Disease and Condition Overview
Dysmenorrhea is characterized by severe abdominal cramps either during or before the menstrual period. In Chinese medicine, the occurrence of dysmenorrhea is closely related to changes in the Penetrating Vessel and Ren Channel, together with the functions of liver and kidney. The basic etiology is excess pathogenic qi or blood and essence deficiency prior to or after the menstrual cycle or rapid changes in the qi and blood of the Penetrating Vessel and Ren Channel causes stagnation in the uterus. Other reasons for the disease include: deficiency in liver and kidney which leads to an undernourished uterus, emotional stress causing liver qi stagnation and difficulty in blood flow, and external pathogenic qi and dampness attacking the uterus causing qi and blood.
The disease is seen mostly in young and adult women and is usually differentiated into primary and secondary syndromes. In primary dysmenorrhea the reproductive organs have no structural changes while in secondary dysmenorrheal there is often a structural change such as endometriosis, adenomyosis, chronic Pelvic Inflammatory Disease (PID) or hysteromyoma.

Pair-point Treatment Combinations

(1) Hegu (LI4), Sanyinjiao (SP6) (Fig 119)
Hegu (LI4) opens channels and invigorates luo-connecting channels, unobstructs and lowers qi. Sanyinjiao (SP6) tonifies spleen and stomach, harmonizes and regulates liver kidney, and regulates qi and blood. This pair point combination, one superior and one inferior, work in synergy to disperse and open qi in the uterus and regulate qi and blood. This treatment is appropriate for all causes of dysmenorrhea.

Needling techniques:
1. Hegu (LI4) perpendicular insertionl to a depth of 1 cun.
2. Sanyinjiao (SP6) perpendicular insertion to a depth of 1 cun.

(2) Guilai (ST29), Sanyinjiao (SP6) (Fig 120)
Guilai (ST29) regulates lower jiao qi. Sanyinjiao (SP6) tonifies spleen and stomach, harmonizes and regulates liver and kidney and regulates qi and blood. This pair point combination, one superior and one inferior, disperses, harmonizes and regulates uterus, regulates qi, invigorates blood and stops pain. This treatment is appropriate for dysmenorrheal caused by irregularities of qi in the lower jiao.

Needling techniques:
1. Guilai (ST29) perpendicular insertion to a depth of 1 cun.
2. Sanyinjiao (SP6) perpendicular insertion to a depth of 1 cun.

Commentaries
Acupuncture treatment of primary dysmenorrhea has excellent results, but not secondary dysmenorrhea because of the etiology of these diseases.
Generally, acupuncture treatment of dysmenorrheal should begin 3-5 days prior to the first day of the menstrual cycle and last until the end of the menstrual period. Continue treatment at least for 2-3 months. Primary dysmenorrhea can be cured usually after 2-4 continuous cycles. As for secondary dysmenorrhea, after reducing symptoms using acupuncture treatments, one should accurately diagnose and treat the root cause appropriately.