Managing Menopause with Chinese Medicine

Managing Menopause with Chinese Medicine

By Yanfang Liu

Menopause is the transition period in a woman’s life when her ovaries stop producing eggs, and menstruation becomes less frequent, eventually stopping altogether.

This process occurs as a normal part of aging, or from surgical removal of the ovaries (Tierney, et. Al. 1997). Although incorrectly
used, the term menopause is broadly understood to describe the natural transition from a woman’s reproductive to a non-reproductive phase in life due to declining ovarian function. (McKinley, et al., 1998)

 

The age of onset of menopause usually takes place between 45 and 55, with the median age in industrialized
countries being 50. This number correlates with the ancient Chinese text “Simple Questions”, which describes women to have 7-year cycles and menopause to occur at the 7^th cycle, at age 49.

 

There are three phases:

1. Perimenopause  – the gradual climacteric period preceding menopause is called perimenopause. It usually starts in a woman’s 40s and lasts 4 years in  average but can last from a few months up to 10 plus years. Many women experience menopausal symptoms in the last years of perimenopause. Periods  may become irregular, scant or heavy; some may even experience prolonged  bleeding. The ovaries are still functioning and pregnancy is still a  possibility, but ovarian function becomes less consistent, less robust,  and estrogen levels tend to decline. Measuring the follicle-stimulating  hormone (FSH) and luteinizing hormone (LH) level in the blood can indicate  if a woman is experiencing perimenopause.
2. Menopause – the time of no menstruation. Menopause  starts at the time of the last menstruation but can only be confirmed  after a naturally occurring absence of any menstrual period for at least  12 months.
3. Post menopause – the time of a woman’s life  following menopause. During this period, most of the transitional stress
   of menopause has passed while other symptoms such as decreased libido, vaginal dryness, and osteoporosis increase.

 

Symptoms of menopause:

The symptoms of menopause could be varies from very mild symptoms to very severe and complicated symptoms, and
involved with many different aspects. The followings are the most common symptoms:

• Hot  flashes or severe body heat, hot sensation in the palms and soles
• Night  sweats
• Fatigue
• Cravings for sweets or carbohydrates
• Diminished sexual desire, vaginal dryness
• Emotional changes such as irritability, mood swings, depression, and/or anxiety or  even panic attack
• Palpitations  often related to fear/anxiety
• Insomnia  or restless sleep
• Fuzzy  thinking (difficulty concentrating, memory problems)
• Weight  gain, especially around the middle abdomen
• Stiffness  and pain of joints
• Swelling  and puffiness
• Pre-period  migraine, breast swelling and tenderness before periods
• Irregular periods, such as irregular menstrual  cycle length, decreased or increased menstrual flow and timing

 

Complications of menopause:

Cardiovascular disease. Heart disease is the leading cause of death in women as well as in men. When a woman experiences menopause, especial post menopause her estrogen levels decline significant, the risk of cardiovascular disease increases.

 

Osteoporosis. During the first few years of post menopause, woman may lose bone density at a rapid rate, which will
increase the risk of osteoporosis. Osteoporosis causes bones to become brittle and weak, leading to an increased risk of fractures. Postmenopausal women are especially susceptible to fractures of the hip, wrist and spine.

 

Urinary incontinence. Menopausal women may experience a frequent, sudden, strong urge to urinate, followed by an
involuntary loss of urine (urge incontinence), or the loss of urine with coughing, laughing or lifting (stress incontinence) because the tissues of woman’s vagina and urethra lose their elasticity due to decline of female hormone.

 

Weight gain. It is common that women gain weight during the menopausal transition, especially around the belly, and hard to loss weight.

 

 Hormonal changes

Hormone changing directly results menopausal syndrome. During the process of menopause, different hormone will decrease in different time and different speed.

Progesterone levels fall first in perimenopause period before changes in estrogen and testosterone.

Estrogen doesn’t diminish until less than a year before the last period, when the ovarian follicles are greatly reduced, estrogen in the form of estradiol markedly decreased right before the last.

Two to six years prior to menopause, estrogen levels increase or remain stable with the drop in progesterone, which allow groups of follicles to grow and mature during successive menstruation as if trying to get rid of the last remaining follicles. During this time, the amount of ovarian follicle decrease at an accelerated rate until the supply of follicles is depleted.

Finally, the levels of the follicle stimulating hormone (FSH) and LH produced in the pituitary gland become erratic and the ovaries begin to skip ovulations until menopause arrives. Once nearing the arrival of menopause, hormone levels will level out and FSH and LH levels then rise to their highest levels for the remaining years of life.

 

Hormonal Treatment:

A.    Hormone Replacement Therapy (HRT)

Estrogen, progesterone or testosterone with the amount and combination of these depending on the individual need of each patient.

B.  The advantage of HRT

The symptoms related with menopause relieve fast; the general heath improved; mental and physical improved; sexual life improved;  Osteoporosis can be prevented; hair and mood swings improved fast, etc.

C.    Disadvantage of HRT

Risk of uterine cancer and breast cancer, existing fibroid or endometriosis worse, formation of embolus, etc.

 

Understanding of Menopause by Chinese Medicine

Menopause is induced by gradual consumption of kidney-Qi, emptiness of the Ren and Chong channels, exhaustion of Tiangui,
breakdown of yin-yang equilibrium in the body and disorders of Zang-Fu, Qi and blood.

The root of the cause is kidney decline either naturally or damaged by many factors such as over child birth, too many or too
closed child birth in short time or in a young age, over sexual activities or surgery. Kidney dominates birth, development and aging of human being according to Chinese Medicine theory. If kidney is damaged or declined earlier than normal, Yin and Yang will be imbalanced and lost of the harmony between the organs.

 

1.     Kidney Qi decline gradually along aging, plus long term illness or over cold food for over time, or a woman with yang deficiency constitution, all above can lead to kidney yang deficiency, which lead to spleen yang deficiency causing accumulation of phlegm or dampness or related disorders. Spleen yang deficiency can further lead to Qi, blood deficiency.

 

2.     Kidney Yin declines gradually along aging, plus excessive emotional change, or loss of blood, or over childbirth, or too many children, too close together or over sexual activity, or over hot spicy food or yin consumed after febrile disease, all these can lead to kidney yin deficiency. Kidney yin deficiency will lead to disharmony between the kidney and heart or Kidney yin deficiency can’t balance the yang, and yang will rising or hyperactive, at same time the imbalance of Yin and Yang can lead to more disorders.

 

In China, most menopausal women use Traditional Chinese Medicine (TCM), particularly Chinese herbs, instead of HRT, with good result of less side effects. 2005, a study by the Women’s Health Institution urged most postmenopausal women to
stop using hormone replacement therapy (HRT). In this report, the global index statistic supported risks exceeding benefits, prompting the data and safety monitoring board to recommend an early end to the trial after 5.2 years. The data showed among the 16,608 participating women an increased risk of invasive breast cancer, bone fractures, coronary heart disease (CHD), stroke, pulmonary embolism, endometrial, colorectal, and other cancers.[1]

[1] Rossouw, Jacques E. et al “Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women.” Journal of the American Medical Association July 17, 2002; 288(3).

 

Differentiation of Syndrome and Treatment with Chinese Herbs:

Chinese Medicine emphasizes the differentiation of syndromes; even within the same “bio-medical disease”, each stage will require a different type of treatment. In addition, each individual develops symptoms in a unique way to him or her body’s constitution. Chinese medicine treats the entire syndrome of each person with a holistic approach that looks beyond symptoms such as individual constitution, season, geographic difference to determine a more appropriate, and a more effective healing method according to the unique TCM diagnosis.

 

Basic syndrome # 1

Kidney – Yin deficiency with deficient heat

Dizziness, tinnitus, night-sweating, hot flushes or feeling heat, 5 palm heat, lower back weakness or soreness, dry mouth, dry and thinner hair, dry and itching skin, constipation, red tongue without coating and thready-rapid or floating-empty pulse.

Treatment strategy: nourish kidney-yin and clear the deficient heat

Pattern formula: Zuo Gui Wan (Restore Left Pill)

 

Basic syndrome # 2

Kidney- yang deficiency

Hot flushes but cold hands and feet, night-sweating in the early morning or sweat in the limited area of the body, pale face, depression, backache, edema easily, tired or fatigue easily, pale tongue with thin white coating, deep and feeble pulse.

Treatment strategy: strengthen kidney, warm the kidney-yang and  balance kidney yin and kidney yang

Pattern formula: You Gui Wan (Restore Right Pill)

 

Basic syndrome  # 3

Kidney-yin and kidney-yang deficiency

Hot flushes but cold hands and feet, night-sweating, frequent-pale urine, flushed or sweat around the neck, slightly agitated, chilliness, dry throat, dizziness, tinnitus, backache, pale or red tongue with thin white coating, deep and feeble or feeble, weak, rapid pulse.

Treatment strategy: nourish the kidneys, nourish yin, gently tonify yang and balance kidney yin and kidney yang

Pattern formula: Er Xian Tang (Two Immortals Decoction)

 

Alternative syndrome # 1

Liver Qi stagnation

Hot flushes, irritability, anxiety, or depression, nervousness, abdominal distension normal tongue or slightly red on
the sides with thin white coating, wiry pulse.

Treatment strategy: regulate liver Qi, tonify liver blood

Pattern formula: Xiao Yao San (Free and Easy Wandering Powder)

 

Alternative syndrome # 2

Liver yang hyperactivity due to kidney and liver yin deficiency

Hot flushes, irritability, anxiety, dizziness, headache, red face, weakness of lower back, red tongue without of coating, wiry or thin wiry-empty pulse.

Treatment strategy: nourish kidney yin and liver yin, calm the liver yang

Pattern formula: Kun Bao Tang (Female Treasure Decoction)

 

Alternative syndrome # 3

Disharmony between the kidneys and heart

Hot flushes, palpitations, insomnia, night sweating, blurred vision, tinnitus, anxiety, mental restlessness, backache, feeling of heat in the evening, dry mouth, dry throat, poor memory, forgetfulness, red tongue redder tip without coating, thread and rapid pulse.

Treatment strategy: harmonize the kidneys and heart, calm the mind and clear deficient heat

Pattern formula: Tian Wan Bu Xin Dan (Heavenly Emperor’s Tonifying The Heart Pill)

 

Alternative syndrome # 4

Accumulation of phlegm-heat

Obesity, a feeling of oppression of the chest, sputum in the chest, a feeling of fullness of the epigastrium, a feeling of distention of the breasts, irritability, belching, nausea, no appetite, moodiness, depression, swollen and may slightly red sides tongue with sticky –yellowish coating, slippery pulse.

Treatment strategy: resolve phlegm, clear heat

Pattern formula: Zhu Ru Wan Dan Tang (Warm Gallbladder Decoction with Bamboo  Shavings)

 

Alternative syndrome # 5

Blood and Qi stagnation

Hot flushes, mental restlessness, or depression, menopause preceded by a period when menses are very irregular and painful for a long time then starting again, dark-clotted blood, insomnia, abdominal pain, purple tongue with thin white coating, wiry or choppy pulse.

Treatment strategy: regulate qi and remove blood stasis

Pattern formula: Wen Jing Tang (Warm The Menses Decoction)

Alternative syndrome # 6

Liver fire or phlegm in live and gallbladder

Hot flushes, irritability with occasional attacks of palpitations, anger easy, constipation, fullness in the chest, red tongue with thick yellowish coating, wiry and rapid pulse.

Treatment strategy: calm the liver, clear the heat and calm the mind

Pattern formula: Chai Hu Jia Long Gu Mu Li  Tang (Bupleurum Plus Dragon Bone and Oyster Shell Decoction ) variation

Alternative syndrome # 7

Qi and blood deficiency

Mild hot flushes, depression, tired even fatigue, loose or diarrhea, poor appetite, pale face, dizziness, palpitation, poor sleep, wake up easy and difficulty go back to sleep again, pale tongue with thin white coating, weak or feeble pulse.

Treatment strategy: nourish the blood, tonify Qi and promote the health

Pattern formula: Gui Pi Tang (Restore The Spleen Decoction)

 

General variation  according to certain symptoms:

1.     diarrhea or loose bowels

– plus Bai Zhu, Bu Gu Zhi (Psoralea), Rou Dou Kou (Mutmeg)

2.    skin itching

–       plus Chan Tui (Cicada Slough), Bai Xian Pi (Dictamnus Root Bark)

3.     Heavy menses

– plus Bu Gu Zhi (Ipsoralea), Ai Ye Tang (Artemisia Leaf)

4.  Night urination

– plus Yi Zhi Ren (Sharpleaf Glangal Fruit), Sang Piao Xiao (Mantis Egg Case)

5.     Dizziness and headache

– plus Tian Ma (Gastrodia Tuber), Gou Teng (Gamnir Vine Stem)

6.     Fuzzy thinking or difficulty concentrating

– plus Bai He (Lily Bulb), Shu Di Huang  (Rehmannia Root)

7.     Insomnia

– plus Wu Wei Zi  (Schisandra Fruit), Suan Zao Ren (Sour Jujube)

8.   Poor memory

–plus Yi Zhi Ren (Sharpleaf Glangal Fruit),

 

Prevention:

1.     Changing attitudes

2.     Have healthy nutrition and diet

3.     Regular exercise

4.     Strengthening kidney

 

I have being treated menopausal syndrome for more than 20 years with acupuncture and Chinese herbs with excellent  results.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dang Gui  (Chinese Angelica
Root or Tang-kuei) – A Miracle Chinese Herb for Women’s Health

Dang Gui, Chinese Angelica Root or Tang-kuei in English, is a very commonly used herb for gynecological conditions in Chinese Medicine. Latin Name: Angelica sinensis (Oliv.) Diels. Pharmaceutical Name: Radix Angelicae Sinensis. Chinese Angelica Root has sweet pungent and bitter taste and warm property. It is very effective in treating heart, liver and spleen disorders according to Chinese Medical theory. Dang Gui is called a Women’s herb and is commonly used for female health.

Dang Gui has the functions of tonifying the blood and regulating menses; invigorating and harmonizing the blood and dispersing cold; moistening the intestines and relieving constipation; and reducing swelling, expelling pus, regenerating flesh and alleviating pain. It is commonly used for the following conditions in Chinese Medicine:

 

1.     Blood deficiency syndrome. Common symptoms: fatigue, pale face, dizziness, ringing in the ears. Tongue: pale. Pulse: thin or weak

2.  Menstrual disorders such as irregular menstruation, amenorrhea, dysmenorrhea

• above disorders caused by blood deficiency,  accompanied with the following symptoms: scanty periods, thin and pale blood during the menstruation, fatigue, pale tongue body and weak or thin or thready pulse.
• above disorders caused by blood stasis, accompanied with the following symptoms: dark or purple blood during the menstruation, clots in the blood, dark complexion, and purple tongue body color or tongue body with purple spots, and choppy pulse.

3.     Various kinds of pain due to blood stasis. Examples include abdominal pain that is sharp in character
or stabbing with fixed location, pain due to traumatic injury, chronic joint and muscle pain, or deformation of the joints. All the above conditions may be accompanied by dark complexion, purple tongue and choppy pulse.

4.   Sores, carbuncles and abscesses at any stage

5.     Constipation due to blood deficiency and intestinal dryness, usually for elderly patients or weak patients

 

Dosage and administration:

•  3-15g decocted in water for an oral dose
• Vinegar-frying or wine-frying strengthens its blood-invigorating properties

 

Safety:

Very safe, but caution in cases of diarrhea or abdominal distention or patients with heat signs. Do not used if patient with
fibroids or breast cancer or breast cancer history.

 

Simple Home Remedies:

1.      Anemia: Dang Gui (Chinese Angelica Root) 15g, Huang Qi (Astragalus Root) 12g.

Preparation:
Add 3 cups of clean filtered water and soak the herbs for at least 30 minutes.
Cook the mixture over high heat and bring to a boil. Reduce to low heat and
simmer for 30 minutes. Remove from heat, drain the liquid and set aside. Keep
the cooked herbs in the original pot, add 2 cups of clean water and repeat the
same cooking steps above. Combine the liquids and take in equal amounts 2 times
a day before a meal. 30 to 60 days as a treatment course.

2.     Painful period:
Dang Gui (Chinese Angelica Root) 15g, Chuan Xiong (Cnidium) 10g, Bai Shao (White Peony) 10g, Hong Hua (Safflower) 6g.

Preparation:
Add 3 cups of clean filtered water and soak the herbs for at least 30 minutes. Cook the mixture over high heat and bring to a boil. Reduce to low heat and simmer for 30 minutes. Remove from heat, drain the liquid and set aside. Keep the cooked herbs in the original pot, add 2 cups of clean water and repeat the same cooking steps above. Combine the liquids and take in equal amounts 2 times a day before a meal. Take for 7 days before menstrual period starts. Repeat the formula for at least 3 cycles.

3.     Weakness after childbirth: Dang Gui (Chinese Angelica Root) 15g, Rou Gui (Cinnamon Bark) 10g, Huang Qi (Astragalus Root) 12g, Sheng Jiang (Fresh Ginger) 15g.

Preparation:
Add 3 cups of clean filtered water and soak the herbs for at least 30 minutes. Cook the mixture over high heat and bring to a boil. Reduce to low heat and simmer for 30 minutes. Remove fr om heat, drain the liquid and set aside. Keep the cooked herbs in the original pot, add 2 cups of clean water and repeat the same cooking steps above. Combine the liquids and take in equal amounts 2 times a day before a meal.

A second method of preparation: Wrapped all the herbs with cheese cloth and add into the cooking pot when boiling soup with meat. When the meat is ready to eat, keep the meat and soup, throw away the herbs. 7 days as one treatment course.

4.      Perimenopausal or menopausal women’s health: Grind Dang Gui (Chinese Angelica Root) 240g -360g into fine powder. Take 2-3g two times a day with warm water for 60 days. Can be taken for longer if needed.