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- Professor Pei Zhengxue’s Syndrome Differentiation and Treatment
- Cold-Induced Blood Stasis Syndrome Symptoms: Before or during menstruation, cold pain in the lower abdomen that worsens with palpation, relieved by warmth; delayed menstrual cycle, scanty menstrual flow, dark-colored blood with clots; aversion to cold and cold extremities, pale complexion; dark tongue, white coating, and deep, tight pulse. Treatment Principle: Warm the meridians to dispel cold and transform blood stasis to relieve pain. Prescription: Shaofu Zhuyu Tang. Cinnamon 6g, Fennel 10g, Dried Ginger 6g, Angelica 10g, Ligusticum 6g, Red Peony 10g, Typha Pollen 10g, Five Spirit Resin 10g, Myrrh 10g, Corydalis 10g. If the lower abdominal cold pain is severe, add Mugwort and Evodia; if cold congeals qi and causes severe pain with syncope, cold extremities, and profuse cold sweat, add Aconite, Asarum, and Morinda; if accompanied by limb soreness and heaviness, with a white, greasy coating, consider adding Atractylodes, Poria, Alisma, and Notopterygium.
- Qi Stagnation and Blood Stasis Syndrome Symptoms: Before or during menstruation, distending pain in the lower abdomen that worsens with palpation, scanty menstrual flow, difficult menstruation, dark purple blood with clots, pain lessens under the clots, chest and breast distension; dark purple tongue, possibly with petechiae, and stringy, stagnant pulse. Treatment Principle: Regulate qi and invigorate blood, transform blood stasis to relieve pain. Prescription: Xuefu Zhuyu Tang. Bupleurum 10g, Citrus Aurantium 10g, White Peony 10g, Licorice 6g, Peach Kernel 10g, Safflower 6g, Achyranthes 10g, Platycodon 15g, Rehmannia 12g, Ligusticum 6g, Angelica 10g. If the pain is accompanied by nausea and vomiting, add Evodia, Pinellia, and Tangerine Peel; if there is a feeling of heaviness and distension in the lower abdomen or in the perineal area, add Bupleurum and Cimicifuga; if depression turns into heat, causing irritability and bitter taste in the mouth, with a red tongue and yellow coating, and a rapid pulse, add Gardenia and Curcuma.
- Qi and Blood Deficiency Syndrome Symptoms: During or after menstruation, mild, pressing pain in the lower abdomen, scanty menstrual flow, pale color and thin consistency; fatigue, dizziness, palpitations, pale complexion, insomnia and vivid dreams; pale tongue, thin coating, and weak pulse. Treatment Principle: Tonify qi and nourish blood, regulate menstruation and relieve pain. Prescription: Bazhen Tang with modifications. Rehmannia 12g, Ligusticum 6g, White Peony 10g, Angelica 10g, Codonopsis 10g, Atractylodes 12g, Poria 12g, Licorice 6g, Astragalus 20g, Motherwort 15g. If the menstrual flow contains blood clots, consider adding Typha Pollen and Five Spirit Resin; if there is difficulty in defecation during menstruation and severe abdominal pain, remove Angelica and add Poria and stir-fried Atractylodes; if insomnia and vivid dreams occur, and the heart and spleen are deficient, consider adding Polygala, Albizia bark, and Night-blooming Jasmine; if accompanied by cold extremities and lower back pain, add Cinnamon, Fennel, and Mugwort.
- Damp-Heat Accumulation Syndrome Symptoms: Before or during menstruation, pain or distension in the lower abdomen with a burning sensation, or pain radiating to the lumbosacral region; or chronic lower abdominal pain that worsens before menstruation, with heavy menstrual flow or prolonged menstruation, dark red color, thick consistency, or presence of blood clots; increased vaginal discharge with yellow, thick, foul-smelling discharge, or accompanied by yellowish-red urine; red tongue, yellow and greasy coating, and slippery or moist pulse. Treatment Principle: Nourish blood and soften the liver, clear heat and drain dampness. Prescription: Danggui Shaoyao San with modifications. Angelica 10g, Peony 15g, Ligusticum 6g, Poria 12g, Alisma 10g, Atractylodes 10g, Moutan Bark 6g, Coptis 6g, Peach Kernel 10g, Safflower 6g. If the menstrual flow contains blood clots, consider adding Typha Pollen and Five Spirit Resin; for lower back pain, add Eucommia, Achyranthes, Dipsacus, and Taxillus; for excessive vaginal discharge, add Dioscorea, Chinese Yam, Phellodendron, and Plantago.
- Analysis of Prescriptions Used by Professor Pei Zhengxue Shaofu Zhuyu Tang, recorded in "Yilin Gaicuo" compiled by the renowned late Qing physician Wang Qingren, is a classic prescription for treating cold-induced blood stasis-type dysmenorrhea. Professor Pei Zhengxue often uses this formula as a base, making adjustments according to the specific syndrome, to treat various gynecological diseases caused by cold invading the Chong and Ren channels and impeding the smooth flow of qi and blood, such as delayed menstruation, amenorrhea, and infertility due to cold in the uterus, among others. This formula is a derivative of Siwu Tang, composed of fennel, Five Spirit Resin, Angelica, Ligusticum, Red Peony, Cinnamon, Myrrh, Typha Pollen, Corydalis, and Dried Ginger. Among these ingredients, fennel is the mature fruit of the Umbelliferae plant anise, with a pungent-warm nature, entering the liver, kidney, and spleen meridians, classified as a warming herb, possessing the effects of regulating qi and harmonizing the middle jiao, dispelling cold and relieving pain, used to treat cold invasion causing lower abdominal cold pain, dysmenorrhea, cold abdominal pain, and testicular discomfort; also applicable to spleen-kidney deficiency with middle jiao qi stagnation. Cinnamon is pungent-sweet and highly warming, entering the spleen, kidney, and liver meridians, with the effects of tonifying fire and supporting yang, dispelling cold and relieving pain, warming the meridians and promoting circulation, guiding fire back to its origin, used to treat cold-damp stagnation-related amenorrhea and dysmenorrhea. Dried Ginger is also a warming herb, pungent and hot, entering the spleen, stomach, lung, and kidney meridians, warming the middle jiao and dispelling cold, while also being stable and not dispersing, returning yang and promoting circulation, warming the lungs and transforming fluids, effectively treating cold-induced lower abdominal pain and vomiting. These three herbs, when combined, enter the liver and kidney meridians and also affect the spleen, enhancing the effects of warming the meridians and relieving pain, as well as reaching the lower jiao. Angelica is a sacred herb for replenishing blood, pungent-sweet-warm, entering the liver, heart, and spleen meridians, with a light and pungent nature, its functions include replenishing blood, regulating menstruation, invigorating blood, and relieving pain, thus serving as a key drug for activating blood and regulating qi, both regulating menstruation and relieving pain, commonly used in gynecological clinical practice. Ligusticum is a blood-activating and stasis-resolving drug, pungent-warm, entering the liver, gallbladder, and pericardium meridians, with the effects of activating blood, regulating qi, and dispelling wind to relieve pain, mainly treating blood stasis and qi stagnation, hence known as the "blood-qi medicine." Corydalis is also a blood-activating and stasis-resolving drug, pungent-bitter-warm, entering the liver, spleen, and heart meridians, as stated in "Compendium of Materia Medica": "It can resolve blood stasis... blood stasis... therefore it specializes in treating all kinds of pain throughout the body." It is the first choice for blood-activating and qi-regulating medicines, treating pain caused by qi stagnation and blood stasis. Myrrh enters the spleen meridians, pungent-bitter-neutral, with a fragrant and dispersing aroma, suitable for treating pain caused by qi stagnation and blood stasis, especially good at dispersing blood stasis and reducing swelling, also having the effect of promoting wound healing and treating surgical wounds and ulcers. Five Spirit Resin is bitter-salty-sweet-warm, entering the liver meridians, classified as a blood-activating and stasis-resolving drug, clinically often used to treat pain caused by various forms of stagnation. Red Peony is bitter-mildly cold, entering the liver meridians, with the effects of clearing heat and cooling blood, activating blood and resolving stasis, classified as a heat-clearing and blood-cooling drug. Typha Pollen is sweet-neutral, entering the liver and pericardium meridians, classified as a stasis-resolving and hemostatic drug, entering the blood, good at dealing with blood stasis, and together with the above-mentioned herbs, this formula has the effects of warming the meridians, dispelling cold, activating blood, and relieving pain, eliminating cold and blood stasis, allowing the condition to resolve itself, representing a typical prescription for treating gynecological diseases caused by blood stasis obstructing the body. Danggui Shaoyao San was first recorded in "Jin Gui Yao Lue." This formula uses Angelica, White Peony, and Ligusticum to nourish blood and regulate the liver, activating blood without being too aggressive, replenishing blood without causing stagnation; Atractylodes, Poria, and Alisma supplement the spleen and drain dampness, strengthening the spleen without hindering dampness, promoting water metabolism without harming the spleen, embedding nourishment within drainage; Poria and Alisma have a mild, sweet, and damp-draining effect, preventing the spleen from being overwhelmed by dampness; Angelica and Ligusticum activate blood and resolve stagnation, ensuring smooth circulation of nutritive blood, collectively embodying the principles of nourishing blood and regulating the liver, supplementing the spleen and removing dampness. Professor Pei Zhengxue believes that the heavy use of White Peony in this formula not only nourishes blood but more importantly allows this herb to calm the liver and relieve pain. The flavors of this formula are gentle, balancing supplementation and drainage, and with adjustments, it is suitable for all types of cold, heat, deficiency, and excess. Modern pharmacological animal experiments have proven that Angelica has a dual effect on the uterus: its alcohol-soluble, non-volatile substances stimulate isolated uteri, causing them to contract, while its high-boiling-point volatile substances inhibit isolated uteri, causing them to relax. White Peony has a relaxing and inhibitory effect on uterine smooth muscle movement; Ligusticum stimulates uterine smooth muscle contraction, strengthening uterine contractions. When Angelica, White Peony, and Ligusticum work together, they can regulate uterine function, and with White Peony and Ligusticum having obvious sedative effects, Angelica also has a certain sedative effect, which may be the main reason why this formula can relieve dysmenorrhea.
- Case Examples Example: 27-year-old unmarried woman. On November 25, 2019, she presented with "lower abdominal pain during menstruation for more than ten years, worsening for half a year." She had her first menstruation at age 15, with regular cycles of 29–31 days, lasting 7–8 days, with relatively heavy flow, dark red color, and thick consistency. Every time before or during menstruation, she experienced burning pain in the lower abdomen, relieved by warmth, occasionally accompanied by nausea and lower back soreness. Her last menstrual period was from October 30 to November 5, 2019. Currently, she feels a burning sensation in the lower abdomen, with increased vaginal discharge, yellow color, and thick consistency, yellowish-red urine, decent sleep, enjoys spicy and stimulating foods, and has sticky stools. Tongue is red, coating is yellow and greasy, pulse is slippery and rapid. Past medical history is unremarkable. No sexual history. Gynecological ultrasound showed: uterus size 4.9 cm × 4.2 cm × 3.9 cm, uterus in horizontal position, no obvious abnormalities in bilateral adnexa. 【Western Medical Diagnosis】Dysmenorrhea (Damp-Heat Accumulation Type). [Treatment Principle] Clear heat and drain dampness, transform blood stasis to relieve pain. Angelica 10g, Peony 15g, Ligusticum 6g, Poria 12g, Alisma 10g, Atractylodes 10g, Moutan Bark 6g, Coptis 6g, Peach Kernel 10g, Safflower 6g. Decocted in water and taken warm. Started medication on the day of consultation, continued until the 4th day of menstruation, and kept taking it after menstruation ended. Avoided spicy and stimulating foods, and refrained from strenuous exercise during menstruation. Second Consultation: December 14, 2014. Menstruation came on November 30, with heavy flow, dark color, and blood clots. Lower abdominal pain slightly relieved, still some lower back soreness, thirst and desire to drink, reduced vaginal discharge compared to before, paler yellow color, improved bowel movements compared to before, red tongue, yellow and greasy coating, slippery pulse. Added Taxillus 10g, Dipsacus 10g, and Scutellaria 10g. Ten doses, decocted in water and taken warm. Started taking medication 10 days before menstruation, continued until the 2nd–4th day of menstruation, advised to stop if menstrual flow becomes heavy, and resume after menstruation ends. Third Consultation: February 1, 2015. Menstruation came on January 27, no abdominal pain during menstruation, menstrual flow and quality were normal, occasional lower back soreness, rosy complexion. Tongue was pale red, coating thin white, pulse slightly slippery. Continued taking the same prescription, ten doses, decocted in water. Follow-up three months later, dysmenorrhea did not recur, all symptoms resolved.
- Ancient and Modern Physicians’ Discussions on Dysmenorrhea Ancient physicians’ understanding of dysmenorrhea first appeared in Zhang Zhongjing’s “Jin Gui Yao Lue · Discussion on Miscellaneous Diseases in Women and Their Pulse Diagnosis and Treatment” during the Eastern Han Dynasty: “If vaginal discharge is obstructed and the lower abdomen is full and painful, and menstruation recurs monthly, Tu Guagen Powder is the main treatment.” This was the first time the pathogenesis of dysmenorrhea caused by blood stasis and the corresponding treatment prescription were proposed. By the Sui Dynasty, Chao Yuanfang’s “Discussions on the Causes and Symptoms of Various Diseases · Miscellaneous Diseases in Women · Symptoms of Abdominal Pain During Menstruation” argued: “When women experience abdominal pain during menstruation, it is due to exhaustion of qi and blood, leading to physical weakness, exposure to cold wind, which invades the uterine vessels, damaging the Chong and Ren channels… The menstrual blood is deficient and exposed to cold wind, so when menstruation approaches, qi and blood are stirred by the cold wind, and the cold wind collides with qi and blood, causing pain.” This was the first time the cause of dysmenorrhea was identified as cold wind invading the Chong and Ren channels. During the Song Dynasty, Chen Ziming believed that cold pathogens could cause dysmenorrhea, as recorded in his “Complete Collection of Good Remedies for Women · Chapter on Regulating Menstruation”: “Women experiencing abdominal pain during menstruation do so because cold wind invades the uterine vessels and Chong and Ren channels…” Later, “The Comprehensive Record of Sacred Benefits · Abdominal Pain During Menstruation in Unmarried Women” also described: “When unmarried women experience abdominal pain during menstruation, it is because Tian Gui has just arrived, the Yingwei system is not yet balanced, the mind is restless, and cold wind occasionally invades, causing blood and qi to flow poorly, leading to menstrual blood becoming stuck in the umbilical region, like a stabbing pain.” This indicated that dysmenorrhea was caused by cold invasion, and further analyzed that adolescent girls all lacked qi, and poor qi and blood circulation led to stagnation in the Chong and Ren channels, resulting in pain due to obstruction. “Danxi Xinfa · Women’s Section” built upon previous summaries and further elaborated: “Pain caused by menstrual blood flowing excessively is due to heat within deficiency, hence the pain; pain caused by menstrual blood approaching is due to blood being real, and sometimes qi being stagnant. When the waist and abdomen ache before menstruation, it is due to stagnation… ” This pointed out the nature of dysmenorrhea, with pre-menstrual symptoms often being excess and post-menstrual symptoms often being deficiency. During the Ming Dynasty, Zhang Jingyue in “The Complete Works of Jingyue · Regulations for Women · Abdominal Pain During Menstruation” noted: “Abdominal pain during menstruation has both deficiency and excess, with excess cases possibly due to cold stagnation, blood stagnation, qi stagnation, or heat stagnation; deficiency cases may be due to blood deficiency or qi deficiency…” He pointed out that both external and internal factors could trigger dysmenorrhea. During the Qing Dynasty, “Fu Qingzhu’s Women’s Medicine” provided an extremely detailed discussion on dysmenorrhea, stating in the text: “Three to five days before menstrual blood arrives, pain appears in the lower abdomen… this is due to the struggle between cold and dampness in the lower jiao.” “Menstrual blood comes and goes suddenly, sometimes painful, sometimes not… this is due to unsatisfied liver qi.” “Abdominal pain for several days before menstruation… this is due to extreme heat and fire not being transformed! The liver belongs to wood, which contains fire; when relaxed, it flows smoothly, but when blocked, it doesn’t.” “Lower abdominal pain after menstruation is due to a hole in the kidney qi.” It believed that cold dampness, qi stagnation, and kidney deficiency were the causes of dysmenorrhea. Notably, “Medical Canon · Essential Principles of Gynecology” not only explained the causes and pathogenesis of dysmenorrhea,
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