 24 were somewhat improved, and 4
showed no improvement. The total effectiveness rate was 90% (3).
Li reported treating 52 cases of primary dysmenorrhea with acupuncture and got good
results. Main acupoints included CV3, UB32, SP8 and SP6. Supplementary points for
excess condition included CV4; for deficient condition included BL23, CV4, and ST36.
Of the 52 cases, following 2 sessions of acupuncture treatment, 32 were cured, 17 were
improved and 3 were ineffective, with an effective rate of 94.2% (4).
CASE HISTORY
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Patient Identification and Chief Complaint
This patient is 28 year-old married female with severe dysmenorrhea.
History of Chief Complaint
The patient started her menses at age 12, her cycle was usually 28 days with 5 days flow.
The patient had severe menstrual cramping with heavy bleeding since June of 2000. She
described the symptoms as feeling
