First Step in Treating Dysmenorrhea: Differentiating Deficiency, Excess, Cold, Heat, and Stagnation
In clinical practice, when treating dysmenorrhea in women, the first step should be differentiating deficiency, excess, cold, heat, and blood stasis. From clinical experience: deficiency-type dysmenorrhea is mostly functional and has high cure rate with traditional Chinese medicine; excess-type dysmenorrhea is often associated with organic changes such as uterine anteversion or retroversion, cervical stenosis, etc., and the significant effective rate of TCM treatment is relatively lower. The basic formula for treating dysmenorrhea is modified from Danggui Shaoyao San in "Golden Chamber," primarily using Danggui, Baishao, Yanhusuo, and Zhi Xiangfu, adding appropriate herbs based on cold, heat, deficiency, excess, or stasis. For deficiency: add Huangqi, Chuan Duan; for excess: add Muxiang, Chuanlianzǐ, Chuanxiong; for cold: add Muxiang, Xiaohuixiang, Su Geng; for heat: replace Baishao with Chishao, add Danpi; for blood stasis: add Puhuang, Wulingzhi; if stasis is obvious and warmth is preferred, use Shaofu Zhuyu Tang (Xiaohuixiang, Ganjiang, Yanhusuo, Zhi Moyao, Danggui, Chuanxiong, Guixin, Chishao, Sheng Puhuang, Wulingzhi) as primary formula, which can effectively warm the channels, relieve pain, and resolve stasis. For mild dysmenorrhea or patients unable to conveniently take herbal decoctions due to study or work, generally take Yimu Gao (patented Chinese medicine, available at pharmacies), which can regulate qi and blood and relieve pain. A 28-year-old woman, Ms. Wang, had suffered from dysmenorrhea for over a year and sought my treatment. She reported severe lower abdominal pain before menstruation, accompanied by lower back soreness and aversion to cold, especially noticeable coldness in the back. Her menstrual blood contained small dark clots. Examination revealed a smooth tongue coating and a taut pulse. Treatment focused on removing stasis and relieving pain: Sheng Puhuang 10g, Wulingzhi 10g, Ganjiang 5g, Danggui 12g, Xiaohuixiang 5g, Baishao 12g, Chuanxiong 9g, Zhi Xiangfuzi 12g, Zhi Moyao 5g, Yanhusuo 12g, Guizhi 8g. One dose daily, decocted for five days. During treatment, Shaofu Zhuyu Tang was combined with Zhi Xiangfuzi. After five doses, coldness dissipated, stasis resolved, and pain ceased. Although the tongue coating remained smooth, no yin-nourishing or fluid-producing herbs were used, but once stasis cleared and qi flow normalized, blood circulation improved, body fluids ascended, and the tongue coating gradually recovered.<dysmenorrhea>