1 Dysmenorrhea (painful menstruation) means that women have periodic pain during or prior to or after menstrual period in the

lower abdomen or even faint in severe cases. It has been customary to classify cases of dysmenorrhea into two main groups: primary or functional dysmenorrhea referring to the one which is not caused by organic diseases, and secondary dysmenorrhea referring to the one caused by organic diseases in reproductive system. Main Points of Diagnosis 1. The pain in the lower abdomen appears with menstrual cycle. 2. The pain can spread over the whole abdomen, lumbosacral region or there is dragging pain in the vulva and anus. It varies in degrees and can be relieved when the menstrual blood flows smoothly. 3. Gynecological examination: Those without organic diseases in the pelvic cavity are primary dysmenorrhea; those with organic diseases in the pelvic cavity are secondary dysmenorrhea. Differentiation and Treatment of Common Syndromes 1. Blood Stasis due to Stagnation of Qi . Main Symptoms and Signs: Distending pain and tenderness in the lower abdomen one or two days prior to or during menstruation accompanied with fullness sensation in the chest, hypochondrium and breast, deep-purple blood with clots, relief of pain after discharge of clots, ecchymoses on the tongue edges, string-like pulse. Therapeutic Principle: Regulating the flow of qi and removing blood stasis to alleviate the pain. Recipe: Modified Decoction for Dissipating Blood Stasis Under Diaphragm. Chinese angelica root - ligusticum root - red peony root - peach kernel safflower - bitter orange - corydalis tuber -trogopterus dung - Sichuan chinaberry - lindera root - nutgrass flatsedge rhizome 2. Stagnancy of Cold and Dampness . Main Symptoms and Signs: Distending pain in the lower abdomen several days prior to or during menstruation, which can be relieved by warmth, menstrual flow scanty in amount, dark in color and with clots, pale tongue with white and greasy fur, deep and tense pulse. Therapeutic Principle: Warming the channels and expelling dampness to arrest pain. Recipe: Modified Decoction for Removing Blood Stagnation in the Lower Abdomen. common fennel fruit - cinnamon bark - red peony root - Chinese angelica root - ligusticum root - corydalis tuber myrrh - cat-tail pollen - trogopterus dung - poria For those with lassitude in loins and legs and excreting copious clear urine, omit poria and add 6 grams of prepared aconite root and 9 grams of argyi leaf. 3. Deficiency of Both Qi and Blood .- Main Symptoms and Signs: Vague pain in the lower abdomen during or 1-2 days after menstruation which can be relieved by pressing, scanty menstruation with reddish and thin blood, accompanied with lack of vitality and asthenia, pale tongue with white and thin fur, thready and weak pulse. Therapeutic Principle: Invigorating qi and enriching the blood to alleviate pain.

2 Recipe: Modified Dysmenorrhea-Healing Decoction. Ginseng - astragalus root - Chinese angelica root -ligusticum root - prepared rehmannia root - white peony root nutgrass flatsedge rhizome - corydalis tuber

Dysmenorrhea and Pain Management in Chinese Medicine In Chinese medicine, pain is the symptom 0f a deeper problem. The root cause of pain can be either an Excess (Shi) pattern or a Deficiency (Xu) pattern. The blockage of Qi and Blood, or the retention of Heat, Dampness or Wind, are Excess patterns. Deficiency of Qi and Blood, or imbalance of Kidney and Liver are Deficiency patterns. Blockage of Qi and Blood causes pain; imbalances of the internal organs cause pain; blockage of the meridians causes pain. Figuring out the source of the pain is the key to diagnosis and treatment. Non-fixed pain is attributed to a Wind pattern. "Chilly" pain is associated with a Cold pattern. Heavy and swollen pain is associated with a Dampness pattern. Sharp pain is associated with a Blood Stasis pattern. Stomach pain and back pain are attributed to retention of Cold in the Middle. Dull pain is associated with a Blood Deficiency pattern. Pain with redness, swelling and heat is associated with a Heat pattern. Joint pain with leg soreness is attributed to Kidney Deficiency. Chinese medicine practitioners use acupuncture and herbal medicine to relieve pain through one or a few of the following strategies: expelling Wind; dissipating Cold; eliminating Dampness; moving Qi; invigorating Blood; nourishing the Blood; clearing the Heat; tonifying the Kidneys. Differentiating the patterns of menstrual pain depends on analyzing the timing, nature, location, intensity, color, volume and quality of the menstrual cycle and discharge, and "reading" the tongue, pulse, and associated symptoms. Generally speaking, menstrual pain before the period indicates an Excess pattern, whereas menstrual pain after the period indicates a Deficiency pattern. Aversion to pressure on the abdomen indicates an Excess pattern, and feeling relief when pressure is applied to the abdomen indicates a Deficiency pattern. Sticky menses with dark-red color indicates an Excess pattern. Feeling relief after passing menstrual blood clots indicates a Blood Stasis pattern. Abdominal pain with hypochondriac distention indicates a Qi Stagnation pattern. Thin menses of a pale-red color, and experiencing pain after the period indicates a Qi and Blood Deficiency pattern. Experiencing "cold" abdominal pain, and passing small, dark blood clots indicates a Cold pattern. Thin menses of a pale-red color, and experiencing back soreness indicates a Kidney-Liver Deficiency pattern. Treatment of Dysmenorrhea with Herbal Medicine Dysmenorrhea is effectively treated with Chinese herbal medicine and acupuncture. The most important of the herbal menstrual pain relievers, angelica (Dang Gui) and corydalis tuber (Yan Hu Suo), are either used in a single herb form or in combination with other herbs in a formula. Following are the most typical patterns of dysmenorrhea with the herbs most commonly prescribed to treat them: 1. Qi Stagnation and Blood Stasis Pattern : Abdominal pain before and during menstruation; menses of a purple or dark color, with small volume and blood clots; decreased pain after passing blood clots; purplish spots on the tongue; and a wiry-choppy-strong pulse. Herbs used: aurantium fruit (Zhi Ke), lindera root (Wu Yao), and cyperus tuber (Xiang Fu) are used to regulate the Qi. Cnidium (Chuan Qiong), persica seed (Tao Ren), and safflower (Hong Hua) are used to invigorate the Blood. One of the popular herbal formulas is Blockage is (Ge Xia Zhu Yu Tang). Dang Gui (Radix Angelicae Sinensis) 48 mg Chuan Xiong (Rhizoma Chuanxiong) 48 mg Tao Ren (Semen Persicae) 48 mg Hong Hua (Flos Carthami) 48 mg Wu Ling Zhi (Feces Trogopterori) 48 mg Wu Yao (Radix Linderae) 48 mg Chi Shao (Radix Rubra Paeoniae) 48 mg Dan Pi (Cortex Moutan) 48 mg Yan Hu Suo (Rhizoma Corydalis) 33 mg Xiang Fu (Rhizoma Cyperi) 33 mg Zhi Ke (Fructus Aurantii) 33 mg Gan Cao (Radix Glycyrrhizae) 17 mg

3 2. Deficiency Cold Pattern: Abdominal pain during or after menstruation; feeling better when pressure and/or warmth are applied to the abdomen; pale, watery menses with small volume; soreness of the lower back and legs; long-drawn-out urination with a thin stream; a white tongue coating, and a deep pulse. Herbs used: Cinnamon bark (Rou Gui) and evodia bark (Wu Zhu Yu) are two herbs that warm the pelvic area (uterus). One of the widely used herbal formulas is "Warming Menses Formula" (Wen Jing Tang). Dang Gui (Radix Angelicae Sinensis) 53.2 mg Bai Shao (Radix Alba Paeoniae) 53.2 mg E Jiao (Gelatinum Corii Asini) 53.2 mg Mai Men Dong (Tuber Ophiopgonis) 53.2 mg Mu Dan Pi (Cortex Moudan) 53.2 mg Dang Shen (Radix Codonopsis) 53.2 mg Ban Xia (Rhizoma Pinelliae) 53.2 mg Wu Zhu Yu (Fructus Evodiae) 32 mg Gui Zhi (Ramulus Cinnamomi) 32 mg Gan Cao (Radix Glycyrrhizae) 32 mg Sheng Jiang (uncooked Rhizoma Zingiberis) 32 mg 3. Cold Dampness Pattern: Abdominal pain before or during periods; application of warmth reduces pain; dark-colored menses with blood clots; aversion to cold; cold limbs; white or white-sticky tongue coating; and a wiry-tight or wiry-slippery pulse. Herbs used: Cinnamon bark (Rou Gui), fennel seed (Xiao Hui Xiang), and dry ginger (Gan Jiang) are three major "warm property" herbs that can remove Dampness from the system. Stagnation`s (Shao Fu Zhu Yu Tang) is a popular formula for this pattern. Dang Gui (Radix Angelicae Sinensis) 58 mg Chuan Xiong (Rhizoma Chuanxiong) 58 mg Chi Shao (Radix Rubra Paeoniae) 58 mg Wu Ling Zhi (Feces Trogopterori) 58 mg Pu Huang (Pollen Typhae) 58 mg Yan Hu Suo (Rhizoma Corydalis) 58 mg Xiao Hui Xiang (Fructus Foeniculi) 58 mg Mo Yao (Myrrha) 38 mg Gan Jiang (dried Rhizoma Zingiberis) 38 mg Rou Gui (Cortex Cinnamomi) 18 mg 4. Damp Heat Pattern: Abdominal pain before menstruation; aversion to heat; soreness and distention of the lower back; a feeling of heat in the abdomen or a low grade fever; menses that are sticky, with a dark red color and blood clots; a burning sensation when the menses flow out; yellow and sticky vaginal discharge; scant urine; a red tongue body, with a yellow-sticky tongue coating; and a wiry-rapid or slippery-rapid pulse. Herbs used: Coptis (Huang Lian),and peony bark (Mu Dan Pi) are two leading herbs for clearing Damp Heat. "Heat-Clearing Blood-Regulating Decoction" (Qing Re Tiao Xue Tang) is a very standard formula for this pattern of dysmenorrhea. Qing Re Tiao Xue Tang : Mu Dan Pi, Huang Lian 5. Qi Blood Deficiency Pattern: Abdominal pain after menstruation; dull abdominal pain; menses that are thin, with a pale color and small volume; tiredness; loose stools; pale complexion; pale tongue body; and a thin-weak pulse. Herbs used: Ginseng (Ren Shen), astragalus (Huang Qi), angelica (Dang Gui), and rehmannia (Di Huang) are the leading Qi and Blood tonic herbs. "Chi Blood Tonic" (Ba Zhen Tang) is a time-tested formula for the Qi Blood Deficiency pattern of disease.
Dang shen - Bai zhu - Fu ling - Gan cao- Dang gui- Bai shao - Chuan xiong - Shu di huang

6. Kidney Liver Deficiency Pattern: Dull abdominal pain after menstruation; sore back; menses that are pale, with small volume; dizziness; ringing in the ears (tinnitus); poor memory; insomnia; a flushed face; hot flashes; a dark-red tongue body; and a deep-thin pulse. Herbs used: Angelica (Dang Gui) and white peony root (Bai Shao) nourish the Blood and Liver. Cornus fruit (Shan Zhu Yu) is a Kidney and Liver tonic. "Liver Tonic" (Tiao Gan Tang) is recommended. Tiao Gan Tang : Dang Gui, Bai Shao, Shan Zhu Yu, Ba Ji Tian, E Jiao, Du Zhong, Shan Yao, Gan Cao Treatment of Dysmenorrhea with Acupuncture

4 Besides using herbal formulas to treat dysmenorrhea, acupuncture is another viable way to treat menstrual pain. Acupuncture can open the blockage of Qi and Blood, balance the internal organs, and clear the blockage of meridians. Scientific studies find the following mechanisms for pain relief: acupuncture stimulates the production of endorphins, blocks the transmission of pain signals, and increases adrenocorticotropic hormone. In order to test these historical and modern claims about the effectiveness of acupuncture in treating dysmenorrhea, a clinical trial was organized at the Gynecology Clinic of the Kaiser-Permanente Medical Center in Oakland, California. Fortythree women with primary dysmenorrhea were followed for one year. Patients were randomly assigned into one of four different groups: the Real Acupuncture Group (RA); the Placebo Acupuncture Group (PA); the Standard Control Group (SC); and the Visitation Control Group (VC) with the following treatments: appropriate acupuncture treatment was provided to the RA Group; Random Point acupuncture treatment was provided to the PA Group; no acupuncture or medical intervention was provided to the SC Group; non-acupuncture visits with physicians were provided to the VC Group. The following results were demonstrated: 10 of 11 (90.9%) showed improvement in the RA Group; 4 of 11 (36.4%) showed improvement in the PA Group; 2 of 11 (18.2%) showed improvement in the SC Group; and 1 of 10 (10%) showed improvement in the VC Group. There was reduction of analgesic medication used by the women in RA Group, but no change or increased use of medication in other groups. Dysmenorrhea (Tong Jing) is a gynecological disorder characterized by cramping pains in the lower abdomen proceeding, during or following menstruation. At times, the pain may radiate to the lower back or sacral region. Fainting may occur with severe pain. The pathology of dysmenorrhea is the impairment of Qi and Blood. The main organs involved are the Liver, Kidney and Spleen. The main channels involved are the Ren and the Chong. Patients with vacuous patterns will experience more pain after the period. The pain will be have a dull quality that is better with pressure. Patients with excess patterns will have more severe pain before the period. The pain is severe and worse with pressure. Frequently patients with excess patterns can have underlying vacuous issues. Although your point selection will be determined by the person in front of you these are some general points used for dysmenorrhea: Ren3, 4, 6, St25(qi), St28(damp), St29 (stasis), Ub32, Ki13, Ki14, Shi Qi Zhui (17 th vertebrae point, located below Lumber 5), Pc6, Li4, St36. TCM Pattern Differentiation Dysmenorrhea may present as one of these patterns or in combination. Other pattern maybe displaying depending on the individual. Excess Patterns: More severe pain at the beginning of the period.

Coagulation of Cold-Damp: most common. Liver Qi Stagnation and Blood Stagnation Descent of Damp-Heat: uncommon, possibly related to PID (Pelvic Inflammatory Disorder).

Vacuity Patterns: More severe pain following period. Yang Deficiency with Internal Cold: Kidney and Spleen. Liver and Kidney Deficiency: Liver (blood), Kidney (essence and qi). Qi and Blood Deficiency: Mostly Liver and Spleen but can also relate to Lung Heat. Origin may relate to loss of nourishment to the Ren and Chong. EXCESS Coagulation of Cold-Damp Indications Cold and Pain of the lower abdomen either proceeding or during menstruation; aggravation of pain upon external pressure and some relief with external application of heat; scanty menstrual discharge that is dark in color and contains blood clots; aversion to cold and,

5 occasionally, body aches and pains. Tongue/Pulse Treatment Method Formulas Point Prescription Tongue may present with a white slimy coat. Pulse is deep and tight. Warm the vessels, dissipate cold, dispel dampness, dispel blood stasis, and relieve pain. Shao Fu Zhu Yu Tang: Lesser Abdomen Stasis Expelling Decoction. Decoction (composicin : ver articulo anterior) Ren3- excess, St28 damp, Sp8- xi cleft, Sp6, Ub32, Shi Qi Zhui, Severe pain add: Ub32, St29.

Liver Qi Stagnation and Blood Stagnation Distending pain in the lower abdomen preceding or during menstruation, aggravation of pain with external pressure, difficult menstruation, scanty menstrual discharge that is dark purple in color and contains blood clots, decrease in pain upon expulsion of clots and disappearance of pain with termination of the menstrual period. Some cases may be accompanied by a distended sensation in the chest, hypochondria and breasts. Tongue is dark with thin whit coat with possible sublingual vein distention. The pulse is deep, wiry, or slippery wiry or choppy. Soothe the liver, rectify qi, dispel blood stasis, and relieve pain. Ge Xia Zhu Yu Tang: Infra-diaphragmatic Stasis Expelling Decoction (composicin : ver articulo anterior) Ren6, Lv3, Sp6, Sp8- pain, Sp10-blood, Ki13-Qi, Ki14-blood, St25-qi, St29-blood, Ub32, Shi Qi Zhui.

Indications

Tongue/Pulse Treatment Method Formulas Point Prescription

Descent of Damp-Heat Lower abdomen pain preceding menstruation, aggravation of pain with external pressure accompanied by a burning sensation or distention pain in the lower sacrum. In some cases, there is a recurrent pain in the lower abdomen that becomes more severe with the onset of menstruation. Accompanying symptoms include thick blackish red menstrual discharge containing blood clots, thick yellow leukorrhea, scanty concentrated urine and, in many cases a mild fever. Tongue is red with yellow slimy coat. The Pulse is rapid and wiry or rapid and slippery. Clear Heat, dispel dampness, dispel blood stasis, and relieves pain. Qing Re Tiao Xue Tang: Heat Clearing Blood Regulating Decoction Decoction (composicin : ver articulo anterior)

Indications

Tongue/Pulse Treatment Method Formulas

Point Prescription Ren3, Sp8, St29, Lv3, Ub23, Li4, Ub32, Shi QI Zhui. VACUITY Yang Deficiency with Internal Cold Indications Cold and Pain of the lower abdomen either during or following menstruation, some relief

6 from pain with external pressure or the application of heat, small volume of dark colored menstrual discharge, weak aching lower back and legs, copious clear urine. The pain has a dull quality. Patients maybe overweight or present with bloating. This pattern is more common with elderly patients. Tongue/Pulse Treatment Method Formulas Tongue has a white moist coat. The pulse is deep. Warm the channels, warm the uterus, and relieves pain. Wen Jing Tang: Menses warming decoction. Two formulas in this case do share the same name. One of the Wen Jing Tangs is commonly used for amenorrhea and menstral irregularity. Decoction (composicin : ver articulo anterior)

Point Prescription Ub23, Ren4, St36, Sp6, 10, Ren3, Sp8, Ub32, Moxa. Liver and Kidney Deficiency Indications Tongue/Pulse Treatment Method Formulas Indistinct lower abdominal pain either proceeding or following menstruation, some relief from pain with external pressure, thin light colored menstrual discharge, aching lower back and spine, general fatigue, dizzy spells and tinnitus and in some cases tidal fever. Additional signs may present as pail nails, scanty urination or an aching lower back. The tongue is pale and the pulse is deep and thready or weak and thready. Supplement the Liver and the Kidney, regulate and rectify the Chong and the Ren, and relieve pain. Tiao Gan Tang: Liver Regulating Decoction Decoction (composicin : ver articulo anterior)

Point Prescription Ub18, 23, Ren4, St36, Ki6, Lv3, 8, St25, Sp6,10. Qi and Blood Deficiency Indications Tongue/Pulse Treatment Method Indistinct lower abdominal pain either proceeding or following menstruation, some relief from pain with external pressure, empty and bearing down sensation in the lower abdomen and pubic regions, scanty menstrual discharge that is light in color and thin in texture, tiredness, fatigue and occasionally dull complexion, loss of appetite or diarrhea. The tongue is pale and the pulse is weak and thready. Supplement qi and blood, and relieve pain. Sheng Yu Tang: Additional this formula is good for infertility due to Qi and Blood Deficiency Decoction (composicin : Xi Yang Shen (Radix Panax Quinquefolii) Sang Piao Xiao (Ootheca Mantidis) Tian Hua Fen (Radix Trichosanthis) Huang Qi (Radix Astragali) Gui Ban (Plastrum Testudinis) Bai Shao (Radix Paeoniae Albae) Mai Men Dong (Tuber Ophiopogonis) Tian Men Dong (Tuber Asparagi) Gou Qi Zi (Fructus Lycii) Shan Zhu Yu (Fructus Corni) Xuan Shen (Radix Scrophulariae) Gui Jian Yu (Ramulus Euonymi)

Formulas

Point Prescription Ub23, Ren4, St36, Sp6, Ub32, Du20, Moxa.

Treatment of Dysmenorrhea with Acupuncture Besides using herbal formulas to treat dysmenorrhea, acupuncture is another viable way to treat menstrual pain. Acupuncture can open the blockage of Qi and Blood, balance the internal organs, and clear the blockage of

7 meridians. Scientific studies find the following mechanisms for pain relief: acupuncture stimulates the production of endorphins, blocks the transmission of pain signals, and increases adrenocorticotropic hormone. In order to test these historical and modern claims about the effectiveness of acupuncture in treating dysmenorrhea, a clinical trial was organized at the Gynecology Clinic of the Kaiser-Permanente Medical Center in Oakland, California. Fortythree women with primary dysmenorrhea were followed for one year. Patients were randomly assigned into one of four different groups: the Real Acupuncture Group (RA); the Placebo Acupuncture Group (PA); the Standard Control Group (SC); and the Visitation Control Group (VC) with the following treatments: appropriate acupuncture treatment was provided to the RA Group; Random Point acupuncture treatment was provided to the PA Group; no acupuncture or medical intervention was provided to the SC Group; non-acupuncture visits with physicians were provided to the VC Group. The following results were demonstrated: 10 of 11 (90.9%) showed improvement in the RA Group; 4 of 11 (36.4%) showed improvement in the PA Group; 2 of 11 (18.2%) showed improvement in the SC Group; and 1 of 10 (10%) showed improvement in the VC Group. There was reduction of analgesic medication used by the women in RA Group, but no change or increased use of medication in other groups. Acupuncture SP6 A team from Shandong University of Traditional Chinese Medicine looked at the effects of two points on primary dysmenorrhea (menstrual pain) - SP 6 and GB 39. Their study involved 66 patients with primary dysmenorrhea. One group needled SP 6 for 5 minutes while the patient was experiencing menstrual pain and the control group used GB 39 which generally would not be used for menstrual pain Within the SP 6 treatment group the patients experienced quick and significant pain reduction using a variety of menstrual pain scores. This simple study helps to illustrate that needling of SP 6 during dysmenorrhea will have an immediate impact on uterine arterial blood flow. While this study did not look into this, acupressure at SP 6 can be recommended to help control symptoms. The points listed below are by no means the only relevant points, rather we list empirical or commonly used points as well as those applicable to use with acupressure as a self-help remedy.

SP 10 Acupuncture Point - Xue Hai - Spleen Meridian SP 6 Acupuncture Point - San Yin Jiao - Spleen Meridian SP 8 Acupuncture Point - Di Ji - Spleen Meridian

Dysmenorrhea is painful menstruation that arises before, during a/or after menstruation. The pain is mainly in the lower abdomen, however, it can occur in the lower back a/or running down the legs.

Etiology & Pathology: o Etiology: Emotional Factors - strong emotions (depression, anger) may lead to stagnation of the LV Qi which may lead to a stagnation of Qi & Blood manifesting as painful menstruation. Cold/Damp Exposure - contact with cold/damp environments (climates, climate controlled buildings, basements) a/or excessive consumption of cold/damp foods (fruit juices, ice cream) may lead to an accumulation of cold/damp in the abdomen which may lead to a stagnation of Qi & Blood manifesting as painful menstruation. Existing Qi/Blood Deficiencies - symptoms may be exacerbated during menstruation leading to dysmenoorhea. Existing LV/KD Deficiencies - constitutional weaknesses a/or in women who have had multiple child-births, thus depleting the KD Jing, worsened by the loss of Blood during menstruation.

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o

Differentiation: When pain is worse prior to a/or during menstruation, this indicates an excess condition: Qi Stagnation Blood Stagnation Accumulation of Cold When the pain is dull, this indicates a deficient condition: LV/KD Deficiency Blood Deficiency Qi Stagnation - Excess Condition Signs & Symptoms: More distention than pain, bloating, breast tenderness is likely, stuffy chest, belching, irritability, short temper. Tongue: Purplish possible, thin white coat Pulse: Wiry Treatment Principle: Resolve Qi Stagnation Treatment Points: LV 2 - move LV Qi, LV 3 may be a better choice CV 6 - tonify Qi, effect lower abdomen CV 3 - help to move Qi in the lower abdomen GB 34 - w/LV 2/LV 3, move LV/GB channel & abdomen w/CV 6 SP 8 - moves Qi and Blood (more for Qi), SP 10 (more for Blood) SP 6 - direct Blood downwards If sacral pain - UB 32 Blood Stagnation - Excess Condition Signs & Symptoms: Less distention, more pain w/stabbing qualities, no breast tenderness, abdominal pain worse w/pressure, blood clots. Tongue: Purplish or purple spots which usually appear on the sides, very thin coat Pulse: Deep, choppy can also be a little wiry Treatment Principle: Resolve Blood Stagnation Treatment Points: ST 29 - move Blood in the abdomen (also good for starting menstruation in patients who have cessation of menstruation) CV 6 - move Qi in the abdomen SP 6 - direct Blood downwards SP 10 - move Blood and Qi LV 3 - w/SP 6 move Qi in the lower abdomen Accumulation of Cold - Excess Condition Signs & Symptoms: Pain that is better w/application of heat a/or pressure, scanty menstrual flow, dark blood w/clots that are smaller than the Blood Stagnation clots. Tongue: White coat Pulse: Deep, tight Treatment Principle: Disperse Cold Resolve Stagnation

Treatment Points: CV 4 - w/moxa, tonify Qi, warm & move abdomen CV 8 - w/moxa, disperse cold ST 28 - w/moxa, warm abdomen, resolve stagnation ST 36 - tonify Qi & Blood

LV/KD Deficiency - Deficient Condition Signs & Symptoms: Dull a/or intermittent pain of the lower abdomen which arises during a/or after menstruation, pain is better w/pressure, sore back, dizziness, tinnitus (not as prevalent), sallow complexion, lassitude, chronic fatigue, light periods likely w/light red blood. Tongue: Light red, thin white coat (if extremely deficient tongue may be flabby) Pulse: Deep, fine or thin Treatment Principle: Tonify LV & KD Move Qi in the Chong Mai and Ren Mai Treatment Points: UB 18 - LV Shu UB 23 - KD Shu CV 4 - tonify Qi, warm and move abdomen KD 3 - tonify KD Qi ST 36 - tonify Qi & Blood Could add LV 3 or LV 8 - help move Qi in the lower abdomen Blood Deficiency - Deficient Condition Signs & Symptoms: Dull pain after menstruation, better w/pressure, dizziness, palpitations, scanty menstruation. Tongue: Pale w/thin moss or slightly peeled (peeled section may appear pale as well) Pulse: Empty, thin Treatment Principle: Tonify Blood Move Qi Treatment Points: UB 18 - LV Shu UB 20 - SP Shu UB 23 - KD Shu SP 6 - tonify SP, Blood SP 10 - tonify & move Blood LV 8 - nourish LV, effect lower warmer