DYSMENORRHOEA CASE HISTORY

The following is a case history sent by Jason Smith in Madrid

Symptoms

A woman aged 43 seeks treatment for painful periods. The periods last three days and are extremely painful. She feels cold in general, but the cold is more intense at period time. 

The period is regular (30 days), lasts 3 days, with little bleeding, and the color is dark red with small clots. The pain is very intense, and is felt around the area of Ren-4/Ren-3. A warm bottle alleviates the pain along with analgesics. The period has always been very painful, especially after the age of 18.

The tongue has a normal color with a thin coating with root. However, the sublingual veins appeared very dark. This patient was a semi professional swimmer, practicing intensely around the age of 13-18.

Diagnosis

The main pattern is a very obvious case of Cold in the Uterus (nature of pain, feeling of cold and alleviation of the pain by a warm bottle). The Cold in the Uterus led to Blood Stasis, as evidenced by the clots, the dark blood and the dark purple sublingual veins.

Treatment

Following the four phases of the menstrual cycle, I decided to center the treatment on phase 4 (pre-menstrual phase), since this is the best time to expel the pathogenic factor, in this case Cold, from the Uterus.

With acupuncture, I used the Chong Mai, with SP-4 and P-6, and a moxa box around the area of Ren-4.

With herbal medicine, the patient was instructed to take four tablets of Wen Jing Tang.

After the first period, the pain was reduced by about 50%. After the second period, the pain was reduced by a further 25%. After the third period, and up to date, the patient only feels a very slight pain.

For prevention, the patient was instructed to use a moxa box before the period every now and then, to prevent a new invasion of Cold.

Observations

This is a very clear example of how a pathogenic factor can invade the body (after swimming during her puberty, incidentally a time when Chong, Ren and Du are in a very vulnerable state), and remain for about 30 years. It also shows how, no matter how much time has elapsed, pathogenic factors must be expelled.

It is also interesting to note that this patient reported having many times sexual intercourse without any protection, and despite that, never getting pregnant. This is probably due to the fact that Cold has been blocking the Uterus, and thus preventing fertilization: this is infertility from a Shi (Full) condition.

MEN: A COMMON MENTAL-EMOTIONAL SYMPTOM

“Men” is a common symptom in Chinese medicine.  The Chinese character shows a door and a heart inside it.  Thus, it would seem to indicate a heart constricted by a door closing on it.  I translate this  symptom as “a feeling of oppression of the chest”.  Men is very difficult to translate and my translation is an attempt to convey the meaning of this symptom: it certainly does not claim to be the “correct” translation of men as most Chinese medicine terms have multiple, simultaneous meanings.

Chinese patients will actually use the term men: they might say, for example, “I sleep badly, I have a bitter taste and feel men.” In my experience, when a Chinese patients says that it means they are depressed. 

A feeling of oppression of the chest is purely subjective: there is nothing to be observed or palpated  (as there is in feeling of fullness or distension).  Some patients would describe it as a “feeling of weight” on the chest.  Other patients may use the term “tightness of the chest.” 

Men indicates Phlegm or severe Qi stagnation.  Men occurs in the chest or, less frequently, in the epigastrium; it does not occur in the lower abdomen. 

   

The term men first appears in chapter 19 of the Su Wen where it is described as a feeling of fullness of the chest with anxiety and blurred vision.

There is another condition characterized by men called “Rising Men Qi” (Men Qi Sheng), a condition that affects newborn babies.  It is characterized by a feeling of men in the umbilical area, the baby is not crying and has difficulty breathing.[i]

Men is rich in meaning and, in my experience, it describes not only a physical sensation in the chest but also a mental-emotional state of anguish associated with it.  A feeling of oppression of the chest reflects emotional stress especially to do with sadness, grief, worry, shame and guilt.  I find this symptom very common in the patients we see.

Chronic anxiety often manifests with the feeling of men in the chest and depression may also be accompanied by this symptom.

The presence of men indicates two things: first, that there is Phlegm; secondly, that the Lungs and/or Heart are involved. 

This Phlegm may be of a non-substantial kind and there may not necessarily be any expectoration of mucus (usually there is not).  Its main manifestation is precisely the feeling of oppression of the chest and possibly a Swollen tongue and a Slippery pulse. 

The main points I would use for a feeling of oppression of the chest are Ren-17 Shanzhong, Ren-15 Jiuwei, P-6 Neiguan, LU-7 Lieque and ST-40 Fenglong.

The main prescriptions that could be used are Ban Xia Hou Po Tang (Pinellia-Magnolia Decoction) or Wen Dan Tang (Warming the Gall-Bladder Decoction).

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[i]  1980 Concise Dictionary of Chinese Medicine (Jian Ming Zhong Yi Ci Dian 简  明  中  医  辞  

典 ). People's Health Publishing House, Beijing, p. 476.