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.
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).
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)