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Dysmenorrhea is a common gynecological condition that is further divided into two categories, namely primary and secondary dysmenorrhea. Traditional Chinese Medicine (TCM) gives good clinical results for the treatment of dysmenorrhea based on the basic principles of holistic view and syndrome differentiation. However, presently, the clinical practice guidelines in TCM for dysmenorrhea treatment are required. The guideline is formulated in strict accordance with the principles of evidence-based medicine with reference to the General Principles for the Compilation of International Guidelines for Diagnosis and Treatment of Traditional Chinese Medicine Syndromes and General Principles for the Compilation of International Clinical Practice Guidelines for Traditional Chinese Medicine Diseases and accordance with the principles and methods of The Appraisal of Guidelines for Research and Evaluation in China (AGREE-China) and World Health Organization guidelines. This guideline includes clinical issues by literature search and questionnaire survey, and eight background questions and 23 prospect questions were finally created. Based on the evidence retrieval, synthesis, consideration of patient preferences and values, intervention costs, advantages, and disadvantages, recommendations are created using the Delphi method and expert consensus method. This guideline clarified the definition, diagnosis, and TCM syndrome classification for dysmenorrhea, and recommends different TCM treatments based on the level of evidence, including Chinese herbal medicine, Chinese patent medicine, acupuncture, and other auxiliary therapies. The present guideline is an international clinical practice guideline for the treatment of dysmenorrhea using TCM. This guideline will provide substantive evidence and standardized guidance for the treatment of dysmenorrhea using TCM, improve the quality and safety of medical services, and standardize diagnosis and treatment plans for dysmenorrhea.

Objective: To explore the short-term and long-term efficacy of buccal acupuncture therapy in the treatment of patients with primary dysmenorrhea (PD)., Methods: A total of 90 patients with PD who were admitted to the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from January 2020 to December 2021 were included in this study and randomly divided into three groups, including the observation group, the control group, and the placebo group, with 30 patients in each group. Patients in the observation group were treated according to the syndrome types of Traditional Chinese Medicine, those in the control group were treated with Saridon, and those in the placebo group received a placebo. The visual analog scale (VAS) scores of these patients were evaluated at different time points (before treatment, 5 min after needle retention, 30 min after needle retention, 1 h after treatment, 2 h after treatment, 1 d after treatment, and 2 d after treatment). The Cox Menstrual Symptom Scale (CMSS) scores were assessed before the treatment and after three courses of treatment. Besides, these two scales were also evaluated during follow-up. Moreover, the pain score and adverse reactions of these patients were assessed during treatment., Results: After treatment, the VAS and CMSS scores in the observation group decreased significantly ( P < 0.05) 5 and 30 min after needle retention and after treatment., Conclusion: Buccal acupuncture therapy is verified to have short-term efficacy in the treatment of PD. In addition, this therapy has an immediate analgesic effect and long-term efficacy in reducing the severity and frequency of PD.

Objective: To explore the sensitization acupoints of women with primary dysmenorrhea (PD) by comparing infrared radiation temperatures between acupoints and non-acupoints., Methods: We tested 10 acupoints of every woman with PD and healthy subjects on premenstrual, menstrual, and postmenstrual days using an infrared imaging device. The primary outcome was the absolute value of body surface temperature difference (AVTD) between the left and right sides of the same testing point., Results: A total of 58 PD patients and 57 healthy volunteers completed the test from May 2016 to May 2017. Compared with the healthy group, we observed a significant reduction and increase in the AVTD in Taichong (LR3) and Sanyinjiao (SP6), respectively, during menstrual days in the PD group (= 0.01; = 0.04); while during postmenstrual days, all AVTDs of Shuiquan (KI5), Diji (SP8), and Xuehai (SP10) were diminished in the PD group (= 0.01; = 0.03; = 0.01, respectively). No significant differences in AVTD were detected at any other points or testing times., Conclusions: Compared with the healthy group, the AVTDs of Taichong (LR3), Sanyinjiao (SP6), Shuiquan (KI5), Diji (SP8), and Xuehai (SP10) at menstruation-relevant points of PD patients were sensitized, providing a reference for the selection of acupoints in the treatment of PD.

Objective: To investigate the influence of the quickness and duration of De Qi (or Qi arrival) on the analgesic effect of acupuncture in primary dysmenorrhea patients with a cold and dampness stagnation pattern., Methods: Sixty-eight patients were randomly assigned to the De Qi group (deep needling with thick needles and manipulation, n = 17) or the non-De Qi group (shallow needling with thin needles and no manipulation, n = 51). Both groups underwent needling at Sanyinjiao (SP 6) for 30 min. The visual analogue scale was used to measure the degree of menstrual pain, and the Acupuncture De Qi Clinical Assessment Scale was used to assess De Qi. Only data from patients who experienced actual De Qi were included in the analysis., Results: Thirty-nine patients experienced actual De Qi. Patients who experienced actual De Qi in the De Qi group (n = 14) felt De Qi more rapidly (P = 0.028) and for a longer duration (P = 0.04) than patients who experienced actual De Qi in the non-De Qi group (n = 25). Both groups showed a reduction in the visual analogue scale score for pain after treatment. The analgesic effect did not significantly differ between the two groups. The occurrence time of De Qi showed a significant negative correlation with pain reduction at 20 and 30 min after needle removal (P < 0.05). There was no correlation between the duration of De Qi and the therapeutic effect., Conclusion: In primary dysmenorrhea patients with a cold and dampness stagnation pattern, quicker onset of De Qi when needling Sanyinjiao (SP 6) achieves a better analgesic outcome. However, a longer duration of De Qi does not affect the degree of analgesia. Compared with minimal acupuncture, active acupuncture stimulation achieves a more rapid onset and longer duration of De Qi.

Objective: To assess skin temperature response to menstruation at acupuncture points in primary dysmenorrhea (PD) patients and healthy volunteers so as to explore acupuncture point specificity in reflecting diseases in the light of skin temperature., Methods: Fifty-two PD patients and 49 healthy volunteers were recruited. Skin temperature measurements were performed with a skin temperature assessment device at 10 points. Absolute difference between skin temperature of the same point on the left and right side is used as main outcome measure., Results: On the first day of menstruation, when menstrual pain attacking in PD patients, a significant increase in skin temperature difference was detected at Taixi (KI 3) compared with the healthy group (P < 0.01). A significant reduction in skin temperature difference was detected at Taixi (KI 3) in the first day of menstruation compared with those values in the third day after menstruation (P < 0.01) in the healthy group. On the third day after menstruation, a significant reduction in skin temperature difference was found at Zhongdu (LR 6) in PD group compared with the healthy group (P < 0.05). No significant differences of skin temperature were detected at other points (P > 0.05)., Conclusion: The skin temperature difference at menstruation-relevant points in PD patients did not all change significantly more than those in women without PD. Significant difference was only found in Taixi (KI 3), the Yuan-source point of Kidney meridian.

Objective: To analyze the effect of needling acupoints (bilateral vs unilateral) with De Qi using data collected from 501 primary dysmenorrhea (PD) patients participating in multi-center, randomized, controlled trail., Methods: De Qi was defined as at least one of the feelings in soreness, numbness, fullness or heaviness at the acupoints when stimulated with needles. The 501 patients were grouped in 3 groups in terms of De Qi or not De Qi in one side (unilateral) or both sides (bilateral) of the body: bilateral De Qi group, unilateral De Qi group, and non-De Qi group. The abdominal pains were measured using visual analog scale (VAS)., Results: In 501 patients, 472 acquired De Qi at unilateral acupoints, 24 De Qi at bilateral acupoint, and 5 had no De Qi at any acupoint. The data of non-De Qi group was excluded as the sample was less than 5% of that in the bilateral De Qi group. There was significant difference in the VAS before and after treatment between unilateral and bilateral De Qi group (P < 0.01). After stratified by acupoints, for the patients needled at Sanyinjiao (SP 6) and Xuanzhong (GB 39), VAS scores in the bilateral De Qi group were larger than those in the unilateral De Qi group (P < 0.05)., Conclusion: Bilateral De Qi was possibly superior to unilateral De Qi in enhancing the immediate analgesic effect of needling the acupoints, but no statistical significance was observed on the patients of needling at non acupoint, which preliminarily suggested this immediate analgesic effect was perhaps along meridians.

Objective: To observe capillary blood flow at acupoints during acupuncture treatment of primary dysmenorrhea and gain new insights into its analgesic mechanism., Methods: Patients with primary dysmenorrhea were enrolled and randomly assigned to a treatment or control group. Subjects' symptoms were differentiated into various Traditional Chinese Medicine (TCM) syndromes and treated for 10 sessions with puncturing acupuncture or self-pressing right-hand Hegu (LI 4), adding other acupoints based on syndrome. Laser speckle was used to compare the change in the vasomotor amplitude and perfusion of the capillaries in Hegu (LI 4) before and during the treatment. Each subject was required to finish the period pain symptoms observation form, verbal rating scales, numerical rating scale, pain rating index, face rating scale, Zung self-rating depression scale, Zung self-rating anxiety scale, and numerical rating scale before and after treatments., Results: After 10 sessions, the symptom scores, pain index (PI), and visual analog scale (VAS) decreased significantly in treatment group. The volume of blood flow in Hegu (LI 4) declined slightly. No significant evidence supported that needling caused capillary contraction, but the capillary vasomotor amplitude at Hegu (LI 4) increased remarkably., Conclusion: Acupuncture can increase the capillary blood flow, thus promoting the flow of Qi and blood in terms ofTCM theory, which facilitates pain relief.

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism., Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture., Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P < 0.05)., Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.

The present study aims at comparing the effects of acupressure using new combination of acupoints, and Ibuprofen on the severity of primary dysmenorrhea (PD). 216 female high school students, aged between 14 to 18 years, were randomly selected and divided into three groups. Each group underwent different treatment techniques: acupressure, Ibuprofen and sham acupressure as a placebo. The results indicated that the three therapeutic techniques were significantly effective in reducing the pain. However the therapeutic efficacies of acupressure and Ibuprofen were similar with no significant difference, and were significantly better than the placebo. Thus acupressure, with no complications, is recommended as an alternative and also a better choice in the decrease of the severity of PD.