Dysmenorrhea refers to lower abdominal pain, distension, and accompanying backache or other discomforts that women experience before, during, or after menstruation. It is one of the most common gynecological symptoms. Severe dysmenorrhea patients often start feeling anxious and fearful before their period even begins, and when the pain strikes, they suffer greatly, affecting their work and quality of life.

It is well known that traditional Chinese acupuncture has significant effects in treating pain. In my practice of applying the diagnostic and therapeutic principles from the “Huangdi Neijing,” I have developed a three-needle method for dysmenorrhea, which has proven to be effective and reliable in clinical applications. I now share this with my colleagues.

I. Core Acupoints and Selection Principles

1. Neiguan (Pericardium Meridian)
   • Location: On the palmar side of the forearm, 2 inches above the wrist crease, between the palmaris longus tendon and the flexor carpi radialis tendon.
   • Principle: The Liver Meridian of the Foot Jueyin encircles the genitalia and reaches the lower abdomen, sharing the same qi with the Pericardium Meridian of the Hand Jueyin, quickly relieving pain caused by stagnation of qi in the lower jiao.
   • Needling Technique: Direct insertion 0.5-1 inch, with strong stimulation by lifting, thrusting, and twirling after obtaining the qi sensation.
2. Lieque (Lung Meridian Collateral Point, Eight Confluent Points of the Ren Meridian)
   • Location: On the radial side of the forearm, 1.5 inches above the wrist crease, between the tendons of the extensor pollicis brevis and the abductor pollicis longus.
   • Principle: The Ren Meridian governs the uterus, and Lieque connects to the Ren Meridian, also regulating the descending of lung qi, which is effective for dysmenorrhea caused by qi stagnation and blood stasis in the middle jiao.
   • Needling Technique: Oblique insertion upward 0.3-0.5 inch, with the needle tip directed towards the elbow.
3. Tongli (Heart Meridian Collateral Point)
   • Location: On the palmar side of the forearm, 1 inch above the wrist crease, on the radial side of the flexor carpi ulnaris tendon.
   • Principle: The Shaoyin Meridian governs the interior, and the Tongli point can regulate heart qi and the sea of blood, targeting chronic pain that has entered the collaterals or mixed deficiency and excess type dysmenorrhea.
   • Needling Technique: Direct insertion 0.3-0.5 inch, with mild stimulation to guide the qi back to its origin.

II. Principles of Point Selection and Operational Procedures

1. Meridian Selection Based on Location
   • Left-sided Lower Abdominal Pain → Use acupoints on the right limb (right Neiguan/Lieque/Tongli);
   • Right-sided Lower Abdominal Pain → Use acupoints on the left limb (left Neiguan/Lieque/Tongli);
   • Central Pain → Prioritize the right limb (with the principle of left for men and right for women as a backup).
2. Stepwise Treatment
   • First Needle: Neiguan (mandatory, 80% of patients experience pain relief upon insertion);
   • Second Needle: Lieque (if pain is not fully relieved, enhance regulation of the Ren Meridian);
   • Third Needle: Tongli (used for stubborn dysmenorrhea or when the condition has entered the collaterals).
3. Retaining and Manipulating the Needles
   • Retain the needles for 20-30 minutes, manipulating them every 5 minutes to enhance the sensation of qi;
   • After acute pain is relieved, moxibustion over the Shenque point through ginger can be used to consolidate the effect.

In clinical practice, based on the location of the patient’s pain, follow the principles of the “Neijing”: if the lower abdomen pain is on the left side, use the patient’s right hand; if the pain is on the right side, use the left hand; if the pain is in the middle, use the right hand (according to the principle of left for men and right for women).

The first needle is Neiguan (the Liver Meridian of the Foot Jueyin encircles the genitalia, reaches the lower abdomen, and shares the same qi with the Pericardium Meridian of the Hand Jueyin). Generally, if the pain stops upon insertion, the second needle is not needed. If the pain is reduced but not gone, the second needle, Lieque (the Lung Meridian Collateral Point, one of the Eight Confluent Points connecting to the Ren Meridian), can be used. If the pain persists after the second needle, and usually 80% of the pain is relieved by this point, the remaining 20% can be addressed with the third needle, Tongli (the Shaoyin Meridian).

Based on my experience, after completing the three-needle treatment for dysmenorrhea and retaining the needles for 20-30 minutes, the pain disappears in the vast majority of cases.

This three-needle method for dysmenorrhea is clinically used for women in the acute phase of dysmenorrhea. It is simple to perform, with rapid effects, and has been proven effective time and again. Those interested are encouraged to try it. If the results are not satisfactory, adjustments can be made according to the principles of the “Neijing,” and further discussion is welcome.

III. Theoretical Basis and Classical Connections

1. Core Ideas of the “Huangdi Neijing”
   • The principle of “treating the upper by treating the lower, treating the left by treating the right” through the correspondence of the same qi;
   • The synergistic effect of meridians under the guidance of “six-meridian differentiation” (the Pericardium Meridian and the Liver Meridian share the same qi, the Lung Meridian and the Ren Meridian intersect).
2. Modern Medical Evidence
   • The Neiguan point activates the vagus nerve, regulates serotonin levels, and inhibits the release of prostaglandins (the main cause of dysmenorrhea);
   • Stimulation of the Lieque point can reduce uterine smooth muscle spasms (animal experiments show a 40% increase in analgesia rate);
   • The Tongli point has a bidirectional regulatory effect on autonomic nervous system dysfunction.

IV. Clinical Key Points and Contraindications

1. Golden Treatment Window
   • Start preventive treatment 3 days before menstruation; three consecutive treatments can significantly lower the pain threshold;
   • In the acute phase, prioritize distal limb acupoints to avoid local stimulation that may worsen congestion.
2. Contraindications and Precautions
   • Pregnant women should avoid using Hegu and Sanyinjiao, which are contraindicated during pregnancy; all three needles in this protocol are safe;
   • In cases of skin damage or local infection, use distal substitute points (such as Taiyuan instead of Lieque);
   • Patients with severe endometriosis need to take Chinese herbal medicine internally.

V. Case Studies

Case 1: Ms. Zhang, 28 years old, with primary dysmenorrhea for 10 years, experiencing cold pain in the lower abdomen and vomiting before menstruation.

• Treatment: Right Neiguan (strong stimulation with twirling) + Left Lieque (Shaoshanhuo technique)
• Result: Pain disappeared 10 minutes after needling, with no recurrence in a 3-month follow-up.

Case 2: Ms. Li, 35 years old, with secondary dysmenorrhea (adenomyosis), experiencing severe pain during menstruation that prevented her from standing.

• Treatment: Right Neiguan → Right Lieque → Right Tongli (all three needles inserted simultaneously)
• Result: After retaining the needles for 25 minutes, the VAS score dropped from 8 to 2, and with the addition of Guizhi Fuling Wan for over a month, significant improvement was observed.

VI. Academic Exchange

This method achieves “simple symptoms, precise points” through the “same qi” thinking of the “Neijing.” It is recommended to combine it with abdominal and umbilical acupuncture to form a comprehensive treatment plan. For stubborn dysmenorrhea, the “Tongli + Ximen” method for strong collateral stimulation can be explored. Colleagues are welcome to verify and optimize this in clinical practice.