Painful menstrual periods (dysmenorrhea) occur quite commonly in Western women. Pain can occur before, during or after the menstrual period.
Dysmenorrhea is found predominantly in liver repletion (shi) and kidney vacuity (xu) constitutional types. In either case, it is due to a slowing down of the qi and blood (xue) circulation. If the qi is circulating freely, no pain will occur.
Menstrual Cycle: East and West
Let's review the menstrual cycle as it is understood in Western medicine and in Chinese medicine. Whatever the length of time for a particular woman, the cycle may be normal if it is regular (approximately 25 to 42 days). Throughout the cycle, in Chinese medicine, what happens with a particular woman is related to her constitutional type. There are two views: One is that the kidney (which governs reproduction) has overall responsibility for the cycle, the other is that the spleen has the primary responsibility. I generally agree with the second view. The spleen is responsible for the production of xue, and is the source of the postnatal qi. It also transforms foods and fluids. The ability of the uterus to stay in position depends on the spleen qi.
The liver qi is active from ovulation through the onset of a period, or even the first few days of the cycle, depending on the length of the actual menses. The liver stores the xue. More and more xue is stored in order to nourish the egg, should it be fertilized. If no nourishment is needed, the liver lets go of the xue. The liver qi allows the xue to be released, and if there is not smooth movement of xue, liver qi is usually the source of the lack of movement. Depression and anxiety (consistent with liver qi stagnation) may occur at this time. The kidney is responsible for the function of the ovaries. The qi of the kidney is predominant after the onset of the period right up until the next ovulation. It stores the jing (essence) and controls the formation of the egg.
Constitution and the Relationship to the Zang Fu
Differentiating qi and xue stagnation is particularly important if you are using herbal therapies. Mental depression and emotional suppression lead to stagnation of liver qi. From this condition, stagnation of xue can develop. Abdominal distention, rather than severe abdominal pain, is characteristic of qi stagnation. There is often no change in the tongue; however, it may have a purple/dusky quality. The fur continues to stay white. The pulse is wiry/bowstring.
Severe pain constitutes xue stagnation as well as qi stagnation. There is often a stuffy chest; pain in the breasts; and irritability, especially before the period. When the period comes, the pain is relieved. If there are blood clots, there is relief of pain when they pass. The tongue is purplish, often with purple spots at the sides. The pulse is deep and choppy.
Kidney xu consitutional types will sometimes have weakness and pain after the period. This is caused by qi xu. This may help you with the correct treatment.
Regulating the Cycle
If the whole constitution is liver shi, there will be a wiry pulse all the time, and anxiousness. We can sedate the liver throughout the whole cycle. (This also may turn out to be relevant in treating endometriosis.) In some women, however, there is a true hormonal imbalance in one portion of the cycle. This may be influenced with Chinese medicine treatment. Depending on the constitutional type, acupuncture and herbs can be used to influence the liver and kidney at appropriate portions of the cycle. (Note: Often in working with infertility, balancing the cycle is a priority, and we find as a side-effect there is an end to painful periods.) We will commonly see a kidney xu, liver shi type prone to painful periods. Right at the time of the period we would treat the imbalance as a shi condition, but throughout the rest of the cycle, we would treat it as a xu condition. I use kidney tonification treatment during one part of the cycle, then liver sedation. I am alert to re-evaluate treatment modalities at any point through tongue, pulse and palpation diagnostic techniques. In any given woman, it is also at least possible that what I see has a more complex origin in the client's emotional history.
The Uterus, the Heart and the Chong Mai
Dramatic changes often become available when I incorporate extraordinary channel treatment along with constitutional treatment. I particularly address imbalances of the chong mai, which often is disturbed when there are painful periods. This channel connects the uterus to the heart.
From a Western perspective, the heart and uterus are the only smooth muscles in the body. This is reflected in the chong mai connection. If there is a destructive effect on one, there is damage to the other. If the channel is injured through emotional trauma, we will have to work to repair it. If there is fear at a young age, the channel will sustain developmental damage. Any resultant symptoms will either persist indefinitely or be displaced into another area.
A kidney xu type will be more affected by fear; a liver shi type will be more affected by anger. When the chong mai is damaged, I strengthen it using Spleen 4 and Pericardium 6. If possible, the treatment may be augmented by ion-pumping cords. (Caution: The physiological problems caused by damage to the chong mai can be healed in a shorter time than can the emotional problems.)
It is important that exploration in this area not be pushed open until the woman is ready to investigate it, with adequate emotional support. Otherwise, the effects can be devastating. (See, for example, descriptions in Western medicine of posttraumatic stress disorder.)
It is important that you are not casual about evaluating the strength of the emotional support system already in place in the woman's life before she even entertains the idea that previous trauma may come up. You cannot offer her a time frame for the complexities of complete emotional recovery.
Conclusion: A Unique Opportunity
When we see gynecological problems, we are approaching an area in which there is a heavy impact from the client's emotional history. We are able to extend to clients our willingness to work in these problem areas and meet the difficulties as we find them. It is very gratifying to be able to offer healing that is elsewhere very hard to find.
Click here for previous articles by Misha Cohen, OMD, LAc.
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