Author: Physician Quek Yi Yan | May 2021 | Zhongjing TCM
Menstrual cramp is perhaps the most common symptom associated with periods, but they should not be something that you have to go through. Menstruation should be painless with minimal premenstrual symptoms. Menstrual cramps can range from a slight discomfort to severe pain, even extending to the entire pelvic region, lower back or inner thighs, and accompanied by nausea and headaches.
What is TCM's understanding of dysmernorrhea?
The menstrual cycle is regulated mainly by the Kidneys, with the help of the Liver and Spleen. Proper functioning of the Chong and Ren meridians are also essential to having a regular cycle and normal period. Chong meridian acts as a blood reservoir and Ren regulates the menstrual cycle and fertility. Having sufficient Kidney Essence and proper Spleen function ensure an abundance of Qi and Blood in the body. This allows for Chong meridian to be filled, leading to the thickening of the endometrium lining and maturation of follicles. Liver then regulates the flow of Qi and Blood, directing them to the Chong meridian after menstruation and emptying them out during menstruation.
Disruption to any stage in this process can cause problems with the menstrual cycle. If the Spleen and Kidneys are impaired, it can result in insufficient Qi and Blood to nourish the uterus and surrounding structures, resulting in pain. If the Liver Qi does not flow properly, the general flow of Qi and Blood will be affected and the uterus would not be able to properly empty out during menstruation, the resulting obstruction can also cause pain. Consuming cold food and drinks can introduce Cold pathogenic factor to our body, also slowing down the flow of Qi and Blood.
Menstrual cramps can be generally caused by either an excess (实) or deficiency (虚) syndrome.
Excess Syndrome
This is prevalent in young females below the age of 30. The most common cause would be stress, having frequent late nights and excessively consuming cold food and drinks. Cold foods refer to anything eaten chilled and food eaten raw. The commonly heard phrase, “Uterus being very Cold (子宫很寒)”, either during TCM consultations or on TCM-related shows, refers to this syndrome.
- Common syndromes: Qi and Blood stagnation, stagnation of Cold
- Symptoms: Localized sharp or stabbing pain in the lower abdomen, having significant amount of blood clots, abdominal bloating, pre-menstrual breast tenderness, irritability or mood swings, having cold hands and feet
Deficiency Syndrome
We see this in individuals with weaker body constitutions, especially those who overwork for long periods of time, are chronically sleep-deprived or are undergoing extreme dieting.
- Common syndromes: Qi and Blood deficiency, Kidney deficiency
- Symptoms: Dull ache in the lower abdomen which can be relieved with pressure, low menstrual flow or short periods, frequent lower backaches, dizziness, chronic fatigue, pale complexion
How can we treat dysmenorrhea?
It is entirely possible to reduce or eliminate menstrual cramps with Traditional Chinese Medicine (TCM) treatment. TCM has a long history of treating many gynaecological disorders. And among them, it has been shown to be effective for treating menstrual cramps. A review of 60 randomized-controlled trials1 suggested that acupuncture might reduce menstrual pain and associated symptoms more effectively compared to no treatment or NSAIDs (Painkillers prescribed for menstrual pain).
During a TCM consultation, a physician will diagnose your syndrome based on your menstrual symptoms, as well as information about your general health, such as sleep, eating habits, bowel movements etc. A treatment plan will then be formulated based on your specific constitution. Treatment methods can include herbal medication or acupuncture, or both. Treatment usually needs to be administered throughout the cycle, with regular follow-ups in between. The entire treatment duration usually lasts around 3 months as it takes time to correct the imbalances within your body. Prescriptions and acupoints used can differ throughout the treatment as the aim of treatment changes according to the stage of your menstrual cycle.
TCM treatment focuses on correcting the imbalances in your body and we believe that these imbalances not only affect your menstrual cycle, but your general health as well. Hence, the benefit of undergoing a TCM treatment is that you may find improvement in other aspects of your health, other than your menstrual cramps. Furthermore, for those who are trying to conceive, by improving your imbalance, it improves your fertility as well.
What can YOU do about dysmenorrhea?
Diet Tips
Avoid taking cold food, iced drinks and raw food, like salads and sashimi, especially a week before and during your period. Cold causes Qi and Blood to stagnate, therefore resulting in pain. If you really cannot give up your iced kopi/teh or ice cream, have some hot ginger tea afterwards. Or if you have to have your poke bowls, you can have more preserved ginger and wasabi to counteract the cooling effects of sashimi. Having warm drinks and soups can help to improve the flow of Qi and Blood and prevent or reduce menstrual cramps.
If you are taking tonics like Bak Foong Pills (Or Bai Feng Wan) and Eight Treasures Soup (Ba Zhen Tang) that can be commonly found in chinese medical halls, only take them after the period has ended. These formulas help to nourish Qi and Blood. At this stage, Chong meridian is emptied and the body is in a deficient state, hence the body is better able to absorb these nourishing herbs.
Ginger Red Dates Tea
Motherwort Tea
Lifestyle Tips
Bundle up in air-conditioned environments, taking note of your abdomen, lower back and legs. Avoid clothing that exposes these areas. For those wearing shorts, it would be good to cover up your legs with a jacket or scarf. This is especially important a week before and during your period. Cold can enter the body via our lower extremities and impede the flow of Qi and Blood. Using a hot water bottle on your abdomen or lower back before and during your period, or taking a hot bath can also help to relieve your cramps.
Regular exercise, especially aerobic exercises, can improve the flow of Qi and Blood. Research2 suggests that exercise, performed for about 45-60 minutes each time, three times or more per week, may provide a significant reduction in menstrual pain intensity.
Acupressure Massage
Stimulating selected acupoints can help to correct the imbalances within the body, thereby providing relief for menstrual cramps.
| San Yin Jiao (SP-6) Place four fingers above the inner ankle, behind the shin bone. |
| Xue Hai (SP-10) With the knee bent, place three fingers above the inner top corner of the knee cap in a 45 degrees angle. |
| Di Ji (SP-8) Four fingers below the angle of tibia, behind the shin bone. How to find the angle of tibia: Run your finger upwards, along the rim of your shin bone on the inner side of your lower leg, until your finger comes to a stop. This is the angle of tibia. |
| Tai Chong (LV-3) Between the first and second feet bones. On the back of your foot, run your finger upwards from in between your first and second toe, until you feel your feet bones. This depression would be the acupoint. |
| Shen Shu (BU-23) Located on the lower back, around 1.5 inches beside the lumbar spine and level with the belly button. Place both fists on each side of your lower back and massage in a circular manner for 3-5 min. Another method would be to rub both palms together until they feel warm and place them on the acupoints. Repeat 10-15 times. |
How to massage: Locate each acupoint with your thumb (with the exception of Shen Shu) and apply firm and steady pressure. Massage in a circular motion for 3-5 minutes 2-3 times a day. Begin doing acupressure massage a week prior to your period until your cramps have stopped. Women who seek to improve their general well-being can perform acupressure massage on these acupoints as well.
*Caution: If you are unsure, do consult a TCM practitioner for advice before carrying out the massage for yourself or others.
References
- Woo, H. L., Ji, H. R., Pak, Y. K., Lee, H., Heo, S. J., Lee, J. M., & Park, K. S. (2018). The efficacy and safety of acupuncture in women with primary dysmenorrhea: A systematic review and meta-analysis. Medicine, 97(23).
- Armour M, Ee CC, Naidoo D, Ayati Z, Chalmers KJ, Steel KA, de Manincor MJ, Delshad E. Exercise for dysmenorrhoea. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD004142.
