First Consensus Meeting on Menopause in the East Asian Region

Traditional Chinese medicine in the treatment of the menopause

Dong Hong guang, F. Lüdicke, Zheng Shu-Rong and A. Campana
Clinic of Infertility and Gynaecological Endocrinology, Geneva University Hospital, Geneva, Switzerland

Background

Traditional Chinese medicine (TCM) holds a systems and holistic view with regard to the physiology and pathology of the human body as well as the diagnosis, prevention and treatment of diseases. It uses Yin Yang and Five Elements as its theoretical tools, and zang-fu (visceral organs) and the meridians as its theoretical basis. According to TCM, qi (vital energy), ‘blood’ and ‘body fluid’ are the fundamental substances which make up the human body and maintain its normal physiological functioning. In the diagnosis and treatment of diseases, the basic characteristic of TCM which sets it apart from modern Western medicine is that of ‘syndrome differentiation’.

TCM has been practised for more than 3000 years in the East. Its related systems have seen rapidly growing acceptance in the West, for the simple reason that they work. An excellent example was the convening and particularly the observations made at the First Consensus Development Conference on Acupuncture held by the US National Institutes of Health. The chairman of the expert panel, Dr David J. Ramsay, President of the University of Maryland, Baltimore, noted that the data supporting acupuncture are ‘as strong as those for many accepted Western medical therapies’ [1].

TCM considers zang-fu as a comprehensive system of physiological functions rather than anatomical entities as is the case in Western medicine. Among the organs in zang-fu, the ‘heart’, ‘liver’, ‘spleen’, ‘lung’ and ‘kidney’ are the main systems, and all other organs and tissues are viewed in connection with them. For instance the
‘kidney’ in TCM is much more than the organ that secretes urine. It stores the essence of life, either inborn or acquired, and is in charge of reproduction, growth and development. The brain, marrow and bones are all related to the ‘kidney’. In addition, it helps the ‘lung’ to inhale air (in TCM the ‘lung’ also has other functions). Research has revealed that the concept of ‘kidney’ in TCM actually refers to several systems in Western medicine, including the urogenital system, endocrine system, part of the immune system and the higher nervous system [2].

It would be useful to point out that the holistic approach of TCM is a concept which not only treats the human body as an integrated whole, but also considers the human body to be one part of the universe. On the one hand, the natural world constantly influences the human body; on the other, the human body adapts to variations in the natural environment. Diseases arise when an imbalance occurs in either of these relations, or in terms of TCM, the balance of Yin and Yang has been disrupted.

Physiology of menstruation

According to Huangdi Neijing Su Wen (The Yellow Emperor’s Canon of Medicine) [3], menstruation is a normal physiological phenomenon caused by the combined actions of the meridians and collaterals, zang-fu organs, qi and ‘blood’ onto baogong (uterus). The normal functioning of menstruation is actuated only when the following conditions are satisfied, namely, that the ‘kidney’ should be fully filled with vital essence; tiangui, which in Western medicine might be compared to hormone functioning accumulated to the extent where it starts to secrete; and the chong and ren meridians should be unencumbered (overflowing with qi). In TCM, the main component of menstruation is ‘blood’. The formation, control and circulation of ‘blood’ depend on the genesis and regulation of qi, while qi and ‘blood’ stem from zang-fu organs. For instance, ‘blood’ is produced from the food essence absorbed by the ‘spleen’; ‘blood’ carries nutrients through the vessels; circulation is promoted by the ‘heart’ with the help of the ‘lung’, controlled by the ‘spleen’ which keeps the blood flowing within the vessels and regulated by the ‘liver’ which serves as a reservoir for ‘blood’; the ‘kidney’ is also closely related to the production of ‘blood’ as it stores vital essence which may transform into ‘blood’.

In short, when zang-fu organs function properly and exist in harmony with one another; qi and ‘blood’ circulate smoothly; with chong and ren meridians unencumbered, all these elements will coordinate to act on the baogong, maintaining a regular menstrual cycle.

The menopause

According to TCM, throughout the period of the climacteric, physiologically speaking, women experience a gradual weakening of the kidney qi (functioning of the ‘kidney’), a deficiency of the chong and ren meridians, depletion of tiangui, and an insufficiency of qi and ‘blood’; thereby, the Yin and Yang of the ‘kidney’ are liable to be out of equilibrium. As the human body is an integral whole, zang-fu organs constantly inter-promote and inter-restrain each other. The deficiency of the ‘kidney’ will affect other zang-fu organs, leading to a disequilibrium in the functioning of the entire zang-fu system, and giving rise to a series of symptoms. Therefore, in treating the menopause, it is first of all necessary to understand that the syndrome is caused by a deficiency of the ‘kidney’; secondly, to ascertain whether the syndrome is caused by a deficiency of Yin or Yang, or both Yin and Yang, in the ‘kidney’; and thirdly, to identify which of the other zang-fu organs have been affected by this deficiency. Treatment can only be administered on this basis.

Deficiency of Yin in the ‘kidney’

Deficiency of the kidney Yin is caused by depletion of the kidney Yin due to protracted illnesses that impair the ‘kidney’, intemperate sexuality, multiple pregnancy, or loss of blood. In addition, it should be noted that physiologically, in the period of the climacteric, a woman’s tiangui has reached the point of exhaustion. An insufficient kidney Yin cannot fulfil its function of harmonizing the ‘heart fire’; as a result, the equilibrium between the ‘heart’ and the ‘kidney’ breaks down, in other words, a discord between ‘heart’ and ‘kidney’ occurs.

A deficiency of Yin in the ‘kidney’ can also affect the liver Yin. Since, physiologically, TCM views the ‘kidney’ and the ‘liver’ as having the same source and the ‘Yin fluids’ of the ‘kidney’ and the ‘liver’ as being mutually promoting, an insufficient kidney Yin will also fail to nourish the ‘liver’, causing insufficiency in the liver Yin, leading to hyperactivity of the liver Yang.

Deficiency of Yang in the ‘kidney’

Deficiency of the kidney Yang is usually the result of an inborn insufficiency of Yang in the patient’s body, but it can also be caused by mingmen huoshuai (a declined fire of the vital gate) in the aged person, an excessive intake of cold foodstuffs, or the injury of the ‘kidney’ due to chronic diseases and intemperate sexuality.

The kidney Yang regulates the ‘water metabolism’, warms the body and energizes the ‘spleen’ for food digestion. Pathologically speaking, a deficient kidney Yang cannot warm the spleen Yang, which will result in a deficiency of both.

‘Syndrome differentiation’ and the treatment of common syndromes

The syndromes of deficiency of the kidney Yin

Deficiency of the kidney Yin and the ‘internal heat’

— Primary manifestations: Hot flushes and sweating; weakness of the lower back and knees; dizziness; feverish sensation in the palms and soles; dryness of the mouth, skin and vagina; amnesia; constipation; reddened tongue with thin, dry coating; thready, rapid pulse.

— Principle of treatment: Nourish kidney Yin and clear away heat.

— Prescription: Zuogui wan (bolus for kidney Yin replenishment) [4].

• Ingredients:

Prepared rehmannia root, Radix rehmanniae praeparata 24 g

Chinese yam, Rhizoma dioscoreae 12 g

Wolfberry fruit, Fructus lycii 12 g

Dogwood fruit, Fructus corni 12 g

Dodder seed, Semen cuscutae 12 g

Achyranthes root, Radix achyranthis bidentatae 9 g

Tortoise-plastron glue, Colla plastri testudinis 12 g

Antler glue, Colla cornus cervi 12 g

• Administration and dosage: In the form of honeyed boluses, 9 g, twice daily.

— Acupuncture treatment:

• Principal points: Shenshu (BL 23), Taixi (KI 3), Sanyinjiao (SP 6), Zhigou
(SJ 7), Dazhui (GV 14), Gaohuang (BL 43), Quchi (LI 11).

Discord between ‘heart’ and ‘kidney’

— Primary manifestations: Fidgets; insomnia; palpitations; soreness and weak sensation in the lower back; amnesia; hot flushes and sweats; reddened tongue with scanty or no coating; thready, rapid pulse.

— Principle of treatment: Harmonizing the ‘heart’ and the ‘kidney’, relieving mental distress, calming the mind.

— Prescription: (1) Zuogui wan (bolus for kidney Yin replenishment, see above), and (2) Bu Xin Dan (cardio-tonic pill) [5].

• Ingredients:

Dried rehmannia root, Radix rehmanniae 24 g

Scrophularia root, Radix scrophulariae 12 g

Arborvitae seed, Semen biotae 12 g

Ophiopogon root, Radix ophiopogonis 9 g

Dangshen, Radix codonopsis pilosulae 12 g

Red sage root, Radix salviae miltiorrhizae 12 g

Poria, Poria 20 g

Platycodon root, Radix platycodi 10 g

Polygala root, Radix polygalae 12 g

Wild jujube seed, Semen ziziphi spinosae 18 g

Radix asparagus cochinchinensis 20 g

Chinese angelica root, Radix angelicae sinensis 16 g

Schisandra fruit, Fructus schisandrae 6 g

• Administration and dosage: In the form of honeyed pills, 6 g, twice daily.

— Acupuncture treatment:

• Principal points: Shenshu (BL 23), Zhaohai (KI 6), Xinshu (BL 15), Shenmen (HT 7), Baihui (CV 20), Sanyinjiao (SP 6).

Deficiency of the liver Yin and kidney Yin

— Primary manifestations: Hot flushes and sweating; dizziness; tinnitus; irritability; headache; reddened tongue with scanty coating; taut, forceful, or taut, thready and rapid pulse.

— Principle of treatment: Nourish the liver Yin and kidney Yin while calming the liver Yang.

— Prescription: Qiju Dihuang Wan (bolus of rehmannia with wolfberry and chrysanthemum).

• Ingredients:

Wolfberry fruit, Fructus lycii 80 g

Chrysanthemum flower, Flos chrysanthemi 60 g

Prepared rehmannia root, Radix rehmanniae praeparata 160 g

Chinese yam, Rhizoma dioscoreae 80 g

Dogwood fruit, Fructus corni 80 g

Poria, Poria 60 g

Alismatis rhizome, Rhizoma alismatis 60 g

Moutan bark, Cortex moutan radicis 60 g

• Administration and dosage: In the form of honeyed pills, 6 g, three times daily.

— Acupuncture treatment:

• Principal points: Shenshu (BL 23), Taixi (KI 3), Sanyinjiao (SP 6), Fengchi (GB 20), Dazhui (GV 14), Ganshu (BL 18), Gaohuang (BL 43).

The syndromes of deficiency of the kidney Yang

Deficiency of the kidney Yang

— Primary manifestations: Pallor or sallow complexion; aversion to cold; weakness of the lower back and knees; sexual hypaesthesia; frequent and profuse urine or urinary incontinence; pale, flabby tongue with white coating; deep weak pulse, worse on the chi of both wrists.

— Principle of treatment: Warming and reinforcing the ‘kidney’.

— Prescription: Yougui wan (bolus for invigorating the kidney Yang) [4].

• Ingredients:

Prepared rehmannia root, Radix rehmanniae praeparata 24 g

Dogwood fruit, Fructus corni 12 g

Chinese yam, Rhizoma dioscoreae 12 g

Wolfberry fruit, Fructus lycii 12 g

Dodder seed, Semen cuscutae 12 g

Antler glue, Colla cornus cervi 12 g

Eucommia bark, Cortex eucommiae 12 g

Chinese angelica root, Radix angelicae sinensis 9 g

Cinnamon bark, Cortex cinnamoni 12 g

Prepared aconite root, Radix aconiti lateralis praeparata 6 g

• Administration and dosage: In the form of honeyed boluses, 9 g, twice daily.

— Acupuncture treatment:

• Principal points: Shenshu (BL 23), Dazhui (GV 14), Mingmen (GV 4), Guanyuan (CV 4), Pangguangshu (BL 28), Sanyinjiao (SP 6).

Deficiency of the spleen Yang and kidney Yang

— Primary manifestations: Pallor or sallow complexion; general lassitude; palpitations; soreness and weakness of the lower back and knees; spontaneous sweating; cold limbs; abdominal distention; poor appetite; oedema of the lower extremities; menorrhagia; pale tongue with teeth prints and white coating; thready and weak pulse.

— Principle of treatment: Warming and invigorating the Yang of both the spleen and kidney.

— Prescription: Yougui wan (bolus for invigorating the kidney Yang, see above) and Lizhong Tang (decoction for regulating Middle-jiao) [4].

• Ingredients: Lizhong Tang

Pilose asiabell root, Radix codonopsis pilosulae 9 g

Dried ginger, Rhizoma zingiberis 6 g

White atractylodes rhizome, Rhizoma atractylodis macrocephalae 9 g

Prepared liquorice, Radix glycyrrhizae praeparata 6 g

• Administration and dosage: Soak ingredients in 600 ml cold water for 30 min, bring to boil then reduce to 200 ml on a low heat; 50 ml, twice daily.

— Acupuncture treatment:

• Principal points: Shenshu (BL 23), Mingmen (GV 4), Qihai (CV 6), Taixi (KI 3), Pishu (BL 20), Gongsun (SP 4), Zusanli (ST 36), Zhongwan (CV 12).

Deficiency of both the kidney Yin and kidney Yang

— Primary manifestations: Pallor or sallow complexion; general lassitude; palpitations; shortness of breath; soreness and weakness of the lower back and knees; hot flushes and sweating; hyposexuality.

— Principle of treatment: Replenish kidney Yin and kidney Yang.

— Prescription: Zuogui wan and Yougui wan (modified) [6].

• Ingredients:

Prepared rehmannia root, Radix rehmanniae praeparata 24 g

Chinese yam, Rhizoma dioscoreae 12 g

Wolfberry fruit, Fructus lycii 12 g

Dogwood fruit, Fructus corni 12 g

Dodder seed, Semen cuscutae 12 g

Achyranthes root, Radix achyranthis bidentatae 9 g

Tortoise-plastron glue, Colla plastri testudinis 12 g

Antler glue, Colla cornus cervi 12 g

Eucommia bark, Cortex eucommiae 12 g

Chinese angelica root, Radix angelicae sinensis 9 g

Cinnamon bark, Cortex cinnamoni 12 g

Prepared aconite root, Radix aconiti lateralis praeparata 6 g

• Administration and dosage: In the form of honeyed boluses, 9 g, twice daily.

— Acupuncture treatment:

• Principal points: Shenshu (BL 23), Dazhui (GV 14), Qihai (CV 6), Taixi (KI 3), Gaohuang (BL 43), Sanyinjiao (SP 6), Zusanli (ST 36), Jingmen (GB 25).

References

1. Holden C. Thumbs up for acupuncture. Science 1997; 278: 1231.

2. Xie ZF. Introduction to basic medical theories. In: Xie ZF, ed. Best of traditional Chinese medicine. Beijing: New World Press, 1995; 9–24.

3. Shang gu tian zhen lun pian di yi (Primary energy). In: Huangdi Neijing Su Wen (The Yellow Emperor’s Canon of Medicine) (in Chinese). Beijing: People’s Health Publication House, 1982; 1–15.

4. Xie ZF. Selected formulae and patent (ready-to-use) medicines. In: Xie ZF, Liao JZ, eds. Traditional Chinese internal medicine. Beijing: Foreign Language Press, 1993; 157–82.

5. Luo YK, Zeng JG, eds. Menopause syndromes. In: Gynecology in Chinese medicine (in Chinese), textbook for medical and pharmacological universities. Shanghai: Shanghai Science and Technology Publishing House, 1984; 86–9.

6. Yang SS et al. Climacteric syndromes. Encyclopedia of clinical Chinese medicine (in Chinese). 1996; 615.