Traditional Chinese Medicine for Dysmenorrhea

Traditional Chinese Medicine (TCM) has been explored as a potential treatment for dysmenorrhea, a debilitating condition characterized by painful menstruation. Several randomized controlled trials (RCTs) have investigated the efficacy and safety of various TCM interventions, including herbal formulas and acupuncture, in alleviating dysmenorrhea symptoms. These studies aim to evaluate whether TCM offers a viable alternative or complementary therapy to conventional treatments for this prevalent condition.

Protocols Studied in Research

[1] Acupuncture for endometriosis-associated pain. (Cited by: 12) (pmid: 36716811)

• Protocol: A multicenter, randomized, single-blind, placebo-controlled trial of 106 women (20-40 years old) with endometriosis-associated pain. Participants received either acupuncture or sham acupuncture for 12 weeks, with treatment adjusted for menstruation. A 12-week follow-up period was included.
• Outcome: Acupuncture significantly reduced dysmenorrhea and pain duration during treatment, improving overall well-being. However, these benefits were not sustained after treatment cessation. No significant differences were found for non-menstrual pain.

[2] Moxibustion robots (MR) and manual moxibustion (MM) for primary dysmenorrhea (PD). (Cited by: 0) (pmid: 33837481)

• Protocol: A randomized controlled pilot trial comparing MR and MM in 70 women with PD. Participants received treatment for 3 menstrual cycles, followed by 3 cycles of follow-up. Pain was assessed using SF-MPQ and CMSS.
• Outcome: Both MR and MM significantly reduced pain and symptoms compared to baseline. No significant difference in effectiveness was found between groups. MR was associated with a significantly lower rate of adverse events compared to MM.

[3] GeGen Decoction for primary dysmenorrhea. (Cited by: 13) (pmid: 32534120)

• Protocol: A randomized, double-blinded, placebo-controlled trial of 30 women with primary dysmenorrhea. Participants received GeGen Decoction or placebo for three menstrual cycles, starting one week before menstruation.
• Outcome: GeGen Decoction significantly reduced menstrual pain intensity compared to placebo, potentially by regulating pituitary hypothalamic ovarian hormones and altering metabolites. No adverse effects were observed.

[4] Guizhi Fuling Wan (GFW), a traditional Chinese medicine, for primary dysmenorrhea (PD) with heat-burning blood-stasis syndrome. (Cited by: 2) (pmid: 36746293)

• Protocol: A randomized, double-blinded, placebo-controlled trial of 121 women with PD. Participants received GFW or placebo twice daily for three menstrual cycles, followed by a 3-month follow-up.
• Outcome: GFW significantly reduced menstrual pain intensity, menstrual symptoms, and anxiety compared to placebo, with no serious adverse events. No significant difference in depression scores was observed.

[5] Buccal acupuncture therapy for primary dysmenorrhea (PD). (Cited by: 2) (pmid: 38213252)

• Protocol: A randomized controlled trial of 90 women with PD compared buccal acupuncture to Saridon (control) and placebo. Visual Analog Scale (VAS) and Cox Menstrual Symptom Scale (CMSS) scores were assessed at multiple time points.
• Outcome: Buccal acupuncture showed significant short-term and long-term efficacy in reducing PD pain and symptom severity compared to control and placebo groups, demonstrating an immediate analgesic effect.

[6] Sanjie Analgesic Capsule (SAC) for endometriosis-associated pain. (Cited by: 0) (pmid: 39046647)

• Protocol: A multicenter, randomized, double-blind, placebo-controlled trial (3:1 ratio) involving 323 Chinese women with endometriosis. Participants received SAC or placebo three times daily for three menstrual cycles.
• Outcome: SAC significantly improved dysmenorrhea and other pain symptoms (chronic pelvic pain, defecation pain) compared to placebo at 3 and 6 months. SAC was well-tolerated with no significant difference in adverse events between groups.

[7] Ding-kun-dan (DKD) and Marvelon (a combined oral contraceptive) for primary dysmenorrhea. (Cited by: 1) (pmid: 37517569)

• Protocol: A prospective, double-blind, multicenter, randomized controlled trial comparing DKD and Marvelon in 136 women with primary dysmenorrhea. Participants received treatment for 12 weeks.
• Outcome: Both DKD and Marvelon effectively reduced pain and symptoms. While Marvelon showed initially superior pain reduction, DKD's efficacy improved over time, becoming non-inferior to Marvelon at 12 weeks. DKD was particularly effective for mild pain. No serious adverse effects were reported.

[8] 2 Hz continuous wave and 2 Hz/100 Hz dilatational wave electroacupuncture (EA) for Polycystic Ovary Syndrome (PCOS) with abdominal obesity. (Cited by: 0) (pmid: 38146250)

• Protocol: A randomized controlled trial comparing two EA frequencies (2 Hz continuous wave vs. 2 Hz/100 Hz dilatational wave) in 58 PCOS patients with abdominal obesity over 12 weeks. Treatment targeted specific acupuncture points.
• Outcome: Both EA frequencies improved ovulation, reduced weight and anxiety. 2 Hz/100 Hz EA was superior in reducing waist circumference, lowering AMH, raising SHBG, and improving PCOS symptoms (acne, fatigue, dysmenorrhea).

[9] Electro-acupuncture at specific acupoints for primary dysmenorrhea. (Cited by: 21) (pmid: 24636695)

• Protocol: A randomized controlled trial (RCT) with 501 participants across three groups (classic acupoint, unrelated acupoint, non-acupoint) receiving three sessions of electro-acupuncture. Pain was measured using VAS scores.
• Outcome: Specific acupoint acupuncture showed a statistically significant, but not clinically significant, reduction in immediate pain compared to unrelated acupoint and non-acupoint groups. No significant differences were found in longer-term outcomes.

[10] Acupuncture combined with spinal Tui Na for primary dysmenorrhea. (Cited by: 6) (pmid: 18416074)

• Protocol: A randomized controlled trial comparing acupuncture combined with spinal Tui Na (treatment group, n=30) versus routine acupuncture alone (control group, n=30) for primary dysmenorrhea.
• Outcome: The combined acupuncture and spinal Tui Na treatment showed a significantly higher total effective rate (93.3% vs 73.3%, p<0.05) compared to acupuncture alone, suggesting superior efficacy for primary dysmenorrhea.

[11] Hongjin Xiaojie Capsule (HJXJC) for moderate to severe cyclical breast pain. (Cited by: 0) (pmid: 39232973)

• Protocol: A multicenter, single-blind, randomized controlled trial (RCT) in China compared HJXJC (four capsules, three times daily for 12 weeks) to a waiting-list control in 298 women with cyclical breast pain.
• Outcome: HJXJC significantly shortened pain duration, reduced pain intensity (SF-MPQ), and decreased breast lump size. No significant effects on breast nodules, uterine fibroids, or adverse effects were observed.

[12] Traditional Chinese medicine (TCM) formula for primary dysmenorrhea. (Cited by: 3) (pmid: 16784743)

• Protocol: A randomized, placebo-controlled trial assessed the safety and efficacy of a TCM formula in treating primary dysmenorrhea. Details on participants and administration are limited in the abstract.
• Outcome: The study found no statistically significant difference between the TCM formula and placebo. However, some efficacy indicators hinted at potential benefit, warranting a larger trial.

[13] Herb-partitioned moxibustion (HPM) for primary dysmenorrhea. (Cited by: 5) (pmid: 32186047)

• Protocol: A randomized controlled trial (RCT) with 640 participants randomized 1:1 to HPM or control. Treatment lasted 3 months with a 3-month follow-up. Pain relief (VAS), CMSS, pain duration, analgesic use, and quality of life were assessed.
• Outcome: HPM significantly reduced menstrual pain intensity and duration, decreased analgesic use, and improved quality of life compared to the control group. These benefits were sustained for 3 months post-treatment.

[14] Electroacupuncture at three acupoints (SP6, GB39, and a non-acupoint) for primary dysmenorrhea. (Cited by: 14) (pmid: 22823583)

• Protocol: A multicenter, randomized controlled trial in 501 women with primary dysmenorrhea. Participants were categorized by Traditional Chinese Medicine (TCM) patterns. Electroacupuncture was applied for 30 minutes when pain was ≥40mm on a VAS scale.
• Outcome: In women with Cold and Dampness Stagnation TCM pattern, SP6 electroacupuncture provided significantly greater immediate pain relief than GB39 or the non-acupoint. No acupoint differences were found in other TCM patterns. This suggests TCM pattern influences acupoint effectiveness.

[15] Traditional Chinese Medicine (TCM) "Removing Blood Stasis and resolving Phlegm, softening and resolving the Lump" (RBS-RP-SRL) for endometriosis. (Cited by: 1) (pmid: 8000220)

• Protocol: A clinical study of 46 endometriosis patients treated with RBS-RP-SRL TCM. No details on randomization or control group are provided.
• Outcome: High overall effectiveness (91.3%) was reported, with significant improvements in dysmenorrhea, anal tenesmus, intercourse pain, lesion size reduction, and pregnancy rates in infertile patients. Improved microcirculation and hemorheology were also observed.

[16] Using structured (TEAMSI-TCM) vs. unstructured (CONTROL) questionnaires for TCM diagnosis of dysmenorrhea. (Cited by: 2) (pmid: 31730401)

• Protocol: A randomized controlled trial of 38 acupuncturists assessing 10 women with dysmenorrhea via video, tongue picture, and pulse description, using either questionnaire with or without training. Inter-rater reliability was assessed using Cohen's kappa.
• Outcome: Both structured and unstructured questionnaires showed low inter-rater reliability for TCM diagnosis of dysmenorrhea. Training did not significantly improve reliability. Challenges in assessing TCM diagnostic reliability persist.

[17] Moxibustion for primary dysmenorrhea. (Cited by: 44) (pmid: 28170396)

• Protocol: A pragmatic, randomized, open-label clinical trial compared moxibustion to conventional drugs for treating primary dysmenorrhea in 133 women over 3 months. Participants and practitioners were not blinded.
• Outcome: Both moxibustion and conventional drugs significantly reduced menstrual pain. While initially similar, moxibustion showed superior sustained pain relief three months post-treatment. The study acknowledges limitations due to lack of blinding.

[18] Warm-water footbath for dysmenorrhoea (menstrual pain) in college students. (Cited by: 1) (pmid: 34560833)

• Protocol: A randomized controlled trial (RCT) of 68 Taiwanese college students with dysmenorrhoea. Participants were randomly assigned to a footbath group or a control group. The footbath intervention lasted 20 minutes on days 1 and 2 of menstruation.
• Outcome: The warm-water footbath significantly reduced dysmenorrhoea pain severity and improved autonomic nervous system activity compared to the control group. Improvements in heart rate variability correlated positively with pain reduction.

[19] Ear acupuncture therapy for dysmenorrhea due to endometriosis. (Cited by: 9) (pmid: 16579094)

• Protocol: The abstract provides no details on the study design, number of participants (other than mentioning 37 cases), or the specifics of the acupuncture treatment.
• Outcome: No outcome data is available as the abstract is missing.

[20] Acupuncture at different points (SP6, GB39, or non-acupoint) for primary dysmenorrhea. (Cited by: 18) (pmid: 24555788)

• Protocol: A randomized controlled trial (RCT) with 60 participants assigned to one of three acupuncture groups. Pain was measured using a visual analog scale (VAS), and Deqi sensations were assessed using a modified MASS scale.
• Outcome: Acupuncture reduced pain in all groups, but there were no significant differences in pain reduction or Deqi sensations between the acupuncture points used or the non-acupoint control.

[21] Acupressure wrist-ankle strap for primary dysmenorrhea. (Cited by: 4) (pmid: 32195949)

• Protocol: A randomized controlled trial (RCT) comparing an acupressure wrist-ankle strap to a control strap in 78 students with primary dysmenorrhea. Participants wore the strap for 30 minutes on their first menstruation day.
• Outcome: This abstract describes the study protocol; therefore, no findings or conclusions regarding the intervention's effect are presented. The study aims to evaluate the analgesic effect.

[22] Si-Wu-Tang (SWT), a traditional Chinese herbal medicine, for dysmenorrhea. (Cited by: 10) (pmid: 18808624)

• Protocol: A two-group time series design compared two SWT administration timings (post-menses vs. onset of menses) in 49 women with dysmenorrhea. Participants received 15g of SWT daily for seven days over two cycles. Pain was measured daily using a visual analogue scale.
• Outcome: While no significant difference was found between the two administration timings, both groups showed a significant reduction in menstrual pain intensity and duration over five menstrual cycles. The study suggests SWT is effective for dysmenorrhea.

[23] Penetrating acupuncture (long needle from BL54 to ST28) for primary dysmenorrhea. (Cited by: 6) (pmid: 31929849)

• Protocol: A randomized, ibuprofen-controlled trial of 62 women with primary dysmenorrhea. Participants received either acupuncture or ibuprofen for three menstrual cycles. Pain intensity was measured using a visual analogue scale.
• Outcome: Acupuncture resulted in significantly lower pain intensity, reduced symptom severity, and a higher responder rate compared to ibuprofen, with no serious adverse events reported.

[24] Wrist-ankle acupuncture (WAA) for primary dysmenorrhea (PD) in young females. (Cited by: 6) (pmid: 28830511)

• Protocol: A randomized, single-blind, controlled trial comparing WAA to sham acupuncture in 60 young women with PD. Participants received either real or sham WAA, and pain levels were assessed using the SF-MPQ.
• Outcome: The abstract describes the study protocol; no outcomes are reported as this is a study protocol, not a results report. The study aims to evaluate the immediate analgesic effect of WAA on PD.

[25] Fu's subcutaneous needling combined with monkshood cake-separated moxibustion for primary dysmenorrhea with cold congealing and blood stasis. (Cited by: 0) (pmid: 39111789)

• Protocol: A randomized controlled trial comparing the combined intervention to monkshood cake-separated moxibustion alone in 58 women with primary dysmenorrhea. Treatment occurred for 3 menstrual cycles, once daily for 3 days per cycle.
• Outcome: The combined intervention showed significantly greater reduction in pain (VAS, CMSS scores), improved symptoms, and lower PGF2alpha levels compared to moxibustion alone, resulting in a higher total effective rate.

[26] Moxibustion treatment for primary dysmenorrhea. (Cited by: 11) (pmid: 25633584)

• Protocol: A randomized controlled trial (RCT) with 222 participants randomly assigned to three groups (moxibustion before/at menstruation onset, or a waiting list control). Participants received moxibustion at specific acupuncture points (SP6 and CV4).
• Outcome: The abstract does not present the study's findings; it only describes the planned methodology for assessing the efficacy and safety of moxibustion at different treatment times for primary dysmenorrhea.

[27] Acupuncture at single point (Shiqizhui/EX-B8) and multi-points, varying treatment timing, for primary dysmenorrhea. (Cited by: 19) (pmid: 23684618)

• Protocol: A randomized controlled trial with 600 participants assigned to four acupuncture groups (single-point pre-menstruation, single-point on-demand, multi-point pre-menstruation, multi-point on-demand) and a control group (no treatment). Treatment efficacy was assessed over three menstrual cycles.
• Outcome: Acupuncture effectively relieved dysmenorrhea pain compared to the control. Pre-menstrual acupuncture was superior for multi-point treatment, while on-demand single-point acupuncture provided faster pain relief. Shiqizhui (EX-B8) proved a convenient single point.

[28] Modified Wenjing decoction combined with online education for primary dysmenorrhea (cold coagulation and blood stasis). (Cited by: 2) (pmid: 35070226)

• Protocol: A retrospective randomized controlled trial (RCT) comparing modified Wenjing decoction plus online education versus online education plus conventional treatment in 111 patients with primary dysmenorrhea. Treatment lasted three menstrual cycles.
• Outcome: Modified Wenjing decoction significantly improved abdominal pain, reduced associated symptoms, and decreased ibuprofen usage compared to the control group. The intervention showed promise for treating this type of dysmenorrhea.

[29] SP6 acupuncture with and without de qi for primary dysmenorrhea with cold and dampness stagnation. (Cited by: 13) (pmid: 28698243)

• Protocol: A randomized controlled trial comparing SP6 acupuncture with deep needling and manipulation (de qi group) versus shallow needling without manipulation (no de qi group) in 88 patients. Pain was measured using a visual analogue scale.
• Outcome: While both groups experienced pain reduction, patients who experienced de qi sensation showed significantly greater pain reduction regardless of assigned treatment group. The study did not find a significant difference between groups in overall pain reduction.

[30] Moxibustion for primary dysmenorrhea (PD). (Cited by: 7) (pmid: 33116807)

• Protocol: A randomized controlled trial of 208 patients with PD comparing pre-menstrual and menstrual-onset moxibustion at points SP6 and RN4 to a waiting list control. Pain duration and intensity, anxiety, and depression were assessed.
• Outcome: Moxibustion was effective in reducing pain duration in PD, with pre-menstrual application showing slightly better results than menstrual-onset application. No significant difference was found in pain severity between the two moxibustion groups.

[31] Acupuncture at tender points versus regular points on the Spleen meridian for primary dysmenorrhea. (Cited by: 1) (pmid: 29888566)

• Protocol: A randomized controlled trial of 72 primary dysmenorrhea patients compared acupuncture at tender points versus regular points (SP6, SP8, SP9) on the Spleen meridian, administered daily for 3 days during each menstrual cycle for 3 months. Pain (VAS) and discomfort (CMSS) were measured.
• Outcome: Acupuncture at tender points showed a significantly stronger analgesic effect than at regular points in relieving pain during the second and third menstrual cycles, but no significant difference in overall discomfort was observed.

[32] Acupuncture for primary dysmenorrhea. (Cited by: 7) (pmid: 24660607)

• Protocol: A randomized controlled trial comparing acupuncture treatment (including Hegu LI4) to a control group (self-pressing Hegu LI4) in patients with primary dysmenorrhea. Laser speckle assessed capillary blood flow changes at Hegu LI4. Multiple pain scales were used.
• Outcome: Acupuncture significantly reduced dysmenorrhea symptoms and pain scores. While blood flow volume at Hegu decreased slightly, capillary vasomotor amplitude increased significantly, suggesting improved microcirculation contributing to pain relief, aligning with TCM principles.

[33] Electroacupuncture (EA) at different acupoints (SP6, GB39, non-meridian) for primary dysmenorrhea. (Cited by: 27) (pmid: 21199306)

• Protocol: A randomized controlled trial of 52 women with primary dysmenorrhea received EA at one of three points (or a waiting list) for 10-30 minutes over three days based on pain levels (VAS score).
• Outcome: EA at SP6 provided significantly greater immediate pain relief compared to GB39, a non-meridian point, and the waiting list, suggesting a specific effect of SP6 on primary dysmenorrhea pain. No significant differences in uterine blood flow were found.

[34] Acupuncture at SP6 (Sanyinjiao) versus GB39 (Xuanzhong) for primary dysmenorrhea. (Cited by: 19) (pmid: 20932189)

• Protocol: A randomized controlled trial compared acupuncture at SP6 and GB39 in 66 women with primary dysmenorrhea. Participants received 5 minutes of acupuncture at their assigned point during menstrual pain.
• Outcome: Acupuncture at SP6 immediately reduced menstrual pain and improved uterine arterial blood flow (as measured by PI, RI, and A/B), while acupuncture at GB39 showed no such effect.

[35] Vitamin K acupuncture point injection for severe primary dysmenorrhea. (Cited by: 13) (pmid: 15775872)

• Protocol: A prospective, observational pilot study in China and Italy involving young women (14-25 years) with severe primary dysmenorrhea for at least 6 months. Bilateral acupuncture point injections of vitamin K (K3 in China, K4 in Italy) were administered on days 1 or 2 of menstruation.
• Outcome: The intervention provided noticeable and statistically significant pain relief within minutes, lasting through subsequent menstrual cycles. Participants experienced reduced pain intensity, duration, analgesic use, and daily life restrictions. No serious adverse events were reported.

[36] Acupuncture at SP6 (Sanyinjiao) for primary dysmenorrheal patients with cold damp stagnation syndrome. (Cited by: 1) (pmid: 29383895)

• Protocol: A randomized controlled trial comparing acupuncture with deqi (with thicker needles, deeper insertion) versus without deqi (thinner needles, shallower insertion) in 64 patients. Pain was measured using VAS scores.
• Outcome: Deqi induction was more successful with thicker needles and deeper insertion. Acupuncture with deqi resulted in significantly greater pain reduction at 30 minutes post-treatment compared to acupuncture without deqi.

[37] Bushen Huoxue Sanyu Decoction (BHSD) for adenomyosis (AM) in patients with Shen deficiency blood stasis syndrome (SDBSS). (Cited by: 1) (pmid: 25566618)

• Protocol: A randomized controlled trial comparing BHSD (CM treatment group, n=50) to Mirena IUD (n=20) in 70 AM patients with SDBSS over a 3-month treatment period. Outcomes measured included dysmenorrhea, menstrual bleeding, SDBSS and CM syndrome scores, uterine volume, and serum CA125.
• Outcome: BHSD effectively reduced dysmenorrhea, menstrual bleeding, uterine volume, and SDBSS and CM syndrome scores compared to baseline. While both treatments showed improvement, BHSD showed superior symptom relief compared to Mirena.

[38] Four-Agents-Decoction (Si Wu Tang) for primary dysmenorrhea. (Cited by: 11) (pmid: 19413507)

• Protocol: A randomized, double-blind, placebo-controlled trial involving 76 young women with primary dysmenorrhea. Participants received either Si Wu Tang or a placebo. Uterine artery pulsatility index (PI), blood pressure, and hemogram parameters were measured.
• Outcome: Si Wu Tang significantly reduced uterine artery PI and menstrual pain intensity compared to placebo, suggesting improvement in "blood stagnation." Changes in blood pressure were also greater in the Si Wu Tang group. No significant effect on anemia-related hemogram parameters was observed. A larger trial is warranted.

[39] Shu-Mu point acupuncture combination, routine acupuncture, and Danazol for endometriosis. (Cited by: 5) (pmid: 17313008)

• Protocol: A randomized controlled trial comparing three treatments (Shu-Mu point acupuncture, routine acupuncture, and Danazol) in 90 endometriosis patients. Treatment effects were assessed via clinical symptoms, CA125 levels, and adverse effects.
• Outcome: All three treatments showed similar overall effectiveness. Shu-Mu point acupuncture was superior for symptom relief (dysmenorrhea, irregular menstruation, etc.) and CA125 reduction, with fewer side effects than Danazol.

[40] Quyujiedu (QYJD) method for treating endometriosis of stasis-toxic syndrome type. (Cited by: 2) (pmid: 16548348)

• Protocol: A randomized controlled trial comparing QYJD to Danazol in 60 patients with endometriosis. A rat model was also used to assess Bax expression. Outcomes included clinical symptoms, pregnancy rate, and cytokine/antibody levels.
• Outcome: QYJD significantly improved symptoms, increased pregnancy rates, and regulated immune markers compared to Danazol. QYJD also enhanced Bax expression in ectopic endometrium, suggesting a role in apoptosis.

Research Interpretation: Summary and Conclusion

Multiple randomized controlled trials (RCTs) and pilot studies investigated various Traditional Chinese Medicine (TCM) interventions for dysmenorrhea, employing diverse protocols including acupuncture (various styles and points), herbal decoctions (GeGen, Si Wu Tang, Wenjing, etc.), moxibustion, and acupressure. Consistent findings across several studies demonstrated significant reductions in menstrual pain intensity and duration compared to placebo or conventional treatments (e.g., ibuprofen, Danazol). While some interventions showed sustained benefits post-treatment, others exhibited short-term efficacy. The effectiveness of specific TCM modalities varied, with some studies highlighting the importance of factors like de qi sensation, acupoint selection based on TCM patterns, and treatment timing. Although many studies reported few adverse events, the heterogeneity in study designs and outcome measures limits the ability to draw definitive conclusions about the overall efficacy and comparative effectiveness of different TCM approaches for dysmenorrhea. Further, larger, well-designed, and standardized RCTs are needed to strengthen the evidence base.

Publications

[1] Li PS; Peng XM; Niu XX; Xu L; Hung Yu Ng E; Wang CC; Dai JF; Lu J; Liang RN (2023). Efficacy of acupuncture for endometriosis-associated pain: a multicenter randomized single-blind placebo-controlled trial Fertility and sterility 119 (5) :815-823.

[2] Zhang HR; Tu HY; Wang Y; Xia SL; Zhao GY; Yang T; Li YK (2021). Effectiveness and Safety of Moxibustion Robots on Primary Dysmenorrhea: A Randomized Controlled Pilot Trial Chinese journal of integrative medicine 27 (8) :578-584.

[3] Chai C; Hong F; Yan Y; Yang L; Zong H; Wang C; Liu Z; Yu B (2020). Effect of traditional Chinese medicine formula GeGen decoction on primary dysmenorrhea: A randomized controlled trial study Journal of ethnopharmacology 261 :113053.

[4] Luo Y; Mao P; Chen P; Li C; Fu X; Zhuang M (2023). Effect of Guizhi Fuling Wan in primary dysmenorrhea: A randomized controlled trial Journal of ethnopharmacology 307 :116247.

[5] Yi Y; Huijun YE; Huiling Z; Lihua J (2024). Clinical observation on 90 cases of primary dysmenorrhea treated by buccal acupuncture therapy: a randomized controlled study Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan 44 (1) :172-181.

[6] Leng JH; Duan H; Guan Z; Zhou YF; Qu H; Xu KH; Zhang SF; Zhang Q; Wang X; Lin KQ; Lang JH (2024). Efficacy and Safety of Sanjie Analgesic Capsule in Patients with Endometriosis-Associated Pain: A Multicenter, 3:1 Randomized, Double-Blind, Placebo-Controlled Trial Chinese journal of integrative medicine 30 (9) :780-787.

[7] Gan J; Zhu SY; Ma X; Ding XS; Deng Y; Wang Y; Sun AJ (2024). The effect of Ding-kun-dan comparing with Marvelon on primary dysmenorrhea: A prospective, double-blind, multicenter, randomized controlled trial Journal of ethnopharmacology 318 (Pt B) :116975.

[8] Shen LY; Fu XF; Zeng Q; Mao XW; Hong QY; Liu XJ; Li HQ; Hu H (2023). Comparison of the efficacy of different frequency electroacupuncture in the treatment of polycystic ovary syndrome patients with abdominal obesity Zhen ci yan jiu = Acupuncture research 48 (12) :1266-1273.

[9] Liu CZ; Xie JP; Wang LP; Liu YQ; Song JS; Chen YY; Shi GX; Zhou W; Gao SZ; Li SL; Xing JM; Ma LX; Wang YX; Zhu J; Liu JP (2014). A randomized controlled trial of single point acupuncture in primary dysmenorrhea Pain medicine (Malden, Mass.) 15 (6) :910-20.

[10] Guo A; Meng Q (2008). Acupuncture combined with spinal tui na for treatment of primary dysmenorrhea in 30 cases Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan 28 (1) :7-9.

[11] Zhang Q; Fan YY; Wu XQ; Huo YD; Wang CH; Liang SB; Wang T; Zhong R; Wang X; Lai BY; Pei XH; Liu JP (2024). Hongjin Xiaojie Capsule, a Chinese patent medicine, for treating moderate to severe cyclical breast pain: A single-blind randomized controlled trial Journal of integrative medicine 22 (5) :552-560.

[12] Kennedy S; Jin X; Yu H; Zhong S; Magill P; van Vliet T; Kistemaker C; Voors C; Pasman W (2006). Randomized controlled trial assessing a traditional Chinese medicine remedy in the treatment of primary dysmenorrhea Fertility and sterility 86 (3) :762-4.

[13] Liu Y; Sun J; Wang X; Shi L; Yan Y (2019). Effect of herb-partitioned moxibustion for primary dysmenorrhea: a randomized clinical trial Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan 39 (2) :237-245.

[14] Liu YQ; Ma LX; Xing JM; Cao HJ; Wang YX; Tang L; Li M; Wang Y; Liang Y; Pu LY; Yu XM; Guo LZ; Jin JL; Wang Z; Ju HM; Jiang YM; Liu JJ; Yuan HW; Li CH; Zhang P; She YF; Liu JP; Zhu J (2013). Does Traditional Chinese Medicine pattern affect acupoint specific effect? Analysis of data from a multicenter, randomized, controlled trial for primary dysmenorrhea Journal of alternative and complementary medicine (New York, N.Y.) 19 (1) :43-9.

[15] Liu JX (1994). [Clinical study of the treatment of endometriosis with traditional Chinese medicine] Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese journal of integrated traditional and Western medicine 14 (6) :337-9, 323-4.

[16] Schnyer RN; McKnight P; Conboy LA; Jacobson E; Ledegza AT; Quilty MT; Davis RB; Wayne PM (2019). Can Reliability of the Chinese Medicine Diagnostic Process Be Improved? Results of a Prospective Randomized Controlled Trial Journal of alternative and complementary medicine (New York, N.Y.) 25 (11) :1103-1108.

[17] Yang M; Chen X; Bo L; Lao L; Chen J; Yu S; Yu Z; Tang H; Yi L; Wu X; Yang J; Liang F (2017). Moxibustion for pain relief in patients with primary dysmenorrhea: A randomized controlled trial PloS one 12 (2) :e0170952.

[18] Wu SJ; Kan WC; Shiao CC (2022). Warm-water footbath improves dysmenorrhoea and heart rate variability in college students: a randomised controlled trial Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology 42 (5) :1204-1210.

[19] Xiang D; Situ Y; Liang X; Cheng L; Zhang G (2002). Ear acupuncture therapy for 37 cases of dysmenorrhea due to endometriosis Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan 22 (4) :282-5.

[20] Shi GX; Li QQ; Liu CZ; Zhu J; Wang LP; Wang J; Han LL; Guan LP; Wu MM (2014). Effect of acupuncture on Deqi traits and pain intensity in primary dysmenorrhea: analysis of data from a larger randomized controlled trial BMC complementary and alternative medicine 14 :69.

[21] Zhai SJ; Ruan Y; Liu Y; Lin Z; Xia C; Fang FF; Zhou QH (2020). Time-effective analgesic effect of acupressure ankle strip pressing wrist and ankle acupuncture point on primary dysmenorrhea: Study protocol clinical trial (SPIRIT compliant) Medicine 99 (12) :e19496.

[22] Cheng JF; Lu ZY; Su YC; Chiang LC; Wang RY (2008). A traditional Chinese herbal medicine used to treat dysmenorrhoea among Taiwanese women Journal of clinical nursing 17 (19) :2588-95.

[23] Wang H; Cao Y; Jin X; Yan M; Wang J; Li R; Ji L (2019). Effect of an Acupuncture Technique of Penetrating through Zhibian (BL54) to Shuidao (ST28) with Long Needle for Pain Relief in Patients with Primary Dysmenorrhea: A Randomized Controlled Trial Pain research & management 2019 :7978180.

[24] Chen Y; Tian S; Tian J; Shu S (2017). Wrist-ankle acupuncture (WAA) for primary dysmenorrhea (PD) of young females: study protocol for a randomized controlled trial BMC complementary and alternative medicine 17 (1) :421.

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