Dysmenorrhea, abbreviated as "dysmenorrheal," refers to the symptom of severe abdominal pain experienced by women during menstruation or around the menstrual period. If there is only mild distending pain in the lower abdomen or waist during the menstrual period, this is a normal phenomenon and does not fall under the category of "dysmenorrhea."

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1. Liver Qi Depression︰Before or during menstruation, there is lower abdominal distension and pain, with varying amounts of menstrual flow, and the blood color may be red or purple, possibly mixed with blood clots. The menstrual flow is not smooth. Hypochondriac pain, breast distension, dysphoria, chest tightness, tongue texture normal or dark purple, and a wiry pulse. If liver depression persists and transforms into heat, symptoms include bitter taste in the mouth, red eyes, vertigo, chest and hypochondriac distension and fullness, menstruation with dark purple and sticky blood, constipation, dark urine, dark red tongue texture, and a thin, rapid or wiry, rapid pulse. Liver depression qi stagnation dysmenorrhea is mostly caused by damage from the seven emotions, constraining of liver qi, disturbance of qi movement, and blood stagnation due to qi stagnation, obstructing the uterus with appendages. Its characteristics are: lower abdominal distension and fullness with pain before and during menstruation, or a feeling of chest tightness and breast distension several days before menstruation, which gradually disappears after menstruation begins. The treatment focuses on soothing the liver and regulating qi to relieve pain, generally using Bupleurum Liver-Soothing Powder, or Supplemented Lindera Decoction; if liver depression transforms into fire, then Xuan Yu Tong Jing Decoction is used.
2. Uterine Blood Stasis︰During menstruation, there is severe lower abdominal pain that radiates to the lumbar region, with unsmooth menstrual flow, dark purple menstrual blood containing clots. The pain is relieved after the clots are expelled. The tongue texture is dark or has ecchymosis, and the pulse is deep, slow, and choppy. Uterus with appendages blood stasis dysmenorrhea is often caused by prolonged qi depression leading to blood vessel stasis, or pre-existing chronic blood stasis, resulting in menstrual blood stasis and stagnation. Its characteristics include: severe abdominal pain that lasts for a relatively long time, dark purple menstrual blood, unsmooth menstrual flow, with pain relief only after the expulsion of blood clots, and dark purple lips and tongue. The treatment primarily focuses on invigorating blood and resolving stasis, supplemented by regulating qi. The recommended formula is Amber Powder. If there is cold pain in the lower abdomen, it is preferable to use Lesser Abdomen Stasis-Expelling Decoction.
3. Cold-dampness Stagnation︰Cold pain in the lower abdomen before or during menstruation, alleviated by warmth, accompanied by chills and cold limbs, delayed menstruation, scanty menstrual flow with unsmooth discharge, dark red menstrual blood mixed with clots, loose stools, persistent leukorrhea, dark tongue texture or with ecchymosis, white and greasy tongue coating that is slippery, deep and tight or deep and slow pulse. Cold-dampness congealing and stagnating belongs to an excess pattern, mainly caused by cold-dampness invading the Chong and Ren channels. Generally, there is cold pain in the lower abdomen before or during menstruation, dark red menstrual blood with clots, white and greasy tongue coating, dark tongue texture or with ecchymosis, deep and tight or deep and slow pulse. Treatment should focus on warming the meridians and dissipating cold, regulating qi and promoting blood circulation. The prescription used is Evodia Decoction with Schizonepeta and Saposhnikovia Root removed and Pinellia and Poria added.
4. Dampness-heat︰Before or during menstruation, there is stabbing pain in the lower abdomen with a burning sensation and tenderness. Menstruation may occur earlier or irregularly, with dark red, foul-smelling, and sticky discharge. There is usually yellow leucorrhea, dry or difficult bowel movements, and scanty dark urine. The tongue texture is red with a yellow, greasy coating, and the pulse is slippery and rapid. The cause of this condition may be due to emotional distress leading to liver depression and spleen deficiency. Liver depression generates heat, while spleen deficiency produces dampness, resulting in the accumulation of dampness-heat. Alternatively, it may be caused by a habitual preference for spicy and rich foods, leading to internal dampness-heat. Or, it may result from careless sexual activity during menstruation, exposing the lower energizer to dampness-heat pathogens. Dampness-heat accumulates in the uterus, obstructing the flow of qi and blood, causing menstrual blood to stagnate in the uterus and resulting in pain. The key points for identifying this syndrome include, in addition to dysmenorrhea, the presence of low-grade fever, yellow and turbid leucorrhea, dark or frequent urination, a red tongue with a yellow, greasy coating, and a rapid pulse—all indicative of a pattern of dampness and heat. Treatment should focus on clearing heat and draining dampness to relieve pain. The recommended formula is Peony and Gardenia Peripatetic Powder with added fried coix seed, patrinia, and other herbs.
5. Deficiency of Both Qi and Blood︰During menstruation or after the period, there is lingering abdominal pain that is relieved by pressure and warmth. The menstrual flow is scanty, pale in color, and thin in quality. The face appears pale or shallow yellow, accompanied by dizziness, palpitations, fatigue, and weakness. The tongue texture is pale with a thin white coating, and the pulse is thin and weak. This condition is known as qi and blood deficiency dysmenorrhea, often caused by constitutional weakness or prolonged illness leading to deficiency of qi and blood, resulting in impaired circulation. Clinical manifestations include: menstrual flow that may be scanty or excessive, pale and thin in quality; a sallow or shallow yellow complexion; mental fatigue; dizziness and flusteredness; weak speech; fatigue and weakness; a thin white tongue coating with a pale tongue body; and a weak, thin pulse. The treatment principle is to tonify and replenish qi and blood. The recommended formulas are Angelica Center-Fortifying Decoction or Three Talents Major Tonifying Pill.
6. Chong and Ren Meridians Deficiency-Cold︰Cold pain in the lower abdomen during or after menstruation, alleviated by warmth and aggravated by cold, preference for warmth and pressure, delayed menstrual cycles, scanty and pale menstrual flow, clear and thin leukorrhea, soreness and pain in the lower back and spine, cold back and limbs, clear and abundant urine, pale and tender tongue texture, thin and white tongue coating, deep and weak pulse manifestation. Chong and Ren deficiency-cold dysmenorrhea is a deficiency pattern, caused by insufficient kidney yang and deficiency-cold in the Chong and Ren channels. The pain occurs during or after menstruation, with scanty and pale menstrual flow, thin and white tongue coating, pale and tender tongue texture, and deep and weak pulse manifestation. Treatment should focus on warming the meridians and relieving pain, using Angelica Cold-Extremities Decoction minus Akebia Stem and adding Cassia Bark and Dried Ginger.
7. Liver-kidney Depletion︰During menstruation and after the period, there is a dull pain in the lower abdomen, with scanty menstrual flow that is pale red in color, accompanied by soreness and weakness in the lower back and knees, dizziness, tinnitus, a red and tender tongue with little coating, and a deep, thin, and rapid pulse. Liver-kidney depletion dysmenorrhea is mostly caused by innate deficiency, inherent weakness of the liver and kidneys, or excessive sexual activity leading to the gradual depletion of yin essence. After menstruation, the Blood Sea becomes even more deficient, resulting in the malnourishment of the uterine vessels. Clinical manifestations include: dull pain in the lower abdomen after menstruation, scanty menstrual flow, delayed cycles, soreness in the lower back and weakness in the knees, dizziness, tinnitus, a pale red tongue with thin coating, and a deep and thin pulse. The treatment should focus on tonifying the liver and kidneys, regulating qi, and relieving pain. Recommended formulas include Guishao Rehmannia Decoction or All-Along Decoction with modifications.

1. Differentiating location: Lower abdominal pain is often due to qi stagnation, typically involving the chest and hypochondrium; lower abdominal pain is often due to blood stasis, often involving the lumbosacral region. Generalized abdominal pain is mostly attributed to spleen-stomach disharmony.
2. Differentiating timing: Pain before or during menstruation is mostly an excess pattern, while pain after menstruation is mostly a deficiency pattern.
3. Differentiating nature: Pain with a sensation of heaviness, intermittent pain, or distension more severe than pain indicates qi stagnation; continuous pain, pain with blood stasis, or pain relieved after the discharge of blood stasis indicates blood stasis. Pulling pain that is aggravated by pressure is indicative of excess and heat, while dull pain that is relieved by pressure is indicative of heat. Twisting pain indicates cold, while stabbing pain indicates heat and stasis.

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1. 《Zhang Cigong's Medical Records．Dysmenorrheal》: "Ephedra is effective for treating dysmenorrheal due to uterine spasms, but it is ineffective for inflammation."
2. Yizong Jinjian Gynecology Essentials ．Menstrual Regulation Section: "For abdominal pain during menstruation, if the pain occurs after menstruation, it is due to qi and blood deficiency; if the pain occurs before menstruation, it is due to stagnation of qi and blood. If it is due to qi stagnation and blood stasis, there is often distension and fullness. If it is due to blood stasis and qi stagnation, there is often pain. It is also necessary to examine the cause of the stagnation and distending pain, whether it is due to deficiency, excess, cold, or heat, and treat accordingly."