2. Physical Signs

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Menstrual or perimenstrual lower abdominal pain is characterized by paroxysmal, cramping, or distending pain, often accompanied by a sensation of heaviness and descent. The pain may radiate to the lumbosacral region and the medial thighs, and in severe cases can be associated with pallor, cold sweats, cold extremities, nausea, vomiting, syncope, and other symptoms.

2. Physical Signs Gynecological examination reveals no abnormalities.

3. Diagnosis Diagnostic Key Points: (1) Medical History: Attention should be paid to whether there has been improper living habits, emotional stress, exposure to cold during menstruation, or excessive consumption of raw and cold foods. (2) Clinical Manifestations: Lower abdominal pain occurs in association with the menstrual cycle, and gynecological examination shows no positive findings. (3) Laboratory Tests: Prostaglandin levels in menstrual blood are generally found to be abnormally elevated, particularly PGF2α. (4) Auxiliary Examinations: Ultrasound and laparoscopy may be performed when necessary to rule out organic lesions.

4. Western Medical Treatment

5. General Treatment Provide psychological comfort and alleviate concerns; when pain is unbearable, appropriate analgesics, sedatives, and antispasmodics should be administered.

6. Prostaglandin Synthase Inhibitors These drugs can block prostaglandin synthesis. ① Phenylpropionic acid derivatives: such as ibuprofen 200–400 mg, three to four times daily, or ketoprofen 50 mg, three times daily. ② Nonsteroidal anti-inflammatory drugs: flufenamic acid 200 mg, three times daily, starting on the first day of menstruation and continuing for 2–3 days. ③ Indomethacin suppositories: one-third to one-half of a suppository each time, inserted rectally.

7. Short-Acting Contraceptives These medications suppress ovulation, reduce PG synthesis and uterine contractions, thereby alleviating pain, and are suitable for those who wish to use contraception.

8. Professor Pei Zhengxue’s Clinical Experience Professor Pei Zhengxue believes that deficiency of kidney qi, lack of essence and blood, insufficient nourishment of Chong and Ren channels, or congenital weakness of spleen qi and dysfunction of its transportation function can lead to insufficient sources of blood and biochemical substances. Alternatively, prolonged serious illness or chronic disease can result in severe depletion of qi and blood. Whenever menstrual blood flows, the "sea of blood" overflows, causing the Chong and Ren channels and the uterus to lose their nourishment, thus triggering dysmenorrhea—this is "pain due to lack of nourishment." Yang deficiency leads to internal accumulation of yin-cold, which causes contraction and stagnation, affecting the circulation of qi and blood. Or, if one has a phlegm-damp constitution, the sticky nature of dampness easily obstructs the flow of qi and stagnates blood circulation. Alternatively, if one has a liver-stagnation constitution, frequent anger can cause qi stagnation and impede blood flow. Or, if one has a blood-stasis constitution, blood stasis leads to qi stagnation, hindering the smooth flow of qi and blood, blocking the Chong and Ren channels, all of which can trigger dysmenorrhea—this is "pain due to obstruction." Dysmenorrhea can arise from deficiency, excess, heat, or cold. It is evident that individual patterns of cold, heat, deficiency, and excess are all potential factors contributing to the onset of dysmenorrhea. If one habitually consumes raw and cold drinks, swims during menstruation, or sits and lies in damp places, it is easy for pathogenic cold to invade, causing yang qi to lose its propelling and warming functions, leading to qi and blood stasis and resulting in dysmenorrhea. Alternatively, if one frequently eats rich, sweet, and greasy foods, over time phlegm-dampness accumulates within the body, obstructing the flow of qi. When qi cannot move freely, blood stasis occurs—this is "pain due to obstruction." Professor Pei Zhengxue believes that the etiology of dysmenorrhea ultimately falls into two categories: deficiency or excess, or a combination of both. The site of the disease is the uterus and the Chong and Ren channels, with "pain due to obstruction" or "pain due to lack of nourishment" being the main pathogenesis. In cases of excess, qi stagnation and blood stasis, cold-induced blood stasis, or damp-heat obstruction can lead to poor circulation of qi and blood in the uterus, resulting in "pain due to obstruction." In cases of deficiency, the primary cause is weak qi and blood, along with kidney qi deficiency, leading to inadequate nourishment of the uterus, hence "pain due to lack of nourishment." Professor Pei Zhengxue also believes that the onset of dysmenorrhea is closely related to the special physiological state during and around menstruation, so it often occurs in conjunction with the menstrual cycle. During non-menstrual periods, since the qi and blood of the Chong and Ren channels are balanced, there are usually not enough pathogenic factors to cause stagnation or insufficiency of qi and blood in the Chong and Ren channels and the uterus, so pain does not occur normally. However, before and after menstruation, the "sea of blood" overflows from fullness to discharge, and qi and blood shift from abundance to sudden deficiency, causing rapid changes in the qi and blood of the uterus and Chong and Ren channels compared to normal times. This makes it easier for pathogenic factors to interfere, combined with individual constitutional factors, leading to poor circulation or inadequate nourishment of qi and blood in the uterus and Chong and Ren channels, resulting in pain due to obstruction or lack of nourishment. After menstruation, as the qi and blood of the uterus and Chong and Ren channels gradually recover, the pain naturally subsides. However, if the underlying causes are not eliminated and the individual's constitution is not improved, the pain will recur with the next menstrual period.

9. Professor Pei Zhengxue’s Syndrome Differentiation and Treatment

10. Cold-Induced Blood Stasis Syndrome Symptoms: Before or during menstruation, cold pain in the lower abdomen that worsens with palpation, relieved by warmth, or delayed menstrual cycle, reduced 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.

11. Qi Stagnation and Blood Stasis Syndrome Symptoms: Before or during menstruation, distending pain in the lower abdomen that worsens with palpation, reduced 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 activate 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.

12. Qi and Blood Deficiency Syndrome Symptoms: During or after menstruation, mild pain in the lower abdomen that is relieved by pressure, reduced menstrual flow, pale and thin blood; fatigue, dizziness, palpitations, pale complexion, insomnia and frequent 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 blood contains 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 frequent dreams are present, and the heart and spleen are weak, consider adding Polygala, Albizia Bark, and Nightshade Vine; if accompanied by aversion to cold and cold pain in the lower back and abdomen, add Cinnamon, Fennel, and Mugwort.

13. Damp-Heat Accumulation Syndrome