Menstrual cramps according to Chinese Medicine

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Menstrual cramps factsheet

Chinese name: 痛经

Pinyin name: Tòng Jīng

Possible causes and remedies:

Menstrual cramps refers to the pain that comes before, during or after the period. It can appears in the lower abdominal, sacral area and it sometimes spread to the legs. Some women might even suffer from nausea, fever, vomiting or fainting. 

The Penetrating Vessel (Chong Mai 冲脉), the Directing Vessel (Ren Mai  任脉)and the Liver are the most influential body parts on the menstrual cycle according to Chinese Medicine. The proper flow of menstrual blood depends on the free movement of Liver Qi and Penetrating Vessel Qi. Also Blood should be sufficient and flow without Stagnation

We explain here the various pathological reasons explaining menstrual cramps from the Traditional Chinese Medicine point of view. 

As you can see below we've detailed for you the six "patterns of disharmony" associated with menstrual cramps. Chinese Medicine sees the body as a system, not a sum of isolated parts. A "pattern" is when the system's harmony is disrupted. It is not equivalent to a Western condition, as a matter of fact here menstrual cramps can be explained by six different patterns.

Each of those patterns can be treated with one or several herbal formulas. Drinking herbal infusions is the most common remedy in Chinese Medicine, together with acupuncture. It is the Chinese Medicine equivalent to drugs, apart that it's 100% natural!

In total we detail below fifteen formulas that can help treat the various patterns that cause menstrual cramps, depending on which pattern fits your profile.

The six "patterns of disharmony" associated with menstrual cramps

Cinnamon Twigs (Gui Zhi) is the key herb for Wen Jing Tang, a formula used for Cold in the Uterus

Cold in the Uterus

Pulse type(s): Choppy (Se), Deep (Chen), Tight (Jin)

Tongue color: Bluish-Purple, Pale

Recommended herbal formulas: Wen Jing Tang, Shao Fu Zhu Yu Tang, Wen Qi Hua Shi Tang

Symptoms: Sore back Sore legs Pale face Cold limbs Scanty periods Feeling of cold Frequent urination Lower abdominal pain Pain relieved with heat Dark clots in menstrual blood

'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 Liver is a so-called "Zang" Organ. Learn more about the Liver in Chinese Medicine

Stagnant Liver-Qi turning into Fire

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

Bupleurum Roots (Chai Hu) is the key herb for Xiao Yao San, a formula used for Qi and Blood Stagnation

Qi and Blood Stagnation

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

Phellodendron Bark (Huang Bo) is the key herb for Er Miao San, a formula used for Damp-Heat

Damp-Heat

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

The Kidneys is a so-called "Zang" Organ. Learn more about the Kidneys in Chinese Medicine

Liver Blood and Kidney Yin Deficiency

Pulse type(s): Empty (Xu), Floating (Fu)

Tongue coating: Complete absence of coating

Tongue color: Red

Recommended herbal formulas: Tiao Gan Tang, Gui Shao Di Huang Tang, Liu Wei Di Huang Wan

Symptoms: Fatigue Tinnitus Sore back Dizziness Scanty periods Blurred vision Delayed period Dull menstrual cramps Pain relieved with massage

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

Blood and Qi Deficiency

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 Blood and Qi Deficiency here

The fifteen herbal formulas that might help with menstrual cramps

Xiao Yao San

Source date: 1107 AD

Number of ingredients: 6 herbs

Key actions: Harmonizes the function of Liver and Spleen. Relieves Liver Qi stagnation. Nourishes the Blood.

Why might Xiao Yao San help with menstrual cramps?

Because it is a formula often recommended to help with the patterns Qi and Blood Stagnation and Damp-Heat which are sometimes associated with menstrual cramps. If any of these patterns look like something you might suffer from, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Xiao Yao San here

Wen Jing Tang

Source date: 220 AD

Number of ingredients: 12 herbs

Key actions: Warms the Uterus and vessels. Nourishes Blood. Dispels Cold. Dispels Blood Stagnation.

Why might Wen Jing Tang help with menstrual cramps?

Because it is a formula often recommended to help treat Cold in the Uterus, a pattern sometimes associated with menstrual cramps. If it looks like you might suffer from Cold in the Uterus, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Wen Jing Tang here

Xuan Yu Tong Jing Tang

Source date: 1826 AD

Number of ingredients: 10 herbs

Key actions: Pacifies the Liver. Removes Stagnation. Drains Fire. Unblocks the Meridians.

Why might Xuan Yu Tong Jing Tang help with menstrual cramps?

Because it is a formula often recommended to help treat Stagnant Liver-Qi turning into Fire, a pattern sometimes associated with menstrual cramps. If it looks like you might suffer from Stagnant Liver-Qi turning into Fire, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Xuan Yu Tong Jing Tang here

Tiao Gan Tang

Source date: 1827 AD

Number of ingredients: 7 herbs

Key actions: Nourishes Kidney and Liver Yin.

Why might Tiao Gan Tang help with menstrual cramps?

Because it is a formula often recommended to help treat Liver Blood and Kidney Yin Deficiency, a pattern sometimes associated with menstrual cramps. If it looks like you might suffer from Liver Blood and Kidney Yin Deficiency, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Tiao Gan Tang here

Ba Zhen Yi Mu Tang

Source date: 1624 AD

Number of ingredients: 9 herbs

Key actions: Tonifies Qi and Blood. Invigorates the Blood.

Why might Ba Zhen Yi Mu Tang help with menstrual cramps?

Because it is a formula often recommended to help treat Blood and Qi Deficiency, a pattern sometimes associated with menstrual cramps. If it looks like you might suffer from Blood and Qi Deficiency, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Ba Zhen Yi Mu Tang here

Shao Fu Zhu Yu Tang

Source date: 1830 AD

Number of ingredients: 10 herbs

Key actions: Expels Cold and warm the menstruation Blood. Stops pain. Invigorates Blood. Dispels Blood stagnation.

Why might Shao Fu Zhu Yu Tang help with menstrual cramps?

Because it is a formula often recommended to help treat Cold in the Uterus, a pattern sometimes associated with menstrual cramps. If it looks like you might suffer from Cold in the Uterus, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Shao Fu Zhu Yu Tang here

Wen Qi Hua Shi Tang

Source date: 1827 AD

Number of ingredients: 7 herbs

Key actions: Supports Kidney Yang. Supplies Spleen Qi. Expels Cold and Dampness from the Uterus.

Why might Wen Qi Hua Shi Tang help with menstrual cramps?

Because it is a formula often recommended to help treat Cold in the Uterus, a pattern sometimes associated with menstrual cramps. If it looks like you might suffer from Cold in the Uterus, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Wen Qi Hua Shi Tang here

Jia Wei Xiao Yao San

Source date: Ming dynasty

Number of ingredients: 10 herbs

Key actions: Clears Liver and Spleen Qi Stagnation. Tonifies Spleen. Clears Deficient Heat. Nourishes the blood.

Why might Jia Wei Xiao Yao San help with menstrual cramps?

Because it is a formula often recommended to help treat Stagnant Liver-Qi turning into Fire, a pattern sometimes associated with menstrual cramps. If it looks like you might suffer from Stagnant Liver-Qi turning into Fire, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Jia Wei Xiao Yao San here

Tao Hong Si Wu Tang

Source date: 1291 AD

Number of ingredients: 6 herbs

Key actions: Tonifies Blood and regulates the Liver. Moves Qi and Blood in the lower abdomen. Stops pain.

Why might Tao Hong Si Wu Tang help with menstrual cramps?

Because it is a formula often recommended to help treat Qi and Blood Stagnation, a pattern sometimes associated with menstrual cramps. If it looks like you might suffer from Qi and Blood Stagnation, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Tao Hong Si Wu Tang here

Ge Xia Zhu Yu Tang

Source date: 1830 AD

Number of ingredients: 12 herbs

Key actions: Invigorates Blood. Eliminates Blood Stagnation below the diaphragm. Stops pain. Promotes Qi movement.

Why might Ge Xia Zhu Yu Tang help with menstrual cramps?

Because it is a formula often recommended to help treat Qi and Blood Stagnation, a pattern sometimes associated with menstrual cramps. If it looks like you might suffer from Qi and Blood Stagnation, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Ge Xia Zhu Yu Tang here

Er Miao San

Source date: 1481 AD

Number of ingredients: 2 herbs

Key actions: Expels Dampness from the Lower Burner. Drains Heat from the Lower Burner.

Why might Er Miao San help with menstrual cramps?

Because it is a formula often recommended to help treat Damp-Heat, a pattern sometimes associated with menstrual cramps. If it looks like you might suffer from Damp-Heat, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Er Miao San here

Qing Re Tiao Xue Tang

Source date: 1576 AD

Number of ingredients: 10 herbs

Key actions: Expel Dampness. Relieve pain. Move Qi and Blood.

Why might Qing Re Tiao Xue Tang help with menstrual cramps?

Because it is a formula often recommended to help treat Damp-Heat, a pattern sometimes associated with menstrual cramps. If it looks like you might suffer from Damp-Heat, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Qing Re Tiao Xue Tang here

Gui Shao Di Huang Tang

Source date: 1706 AD

Number of ingredients: 8 herbs

Key actions: Nourishes Blood. Nourishes Yin.

Why might Gui Shao Di Huang Tang help with menstrual cramps?

Because it is a formula often recommended to help treat Liver Blood and Kidney Yin Deficiency, a pattern sometimes associated with menstrual cramps. If it looks like you might suffer from Liver Blood and Kidney Yin Deficiency, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Gui Shao Di Huang Tang here

Liu Wei Di Huang Wan

Source date: 1119 AD

Number of ingredients: 6 herbs

Key actions: Nutritive tonic for the Liver and Kidney Yin Essence (nourishes the parasympathetic nervous system).

Why might Liu Wei Di Huang Wan help with menstrual cramps?

Because it is a formula often recommended to help treat Liver Blood and Kidney Yin Deficiency, a pattern sometimes associated with menstrual cramps. If it looks like you might suffer from Liver Blood and Kidney Yin Deficiency, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Liu Wei Di Huang Wan here

Sheng Yu Tang

Source date: 1336 AD

Number of ingredients: 6 herbs

Key actions: Tonifies Qi and Blood. Preserves the Blood.

Why might Sheng Yu Tang help with menstrual cramps?

Because it is a formula often recommended to help treat Blood and Qi Deficiency, a pattern sometimes associated with menstrual cramps. If it looks like you might suffer from Blood and Qi Deficiency, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Sheng Yu Tang here