1. Dysmenorrhea 痛经， Tong Jing

2. Concept Dysmenorrhea or painful menstruation is characterized by continual pain or even acute pain in the lower abdomen and lumbar region before,during or after menstruation,usually accompanied with pallor,profuse cold sweat on the head,cold limbs,nausea and vomiting.A light distending pain or discomfort in the lower abdomen or lumbar region is a frequent occurrence and is not diagnosed as dysmenorrhea.

3. Etiology and Pathogenesis 1.cold Dampness Obstruction Prolonged residence in damp housing conditions or getting wet and being exposed to cold during the menstrual period may produce cold dampness which impairs the Lower Jiao and stagnates in the uterus,thereby congealing the blood and obstructing the menstrual flow causing pain.

4. 2.Liver Qi Stagnation Cold dampness obstruction in the uterus,liver qi stagnation,impairment of the Chong and Ren meridians Liver and kidney Yin deficiency,depletion of essence and deficiency of blood Stasis of menstrual blood in the uterus Under nourishme nt of the uterus Dysmenorrhea

5. 3.Liver and Kidney Yin Deficiency A liver and kidney Yin deficiency,weak constitution or excessive sexual activity leads to liver and kidney Yin deficiency,depletion of essence,deficiency of blood,and insufficient blood supply in the Chong and Ren meridians.After menstruation,the sea of blood is totally depleted and is even less able to nourish the uterus,causing deficiency pain in the lower abdomen.

6. Differentiation

7. 1.cold Dampness Obstruction Main manifestations:Cold pain occurs in the lower abdomen before or during menstruation,the pain is aggravated when pressure is applied,and may radiate to the back,but it may be alleviated when heat is applied.In acute cases,the pain radiates to the lower back. Accompanying symptoms and Signs:Scanty menstruation with dark menses,often with clots Tongue and Pulse :A thin and white tongue coating,a deep and tense pulse

8. 2.Liver Qi Stagnation Main Manifestations:distending pain in the lower abdomen before or during menstruation,the feeling of distention being predominant to the pain,obstructed menstrual flow Accompanying Symptoms and Signs:Scanty periods often with clottedblood,accompanied by distending pain in the chest,hypochondrium and breasts Tongue and pulse:A dark tongue with ecchymosis,a thin and white coating,a deep and wiry pulse

9. 3. Liver and Kidney Yin Deficiency Main Manifestation:Dull pain in the lower abdomen during or after menstruation,alleviated by pressure Accompanying Symptoms and Signs:Pink,clear and thin menstrual blood,soreness of the lowerback, dizziness,tinnitus,pale complexion, mental fatigue Tongue and pulse:A pale tongue,a deep and thread pulse.

10. Treatment

11. 1. cold Dampness Obstruction Treatment Principle:Dispersing cold and dampness,inducing menstruation to relieve pain,mainly selecting joints from the Ren and the Foot Taiyin meridians Acupoint Selection:Zhongji(RN3),Shuidao(ST28),Diji(SP8) Method:All points are punctured perpendicularly to a depth of 1.0-1.5 cun with the reducing method,needles are retained for 20 minutes.Alternatively,moxibustion may be applied.

12. 2.Liver Qi Stagnation Treatment Principle:Dispersing the stagnated liver qi for regulating the circlation of qi to promote menstrual flow Acupoint Selection:Qihai(RN6),Taichong(LR3),Sany injiao(SP6) Method:Puncture Qihai perpendicularly 1.0-1.5 cun and Taichong and Sanyinjiao 1.0 cun.Use reducing or even method.

13. 3.Liver and Kidney Yin Deficiency Treatment Principle:Nourishing the liver and kidney Yin,regulating and reinforcing the chong and Ren meridians Acupoint Selection:Ganshu(BL18),Shenshu(BL23),Guanyua n(RN4),Zusanli(ST36),Zhaohai(KI6).

14. Method:Ganshu and Shenshu are punctured obliquely towards the spine to a depth of 1.5 cun.Guanyuan and Zusanli are punctured perpendicularly 1.5 cun.Zhaohai is punctured perpendicularly 1.0 cun.All the points are punctured with the reinforcing methed by lifting and thrusting while twirling the needles.Moxibustion may also be applied.

15. Other Therapies Ear Acupuncture Otopoint :Uterus,Endocrine,Sympathesi s,kidney Method:Select 2-3 points each time,give mild stimulation,retain the needles for 15-20 minutes.

16. DifferentiationTreatment principleAcupoint selection Cold dampness obstruction Dispersing cold and dampness,inducing menstruation to relieve pain RN3,ST28,SP8 For acute pain, adding BL32,ST29 For abdominal pain radiating to the lower back, adding DU4,BL23 Liver qi stagnation Soothing the liver and regulating qi,promoting menstrual flow to stop pain RN6,LR3,SP6 Deficiency of the liver and kidney Tonifying the liver and kidney,regulating the Chong and Ren meridians BL18,BL23,KI6,RN4,ST36