Key Diagnostic Points:

1.       The pain in the lower abdomen appears with the menstrual cycle.

2.       The pain can spread over the whole abdomen, the lumbo-sacral 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.       Pain beginning before or during the period suggests excess.

4.       Pain beginning at the end or after the period suggests deficiency.

5.       Pressure making the pain worse suggests excess.

6.       Pressure making the pain better suggests deficiency.

Differential Diagnosis:

1. Stagnation of Qi and Blood

Lower abdominal pain during, or one to two days before, the period, feelings of distention and tenderness in the abdomen and breasts, hesitant start of menstrual flow, pain relieved after passing clots, pre-menstrual tension and irritability.

Blood: Dark with clots
Tongue: Purple body with purple spots
Pulse: Wiry

2. Stagnation of cold

Lower abdominal pain several days before the period or during the period. Pain relieved by the application of heat, feelings of cold in the abdomen, and sore back.

Blood: Scanty, dark, with clots
Tongue: Bluish to bluish-purple
Pulse: Wiry

3. Damp Heat attacking the lower Jiao Hypogastric pain before or during the period, burning sensation extending to the sacrum, feeling of heat, vaginal discharge, scanty-dark urine.

Blood: Red with small clots
Tongue: Red with yellow-greasy coat
Pulse: Slippery

4. Deficiency of Qi and Blood.

Dull hypogastric pain toward the end of or after the period, dragging sensation in the lower abdomen, pain relieved by pressure and massage, fatigue, slight dizziness.

Blood: Scanty, red and thin
Tongue: Pale with thin white coat
Pulse: Thready and weak

5. Deficiency of Kidney and Liver

Dull hypogastric pain toward the end of or after the period, sore back, dizziness, pain relieved by pressure and massage, tinnitus, blurred vision, exhaustion.

Blood: Scanty
Tongue: Red with no coat
Pulse: Thread-weak or deep-thready