Acupuncture Treatment of Dysmenorrhea

| March 1, 2010 | 0 Comments | 498 views

Case History
Ms. Wang, a university student aged 2l years, paid her 1st visit on Aug. l6, l998, with the chief complaint of dysmenorrhea for one year. The patient complained that in the summer of l989, one day during her menstrual period when she walked in rain thus got cold. Later, she swam in cold water several times, leading to dysmenorrhea. In the past year when her menstrual period came, she would have unbearable sharp but cold pain in the lower abdomen two days before the menstruation started. The pain would be somewhat relieved by warmth. During menstruation, the bleeding was scanty and dark with clots. Gynecological examination revealed that the size, location and movement of the uterus were all normal. She had been treated with western medicine to no avail. Therefore, this time she came to us for treatment. Examination showed that the patient was of medium height and well-developed but with sickly complexion. Her blood pressure was ll5/70 mmHg, heart rate 80 bpm, and regular X-ray examination revealed normal heart and lungs. TCM examination showed a cold and tenderness in the lower abdomen with several tender points along the courses of the Spleen and Liver meridians at the medial sides of both legs, the tongue coating white-sticky and the pulse deep-wiry.

Discussion
Dr. Wu: Let’s analyses the case on the basis of her history.
Dr. Zhang: I think this is a case of dysmenorrhea due to stagnation of cold and
dampness. Her walking in rain and swimming in cold water constitute the causative factor for the invasion of cold and dampness into the body which stay in the uterus, leading to the stagnation of Qi and blood in the uterine collaterals, hence the pain. By location differentiation, it should be in the uterus. In view of its clinical manifestations, cold-pain in the lower abdomen during the menstrual period, which responds to warmth is the sign of cold; while white-sticky tongue coating is the sign of dampness; and pain with tenderness belongs to the excess syndrome.

Dr. Li: I share the same view with Dr. Zhang. I only wan to add two points. One is about menstruation. As has been differentiated by Dr. Zhang, this case is due to stagnation of pathogenic cold-dampness in the uterus. The pathogenic cold results in restrained flow of Qi and blood, thus scanty menstruation occurs, whereas stagnated coldness contributes to the formation of blood clots. Another point is about the pulse. Deep pulse indicates the disorder in the interior while wiry pulse usually indicates disorder of the liver and various types of pain (in this case the abdominal pain). Here, I would like to ask two questions. One is that as dysmenorrhea tends to appear before, after or during the menstrual period, what is the clinical significance of its occurrence at different time? The other question is, how to explain the obvious tender points along the medial sides of the patient's legs.

Dr. Wang: I agree with the analyses by both of you. I am not so clear either about
Dr. Li's two questions. Dr. Wu, would you please explain to us?

Dr. Wu: First of all, I should say that you've given objective and exact analyses of this case. The questions raised by Dr. Li are of universal significance, and I would like to answer them one by one.
First, the time of dysmenorrhea: Generally speaking, dysmenorrhea lasts the whole period of menstruation, but specific individuals vary in time. Clinically, dysmenOrrhea occurring before or during the menstrual period often belongs to the excess syndrome, whereas that after the period belongs mostly to the deficiency syndrome. The causative factors for the excess syndrome of dysmenorrhea are stagnation of Qi and blood stasis, and stagnation of cold in the uterus, affecting the normal flow of menstrual blood, and resulting in the pain during the menstrual period. In the excess syndrome, lower abdominal distending pain before or during the menstrual period is mostly due to stagnation of Qi and blood stasis, while lower abdominal cold-pain which can be somewhat relieved by warmth is mostly due to stagnation of cold. Of course, in our clinical practice, differentiations should also be based on other clinical manifestations. The lower abdominal dull pain during or after the menstrual period which can be slightly relieved by pressing, with a pale complexion, weakness, light-red and scanty menstrual bleeding, white tongue coating, and thready-weak pulse are often caused by deficiency and loss of Qi and blood failing to nourish the uterine collaterals. The case we are discussing now belongs to the excess syndrome due to stagnation of cold in the uterus.
Second, the question about the tender points along the lower limbs: tender points are also called reaction points. According to TCM theory, when a certain organ of the human body is in disorder, it may have reactions in the corresponding part on the body and disorders of different organs have different reaction points. Clinically, reaction points can often be found on the back or along the courses of meridians corresponding to the Zang-Fu organs. Doctors may try to find these reaction points by means of palpation so as to help make diagnosis. Menstruation is related to the Chong and Ren meridians both of which originate in the uterus and connect with the three Yin meridians of the foot in the abdomen. In case of irregular menstruation, certain reaction points may be found along the courses of the Liver, Spleen, and Kidney meridians. What about the treatment principle and prescription for this case?

Dr. Wang: I think the principle of treatment should be based on differentiations. Since this case is induced by stagnation of cold in the uterus, the treatment should be aimed at clearing away cold and dampness with warmth to promote a free flow of blood and to check pain. Acupuncture and moxibustion can be applied in combination. The prescription: Zhongji (CV 3), Shuidao (ST 28), and Sanyinjiao (SP6). Analysis: Zhongji (CV 3) is a point on the Ren meridian connected with the uterus (moxibustion on it can give the effect of promoting a free flow of Qi in the uterine collaterals), and Shuidao (ST 28) is a point on the Foot Yangming meridian which is connected with the Chong meridian, therefore, the combined use of Zhongji (CV 3) and Shuidao (ST 28) can give the effect of checking pain by warming the meridians. Sanyinjiao (SP 6), a point on the Spleen meridian, can not only exert the effect of strengthening the spleen to eliminate dampness, but also regulating the flow of blood and checking pain.

Dr. Li: I agree with Dr. Wang's opinion on the treatment principle and point prescription. Here, I would like to add some other points to his prescription. Points Hegu (LI 4) and Taichong (LR 3) can be added to enhance the pain-checking effect. Besides, Ashi points located near point Diji (SP 8) can be selected too.

Dr. Zhang: I think auricular points can be used in combination, such as Uterus, Endocrine, Sympathetic Nerve, Kidney, Liver and Spleen.

Dr. Wu: After hearing your discussion as well as your proposals, I have got a comprehensive view in terms of the treatment principle and methods. Now I have two points to add here. One is the time and length of treatment for dysmenorrhea. Since
dysmenorrhea is characterized by periodic pain, corresponding measures of treatment
should be taken. Generally acupuncture treatment starts one week before menstruation
starts, once every other day 20 minutes each time until the end of menstruation. The
treatment continues twice a week after menstruation finishes, altogether 5 treatments
for each menstrual cycle. Then, the same treatment starts again one week before the coming menstruation. The treatment is usually given for 3 menstrual cycles. The second point is that doctors should tell the patients to pay attention to menstrual hygiene and avoid eating cold and raw food. Pathogenic cold and dampness may directly invade the Zang-Fu organs because of intake of cold and raw food or hands and feet being soaked in cold water. It is particularly easy for pathogenic cold to invade the abdomen through the three Yin meridians of the foot. Other pains may also be caused due to invasion of cold into the human body which blocks the meridians and affects a free flow of Qi and blood.

Treatment and Results
The above-mentioned acupuncture therapy was applied, with the uniform reinforcing-reducing method adopted for point Zhongii (CV 3) and Shuidao (ST 28), and moxibustion were also given. The reducing method was used for Sanyinjiao (SP 6), Hegu (LI 4), Taichong (LR 3), and the Ashi points on the lower limbs. Aricular seed-embedding therapy was used in combination. Beginning from Aug. 16 (the day When she paid her first visit), the patient was treated three times. When her menstrual period began, she felt much relieved from pain. Another two treatments were given after the period. The same treatment began on Sep. l1, seven days before the second cycle of menstrual period. After treatment for 5 menstrual cycles, the patient's pain was completely checked. Another 5 treatments were given for consolidation. Follow-up given half a year later showed no recurrences.

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