1. Acupuncture Treatment of Diseases Gynecology 1: Dysmenorrhea 痛经

2. Definition: 1.Refers cold pain in the lower abdomen, at times radiating to the lumbosacral region during or after menstruation. 2.Often relates to pathological changes of the genitalia, psychological and endocrine factors in western medicine. 3.Primary: refers to a condition without pathological changes in the genitalia, usually disappear after giving birth. 4.Secondary: caused by diseases such as endometriosis, acute or chronic PID, tumors etc.

3. Causes and Pathogenesis : Excess pattern: 1.Stagnation of liver qi due to emotional factors resulting in impedes blood circulation in the uterus. 2.Contraction of external cold; or drinking cold drinks during menstruation; or exposure to rain or wading in cold water. Deficiency pattern: 1.Deficiency in spleen and stomach leading to insufficiency of qi and blood caused by serious and prolong illness; 2.Poor or weak constitution leading to insufficiency of the essence and blood of the liver and kidney. The above factors may cause a retention of cold or dampness in the uterus, insufficiency of blood in the Penetrating and Conception Vessels leading to uterine failure for nourishment resulting in dysmenorrhea.

4. Clinical Manifestations: Excess patterns: Chief symptoms: i.Unsmooth menstruation. ii.Pain in the lower abdomen. iii.Dislike pressure. iv.Worsen during menstruation. v.Relief after discharging clots. vi.Colour: Red or dark purple menses with clots.

5. Clinical Manifestations: 1.Qi stagnation and Blood stasis type Stated manifestations with: i.Lower abdominal pain before menstruation a/w lower abdomen distension, and radiate to the back. ii.Breast pain/ distension. iii.Scanty menstruation with occasional clots– due to blood stasis. iv.Purplish tongue. v.Thin tongue coating. vi.Wiry, thready pulse.

6. Clinical Manifestations: 2.Stagnant Cold type Stated manifestations with: i.Cold and pain in the lower abdomen. ii.Relieve by warmth. iii.Scant dark purple menses with clots. iv.Cold limbs. v.Aversion to cold. vi.Light coloured tongue. vii.Greasy white tongue coating. viii.Deep, tight pulse.

7. Clinical Manifestations: Deficiency patterns: Chief symptoms: i.Dull pain in the lower abdomen appearing after menstruation. ii.Preference for pressure on the abdomen. iii.Pink, scanty menses.

8. Clinical Manifestations: 1.Qi-Blood deficiency type Stated manifestations with: i.Pale complexion. ii.Lassitude. iii.Vertigo. iv.Dizziness. v.Palpitations. vi.Pale and plumb tongue with teeth marks. vii.Thin tongue coating. viii.Weak, thready pulse.

9. Clinical Manifestations: 2.Liver-Kidney deficiency type Stated manifestations with: i.Soreness and weakness in the loins and knees. ii.Insomnia. iii.Tinnitus. iv.Dizziness. v.Blurred vision. vi.Red tongue. vii.Thin scanty tongue coating. viii.Thready pulse.

10. Treatment : General principle (Excess Types) Remove obstruction of channels. Relieve pain. Regulate qi and disperse cold. Principle channels: 1.CV channel. 2.Spleen channel. 3.Bladder channel.

11. Principle acupoints : 1.CV 3 Zhongji 中极. 2.SP 6 Sanyinjiao 三阴交. 3.SP 8 Diji 地机. 4.BL 32 Ciliao 次髎.

12. Prescription explanation (Principle acupoint): 1.CV 3 Zhongji 中极： Channel acupoint of the CV, chosen to regulate qi of the Penetrating and CV, disperse cold and promote circulation. 2. SP 6 Sanyinjiao 三阴交： Crossing acupoint of the LI/SP/KI channel, chosen to remove obstructions of the channel and relieve pain. 3.SP 8 Diji 地机 : Xi-Cleft acupoint of the SP channel where qi of the viscera runs the deepest, chosen to regulate qi and blood of the spleen channel. Xi-Cleft acupoint of the Yin channel can also used in Blood syndrome cases.

13. Principle of treatment 1.Qi stagnation and Blood stasis type Remove obstruction of channels, relieve pain and regulate qi. Supplementary acupoints: 1.LR 3 Taichong 太冲. 2.GB 34 Yanglingquan 阳陵泉.

14. Principle of treatment 2.Cold Stagnation type Remove obstruction of channels, relieve pain and regulate qi and disperse cold. Principle acupoints: as stated Supplementary acupoints: 1.ST 29 Guilai 归来.

15. Treatment : General principle (Deficiency Types) Strengthen constitution. Warmth Lower Energizer. Warm and nourish the channels Replenish qi and blood. Principle channels: 1.CV channel. 2.Spleen channel. 3.Stomach channel.

16. Principle acupoints : 1.CV 3 Guanyuan 关元. 2.CV 6 Qihai 气海. 3.SP 6 Sanyinjiao 三阴交. 4.ST 36 Zusanli 足三里.

17. Prescription explanation (Principle acupoint): 1.CV 4 Guanyuan, CV 6 Qihai ： Channel acupoints of the CV, chosen to strengthen constitution, warm the lower energizer, nourish the CV and Penetrating vessels. 2. SP 6 Sanyinjiao 三阴交： Crossing acupoint of the LI/SP/KI channel, chosen to benefit the three vessels and nourish the uterus. 3.ST 36 Zusanli 足三里 : He-Sea and LowerHe-Sea acupoint of the ST channel where qi of the organ congregates, chosen to replenish qi and blood.

18. Principle of treatment 1.Qi-Blood deficiency type: Strengthen constitution, warmth Lower Energizer, warm and nourish the channels and replenish qi and blood. Principle acupoints: as stated Supplementary acupoints: 1.BL 20 Pishu 脾俞. 2.BL 21 Weishu 胃俞.

19. Principle of treatment 1.Liver-Kidney deficiency type: Strengthen constitution, warmth Lower Energizer, warm and nourish the channels and replenish qi and blood. Principle acupoints: as stated Supplementary acupoints: 1.BL 18 Ganshu 肝俞. 2.BL 23 Shenshu 肾俞. 3.KI 3 Taixi 太溪

20. TCM medical advises: 1.Works well together with moxibustion. 2.Treatment begins 3-5 days before menstruation. 3.Avoid strong physical exertion and mental irritation. 4.Avoid cold and raw food.