This is a variant of a modern formulation (Tong Jing Wan = ‘pill for painful periods’) designed to alleviate severe menstrual pain. In contemporary China there are several prepared herbal formulas called ‘Tong Jing Wan’ that are specifically designed to alleviate menstrual pain. These formulas generally contain a variety of Blood regulating herbs, along with some Qi regulating and Blood tonifying ingredients. In addition, some may also contain Liver-Spleen harmonising or Interior Warming herbal ingredients.

This particular version is composed of strong Blood moving herbs together with some Blood tonifying and Qi regulating ingredients. In this way, the formula is mainly directed towards the secondary aspect (biao) of the disorder, i.e. the manifest symptoms, to provide rapid and timely relief. It is generally used during the second half of the menstrual cycle; while during the first half of the cycle the treatment may be directed towards the primary aspects (ben), such as Liver Qi constraint or Cold invasion of the Uterus.

It should be noted that strong Blood moving herbs may bring on, or worsen, menorrhagia in susceptible women. To avoid this unwanted effect, Notoginseng (tian qi) and White Peony (bai shao) have been included in this formula. The former herb has a strong hemostatic action, while the latter has astringing and Blood harmonising actions. However, the overall effect of the formula is to dispel pathogenic factors and because of this it should be combined with a suitable tonifying formula in cases with deficiency, as noted above under ‘Combinations’. Generally the tonifying formula is given alone during the first half of the cycle and this formula is given alone during the second half of the cycle.

TCM ACTIONS
Activates the Blood and breaks up stasis, alleviates pain.

TCM SYNDROMES
Blood stasis in the uterus (also referred to as Blood stasis in the Chong and Ren Channels)

INDICATIONS
Dysmenorrhea (severe), endometriosis.

SIGNS & SYMPTOMS
(Key clinical features in bold)

• Severe lower abdominal pain at the time of menstruation
• Dark and clotted menstrual flow
• Irregular periods
• Headache
• Dark tongue that may have dark spots