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Menopause

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Menopause

Introduction

Menopausal Syndrome is one of the commonly-encountered women's conditions. Its clinical manisfestations can be summarized as changes in the reproductive system, aging of the human body, and abnormalcy in the neuropsychic state. (1) Among its more typical symptoms are neuropsychic and vasomotorial symptoms. (2) In traditional Chinese medicine, Menopausal Syndrome falls into the categories of "conditions during the menopausal period" and "hysteria." (3) , (4)

Literature on Menopausal Syndrome
Qi Zhongpu of the Song Dynasty wrote in Hundred Questions on Women's Diseases: "At the end of a woman's reproductive period, menstruation stops. Menopausal Syndrome results if menstruation resumes after it has stopped." And in Principles of Obstetrics and Gynecology, Xiao Yun of the Qing Dynasty described Menopausal Syndrome this way: "Woman's reproductive life revolves around the blood system. At the end of the seven seven-year cycles in a woman's life, the reproductive period ends and menstruation stops. At this point, the Chong and Ren Channels are impaired and deficient, menopause sets in and amenorrhea begins, resulting in infertility. From this point on, if a woman is not careful and lets overstrain or moodiness get the better of herself, she is susceptible to being taken victim by pathogenic factors, causing the stopped menstruation to reflow again."

Etiology/Pathogenesis

Traditional medicine
Luo thinks that most Menopausal Syndrome cases can be traced to a common origin of liver and kidney deficiencies. (5) Xia believes that depleted kidney-qi and the discontinuation of menstruation are the fundamental causes of Menopausal Syndrome, and that the flaring-up of the heart- and liver-qi is the direct cause of Menopausal Syndrome; therefore, Menopausal Syndrome is really due to kidney-yin deficiency and the flaring-up of the heart and liver-qi. (6) Wang points out that Menopausal Syndrome originates from depleted kidney-qi, discontinuation of menstruation, impaired and deficient Chong and Ren Channels, insufficient essence and blood, imbalance of yin and yang, and imharmonious channels, which cause visceral dysfunctions and inharmonious heart, liver, spleen, and kidney functions. (7) Wang, on the other hand, believes that women owe their innate essence to the liver, and that in the course of life, they go through menstruation, pregnancy, delivery, and breast-feeding, all of which ineviably impair the liver-blood, leading to malnourished liver-qi and liver-qi deficiency, which in turn cause Menopausal Syndrome. (8) Furthermore, Wang argues that in exploring Menopausal Syndrome pathogenesis, in addition to kidney deficiency, the influence of the Eight Extra-channels is a factor worth looking into. (9)

Modern medicine
Serous estrogen test
Zhang's research finds that while the follicle stimulating hormone (FSH) and luteinizing hormone levels of Menopausal Syndrome patients are significantly higher than those of the control group, both the estradiol (E2) and estrogen receptor levels are significantly lower than those of the control group. (10) Zhang, therefore, concludes that Menopausal Syndrome pathogenesis must be related not only to the lowered estrogen level, but also to the lowered estrogen receptor level in the cell.

Hematuresis test
Gu finds that Menopausal Syndrome patients with fire hyperactivity due to yin deficiency have a plasma lipid peroxide (LPO) level significantly higher than the same-age control group, indicating that the heightened LPO level of Menopausal Syndrome patients has something to do with fire hyperactivity due to yin deficiency. (11) In addition, Xia finds that patients with fire hyperactivity due to yin deficiency tend to have sympathetic hyperfunction, with heart-fire hyperactivity due to yin deficiency related to sympathetic-adrenomedullary hyperactivity, and liver-fire hyperactivity due to yin deficiency related to sympathetic-adrenocortical hyperactivity.

Socio-psychological factors
Zhang's investigation into Menopausal Syndrome's socio-psychological factors reveals that in addition to the personality factor, social-environmental factors (e.g., tragedies in personal life, financial difficulties, and relationship problems) also play an important role in Menopausal Syndrome pathogenesis by creating a depressing environment from which the patient finds it hard to escape. (12)

Primary Treatments with Chinese Medicinal Herbs

Geng Nian An

Ingredients: Shu Di Huang (Processed Rehmannia), He Shou Wu (Fleece-flower Root), Ze Xie (Alisma), Fu Ling (Hoelen), Wu Wei Zi (Schizandra), Zhen Zhu Mu (Nacre), Ye Jiao Teng (Polygonum Stem), Yuan Shen (Scrophularia), Fu Xiao Mai (Wheat)

Clinical Application:
Zhang has used this formula to treat 382 patients suffering the menopausal syndrome, and reported an overall effective rate of 98.2%. (13) Ten days to one month into the treatment, the patients started showing improvement in mood swings, sleeping, appetite, blood pressure fluctuation, hot flashes, sweating, dizziness, and forgetfulness (14) . Ren, et al. has treated 30 Menopausal syndrome patients with irregular coordination of the heart and the kidney, and reported 23 cases resolved and 7 improved. (15) Furthermore, Xing has used a modified version of this formula to treat 35 Menopausal syndrome patients with hyperactivity of yang due to yin deficiency, and reported 8 cases resolved, 20 significantly improved, 6 improved, and 1 without response, achieving an overall effective rate of 97.14%. (16)

Other Treatments with Chinese Medicinal Herbs

Geng Nian An Tang modification

Dai, et al. have treated 45 Menopausal Syndrome cases with a modified Geng Nian An Tang (Shu Di Huang, processed He Shou Wu, Gou Qi Zi, Shan Zhu Yu, Nu Zhen Zi, Mai Dong, Bai He, Ci Ji Li, Gui Ban, and Long Gu), and reported 13 cases recovered, 25 significantly improved, and 6 improved, and 1 without response, tallying up an overall effective rate of 97.8%. (17)

Zi Shen Yang Gan Qing Xin Tang

In combination with psychotherapy, Fang has adopted a heart-liver-kidney approach to treating Menopausal Syndrome and treated 38 Menopausal Syndrome cases with a self-formulated Zi Shen Yang Gan Qing Xin Tang (Tu Si Zi, Han Lian Cao, Nu Zhen Zi, Fu Ling, Dan Shen, Mai Dong, each of Shan Zhu Yu, Suan Zao Ren, Wu Wei Zi, and processed Gan Cao), and reported 16 cases significantly improved and 22 cases improved. (18)

Bai He, Fu Xiao Mai, Long Gu, Mu Li, Dan Shen, processed Gan Cao, Sheng Di Huang, Dang Gui, Bai Shao, Wu Wei Zi, and processed Suan Zao Ren

Chai has used a base formula plus case-specific formulas to treat 45 Menopausal Syndrome cases (the base formulas consists of Bai He and Fu Xiao Mai, Long Gu, Mu Li, and Dan Shen, processed Gan Cao, Sheng Di Huang, Dang Gui, Bai Shao, Wu Wei Zi, and processed Suan Zao Ren; and case-specific formulas are: Liu Wei Di Huang Wan for kidney-yin deficiency, Jin Gui Shen Qi Wan for kidney-yang deficiency, Jia Wei Xiao Yao Wan for liver-qi stagnation and spleen deficiency, and Ren Shen Gui Pi Wan for deficiency of both the heart and the spleen), and reported 29 cases significantly improved, 14 improved, and 2 without response, totalling an overall effective rate of 95.5%. (19)

Treating Menopausal Syndrome with Patent Formulas

Wang, et al. have treated 234 Menopausal Syndrome cases due to the flaring-up of the heart and liver-fire with Geng Nian Shu (Huang Lian, Mai Dong, Bai Shao, and Suan Zao Ren), and reported an overall effective rate of 85.8%, significantly higher than the control group's 48.6% (p

Acupunture & Acupressure

Wang has combined acupuncture and herbal medicine to treat Menopausal Syndrome. The herbal formula used is a modified Tian Ma Gou Teng Yin, and the key acupunture points are the elbow and knee joints (LI 4, and Liv 3) and Sanyinjiao (Sp 6). (20)

Mu has focused on the Eight Liuzhu (multiple abscess) Acupoints (Lu 7, SI 3, P 6, Sp 4, K 6, St 25) to treat Menopausal Syndrome. (21) While Yang has used the ear-pressure method to treat Menopausal Syndrome. (22)

References

  1. Li Qing Sheng. Journal of Hunan Traditional Chinese Medicine. 1998;4(2):8.
  2. Task Force on Menopausal Health. Journal of Traditional Chinese Medicine. 1991;71(10):585.
  3. Chen Da Rong, et al. Journal of Chinese Experimental Pharmacology. 1991;(3):6.
  4. Luo Yuan Kai. Practical TCM Gynecology. Shanghai: Science & Technology Press; 1994.
  5. Luo Yuan Kai, et al. Journal of Traditional Chinese Medicine. 1995;(2):25.
  6. Xia Gua Cheng, et al. Journal of Traditional Chinese Medicine. 1995;10(4).
  7. Wang Ping. Henan Traditional Chinese Medicint. 1992;12(30):108.
  8. Wang Hui, et al. Journal of University of Zhejiang Traditional Chinese Medicine. 1997;21(1):18.
  9. Wang Xiao Ping. Journal of Traditional Chinese Medicine. 1995;10(4):43.
  10. Zhang Jia Qing, et al. Journal of Traditional Chinese and Western Medicine. 1996;(9):45.
  11. Gu Wen Lian, et al. Journal of Traditional Chinese Medicine. 1990;(9):45.
  12. Zhang Li Rong. Infertility and Other Women's Conditions. Tianjin: Science & Technology Translation Press; 1994.
  13. Zhang Li Rong. Combining Traditional Chinese Medicine and Western Medicine to Treat the Menopausal Syndrome. Beijing: Chinese Medical Science Press; 1988.
  14. Wang Yu Fen, et al. Zhong Yao Xin Yao Yu Lin Chuang Yao Li. 1995;6(1):37-39.
  15. Ren Jing Ping, et al. Shanxi Zhong Yi. 1998;14(5):20-21.
  16. Xing Yan Ling. Tianjin Zhong Yi. 1999;16(4):41-42.
  17. Dai Xiu Min, et al. Jilin Traditional Chinese Medicine. 1996;(6):22.
  18. Fang Ru Zhou. Journal of Changchun Traditional Chinese Medicine. 1997;13(1):47.
  19. Chai Li Nal. Shanxi Traditional Chinese Medicine. 1997;13(3).
  20. Wang Yu Ming, et al. Journal of University of Zhejiang Traditional Chinese Medicine. 1993;17(2):48.
  21. Mu Hua Min. New Traditional Chinese Medicine. 1995;27(2):32.
  22. Yang Qing Fang. Journal of Yunnan Traditional Chinese Medicine. 1993;14(5):27.