Dysmenorrhea refers to the pain in the abdomen or lower back, or even pain in the lumbar sacral region, which occurs during and around the menstrual period of women. It occurs every time with the menstrual cycle, and in severe cases, it can be accompanied by nausea and vomiting, cold sweat, cold hands and feet, and even fainting, which affects work and life. At present, it is often categorized into primary and secondary dysmenorrhea. Primary dysmenorrhea refers to those who have no obvious lesions in their reproductive organs, so it is also known as functional dysmenorrhea, which is mostly seen in adolescent girls, unmarried and married people who have not had children. This kind of dysmenorrhea can be relieved or disappear after normal delivery. Secondary dysmenorrhea is often caused by organic lesions of the reproductive organs.

Aetiology and epidemiology:

Primary dysmenorrhea occurs in addition to physical and mental factors, mainly related to the patient's secretory period of endometrial prostaglandin (PG) F2α content is too high. Therefore, dysmenorrhea often occurs in the menstrual cycle with ovulation.

This disease is a common gynecological clinical disease, according to the 1980 National Women's Menstrual Physiological Constants Collaborative Group survey, the incidence of dysmenorrhea is 33.19%.

Modern medical pathology:

PGF2α is synthesized within the endometrium in the secretory phase under the action of progesterone, and its receptor is in the uterine muscle wall; when the endometrium is broken during menstruation, PGF2α is released, stimulating the uterine muscle to contract strongly, increasing the pressure in the uterus, decreasing the local blood flow, and ischemia, hypoxia, thus causing pain. In addition, the narrowing of the cervical canal, the uterus is overly tilted, resulting in poor outflow of menstrual blood, can also cause dysmenorrhea.

Chinese medicine etiology:

Chinese medicine believes that: women in the menstrual period and before and after menstruation, physiological changes in the blood and qi of the Chong Ren is more than the usual rapid changes, at this time, if the sense of disease or potential causes of disease and qi and blood related to the Chong Ren, the uterus, the blood and qi operation is not smooth, then the "not through the pain"; or to the Chong Ren, the uterus is lost in the moistening, and the "not glory is pain". Dysmenorrhea is mostly due to emotional injuries. The six obscenities are harmful, resulting in the blockage of Chongren, or due to the lack of essence and blood, the cells and veins are not moistened due to.

Clinical manifestations:

1. Abdominal pain: generally appear a few months after menarche, characterized by pain hours before the onset of menstruation, the beginning of menstruation pain gradually or rapidly intensified, paroxysmal lower abdominal cramps, distension, pain, and radiation to the lumbar-sacral area, the inside of the femur, and the vagina, anus. The pain usually lasts for several hours or even 1 to 2 days. Later, the pain gradually reduces or even disappears. When the abdominal pain is severe, it may be accompanied by pallor, cold sweat, cold hands and feet, and even produce symptoms such as syncope and collapse.

2. Gastrointestinal symptoms: such as nausea, vomiting, diarrhea and intestinal flatulence or intestinal cramping pain. Usually lasts for several hours, and after l to 2 days, the symptoms gradually reduce and disappear.

Diagnosis:

Diagnostic criteria for dysmenorrhea:

1. Severe lower abdominal pain and lumbago during or around the time of menstruation, which affects work and life.

2. Primary: dysmenorrhea since the first menstruation, and those with severe pain are bedridden and unable to work. There is no obvious abnormality in gynecological examination, and the uterus is slightly underdeveloped and smaller. Mostly seen in unmarried and childless people.

3. Secondary: caused by organic lesions of the reproductive organs, commonly seen in pelvic inflammatory disease, endometriosis and so on.

Laboratory examination:

1. Gynecological examination: there is no obvious abnormal lesion of the pelvic reproductive organs, and sometimes it can be seen that the cervical opening is narrow, and the uterus is excessively tilted and flexed.

2. Basal body temperature is measured with a biphasic curve.

3. Menstrual blood prostaglandin measurement: shows an abnormal increase.

Differential diagnosis:

Western medicine:

1. Endometriosis: its dysmenorrhea is characterized by secondary and progressive aggravation, and it occurs most often in women between 30 and 40 years old. Gynecological examination is often in the uterine rectal depression and uterosacral ligament to find one or several tender hard nodules or masses. The nodule increases in size or new nodules appear during menstruation. In addition, direct biopsy and laparoscopy can mostly confirm the diagnosis.

2. Abdominal pain due to obstruction of menstrual blood drainage: the abdominal pain is characterized by cyclicity, accompanied by menorrhagia or even amenorrhea. Common in congenital vaginal malformation; cervical surgery scar formation, so that the cervical opening narrow or even atresia; abortion or scraping rough operation, resulting in the cervical canal and the uterine cavity adhesion. The diagnosis can be clarified by taking medical history and gynecological examination.

Chinese medicine:

1. Pelvic inflammatory disease: pain in the right and left lesser abdomen that refuses to be pressed, mostly accompanied by fever, leukorrhea, not characterized by cyclic episodes.

2. Menstrual epistaxis: pain in the lower abdomen, mostly accompanied by periodic epistaxis or epistaxis, and menstrual flow is reduced or not working, etc..

3. Ectopic pregnancy: there may be a history of menopause, a small amount of blood in the vagina, tearing pain in the lower abdomen on one side of the protruding side, obvious pressure and rebound pain in the abdominal examination, and a positive hypospadias test.

4. Abortion: there is a history of menopause and early pregnancy reaction, vaginal bleeding and abdominal pain is often seen in the embryo discharge, urine gestational test positive or weak positive.

Modern medical therapy:

The treatment of this disease, the current use of steroid hormone drugs to inhibit ovulation, and prostaglandin antagonists, antispasmodic and analgesic drugs, these methods can be effective, but hormone drugs are easy to interfere with the normal menstrual cycle, leading to menstrual disorders, and the latter half-life is short, efficacy can not be sustained, and not yet reached the goal of the root cause.

I. General treatment

1. For patients with dysmenorrhea, especially adolescent girls, they should be patiently told about the physiological knowledge of menstruation, so that they understand that menstruation is a physiological phenomenon during the development of sexual maturity, and that during menstruation some physiological changes, such as mild lumbar pain, abdominal cramps, etc., will take place to eliminate their fears and anxieties.

2. Pre-menstrual and menstrual period should avoid mental tension and labor and feeling cold.

3. For those who are physically weak, they should increase their nutrition and pay attention to exercise to enhance their health.

Two, symptomatic treatment

1. Analgesic, antispasmodic: in order to prevent the onset of dysmenorrhea, in the menstrual period 12 to 24 hours before the onset of oral antispasmodic analgesic drugs. Mild dysmenorrhea can be oral pain tablets or codeine phosphate 60mg; severe dysmenorrhea patients can be subcutaneous injection of atropine sulfate 0.5mg. In addition, barbiturates are also effective for dysmenorrhea.

2. Sedation: For patients with severe dysmenorrhea accompanied by nervousness and emotional instability, a small amount of chlorpromazine can be given orally.

Three, endocrine therapy

1. estrogen therapy: for uterine dysplasia and low menstrual flow. Generally used 0.5 ~ 1mg of estradiol, in the sixth day of menstruation began to take orally, once a night, renewed for 20 days, with three menstrual cycles. The purpose of this method is to inhibit ovulation and prevent the occurrence of the next dysmenorrhea. The disadvantage is that some patients may experience nausea, vomiting, etc. Vitamin B6 can be given orally at the same time to minimize the reaction.

2. Progesterone therapy: the purpose is to inhibit the pituitary function to prevent ovulation, thus eliminating the symptoms of dysmenorrhea. Commonly used norethindrone (gynecological tablets), norethindrone or methylgestrinone (progesterone) 4 to 8 mg per day, orally. It is taken for 20 days starting from the 5th day of menstruation for three consecutive menstrual cycles. Most patients are free of dysmenorrhea for six months after stopping the drug.

3. Oral contraceptive therapy: use contraceptive pill Ⅰ (compound norethindrone tablets) or Ⅱ (compound medroxyprogesterone tablets), on the fifth day of menstruation, every night oral 1 ~ 1.5 tablets, for 22 days. Symptoms can be reduced in the first month after treatment, and the effect is more significant from the second month onwards.

Four, prostaglandin antagonists

naProxen for a prostaglandin antagonists, for married women usually available naProxen sodium 275mg, vaginal administration, 1 hour later, can be painless. Oral anti-inflammatory pain can also be taken, 25mg once, two to three times daily, starting on the first day before menstruation and continuing until the second or third day of menstruation. In addition, you can also take acetylsalicylic acid 0.3g, methyl chloroform 250mg, the same way as anti-inflammatory pain.

V. Surgical treatment

1. Dilatation of the cervix: for patients with cervical stenosis, the cervical canal is dilated with instruments to facilitate the smooth flow of menstrual blood.

2. Uterine suspension surgery: If the uterus is extremely tilted backward and flexed, by the above methods, the effect is not obvious, it is feasible to use this method. It is beneficial to the flow of menstrual blood to reduce menstrual cramps, and at the same time helps conception, the long marriage infertility can be considered for the implementation of this operation.

3. Presacral neurectomy: It may be appropriate for patients with severe dysmenorrhea who cannot tolerate ovulation inhibitors or have contraindications.

The main evidence of dysmenorrhea is the pain in the abdomen that accompanies the menstrual cycle. Therefore, the attributes of the pain should be identified first, and according to the time, nature, location, and degree of the pain, combined with the period of the menstruation, color, quantity, quality, concurrent symptoms, tongue, pulse, and the patient's physical condition to identify the cold, heat, deficiency and solidity of the menstruation. For example, if the menstrual blood is small in quantity, thick in texture and lumpy, and the pain occurs before menstruation, it is mostly real; if the menstrual blood is small in quantity, dark red in color and thin in texture, and the pain occurs after menstruation, it is mostly imaginary; if the pain is shooting, cramping, burning, stabbing, and refuses to be pressed, it is real; if the pain is hidden, XIU pain, crushing pain, and likes to be rubbed and pressed, it is imaginary. In addition, the abdominal pain of intestinal carbuncle, obstruction in the abdomen, stomach and epigastric pain, etc., can also occur during menstruation or be aggravated during menstruation. Therefore, when the symptoms, need to be detailed clinic and based on auxiliary means to identify.

1. Qi stagnation and blood stasis

Substantive evidence: abdominal distension and pain one or two days before or during menstruation, refusing to be pressed, small amount of menstrual blood, or poor discharge, the menstrual blood is purplish and dark and there are lumps, and the pain is relieved by discharging of the blood clots; the chest, breasts, and abdomen are swollen; tongue is purplish and dark, and there are petechiae along the edge of the tongue; the pulse is heavy and stringy.

Treatment: activate blood circulation and eliminate blood stasis, move Qi to relieve pain.

Prescription: blood circulation and blood stasis soup plus reduction. Angelica tail 10g, chuanxiong 10g, peach kernel 15g, safflower 15g, hyssop 10g, yuanhu 15g, xiangsui 10g, wu yao 15g. if both bitter mouth, moss yellow, menstruation prolongation, menstrual blood dark and thick, for the liver depresses the heat of the phenomenon, add gardenia 10g, xiakucuo cao 10g; if you see the chest tightness and nausea, for the spleen of the liver department, add jiaojiaojiao 15g, poria 15g, chen pi 15g.

2.

2. Cold condensation in the uterus

(l) Yang deficiency and internal cold

The main evidence: cold pain in the abdomen during or after menstruation, like to press, and the pain is reduced by heat, the amount of menstruation is small, the color is dark and pale, the waist and legs are aching and weak, the urine is clear and long, the moss is white and moist, and the pulse is sunken.

Treatment: warming menstruation and dispersing cold, warming the uterus and relieving pain.

Prescription: warm menstruation soup plus reduction. 10g of Cornus officinalis, 10g of fennel, 15g of cinnamon sticks, 15g of angelica sinensis, 20g of white peony, 10g of Colla Corii Asini, 10g of licorice, 10g of jujubes, 3g of fine pungent extracts, 10g of eucommia seeds, 5g of epimedium, and 15g of eucommia seeds for those who suffer from soreness of waist and legs; 15g of eucommia seeds for those who suffer from low menstruation; 15g of safflower for those who suffer from low menstruation.

(2) Cold and dampness stagnation

Main symptom: cold pains in the abdominal area prior to or during the period. Cold pain in the abdomen before or during menstruation, pain decreases with heat, pain is severe when pressed, menstrual flow is small, dark and lumpy, nausea and vomiting, fear of cold, loose stools, white and greasy moss, and a sunken and tight pulse.

Treatment: Warming the menstruation, dispersing cold and removing dampness, promoting blood circulation and regulating qi to stop pain.

Prescription: Shaogangxue Yu Tang plus reduction. Angelica sinensis 15g, red peony 15g, chuanxiong rhizoma 10g, meat hanging 10g, ginger 15g, fennel 10g, yuanhu 15g, wulingzhi 15g, pohuang 15g (separate package), neem 10g, poria 15g, half-sia 10g, atractylodes macrocephala 15g, and lumbago, plus chuanjian breaks 15g, eucommia 15g.

3. Dampness-heat downstream

Substantiating evidence: pre-menstrual, menstruation, menstruation. Abdominal distension and pain, heavy menstrual flow, red color, thick or lumpy, weekday yellowish or foul smell, red tongue with yellowish greasy moss, stringy pulse.

Treatment: clearing away heat and dampness, resolving blood stasis and relieving pain.

Prescription: clearing heat and regulating the blood Tang Plus Reduction. White peony 15g, Chuanxiong 10g, Angelica sinensis 15g, Dampy 15g, Huanglian 10g, Radix Rehmanniae Praeparata 15g, peach kernel I5g, safflower 15g, Yuanhu I5g, Hongteng I5g, Semen Coix lacryma I5g, Atractylodes Macrocephala 15g, Poria cocos 15g. For abdominal distension and pain, add Yuanhu 15g, Neem 15g, and if the bandage is yellowish in color, add Plantago Ovatae 15g.

4.qi/blood Weakness

Substantiation: during or after menstruation, hidden pain in the abdomen, like rubbing and pressing, menstruation is light in color and low in quantity, thin in quality, accompanied by fatigue and weakness, pale face, pale tongue, thin moss, and weak pulse.

Treatment: benefit qi, tonify blood and relieve pain. Hidden pain in the abdomen after menstruation, lumbar pain, small amount of menstrual blood and thin, the color of menstruation is dark, or there is dizziness and tinnitus, the abdomen is empty and not warm, the tongue is pale, the moss is thin and white, and the pulse is thin.

Treatment: benefit the kidney and nourish the liver to relieve pain.

Prescription: tonifying the liver soup plus reduction. Radix Angelicae Sinensis 15g, Radix Paeoniae Alba 20g, Cornu Cervi Pantotrichum 15g, Rhizoma Dioscoreae 25g, Chuanjian Breaks 15g, Ba Ji Tian 15g, if there is hot flashes at the same time, add Artemisiae argentatae 10g, turtle shells 15g, Dibasilariae chinensis 10g; if there is empty and cold in the abdomen, add Radix Pseudostellariae japonica 10g; if there is abdominal pain and lumbosacral pain, and if the nocturnal urinary frequency is frequent and clear and long, add Yi Zhi Ren 15g, cuttlebone 30g.

Prescriptions:

1, Motherwort ( Dried) 30g, hawthorn 30g, saffron 10g, brown sugar appropriate amount. Water decoction. Applicable to blood stasis type dysmenorrhea.

2. 12g of mugwort leaves, 30g of brown sugar, 12g of fragrant ferns, 3 slices of ginger, water decoction, 1 dose / day.

3. Sunflower disk 60g, brown sugar 30g, water decoction, 1 dose / day.

4. Dysmenorrhea: cinnamon 3g, angelica 10g, trigonelline 10g, curcuma 10g, saffron 10g, salvia 10g, 10g, 10g, 6g, 10g, 10g, the above medicines are made of punch, each dose is divided into 2 sachets, 10g per bag, 2 days before the menstruation, 2 times a day, each time 1 bag of punch, continue to menstruation to 3 days after the stop taking, even served for 3 menstrual cycles as a course of treatment. The course of treatment is 3 menstrual cycles in a row. It is suitable for dysmenorrhea of qi stagnation and blood stasis type.

Chinese medicines:

1. Shaobinghu Pill: It has the function of activating blood circulation, removing blood stasis, warming menstruation and relieving pain, and is used to treat menstrual cramps caused by cold condensation and blood stasis. Take 1 pill each time, 2-3 times a day orally.

2. Regulate menstruation and activate blood circulation tablets: have the effect of soothing the liver and relieving depression, promoting blood circulation, regulating menstruation and relieving pain. It can be used to treat dysmenorrhea caused by liver depression and Qi stagnation. Each time 5 tablets, 3 times a day, orally.

3. Women's menstrual cramps pill: has the effect of activating blood circulation and removing blood stasis, regulating menstruation and relieving pain. It is suitable for dysmenorrhea caused by stagnation of qi and blood. 6g per dose, 2 times a day orally.

Acupuncture and massage therapy:

1. Body acupuncture:

(1) Acupuncture points: zhongji, diji, jiros, qi stagnation and blood stasis add taichong, sea of blood; cold congealed in the middle of the cell, add shui dao, guanyuan; dampness and heat downstream add ququan, yanglingquan; qi and blood weakness, add spleen yu, foot three li; liver and kidney deficiency report add kidney yu, liver yu, foot three li. The solid evidence with diarrhea, deficiency needle with flat tonic flat diarrhea method.

(2) Take Guanyuan, Sanyinjiao, Diji, and Guilai. Use diarrhea for solid evidence, tonic plus moxibustion for deficiency evidence, and moxibustion or fire cupping after needling for cold evidence.

(3) seventeen vertebrae: L5 spinal protrusion, straight stab about 1.5 inches, leave the needle for 15-20 minutes.

2. Auricular acupuncture treatment:

(1) Acupuncture points: the main points are taken from the internal genitalia, endocrine, edge of the middle, Shenmen, boat angle; supporting points are taken from the sympathetic, liver, kidney, subcortical. Treatment begins 1 week before menstruation, 1 time per day, each time one side of the ear point, alternating between the two ears, treatment until menstruation clean.

(2) Take the uterus, sympathetic, endocrine, screen, brain, and lumbar and abdominal areas, 2 to 3 points/times, medium-strong stimulation, and leave the needle in place for 15 to 30 minutes.

3. Massage:

Massage therapy: mo qihai and guanyuan for 6 minutes each, knead for 2 minutes, roll and press kidney yu and baosao for 4 minutes each.

Other therapies:

(I) Dietary therapy

1. Ai Ye Japonica Rice Porridge: 40g of fresh Ai Ye (halved in dry form), 50g of Japonica Rice, and an appropriate amount of brown sugar. First of all, the mugwort leaves and water decoction, take the juice of 500ml, and then wash the round-grained rice, into the juice, to the fire boil, add brown sugar, stir, and then use the fire to cook until the rice is rotten and soup thick degree. From 3 days after the menstrual period to serve, about 3 days before the next menstrual period to stop serving, 2 times a day, morning and evening on an empty stomach, warm food, suitable for cold dysmenorrhea.

2. Hawthorn wine: Hawthorn 500g (dry product halved) core, washed, chopped, put into bottle, add 60 degree high quality white wine 300ml, soak for 10~15 days, shake 3~5 times a day. Start to take 2 days before menstruation, twice a day. Each time 10 ~ 20ml, served for 7 days, for qi stagnation blood stasis type dysmenorrhea.

(B) dysmenorrhea medication hot pack

Chuanwu, Xu Changqing, Ai Ye, Lingxian, safflower, ice, will be crushed into a fine powder to join the heating agent, mixing, the right amount into a non-woven composite bag, immediately seal, and then into a composite plastic bag, sealing that is obtained. When used to cut open the plastic outer bag, remove the inner bag gently rub or shake several times, fixed in the lower abdomen, 10 minutes later, the fever temperature of 40 ~ 70 ℃, can last 36 ~ 48 hours, 3 months for 1 course of treatment.

Therapeutic principles:

For the treatment of dysmenorrhea, Western medicine emphasizes analgesia, sedation, and prostaglandin inhibitors for treatment, which is fast, but with big side effects, and the effect is difficult to last. The Chinese medicine is based on the overall concept, the identification of the treatment, although the speed of pain is not as fast as Western medicine, but after a period of systematic treatment, can be expected to be cured.

The first diagnosis of the patient, after the diagnosis is established, should advocate the first use of traditional Chinese medicine for diagnosis and treatment of severe dysmenorrhea patients, the acute phase of the use of acupuncture and moxibustion therapy or appropriate to give spasmolytic, analgesic drugs; at the same time with the treatment of traditional Chinese medicine. According to the domestic Chinese medicine pharmacological research shows that: many blood circulation and eliminate blood stasis medicine has a significant inhibition of prostaglandin Fα activity and antispasmodic effect, for this reason, the identification of evidence and identification of the disease is fully integrated, can also achieve good results. If the treatment of three menstrual cycles, the effect is still not significant, can also be added with prostaglandin antagonist treatment.

Because of the severity of dysmenorrhea and diagnostic criteria, it is difficult to determine through the patient's subjective feelings. For this reason, Sun Ningquan et al. took the lead in detecting PGF in endometrium and menstrual blood before and after treatment of dysmenorrhea as an objective indicator to measure the therapeutic effect of traditional Chinese medicine. In addition, pelvic blood flow charts, nail wrinkle microcirculation and blood rheology and other related indicators have been used as an objective basis for TCM treatment of dysmenorrhea.

The treatment is based on regulating qi and blood, and according to the different types of symptoms, it is necessary to move qi, activate blood, disperse cold, cool the blood, replenish the deficiency, or diarrhea the reality. The method of treatment is divided into two steps: regulating blood during menstruation to stop the pain and treat the symptoms, usually identify the cause and treat the root cause, and combined with the physical condition, or adjust the liver, or benefit the kidneys, or support the spleen, so that the circulation of qi and blood, menstrual blood flow, abdominal pain disappears. The treatment of dysmenorrhea always focuses on regulating qi and blood. If it is caused by cold, it is appropriate to warm it and pass it; if it is caused by heat, it is appropriate to clear it and pass it; if it is caused by qi stagnation and blood stasis, it is appropriate to move it and pass it; and if it is caused by emptiness, it is appropriate to replenish it and pass it. In addition, patients with dysmenorrhea, the clinical method of medication should also be used at the right time. That is, premenstrual or menstrual abdominal pain, more in the premenstrual 4 ~ 5 days before the start of the medication to welcome and take the blood 1 ~ 2 days after the drug can be discontinued; postmenstrual abdominal pain, it is appropriate to see the blood after the first day after the first day of the medication, and even served for 1 week, in order to supplement the seek through, so that the positive qi can be restored. During the intermenstrual period, it should be adjusted according to the patient's physical condition. This is a good way to achieve good results with three consecutive cycles of treatment.

Therapeutic effect and prognosis:

1. Cure: complete disappearance of menstrual abdominal pain and related symptoms.

2. Improvement: menstrual abdominal pain and related symptoms are relieved.