Menstrual cramps according to Chinese Medicine

'Cold in the Uterus' is one the most common TCM patterns for women who suffer from dysmenorrhea. It can causes intense pain but can be largely relieved with the application of heat. Blood Stagnation often comes along as a consequence of this pattern because Cold obstructs the Uterus and thus impairs the flow of Blood.

If Cold in the Uterus is the main cause behind menstrual cramps, the menstrual blood is often red and the clots are typically dark and rather small or stringy. However, if Blood Stagnation is the main cause, the blood itself is dark (instead of red) and the clots are rather large. 

There are two subtypes of Cold in the Uterus patterns: Full Cold or Empty Cold.

Full cold refers to actual Cold Evil invading the Uterus. It tends to happen to women who consume excessive amount of cold food (e.g. ice cream, raw food, ice-cold drinks), live in cold environment or do sports in winter or during menstruation. Dampness Stagnation often come along with this Full Cold pattern. The treatment principle is to use herbs that expel Cold and Dampness and warm the Uterus. Formulas like Shao Fu Zhu Yu Tang are recommended. 

Empty Cold is linked to Yang Deficiency, especially in the Spleen and Kidney. With Yang Deficiency in these two Organs, body water metabolism is impaired and thus Coldness in the Body Fluids can not be transferred and accumulates. Also, when Yang is lacking, it can not warm the necessary Organs. As a result, treating Empty Cold only with herbs that expel Coldness is not enough, the treatment should focus on supporting Yang and boosting Qi. Wen Qi Hua Shi Tang is a good formula for this. It is used for long-term retention of Cold and Dampness in the Uterus which leads to Qi and Yang Deficiency and painful periods.

Read more about Cold in the Uterus here

The cramps caused by this pattern usually happens before or during the period. The symptoms are similar to these from Liver Qi Stagnation but more intense. The menstrual blood is dark purple and the flow is heavy. The patients is often irritable and gets angry easily. They feel thirsty and have a sensation of heat in their body. Dry stools is also a typical symptom. 

Liver Fire is a consequence of a long-term Stagnation of Liver-Qi. It should be treated by eliminating Stagnation rather than simply clearing Heat with bitter-cold herbs. 

Read more about Stagnant Liver-Qi turning into Fire here

When Damp-Heat causes menstrual cramps a feeling of lower abdominal tightness, distention, and cramps appears and gets stronger when the period is about to start. The discomfort lasts until the middle of the periods. The menstrual flow is often heavy and the blood is purplish in color and thick in texture. Other typical symptom can be an excessive smelly yellow vaginal discharge outside of menstruation times.

When patients have a history of pelvic inflammatory disease, chronic vaginitis, or appendicitis, they tend to have bigger chance falling under this pattern. The cramps can be either on both sides or just on one side, which tends to be the lower right side of the abdominals. Also, women suffering from this pattern might have a sore back and limbs as well as feel pain and heat in the knees.

Read more about Damp-Heat here

Qi and Blood Stagnation is one of the most common patterns behind painful periods and it often comes along other patterns. For instance, when there is dysmenorrhea due to Qi and Blood Deficiency as the main pattern, some degree of Qi or Blood Stagnation often occurs at the same time. Similarly the pattern Cold in the Uterus, another frequent cause of menstrual cramps, also causes Blood Stagnation. 

According to Chinese Medicine, the Liver and the Penetrating Vessel are the body parts most involved in Qi and Blood Stagnation. If Liver Qi does not flow freely, Blood stagnates and causes pain before and during the period. As for the Penetrating Vessel, it notably supplies and coordinates Blood to the Uterus, a function that's impaired if Liver Qi and Blood stagnate.

When the menstrual cramps are mainly due to Qi Stagnation, abdominal distension is the most obvious symptoms, especially one or two days before menstruation or at the very beginning of the periods. The condition is aggravated by emotional upset and stress. Pre-menstrual tension, irritability, depression and a wiry pulse are other symptoms. The tongue color is often normal, except in serious and chronic cases when it may be red on the sides.

If Blood Stagnation is more prominent, there is more pain than distention and the pain tends to be intense and stabbing. The flow doesn't go easily and it tends to be scanty as well as dark and purplish in color. Often there are dark clots in the blood, which is the typical indicator of this pattern. The larger the clots, the more severe the Stagnation. There is usually a relief of pain after blood clots are discharged. Purple color tongue is also a typical symptom.

Read more about Qi and Blood Stagnation here

Qi and Blood Deficiency often only causes dull menstrual cramps. Even in painful periods caused by a Deficiency there is often also an element of Stagnation because Qi can not move Blood properly, which is what leads to dysmenorrhea. It often come along with a dragging feeling around the perineum that can be relieved by massage. There are no clots in the menstrual blood, but the blood is scanty and thin with a pale color.

The cramps often happen towards the end of or after the period. It is because the Penetrating Vessel's 'Sea of Blood' is empty after releasing menstrual blood and there is not enough Qi to move the Blood back in.

The treatment principle is to tonify Qi, nourish Blood and strengthen the Spleen which is the base of producing additional Qi and Blood. 

Read more about Qi and Blood Deficiency here

Like with the Blood and Qi Deficiency pattern, dysmenorrhea caused by Liver Blood and Kidney Yin Deficiency also causes dull pain and often come towards the end of or after the period. It is more often seen in older, premenopausal women.

In this pattern, the menstrual cramps occur because there is no sufficient Liver Blood and Kidney Yin to fill the Uterus and to nourish the sinews. The pain often extends to the top of the thighs along the course of the Liver Channel. The treatment principles is to nourish Liver Blood and Kidney Yin, tonify the Uterus and nourish the Essence.

Read more about Liver Blood and Kidney Yin Deficiency here