Menopausal syndrome according to Chinese Medicine

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Climacteric syndrome, Menopause and Perimenopausal syndrome redirect here

Menopausal syndrome factsheet

Chinese name: 更年期

Pinyin name: Gēng Nián Qí

Possible causes and remedies:

Menopause means the permanent cessation of menstruation. It is not a disease in and of itself, but rather a natural life phase during which a woman transits from a reproductive stage to a non-productive one. The ovarian function declines during the menopause period, which can last between 2 to 5 years.

Some women have a smooth transition, while due to stress, overwork or diet  there are an increasing amount of women who experience discomforting symptoms such as hot flashes, insomnia, night sweats, heart palpitations, anxiety, irritability, tinnitus, dizziness, vertigo, headaches, fatigue, memory loss, soreness of the limbs, hypertension, etc. One or several of these symptoms together at the time of menopause is what is called 'menopausal syndrome' or 'climacteric syndrome'.

Some women have mild symptoms, while some have very severe ones which severely impact their quality of life. The discomfort can last from a couple of weeks to decades after the periods have ceased completely. Some women regard their new status as natural and unavoidable but Chinese Medicine theory believes these are signs of imbalance that can often be treated very successfully.

From TCM perspective, the menopause syndrome is fundamentally a result of gradually decreasing of Kidney Essence, either in its Yin or Yang aspect. However as we will be see below there can also be other causes.

Please be aware that TCM herbal treatment is not in contradiction with any hormone replacement therapy (HRT), because the two methods work from very different perspectives.

As you can see below we've detailed for you the seven "patterns of disharmony" associated with menopausal syndrome. Chinese Medicine sees the body as a system, not a sum of isolated parts. A "pattern" is when the system's harmony is disrupted. It is not equivalent to a Western condition, as a matter of fact here menopausal syndrome can be explained by seven different patterns.

Each of those patterns can be treated with one or several herbal formulas. Drinking herbal infusions is the most common remedy in Chinese Medicine, together with acupuncture. It is the Chinese Medicine equivalent to drugs, apart that it's 100% natural!

In total we detail below sixteen formulas that can help treat the various patterns that cause menopausal syndrome, depending on which pattern fits your profile.

The seven "patterns of disharmony" associated with menopausal syndrome

Atractylodes Rhizomes (Bai Zhu) is the key herb for Yue Ju Wan, a formula used for Phlegm

Phlegm

Pulse type(s): Wiry (Xian)

Tongue coating: Sticky coating

Tongue color: Red sides

Recommended herbal formulas: Yue Ju Wan, Wen Dan Tang, Ban Xia Hou Pu Tang

Symptoms: Nausea Oedema Obesity Belching Moodiness Depression Irritability Poor appetite Chest fullness Breast distention Abdominal fullness Sputum in the chest

This pattern often appears among young women with premature menopause. The symptoms are due to Phlegm or Dampness accumulating in the Lower Burner instead of the more typical decline of Kidneys Essence, normally the key cause for menopausal syndrome. As for absence of menstruationSpleen Qi Deficiency is the fundamental reason leading to Phlegm. This is because the Spleen rules the transformation and transportation of Body Fluids. The malfunction of this Organ leads to the accumulation of these fluids and eventually they coagulate and Phlegm appears.

Sometimes there is the case of having both Phlegm and Kidney Essence Deficiency together. In this case it is suggested to first treat the Phlegm or Dampness and deal with other patterns later. 

The treatment principle is to resolve Phlegm, fortify the Spleen, move Qi and eliminate Stagnation.

Read more about Phlegm here

The Kidneys is a so-called "Zang" Organ. Learn more about the Kidneys in Chinese Medicine

Kidney Yang Deficiency

According to Chinese Medicine, both Spleen and Kidney Yang Deficiency are interlinked reasons behind menopausal syndrome. It is because the Spleen Yang originates from the Kidney Yang so a deficiency in one will cause a deficiency in the other. In turn the Spleen supplies the Kidneys with postnatal Grain Qi and the Blood it transforms from food and drinks.

When the Spleen Yang is deficient due to Kidney Yang Deficiency, its ability to generate sufficient grain Qi, Blood and Post-Heaven Essence decreases. This means the Kidneys have no other option than to consume the reserves of Pre-Heaven Essence they store. Essence is a critical ingredient to generate periods. If the situation last for a while, the Kidneys' Essence gets depleted and premature menopause and premature aging follow. 

The treatment principle is to tonify and warm the Kidneys, tonify Yang, strengthen the Spleen and warm the Centre. 

Read more about Kidney Yang Deficiency here

The Kidneys is a so-called "Zang" Organ. Learn more about the Kidneys in Chinese Medicine

Kidney Yin Deficiency

Pulse type(s): Deep (Chen), Empty (Xu), Fine (Xi), Floating (Fu)

Tongue coating: Complete absence of coating

Tongue color: Red

Recommended herbal formulas: Zuo Gui Yin, Qi Ju Di Huang Wan, Dang Gui Di Huang Yin, Dan Zhi Xiao Yao San

Symptoms: Itching Tinnitus Dry hair Dry skin Dizziness Sore back Dry mouth Sore knees Weak knees Dry throat Dry tongue Malar flush Night sweats Constipation Irritability Weak lower back Hot palms and soles

Decreasing of Kidney Essence is the fundamental cause for all menopause-related ailments. It can take the form of Kidney Yin Deficiency, Kidney Yang Deficiency or a combination of these two patterns. 

The Kidneys govern the bones and generate the marrow. In case of Kidney Yin Deficiency,  the Yin and Essence fails to nourish the lower parts of the body properly, therefore the lower back and knees become weak and sore. It can even result in some atrophy of the lower extremities the most severe cases. Body Fluids is a Yin elements and it dries up in case of Kidney Yin Deficiency. It is not able to moisten the body: the throat, mouth and tongue - which are located along the Kidney Channel - become dry and red. The Yin Deficiency also causes Empty Heat and thus some hot symptoms like malar flush may appear. 

Emotional stress is one of the most significant causes of Kidney Yin Deficiency as a cause of menopausal syndrome, especially when the stress lasts for years before the start of the menopause. The Kidneys' functions can be greatly influenced by worry, anxiety and fear. The situation gets worse if the patients also work excessively without proper and sufficient rest. Finally, having too many children too close to each other also affects the Kidney Yin negatively. 

The treatment principle is to nourish Kidney Yin, subdue Yang and clear Empty Heat with appropriate herbal formulas. A more relaxed lifestyle with reduced emotional stress is also obviously recommended.

Read more about Kidney Yin Deficiency here

Qi and Blood Stagnation

In opposition to patterns related to Kidney Essence Deficiency, this is an Excess type of menopausal syndrome as it is due to Blood Stagnation (sometimes paired with Qi Stagnation). It often happens in Liver and it normally results from emotional factors such as anger, frustration, resentment, irritation, worry or anxiety. 

According to some TCM gynecology books, women who have the most severe menopausal syndrome are often these with long history of Liver Qi and Blood Stagnation.

If the patient also suffers from Kidney Essence Deficiency at the same time, it is recommended to first treat Blood and Qi Stagnation. 

The treatment principle is to invigorate Blood, move Qi, eliminate Stagnation and calm the Mind.

Read more about Qi and Blood Stagnation here

The Heart is a so-called "Zang" Organ. Learn more about the Heart in Chinese Medicine

Disharmony between Heart and Kidneys

This pattern is sometimes not listed as a separate pattern under menopausal syndrome by many TCM gynecology books, because it is another variation of Kidney Yin Deficiency with Empty Heart Heat

Emotional stress is one of the most critical reasons leading to menopausal syndrome, especially when the high level of stress lasts for a long period of time. The situation is made worse if the patient also overworks and is exhausted as a result. Worry, fear and anxiety harm the Kidneys and result in its Yin Deficiency, which can further deplete Heart Yin and cause Heart Empty Heat. Because Heart houses the Mind, there are Heart related symptoms such as palpitations, mental restlessness or poor memory. 

The treatment principle is to nourish Kidney Yin, calm the Mind and clear Empty Heat.

Read more about Disharmony between Heart and Kidneys here

The Kidneys is a so-called "Zang" Organ. Learn more about the Kidneys in Chinese Medicine

Kidney and Liver Yin Deficiency

Pulse type(s): Empty (Xu), Wiry (Xian), Floating (Fu)

Tongue coating: Complete absence of coating

Tongue color: Red

Recommended herbal formulas: Qi Ju Di Huang Wan, Liu Wei Di Huang Wan, Gui Shao Di Huang Tang, Zuo Gui Yin

Symptoms: Tics Tinnitus Dry eyes Dry skin Dizziness Sore back Headaches Amenorrhea Joint pain Hot flushes Night sweats Blurred vision Spontaneous and nocturnal emissions

The symptoms under this pattern are very similar to those under Kidney Yin Deficiency but the condition is much more severe. The Kidney Yin is so Deficient that it dries up the Liver Yin

Prolonged Yin Deficiency leads to Liver Yang Rising, as the Yang can not be kept under control. Sometime it can even agitate Liver Wind Internally. Then symptoms such as dizziness, tics, headache and tinnitus appear. Blurred vision is also a typical sign, as Liver opens into the eyes. The Liver houses the Ethereal Soul which, with that condition, has no place to rest at night; hence the insomnia and dream-disturbed sleep.  

Deficiency of both Kidney and Liver Yin together can cause spontaneous emissions as both Organs can not store Essence. Premature graying or loss of hair are other consequences.

This pattern often occurs due to excessive exercise or sex, prolonged physical exertion without proper rest, Blood Deficiency such as chronic menorrhagia or prolonged emotional stress such as anger, resentment or frustration. 

The treatment principle is to nourish both Kidney and Liver Yin, subdue Liver Yang, calm the Mind and settle the Ethereal Soul.

Read more about Kidney and Liver Yin Deficiency here

The Kidneys is a so-called "Zang" Organ. Learn more about the Kidneys in Chinese Medicine

Deficiency of both the Kidney Yin and Yang

Pulse type(s): Rapid (Shu), Empty (Xu), Fine (Xi), Floating (Fu)

Tongue color: Red

Recommended herbal formulas: Er Xian Tang, Er Zhi Wan

Symptoms: Chills Tinnitus Back pain Dizziness Dry throat Hot flushes Night sweats Frequent urination Cold hands and feet Sore and weak limbs

The fundamentally reason for menopausal syndrome is due to Kidney Essence decreasing. It can take the form of Kidney Yin or Yang Deficiency or the combination of these two. The combined pattern is actually quite common among women over 40s. It is more the rule than the exception. 

Depending on the predominant type (i.e. Yin or Yang Deficiency), the tongue color will be red (for Yin Deficiency) or pale (for Yang Deficiency). The pulse can be Floating-Empty or Fine-Rapid if Yin Deficiency predominates or Weak-Deep if Yang Deficiency predominates. 

Patients can be given two type of herbal formulas simultaneously to treat this combined pattern but each with a reduced dosage. For example, a Yang-nourishing formula can be given in the morning and a Yin-nourishing one for the evening. The volume should be adapted based on the  predominant type: a higher dose of Yin-nourishing formula if Yin-Deficiency is more severe and vice versa. 

The treatment principle is to nourish the Kidneys, nourish Yin, gently tonify Yang and calm the Mind.

Read more about Deficiency of both the Kidney Yin and Yang here

The sixteen herbal formulas that might help with menopausal syndrome

Zuo Gui Yin

Source date: 1624 AD

Number of ingredients: 6 herbs

Key actions: Nourishes the Yin. Tonifies the Kidneys.

Why might Zuo Gui Yin help with menopausal syndrome?

Because it is a formula often recommended to help with the patterns Kidney Yin Deficiency and Kidney and Liver Yin Deficiency which are sometimes associated with menopausal syndrome. If any of these patterns look like something you might suffer from, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Zuo Gui Yin here

Qi Ju Di Huang Wan

Source date: 1350 AD

Number of ingredients: 8 herbs

Key actions: Nourishes Kidney and Liver Yin. Improves vision.

Why might Qi Ju Di Huang Wan help with menopausal syndrome?

Because it is a formula often recommended to help with the patterns Kidney Yin Deficiency and Kidney and Liver Yin Deficiency which are sometimes associated with menopausal syndrome. If any of these patterns look like something you might suffer from, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Qi Ju Di Huang Wan here

Liu Wei Di Huang Wan

Source date: 1119 AD

Number of ingredients: 6 herbs

Key actions: Nutritive tonic for the Liver and Kidney Yin Essence (nourishes the parasympathetic nervous system).

Why might Liu Wei Di Huang Wan help with menopausal syndrome?

Because it is a formula often recommended to help with the patterns Disharmony between Heart and Kidneys and Kidney and Liver Yin Deficiency which are sometimes associated with menopausal syndrome. If any of these patterns look like something you might suffer from, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Liu Wei Di Huang Wan here

Yue Ju Wan

Source date: 1481 AD

Number of ingredients: 5 herbs

Key actions: Promotes the movement of Qi. Releases all types of Stagnation (Qi, Blood, Phlegm, Fire, Food and Dampness).

Why might Yue Ju Wan help with menopausal syndrome?

Because it is a formula often recommended to help treat Phlegm, a pattern sometimes associated with menopausal syndrome. If it looks like you might suffer from Phlegm, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Yue Ju Wan here

You Gui Wan

Source date: 1624 AD

Number of ingredients: 10 herbs

Key actions: Warms and tonifies Kidney Yang. Replenishes the Essence. Tonifies the Blood.

Why might You Gui Wan help with menopausal syndrome?

Because it is a formula often recommended to help treat Kidney Yang Deficiency, a pattern sometimes associated with menopausal syndrome. If it looks like you might suffer from Kidney Yang Deficiency, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about You Gui Wan here

Ge Xia Zhu Yu Tang

Source date: 1830 AD

Number of ingredients: 12 herbs

Key actions: Invigorates Blood. Eliminates Blood Stagnation below the diaphragm. Stops pain. Promotes Qi movement.

Why might Ge Xia Zhu Yu Tang help with menopausal syndrome?

Because it is a formula often recommended to help treat Qi and Blood Stagnation, a pattern sometimes associated with menopausal syndrome. If it looks like you might suffer from Qi and Blood Stagnation, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Ge Xia Zhu Yu Tang here

Er Xian Tang

Source date: 1950 AD

Number of ingredients: 6 herbs

Key actions: Nourishes Yin and tonifies Yang of the Kidneys. Clears Empty Heat. Regulates the Directing and Penetrating Vessels.

Why might Er Xian Tang help with menopausal syndrome?

Because it is a formula often recommended to help treat Deficiency of both the Kidney Yin and Yang, a pattern sometimes associated with menopausal syndrome. If it looks like you might suffer from Deficiency of both the Kidney Yin and Yang, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Er Xian Tang here

Wen Dan Tang

Source date: 1174 AD

Number of ingredients: 8 herbs

Key actions: Clears Hot-Phlegm. Clears Gallbladder heat. Regulates Qi. Harmonizes the Stomach.

Why might Wen Dan Tang help with menopausal syndrome?

Because it is a formula often recommended to help treat Phlegm, a pattern sometimes associated with menopausal syndrome. If it looks like you might suffer from Phlegm, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Wen Dan Tang here

Ban Xia Hou Pu Tang

Source date: 220 AD

Number of ingredients: 5 herbs

Key actions: Regulates the flow of Qi, treats esophageal spasm. Clears Phlegm.

Why might Ban Xia Hou Pu Tang help with menopausal syndrome?

Because it is a formula often recommended to help treat Phlegm, a pattern sometimes associated with menopausal syndrome. If it looks like you might suffer from Phlegm, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Ban Xia Hou Pu Tang here

Dang Gui Di Huang Yin

Source date: 1640 AD

Number of ingredients: 7 herbs

Key actions: Nourishes Blood. Tonifies Kidney and Liver Yin. Regulates the menstrual cycle.

Why might Dang Gui Di Huang Yin help with menopausal syndrome?

Because it is a formula often recommended to help treat Kidney Yin Deficiency, a pattern sometimes associated with menopausal syndrome. If it looks like you might suffer from Kidney Yin Deficiency, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Dang Gui Di Huang Yin here

Dan Zhi Xiao Yao San

Source date: 2002 AD

Number of ingredients: 8 herbs

Key actions: Clears Liver Fire from Stagnant Liver Qi.

Why might Dan Zhi Xiao Yao San help with menopausal syndrome?

Because it is a formula often recommended to help treat Kidney Yin Deficiency, a pattern sometimes associated with menopausal syndrome. If it looks like you might suffer from Kidney Yin Deficiency, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Dan Zhi Xiao Yao San here

Wen Jing Tang

Source date: 220 AD

Number of ingredients: 12 herbs

Key actions: Warms the Uterus and vessels. Nourishes Blood. Dispels Cold. Dispels Blood Stagnation.

Why might Wen Jing Tang help with menopausal syndrome?

Because it is a formula often recommended to help treat Qi and Blood Stagnation, a pattern sometimes associated with menopausal syndrome. If it looks like you might suffer from Qi and Blood Stagnation, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Wen Jing Tang here

Gui Zhi Fu Ling Wan

Source date: 220 AD

Number of ingredients: 5 herbs

Key actions: Promotes Blood and lymphatic circulation, thus eleminates Blood Stagnation. Softens and resolves hard lumps such as cysts and fibroids.

Why might Gui Zhi Fu Ling Wan help with menopausal syndrome?

Because it is a formula often recommended to help treat Qi and Blood Stagnation, a pattern sometimes associated with menopausal syndrome. If it looks like you might suffer from Qi and Blood Stagnation, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Gui Zhi Fu Ling Wan here

Tian Wang Bu Xin Dan

Source date: 16th century

Number of ingredients: 14 herbs

Key actions: Nutritive tonic: Nourishes Yin, Blood and Vital Essence of the Heart and Kidney. Clears away pathogenic Heat, clears Deficient Heat. Sedative.

Why might Tian Wang Bu Xin Dan help with menopausal syndrome?

Because it is a formula often recommended to help treat Disharmony between Heart and Kidneys, a pattern sometimes associated with menopausal syndrome. If it looks like you might suffer from Disharmony between Heart and Kidneys, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Tian Wang Bu Xin Dan here

Gui Shao Di Huang Tang

Source date: 1706 AD

Number of ingredients: 8 herbs

Key actions: Nourishes Blood. Nourishes Yin.

Why might Gui Shao Di Huang Tang help with menopausal syndrome?

Because it is a formula often recommended to help treat Kidney and Liver Yin Deficiency, a pattern sometimes associated with menopausal syndrome. If it looks like you might suffer from Kidney and Liver Yin Deficiency, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Gui Shao Di Huang Tang here

Er Zhi Wan

Source date: 1534 AD

Number of ingredients: 2 herbs

Key actions: Nourishes Liver Yin. Nourishes Kidney Yin.

Why might Er Zhi Wan help with menopausal syndrome?

Because it is a formula often recommended to help treat Deficiency of both the Kidney Yin and Yang, a pattern sometimes associated with menopausal syndrome. If it looks like you might suffer from Deficiency of both the Kidney Yin and Yang, this formula might help (although please seek confirmation with a professional practitioner beforehand).

Read more about Er Zhi Wan here