Dysmenorrhea, or painful menstruation, is perhaps the most commonly encountered gynecological complaint. Referred to as tong jing in Chinese, dysmenorrhea is the main presenting symptom in Western medical diseases categories such as endometriosis, uterine fibroids and ovarian cysts, and is most often the sole presenting complaint in gynecological pathologies. In this series of articles, I will examine ways to effectively blend Western herbs with TCM medicinals/formulas to effectively target painful menstruation. I will also discuss some important natural supplements that are critical for resolving chronic dysmenorrhea and can work in tandem with herbal protocols to reestablish patterns of harmony and health in the menstrual cycle.
The main TCM patterns behind the majority of cases of dysmenorrhea is liver depression/qi stagnation/blood stasis. There is not enough space in this short article to discuss pathology in depth, so please keep in mind that many times, other more complex patterns will overlap these common patterns. When this occurs, the practitioner must target all presenting patterns to effectively resolve the pattern of disharmony. Be that as it may, we will focus on ways to integrate specific Western herbs into the patterns of liver depression/qi stagnation/blood stasis.
Regardless of the complexity of pattern combinations in dysmenorrhea, the main course of therapy will be to free and regulate the flow of qi and blood. The most effective TCM medicinals to quickly accomplish this are: dang gui, bai shao, chuan xiong and xiang fu. One can use this simple modification of Si Wu Tang as a skeleton formula to flesh out as needed to addresses other pattern complications. The combination of dang gui/bai shao will course qi, invigorate blood and emolliate the liver viscus. Chuan xiong will effectively invigorate blood and stop pain and xiang fu is a key gynecology medicinal to course the qi mechanism and stop pain.
Two very effective Western herbs that can be added to this TCM formula are cramp bark (Viburnum opulus) and black haw (Viburnum prunifolium). Both of these Western herbs have been used extensively in Eclectic/Physiomedicalist herbal traditions as effective antispasmodics in the condition of dysmenorrhea. Both herbs are very similar in action and tend to course blood/stop pain and be slightly warming in nature. Some interesting Eclectic indications for black haw were "irritable nervous system," coupled with digestive complaints, uterine prolapse and scanty menstrual flow. If we view this constellation of symptoms through the lens of TCM, the pattern of liver/spleen disharmony with blood stasis seems to emerge.
Cramp bark had many of the same indications, however one of the unique clues that would suggest its use was the sign of cold limbs coupled with scanty menstrual flow and dysmenorrhea. This suggests a strong ability to course qi and invigorate blood. Cramp bark was also utilized as a mild cardiac tonic to improve circulation, which can contribute to its ability to invigorate the blood in TCM methodology.
With these ideas in mind, it is easy to see how practitioners can simply add either or both of these Western herbs to the aforementioned Si Wu Tang variation to quickly and effectively address acute, painful menstrual cramps. Both cramp bark and black haw work rather quickly and can be added four to five days prior to the time of expected menstrual pain. One of the most effective ways to utilize these herbs is with liquid extracts combined with a TCM tea or patent. It is usually best dosed every three to four hours if pain is severe or one to three times a day in cases of mild menstrual pain.
Another effective protocol is to utilize the Si Wu Tang variation in tea or pill form twice daily and use cramp bark/black haw with chamomile tea every one to two hours as needed until cramps subside. Chamomile (Matricaria recutita) is a gentle yet dependable nervine and anti-inflammatory. Some interesting Eclectic indications for chamomile were for patients who were touchy, impatient and sensitive to pain. These indications also suggest the ability to course qi,so one can see how it can be easily combined with cramp bark/black haw for acute or chronic dysmenorrhea. When using chamomile, always determine if patient is allergic to the daisy-family of plants. If so, it is best to avoid its use.
I hope this short article on integrating Eastern/Western herbs in dysmenorrhea was stimulating and allows clinicians to examine new therapeutic options for effectively providing pain relief to their patients. In Part 2 of this series, I will examine important nutritional deficiencies that can contribute to chronic dysmenorrhea presentations and explore more options for integrating Western herbs with TCM formulas/patents.
