DYSMENORRHEA

Lee Chong Leng

1

CONTENTS

1)

Introduction 4 - 5

2)

Clinical Manifestations 6 -13

3)

Essentials for Diagnosis 14

4)

Treatment with Tuina Therapy

15 - 43

5)

Cautions 443

DYSMENORRHEA

Periodical abdominal pain or lumbago, even unbearable pain before or after the menstrual period

Often accompanied by pale complexion, vomiting, dripping clammy sweating and cold limbs

Often seen among unmarried young women, also called “menstrual abdominal pain”

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DYSMENORRHEA

Dysmenorrhea may start from menarche, related to disorder of autonomic nerve and uterus spasm, or imperfect uterus growth, narrow cervix of uterus and over-flexion of uterus which affect smooth circulation of blood

Secondary dysmenorrhea often follows the organic disease of genital organ, such as inflammation and myoma of uterus

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CLINICAL MANIFESTATIONS

Lower abdominal pain, sometime involving the whole abdomen or lumbosacral region, and dropping pain in the vulvae and anus.

If the pain is serious, it may cause pale complexion, dripping clammy sweating, cold limbs, even coma and prostration during menstruation.

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CLINICAL MANIFESTATIONS

Can be differentiated as of deficiency type or excess type according to the time and the nature of pain

Dysmenorrhea before the menstruation is excess in nature

If it is not palpable, it is excess in nature

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CLINICAL MANIFESTATIONS

If it becomes alleviated with warmth, it is caused by cold; if it becomes worsened with warmth, it is caused by heat

If the pain is more serious than distention and becomes alleviated after discharge of blood clots, it is caused by blood stasis; if distention is more serious than pain, it is caused by Qi stagnation

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CLINICAL MANIFESTATIONS

Causes of dysmenorrhea :

Qi stagnation and blood stasis 气滞血瘀 Stagnation of cold dampness 寒湿凝滞Deficiency of Qi and blood 气血虚弱Deficiency of liver and kidney 肝肾虚损

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CLINICAL MANIFESTATIONS

Qi stagnation and blood stasis:

Non-palpable abdominal distension and pain before or during menstruation

Scanty menorrhea or unsmooth menstruation with purple & blackish clots, alleviation after discharge

Accompanied by discomfort in the chest, breast and hypochondriac region

Darkish tongue even with spots, thin and wiry pulse.

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Qi stagnation and blood stasisQi stagnation and blood stasisQi stagnation and blood stasis

CLINICAL MANIFESTATIONS

Stagnation of cold dampness:

Cold pain in the lower abdomen several days before or during menstruation

Alleviation with warmth, aggravation under pressure

Blackish menorrhea with blood clots, or aversion to cold and body pain

Whitish and greasy tongue coating, thin and tense pulse

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CLINICAL MANIFESTATIONS

Deficiency of Qi and blood :

Vague pain after or during menstruation, alleviation under pressure

Light or thin menorrhea

Lassitude, lusterless complexion

Anorexia and loose stool

Light tongue with thin coating, weak and thin pulse 12

CLINICAL MANIFESTATIONS

Deficiency of liver and kidney :

Vague pain one or two days after menstruation, lumbago, scanty thin and blackish menorrhea, OR

Accompanied tinnitus, vertigo, giddiness, waist or lumbar pain

Sense of dropping in the abdomen, tidal fever, reddish cheeks,

Light tongue with thin whitish or yellowish coating, deep and thin pulse

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ESSENTIALS FOR DIAGNOSIS

1. Lower abdominal pain involving the waist and sacrum, even coma before or after or during menstruation, often appearing periodically

2. Commonly seen among young and unmarried women

3. Exclude abdominal pain due to organic pathological changes of pelvis 14

TREATMENT WITH TUINA THERAPY

Principle:

Regulating Qi and blood, warming meridians to dispel cold （通调气血，温经散寒）

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TREATMENT WITH TUINA THERAPY

Acupoints and location:

Qihai (CV 6), Guanyuan (CV 4), Shenshu (BL 23), Baliao, abdomen, lower abdomen, waist and back

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TREATMENT WITH TUINA THERAPY

Operation 1:

(1)Patient -- supine position

(2)Rub the lower abdomen, then apply one-finger pushing, pointed pressing and rubbing manipulations to Qihai (CV 6) and Guanyuan (CV 4), 5 minutes for each Acupoint

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Zhongwan ( 中脘 ) ， Tianshu ( 天枢 ) ， Qihai ( 气海 )

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Guanyuan ( 关元 )

TREATMENT WITH TUINA THERAPY

Operation 2:

(1)Patient -- prone position

(2)Roll the bilateral sides of the spine column and waist, then applying one-finger pushing and pointed pressing manipulations to Shenshu (BL 23) and Baliao until ache and distension are felt

(3)Rub the waist and Baliao points until it turns warm

(4)The time for operation is about 5 minutes

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Shenshu ( 肾俞 ) ， Dachangshu (大肠俞 )

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Baliao ( 八髎 )

MANIPULATIONSACCORDING TO

SYNDROME DIFFERENTIATION

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(1) QI STAGNATION AND BLOOD STASIS

Press and rub Zhangmen (LR 13), Qimen (LR 14), Ganshu (BL 18) and Geshu (BL 17)

Grasp Xuehai (SP 10) and Sanyinjiao (SP 6) until it is aching and distending

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Qimen ( 期门 ) ， Zhangmen (章门 )

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Geshu ( 膈俞 ) ， Ganshu ( 肝俞 ) ， Pishu ( 脾俞 ) ， Shenshu ( 肾俞 )

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Xuehai ( 血海 )

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Sanyinjiao ( 三阴交 )

(2) STAGNATION OF COLD DAMPNESS

Rub vertically the governor vessel over the back

Rub horizontally Shenshu (BL 23) and Mingmen (GV 4) until it becomes warm

Press and rub Xuehai (SP 10) and Sanyinjiao (SP 6)

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Shenshu ( 肾俞 ) ， Dachangshu (大肠俞 )

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Mingmen ( 命门 )

(3) DEFICIENCY - QI & BLOOD

Rub vertically the Governor vessel over the back

Rub horizontally the back till it is warm

Wipe, press and knead Zhongwan (CV 12), Pishu (BL 20), Weishu (BL 21) and Zusanli (ST 36)

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Zhongwan ( 中脘 ) ， Tianshu ( 天枢 ) ， Qihai ( 气海 )

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Geshu ( 膈俞 ) ， Ganshu ( 肝俞 ) ， Pishu ( 脾俞 ) ， Shenshu ( 肾俞 )

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Weishu ( 胃俞 )

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Zusanli ( 足三里 )

(4) DEFICIENCY OF LIVER AND KIDNEY

Rub vertically the governor vessel over the back

Rub horizontally Shenshu (BL 23) and Mingmen (GV 4) until it is warm

Press and knead Zhaohai (KI 6), Taixi (KI 3), Ganshu (BL 18), Shenshu (BL 23) and Yongquan (KI 1)

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Zhaohai ( 照海 )

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Taixi ( 太溪 )

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Geshu ( 膈俞 ) ， Ganshu ( 肝俞 ) ， Pishu ( 脾俞 ) ， Shenshu ( 肾俞 )

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Yongquan ( 涌泉 )

(5) DYSMENORRHEA OF EXCESS TYPE

If there are deflected spinous process and slight tenderness at the fourth lumbar vertebrae or other lumbar vertebrae (mainly at the fourth lumbar vertebra), use rotating and obliquely pulling manipulations to correct the deflected spinous process

Rub vertically the governor vessel Rub horizontally Baliao points until it is

warm

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DYSMENORRHEA TREATMENT

The treatment should be taken twice one week before menstruation and continued for three successive months

Six times make up one course of treatment

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CAUTIONS

1. Keep warm, avoid cold, and keep clean and hygienic during the menstrual period

2. Take proper rest and avoid overstrain

3. Keep peaceful mind and avoid fury and anxiety

4. The late result of Tuina therapy in treating dysmenorrhea due to organic diseases is unsatisfactory

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THANK YOU