1. DYSMENORRHEA
Lee Chong Leng

3. CONTENTS 1) Introduction 4 - 5 2) Clinical Manifestations 6 -13 3)
Essentials for Diagnosis 14 4)
Treatment with Tuina Therapy 5)
Cautions 44

4. 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”

5. 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

6. 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. .

7. 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

8. 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

9. 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

10. 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.
Qi stagnation and blood stasis
Qi stagnation and blood stasis
Qi stagnation and blood stasis

11. 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

12. 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

13. 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

14. ESSENTIALS FOR DIAGNOSIS
Lower abdominal pain involving the waist and sacrum, even coma before or after or during menstruation, often appearing periodically
Commonly seen among young and unmarried women
Exclude abdominal pain due to organic pathological changes of pelvis

15. TREATMENT WITH TUINA THERAPY
Principle:
Regulating Qi and blood, warming meridians to dispel cold
（通调气血，温经散寒）

16. TREATMENT WITH TUINA THERAPY
Acupoints and location:
Qihai (CV 6), Guanyuan (CV 4), Shenshu (BL 23), Baliao, abdomen, lower abdomen, waist and back

17. Treatment with tuina therapy
Operation 1:
Patient -- supine position
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

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

19. Guanyuan (关元)

20. TREATMENT WITH TUINA THERAPY
Operation 2:
Patient -- prone position
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
Rub the waist and Baliao points until it turns warm
The time for operation is about 5 minutes

21. Shenshu (肾俞)，Dachangshu (大肠俞)

22. Baliao (八髎)

23. MANIPULATIONS ACCORDING TO SYNDROME DIFFERENTIATION

24. (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

25. Qimen (期门)，Zhangmen (章门)

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

27. Xuehai (血海)

28. Sanyinjiao (三阴交)

29. (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)

30. Shenshu (肾俞)，Dachangshu (大肠俞)

31. Mingmen (命门)

32. (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)

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

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

35. Weishu (胃俞)

36. Zusanli (足三里)

37. (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)

38. Zhaohai (照海)

39. Taixi (太溪)

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

41. Yongquan (涌泉)

42. (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
(5) DYSMENORRHEA OF EXCESS TYPE

43. 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

44. CAUTIONS
Keep warm, avoid cold, and keep clean and hygienic during the menstrual period
Take proper rest and avoid overstrain
Keep peaceful mind and avoid fury and anxiety
The late result of Tuina therapy in treating dysmenorrhea due to organic diseases is unsatisfactory

45. THANK YOU