Dysmenorrhea

General

Clinical Manifestations	Recurring sharp or dull pain in the lower abdomen or pelvis 1-2 days before, during, or after the period The pain can radiate to the whole abdomen, lower back and anal/genital area (Endometriosis can have a feeling of downward pulling on the anus). The pain generally diminishes after the period ends. The pain can be stabbing, burning, squeezing, dull, down-bearing and in severe cases, can cause nausea, vomiting, cold sweating and fainting. This seems to happen mostly in younger women. Primary Dysmenorrhea: Cramping pain in the lower abdomen occurring just before or during menstruation. Secondary Dysmenorrhea: Menstrual cramps that are caused by an underlying condition, such as a reproductive disease, a structural abnormality or an intrauterine birth.
Treatment Principle	Promote blood circulation Warm the uterus Enhancing the flow of Qi and Blood
Herb Formulas	Dysmenorrhea #1 For membranous dysmenorrhea: Dysmenorrhea #2 For Wind-Damp-Heat: Dang Gui Nian Tong Tang For abdominal cramping: Shao Yao Gan Cao Tang
Points	SP-6, SP-10, CV-4 KI-3, REN-4, SP-4, ST-25, ST-29, ST-30, ST-36 Excess: REN-3, UB-32, SP-8 Deficiency: DU-4, UB-23, REN-4, ST-36, KI-12 Ear: Uterus, Kidney, Ovary, Endocrine

Wind-Cold

Clinical Manifestations	Itching or tickling in the throat Cough with expectoration of thin, watery or frothy white sputum Chills with low grade fever Anhidrosis No thirst Headache Aversion to Wind Blocked and / or runny nose with clear, watery nasal discharge Sneezing General body aches Maybe asthma T: Pink C: Thin, white and moist P: Superficial and tight
Treatment Principle	Expel Wind Dispel Cold Resolve Phlegm
Herb Formulas	Ma Huang Tang
Points

Wind-Cold Invasion With Damp Accumulation

Clinical Manifestations	Itching or tickling in the throat Wheezing Sneezing Gasping Cough with expectoration of thin, watery or frothy white sputum General body aches No thirst Dyspnea Headache Body aches A sensation of heaviness Chills with low grade fever Maybe asthma Intolerance of Cold Anhidrosis Blocked and/or runny nose with watery nasal discharge Chest discomfort Neck stiffness Irritability T: Pink C: Thin, white and moist P: Superficial and tight
Treatment Principle	Disperse Wind-Cold Induce diaphoresis Dispel Dampness
Herb Formulas	Ma Huang Jia Zhu Tang
Points	DU-16, GB-20, UB-12, LI-4, SJ-5 (Sedating technique), UB-13, LU-7, REN-17, SP-6, SP-9, Moxa REN-4, REN-6, DU-4

Jue Yin Level - Cold And Heat

Clinical Manifestations	Intermittent attacks of abdominal pain Stifling sensation in the chest and epigastrium A sensation of warmth in the chest and epigastrium Irritability in the chest and epigastrium Vomiting after eating Extremely Cold extremities Vomiting of roundworms Incessant diarrhea Hunger with no desire to eat Vomiting immediately after eating Heat in the Stomach with Cold in the Intestines Bitter taste in the mouth Frequent urination Anxiety Abdominal pain (better with warmth and pressure) Pain beneath the Heart Borborygmus Unquenchable thirst Running piglet Qi Pain and Heat in the Stomach Discharge of small amounts of pus Irritability Recurrent nausea and vomiting Diarrhea Dry throat Turbid urine Polydipsia T: Red or geographic or pale C: White P: Hidden or Wiry and tight
Treatment Principle	Warm the Internal organs Warm the Middle Jiao Warms the Intestines Drains Heat Replenishes Qi Dispels parasites Calms roundworms Drains the Liver Calms the Stomach Promotes Blood circulation Relieves pain
Herb Formulas	Wu Mei Wan
Points

Spleen Not Governing The Blood

Clinical Manifestations	Sallow or pale complexion Anorexia Four limbs feel tired and heavy Physical and mental exhaustion Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose or unformed stools Shortness of breath Dizziness Palpitations Functional Uterine Bleeding Purpura Epistaxis Hemafecia Hematuria Menorrhagia Metrorrhagia T: Pale and flabby - may have teethmarks C: White P: Thready and weak
Treatment Principle	Benefit Qi Conserve Blood
Herb Formulas	Jiao Ai Tang
Points	SP-1, SP-3, ST-36, UB-20 For Deficiency type uterine bleeding: DU-20, LI-11, REN-4, SP-4, SP-10, SP-14, UB-17

Spleen Yang Deficiency

Clinical Manifestations	Sallow complexion Anorexia (maybe with vomiting) Four limbs feel tired and heavy Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose stools or watery stools containing undigested food Shortness of breath Pain in the epigastrium with cold sensations (pain is relieved by warmth) Cold limbs Feeling chilled Mental fatigue Maybe scanty urine with edema Maybe clear, watery vaginal discharge T: Pale C: Thin and white P: Deep and weak
Treatment Principle	Warm the Center Dispel Cold.
Herb Formulas	Fu Zi Li Zhong Tang With constipation: Wen Pi Tang Chinese patent medicines: Fu Zi Li Zhong Wan
Points	Warm-needle UB-20, LIV-13, SP-3, SP-5, SP-6, ST-36, REN-12

Spleen And Stomach Deficiency Cold

Clinical Manifestations	Chronic, intermittent, dull abdominal pain which is better with warmth and pressure and ingesting warm fluids Waxy, pale or sallow lusterless complexion Anorexia (maybe with vomiting) Easily satiated Four limbs feel tired and heavy Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose stools or watery stools containing undigested food Shortness of breath Pain in the epigastrium with cold sensations relieved by warmth Intolerance of Cold Cold limbs Feeling chilled Lethargy Fatigue Mental fatigue Depression Low spirits Maybe scanty urine with edema Maybe clear, watery vaginal discharge T: Pale maybe swollen C: White or Thin and white or White and greasy P: Deep, thready and forceless or Deep and weak or Thready and weak
Treatment Principle	Warm the Middle Jiao Strengthen the Spleen and Stomach
Herb Formulas	Fu Zi Li Zhong Tang Wu Zhu Yu Tang Xiao Jian Zhong Tang With Blood Stagnation: An Zhong San Chinese patent medicines: Li Zhong Wan With Kidney Yang Deficiency: Jin Kui Shen Qi Wan With Qi and Blood Deficiency: Shi Quan Da Bu Wan
Points	Moxa or moxa needle KI-3, LI-11, REN-4, REN-6, REN-7, REN-12, SP-4, SP-6, ST-25, ST-30, ST-36 With nausea: + PC-6 With severe pain or diarrhea : + strong moxa REN-8 Ear: Abdomen, Large Intestine, Small Intestine, Stomach,Spleen, Shenmen, Adrenal, Sympathetic

Cold Accumulation In The Spleen And Stomach

Clinical Manifestations	Sudden, violent pain Pain responds to warmth Loose stools Diarrhea Nausea No thirst Clear urine T: Normal C: White or White and sticky P: Deep and tight or Deep, wiry and slow
Treatment Principle	Warm the abdomen Disperse Cold
Herb Formulas	Xiang Sha Liu Jun Zi Tang Fu Zi Li Zhong Wan Liang Fu Wan + Zheng Qi Tian Xiang San
Points	Above the umbilicus: SP-4, ST-24, REN-10 Around the umbilicus: KI-5, REN-6, ST-25 Lower abdomen: 1. SP-6, ST-29, REN-4, moxa REN-8 2. Moxa UB-20, UB-21, REN-6, REN-12, ST-21, ST-36, PC-6, SP-4 3. PC-6, ST-36, REN-11 4. REN-6, REN-10, REN-12, REN-13, PC-6, ST-21, ST-25, ST-34, ST-36 If chronic: Huatuojiaji

Heart Blood And Spleen Qi Deficiency

Clinical Manifestations	Palpitations Insomnia Much dreaming Easily startled Poor memory Four limbs tired and lethargic Loss of appetite Distention and fullness of the epigastrium and abdomen Loose stools Sallow complexion Copious, pale menses Uterine bleeding or Light menstrual flow or Amenorrhea T: Pale P: Thready and weak
Treatment Principle	Reinforce and Benefit the Heart and Spleen
Herb Formulas	Gui Pi Tang
Points	HT-7, REN-4, SP-1, SP-6, ST-36, UB-15, UB-20

Liver Qi Stagnation

Clinical Manifestations	Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Pink C: Thin and white P: Wiry
Treatment Principle	Soothe the Liver Clear Stagnation
Herb Formulas	Chai Hu Shu Gan Tang  modified Tian Tai Wu Yao San modified With Kidney Deficiency: Ding Jing Fang For Spleen Qi Stagnation with constipation: Liu Mo Tang With pain and urgent diarrhea: Tong Xie Yao Fang With Qi and Blood Deficiency: Xiao Yao San Affecting the Liver channel and genitals: Tian Tai Wu Yao San For severe Liver Excess with: Long Dan Xie Gan Tang Chinese Patent Medicines: Chai Hu Shu Gan Wan With sluggish bowels and Food Stagnation: Mu Xiang Shun Qi Wan With constipation: Chen Xiang Hua Qi Wan For Qi Stagnation type pain: Shu Gan Wan With Qi and Blood Deficiency: Xiao Yao Wan
Points	GB-40, GB-41, LIV-2, LIV-3, LIV-4, LIV-5, LIV-13, LIV-14, PC-6, SJ-6, SP-6, UB-18 GB-34,  LIV-3, LIV-13, PC-6, REN-6, SJ-6, ST-21, ST-25, ST-36 With Blood or Yin Deficiency: + SP-6, UB-18, UB-23 With severe pain: + LIV-5, SP-8 With nervousness, anxiety or tension: + HT-7, Yintang Ear: Shenmen, Liver, Abdomen, Stomach, Large Intestine, Small Intestine, Subcortex, Endocrine, Sympathetic

Liver Qi Stagnation Transforms Into Fire

Clinical Manifestations	Dysmenorrhea Burning, throbbing pain before and during menstruation Irregular period, either earlier or later Abdominal pain before or during period Menses with dark red clots or sticky mucous Dark menstrual blood Dry stools Dry sore eyes Heavy period Abdominal distention Distending pain in breasts Chest distention Dry mouth with a bitter taste Headache Insomnia Irritability Outbursts of yelling or anger Thirst Scarce and yellow urine General feeling of Heat May be acne related to the period T: Red body (redder on sides) C: Yellow and sticky P: Wiry and rapid or Thready and taut
Treatment Principle	Soften the Liver Removing Blood Stasis Dredge the channels Clear away Stagnant Heat Drain Fire Relieve pain
Herb Formulas	Xuan Yu Tong Jing Tang modified (three days before menstruation until menstrual finish) Xiao Chai Hu Tang modified Jia Wei Xiao Yao San For mild Heat signs: Jin Ling Zi San
Points	LIV-8, SP-8, LU-7, KI-4 REN-6, REN-7, LIV-1 REN-6, LIV-3, SP-6

Liver Qi Stagnation Attacks The Spleen

Clinical Manifestations	Abdominal distention and pain Gas Borborygmus Diarrhea Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Pink C: White and greasy P: Slippery and wiry
Treatment Principle	Soothe the Liver Invigorate the Spleen
Herb Formulas	Si Ni San Shao Yao Gan Cao Tang
Points	LIV-3, LIV-13, SP-6, ST-25, ST-36, ST-37

Liver Qi Stagnation Invades The Stomach

Clinical Manifestations	Chest and abdominal distention A stifling sensation in the chest and abdomen Fixed pain in the hypochondria Belching with a fetid odor Nausea Vomiting Headache Epigastric and abdominal fullness and pain Acid reflux Mild coughing with copious sputum Reduced appetite Indigestion T: Normal C: Thin and white or Greasy or Slippery, P: Wiry and taut or Running
Treatment Principle	Regulate Qi Release Stagnation
Herb Formulas	Yue Ju Wan Liang Fu Wan
Points	LIV-3, LIV-14, PC-6, REN-12

Liver Qi Stagnation: Phlegm And Qi Stagnant And Blocked

Clinical Manifestations	Feeling of obstruction in throat as if a slice of roast meat were stuck there which cannot be coughed up nor swallowed down. This sensation becomes more prominent during emotional upset and subsides when relaxed Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Pink C: Thin and white P: Slippery and wiry (slippery due to Phlegm)
Treatment Principle	Spread Qi Resolve Phlegm
Herb Formulas	Ban Xia Hou Po Tang
Points	LI-18, LIV-3, PC-5, SI-17, SJ-6

Liver Qi Stagnation With Cold Accumulation

Clinical Manifestations	Epigastric pain (better with warmth) Stifling sensation in the chest Hypochondriac pain Lack of thirst Likes to drink warm fluids Vomiting Painful menstruation T: Pink C: White P: Wiry and tight or Deep and slow
Treatment Principle	Warm the Middle Jiao Dispel Cold Promote Qi movement Alleviate pain
Herb Formulas	Liang Fu Wan
Points

Liver Qi And Blood Stagnation

Clinical Manifestations	One or two days before or during first day of menses there is: Lower abdominal distension and pain Distention and pain in the lower chest and the breasts Pressure makes worse Generally scanty Blood flow The flow starts and stops Dark-purple color with clots When the clots pass the pain is relieved (or when menses stop) Premenstrual syndrome Abdominal masses which are visible when lying down Piercing hypochondriac pain Irritability Stomach distention and upset Indigestion Constipation Dysmenorrhea Amenorrhea Chronic diarrhea Daybreak diarrhea Palpable abdominal masses Irregular menstruation Hypochondriac distention Facial color dark and dull Emaciation Sides and ribs distended on both sides (maybe with sharp pain) Enlargement of the Liver and Spleen Suffocating sensation in chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Dysmenorrhea Breast distention and pain before and during menses T: Dark and red or Purple with purple spots on the side and possible sublingual vein distention C: White P: Wiry or Choppy or Wiry, choppy and tight or Deep and wiry, or Slippery and wiry or Wiry, choppy and strong or Wiry, choppy and slow
Treatment Principle	Regulate Qi Soothe the Liver Invigorate the Blood Break up Stasis Relieve pain
Herb Formulas	Ge Xia Zhu Yu Tang Xue Fu Zhu Yu Tang Shi Xiao San Jia Wei Wu Yao Tang modified (three days previous to menstruation till menstrual finish) With Dampness: Dang Gui Shao Yao San
Points	REN-3, UB-32, SP-8 LI-4, LIV-3, REN-3, Zigong, SP-6, SP-8 , SP-10 REN-6, LIV-3, SP-6, SP-8, SP-10, KI-13, KI-14, ST-25, ST-29, UB-32, Shiqizhuixia REN-6, LIV-3, SP-6, SP-8, SP-10, ST-29, KI-13, LI-4 SP-6, SP-8, SP-10 KI-14, UB-17, UB-22, SP-6, ST-36 LIV-3, SP-6, SP-10 REN-7, REN-3, SP-6, SP-10 REN-6, KI-13, REN-17, SP-10

Cold Stagnation In The Liver Channel

Clinical Manifestations	Contractions and cold sensations of scrotum which are alleviated by warmth Pain, distention, fullness and cold sensation in lower abdomen Cold limbs Dislike of cold and preference for warmth Lower abdominal pain radiating to the testicles May be localized sensation of Cold Menstrual pain and hardness Hypochondriac pain Abdominal pain Mobile abdominal masses Flank pain Leukorrhea T: Pale C: White or White and greasy P: Deep and slow or Wiry and tight or Deep and wiry or Slow or Deep and Excess
Treatment Principle	Warm the Liver Dispel Cold.
Herb Formulas	Tian Tai Wu Yao San Nuan Gan Jian
Points	Moxa or moxa-needle REN-4. SP-6, LIV-1

Liver Fire Attacks The Stomach

Clinical Manifestations	Restlessness Easily angered Regurgitation of gastric acid Stomach pain Hungers easily Dry mouth Bitter taste in mouth T: Red C: Yellow P: Wiry and Rapid
Treatment Principle	Reduce Liver Fire
Herb Formulas	Hua Gan Jian
Points	ST-36, REN-12, SP-4, PC-6, LIV-2, LIV-14, LI-4, LI-11 PC-6, ST-36, REN-12, LIV-2, LIV-3

Liver Blood Deficiency

Clinical Manifestations	Pale complexion Pale lips Blurred or failing vision Spots before the eyes Dizziness Dry eyes Pale nail beds Irritability Frightens easily Insomnia with much dreaming Tinnitus Numbness of the limbs Light menses or Amenorrhea Late menses T: Pale C: Little P: Thready
Treatment Principle	Nourish the Liver Reinforce the Blood
Herb Formulas	Hei Xiao Yao San
Points	LIV-3, REN-4, SP-6, ST-36, UB-17, UB-18, UB-20

Liver And Kidney Deficiency

Clinical Manifestations	Menstrual pain relieved by pressure and massage Dull hypogastric pain towards end or after period Persistent indistinct lower abdominal pain either proceeding or following menstruation Clear leukorrhea Delayed puberty Irregular menstruation which is scanty or profuse and red in color or Menses that are pale, with small volume Scanty leukorrhea Sensation of Cold in the lower abdomen Stunted growth Sore and aching lower back and spine Dizziness Pale complexion Pail nails Tinnitus Blurred vision General fatigue Exhaustion Increased clear urine Dusky complexion In some cases tidal fever Scanty urination Poor memory Insomnia A flushed face Hot flashes T: Red or Dark red or Pale C: Little or None P: Weak and fine or Fine and faint or Floating, empty or Deep and thready or Thready and tight
Treatment Principle	Nourish Liver and Kidney Yin Regulate menstruation Nourish Kidney Jing Tonify the Blood Strengthen Kidney Yang Alleviate pain
Herb Formulas	Tiao Gan Tang (from the menstrual onset until three days after menstruation) Yi Shen Tong Jing Tang With Liver Qi Stagnation: Liu Wei Di Huang Wan + Xiao Yao San
Points	DU-4, UB-23, REN-4, ST-36, KI-12 REN-3, REN-4, REN-6, LIV-8, KI-3, KI-10, ST-36 UB-18, UB-23, REN-4, ST-36, KI-6 UB-18, UB-23, REN-4, ST-36, KI-6, LIV-3, LIV-8, ST-25, SP-6, SP-10 UB-18, UB-23, REN-4, ST-36, SP-6, KI-6, LIV-3, KI-3

Liver And Kidney Yin Deficiency

Clinical Manifestations	Facial complexion pale and sallow Both cheeks slightly red Dizziness Dry eyes Blurred vision Spots before the eyes Numbness of limbs Flaccid paralysis (Wei syndrome), weakness Tinnitus Deafness Forgetfulness Low back and knees sore and painful Throat dry and painful Five Sole Heat Low-grade fever Night sweats Irritability Insomnia Stools difficult to pass Constipation Irregular menses or Scanty menses or Amenorrhea Dysmenorrhea Vaginal discharge T: Red C: None P: Thready and rapid
Treatment Principle	Nourish and Reinforce the Liver and Kidneys
Herb Formulas	Qi Ju Di Huang Wan Yi Guan Jian With fever: Liang Di Tang With Yang Rising: Tian Ma Gou Teng Yin Yi Guan Jian  modified With Fire Rising: Zhi Bai Di Huang Wan Yu Nu Jian For secondary dysmenorrhea: Tiao Gan Tang modified
Points	KI-3, LIV-3, SP-6, UB-18, UB-23

Liver, Kidney And Spleen Disharmony

Clinical Manifestations	Irregular periods Dysmenorrhea Possibly profuse bleeding Amenorrhea Depression Sighing Irritability T: Normal or Slightly red on the sides C: Normal P: Wiry
Treatment Principle	Nourish the Blood Invigorate the Blood Regulate menstruation Tonify the Kidneys Benefit the Spleen Nourish the Liver Spread Liver Qi
Herb Formulas	Ding Jing Tang
Points

Kidney Yang Deficiency

Clinical Manifestations	Lumbago: low back feels cold, weak and aching Feeling chilled Aversion to Cold Cold limbs General debility Pale face Urinary frequency with abundant, clear urine or Oliguria with edema Maybe nocturia Lassitude Withdrawn, subdued behavior Knees feel cold and aching Dizziness Tinnitus Impotence Spermatorrhea Premature ejaculation Low libido Female infertility ("uterus cold and infertile") Maybe anorexia Maybe loose stools Maybe chronic diarrhea or "cock crow" diarrhea T: Pale and swollen C: Thin and white P: Deep and thready - maybe slow
Treatment Principle	Warm and Reinforce Kidney Yang
Herb Formulas	Ba Wei Di Huang Wan
Points	Moxa or moxa needle DU-4, KI-3, REN-4, UB-23 For chronic diarrhea, rectal prolapse and Vanquished Yang: + moxa DU-20, REN-8 For Kidney Yang Deficiency impotence: moxa or moxa needle DU-4, DU-20, KI-3, REN-4, UB-23 For Kidney Yang Deficiency (Cock Crow) Diarrhea: moxa or moxa needle DU-20, KI-3, REN-4, UB-23

Kidney Yang Deficiency With Water Flooding

Clinical Manifestations	Edema of whole body particularly at and below the waist Pitting edema Low back pain, aching and heaviness Abdominal distention with full sensations Oliguria Cold limbs Face gray and congested or pale Feeling nervous and cold with mental weariness In severe cases: Ascites T: Pale and swollen C: Thin, white or Thick, white and sticky P: Deep and thready With Water Flooding the Lungs: Cough with copious, thin watery phlegm Asthma with phlegmy sound (wheezing) Dyspnea Facial edema Edema of limbs Dysuria T: Pale and swollen C: White and moist or White and greasy P: Superficial and tight
Treatment Principle	Warm Kidneys Promote diuresis
Herb Formulas	Zhen Wu Tang
Points	KI-7, REN-6, REN-9, SP-6, SP-9, ST-28, ST-36, UB-20, UB-22, UB-23, UB-39

Kidney Qi Deficiency

Clinical Manifestations	The lower abdominal pain is vague and occurs during or following menstrual flow There is preference for pressure The menses are decreased and are light and thin Dizziness Tinnitus Aching weakness in the waist and legs Increased clear urine Dusky complexion T: Pale C: Thin and white P: Deep and thready
Treatment Principle	Strengthen the Kidney Replenish Jing Generate blood Stop pain
Herb Formulas	Tiao Gan Tang
Points

Kidney Deficiency With Blood Stagnation

Clinical Manifestations	Severe abdominal pain occurs the first day of period accompanied Normally a history of irregular period is present Lower back soreness Delayed period Purple dark menstrual Blood Scanty menses mixed with blood clots T: Red C:P White P: Thready and taut
Treatment Principle	Tonifying the Kidneys Remove Blood Stasis Relieve pain
Herb Formulas	Ge Xia Zhu Yu Tangmodified (three days before menstruation till the finish) Gui Shao Di Hang Tang modified (seven days after menstruation until three days before menstruation) Ding Jing Tang
Points	REN-4, KI-3, KI-12, UB-17

Kidney, Heart And Spleen Deficiency

Clinical Manifestations	Irregular periods Scanty bleeding Clots in the menstrual Blood Abdominal distention Breast distention Premenstrual tension Depression Sighing Irritability T: Normal or Slightly red on the sides C: Normal P: Wiry
Treatment Principle	Nourish the Blood Invigorate the Blood Regulate menstruation Tonify the Kidneys Benefit the Spleen
Herb Formulas	Ding Jing Tang
Points

Cold In The Uterus

Clinical Manifestations	Kidney Yang Deficiency: Abdominal pain during or after the period The pain has a dull quality Pressure and warmth helps Pale, watery menses with small volume or dull-dark red blood Mild persistent uterine bleeding Irregular menstruation (either early or late) Prolonged menstruation Amenorrhea Metrorrhagia Extended or continuous menstrual flow Lower abdominal distention Lower abdominal Cold Lower abdominal pain Patients maybe overweight or present with bloating Infertility Dry lips Dry mouth Pale complexion Leukorrhea Low grade fever at dusk Irritability Five sole Heat No desire to drink Distending breast pain Low back coldness and pain Weak aching lower back and legs Copious clear urine or long-drawn-out urination with a thin stream Loose stools Cold limbs Aversion to Cold This pattern is more common with elderly patients T: Pale or Purple with petechiae C: White and moist P: Deep or Thready and choppy or Deep, thready and choppy	Cold-Damp Blocking the Lower Jiao: Cold and pain of the lower abdomen either proceeding or during menstruation Aggravation of pain upon external pressure Some relief with external application of Heat Whole body aches Palpable masses that may or may not be painful Lower abdominal pain without palpable masses Lower abdominal distention Lower back pain Lower abdominal distention during menstruation Frequent menstruation (3-5 timer per month) Spotting Dark purple menstrual Blood (usually with clots) Abnormal uterine bleeding with abdominal soreness and pain Aversion to Cold Depression Cold extremities White vaginal discharge T: Normal or Pale C: White or Greasy and white P: Choppy or Tense or Deep and tight or Wiry and tight or Wiry and slippery or Deep and slippery
Treatment Principle	Kidney Yang Deficiency: Warm the Chong and Ren channels Warm the uterus Regulate menstruation Alleviate pain Eliminate Blood Stasis Cold-Damp Blocking the lower Jiao: Expel Cold Eliminate Damp Warm meridians Relieve pain Dispel Blood Stasis
Herb Formulas	Kidney Yang Deficiency: Wen Jing Tang Ai Fu Nuan Gong Wan Shen Qi Wan Dang Gui Sheng Jiang Yang Rou Tang Due to Liver and Kidney Deficiency; Nuan Gan Jian Cold-Damp Blocking the lower Jiao: Shao Fu Zhu Yu Tang modified (three days before menstruation until menstrual finish) Wu Zhu Yu Tang Wu Ji San
Points	REN-3, UB-32, SP-8 REN-3, ST-28, SP-8 Moxa UB-31, UB-32, UB-33, UB-34 REN-3, REN-4, needle ST-36, KI-3, SP-6, DU-3, DU-4 REN-3, SP-8 , Moxa ST-28 SP-6, SP-8, SP-10 KI-14, UB-17, UB-22, SP-6, ST-36 Cold-Damp Blocking the lower Jiao: ST-29 LU-7, SJ-6, REN-6 LU-7, UB-17, UB-18, UB-23, SP-6 REN-3, ST-28, SP-8, SP-6, UB-32, Shiqizhuixia REN-2, ST-28, SP-8, SP-9, SP-6, UB-32, ST-29, KI-14 With abdominal pain: + DU-4 Moxa, UB-23, UB-42 For severe pain: +UB-32, ST-29 For Kidney Yang Deficiency: Moxa UB-23, UB-32, REN-4, ST-36, SP-6, SP-8, SP-10, REN-3 Moxa REN-4, SP-6, UB-23, DU-4, SP-8 , ST-29, KI-7 SP-4, SP-8, ST-28, ST-30 SP-4, ST-30, REN-4

Damp-Heat In The Lower Jiao

Clinical Manifestations	Distension and pain before or during menses Burning abdominal pain which precedes or follows the menstrual flow with guarding The pain extends to the sacrum Soreness and distention of the lower back Pressure makes the pain worse There may be constant lower abdominal pain that worsens with menstruation Hot sensations A feeling of heat in the abdomen Aversion to Heat Yellow smelly vaginal discharge between periods Dark-red or purple thick Blood with clots Maybe heavy bleeding Maybe dark, scanty, concentrated urine May be a mild fever T: Red C: Yellow and greasy P: Wiry and rapid or slippery and rapid or soft and rapid
Treatment Principle	Cool Heat Eliminate Dampness Eliminate Blood Stasis Alleviate pain
Herb Formulas	Qing Re Tiao Xue Tang With bleeding: Xiao Yao San + Er Miao San
Points	REN-3, UB-32, SP-8 REN-4, LIV-2, LIV-3, LIV-5, LI-11, SP-6, KI-2 REN-3, SP-8, ST-29, LIV-3, UB-23, LIV-4, UB-32, Shiqizhuixia. SP-6, SP-8, SP-9, SP-10, REN-3, LI-4, LI-11, GB-34, ST-28 SP-6, SP-8, SP-10 KI-14, UB-17, UB-22, SP-6, ST-36

Qi Stagnation With Deficiency

Clinical Manifestations	Painful menstruation The period is either scant or normal in volume It starts out slowly Dark in color Small clots Sensitivity to pressure The pain comes and goes T: Dusky C: White P: Wiry and thready
Treatment Principle	Nourish the Blood Regulate the Liver Regulate menstruation
Herb Formulas	Xiao Yao San Chai Hu Shu Gan Tang modified
Points	LIV-8, SP-8, LU-7, KI-4 REN-6, REN-7, LIV-1

Qi And Blood Stagnation

Clinical Manifestations	Dysmenorrhea Distended abdominal pain one or two days before or during menstruation which is worse with pressure Qi Stagnation: more distention than pain Blood Stagnation: more pain than distention Hypomenorrhea with dark purple Blood Bleeding is hesitant with clots Distention and pain in the chest and flanks Pain that is fixed, stabbing and /or severe or Pains that move around Depression Irritability Dark complexion Fixed, palpable masses Purple lips Purple nails Dry skin Blue, dark or purplish discoloration of skin in small or large areas, Varicose and spider veins Cold hands and feet Tendency to hemorrhage dark blood or clots T: Purple, possible purple or red spots C: White P: Choppy or Wiry and choppy
Treatment Principle	Invigorate and nourish the Blood Regulate Qi Break up Stagnation
Herb Formulas	Qi Stagnation more prominent: Jia Wei Wu Yao Tang Ba Wu Tang Blood Stagnation more prominent: Ge Xia Zhu Yu Tang Tao Hong Si Wu Tang With Liver Excess including a bitter taste, a yellow tongue coat and long-lasting, thick purple menstruation: Xue Fu Zhu Yu Tangmodified
Points	GB-40, GB-41, LIV-3, LIV-14, PC-6, SJ-6, SP-6, SP-10, ST-36, UB-17, UB-18, UB-40

Qi And Blood Deficiency

Clinical Manifestations	Dull, empty, bearing-down pain with a straining sensation in the lower abdomen and pubic regions one or two days after menstrual onset or during the menstrual period or even after period Preference for pressure The menses are decreased and are light and thin Lassitude Tiredness Weakness Fatigue Dizziness Blurred vision Palpitations of the Heart Insomnia with dream-disturbed sleep Pale complexion Occasionally dull complexion Loss of appetite Loose stools Diarrhea T: Pale C: Thin P: Thready and feeble
Treatment Principle	Augment Qi Generate Blood Harmonize the Middle Jiao Stop pain
Herb Formulas	Huang Qi Jian Zhong Tang modified Ba Zhen Tang (from onset until three days after menstruation) Sheng Yu Tang modified Shi Quan Da Bu Tang Tai Shan Pan Shi San  modified Nu Ke Ba Zhen Wan Ba Zhen Yi Mu Wan With Cold: Fu Ke Zhong Zi Wan For secondary dysmenorrhea: Shi Quan Da Bu Tang  modified
Points	DU-4, UB-23, REN-4, ST-36, KI-12 ST-36, SP-6, KI-3, GB-39, UB-13, UB-15, UB-17, UB-18, UB-20, UB-23, DU-4 Moxa UB-23, REN-4, ST-36, SP-6, UB-32, DU-20 REN-6, ST-36, SP-6, REN-6, ST-36, SP-6, UB-17, UB-20, LIV-8

Qi, Yang And Blood Deficiency

Clinical Manifestations	Amnesia Palpitations Feverishness Anorexia Emaciation Pale face Insomnia Dyspnea on mild exertion Fatigue Shortness of breath Weight loss Dry skin Dry mouth Dry throat Dry lips Uterine bleeding Irregular menstruation May suddenly lose consciousness Slack jaw Restless at night Lassitude Tendency toward being frightened easily Weakness Sallow complexion Dizziness Tremors in the limbs Spontaneous perspiration Fever and severe chills General debility Mental instability Coughing and gasping Night sweats Amnesia Diarrhea Turbid urine Nocturnal emission Impotence Constipation Feeble breathing Tired limbs T: Pale C:White P: Thready and weak or thready, rapid and weak or Deep and weak
Treatment Principle	TonifY Qi Nourish the Blood Strengthen the Spleen and Lungs Nourish the Heart Calm the Shen
Herb Formulas	Ren Shen Yang Rong Tang Ren Shen Dang Shao San
Points

Blood Stagnation

Clinical Manifestations	Mild, persistent uterine bleeding of purple and black blood during pregnancy Abdominal pain that is worse with pressure Abdominal spasms and tension Immobile masses in the lower abdomen with pain and tenderness Amenorrhea with distention and pain Dysmenorrhea Headache Sinus congestion Constipation Excess weight in the pelvis Lower back ache Irregular menstruation Nervousness Fatigue Fetal instability Skin eruptions Scanty menstrual flow Scaly, dry skin Retention of lochia Headache Shoulder stiffness Vertigo Cold low body and feet Flushed face Protruding abdomen T: Dark purple or with echymoses or petechiae or pale with purplish spots C: White P: Choppy or Tense and deep and slow
Treatment Principle	Invigorate the Blood Transform Blood Stasis Soften lumps Reduce fixed abdominal pain
Herb Formulas	Gui Zhi Fu Ling Wan Dan Shen Yin Di Dang Tang Zhe Cong Yin Yan Hu Suo San With Kidney Deficiency: Ding Jing Tang
Points

Blood Stasis Due To Cold In The Blood

Clinical Manifestations	The lower abdominal pain has a cold quality It precedes or accompanies the menstrual flow There is guarding Pain is alleviated by warmth The menses are decreased The Blood is a dark color and contains clots. Cold-aversion Cold limbs Pale greenish complexion T: Dark C: White P: Deep and tight
Treatment Principle	Warm the channels Dispel Cold Eliminate Stasis Stop pain
Herb Formulas	Wen Jing Tang Tian Tai Wu Yao San
Points	SP-6, SP-8, SP-10 KI-14, UB-17, UB-22, SP-6, ST-36

Blood Deficiency

Clinical Manifestations	Abdominal pain Irritability Slight chills Spasms of the calf muscles Cramps in the hands Weak legs Hypertonicity of the extremities characterized by difficult flexion and extension Wheezing Coughing Hiccup Constipation Vomiting Diarrhea Sciatic pain Severe and painful muscle spasms in the Stomach, bronchi, Gallbladder and uterus. Intestines Shoulder pain Pain in the head, body or limbs due to arterial spasms characterized by a severe pulling pain T: Normal or Reddish C: None or Yellowish P: Wiry and rapid or Thready and rapid
Treatment Principle	Soften the Liver Nourish the Blood Nourish Yin Moderate painful spasms Relieve pain Harmonize the Middle Jiao Replenish Body Fluids
Herb Formulas	Shao Yao Gan Cao Tang Si Wu Tang
Points

Blood Deficiency With Qi Stagnation

Clinical Manifestations	Irregular menstruation Late menstruation Scanty menstruation Distension of the lower abdomen Menstruation with purple blood and clots Pain of the abdomen which is worse upon pressure and diminishes with menstruation Pain is worse with pressure Pain decreases with the passage of clots Swelling and edema of the lower extremities A feeling of oppression in the chest and epigastrium Dry mouth Dark, purplish menses with clots or Dark purple edges T: Red or Purple P: Deep and strong or Hesitant or Choppy and rough
Treatment Principle	Invigorate the Blood Nourish the Blood Move Qi
Herb Formulas	Guo Qi Yin
Points

Blood Deficiency With Blood Stasis

Clinical Manifestations	Severe pain during menses Scanty flow Small clots T: Pale and purplish C: White P: Thready and wiry or Choppy
Treatment Principle	Nourish the Blood Eliminate Blood Stasis Regulate menstruation
Herb Formulas	Tao Hong Si Wu Tang Si Wu Tang Jian Wei Huang Qi Jian Zhong Tangmodified With Heat: Si Wu Tang+ Shi Hui San
Points	LIV-2, LIV-8, SP-8, UB-17 LU-7, UB-17, UB-18, UB-23, SP-6

Cold And Blood Stagnation In The Channels

Clinical Manifestations	Abdominal pain with icy cold hands and feet Extremities are cyanotic and difficult to warm up P: Thready or Imperceptible
Treatment Principle	Warm the channels Disperse Cold Nourish the Blood Unblock the channels
Herb Formulas	Dang Gui Si Ni Tang
Points

Cold-Damp Accumulation

Clinical Manifestations	Pain before or during menstruation which responds to warmth Scanty, dark. clotted menstrual discharge Cold limbs T:Normal C: White and sticky P: Deep and tense
Treatment Principle	Disperse Cold Warm the channels Eliminate Dampness
Herb Formulas	Wu Zhu Yu Tang Wen Jing Tang  modified Shao Fu Zhu Yu Tang
Points

Jing And Blood Deficiency Due To Kidney, Spleen And Heart Deficiency

Clinical Manifestations	Fatigue Heavy and painful lower back Dream-disturbed sleep General weakness Lack of interest in food or drink Fever Night sweats Seminal emission Forgetfulness Toothache Dizziness Gum swelling General pitted edema which is worse in the lower body Vaginal discharge Discharge of rice-water like urination without dysuria Aversion to Cold Impotence Decreased libido Emaciation Loose teeth Signs of premature aging Abdominal Cold Easily frightened T: Pale or Pale and thick C: Smooth and white P: Moderate and weak or Deep and weak
Treatment Principle	Tonify the Spleen and Kidneys Nourish the Heart Enrich Yin Nourish the Blood and Yang Augment Qi
Herb Formulas	Huan Shao Dan
Points

Internal Heat

Clinical Manifestations	Lower abdominal distention and pain (usually on right) Pain increases on pressure with rebound tenderness Guarding of the abdominal musculature Groin pain resembling urinary dysfunction without urinary difficulty Groin pain relieved by flexing hip and knee Groin pain intensified by extending hip Perspiration Irregular or intermittent fever followed by chills and perspiration May be mass in lower right quadrant of abdomen Aversion to Cold Hard lumps T: Pink C: Thin, white or yellow and greasy P: Slippery and rapid or Tight or Wiry and tight or Tight and rapid
Treatment Principle	Drain Heat Break up Blood Stasis Invigorate the Blood Disperse nodules Reduce swelling
Herb Formulas	Da Huang Mu Dan Pi Tang Chai Hu Qing Gan Tang
Points	REN-6, SP-6, SP-9, SP-10, LU-9, KI-3 UB-28, UB-23, REN-2, SP-6

Excess Heat

Clinical Manifestations	Early periods Heavy menstruation Profuse, thick, dark-red or purplish-red flow Profuse bleeding Dysmenorrhea Anxiety Feverish feeling Purple clots in menses Breast distention Hypochondriac pain or Abdominal distention Irritability Stifling sensation in the epigastrium or abdomen May be a bad odor Paroxysms of lower abdominal pain Thirst Preference for cold drinks Burning sensation in the Heart Red face Sore and weak low back and knees Dry mouth Yellow urine Constipation Dry feces May be red eyes Oral ulcerations Epistaxis T: Red C: Yellow P: Slippery and rapid
Treatment Principle	Clear Heat Cool the Blood Purge Fire
Herb Formulas	Qing Jing Tang
Points

Deficiency Cold Of The Chong And Ren Channels

Clinical Manifestations	Mild persistent uterine bleeding Irregular menstruation (either early or late) Prolonged menstruation Skipped period Metrorrhagia Extended or continuous menstrual flow Pain Lower abdominal distention Lower abdominal Cold Lower abdominal pain Infertility Dry lips Dry mouth Spermatorrhea Pale complexion Leukorrhea Amenorrhea Bleeding between periods Low grade fever at dusk Irritability Five sole Heat No desire to drink Distending breast pain Low back coldness and pain Loose stools Cold limbs Aversion to Cold T: Purple with petechiae P: Thready and choppy
Treatment Principle	Warm the menses Regulate menstruation Dispel Cold Warm the channels Nourish the Blood Dispel Blood Stasis
Herb Formulas	Wen Jing Tang Jiao Ai Tang Wen Jing Tang + Si Ni Tang  modified With Damp Stagnation: Shao Fu Zhu Yu Tang modified
Points

Lower Jiao Blood Stagnation With Heat

Clinical Manifestations	Acute lower abdominal pain Incontinence of urine Night fevers Delirious speech Irritability Restlessness Thirst May be mania (severe) Dysmenorrhea Amenorrhea Hard stool Dark red complexion Headache Vertigo Tinnitus Insomnia Palpitations Constipation Frequent urination Emotional instability Chills in the waist and feet Afternoon fever Tremors Excruciating abdominal pain with cold Black stool May be chills and fever Hemoptysis Hematuria Red eyes Pain and distention of the head Toothache Irregular menstruation Lochioschesis Severe wheezing Distention of the chest T: Red and dry C: Yellow P: Deep and forceful or Choppy
Treatment Principle	Drain Heat Break up Blood Stasis
Herb Formulas	Tao He Cheng Qi Tang
Points

Postpartum Cold And Blood Stagnation

Clinical Manifestations	Fixed lower abdominal pain in postpartum women Incomplete expression of the placenta Continual discharge of purple clotted lochia T: Pale-purple
Treatment Principle	Activate the Blood Break up Stasis Warm the Uterus Stop pain
Herb Formulas	Sheng Hua Tang
Points