Dysmenorrhea with Abdominal Cold
F, 31 years old. 31-year-old woman with intense dysmenorrhea for 2 years, with dark clots, partial relief with local heat and sensation of cold in the lower abdomen.
The patient
- Age and sex
- 31 years · F
- Chief complaint
- 31-year-old woman with intense dysmenorrhea for 2 years, with dark clots, partial relief with local heat and sensation of cold in the lower abdomen.
- Tongue
- Dark purple body, especially on the edges. White coating.
- Pulse
- A wiry (Xian) and rough (Se) or slow (Chi) pulse in the Guan (關) and Chi (尺) positions.
Symptoms
- Intense menstrual pain, cramping or static
- Dark clots in menstrual flow
- Pain relief with a hot water bottle
- Sensation of cold in the lower abdomen
- Cold hands and feet
- Irregular cycles with frequent delay
Warning signs to rule out
- Pain worsening cycle after cycle, deep pain during intercourse, pain outside menstruation, or difficulty conceiving. → Gynaecological referral for suspected endometriosis. Treating the pattern helps, but the diagnosis cannot wait to see whether it helps.
- Very heavy bleeding, large clots, or periods lasting more than seven days. → Gynaecological assessment and full blood count: fibroids and iron-deficiency anaemia must be ruled out.
- Acute one-sided pelvic pain with a missed period or unusual bleeding. → Emergency care. An ectopic pregnancy presents exactly like this and allows no delay.
Case resolution
Think through the pattern first, then expand the resolution
- Pattern
- Blood Stagnation with Cold in the Uterus (Kidney Yang Deficiency)
- Meridians involved
- Liver, Conception Vessel, Kidney
- Pathogenic factors
- Blood Stagnation (Xue Yu), Internal Cold in the Uterus, Kidney Yang Deficiency
Cold congeals and contracts, creating Blood Stagnation in the Uterus. Dark clots are the evidence of stagnant Blood. Kidney Yang deficiency cannot warm the Uterus, perpetuating the Cold-Stagnation cycle. Relief with heat confirms the Cold nature of the pattern. Purple tongue is the classic sign of Blood Stagnation.
Differential diagnosis
Shares: Pain before and at the start of the period, clots, and relief once they pass.
Sets it apart: In Qi stagnation the pain is distending and shifting, tied to breast tenderness and irritability, and does not respond to heat. Here the pain is stabbing and fixed, clearly improves with a hot water bottle, and comes with a cold sensation in the lower abdomen.
Shares: Menstrual pain that improves with local heat.
Sets it apart: In vacuity the pain is dull, appears at the end of or after the period and improves with pressure; bleeding is scanty and pale. Here pain peaks on day one, worsens with pressure and the blood is dark with clots: this is excess, not vacuity.
Shares: Cycle-linked pelvic pain.
Sets it apart: Damp-Heat presents with yellow, malodorous discharge, a burning sensation and a yellow greasy coating, and local heat worsens the pain instead of relieving it. It is the sign that rules this case out fastest.
Treatment
Principle: Warm the uterus and dispel Cold, move Blood and stop pain, while tonifying Kidney Yang as the background.
| Point | Role | Technique |
|---|---|---|
| CV4 | Guanyuan: the point that warms the uterus. With moxa it is the axis of the treatment, not an add-on. | Indirect moxa for fifteen to twenty minutes. Perpendicular needling 0.8-1.2 cun with the bladder empty. Contraindicated in pregnancy. |
| SP6 | Crossing of the three Yin: the reference point for dysmenorrhoea; it moves Blood and regulates the uterus. | Perpendicular 1-1.5 cun, reducing. Contraindicated in pregnancy. |
| SP10 | Sea of Blood: it breaks the stasis behind the dark clots. | Perpendicular 1-1.5 cun, reducing. |
| LV3 | Liver Yuan-source: the Liver governs menstrual Blood and here it opens the way for circulation. | Perpendicular 0.5-0.8 cun, reducing. |
| ST29 | Guilai: a local point over the uterus, especially useful with moxa when Cold is present. | Perpendicular 0.8-1.2 cun with moxa. Contraindicated in pregnancy. |
| BL23 | Kidney Back-Shu: it treats the deficient Yang background that lets Cold settle in every cycle. | Perpendicular 0.8-1 cun with moxa, tonifying. |
Formula: Shao Fu Zhu Yu Tang. Warms the lower abdomen and breaks Blood stasis from Cold. When vacuity outweighs the stasis, with scanty periods and cold hands, Wen Jing Tang fits better.
- Frequency
- Two sessions weekly in the week before menstruation, across three complete cycles. Treating during bleeding relieves the episode; treating beforehand changes the next cycle, and that is the difference between soothing and resolving.
Home care
- A heat pack on the lower abdomen for twenty minutes a day from one week before the period.
- Cut cold drinks, ice cream and raw food in the week before: Cold that enters through the mouth ends up in the uterus.
- Moxa on CV4 for fifteen minutes, three times a week during the premenstrual phase.
- Keep the feet covered and avoid sitting on cold surfaces; the Kidney channel starts on the sole.
Progress
- Cycle 1 · day 21, five days before the period On day one of the previous cycle the pain was 9 out of 10 and she needed three painkillers. Dark clots and a cold sensation in the lower abdomen. Moxa on CV4 and ST29, needling SP6, SP10 and LV3. Home moxa is taught and cold foods are removed in the preceding week. That cycle the pain drops to 6 out of 10 and one painkiller is enough.
- Cycle 1 · day 26, two days before Cold in the lower back and cold hands persist: the deficient Yang background is untouched. BL23 with moxa is added. Without treating the root, every winter would reproduce the same picture. She notices a warmer lower back and sleeps without socks for the first time in months.
- Cycle 2 · day 22 Pain 4 out of 10 in the previous cycle and brighter blood with fewer clots. The scheme is kept and Zigong is added. Shao Fu Zhu Yu Tang is started for the seven days before the period. A cycle with pain at 3 out of 10 and no painkillers.
- Cycle 3 · day 21 Pain 2 out of 10 on day one, no clots and no cold sensation. Treatment ends, with home moxa in the premenstrual phase and a review in three months. The result holds over the next two cycles without sessions.
- Discharge
- Treatment ends after three consecutive cycles with pain of 3 out of 10 or less and no painkillers. A single good cycle does not count: the cycle has its own variability.
- Watch for relapses
- Winters and the cycles that follow cold swims or training in the cold. The dark clot returns before the pain does: that is the cue to resume moxa in the week before.
Health notice. Educational and study content. It describes concepts of Traditional Chinese Medicine and does not replace diagnosis or treatment by a healthcare professional. Needling, medicinal herbs and invasive techniques must be applied by trained professionals. Safety guide.
