MENSE-EASE

BACKGROUND

Dysmenorrhea is uterine pain associated with menses, starting one to three days before the menses, peaks 24 hours after the menses, and subsides after two to three days. Dysmenorrhea may be primary or secondary. Primary dysmenorrhea is more common, is not associated with structural disorder, and is characterized by pain resulting from uterine contractions and ischemia mediated by prostaglandins and other inflammatory mediators. Secondary dysmenorrhea is less common, and is usually caused by pelvic abnormalities, such as endometriosis, fibroids, and uterine adenomyosis.

FORMULA EXPLANATION

Mense-Ease is formulated specifically to treat women’s disorders, such as pain in various gynecological disorders like dysmenorrhea, endometriosis, premenstrual syndrome (PMS) and polycystic ovarian syndrome (PCOS). These women’s disorders are considered as qi and blood stagnation in the lower jiao. Mense-Ease contains herbs that activate qi and blood circulation, remove qi and blood stagnation, and relieve pain and cramps.

Pu Huang (Pollen Typhae) has an excitatory action on the uterus and works to invigorate blood circulation and relieve pain by eliminating blood stasis. Ai Ye (Folium Artemisiae Argyi) and Chi Shao (Radix Paeoniae Rubrae) have antispasmodic effects on the smooth muscles to relieve pain. Yan Hu Suo (Rhizoma Corydalis), Chuan Xiong (Rhizoma Chuanxiong), Mu Dan Pi (Cortex Moutan), Gui Zhi (Ramulus Cinnamomi), Tao Ren (Semen Persicae), Dang Gui (Radix Angelicae Sinensis), Niu Xi (Radix Achyranthis Bidentatae), and Hong Hua (Flos Carthami) activate blood circulation, remove blood stasis, and relieve pain. Wu Yao (Radix Linderae) and Xiang Fu (Rhizoma Cyperi) are qi regulators that help to relieve abdominal bloating and distension.

In short, Mense-Ease moves qi and blood in the lower jiao to treat various gynecological disorders such as dysmenorrhea, endometriosis, PMS and PCOS.

CAUTIONS & CONTRAINDICATIONS

* This formula is contraindicated during pregnancy and nursing.

* This herbal formula contains herbs that invigorate blood circulation, such as Dang Gui (Radix Angelicae Sinensis). Therefore, patients who are on anticoagulant or antiplatelet therapies, such as Coumadin (warfarin), should use this formula with caution, or not at all, as there may be a higher risk of bleeding and bruising.[1]^,[2],[3]

CLINICAL NOTES

* Resolve (Lower) and Calm can be used one week prior to each menstrual cycle at 2 to 4 capsules each twice daily to help move qi and blood in the uterus and prepare for smooth shedding of the uterine wall during menstruation. Unless the patient is extremely deficient in qi or blood, this principle can be applied to all patients, especially those with blood stagnation.

* For most patients, heat pads or moxa will always relieve pain. Moxa treatments should be 30 minutes or longer for maximum effect.

* Imperial Tonic is an excellent postpartum tonic. Women lose a tremendous amount of jing (essence) and blood after labor. The concept of replenishing the Kidney jing (essence) is not prevalent in the West. As a result, many women age faster and suffer from low back pain or symptoms of Kidney yin or jing (essence) deficiency later in their lives. This is a great formula to start one or two weeks after delivery. It helps replenish qi, blood, yin and yang that may have been lost during labor. Also, it is beneficial to nursing mothers, as more nutrients will be passed down to the baby. However, before tonifying the patient with Imperial Tonic, Sheng Hua Tang (Generation and Transformation Decoction) should be used for one week to clear out residual blood stagnation and to relieve pain. This will prevent future gynecological complications due to blood stagnation in the pelvis.

* For individuals who had a cesarean section, Flex (TMX) can be used to relieve pain and facilitate recovery.

Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:

* Ren pulse, a thin, long, straight, wiry pulse on and proximal to the left chi that is deep to the bone. It is one of the eight extra meridians.

* Polycystic ovaries: turtle pulse, a convex-shaped pulse, on the left chi.

* Blood stasis: dispersing pulse in the left chi.

SUPPLEMENTARY FORMULAS

* To enhance the effect to relieve pain, add Herbal ANG.

* For premenstrual syndrome (PMS), irritability, stress, or emotional disorders, add Calm.

* For irritability, stress, or emotional disorders with insomnia in patients with deficiency, add Calm ZZZ.

* For cystitis, urinary tract or lower jiao infections, use V-Support with Herbal ABX.

* For fever and fire signs, add Gardenia Complex.

* For cysts in the uterus and ovaries, fibroids or endometriosis, use Resolve (Lower).

* For back pain, use Back Support (CR).

* For menses with blood clots, add Resolve (Lower).

* For severe blood stagnation, add Circulation (SJ).

* For infertility, use Blossom (Phase 1-4).

* To stop bleeding, add Notoginseng 9 .

* For headache with blood deficiency, add Corydalin (CR).

* For gynecological pain due to scar tissue causing excessive qi and blood stagnation, add Flex (TMX).

* For acne, add Dermatrol (Clear).

ACUPUNCTURE TREATMENT

Traditional Points:

* Sanyinjiao (SP 6), Guilai (ST 29), Zhongji (CV 3), Zusanli (ST 36), Xuehai (SP 10), Qihai (CV 6), Geshu (BL 17), Diji (SP 8), Taichong (LR 3), Xingjian (LR 2)

* Needle Yinlingquan (SP 9), Lougu (SP 7) and Sanyinjiao (SP 6). Massage local tender points around Sanyinjiao (SP 6).

Classic Master Tung's Points:

* Dysmenorrhea: Fuke (T 11.24), Linggu (T 22.05), Tianhuang (T 77.17), Dihuang (T 77.19), Renhuang (T 77.21), Tianhuang (T 88.13), Minghuang (T 88.12), Qihuang (T 88.14), Simazhong (T 88.17), Sihuashang (T 77.08), Menjin (T 66.05), Tianshu (ST 25), Zhongji (CV 3)

* Polycystic ovarian syndrome (PCOS): Huanchao (T 11.06), Waisanguan (T 77.27), Yizhong (T 77.05), Erzhong (T 77.06), Sanzhong (T 77.07), Jiemeiyi (T 88.04), Jiemeier (T 88.05), Jiemeisan (T 88.06)

* Back pain from endometriosis: Fuke (T 11.24), Yunbai (T 44.11), Tongshen (T 88.09), Tianhuangfu [Shenguan] (T 77.18)

Master Tung’s Points by Dr. Chuan-Min Wang:

* Dysmenorrhea: Needle or bleed Menjin (T 66.05).

Balance Method by Dr. Richard Tan:

* Left side: Yinlingquan (SP 9), Diji (SP 8), Sanyinjiao (SP 6), Hegu (LI 4), Linggu (T 22.05)

* Right side: Zusanli (ST 36) or ah shi points nearby, Chize (LU 5), Kongzui (LU 6), Lieque (LU 7) or ah shi points nearby, Diwuhui (GB 42), Zulinqi (GB 41)

* Left and right sides can be alternated from treatment to treatment.

Ear Acupuncture:

* Ear seeds are very effective for relieving menstrual pain. The primary points to select are: Shenmen, Sympathetic, Uterus, Endocrine, Brain Stem and Ovary. Adjunct points can be used on other affected areas such as the Back for back pain, Spleen for diarrhea and so on.

* Ear seeds can be placed one week before each menstrual cycle. The patient should massage the points for five minutes three times each day or as frequently as possible. To prevent the seeds from falling out, advise the patient not to wash that ear during showers and not to rub the ear too hard with a towel while the ear is still wet. Each course of treatment is four months. Alternate ear each month.

Auricular Medicine by Dr. Li-Chun Huang:

* Menstrual disorder (menoxenia): Gonadotropin, Uterus, Kidney, Liver, Pituitary, Ovary, Endocrine

* Amenorrhea and hypomenorrhea: Uterus, Ovary, Gonadotropin, Exciting Point, Pituitary Point, Endocrine, Kidney, Liver, Sympathetic

* Dysmenorrhea: Uterus, Pelvic, Liver, Sympathetic, Kidney, Ovary, Endocrine, Pituitary, Lower Jiao, Cervix. Bleed Ear Apex.

* Endometritis: Uterus, Cervix, Kidney, Liver, Ovary, Pituitary, Thalamus, Endocrine, Gonadotropin, San Jiao.

NUTRITION

* Foods and fruits that are cold or sour in nature should be avoided, especially one week prior to or during menstruation. Cold and sour foods create more stagnation, and may worsen the pain.

* Decrease the consumption of salt, red meats, processed foods, junk foods, and foods with high sodium content. Caffeine should be avoided as it acts as a stimulant to excite the central nervous system and as a diuretic to deplete many important nutrients.

* Increase the consumption of whole-grain foods, broiled chicken, turkey, and fish.

* Drink a large quantity of distilled water daily before, during, and after the menstruation.

* Menstrual cramps due to calcium deficiency should be treated with ingestion of foods rich in calcium, such as green vegetables, legumes, and seaweeds.

* Ensure there is an adequate intake of vitamin B complex and vitamin E, which are important for production of sex hormones. Deficiency of zinc may also contribute to irregular menstruation.

* A folk remedy for menstrual pain uses a stalk of ginger (sliced) with 3 pieces of green onion, 30 grams of brown sugar and 3 cups of water. Bring the mixture to a boil and cook for five minutes. Add a teaspoon of white pepper and serve.

The Tao of Nutrition by Dr. Maoshing Ni and Cathy McNease:

* Premenstrual syndrome, including lower abdominal pain and bloating prior to menstruation: Make tea from cinnamon and hawthorn berries.

* Menstrual pain: Drink wine that was prepared with the herb motherwort (Leonorus cardiaca) prior to the onset of menses; the menstrual period will probably be a little heavier than usual.

LIFESTYLE INSTRUCTIONS

* Avoid sports that may expose the body to cold environments, such as snow skiing or cold-water sports.

* Hot baths or hot showers aimed at the abdomen help to relieve menstrual pain and cramps.

* Hot compresses on the abdomen increase blood circulation, relax abdominal muscles, and relieve pain.

* Stress can sometimes lead to irregular or no menstruation. Avoid stressful situations, or engage in stress-reducing activities.

* A regular and healthy lifestyle with adequate rest and relaxation is the basic requirement for a normal menstrual cycle.

* Wear clothes that fully cover the body and do not expose the belly or the abdomen to the cold environment. Avoid wearing tight pants.

CASE STUDIES

* G.E., a 44-year-old woman, presented with painful menstruation, starts and stops, and excessive flow with clotting. Other findings included pain upon palpation of the abdomen and a pulse that was deep, strong, and wiry. The Western diagnosis was menorrhagia; The TCM diagnosis was blood stasis. The patient was prescribed Mense-Ease and Resolve (Lower). Since this tends to happen every few months, the patient keeps the herbs on hand. Each time it resolves the pain, it is very helpful to her. Submitted by A.I., Hilo, Hawaii.

* L.C., a 50-year-old female, presented with macular degeneration, experiencing pain one week before her menses and waking up at night. Tinnitus, low back and abdominal pain were also present. Her menses consisted of a bright red color, sometimes dark brown, and some clots. Pulse was thready and weak and her tongue had teeth marks and a red tip. The practitioner diagnosed this condition as Liver and Kidney yin deficiencies with qi and blood stagnation in the lower jiao. Upon diagnosis the patient was prescribed Nourish and Mense-Ease. After taking the herbs for two months, the patient no longer has pain with her menses and felt better overall. Submitted by T.W., Perrysburg, Ohio.

* S.T., a 27-year-old female, presented with PMS symptoms consisting of severe cramping and moodiness. Pulse was choppy and the tongue was purple. The practitioner diagnosed this condition as Liver qi and blood stagnation. Mense-Ease was prescribed at 4-6 capsules three times a day, along with Calm to take as needed. After taking Mense-Ease for one cycle, the patient reported less menstrual pain and less cramping and moodiness. In addition, she reported that Calm had immediate effectiveness. Submitted by S.L., Yuma, Arizona.

* S.H., a 19-year old female, presented with multiple symptoms consisting of cramps, fibrocystic breasts, moodiness, and headaches. Pulse was thready and wiry; tongue was swollen with a yellow coating. The practitioner diagnosed this condition as Liver blood and Spleen qi deficiencies with dampness of the Spleen. For treatment, Mense-Ease was prescribed. In result of taking the herbs, the patient’s cramps and breast pain had dissipated within 24 hours. Overall, the pain had decreased from and an 8/10 to a 4/10 level. After two days, the pain decreased to a 1/10 level. Submitted by V.G., Virginia Beach, Virginia.

* A 27-year-old female office worker presented with pain in her lower abdomen. The pain was more prominent before and during menses. She also had occasional bloody stools. The patient had a history of chronic yeast infections and endometriosis, which were resolved by surgeries. The practitioner diagnosed the condition as blood and qi stagnation with damp-heat in the lower jiao. After taking Mense-Ease and Resolve (Lower), menstrual pain reduced and rectal bleeding abated. Submitted by N.H., Boulder, Colorado.

* A 51-year-old female postal worker noticed an irregularity in her menstrual cycle. For the past three years, she had noticed an increase in her menstrual irregularity. The patient noted moderate pain and heavy bleeding eight days out of her whole cycle. Computerized Electrodermal Screening (EAV) detected higher than average readings, which was indicative of stress or irritation to her glands. The practitioner diagnosed this as peri-menopausal dysmenorrhea/menorrhagia due to qi and blood stagnation in lower jiao. After two months of taking Mense-Ease (2 capsules with each meal), the patient’s menstrual discomfort improved 75% and her excessive bleeding was completely resolved. Submitted by D.H., Fort Myers, Florida.

* L.L., a 27-year-old female, presented with severe menstrual cramps, numerous dark blood clots, headache, acne breakouts with periods, extreme fatigue which forced her to lie in bed all day on the first day of the period. She stated that she must fast the first day otherwise she has nausea and vomiting. The blood pressure was 110/72 mmHg and the heart rate was 76 beats per minute. Her teeth-marked tongue appeared dark purple with red dots on the tip and sides. Tongue coating was thin and white. The pulse was slippery and thin. The diagnosis was Liver blood stagnation with Spleen qi deficiency and Liver qi stagnation. Mense-Ease was prescribed. After taking it for two weeks, the patient’s next period was much less debilitating. She reported fewer blood clots, no more headaches, normal body temperature, and less intense cramping. After two months, the symptoms have decreased by 50%. She was able to function and eat on day one of her period, whereas before, she was bed-ridden. Submitted by J.C.O., Whittier, California.

* S.M. presented with dysmenorrhea, cramping with dark blood clots, and fatigue. The tongue was purplish pale and the pulse was slippery and slow. She also had a pale complexion. The doctor diagnosed her with qi and blood stagnation and Mense-Ease was prescribed. After taking the formula, the patient reported relief of lower abdominal pain and reduction in blood clots. Submitted by B.F., Newport Beach, California.

* A 28-year-old female dental hygienist presented with a palpable lump on her lower abdomen near acupuncture point Zigongxue (Uterus). She had severe premenstrual syndrome (PMS) affecting her emotionally, as well as large dark clots in her menstrual discharge. She had one week of constant dull pain on her left lower abdomen especially after her period. She described the pain as a grabbing, shooting type of pain as though someone was tightening a rope around her belly. She had a history of candida. She sought to get pregnant, and therefore discontinued taking her birth control pills. Laparoscopy was done in 1995 to remove her right ovary and in 1999 to remove endometriosis. Scar tissue was present in her left lower abdomen from a hernia operation when she was a youngster. Cysts were also present on her left ovary. Lastly, the patient also had a history of hypothyroidism and hay fever. Her tongue color was unremarkable and her tongue coating appeared moist. Her tongue root coating would alternate from white to yellow. Her sublingual region was also unremarkable. The patient’s pulse was constantly deep, thready and soft. The practitioner diagnosed this clinical picture as damp-heat in the lower jiao and Spleen qi deficiency leading to the accumulation of dampness. The practitioner prescribed Mense-Ease to regulate her menstruation, and Resolve (Lower) to treat endometriosis. The patient was instructed to take 3 to 5 capsules of each formula three times daily, starting three days before her period and to continue the dose throughout her menstrual flow and for one week afterwards. After taking the herbs, she became less emotional. She noted fewer episodes of cramps the first month and no pain during the second month of her herbal therapy. Although her lower abdominal pain lingered, the intensity lessened, the frequency reduced, and the affected area dwindled. The patient also finally discontinued her caffeine intake, which she also attributed to her pain. After three months of herbal treatment, surgery was done to remove two inches of tissue. Ultrasound confirmed the complete absence of ovarian cysts after three months of herbal therapy. Doppler ultrasound showed a favorable pulsatility index for uterine blood flow. There were no blockages present in her reproductive system. The practitioner concluded that Mense-Ease was quite effective in treating other patients with similar conditions. The efficacy of Resolve (Lower) was also proven clinically with ultrasound results. Submitted by T.K., Denver, Colorado.

PHARMACOLOGICAL AND CLINICAL RESEARCH

Mense-Ease is formulated specifically to treat pain in various gynecological disorders, such as dysmenorrhea, endometriosis, fibroids and postpartum pain. Mense-Ease contains many herbs that exert strong analgesic, anti-inflammatory and antispasmodic effects.

Mense-Ease has many herbs with analgesic action to directly relieve pain. Yan Hu Suo (Rhizoma Corydalis) is one of the strongest and most potent herbs for the treatment of pain, and is commonly used to treat amenorrhea or menstrual pain, hernial pain, chest and hypochondriac pain, epigastric and abdominal pain, and pain of the extremities. According to laboratory studies, the extract of Yan Hu Suo (Rhizoma Corydalis) is effective in both acute and chronic phases of pain and inflammation. With adjustment in dosage, the analgesic potency of Yan Hu Suo (Rhizoma Corydalis) has been compared to that of morphine. Though the maximum analgesic effect of Yan Hu Suo (Rhizoma Corydalis) is not as strong as morphine, it has been determined that the herb is much safer, with significantly less side effects, less risk of tolerance, and no evidence of physical dependence even with long-term use.[4] In addition to Yan Hu Suo (Rhizoma Corydalis), Xiang Fu (Rhizoma Cyperi), Dang Gui (Radix Angelicae Sinensis) and Niu Xi (Radix Achyranthis Bidentatae) are three other herbs with analgesic effect to relieve pain.[5]^,[6]^,[7]

Mense-Ease also has many herbs with anti-inflammatory actions to reduce inflammation. Dang Gui (Radix Angelicae Sinensis) has an anti-inflammatory effect similar to that of acetylsalicylic acid. It decreases vascular permeability to reduce inflammation.[8] Its anti-inflammatory effect is approximately 1.1 times stronger than acetylsalicylic acid, and its analgesic effect is approximately 1.7 times stronger than acetylsalicylic acid.[9]The anti-inflammatory property of Dang Gui (Radix Angelicae Sinensis) is attributed to the inhibition of pro-inflammatory mediators, including nitric oxide and prostaglandin E2 in peritoneal macrophages.[10] Mu Dan Pi (Cortex Moutan) is another herb with strong anti-inflammatory actions. According to laboratory studies, the mechanism of the anti-inflammatory effect is attributed to inhibition of prostaglandin synthesis and decreased permeability of the blood vessels.[11]^,[12] Pu Huang (Pollen Typhae) also demonstrates marked anti-inflammatory action through improved circulation and decreased permeability of blood vessels.[13] Lastly, Wu Yao (Radix Linderae) and Xiang Fu (Rhizoma Cyperi) are two other herbs that exert significant anti-inflammatory effects through their inhibitory activities on the production of inflammatory mediators.[14]^,[15]

Since dysmenorrhea is directly associated with uterine contraction, herbs are used to relax muscle contraction and relieve pain. Xiang Fu (Rhizoma Cyperi) is a uterine relaxant that has an inhibitory effect on the uterus.[16] Chi Shao (Radix Paeoniae Rubra) has an inhibitory effect on the smooth muscles of the intestines and uterus.[17] Lastly, Dang Gui (Radix Angelicae Sinensis) has a dual effect to regulate the smooth muscle of the uterus. Clinical studies have shown that when the uterus is in a state of relaxation, Dang Gui (Radix Angelicae Sinensis) can induce contraction. Conversely, if the uterus is in a contracted state, then Dang Gui (Radix Angelicae Sinensis) promotes relaxation. This dual action is credited for the therapeutic effect of relieving spasms and stopping pain.[18]

Lastly, Mense-Ease incorporates many other herbs to treat associated conditions of dysmenorrhea. Chi Shao (Radix Paeoniae Rubra), Hong Hua (Flos Carthami) and Tao Ren (Semen Persicae) have antiplatelet and anticoagulant effects, and are effective to treat endometrial clots. Chi Shao (Radix Paeoniae Rubra) and Yan Hu Suo (Rhizoma Corydalis) have sedative and tranquilizing effects, and are helpful to alleviate irritability, anxiety and emotional instability.[19]^,[20] Lastly, to relieve ischemia associated with uterine contraction and pain, Gui Zhi (Ramulus Cinnamomi) and Mu Dan Pi (Cortex Moutan) are used to relax and dilate blood vessels and promote blood circulation.[21]^,[22]

In summary, Mense-Ease is a great formula to treat menses-related abnormalities, such as dysmenorrhea, pain in various gynecological disorders, cramping and pain due to endometriosis, postpartum pain, and PMS.

COMPARATIVE ANALYSIS

Dysmenorrhea is a condition that almost all women suffer on an occasional basis. As common as these conditions are, there are few drug treatments available. On one hand, there are over-the-counter (OTC) drugs such as Midol and Motrin (ibuprofen) that reduce swelling and inflammation. These drugs treat the symptoms, and do not regulate menstruation or change the long-term prognosis of the condition. Those who have dysmenorrhea are likely to have the same conditions on a monthly basis when treated with only these OTC drugs. On the other hand, there are prescription drugs such as birth control pills or patches that regulate menstrual cycles. Though they are more effective, they often cause serious side effects, such as weight gain, hyperkalemia, clotting disorders, retinal thrombosis, cancer, liver damage, hypertriglyceridemia, hypertension, bleeding, and fertility impairment. In short, drug treatment options are very limited between those that treat only symptoms and do not work well, and those that work well but may have significant side effects.

Herbal therapy is extremely effective to regulate menstruation and relieve PMS and dysmenorrhea. These herbs have analgesic effects to relieve pain, anti-inflammatory effects to reduce swelling and inflammation, and antispasmodic effects to relieve cramping. Furthermore, many herbs have been shown to have a marked effect to regulate hormones to promote normal menstruation. However, this effect requires continuous use of herbs for at least one to two cycles. In short, herbal therapy is extremely beneficial for treatment of menstrual disorders, as it treats both the symptoms and the cause of PMS and dysmenorrhea.

In conclusion, drugs offer limited options for the treatment of dysmenorrhea. OTC drugs are ineffective and do not have lasting effects. Birth control pills are effective, but these drugs carry significant short- and long-term side effects. Herbs, on the other hand, are extremely effective for both immediate and prolonged benefits. Furthermore, they are very safe and are associated with few or no side effects. Individuals with such menstrual disorders should definitely explore these non-drug treatment options.

Mense-Ease ™

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