Primary Dysmenorrhea Overview And Traditional Chinese Medicine Perspectives
Feb 21, 2025
2.5 Chinese Patent Medicines
Studies have shown that Chinese patent medicines, such as Sanjie Zhentong Capsules, Yimucao Granules, Fufang Yimucao Capsules, Kunning Granules, and Tongjingbao Granules, are clinically effective in treating primary dysmenorrhea. Their mechanisms of action involve regulating PG levels:
Sanjie Zhentong Capsules [61] and Yimucao Granules [62] focus on reducing PGF₂α levels in the uterine tissues of patients with primary dysmenorrhea.
Fufang Yimucao Capsules [63] and Kunning Granules [64] not only lower PGF₂α levels but also increase PGE₂ levels. Additionally, Kunning Granules demonstrate the ability to downregulate COX-2 protein expression.
Tongjingbao Granules exert their therapeutic effect by antagonizing the abnormal contractions of uterine smooth muscles caused by elevated PGF₂α levels [65].
It is worth noting that most Chinese patent medicines are modern formulations derived from traditional TCM prescriptions, which substantiate the significant efficacy of TCM formulas in treating primary dysmenorrhea. Additionally, due to the relatively low prevalence of qi and blood deficiency-type primary dysmenorrhea, the development and research of Chinese patent medicines targeting this syndrome have received limited attention [66]. This indicates the need for greater focus on this type in future studies to explore more effective treatment methods and meet the diverse needs of patients.
Tcm Cistanche For Primary Dysmenorrhea
2.6 Acupuncture and Moxibustion
Acupuncture alleviates pain by precisely stimulating specific acupoints, regulating inflammatory factors, optimizing uterine tissue function, and promoting blood circulation to dispel stasis. Increased acupuncture intensity has been shown to enhance analgesic effects and improve levels of inflammatory factors [67–69], demonstrating a dose-response relationship for acupuncture therapy.
Moxibustion employs the warming effect of burning moxa sticks or cones to warm the meridians, promote blood circulation, and relieve pain, making it particularly suitable for the cold-dampness blood stasis type of primary dysmenorrhea [70]. Studies have shown that both acupuncture and moxibustion can regulate serum PG levels, improve uterine vascular conditions, alleviate smooth muscle spasms, and thus reduce pain in patients with primary dysmenorrhea [71].
He's Three-Passage Therapy, developed by TCM master He Puren, has been shown to significantly alleviate qi stagnation and blood stasis-type primary dysmenorrhea by inhibiting COX protein expression and reducing PGF₂α levels [72].
Liu Ruiping et al. [73] applied the academic concepts of the Yan-Zhao Gao acupuncture school, using the principles of "strengthening the spleen and stomach and regulating the Ren meridian" to treat qi and blood deficiency-type and cold-dampness blood stasis-type primary dysmenorrhea with specific acupoints. This method was more effective than ibuprofen, with mechanisms linked to reducing PGF₂α levels and increasing PGE₂ levels.
Studies have also shown that the Back-Shu and Front-Mu Acupoint Pairing Method uniquely regulates uterine PGF₂α and β-endorphin (β-EP) levels and improves hemorheology parameters [74].
Medicinal Moxibustion [75] and Thunder-Fire Moxibustion [76] can alleviate abdominal pain in primary dysmenorrhea by increasing β-EP and PGE₂ levels, reducing PGF₂α levels, and enhancing spleen NK cell activity.
The combination of acupuncture and moxibustion has been shown to be superior in treating primary dysmenorrhea and regulating PG levels [77], offering a more comprehensive and effective treatment for patients.
2.7 Tuina Therapy
Tuina therapy promotes qi and blood circulation, unblocks the meridians, and relieves pain. It is widely used in the treatment of primary dysmenorrhea. Proper tuina techniques generate heat through physical friction, increasing local tissue temperature, dilating blood vessels, accelerating blood flow, clearing pathological substances, and optimizing the local microenvironment to effectively alleviate pain [78–79].
Abdominal vibration tuina, represented by the "relaxation and vibration method," has shown significant therapeutic effects for primary dysmenorrhea. Shen Qian et al. [80] demonstrated through experiments that abdominal vibration tuina reduces PGF₂α levels, increases PGE₂ levels, and inhibits the expression of PGF₂α receptors in the endometrium. This finding provides a scientific basis for the clinical application of tuina therapy and opens new avenues for its use in treating primary dysmenorrhea.
Other techniques, such as abdominal rubbing, one-finger meditation, and waist rubbing, applied to specific acupoints, have also been shown to effectively treat primary dysmenorrhea, with mechanisms related to the reduction of PGF₂α levels [81–83].
2.8 Other Unique TCM Therapies
Acupoint Embedding Therapy: Provides prolonged stimulation to acupoints for sustained efficacy.
Electroacupuncture: Combines traditional acupuncture with microcurrent stimulation of acupoints.
Percutaneous Acupoint Electrical Stimulation: Uses microcurrents similar to human bioelectricity to stimulate acupoints, combining transcutaneous electrical nerve stimulation with acupuncture.
Graphene Warm Uterus Patch: Fuses traditional acupoint therapy with modern materials technology, significantly enhancing drug permeability and absorption.
Auricular Acupuncture: Stimulates ear acupoints to treat diseases, offering simple, safe, and effective treatment.
Research has shown that the mechanisms of these therapies in treating primary dysmenorrhea are closely related to regulating PG levels. For example:
Auricular Acupuncture [84] primarily increases PGE₂ levels.
Acupoint Embedding [85–86], Electroacupuncture [87], Percutaneous Acupoint Electrical Stimulation [88], and Graphene Warm Uterus Patch [89] not only increase PGE₂ levels but also reduce PGF₂α levels. Acupoint embedding also downregulates COX-2 protein expression.
2.9 Combined Internal and External Therapy
Combining internal and external therapies enhances efficacy, shortens treatment cycles, and accelerates recovery. Acupuncture combined with herbal medicine has become a research hotspot in TCM for primary dysmenorrhea.
Studies have shown that Gexia Zhuyu Decoction combined with acupuncture effectively treats qi stagnation and blood stasis-type primary dysmenorrhea [90].
Wenjing Qutong Decoction combined with navel moxibustion [91] and Xiangsha Liujunzi Decoction with modified warm acupuncture [92] have shown excellent results in treating cold-dampness blood stasis-type primary dysmenorrhea. These combined therapies primarily work by increasing serum PGE₂ levels and reducing PGF₂α levels, with clinical efficacy surpassing that of any single therapy.
Another study reported that Wenjing Decoction combined with a self-made warm uterus patch applied to specific acupoints effectively treated primary dysmenorrhea by reducing inflammation markers, including PGF₂α [93].
3. Conclusion
Primary dysmenorrhea has a high prevalence rate and significantly impacts women's daily lives. Modern medicine identifies abnormal fluctuations in prostaglandin (PG) levels as one of the key factors in the onset of primary dysmenorrhea. While Western medications have demonstrated some efficacy in treating primary dysmenorrhea by regulating PG levels, their clinical safety and long-term effectiveness still require improvement.
Traditional Chinese Medicine (TCM) offers diverse treatment methods for primary dysmenorrhea, including TCM monomer extracts, single medicinal herbs, commonly used herbal pairs, Chinese herbal formulas, acupuncture, tuina therapy, auricular acupressure, and combined therapies. These approaches regulate PG levels to achieve therapeutic effects. However, the following challenges remain:
Efficacy Variation Due to Individual Differences: Differences in patients' constitutions lead to varied responses to the same treatment, posing challenges for standardization and reproducibility in TCM therapy.
Poor Taste of Traditional Herbal Decoctions: As one of the most common forms of TCM, decoctions often have an unpleasant taste, discouraging patients from long-term use. Although modern technologies have developed alternative formulations, such as granules and capsules, further research and optimization are needed to maintain efficacy and improve patient acceptance.
Pain and Discomfort During Acupuncture: Although acupuncture is highly effective in treating primary dysmenorrhea, some patients find it difficult to accept or persist with the treatment due to fear of pain or discomfort and low tolerance.
Lifestyle Habits Impacting Efficacy: Unhealthy habits such as irregular eating, disrupted sleep patterns, and lack of exercise not only exacerbate primary dysmenorrhea symptoms but may also weaken the effectiveness of TCM treatments.
In the future, therapeutic approaches should be optimized while ensuring clinical efficacy and safety. For instance, modern technologies such as big data analysis and artificial intelligence can be employed to accurately assess patients' constitutions, disease characteristics, and lifestyle factors, enabling the development of more personalized and precise treatment plans. Additionally, the development of more palatable, convenient, and effective TCM formulations would enhance patient acceptance of TCM. Moreover, the development and application of painless acupuncture techniques would provide a more comfortable treatment experience for patients who fear needles. Finally, emphasizing the integration of internal and external TCM therapies to create a more comprehensive and systematic treatment model could improve therapeutic outcomes and reduce recurrence rates.
In conclusion, with continuous innovation and development in TCM therapies, alongside increasing public awareness and acceptance, TCM will undoubtedly play a greater role in serving patients with primary dysmenorrhea and improving their quality of life.
