A 30-year-old woman suffering from a five-year history of dysmenorrhea, cold extremities, and sticky stools was managed using a Qi and blood-tonifying herbal strategy.

Case ID: CHC-0039

Case Summary

This case describes a 30-year-old woman presenting with primary dysmenorrhea spanning five years, accompanied by systemic coldness and digestive dampness. The original report documented a conventional diagnosis of primary dysmenorrhea and a TCM assessment of Menstrual Abdominal Pain driven by Qi and Blood Deficiency with Cold-Dampness obstructing the collaterals. She was managed with a dynamic herbal approach designed to rebuild her foundational Qi and blood while actively warming the meridians and draining the middle jiao dampness.

Patient Presentation

• Patient: 30-year-old female (Surname: Liu).
• Main Complaint: Dysmenorrhea for 5 years, accompanied by cold hands and feet and sticky stools.
• History: The patient sought consultation on February 28, 2018. It was the first day of her menstrual cycle. She presented with a scanty amount of pale menstrual blood, a dull pain in her lower abdomen that felt better with pressure (喜按), dizziness, a pale complexion, nausea with a feeling of stuffiness in the chest and abdomen (呕恶痞闷), and cold hands and feet.

Examination and Diagnosis

• Conventional Diagnosis: Primary dysmenorrhea.
• TCM Tongue and Pulse: The tongue was pale and puffy with teeth marks, and the coating was white and greasy. The pulse was fine and rapid (脉细数).

TCM Assessment

The original practitioner interpreted the presentation as Menstrual Abdominal Pain driven by Qi and Blood Deficiency with Cold-Dampness Obstructing the Collaterals (经行腹痛 – 气血不足，寒湿阻络).

According to the holistic principles of yin and yang Chinese Medicine proper menstruation relies on an abundance of Qi and blood to nourish the uterus and its vessels. The original report noted that her Qi and blood deficiency meant the uterus and uterine vessels were malnourished, leading to the dull abdominal pain that responded well to applied pressure. The lack of blood rising to the head caused her dizziness and pale complexion.

Meanwhile, internal dampness obstructed her middle jiao (digestive system), disrupting the ascending and descending Qi flow, which manifested as nausea, stuffiness, and sticky stools. Finally, external or internal cold injured her Yang Qi, preventing it from reaching her extremities and causing her cold hands and feet. The pale, puffy tongue with a white, greasy coating objectively confirmed this systemic dampness and deficiency.

Treatment Approach

The primary treatment principle was to tonify Qi and blood, unblock the collaterals, and stop pain (补益气血，通络止痛). The strategy required warming the center to relieve acute spasms while concurrently resolving the heavy digestive dampness.

Herbal Formulas and Modifications

• Initial Formula (February 28, 2018): A 13-herb decoction designed to tonify, warm, and dry dampness.
  • Tonifying Qi and Blood: Dang Gui (10g), Chuan Xiong (10g), E Jiao (Donkey-hide Gelatin, 10g), and Shu Dang Shen (Prepared Codonopsis, 30g) formed the core to strongly replenish Qi and nourish the blood.
  • Warming the Middle and Relieving Spasm: Gui Zhi (10g), Bai Shao (15g), Sheng Jiang (10g), and Zhi Gan Cao (10g) worked together to warm the center, tonify deficiency, and gently relax smooth muscle spasms to stop the abdominal pain (缓急止痛).
  • Drying Dampness and Stopping Nausea: Fa Ban Xia (10g) and Di Long (Earthworm, 5g) were used to dry dampness, transform phlegm, and descend rebellious Qi to stop the nausea.
  • Nourishing Yin and Regulating Liver: Mai Dong (10g) benefited Qi and nourished Yin, while Cu Xiang Fu (Vinegar-prepared Cyperus, 10g) soothed the Liver, regulated Qi, and stopped menstrual pain.
  • Clearing Heat and Moving Blood: Mu Dan Pi (10g) cleared localized heat and invigorated blood to remove stasis.
• Second Visit (March 4, 2018): After 4 daily doses, the abdominal pain, cold extremities, and sticky stools had all improved. The practitioner dynamically adjusted the formula: removing E Jiao, Sheng Jiang, and Fa Ban Xia, and adding Hei Shun Pian (Processed Aconite, 10g) and Xian Mao (10g) to strongly warm Kidney Yang and dispel deep cold, along with Bei Chai Hu (15g) to further soothe the Liver. (3 doses prescribed).
• Third Visit (March 8, 2018): Her menstruation had finished, stools were formed, and cold extremities were lessened. Her tongue shifted to red with a white coating. The deep warming herb Hei Shun Pian was removed to prevent excessive heating now that the cycle was over. The patient was prescribed 7 more doses of the remaining herbs to consolidate the therapeutic effect.

Follow-Up

• Following the third visit, the patient successfully completed the consolidation phase, stabilizing her digestion and significantly alleviating her chronic menstrual pain and systemic coldness.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is treating dysmenorrhea not purely as a localized uterine cramp, but as a systemic imbalance combining Qi/Blood deficiency with heavy digestive dampness.

When a patient presents with menstrual pain alongside nausea and sticky stools, using heavy, cloying blood tonics alone can severely worsen the digestion. The original practitioner skillfully balanced the prescription by combining strong blood tonics (Dang Gui, E Jiao) with dampness-drying herbs (Ban Xia) and spasm-relieving botanicals (Gui Zhi, Bai Shao). This ensured the uterus received the necessary nourishment without further congesting the Spleen and Stomach, demonstrating a highly effective, whole-body approach to gynecological care.

---

Source

• Original source: Traditional Chinese Medicine Bureau of Guangdong Province / Qingyuan Maternal and Child Health Hospital
• Original title: 【以案说医】曾宪进：补益气血，缓急止痛法治疗痛经案
• Practitioner: Professor Zeng Xianjin (曾宪进)
• Publication date: September 24, 2024
• Original language: Chinese
• ChineseHerb.org version: English translation and editorial adaptation