By John Chen, PhD, PharmD, OMD, LAc Traditional Chinese Medicine Perspective According
to traditional Chinese medicine, the fundamental changes that occur
during menopause can be attributed to kidney deficiency. Since the
kidney is the organ responsible for growth, maturation and aging, the
deficiency of kidney yin is directly related to signs, symptoms and
complications of menopause. In addition to kidney yin deficiency, other
common conditions that occur in menopause are kidney yang deficiency;
kidney essence (jing) deficiency; liver qi stagnation;
blood deficiency; and uprising deficiency heat. Therefore, treatment of
menopause using Chinese herbal medicine can be divided into two parts:
primary diagnosis and treatment, and differential diagnosis and
treatment. Differential Diagnosis and Treatment This
section addresses the treatment of menopause based on differential
diagnosis according to the theories of the traditional Chinese medicine.
While all patients with menopause will have kidney yin deficiency, many
will have other associated conditions that must be addressed. The
differential diagnosis and treatments are as follows. Kidney
yin deficiency, one of the most common scenarios of menopause, is
characterized by symptoms such as delayed menstruation (scanty in amount
or ceased completely); hair loss; scanty vaginal discharge; dryness of
vagina; dizziness; tinnitus; hot flashes; night sweats; five heart
irritable heat (heat and irritable sensation in the chest, palms and
soles); hot flashes; insomnia; increased dreams; itchy skin or
formication (tactile hallucination with feeling of insects crawling on
skin); and soreness and weakness of lower back and knees. The tongue is
red with scanty coating, and there is a thready rapid pulse. The
recommended herbal formulas are zhi bai di huang wan and qing hao bie jia tang. Liver qi stagnation
is evident with the showing of irritability; nervousness; hypochondriac
distention; constipation; palpitations; insomnia; emotional
instability; and generalized weakness. The tongue is red with a thin
yellow coating, and the pulse is wiry. The recommended herbal formulas
are chai hu jia long mu tang and jia wei xiao yao san. Blood
deficiency can be diagnosed when the clinical manifestation shows
dizziness; hot flushes; sweating; insomnia; dryness of skin; sallow
complexion; emotional instability; and myalgia. There is a pale tongue
with a thin coating, and a thready pulse. The recommended herbal
formulas are si wu tang and gui pi tang. Uprising
deficiency heat will show such symptoms and signs as severe night
sweating and hot flushes; a bone-steaming sensation; irritability;
dizziness; nervousness; and emaciation. The tongue is red with a thin
coating, and there is a thready rapid pulse. The recommended herbal
formula is qing hao bie jia tang. Kidney yang
deficiency, probably the least common of all menopause diagnosis, is
characterized by heavy menstrual bleeding; metrorrhagia or complete
ceasing of menstruation; soreness and weakness of the lower back and
knees; edema of the face and limbs; cold limbs; cold appearance; loose
stools; polyuria; and urinary incontinence. There is a pale tongue with
thin coating, and a deep-thready-weak pulse. The recommended herbal
formulas are you gui wan and li zhong tang. Kidney essence (jing)
deficiency can be diagnosed with such symptoms and signs as weakness
and soreness of the lower back and legs; inability to stand for a
prolonged period of time; and decreased bone mass density. Kidney jing deficiency is directly related to the Western diagnosis of osteoporosis. Gui lu er xian jiao
is the formula of choice for the prevention and treatment of
osteoporosis as it contains herbs that increase the utilization of
calcium; strengthen the bones; prevent fractures; and promote healing.
From the Western medicine perspective, these herbs are rich in calcium,
and function to increase adsorption of calcium into bone and promote the
growth and healing of bones. According to a clinical study conducted in
Taiwan, the use of herbs in gui lu er xian jiao has been found to increase bone mass density by an average of 3.4% in one year.
In addition to herbs, an adequate amount of calcium and vitamin D
should be taken on a daily basis to ensure proper integrity of bones. Lifestyle and Dietary Instructions Menopause
patients are encouraged to follow a diet with a high content of raw
foods, fruits and vegetables to stabilize blood sugar. Some foods may
promote hot flashes or aggreate mood swings and should be avoided, such
as dairy products, red meats, alcohol, sugar, spicy foods, and caffeine.
Cigarette smoking or exposure to second-hand smoke should be avoided as
they may dry up yin and body fluid. Lastly, stress, tension and anxiety
should be avoided as much as possible. Author's Comments Traditional
Chinese medicine is extremely effective in treating menopause and
related conditions. However, it is important to keep in mind that as
kidney tonic herbs treat menopause, they also regulate the endocrine
system. Therefore, it is not unusual for women to experience
menstruation once the herbs are initiated. In addition, some herbs have
estrogen-like effects and should be avoided in patients who have
estrogen-dependent cancer. Examples of these herbs include fructus
cnidii monnieri (she chuang zi), semen cassiae (jue ming zi), radicis angelicae sinensis (dang gui), flos carthami tinctorii (hong hua) and semen astragali complanati (sha yuan zi). Conclusion Though
menopausal signs and symptoms are disturbing, they are self-limiting
and not life-threatening. Such signs and symptoms may be prominent for a
few years, but they will gradually lessen in severity and eventually
disappear. Osteoporosis, on the other hand, will continue to deteriorate
with age and can be life-threatening. It is a disorder that requires
active intervention and treatment. Hormone replacement
therapy is considered the standard treatment for menopause and related
conditions. However, there is not a consensus as to when and how to use
these medications. While they may alleviate hot flashes and prevent
osteoporosis, they will also increase the risk of breast, ovarian and
uterine cancer, and have a number of significant side-effects. The
bottom line is that synthetic hormones can never replace endogenous
ones. Therefore, no matter when and how they are prescribed, the
potential for adverse reactions will always be present. Traditional
Chinese medicine, on the other hand, offers a gentle yet effective way
to address menopause and related conditions. Chinese herbs have
demonstrated via numerous in vivo and in vitro studies
to have a marked effect on the endocrine system to alleviate hot
flashes, vasomotor instability, loss of bone mass, and other conditions
associated with menopause. Most importantly, they are much gentler and
safer on the body. Menopause Conditions and TreatmentsDiagnosisClinical ManifestationHerbal Rx Kidney Yin Deficiency Delayed
menstruation (scanty in amount of ceased completely); hair loss; scanty
vaginal discharge; dryness of vagina; dizziness; tinnitus; hot flashes;
night sweats; five heart irritable heat (heat and irritable sensation
in the chest, palms and soles); hot flashes; insomnia; increased dreams;
itchy skin or formication (tactile hallucination with feeling of
insects crawling on skin); soreness and weakness of lower back and knees Anemarrhena phellodendron & rehmannia formula (zhi bai di huang wan) and artemisia & turtle shell decoction (qing hao bie jia tang) Liver Qi Stagnation Irritability;
nervousness; hypochondriac distention; constipation; palpitations;
insomnia; emotional instability; generalized weakness. Bupleurum & dragonbone combination (chai hu jia long mu tang) and bupleurum & peony formula (jia wei ziao yao san) Blood Deficiency Dizziness; hot flushes; sweating; insomnia; dryness of skin; sallow complexion; emotional instability; myalgia. Tang kuei four combination (si wu tang) and ginseng & longan combination (gui pi tang) Uprising Deficiency Heat Hot flushes; bone-steaming sensation; irritability; dizziness; nervousness; emaciation. Artemisia & turtle shell decoction (qing hao bie jia tang) Kidney Yang Deficiency Heavy
menstrual bleeding; metrorrhagia or complete ceasing of menstruation;
soreness and weakness of the lower back and knees; edema of the face and
limbs; cold limbs; cold appearance; loose stools; polyuria; urinary
incontinence. Eucommia & rehmannia formula (you gui wan) and ginseng & ginger combination (li zhong tang) Kidney Essence (Jing) Deficiency Weakness
and soreness of the lower back and legs; inability to stand for a
prolonged period of time; decreased bone mass density. Testudinis & cervi formula (gui lu er xian jiao) References
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