Painful menstruation can arise from a variety of causes, including emotional factors, cervical or uterine abnormalities, cysts or tumors, or endometriosis. In traditional Chinese medicine, most patterns are variations on deficiency or stagnation of qi and blood.

When qi is more stagnant than blood, symptoms of premenstrual syndrome (PMS) and pain in the breasts, ribs, abdomen, and back can occur, along with a scanty menstrual flow with some clots. The treatment principle is to regulate qi, and the classic herbal formula for that is Xiao Yao Wan.

When blood is more stagnant than qi, symptoms include sharp abdominal pain that is relieved after the menstrual blood flow begins. The blood is darker than normal with dark clots. The classic formula for this pattern is Tao Hong Si Wu Tang ("Four Substance Decoction with Safflower and Peach Pit"). If the pattern is one of qi and blood deficiency, dull pain occurs after the menstrual flow is finished. The pain, which is relieved with pressure, may be accompanied by fatigue, pale face and tongue, dizziness, and a weak pulse. The standard formula to tonify qi and blood is Ba Zhen Tang ("Eight Precious Ingredients Decoction"). It is available as the patent remedy Nu Ke Ba Zhen Wan. In all cases of menstrual pain, Yan Hu Suo Zhi Tong Pian can be used along with the other herbs to help relieve the pain.

Acute menstrual pain can sometimes be relieved with just a single acupuncture treatment, depending on the severity of the underlying pattern of disharmony. If there is pain due to stagnation from cold, moxibustion also provides immediate relief. In chronic cases, it usually takes up to three months or more for the cycle to return to normal.

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ABOUT THE AUTHORS:

Bill Schoenbart has been practicing traditional Chinese medicine (TCM) since 1991, when he earned a Masters degree in TCM. He teaches TCM medical theory and herbalism at an acupuncture school in California, and also maintains a clinical practice.

Ellen Shefi is a licensed massage technician, licensed acupuncturist, and registered dietician. She is a member of the American Association of Acupuncture and Oriental Medicine, the American Herb Association, and the Oregon Acupuncture Association.