Researchers find warm needle acupuncture combined with herbal medicine safe and effective for the alleviation of menstrual cramping and pain. In a controlled clinical trial, administration of acupuncture plus moxibustion obtained a 90.7% total effective rate for the relief of primary dysmenorrhea (menstrual cramps and pain). The group receiving acupuncture plus herbs outperformed a drug control group receiving the NSAID (non-steroidal anti-inflammatory drug) flufenamic acid. The NSAID is classified as an analgesic, anti-inflammatory, and antipyretic drug. The group receiving NSAID pain management achieved a 72.1% total effective rate. Acupuncture plus moxibustion with herbs outperformed the NSAID by 18.6%.

A total of 86 patients with primary dysmenorrhea were randomly divided into a Traditional Chinese Medicine (TCM) treatment group (i.e., acupuncture, moxa, herbs) and a drug control group (i.e., flufenamic acid). A one month follow-up confirmed the results. TCM achieved a 90.7% total effective rate and the drug therapy had a 72.1% rate. Recurrence of symptoms was significantly lower in the TCM group than the drug group. Additionally, levels of plasma PGF2-alpha (prostaglandin F2 alpha) and PGE2 (prostaglandin E2) improved significantly in the TCM group. The biochemical improvements were significantly greater in the TCM group than changes achieved in the drug group.

Primary dysmenorrhea is lower abdominal cramping and pain that occurs before, during, or after menstruation. By definition, primary dysmenorrhea is not due to a separate biomedically defined disorder, including endometriosis; it is not due to an identifiable pathology. Primary dysmenorrhea may be accompanied by back pain, digestive disturbances, or nausea. Severe dysmenorrhea impacts the overall quality of life. In TCM, primary dysmenorrhea is due to an identifiable disharmony, often in the kidneys, liver, spleen, or reproductive system. According to TCM principles, dysmenorrhea is often due to qi stagnation, blood stasis, qi and blood deficiency, liver and kidney deficiency, or accumulation of cold. Each of these principles may also be understood in biomedical terms. For example, qi stagnation often involves excess activation of the sympathetic division of the autonomic nervous system and deficiency of parasympathetic tone. Qi stagnation may lead to blood deficiency, which may be understood in the context of anemia or subacute fatigue.

The research was conducted under the auspices of Ma Tianan at the physiatry department of the People’s Hosptial in Luoyang City (Henan). A total of 86 patients were randomly divided into a TCM treatment group and a drug control group. Participants in both groups had an average age of 30 and had similar medical histories of primary dysmenorrhea prior to enrollment in the study. In the control group, 24 of the women participating in the study had given birth to at least one child. In the TCM treatment group, the number was similar. A total of 25 women had given birth to at least one child. The average age range for both groups was statistically similar. For the drug control group, the ages ranged from 18 – 45. In the TCM treatment group, the ages ranged from 19 – 47.

The drug control group received routine drug therapy consisting of flufenamic acid treatment (200 mg, three times per day) for one month. The TCM treatment group received acupuncture with moxibustion plus adminisration of a Yi Mu Cao electuary for oral ingestion. The electuary was consumed at a rate of two doses per day for one month. Yi Mu Cao (motherwort, Leonuri Herba) is translated as benefit the mother grass. This herb is traditionally used in Chinese medicine for enhancing blood circulation, removing stasis, promoting urination, and clearing heat-toxins. Yi Mu Cao is traditionally used for the treatment of irregular menstruation, dysmenorrhea, abnormal uterine bleeding, and lochia retention. Due to its ability to invigorate blood circulation, this herb is contraindicated for use during pregnacy. The acupucture points used in the study were the following:

BL31 (Shangliao)
BL32 (Ciliao)
SP6 (Sanyinjiao)

The acupoints were chosen for their ability to activate blood circulation and to dissipate blood stasis for the purposes of regulating qi and stopping pain. Needling of acupoint BL32 (Ciliao) stimulates the pelvic plexus thereby regulating local internal organs, relieving spasms of the uterine smooth muscle, and stopping pain. Needle retention time was 30 minutes per acupuncture session.

Improvements were measured with both subjective and objective instruments. Pain levels, recovery time, recurrence rates, PGF2-α levels, and PGE2 levels were all included in the measurements. Treatment efficacy was categorized into 3 tiers:

Recovery: Primary dysmenorhea (PD) symptoms completely disappear, no recurrence of symptoms.
Effective: Significant alleviation of PD symptoms.
Not effective: No significant improvement.
 

Results
The TCM treatment group’s symptoms resolved completely on average by day 12. The drug control group took an additional 6 days for this level of efficacy to take effect, with average resolution of PD by day 18. PGF2-α and PGE2 levels improved more greatly in the TCM group by approximately 25%. In the TCM treatment group, 4 cases did not respond with significant results. In the drug control group, 12 cases did not responsd to NSAID therapy. In the TCM treatment group, only 3 of 43 cases had no improvement. In the drug control group, 13 of 43 cases had no improvement. The relapse rate was significantly lower in the TCM treatment group than the drug group. After a month of therapy, the TCM treatment group achieved a total effective rate of 90.7% and the control group achieved a 72.1% total effective rate. The number of patients completely recovering in the TCM treatment group was 17. In the drug control group, 13 patients completely recovered.

The combination of acupuncture, moxibustion, and herbs outperformed NSAID drug therapy. Clinical assessemtns and objective measures of improvement confirm the conclusions of the researchers; TCM is safe and effective for the treatment of primary dysmenorrhea.

Hubei University of Medicine Research
In related research, Jiao et al. had similar findings. Acupuncture combined with moxibustion had a 96.8% total effective rate for the treatment of dysmenorrhea. Ibuprofen achieved a 58.1% total effective rate. Participants were randomly divided into an acupuncture plus moxibustion group and an ibuprofen drug group. The primary acupoints were the following:
Sanyinjiao (SP6)
Guanyuan (CV4)
Zhongji (CV3)

Secondary acupuncture points were chosen based upon differential diagnostics. For qi and blood stasis, the following acupuncture points were added:
Taichong (LV3)
Xuehai (SP10)

For liver qi stagnation with damp-heat, the following were added:
Xingjian (LV2)
Yinlingquan (SP9)

For liver and kidney deficiency, the following were added:
Shenshu (BL23)
Mingmen (GV4)

For qi and blood deficiency, the following were added:
Qihai (CV6)
Zusanli (ST36)

Manual acupuncture manipulation techniques were applied to achieve deqi at each acupoint. Next, the needles were warmed with moxibustion. Acupuncture was applied daily for 3 – 4 days during menstruation. Treatment was also administered on the two days prior to the next menstrual cycle. The entire course of treatment was comprised of three menstrual cycles.

In the ibuprofen group, patients were administered ibuprofen starting 1 – 2 days prior to menstruation. Oral ingestion (300 mg capsules, 2 times per day, for 2 – 3 days) for three menstrual cycles was the protocol. Vitamin B was administered for patients with stomach discomfort. Based upon the data, the researchers conclude that acupuncture combined with moxibustion is more effective than ibuprofen for the relief of dysmenorrhea.

References
Ma TA. Effect on Plasma PGF2 d,PGE2 by Wagnl Acupuncture Combined with Yi Mu Cao Electuary Treatment for Primary Dysmenorrhea. Chinese Community Doctors. 2014.6:95-96.

Wang SZ. (1991) .Theory and Practice of Obstetrics and Gynecology.Shanghai Scientific &Technical Publisher. 2009:122-123.

Kou HY. (2010). Tiaojingzhitong Decoction in Treatment of 92 cases of Primary Dysmenorrhea.Shaanxi Journal of Traditional Chinese Medicine. 20(15):204-205.

Xu SJ.(2010). Clinical Observation on Dan’e Fukang Decocted Extract in Treating 118 Cases of Dysmenorrhea.Henan Traditional Chinese Medicine.11(15):143-144.

Fang L, Zhu XB, Zhu CC. (2010) Study on Mechanism of Active Site of Jingqian Sanji Zhitong Formula in Treating Primary Dysmenorrhea.Chinese Archives of Traditional Chinese Medicine.41(4):615-617.

Hou GY, Guo XQ, Cao L. (2011).Treatment of PD of Cold Coagulation and Blood Stasis with Acupuncture Combined with TCM.Journal of Clinical Acupuncture and Moxibustion. 23(5):193-194.