In my last article, I discussed options for integrating two effective Western herbs with TCM medicinals to minimize the pain of dysmenorrhea. In this part, I will continue to examine ways to use TCM medicinals to treat dysmenorrhea and discuss important natural supplements which can complement herbal protocols to more effectively assuage menstrual pain.
We discussed a variation of Si Wu Tang consisting of bai shao, dang gui, chuan xiong and xiang fu in my previous article. This is an excellent TCM formula to build upon for both acute and chronic dysmenorrhea. If one is unable to use cramp bark or black haw, one can also use the TCM medicinals yan hu suo and yu jin in combination with the Si Wu Tang variation. Yan hu suo (Corydalis rhizoma) is acrid, bitter and warm, and quickens the blood, moves the qi and eliminates pain. Yu jin (Curcumae radix) is acrid, bitter and cold, and quickens the blood, moves the qi, eliminates pain and resolves depression. If we combine the two together, the cold and warm natures work in harmony to stop menstrual pain more effectively than either would by themselves.
Chronic or long-standing liver depression qi stagnation can lead to depressive heat, which can easily damage liver blood/yin. If this pattern presents itself along the qi stagnation and blood stasis, if becomes very important to emmoliate or soften the liver viscus in order to not further damage the yin by moving the qi too harshly. This can easily be done by increasing the dose of bai shao in the Si Wu Tangvariation or simply adding the two-herb formula Er Zhi Wan to the Si Wu Tang variation.
Another effective way to modify the Si Wu Tang variation is to use vinegar-processed bai shao, yan hu suo and xiang fu to more effectively course the liver qi and/or use wine-processed dang gui or dang gui wei to more effectively quicken or invigorate the blood. If menstruation is excessive, the dose of dang gui can be lowered to 3 to 5 g to effectively prevent blood stasis and nourish blood without causing excessive bleeding.
Along with herbal therapies and acupuncture, assessing basic nutritional deficiencies is very important when addressing dysmenorrhea. Two of the most common nutritional deficiencies to target are omega-3 fatty acids and magnesium. Both are critical nutrients to prevent uterine spasms and cramping. Research has also shown that both have the ability to help the nervous system more efficiently manage stress reactions. These actions clearly have a role in any pattern in which liver depression qi stagnation plays a primary or significant contributing role.
The majority of research on omega-3 fatty acids is focused on fish oils and the fats EPA and DHA. Plant-based omega-3s do not contain EPA or DHA, but still may play an effective role against inflammatory chain reactions that can contribute to uterine spasms and cramping. Many plant-based oils are now fortified with algae sources based on the research on the mood enhancing benefits of DHA. These are excellent options for patients who seek to avoid animal-source omega-3s. An effective clinical dose of omega-3s can more easily be reached by using liquids dosed at one tablespoon per 100 pounds of body weight. This can be added to salads or smoothies to ensure patient compliance.
Magnesium is also a critical nutrient to prevent dysmenorrhea and is one of the most common nutritional deficiencies. The dose of magnesium to effectively treat menstrual issues can range from 400 to 800 mg, depending on the level of deficiency. Magnesium citrate is the most common type and can be very effective, however it can also act as a laxative. If this occurs, it is best to use Magnesium glycinate to insure adequate absorption and prevention of loose stools. Magnesium can be added one week prior to menses or can be integrated into a standard daily protocol in cases of chronic dysmenorrhea.
I hope these short articles on dysmenorrhea help clinicians more effectively treat this common and debilitating condition. If the clinician combines the herbal and nutrient therapies discussed with acupuncture and yoga/ tai chi, many cases of dysmenorrhea can be resolved within one to three menstrual cycles.
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