Case 1: primary dysmenorrhea

A young woman , 23 years old.
Patient’s first visit was March 12, 2012

General Appearance: Patient is of robust physique, with white skin, pale complexion and scattered acne. Her lips are thick and red.

Relevant medical history: Patient has had dysmenorrhea for more than 3 years. She has pain extending from the lower abdomen into the inguinal region. The pain is periodic and gets better with pressure and warmth. Her period lasts 2 to 3 days. Her appetite is good. Her bowel movements and urination are regular. She has some bloating and gas. She gets easily fatigued. Her sleep is poor and her hands and feet are icy cold.

Physical Exam: She has acne around her mouth, chin, and back. Her lower legs have dry skin. Around her navel she has hair. Her tongue is pale red. Ultrasound: Her uterus is posteriorly positioned.

Formula : sheng ma huang 5g , ge gen 30g, gui zhi 15g, chi shao 15g, sheng gan cao 5g, gan jiang 10g, hong zao 20g, 10 bags total. Each week take 1 bag everyday for 5 days then stop taking for 2 days.

April 9, 2012 second visit: After taking the formula the patient's gas and bloating improved as well as her sleep. On march 21 she had a period with no dysmenorrhea. Added to the original formula lian qiao 30g , and prescribed 10 bags, with directions to take 2 bags every week.

Case Notes:

1) The records regarding the color and volume of her menstrual flow were incomplete and is the reason why they were not included in the case. With regards to the symptoms, "likes warmth and pressure, is easily fatigued, sleep is poor, hands and feet are icy cold." dang gui shao yao san is used for these symptoms.

2) Dr. Huang uses Ge Gen Tang , because this patient reflects a Ge Gen Tang constitution. It was combined with dang gui shao yao san to treat the patient.

Case 2: primary dysmenorrhea

Young woman , 25 years old, teacher. January 31, 2012 had first visit.

General appearance : Patient's body is thin. Her lips are red, complexion is red and oily. Her chin is covered with acne. Her eyes are bright, and she has double lids. Her height is 165 cm (5'5") , weight is 53 kg (117 lbs).

Relevant medical history : The patient has had dysmenorrhea for 10 years. Her period started when she was 15 yrs old and developed dysmenorrhea shortly after. Her period arrives with severe pain, and feels better with pressure and warmth. Last year in August her period began to be delayed. The volume of the period decreased and then the dysmenorrhea was as before. She lacks a good appetite in the morning and is occasionally thirsty. When she eats breakfast out, about a half an hour later, she gets diarrhea. Her sleep is poor, dream-filled and will awaken easily. Her previous physical exam indicated mammary gland hyperplasia and cysts in her fallopian tubes and ovaries.

Physical Exam: the tip of her tongue was red, with a greasy coating. Her pulse was slippery and strong .

Formula: jiang ban xia 10 g, fu ling 10 g, zi su geng 10 g, Hou po 10g, zhi ke 10 g, huang qin 5g, zhi zi 10 g, lian qiao 20 g, gan jiang 5g , 15 bags, every week take 5 bags, then take 2 days off.

April 14, 2012 second visit: after taking the formula the patient had two periods without dysmenorrhea, her acne went away , and her sleep improved. She is continuing with the original formula and taking 10 bags.

Case Notes: This case shows the hypersensitivity of a "fire banxia type" constitution.

Case 3: primary dysmenorrhea case

Young woman , 23 years old. October 17, 2009 had first visit.

General appearance: Patient's middle is slightly thin and skin color is yellow and white. Her complexion is dusky yellow with dark macules.

Relevant medical history: Patient has had dysmenorrhea for many years. When the pain is severe, she may also have vomiting and diarrhea.She uses pain killers in a suppository form and despite progressively stronger doses her dysmenorrhea has not improved. Her period is typically irregular , and it lasts 7 to 10 days. She also gets headaches frequently. Her sleep is okay, but typically dream-filled. Her bowels and urination are fine. 

Physical Exam: The subcostal areas are tight and when pressed there is discomfort. Her epigastrium is also painful with pressure. Her tongue is pale with tooth marks. The skin on her lower legs is dry .

Formula : chai hu 12g , bai shao 12g, zhi ke 15g, sheng gan cao 10g, dang gui 15g, chuan xiong 15g, tao ren 15g , hong hua 10 g, 15 bags.

December 8, 2009 second visit: On November 9 she had a small amount of bleeding. On November 28 period has very little flow, the color is dark. Her breasts are distended and painful. Her headache has eased but not yet cleared.

Formula: chai hu 12 g, bai shao 12 g, zhi ke 12 g, sheng gan cao 3g, dang gui 12 g chuan xiong 12 g, tao ren 12 g, hong hua 6g , 21 bags.

January 5, 2010 third visit: December 30 her period came, the color was dark, and was small in amount. She reported it was not painful. Her headache has been significantly reduced.

Added to the last formula huai niu xi 15g , prescribed 20 bags, for her to take 1 bag every other day.

Case notes:
1) She has dysmenorrhea accompanied by vomiting and diarrhea. She gets frequent headaches and her complexion is dusky yellow with dark macules on her skin. Her tongue is pale with tooth marks. Physicians usually consider using Dang gui si ni plus wu zhu yu sheng jiang tang, or Dang gui shao yao san combined with zhen wu tang types of formulas for before and during a period.
2) According to Dr Huang, the patient's constitution is a ba wei huo xue tang constitution. There is a description of that constitutional pattern in a previous article.

Case 4: Stubborn dysmenorrhea case

Ms. Y, 28 yo 8/29/2011 first visit.

General appearance: Thin body, white skin, yellow face and a worried affect. 158 cm tall, 44kg.

Relevant medical history: Ms. Y has had dysmenorrhea for ten years, and it has gotten worse in the last two. The pain starts when the period begins and she must take painkillers. The menstrual color is dusky with lots of clots and flow lasts seven to ten days. Before the flow she has breast distention and all her limbs are cold. She can sleep. Her stools are hard and dry, but when she gets chilled she gets diarrhea. She has a history of cervicitis and acne.

Family history: Mother has gallstones, father suffers from intestinal disease.

Physical exam: She has a small amount of acne on the forehead, and pressing the subcostal region elicits discomfort.  Her tongue is pale red with slightly greasy fur. Pulse is wiry and thin, and the skin on her lower legs is slightly dry.

Prescription: chai hu 15g, bai shao 15g, sheng gan cao 5g, zhi ke 15g, gui zhi 15g, mu dan pi 15g, tao ren 15g,  fú líng 15g, chi shao 15g, 15 bags. Five bags per week.

10/17/2011 second visit: After taking the medicine the dysmenorrhea did not reduce. This period the pain was very intense and the acne was still present. Her vagina is dry and rough and itchy. There is yellow discharge with a strong smell. When she has a cervical infection she uses vaginal suppositories to cure it. After the dysmenorrhea her weight drops. She feels extremely hungry and craves sweets. During the dysmenorrhea she easily gets chills and diarrhea. The tongue is red, fur root is yellow and greasy. Thin pulse.

Prescription: Rou gui 10g, gui zhi 10g, bai shao 30g, zhi gan cao 10g, dang gui 10g, gan jiang 10g, hong zao 30g, yi tang 2 spoonfuls (divided into four portions). 15 bags, each bag taken over two days.

11/14/2011 third visit: She's all smiles. She says her menses came and went and the pain was greatly reduced. She did not need to take painkillers. The menstruation lasted nine days. The acne has reduced, and her stools are slightly dry. Pulse is wiry and slippery. Use the previous formula, but increase bai shao to 40g, 15 bags, each bag taken over two days.

Case notes: The first formula was not effective, and on the second visit we noted "There is yellow discharge with a strong smell. Tongue is red, fur root is yellow and greasy." How should we change the formula? We must understand the physical constitution. Her body was thin and white, she had a yellow face with cold limbs, and when she gets chilled she has diarrhea. During menstruation, she easily gets chills and diarrhea. This is a gui zhi constitution. What formula should we use? Her weight was dropping, she was clearly hungry and craved sweet food, so dang gui jian zhong tang becomes a clear choice.

Case 5: Endometriosis

Ms. W, 36 years old 5/15/2012 first visit.

General appearance: The skin on her body is yellow, facial color is dark yellow with tan macules. 

Relevant medical history: She's had endometriosis for many years and many treatments without effect. Her cycle is very prolonged with a light flow. The menstruation lasts for 3-5 days, it is dusky in color with lots of clots. Before menstruation she experiences breast distention and tenderness. Her sleep is insufficient, shallow, dream-filled, and she wakes early. She is able to eat, and her stools are slightly soft.  She has hemorrhoids, anal fissures and bloody stools and a history of small cysts in her mammary glands.

Physical exam: Her tongue is pale red with greasy fur. Pulse is thin.

Prescription: Dang Gui Jian Zhong Tang with xi xin. 7 bags, one bag per day.

5/26/2012 second visit: After taking the herbs her sleep improved, she has developed small pimples on her back, and she has bad breath. Her stools are a little dry, and she has anal fissures and blood in the stool. The tongue is red with a thick greasy coat.

Prescription: Huang qin 15g bai shao 30g, sheng gan cao 5g, hong zao 20g, 10 bags. Every week take one bag a day for five days and stop for two.

6/10/2012 third visit: Menstruation started May 30th, menses were moderate, few clots, and menstrual pain slowly resolved. Before menstruation her breasts were swollen and tender. To the same formula add 30g fresh mai ya, 15 bags, every week take the formula for four days and stop for three.

6/24/2012 fourth visit: The last menstrual flow was from June 30 to July 3, flow was heavy, purple in color, with clots, and pain was very slight. Breast distention and tenderness is lighter, and she had back pain with the flow. Her bowels are regular and her sleep is normal. Tongue is dark red, fur root is greasy and thick.

Same formula, 15 bags, every week take for three days and rest four.

Case notes: Dysmenorrhea is a commonly seen disease in outpatients. It is also a type of disease that Chinese medicine is very good at treating. The previous five cases cover external-internal, hot-cold, and deficiency-excess. 

The treatment techniques and methodologies are all different. Easily treated and frustrating cases are covered for the enlightenment of the reader.