1. Background and purpose
Dysmenorrhea is one of the most frequent gynecological disorder, with a prevalence ranging 50% in women of reproductive age. According to research performed in Korea, 78% of middle school students have complained of dysmenorrhea, and 78.3% of high school girls have experienced dysmenorrhea every month. In addition, a study of college students in 20s reported that quality of life decreased with increasing discomfort during menstruation. As a result, the reduction of efficiency in work and study due to dysmenorrhea, leads to socioeconomic loss and affects the quality of life in women.
Korean medicine showed a relatively excellent therapeutic effect in dysmenorrhea. this Clinical Practice Guideline(CPG) has been developed to provide high quality treatment of Korean medicine, reflecting the opinion of domestic and foreign experts and using collection and analysis of evidence, associated with the criteria of diagnosis and evaluation and treatment of Korean medicine, in base of evidence-based medicine(EBM).
2. Overview of Disease
Primary dysmenorrhea(N94.4 Primary dysmenorrhea; KCD-7 and ICD-10 Criteria) is a common symptom that occurs in about 50-90 % of fertile women around the world. Young women are usually more likely to have primary dysmenorrhea and the prevalence decreases with ages. Primary dysmenorrhea occurs without a specific cause, whereas secondary dysmenorrhea refers to menstrual pain caused by a specific pelvic lesion. Primary dysmenorrhea generally appears within 1 to 2 years of menarche when the ovulation cycle is established, and secondary dysmenorrhea can occur as the years pass after menarche, and may occur along with the anovulation cycle. Primary dysmenorrhea usually begins at the same time as or several hours before the onset of menstruation and lasts for 2-3 days. Pain, similar to delivery pain, mainly appears as pain with cramps in the upper part of pubic bone, accompanied by symptoms such as lower back pain, thigh-related pain, nausea, vomiting, and diarrhea.
In Korean medicine, it corresponds to ‘tonggyeong(痛經)’, ‘gyeonghaeng abdomial pain(經行腹痛)’, ‘gyeonggi abdominal pain(經期腹痛)’, etc. In 《Dong-ui-bogam》, pain during menstruation is caused by hyeolsab(血澁), so that Cheongyeoljohyeol-tang or Samul-tang with Hyeonho-sack, Gorryeongeun, Bongchul, Hyangbuja Doin, Honghwa, and Hwangryun are used for treatment. On the other hand, pain after menstruation is treated with Palmul-tang, regarded as heojungyuyeol(虛中有熱). Later, in 《cheong-ganguigam》, Hyunbuikyung-tang was introduced as a representative prescription that can be used for giche(氣滯).
