Xiangfa Luomengqu (Dysmenorrhea)
Overview
In Miao medicine, menstrual abdominal pain is referred to as Xiangfa Luomengqu. It is often caused by a deficiency of qi and blood, or poor personal hygiene. Women may experience lower abdominal pain during or around the time of menstruation, often radiating to the lower back. In severe cases, the pain may be intense enough to cause fainting. It is also known as Cuogajimengqu and Chaowomengqiu, and it corresponds to the concept of dysmenorrhea in traditional Chinese medicine.
In traditional Chinese medicine, dysmenorrhea refers to a disorder characterized by cyclic pain in the lower abdomen before or during menstruation. It may also involve pain radiating to the back or even cause syncope in extreme cases. It is also referred to as “menstrual abdominal pain.”
From the perspective of Western medicine, both primary and secondary dysmenorrhea are relevant here. Primary dysmenorrhea, also called functional dysmenorrhea, is not linked to any identifiable structural abnormality of the reproductive system. Secondary dysmenorrhea is usually related to conditions such as endometriosis, adenomyosis, or chronic pelvic inflammation.
Miao Medicine Classification
This condition is categorized as a minor illness and is classified into two subtypes: heat-type menstrual pain and cold-type menstrual pain.
Etiology
It is typically caused by a deficiency of qi and blood, or unclean personal hygiene habits. Pain occurs around the time of menstruation, spreading from the lower abdomen to the lower back. In severe cases, the pain may become unbearable and cause fainting.
Pathogenesis
The condition arises from a combination of factors, including poor hygiene, excessive sexual activity, weak physical constitution, and chronic illness that weakens the digestive system. In young, unmarried women, it often results from congenital deficiency. Menstrual pain in these individuals is primarily due to a lack of qi and blood, poor circulation, and stagnation caused by qi constraint.
Diagnostic Points
Diagnosis Criteria
Lower abdominal pain, distention, and backache occurring before or during menstruation.
Must exclude other causes of abdominal pain unrelated to dysmenorrhea.
Related Tests
Prostaglandin levels in the blood, particularly elevated PGF2α (Prostaglandin F2 alpha).
Ultrasound and laparoscopy may be performed to rule out structural abnormalities.
Differential Diagnosis
Chuo Daipézhu (Threatened miscarriage) can be differentiated by a history of missed periods, early pregnancy symptoms, and a positive pregnancy test. These patients may experience mild vaginal bleeding, lower abdominal pain, lower backache, and a feeling of heaviness. Gynecological exam reveals an enlarged and softened uterus appropriate to gestational age. Ultrasound can detect a gestational sac, embryo, or fetal heartbeat. In contrast, patients with dysmenorrhea have no history of missed periods or pregnancy symptoms, and no signs of pregnancy appear on pelvic imaging.
Syndrome Differentiation and Treatment
1. Heat-Type Menstrual Pain
Symptoms: Distending pain in the lower abdomen before or during menstruation, often with scanty and dark purple menstrual blood, clots, breast tenderness, chest tightness, lower abdominal burning pain extending downward, prolonged periods, yellow foul-smelling vaginal discharge, low-grade fever, and dark urine.
Syndrome Type: Heat-related pattern.
Treatment Principle: Promote blood circulation, resolve stasis, regulate qi, and relieve pain.
Prescription:
Jialao Geique (Motherwort, yi mu cao) 15g
Yangjie Ga (Spatholobus stem, ji xue teng) 15g
Gadou Loulie (Peach kernel, tao ren) 12g
Yangsong Ba (Cyperus rhizome, xiang fu) 12g
Gangsou Zha (Leech, shui zhi) 8g
Explanation:
Motherwort (yi mu cao): Cold in nature, bitter in taste. Activates blood and resolves stasis, regulates menstruation, reduces water retention.
Spatholobus stem (ji xue teng): Warm in nature, sweet and slightly bitter. Nourishes blood and regulates menstruation.
Peach kernel (tao ren): Cold, bitter. Promotes blood circulation and unblocks meridians.
Cyperus rhizome (xiang fu): Warm, acrid and slightly bitter. Regulates liver qi and relieves pain.
Leech (shui zhi): Cold, salty and bitter. Dispels blood stasis and unblocks menstruation.
The combination of herbs promotes circulation, regulates menstruation, and alleviates pain.
2. Cold-Type Menstrual Pain
Symptoms: Dull lower abdominal pain during or after menstruation, relieved by pressure or warmth. Sensation of heaviness in the lower abdomen or perineal area, scanty and pale menstrual flow, light consistency, pale complexion, dizziness, palpitations, fatigue, forgetfulness, and insomnia.
Syndrome Type: Cold-related pattern.
Treatment Principle: Tonify qi and nourish blood, regulate menstruation and relieve pain.
Prescription:
Jijiano (Clerodendrum flower, yang que hua) 20g
Jialao Geique (Motherwort, yi mu cao) 20g
Wolao (Chinese angelica root, dang gui) 15g
Yangsong Ba (Cyperus rhizome, xiang fu) 12g
White peony root (bai shao) 12g
Explanation:
Clerodendrum flower (yang que hua): Warm, mildly sweet and pungent. Tonifies qi and yin, invigorates blood and regulates menstruation.
Motherwort (yi mu cao): Cold and bitter. Promotes blood flow, resolves stasis, and regulates menstruation.
Chinese angelica root (dang gui): Warm and sweet. Tonifies and invigorates the blood.
Cyperus rhizome (xiang fu): Warm and pungent. Regulates liver qi, harmonizes menstruation, and relieves pain.
White peony root (bai shao): Cold and bitter. Nourishes blood and softens the liver.
This combination of herbs nourishes the blood, regulates the cycle, and alleviates pain.
Prevention and Care
Keep warm during menstruation; avoid exposure to cold and refrain from catching a cold.
Avoid cold drinks and raw or chilled foods during the period. Swimming and cold baths should be avoided.
Maintain vaginal hygiene during menstruation.
Keep emotions stable, stay relaxed, and address psychological distress.
Ensure adequate rest and sleep, engage in moderate regular exercise, and avoid smoking.
Remarks
Miao medicine holds that Xiangfa Luomengqu (dysmenorrhea) mainly results from insufficient qi and blood or unclean personal hygiene. The patient’s underlying weakness, kidney deficiency, and lack of nourishment to the reproductive system lead to poor circulation, qi stagnation, and blood stasis. As menstruation approaches, sudden changes in qi and blood within the reproductive channels result in abdominal pain.
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