Chinese Medicine for Painful Periods
Chief Complaint: Dysmenorrhea
Western Diagnosis: Endometriosis
History: Patient complains of severe, often sharp, lower abdominal-pelvic pain for approximately one week before and during first day of menses accompanied by severe symptoms of Premenstrual Tension. Duration approximately 3 years (2004 to Present). Pain rated “9-10” on scale of 1 to 10.
Takes Advil (Ibuprofen) or other Non-steroidal anti-inflammatory drugs (NSAIDS) when needed – often more than recommended dosages. Wants to address these issues without more potent pain medication or hormone therapy. Also complains of regular bouts of fatigue and mild depression.
Additional Patient History:
-1987 – Moved to the United States from South Africa. (Age 15) Severe culture shock. Depression.
-1987 – History of Depression – Untreated. On and off over lifetime. Described as “Minor.” Does not impede her life, just “sometimes present.”
-2003 – Survivor of Rape. Completed therapy. Say’s feels “resolved but not the same.”
-2004 – Broke off Engagement with Fiancee. Extreme “disappointment.”
-2004 to Present – Diagnosed with Endometriosis. Chronic Pelvic Pain prior to and during Menstruation. Chose not to utilize Western Medical options – birth control/hormone therapy and pain medication.
-Does take Advil (Ibuprofen) as needed, and often more than recommended dosages.
-History of Chronic Stress & Anxiety – Work Related and General (“Being Jewish, Being a Woman”)
-Not close to family – they all live in South Africa and Europe.
-Smokes marijuana – 2 to 4 X Monthly – sometimes more, sometimes less.
-Drinks ½ bottle of red wine Weekly, “to help [her] relax.”
-Eats “Mediterranean” and greasy, processed food.
-Swims 2-3 times per week plus walks ½ hour per day if energy and weather good
Symptoms: Severe lower abdominal pelvic pain and tenderness one week prior and during first day of menses – accompanied extreme irritability, easily angered (i.e. “I feel bitchy and mean and I just don’t care…”), aching lower back and hips at hip bone area (“…feels like a tight belt squeezing me…”).
Pain described as sharp, and radiates through to the lower hip. Pain slightly better with warmth, but not nearly relieved, and dislikes pressure. Menstrual cycles average 28 days, moderate in amount, and duration of menses is 4 -6 days. Prior to menses she has painful breast distention, “tightness” under her rib cage (“It’s difficult to take a deep breath.”), and fullness and bloating in lower abdomen/pelvic area. During menses she has dark red blood throughout, and passes 2 – 3 inch blood clots in first several days.
The first day of her menses is extremely painful (“I just stay home in bed and eat Advil…” ). Menstrual pain is about 70% relieved usually after the second day of her menses, and clotting is mostly gone. Reports that menses and Pre-Menstrual Tension (PMS) are worse during months when feeling stressed (i.e. work) or tired. Gets headaches and fatigue off and on, especially with stress.
Also reports regular bouts of mild depression, but feels it is not a problem. Urination normal. Stools slightly loose at times, especially under stress or fatigue. Body temperature normal. Normal to pale complexion. Voice “groaning.” Bitter taste in mouth “sometimes” when wakes up. “Shen” is a little dull. Sleep okay (6 -7 hours).
Palpation: Bilaterally Wiry, Slightly Deep (a little uneven, but not quite “Choppy.”)
Observation: Tongue: Dull, Slightly Purple tongue with spots, redder rides that are swollen and very scalloped.
Thin-white tongue coat. Sublingual veins very dark purple and distended.
OM Diagnosis: Qi Stagnation and Blood Stasis with Underlying Sp Qi Xu
Treatment Principle: Treatment Principles:
-Soothe the LV, Break up Qi Stagnation to Stop Pain
-Invigorate the Blood, Relieve Blood Stasis
-Open & Regulate the Chong Channel
-Boost the SP Qi
Point Prescription: SP4, SP 6, LI 4, SP 8, SP10,LV 3, ST 36, Ren 2, Zigong (Extra)
Herb Prescription: Raw Herbal Formula
Ge Xia Zhu Yu Tang (Driving Out Blood Stasis below the Diaphragm Decoction) with modifications
Dang Gui 3 qian
Chuan Xiong 3 qian
Xue Jie 1 qian
Chi Shao 3 qian
Tao Ren 3 qian
Gan Cao 2 qian
Hong Hua 2 qian
Zhi Ke 3 qian
Xiang Fu 3 qian
Yan Hu Suo 4 qian
Wu Ling Zhi 3 qian
Wu Yao 3 qian
Mu Dan Pi 3 qian
Modifications:
Zhi Ru Xiang 2 qian
Zhi Mo Yao 2 qian
Xia Ku Cao 5 qian
Chai Hu 3 qian
Ju He 3 qian
Ren Shen 5 qian
Huang Qi 5 qian
Lifestyle Prescription: The patient was recommended acupuncture treatment twice a week for three weeks initially. After the third week, she was expected to have her treatments reduced to once weekly, but this would depend on her progress. She was prescribed the Herbal Prescription Ge Xia Zhu Yu Tang with modifications (please see below for details), and acupuncture.
During the first session it was suggested that she consider reducing her intake of greasy, fatty foods and alcohol to assist in the body’s conservation of energy (preserve Sp Qi) and to reduce the perpetuation of stasis.
It was explained how greasy foods and alcohol clog the body system (i.e. digestion and energy), and she agreed to try. She also agreed to limit swimming to warm weather only.
As well, it was suggested that she consider not smoking marijuana as it too clogs the body system. She felt that this was something she would not give up unless the pain was more significantly reduced. It was suggested she keep a diary of her energy, emotional state and the level of pain and PMS she experienced during her menses.
Results: The patient agreed to and complied with the proposed Treatment Plan of acupuncture treatment twice a week for three weeks. She also made efforts to reduce clogging foods and alcohol in her diet, and began a diary charting emotional state, and PMS symptoms and pain during menses.
During the first three weeks of treatment, her acupuncture was initially the same as her first visit. There were a few adjustments on week three, in that she had a Wind-Cold as well, and we added: GB 20 (Wind Cold), Lu 7 (Luo), and UB 12 (Release the Exterior). At end of week three, she had had another menses, and her pain rated “5 to 6” on scale of 1 to 10. Patient felt this was a great improvement.
Her state of “Shen” was notably improved, and her state of mind hopeful.
Based on her good progress, after week three her treatments were reduced to once weekly. She receive acupuncture and herbal medicine weekly for the next several months, making even more improvement. At her third month (week 16), her PMS was also greatly reduced her menstrual pain had subsided to a “2-3” on a scale of 1 to 10. At this point her formula was modified to include: Shu Di Huang (2 Qian) and the Chai Hu and Ju He and Xia Ku Cao were removed. The thinking was that now that the breast distention and PMS was so greatly reduced, the other Qi moving, stagnation prevention herbs would be sufficient. The Shu Di Huang would now further nourish the blood, now that some of the stasis was relieved, there was less concern with it’s cloying.
By week 20 the patient reported feeling significantly better. Her “mild depression” had also lifted, noting that now that she felt better, she realized it had been affecting her much more than she thought. Her state of Shen appeared “bright” and her hair shiny, face with good color, Tongue was medium pink (no longer purplish), with only slightly swollen sides (no red, no prickles) but no scallops, and pulse moderate, slightly slippery at SP position. She had also started exercising and lost 6 lbs, and felt good about this. She had also decided to quit smoking marijuana altogether.
Patient scheduled to return for M.D. exam in two weeks. Is excited to report progress to M.D.
Synopsis: The patient’s progress towards her goal of reducing pms and pain at menses was evident weekly, unlike more typical patients whose progress had ups and downs. The treatment plan was adhered to fairly well, with both acupuncture and formula prescriptions needing very little modification. The patients progress led her to be inspired to implement the daily lifestyle changes that would support her reducing Qi stagnation, remove the blood stasis and boost her qi more long term. This added to the general effectiveness of treatments. It also gave me a good general outline for treating this common set of patterns. Overall, this was one of the more successful cases I’ve observed.
Name: Cristina R. de La Mar
Credentials: M.S., L.Ac., Certified Detox Specialist
Clinic Name: Grace Point – Acupuncture, Herbal Medicine & Body Therapy
Street address: 19 W. 21st Street, Suite #904
City: New York
State: N.Y.
Zip: 10010
Country: USA
Phone 1: (917) 210-1063
Email: gracepointacu@aol.com
Specialties: General Practice, Preventative Medicine/Fitness, Certified Detox Specialist. Additional Experience in Oncology, Family Medicine, Chronic Illness
Website: www.gracepointacupuncture.com
Last modified: September 8, 2009 
Posted in: Gynecological
