Analysis on the Theory of Treating Primary Dysmenorrhea by "Helping Yang and Suppressing Yin"

: Primary dysmenorrhea (PD) is a common clinical gynecological disease with a high incidence. Professor Zhang Xiaofeng, based on the theory of "Yang qi, Yin forming" in "Huangdi Neijing", and combined with years of clinical experience, believes that the deficiency of Yang qi is based, and the "Yin forming" of cold coagulation, blood stasis, phlegm, dampness and humidity is relatively too prosperous. The method of supporting Yang and suppressing Yin was used to treat the disease, at the same time, combined with the menstrual cycle, provide power for "Yang qi" and inhibit the production of "Yin forming", so as to improve the clinical effect.


Introduction
Primary dysmenorrhea, also known as "functional dysmenorrhea", is one of the common clinical gynecological diseases. It is to point to the woman is during menstruation or before and after menstruation, appear recurrent lower abdominal pain, or accompanied by lumbosacral pain, or even severe pain syncope, affect the normal work and life of the disease. Easy to occur in adolescence, more common in childless and unmarried women [1] . Studies have shown that dysmenorrhea is mostly related to endocrine, genetic, mental and any pathological factors causing excessive uterine contraction [2] .
The tutor, Professor Zhang Xiaofeng, has been engaged in the clinical and scientific research work of gynecological medicine for more than 30 years, and has accumulated rich experience in the diagnosis and treatment of integrated traditional Chinese and western medicine of dysmenorrhea, and has good clinical effect.

The understanding of primary dysmenorrhea in ancient medicine
There is no specific record of "primary dysmenorrhea" in the name of "primary dysmenorrhea". However, its clinical symptoms and prescription treatment have long been recorded before. The earliest is Zhang Zhongjing, seen in the "golden Chamber of women miscellaneous diseases and treatment": " take down, after the water adverse, less belly full of pain, after January goodbye, the Lord." "Su wen" cloud: "Heaven and earth are mild, the water quiet, cold, the water coagulate". The water can not flow smoothly, the birth of dysmenorrhea.

The treatment of Yin suppression in primary dysmenorrhea is based on the theory of "Yin forming, Yang Hua qi"
"Yang generated gas, Yin forming" first seen in the "element ask Yin and Yang should be like the big theory": " Yin static Yang manic. Yang sheng Yin long, Yang kill Yin hidden. Yang Hua gas, Yin forming. "Zhang Jingyue" class classics "note:" Yang dynamic and scattered, so the gas. The Yin is quiet and condensed, so they take shape. "Many doctors in later generations believe that" Yang Hua gas, Yin forming " can be understood as Yang has the characteristics of movement, dispersion, active, main scattered, is invisible, and has the function of transforming tangible material into invisible gas; Yin has the characteristics of quiet, condensed, main static, main coagulation, is physical (physiological or pathological), but also has the function of condensing invisible gas into tangible things [3] .
As Zhang Zhicong, a doctor in the Qing Dynasty, said in his Notes to the Yellow Emperor, "Heavenly creatures, so the Yang changes all things, while our spirit changes from Yang; Yin becomes the form of all things, while our form comes from Yin things." For the human body, "Yang Hua qi" refers to the evolution process of living material from tangible to invisible. The human body relies on essence, blood, jin, liquid and other physical substances into invisible qi, in order to promote and maintain various physiological activities of the body, that is, the process of "drinking into the stomach, swimming into essence qi". Yin forming " is from the evolution of invisible to tangible, such as the lung inhalation of clear qi, the spleen and stomach transport of water grain fine micro gas to enrich the human body, promote the development of the process of [4] ."Yang generated gas" and "Yin forming" are like human body material metabolism produces energy, energy metabolism produces material, for mutual use. The relationship between Yin and Yang in human body is Yang dominant and Yin subordinate. The balance between Yin and Yang, Yin pingyang secret, Yin and Yang state are all dynamic balance dominated by Yang. Therefore, Yang is still the main driving force for "Yang to transform Qi and Yin to form Qi", and only with sufficient Yang and normal gasification can life develop in a coordinated and orderly way [5] .

The understanding of the theory of "Yin forming, Yang generated qi" in the primary dysmenorrhea machine
Primary dysmenorrhea is also known as "abdominal pain", the etiology and pathogenesis can be generalized as "no glory, then pass" or "no pain". Zhao Ruihua believes that blood stasis block chong Ren, cell palace, adult disease cause pain is the basic disease of the disease, "Yang generated qi" is insufficient, leading to "Yin forming" is too the core of the disease. Yang deficiency caused by spleen and kidney deficiency is the root of the disease, Yang depression caused by liver qi stagnation is an important link of the occurrence and development of the disease, and blood stasis is the central link of the occurrence and development of the disease [6] . Women with blood for this, blood is warm line, cold coagulation. If the element body spleen kidney Yang deficiency, or spleen and stomach deficiency, long disease consumption, liver and kidney deficiency, resulting in insufficient "Yang qi" function, the blood and other Yin essence substances can not normally transpiration and gasification, can not spread the body for the normal operation of the viscera to provide power, make the blood sea empty, cell loss, "not glorious" for dysmenorrhea. "Yang Hua gas" is insufficient, further cause "Yin forming" too much, the formation of invisible evil block meridians, qi and blood, it is "the pain caused by obstructed".

Treatment of primary dysmenorrhea by helping Yang and suppressing Yin
"Fu Yang and suppressing Yin suppression method" is the basic diagnosis and treatment idea of typhoid fever. Lu Zhuzhi, a famous Shu doctor, emphasizes "Yang Lord Yin from", saying: " Personal life lies to the pole by fire, and the treatment legislation is to eliminate Yin with fire [7] ." Some scholar [8] also pointed out that Fuyang is not just the application of wenyang drugs, but to help the body to restore its function, making it from pathological to normal. Zhang Jingyue, a physician in the Ming Dynasty, proposed the method of "helping Yang and eliminating Yin" in his book "Lei Jing Fu Yi", that is, to inhibit the generation of pathological factors of "Yin forming" by supporting Yang qi and invigorating the function of "Yang Hua qi". Some experts apply this method to treat and apply this method to treat gynecological diseases, in addition to helping Yang temperature, can also add blood circulation and remove blood stasis, accelerate the elimination or inhibition of the evil of "Yin forming". When prescribing, choose more peaceful or warm and can regulate qi and blood, Yang points of drugs, less cold, moist and other drugs into the Yin points, in the humid heat really need to clear heat, should also be the disease, prevent cold and cold Yang [9] . Treatment should also be combined with the menstrual cycle and staging and treatment, in order to improve the clinical efficacy.

Emergency measures
The treatment of menstrual disease when pay attention to the cycle change and timing of menstruation, rely on the process of removing old cloth and new, through the need to fall off completely, to lay a new foundation for the next menstruation. Therefore, in the early stage and menstrual period, promoting blood circulation and remove blood stasis and relieve pain are often used, and the drugs to develop qi and warm Yang jointly "benefit the situation" to achieve the purpose of removing blood stasis, dredging qi and blood, promote blood circulation and relieve pain. Drug at this stage is the key to pain relief and symptoms, more than 5-7 d before menstruation. It can also accelerate the elimination of the evil of "Yin forming".

Slow delay shall cure its foundation
After the late period of cell veins empty, then take the method of rejuvenation, focusing on the product of tonifying Qi and blood, "help Yang", to tonifying liver, spleen and kidney as a foothold, this is the act of consolidating the foundation. "Qi is the handsome of blood", Yang qi is the power to promote blood circulation, Yang qi is sufficient blood and other Yin essence substances normal transpiration and gasification, the cloth scattered body provides power for the normal operation of the viscera, the function of Yang qi is normal, which can further reduce the phenomenon of "Yin forming" too much.

Typical cases
Li, female, 22 years old, unmarried, was first diagnosed on January 4, 2022. Chief complaint: Abdominal pain for 6 years. The patient had regular menstruation in the past, 6/28-32, with moderate menstrual volume, dark red color, and a small amount of blood clots. The pain in the lower abdomen was unbearable from the first day before menstruation to the second day of menstruation, and the heat and pain was slightly relieved, even nausea and vomiting. LMP: December 6, 2021. Engraze: The 27th day of menstrual cycle, no obvious belt, feel cold in the lower abdomen, dull pain, Na stay, rest can, urine is normal, stool is thin and not formed, 2 times/day, tongue is light fat, there are tooth marks on the edge, moss thin root white greasy, pulse heavy slightly tight. Abdominal ultrasound (other hospital 2022.12.3): No obvious abnormalities. TCM diagnosis: primary dysmenorrhea; Western medicine diagnosis: dysmenorrhea. Syndrome differentiation belongs to cold coagulation and blood stasis, cold guest cell palace, blood is cold coagulation, blood stasis cell palace, so the lower abdomen is cold and painful before or during menstruation. In the early stage of the treatment, the treatment is based on warm meridian to dissipate cold, remove stasis and relieve pain. The prescription is as follows: Angelica 12g, fried paeoniae paeoniae 15g, Chuanxiong 10g, Xiangfu 10g, rhizoma corydalis 12g, fennel 12g, Evodia rutaecarpa7g, Motherwort 15g, fried atractylodes 20g, Shengpu Huang 12g, Wuling lipid 10g, Wuyao 10g, myrrh 6g, processed licorice 6g. Seven doses, decocted in water, 1 dose a day, morning and evening after meals.
At the second visit on January 13, 2022, the patient complained that she had menses on January 5, and the pain in the lower abdomen was relieved, the urine was adjusted, and the stool was thin, twice a day. Belongs to the late stage, the treatment to warm the spleen and kidney, nourishing blood regulating meridian. The advance and retreat of the front, prescription: to Wulingzhi, Puhuang, myrrh, Aconitum, rhizoma corydalis, Evodia rutaecarpa, plus Dangshen 15g, salvia miltiorrhiza 15g, Caulis Spatholobi 20g, tangerine peel 10g, cinnamon 3g, continuous breaken 15g, parasitic loranthus 15g. 14 doses, decocted in water, 1 dose a day, morning and evening. After that, the method of tonifying kidney and promoting blood circulation was used to regulate 2 menstrual cycles, 28 d, 6 d, medium menstrual volume, and the abdominal pain was significantly relieved. Telephone follow-up, the patient complained of no pain and discomfort in the past three months.
Note: Patients with primary dysmenorrhea for many years, gynecological examination did not see obvious abnormalities, combined with the main symptoms of patients, and patients like to eat raw and cold, the first diagnosis of menstruation will come, to give less abdominal Zhuyu decoction. The whole side chooses more sexual taste dry strong drugs, to "help Yang to suppress Yin, to eliminate Yin with fire", combined with the patient's stool is thin, so add dogwood, fried whitening, burning licorice to help the spleen and Yang, protect the spleen and stomach. In the second diagnosis, the late menstrual pulse deficiency, so the removal of qi, tangerine skin, qi, spleen, tonifying qi, Salvia miltiorrhiza, chicken blood vine blood circulation and meridian, with a small amount of cassia bark fire to yuan; continued broken, parasitic tonifying the liver and kidney. During the third diagnosis, the patient has no obvious discomfort after taking medicine, menstruation is coming, and it is slightly difficult to fall asleep to choose the first diagnosis prescription, and add 20g to help sleep. After that, the patient kept the dosage for 2 months, slow up its work, gradually nourish the spleen and stomach, improve the cold constitution, warm the meridians and meridians, and then used self-management with moxibustion to promote the normal function of "Yang Hua qi", "Yin forming" self-elimination, and no dysmenorrhea.

Discussion
"Yanghua qi, Yin forming" is the functional performance of human life activities, and the occurrence of dysmenorrhea is the result of "Yang hua qi, Yin forming" imbalance. Studies show that "Yang Hua gas" mainly summarizes the process of energy metabolism in metabolism, while "Yin forming" mainly summarizes the process of substance metabolism in metabolism [10] .Clinical treatment of this disease should pay attention to the role of Yang in the body, in view of the "not glory, not general pain" the cause of dysmenorrhea, based on "Yang qi, Yin forming" theory, tonifying spleen and kidney, promoting blood stasis, FuYang to qi, inhibit Yin forming too, discusses the application of fu Yang suppress Yin method in this disease, provide new ideas for traditional Chinese medicine treatment of this disease.