Using Traditional Chinese Medicine as an Alternative - by Zhijin Tang

Menopause usually affects women in their middle age. To treat the menopause, hormone replacement therapy (HRT) has been strongly recommended in the last few decades. Indeed, it can help with many problems of the menopause, but like every drug treatment, it has side effects.

This article will argue that, based on recent studies, the risks of HRT outweigh its benefits, and some possible alternatives to HRT, such as acupuncture, herbal medicine, diet control and physical exercise, should be considered for possible alternative treatments of the menopause.

I. Menopause & HRT

The hormones involved in the menstrual cycle of women are oestrogen (US spelling – estrogen), and progesterone. Oestrogen is responsible for producing female sexual characteristics, it is also considered to be responsible for the menstrual cycle and the formation of the duct system in the breast. Progesterone is mainly for thickening the endometrium of the womb for the fertilised egg, and preparing the body for pregnancy. (Chester, 1979)

Menopause means literally ‘the end of menstruation’, the time when a women finally stops releasing eggs (ovulating) and stops the monthly shedding of the lining of the womb. To understand the problems HRT or other alternatives can address, the symptoms of the menopause should be known first. Normally, women finish menstruating naturally at around the age of 45 to 55, when the levels of oestrogen and progesterone in the body decline. Hormonal changes can effect women in various ways. The three symptoms that are most clearly related to the hormonal changes during the climacteric are hot flushes, night sweats and vaginal dryness. Some women may experience other problems, such as tiredness, sleeplessness, feeling easily upset, poor memory, frequent headaches, joint pains and weight gain (Dickson and Henriques, 1987). Some women may not have many serious problems around their menopause. However, some female in their younger age may experience the menopausal symptoms after ovaries operation, or dysfunctional ovary after chemotherapy, although they are not at the menopausal age.

As mentioned earlier, HRT has been strongly recommended for the main treatment of the menopause in the last few decades. It can comprise of oestrogen alone, or a combination of oestrogen and progesterone.

Many studies show that HRT may help to relieve hot flushes and night sweats and reduce vaginal problems resulting from oestrogen loss. It may be helpful in preventing osteoporosis and improving the lipid profile, and it may improve heart health. HRT may also prevent Alzheimer’s disease and muscular degeneration, and may generally improve the quality of life. (Dickson and Henriques, 1987; Coney, 1995)

Although HRT has some benefits to menopausal symptoms, its increased risks have meant that certain groups of women, such as “women with a history of breast cancer, women with a history of endometrial cancer” (Coney, 1995: 215), have been advised against it.

One study (Stapleton S., 2002) shows that after discovering a 26% increased risk of breast cancer, scientists have warned women against long-term use of HRT even if there is a heart benefit. The study (Chen, et al., 2002) shows “long-term use of HRT is associated with an increased risk of breast cancer and that such use may be related particularly to lobular tumors”. Other increased risks of HRT have also been discussed in the research, such as a 41% increase in strokes, a 29% increase in heart attacks, a 22% rise in cardio-vascular disease and a 2-fold increase of blood clots. The National Heart, Lung and Blood Institute (NHLBI) has stopped a major research project on HRT because results show that the health risks overweight the benefits.

Recently, a study from the Women Health Initiative (WHI) also warned, women should stop the combination of oestrogen and progesterone because the risks now exceed the benefits. WHI concluded that oestrogen plus progesterone do not prevent heart disease and is not beneficial overall. (Web 1)

With growing concern over the health risks of HRT, more and more females have decided to discontinue HRT and choose other alternatives. According to NHS statistics, HRT prescriptions were down 15% in 2003, as women abandoned the therapy because of the increased risks that were exposed. Other alternatives to HRT in the treatment of the menopause should be considered, such as Traditional Chinese Medicine (TCM), which includes acupuncture and herbal therapy; diet control, and physical exercise. Further studies and research for these alternatives are being conducted.

II. Menopause & TCM

TCM has been using acupuncture and herbal therapy to treat the menopause for thousands of years with successful results. Nowadays, many research institutes in the west have started research projects into Chinese Herbs and acupuncture. Studies, such as a recent result from the North American Menopause Society (NAMS), shows how herbs affect some symptoms of menopause, for example, ‘Dong Quain(Dang Gui) and Ginseng (Ren Shen) stimulate the growth of MCF-7 cells independent of estrogenic activity’. (Amato, et al., 2002)

Many studies show that to relieve hot flushes, some herbs, such as Dong Qual (Dang Gui) and Licorice root (Gan Cao), may be effective. To reduce night sweats and insomnia, herbs like Schisandra Chinensis (Wu Wei Zi), Zizyphus Spinosa are suggested. To improve vaginal dryness Dong Qual and Licorice root may be effective. Ginseng is another recommended herb for menopause patients, as it may increase energy, normalise blood pressure and relieve depression and fatigue. To limit the risks of each herb, experienced TCM doctors may help to combine herbs into a suggested formula.

The menopause has been discussed in some early TCM classical lectures. According to the Yellow Emperor’s Classic (Hung Di Nei Jing, Su Wen - Shang Gu Tian Zhen Lun): ‘Female age seven, Kidney Qi strong, hair grows, ‘milk teeth’ lost; Age 14, Tian Qui (Heaven Seeds) arrives, Ren meridian opens, Tai Chong meridian through, menstruation starts; … ; Age 49, Ren meridian deficient, Tai Chong meridian weakens, Tain Qui departs, menstruation ends’.

This literature shows the understanding of Chinese medicine towards the menopause. It clearly explains in the terms of TCM the menopause is due to declining or exhaustion of Kidney Qi, Tain Qui deficiency in the Chong and Ren meridians. This breaks the balance of Yin and Yang and brings on disturbance of Qi and Blood in the body. These imbalances can be the result or the cause of the symptoms.

In many studies, Kidney deficiency is named as the main cause of the menopause in TCM. In most cases during my clinical practice, menopause show as Kidney Yin deficiency, or Kidney Yang deficiency, or both Yin & Yang deficiency, in some cases the Yin deficiency can impair the function of the Heart, Liver and Spleen. The TCM treatment principle for this syndrome is to tonify and protect Kidney Qi, nourish the blood, enrich the Yin and clear the empty heat in the body.

In my personal clinical experience, the menopause is very complicated to treat, however through correct diagnosis and appropriate differentiation with the help of herbs and acupuncture, significant improvements can always be achieved. Clinically I define the menopause as the following five types of imbalance.

Type 1, Kidney Yin deficiency

Clinical manifestations include hot flushes, heat sensations in the body, sweats, sore and weakened limbs and knees. Commonly patients may carry out irregular menstruation with bright red color blood, sometime patients may experience a shortened menstrual cycle, dry mouth, dry and itching skin, constipation, scanty and yellow urine. In severe cases dizziness, nausea and tinnitus may occur. Red tongue with little coating, and a thready, rapid pulse.

Treatment Method: Nourish Kidney Yin and suppress Yang

Herbal Prescription: Sheng Di Huang, Shu Di Huang, Mai Men Dong, Xuan Shen, Zhen Zhu Mu, Mu Dan Pi, Ze Xie, Fu Ling, Gou Teng

Type 2, Kidney Yin deficiency and Liver Yang rising

Main symptoms include hot flushes, sweats, sore and weakened lower back and knees, irregular menstruation. Patients also experience irritation, pain in the chest, and insomnia or dream-disturbed sleep. Often patients can have a bitter taste in the mouth or a dry mouth and throat. In severe case dizziness, nausea, tinnitus may occur. Red with little coating tongue, and a wiry, thready pulse.

Treatment Method: Nourish the Kidney and the Liver, enrich the Yin and anchor the Yang.

Herbal Prescription: Sheng Di Huang, Chi Shao, Bai Shao, Shan Zhu Yu, Suan Zao Ren, Sang Ye, Ju Hua, Chuan Lian Zi, Fu Ling.

Type 3, Deficiency of both Kidney Yin and Yang

Clinical manifestations are a sore and weak lower back and knees. Patients may occasionally feel an aversion to cold, and occasionally feel hot flushes and night sweats. Irregular menstruation with light or dark color blood. In severe case dizziness, nausea, tinnitus may occurred. Red tongue with thin coating and thready pulse.

Treatment Method: Tonify the Kidney Yin and Yang and nourish Chong Ren.

Herbal Prescription: Ren Shen, Gao Qi Zi, Shu Di Huang, Dang Gui, Shan Zhu Yu, Zhi Mu, Huang Bai, Mu Dan Pi, Fu Ling.

Type 4, Liver constrained with blood deficiency

Clinical manifestations include irritability, hot flushes, night sweats, irregular and shortened menstrual cycle with pale-red blood. Patients may also experience dizziness, tinnitus, palpitations, insomnia or dream-disturbed sleep, fatigue and reduced appetite. Pale-red tongue with wiry and deficient pulse.

Treatment Method: Spread the Liver Qi, strenghten the spleen, and nourish the blood to regulate menstruation.

Herbal Prescription: Sheng Di Huang, Bai Zhu, Bai Shao, Dang Gui, Fu Ling, Chai Hu, Mu Dan Pi, Yi Mu Cao, Gan Cao

Type 5, Deficiency of Spleen and Kidney

Clinical symptoms are pallid complexion, low spirit and fatigue, coldness and weakness in the limps and knees, reduced appetite with fullness sensation in the stomach, loose stools and irregular menstruation with profuse flow. Urination often during the nights.

Treatment Method: Warm the Kidney Yin, tonify the Kidney Yang, warm the middle burner and strengthen the spleen.

Herbal Prescription: Dang Shan, Bai Zhu, Huang Qi, Shu Di Huang, Mu Dan Pi, Yu Zhu, Rou Cong Rong, Shan Zha, Yin Yang Huo.

The treatment principle of acupuncture is the same as herbal medicine. Acupuncture can be used to regulate Chong Ren, nourish the Yin and tonify the kidney. In my clinical experience the commonly used acupuncture points for this treatment are:

Guan Yuan （CV4）– regulate Chong Ren;

Qi Hai （CV6）– regulate Qi in the body;

San Yin Jiao （SP6）– regulate and tonify the heart, liver and spleen;

For liver constraint, Tai Chong（LR3）,Gan Shu （BL18）can be combined;

To clear the heat and nourish Kidney Yin, Tai Xi（KI3）, Ran Gu（KI2） is often applied;

To activate the blood and move the Qi, Xue Hai（SP10）, Gui Lai（ST29） needle points;

Zu San Li（ST36）, Pi Shu（BL20）, always chosen to treat the deficiency of the Spleen.

Ear acupuncture is often used to treat the menopause clinically. The efficient points are: Endocrine (MA-IC3), Ovary (MA-TF), Kidney (MA-SC), Liver (MA-SC5); for palpitation, Heart (MC-IC), Subcortex (MA-AT1); treating irritability use Liver Yang (MA-H); treating hot flushes, heat sensation in the body, use bloodletting on Sympathetic (MA-H), Ear Apex (MA-H6); loose stools due to spleen deficiency, treat Spleen (MA-IC) and Triple Burner (MA-IC4).

III. Typical Case Study

Mrs. R. 48 years old, first visit September 2003

Four years ago, her menstrual cycle became irregularly, sometimes having prolonged menstruation, sometimes shortened. Also she experienced tinnitus, dizziness, insomnia, palpitations, sweating, and was irritable. She could feel difficult to control her temper in the last few years. She also experienced hot flushes, hot palms and soles, and fatigue. Her GP diagnosed her symptoms as the menopause, and suggested a prescription of HRT as oral administration of oestrogen and vitamin B6. After taking HRT the symptoms reduced, however the symptoms came back once she stopped taking HRT.

Due to the new finding of the risks of HRT, Mrs. R wants to try an alternative treatment, instead of taking HRT long term.

I diagnosed the condition as Kidney Yin deficiency, that causes the deficiency of Liver Yin. The treatment method I used was to nourish the Kidney and Liver, enrich the Yin and anchor the Yang.

Herbal Prescription: Shu Di Huang, Shan Yao, Fu Ling, Mu Dan Pi, Dang Gui, Bai Shao, Gou Qi Zi, Chai Hu, Chuan Lian Zi.

Acupuncture Prescription: Qi Hai（CV6）, Guan Yuan（CV4）, San Yin Jiao（SP6）, Tai Chong（LR3）, Tai Xi（KI3）, Ran Gu（KI2）.

Ear acupuncture: Internal Reproductive Organs (MA-TF), Kidney (MA-SC), Liver (MA-SC5), Ovary (MA-TF), Endocrine (MA-IC3), Anterior Ear Lobe (MA-L).

Suggested that she avoids greasy and spicy foods.

After one course of (four) treatments her energy and sleeping was better. Dizziness and tinnitus reduced, but she still has hot flushes. After another Two courses of (eight) treatments most symptoms have gone.

IV. Personal Experiences

1. Menopause is such a complex disorder, complaints from patients vary and are lengthy, however the treatment principle should be based on the diagnosis and pathogenic factors, it can not just treat the main symptoms.

2. In TCM, Kidney deficiency is the main course in most menopause cases. The treatment principle is to tonify and protect the Kidney Qi. For Yin deficiency, nourish Yin and suppress Yang; Yang deficiency, treatment should tonify Yang and strengthen the Spleen; deficiency of both Yin and Yang, treatment needs to tonify both Ying and Yang, and balance the body; Liver constrained, spread the Liver Qi; Spleen deficiency, strengthen the Spleen.

3. TCM treatments can be discontinued once the distressing symptoms disappear and the hormone balance is restored.

4. Studies show that diet control may be important for the menopause. A sensible well-balanced diet containing essential vitamins and minerals can help the body adapt and adjust more easily to the changes. A good diet contributes effectively to a reduction in heart and blood vessel problems and, according to some experts, can help to prevent or contain the development of cancers. (Dicksson and Henriques, 1987)

5. Women who take physical exercise regularly are thought to have fewer menopausal problems than women who do not. Exercise is important for the body generally and it is good for the circulation and for preventing osteoporosis and weight gain.

Clearly, all women on HRT need to be counseled, especially in the light of the recent findings and made aware of the evidence that the risks of HRT may exceed the benefits. (WHI Web 1; MCA Web 6). Women who have taken HRT for a long time, in particular, need to be advised again and other alternatives, such as Traditional Chinese Medicine, should be considered.

References:

Chen C, Weiss N.S, Newcomb P, Barlow W, White E. (2002) Hormone Replacement Therapy in Relation to Breast Cancer. Journal of American Medical Association, 2002;287: 734-741

Chesler, P. (1979). Menopause: A Positive Approach. The Harvester Press.

Coney, S. (1995). Menopause Industry. The Women’s Press Ltd.

Dickson, A & Henriques, N. (1987). Menopause, The Women’s View. Grapevine.

Stapleton S. （2002）Increased Breast Cancer Risk Causes National Heart, Lung and Blood Institute to Halt Major HRT Study. American Medical News (Jul, 2002)

Utian, W.H. (1990). The Menopause in Perspective: From Potions to Patches. In Multidisciplinary Perspectives on Menopause. Edited by Flint M, Kronenberg F, and Utian W. New York Academy of Sciences.

Web Sources:

1. June 2002 HRT Update. www.whi.org (Women’s Health Initiative)

2. Elliot V.S. (2002) Value of Long-term Hormone Replacement Therapy Questioned. www.ama-assn.org (American Medical Association)

3. Menopause Treatment According to Symptoms. www.cathayherbal.com

4. Hormone Replacement Therapy (HRT) and Breast Cancer: Information For Patients (2002) www.mca.gov.uk (Medicines Control Agency)

5. Products for Relieving Menopausal Symptoms: it’s your choice (2002) www.merck-medco.com

6. Amato P, Christophe S, Mellon P L. Estrogenic Activity of Herbs Commonly used as Remedies for Menopausal Symptoms (2002) The North American Menopause Society www.menopause.org