PHYTOTHERAPY RESEARCH

Phytother. Res. 20, 819–824 (2006)

Published online 11 July 2006 in Wiley InterScience
CHINESE HERBS FOR DYSMENORRHEA 819
(www.interscience.wiley.com) DOI: 10.1002/ptr.1905

REVIEW ARTICLE
Common Traditional Chinese Medicinal Herbs
for Dysmenorrhea

Wei Jia1,2*, Xiaorong Wang1, Desheng Xu2, Aihua Zhao1 and Yongyu Zhang2
1
The School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China
2
Center for Traditional Chinese Medicine and Systems Biology, Shanghai University of Traditional Chinese Medicine, Shanghai,
China

Dysmenorrhea is painful menstrual cramps, which negatively impacts the quality of life of those diagnosed.
The paper reviews traditional Chinese medicine’s treatment of dysmenorrhea through the use of combination-
herbal-formula therapeutics. These herbal treatments are effective for dysmenorrhea with minimal side
effects. Pharmacological studies suggest Chinese herbal dysmenorrhea therapies likely decrease prostaglandin
levels, modulate nitric oxide, increase plasma β -endorphin ( β -EP) levels, block calcium-channels and improve
microcirculation. Conventional therapy for dysmenorrhea, which usually includes non-steroidal antiinflammatory
drugs (NSAIDs), provides symptomatic relief but has increasing adverse effects with long-term use. Therefore,
Chinese herbal medicines, including simple herbal and combination formulas, are perhaps the ideal therapeu-
tics of choice. Copyright © 2006 John Wiley & Sons, Ltd.

Keywords: dysmenorrhea; traditional Chinese medicine; Chinese herbs; combined formulas.

with clinically diagnosed dysmenorrhea, compared with

INTRODUCTION
Dysmenorrhea causes severe pain which negatively
impacts on a woman’s quality of life. Dysmenorrhea
is classified as either primary or secondary. Primary
dysmenorrhea results from elevated prostaglandins
(PGs), has no visible pelvic disease and produces uterine
ischemia and pain. Secondary dysmenorrhea presents
with both high PG levels and uterine pathologies
such as endometriosis and pelvic inflammation (Harel,
2002; Coll Capdevila, 1997). Primary and secondary dys-
menorrhea are both common gynecological complaints,
with 30–60% of reproductive age women reporting pain
during menstruation. Of those reporting pain, 13.5%
suffer pain too severe to maintain their normal life or
job during 1–3 days of the menstrual cycle (Liao, 2004).
Though the mechanisms of primary dysmemorrhea
occurring most frequently in teens have not been
elucidated, prostaglandin (PGs), leukotrienes (LTs)
and vasopressin are likely involved. Before menstrua-
tion but after progesterone withdrawal, a PG and LT
cascade is initiated in the uterus. The inflammatory
response, which is mediated by these PGs and LTs,
produces abdominal pain, cramps, headaches and other
systemic discomfort exhibited as facial paleness, cold
sweats, nausea, vomiting and bloating (Deligeoroglou,
2000). Furthermore, PG plasma and vasopressin levels
are elevated (Ostad et al., 2001; Dawood, 1990). Uterine
PG production is up to seven times greater in women
* Correspondence to: Dr W. Jia, School of Pharmacy, Shanghai Jiao Tong
University, Shanghai 200240, China.
E-mail: Weijia@sjtu.edu.cn
Contact/grant sponsor: Shanghai Leading Academic Discipline Project;
contract/grant number: T0301.
Copyright © 2006 John Wiley & Sons, Ltd.
Copyright © 2006 John Wiley & Sons, Ltd.
controls (Ostad et al., 2001). Vasopressin increases
premenstrually and was found in non-pregnant women
to be five times more effective on uterine activity than
that of oxytocin (Deligeoroglou, 2000; Dawood, 1990).
As a result, dysmenorrhea is caused by uterine muscle
hypercontractility, subsequent blood flow reduction and
concurrent uterine ischemia (Akerlund, 1979). Corre-
spondingly, there is a significant reduction in uterine
blood flow associated with the time of maximal pain
(Khamis et al., 2003). Studies suggest uterine diameter
and endometrial thickness are related to severe pri-
mary dysmenorrhea (Dmitrovic, 2004).
Current dysmenorrhea therapies include non-
steroidal antiinflammatory drugs (NSAIDs), combined
with oral contraceptives, beta-blockers, vitamin B1,
vitamin B6, magnesium and calcium channel-blockers
(Pei et al., 2001; Milsom et al., 2002; Vercellini, 2003;
Hendrix and Alexander, 2002; Wilson and Murphy,
2001).
NSAIDs relieve dysmenorrheal effects by inhibiting
cyclooxygenase production, a component of the arachi-
donic acid cascade (Ostad et al., 2001). However, the
majority of NSAIDs have adverse long-term effects
involving disorders of the liver, kidney and digestive
systems. In addition, acute liver injury and acute renal
failure have also been reported (Garcia-Rodriguez
et al., 1994; Perez-Gutthann et al., 1996). While
oral contraceptives can be an effective dysmenorrheal
treatment, by reducing PGs, inhibiting endocardium
proliferation and reducing blood flow, this treatment
may not be suitable for all women, especially those
pursuing pregnancy (Hendrix and Alexander, 2002;
Vercellini et al., 2003). Beta ( β )-blockers, vitamin B1,
B6, magnesium, calcium channel-blockers and psycho-
therapeutic method (Wilson and Murphy, 2001) are
all recommended as potential treatments for primary
Received
Phytother. Res. 20,3819–824
February(2006)
2006
Accepted 2 March
DOI: 2006
10.1002/ptr
820 W. JIA ET AL.

dysmenorrhea. Cervical dilatation and laparoscopic Table 1. 30 herbs used most frequently in TCM for dysmenorrhea
resection of the uterosacral ligaments are used in
patients with severe dysmenorrhea (Andersson, 1988; Pharmacopea name Binomial name
Vercellini, 2003). In China, traditional Chinese medi-
cine and herbs are considered as an alternative treat- Caulis Sargentodoxae Sargentodoxa cuneata
Cortex Cinnamomi Cassiae Cinnamomum cassia
ment for dysmenorrhea. This paper reviews traditional
Cortex Moutan Paeonia suffruticosa
Chinese medical herbal therapies used for the treat- Faeces Trogopterorum Trogopterus xanthipes
ment of dysmenorrhea. or Pteromys volans
Flos Carthami Carthamus tinctorius
Flos Rosae Chinensis Rosa chinensis
Fructus Akebiae Akebia quinata
TRADITIONAL CHINESE MEDICINE (TCM) Fructus Foeniculi Foeniculum vulgare
TREATMENT OF DYSMENORRHEA Fructus Jujubae Ziziphus jujube
Herba Leonuri and Leonurus heterophyllus
Traditional Chinese medicine (TCM) differs from West- Fructus Leonuri
Herba Selaginellae Selaginella tamariscina
ern medicine not only in theory and diagnosis but also
Herba Lycopi Lycopus iucidus
in interpretation of both normal physiological function Herba Verbenae Verbena officinalis
and pathological changes in the human body. In a word, Lignum Sappan Lignum sappan
TCM emphasizes the harmony between the human Pollen Typhae Typha angustifolia
body and the illness that is caused by the ‘Yin’ and Radix Angelicae Sinensis Angelicae sinensis
‘Yang’ imbalance resulting from invasion of exogenous Radix Astragali Astragalus membranaceus
factors. Dysmenorrhea was first documented in Gin Radix Curcumae Aromaticae Curcuma aromatica
Gui Yao Lu by Zhongjing Zhang of Donghan dynasty Radix Linderae Lindera strychnifolia
(A.D.196). In TCM, the main cause of dysmenorrhea Radix Paeoniae Alba and Paeonia veitchii and
is qi stasis in the liver by the invasion of six exo- Radix Paeoniae Rubra Paeoni lactiflora
Radix Rehmanniae Rehmannia glutinosa
genous pathogenic factors. Qi stasis concurrently blocks
Radix Salviae Miltiorrhizae Salvia miltiorrhiza
the blood flow, which further forms blood stasis and Rhizima Chuanxiong Ligusticum chuanxiong
lumps. Menstrual pain resulting from qi is due to Rhizoma Corydalis Corydalis yanhusuo
stagnated and retained blood. Blood deficiency and Rhizoma Curcumae Longae Curcuma longa
coldness in the whole human body are two additional Rhizoma Cyperi Cyperus rotundus
causes of dysmenorrhea. Thus, dysmenorrhea can be Semen Persicae Prunus persica
divided into qi stasis, blood stasis, or blood deficiency Semen Vaccariae Vaccaria segetalis
types according to different situations. The essence
of the TCM theory for treating nonspecific disorders,
such as dysmenorrhea, involves eliminating the intrinsic
causes. PHARMACOLOGICAL STUDIES AND
Treatment of the qi stasis type of dysmenorrhea, aims CLINICAL SURVEY OF 5 WIDELY USED TCM
to promote fluid qi movement. To promote qi and HERBAL TREATMENTS IN DYSMENORRHEA
blood flow, traditional medicinal herbs such as Cyperus
rotundus, Foeniculum vulgare, Angelicae sinensis and Current research suggests several mechanisms by which
Ligusticum chuanxiong, are often recommended. In the TCM herbal treatments effectively treat dysmenorrhea
blood stasis type, Angelicae sinensis, Ligusticum chuan- including: modulation of PGs levels, nitric oxide reduc-
xiong, Paeonia lactiflora and Typha angustifolia are tion, calcium channel inhibition, β -endorphin upregula-
recommended to break blood stasis and resolve lumps, tion and microcirculation regulation (Wei and Wu, 2000;
thereby activating blood circulation. Angelicae sinensis, Ma et al., 2004; Liu et al., 2004a; Peng et al., 2001; Liu
Codonopsis pilosula, Rehmannia glutinosa, Paeonia veit- and Jiang, 2000). Combined herbal formulas would be
chii, Paeonia lactiflora and Polygoum multiflorum herbs expected to incorporate several mechanisms to treat
are prescribed for the blood deficiency type to prevent symptoms of dysmenorrhea. The following section de-
asthenia and strengthen the body to withstand patho- scribes the potential mode of action of five frequently
genic invasion. used herbal prescriptions for dysmenorrheal treatment.
Approximately 136 Chinese medicinal herbs are
prescribed in the TCM treatment of dysmenorrhea. Aifu Nuangong pill. Aifu Nuangong pills, administered
According to the literature, the 30 herbs listed below gastrointestinally at three doses of 6 × 10−5, 12 × 10−5
have been used most frequently by clinicians (Dong, and 24 × 10−5 g/kg on an oxytocin-induced rat model,
2003) (Table 1). significantly (p < 0.01) decreased the frequency of writh-
Combined prescriptions, according to the compara- ing in rats observed when compared with a positive
bility principle in TCM, are often used to streng- control group (morphine solution at dose of 6 × 10−4 g/
then herbal effectiveness and to mitigate toxic effects. mL) (Wang et al., 2003). Subsequently, the average β -
Hundreds of combined formulas to treat symptomatic EP concentrations were 169.3 and 176.5 ng/L in the
dysmenorrhea have been documented in various his- median and highest dose groups. These data were con-
torical Material Medica and contemporary journals. sistent with that of the blank group (150.1 ng/L). The
Currently 13 unique prescriptions for treating dysmenor- above results implied that increasing the blood serum
rhea are approved by the Chinese State Food and Drug β -EP concentration is likely to contribute to the ability
Administration (SFDA). The most frequently used, of the Aifu Nuangong pill to alleviate pain, in addition
compositions and usage interpretations of TCM are to its direct influence on uterine smooth muscular con-
listed in Table 2. traction. Further, Radix Angelicae Sinensis (Angelicae
Copyright © 2006 John Wiley & Sons, Ltd. Phytother. Res. 20, 819–824 (2006)
DOI: 10.1002/ptr

Table 2. Combination formulas and their traditional use in dysmenorrheal treatments
Chinese name
Aifu Nuangong pill
Bazhen decoction
Danggui Shaoyao powder
Gexia Zhuyu decoction
Jiuqi Niantong pill
Peikun pill
Shaofu Zhuyu decoction
Shaoyao Gancao decoction
Tiaogan decoction
Copyright © 2006 John Wiley & Sons, Ltd.
CHINESE HERBS FOR DYSMENORRHEA 821
Composition Chinese traditional use
Folium Artemisiae Regulating qi and supplementing blood to warm
Rhizoma Cyperi uterine for menoxenia and dysmenorrhea
Fructus Evodiae
Cortex Cinnamomi Cassiae
Radix Angelicae Sinensis
Rhizima Chuanxiong Radix
Paeoniae Alba
Radix Rehmanniae
Radix Scutellariae
Radix Dipsaci
Radix Codonopsis Strengthening the spleen and nourishing qi,
Rhizoma Atractylodis invigorating blood and stopping bleeding
Marcroephalae Poria Applicable to the treatment of cold coagulation
Radix Angelicae Sinensis and blood stasis
Radix Paeoniae Alba
Rhizoma Rehmanniae Praeparata
Radix Glycyrrhizae
Radix Astragali
Radix Aucklaneliae
Radix Angelicae Sinensis
Radix Paeoniae Rubra
Rhizima Chuanxiong
Rhizima Atractylodis
Macrocephlae Poria
Rhizoma Alismatis
Radix Angelicae Sinensis Smoothing the liver to regulate qi and resolving
Faeces Trogopterorum stasis to stop pain
Rhizima Chuanxiong
Radix Linderae
Radix Paeoniae Rubra
Rhizoma Corydalis Yanhusuo
Rhizoma Cyperi
etc.
Rhizoma Cyper Regulating qi and activating blood to relieve pain
Radix Aucklandiae
Rhizoma Alpiniae officinarum
Rhizoma Corydalis
Pericarpium Citri Reticulatae
Radix curcumae
Rhizoma Curcumae
Semen Arecae
Radix Glycyrrhizae
Faeces Trogopterorum
Radix Angelicae Sinensis Nourishing blood and regulating the liver, replenishing
Rhizoma Rehmanniae Praeparata the kidney and enriching essence
Radix Astragali Dissolving the stagnation in blood vessels to promote
etc. blood circulation and dispersing coldness for relieving
Radix Angelicae Sinensis pain
Pollen Typhae
Faeces Trogopterorum
Radix Paeoniae Rubra
Fructus Foeniculi
Rhizoma Corydalis
Commiphora Myrrha
Rhizima Chuanxiong
Cinnamomum Zeylanicum
Rhizoma Zingiberis Preparara
Radix Paeoniae Alba Treatment of dysmenorrhea with cold coagulation and
Radix Glycyrrhizae blood stasis
Rhizoma Dioscoreae Nourishing blood and regulating the liver, replenishing
Colla Corii Asini the kidney and enriching essence
Radix Angelicae Sinensis
Radix Paeoniae Alba
Fructus Coni
Phytother. Res. 20, 819–824 (2006)
DOI: 10.1002/ptr
822 W. JIA ET AL.

Table 2. (Continued)

Chinese name Composition Chinese traditional use

Radix Morindae Officinalis

Tongjing pill
Xuefu Zhuyu decoction
Yueyueshu powder
Yuanhu Zhitong tablet
Fructus Lycii
Rhizoma Cyperi
Rhizoma Rehmanniae Praeparata
Semen Astragali Complanati
Radix Glycyrrhizae
Radix Angelicae Sinensis Warming human body to disperse cold coagulation
Radix Paeoniae Alba and blood stasis resulting in coldness
Rhizima Chuanxiong
Rhizoma Rehmanniae Praeparata
Radix Aucklaneliae
etc.
Radix Angelicae Sinensis Smoothing the liver to regulate qi and resolving stasis
Rhizima Chuanxiong to stop pain
Radix Paeoniae Rubra
Flos Carthami
Semen Persicae
Radix Cyathulae
Rhizoma Cyperi
Pericarpium Citri
Reticulatae Viride
Fructus Aurantii
Radix Aucklaneliae
Rhizoma Corydalis Yanhusuo Applicable to the treatment of cold coagulation and
Faeces Trogopterorum blood stasis
Radix Glycyrrhizae
Radix Salviae Miltiorrhizae
Cortex Cinnamomi Cassiae
Flos Carthami
Faeces Trogopterorum
Rhizoma Sparganii
Rhizoma Curcumae
Rhizoma Corydalis Yanhusuo
Radix Angelicae Sinensis
Radix Aucklaneliae
Rhizoma Corydalis Yanhusuo
Radix Angelicae Dahuricae Applicable to the treatment of dysmenorrhea due to
‘qi’ stagnation and blood stasis

sinensis), a component of the Aifu Nuangong pill,
relaxes uterine smooth muscle and increases blood
circulation. Ligustilide, isolated from Radix Angelicae
Sinensis, is used to treat dysmenorrhea, because it can
relax the contraction of uterine smooth muscle (Liu
et al., 2004a, 2004b). Lastly, 95% of dysmenorrhea
patients in the Shenzhen traditional Chinese hospital
of Guanzhou traditional Chinese Medical College, who
were treated with the modified Aifu Nuangong formula,
recovered (Wang et al., 2003).
Jiuqi Niantong capsule. Peng Zhipei demonstrated that
the Jiuqi Niantong capsule, used to treat dysmenorrhea,
increased β -EP, NO and ET-1 in blood plasma of
uterine tissue (Peng et al., 1999b). In mice with oxytocin-
induced dysmenorrhea, the Jiuqi Niantong pill produced
a statistically significant reduction in latent periods and
writhing times, a proxy for pain, compared with the
control group (treated with distilled water) (Peng et al.,
1999a).
Shaofu Zhuyu pill. The Shaofu Zhuyu pill at doses of
1.8 and 3.6 g/kg significantly extended the latent period
Copyright © 2006 John Wiley & Sons, Ltd.
in mice with oxytocin-induced dysmenorrhea. At doses
of 1 and 2 g/kg in rats, the Shaofu Zhuyu Pill also
alleviated uterine contractions (Wu, 2003). Further
studies verified the usefulness of the Shaofu Zhuyu
pill for chronic inflammation, uterine hyperplasia,
improving perimetrium microcirculation, and decreas-
ing whole blood viscosity in animals. In 126 patients
with dysmenorrhea treated with the Shaofu Zhuyu
pill for 4 days, 102 showed significantly reduced
lower abdominal pain (Zhou et al., 2002). Thus, the
Shaofu Zhuyu pill relieves pain from uterine smooth
muscle contractions, and decreases blood viscosity and
inflammation.
Peikun capsule. Isolated uterine muscle preparations
from female rats and dysmenorrheal mouse models,
induced by diethylstilbestrol and oxytocin, were used
to evaluate the effectiveness of the Peikun capsule on
uterine contractile force, frequency and degree of
activity. When graded concentrations (from 0.1, 0.2, 0.4,
0.8, 1.6 g/L) were added to isolated uterine muscle,
contractile forces were inhibited by 11.6–65.7%, fre-
quencies were reduced by 28.2–60.2%, and activities
Phytother. Res. 20, 819–824 (2006)
DOI: 10.1002/ptr
 CHINESE HERBS FOR DYSMENORRHEA
were reduced by 36.6–84.6% with IC50 of 0.69 g/L,
0.83 g/L and 0.23 g/L, respectively in vitro (Cao et al.,
2002). In addition, the writhing of times of dysmenor-
rhea mice were significantly reduced at doses of 2.0
and 5.0 g/kg. The results showed that Peikun capsule
can effectively inhibit uterine contraction, thereby
alleviating pain from dysmenorrhea. In another investi-
gation, the Peikun capsule reduced oxygen consump-
tion, raised the pain threshold and lowered body
temperature (Cao et al., 2001). This combination
formula exerts a holistic effect in the treatment of
dysmenorrhea by nourishing yin and supplementing
the kidney.
Yueyueshu powder. Zhao Shumei reported treating
primary and secondary dysmenorrhea in 97 patients
with either Yueyueshu powder or the PG blocker,
indomethacin, at the Baotou Medical College Hospital.
Patients received 10 g of Yueyueshu powder twice daily
or 25 mg indomethacin three times daily. The efficacy
of Yueyueshu powder was 77.8% and 69.1% in pri-
mary and secondary dysmenorrhea, respectively, while
the efficacy of indomethacin was 76.1% and 36.1%
for primary and secondary dysmenorrhea, respectively
(Zhao and Hong, 1996). In traditional Chinese medi-
cine, this formula can dispense cold coagulation and
dissolve blood stasis to ‘warm up’ the body and pro-
mote blood flow, which could be a multicomponents-
to-multitargets approach, rather than a single
PG-blocking mechanism.
CONCLUSION
Dysmenorrhea is one of the most common gynecological
ailments directly influencing a woman’s quality of life.
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Non-steroidal antiinflammatory drugs (NSAIDs) are
usually employed rapidly to reduce the symptoms
of dysmenorrhea. However, long term treatment with
NSAIDs can have severe side effects. Traditional
Chinese medicine and medicinal herbs have been used
to protect and treat conventional chronic diseases
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effectiveness of TCM herbs was first verified in patients
and then contemporary scientific technologies have
gradually validated their effectiveness.
Since Chinese herbal treatments (simple or combi-
natorial) are effective and often have reduced side
effects, medicinal herbs are considered to be an alter-
native to conventional remedies for many diseases.
Herbal prescriptions, containing unique herbal formu-
lations, effectively treat dysmenorrhea by dispelling
qi stasis, dissolving blood stasis and dissociating lumps
in blood vessels, thereby promoting qi and blood flow.
Herbal formulations improve the benefits of each
constituent while minimizing the toxic effects of others,
thereby promoting the best therapeutic benefit with
minimal side-effects. In fact, most herbs can eliminate
intrinsic causes of disease. In TCM, qi and stasis result-
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The precise mechanisms of TCM herbal action need
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formulations and meet the growing demands for herbal
medicine and phytotherapies in the coming decades.
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