Painful Periods and Infertility from Cold in the Uterus – A TCM Case Study
Case history submitted by Jason Smith, Madrid.
Overview of the Case
A 43-year-old woman sought treatment for severe menstrual pain (dysmenorrhea). Her menstrual cycle was regular (every 30 days) and lasted three days, but bleeding was light. Menstrual blood was dark red with small clots, and pain was extremely intense, focused around the Ren-4/Ren-3 area.
The patient reported a general feeling of cold, worsening significantly during menstruation. Pain was relieved by a hot water bottle and analgesics. She had experienced painful periods since the age of 18.
Additional observations:
– Tongue: normal colour, thin coating with root
– Sublingual veins: very dark
– Background: semi-professional swimmer from ages 13–18, training extensively in cold water
Symptoms in Detail
– Pain location: Lower abdomen (Ren-4/Ren-3 area)
– Cycle: 30 days, 3 days of bleeding
– Flow: Light
– Blood quality: Dark red, small clots
– Temperature sensation: Strong aversion to cold, worse at menstruation
– Pain relief: Warmth (hot water bottle), analgesics
TCM Diagnosis: Cold in the Uterus and Blood Stasis
This presentation was a clear case of Cold in the Uterus — evident from the cold nature of pain, its alleviation by warmth, and a history of prolonged cold exposure during puberty.
Over time, this Cold pattern led to Blood Stasis in the Uterus – indicated by:
– Dark, clotty menstrual blood
– Dark purple sublingual veins
Treatment Strategy in TCM
Focusing on the Premenstrual Phase
Following the four phases of the menstrual cycle in TCM, treatment targeted Phase 4 (premenstrual phase) — the optimal time to expel pathogenic Cold from the uterus.
Acupuncture Treatment
– Activation of the Chong Mai using SP-4 and P-6
– Moxibustion therapy applied with a moxa box over Ren-4 to warm the uterus and dispel Cold
Herbal Formula
– Wen Jing Tang – to warm the channels, nourish blood, and regulate menstruation
– Warm the Menses – expel Cold, warm the Uterus, invigorate Blood, eliminate stasis, nourish Blood, tonify and warm Kidney-Yang.
Difference from classical antecedent: Tonify Kidney-Yang, invigorate Blood.
Results and Progress
– After first cycle: Pain reduced by approximately 50%
– After second cycle: Additional 25% improvement
– After third cycle: Only slight discomfort remained
Preventive advice: Use a moxa box before menstruation on occasion to prevent re-invasion of Cold.
Clinical Observations and Insights
This case highlights how pathogenic Cold can enter the body during vulnerable life stages such as puberty — when the Chong Mai, Ren Mai, and Du Mai are still developing — and persist for decades if untreated.
Notably, the patient reported frequent unprotected intercourse without pregnancy. In TCM, this can be seen as Shi-type infertility ([link to “TCM Infertility Patterns” page]) — Cold blocking the uterus and preventing conception.
Key Takeaways for Practitioners
– Cold in the Uterus is a common cause of both painful periods and infertility.
– Even long-standing pathogenic factors must be expelled for full recovery.
– Wen Jing Tang, acupuncture on the Chong Mai, and moxibustion are effective for treating Cold-induced dysmenorrhea.