Randomized Trial of Huangdi Neijing Three-Talents Acupuncture plus NSAIDs for Primary Dysmenorrhea (Deficiency-Cold Pattern)

Primary dysmenorrhea (PD) is a common gynecological disorder that severely affects women's quality of life and daily functioning. Conventional pharmacological therapy with non-steroidal anti-inflammatory drugs (NSAIDs) provides symptom relief but may cause side effects or tolerance with long-term use. Acupuncture has been widely applied as an adjunct treatment, yet evidence for specific techniques such as Huangdi Neijing acupuncture using the Three-Talents (three-layer) method remains limited. In this randomized controlled trial, 240 patients with deficiency-cold pattern PD were equally allocated to a control group receiving NSAIDs alone or a study group receiving NSAIDs combined with Huangdi Neijing acupuncture. Needling was performed at Shousanli (LI10), Zusanli (ST36), Jiaji at L5 (EX-B2), Weizhong (BL40), Yaoyangguan (DU3), and Shenshu (BL23). At LI10 and ST36, the Three-Talents method was applied through sequential superficial, intermediate, and deep insertions to stimulate multiple tissue layers. Treatments were administered once per menstrual cycle for three cycles. Outcome measures included clinical response rate, duration of abdominal pain, TCM syndrome scores, uterine-artery hemodynamics, visual analogue scale (VAS), Cox Menstrual Symptom Scale (CMSS), and serum prostaglandin levels. Compared with NSAIDs alone, the combination therapy showed higher efficacy (91.7% vs 78.3%), shorter pain duration, and greater reductions in VAS and CMSS scores. Uterine blood-flow indices improved, and serum PGF2 α decreased while PGE2increased, leading to a lower PGF2 α/PGE2 ratio. These findings indicate that integrating Huangdi Neijing Three-Talents acupuncture with NSAIDs enhances pain relief and uterine function in deficiency-cold pattern PD, providing a reproducible clinical protocol for future application.