Phyto B 240 count

 

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Menopausal syndrome varies markedly among women.  The most common symptoms include hot flushes (often called hot flashes, but the disorder involves red "flushing" of the skin), dryness and thinning of skin and vaginal wall, mood swings and depression, and insomnia.  In addition, there is often a gradual weakening of the bones (reduction of bone density) known as osteoporosis that eventually leads to easy fracture.  All of these symptoms are the result of declining levels of sex hormones, especially estrogens. 

In seeking information about potential Chinese herbal therapies for menopause, one is directed to the modern rather than the traditional practices.  This is because there is limited reference to this problem in older Chinese medical literature.  As an example, in the highly respected 14th century book Danxi Zhifa Xinyao (1), there are chapters on gynecology and childbearing, but just a single mention of menopause, with reference to a problem of abdominal pain said to be the result of menopause. 

It is unclear to what extent the various menopausal symptoms had been experienced by women in the Orient prior to the modern era.  Several factors could have contributed to a low level of concern for menopausal symptoms.  There are significant differences between Chinese women in past centuries and modern Western women, in dietary constituents, amount of manual labor, frequency of child bearing, and life span, affecting the incidence and nature of various menopausal symptoms.  There could also have been a less frequent seeking of medical attention for menopausal syndrome which, even if the symptoms were significant, might not have been deemed serious enough to require treatment.  By contrast, women today are asked to address the long-term implications of menopause, such as osteoporosis and the risk of heart disease, even if their symptoms of menopause are currently negligible.  The occurrence of symptoms, even if not severe, simply increases the urgency of this already-expected seeking of assistance.

Although little valuable information about early treatments for menopause is available, we do have access to an ancient description of female aging and loss of fertility from the first pages of the Neijing Suwen (ca. 100 B.C.).  The changes in the body are depicted in seven year intervals (2):

At 28 years, the bones and tendons are well developed and the hair and secondary sex characteristics are complete.  This is the height of female development.  At 35 years, the stomach and large intestine channels (yangming channels) that govern the major facial muscles begin to deplete: the muscles begin to atrophy, facial wrinkles appear, and the hair begins to thin.  At 42, all the yang channels (taiyang, shaoyang, yangming) are exhausted, the entire face is wrinkled, and the hair begins to turn gray.  At 49 years, the ren and chong channels are completely empty, and the tiangui has dried up.  Hence, the flow of menses ceases and the woman is no longer able to conceive.

This description still applies reasonably well, though we know that each individual women ages differently and not precisely according to a set 7-year cycle.  The main difference between modern experience and this description is that with skin care products, modern diet (rich in vitamins), and less sun exposure, fewer women have their entire face wrinkled by age 42.  In the same text, there is an explanation for the rare cases where older men and women are still able to have children.  This capability is said to be due to two factors:

These individuals inherited an unusual abundance of jing and also realized how to lead their lives properly and protect their vitality.  At age 64 for males and 49 for females, these individuals still have excess kidney energy as well as qi and blood, so they still have the capacity to procreate.

For those who have not inherited an abundance of jing or have not protected it via their lifestyle, herbalists hold out some hope, if not for restoration of fertility, at least for fewer signs of the associated aging process, by providing tonics that nourish the kidney energy, the qi, and the blood.  Such treatment may slow down the physiological changes that lead to uncomfortable menopausal symptoms.

FORMULAS RECOMMENDED FOR MENOPAUSE

Rehmannia, because it is said to nourish yin and blood, benefit the kidney and marrow, and reduce fevers (see: Rehmannia), is an herb commonly selected for treatment of menopause by modern Chinese doctors.  This herb is often used in the context of a formula that is focused on nourishing kidney yin or kidney yang or both, depending on the needs of the individual.  Following are several currently-recommended menopause formulas derived from several modern Chinese textbooks that have been translated to English, and from one article that presented a survey of several clinical practices in China.  These formulas are described in terms of a one-day dose in decoction form; the amounts are in grams.  Most herbs are prescribed in the standard doses of 9–15 grams, with larger amounts of the mineral materials (e.g., 30 grams for dragon bone, dragon tooth, oyster shell), and smaller amounts for strong-acting herbs, such as aconite, cinnamon bark, and coptis, or for herbs that are added to benefit the stomach function, such as ginger, jujube, and licorice (when licorice is not also a main herb of the formula).  Rehmannia is sometimes used in heavy doses of 24 grams or more.

From Clinic of Traditional Chinese Medicine (3):

Deficiency of Kidney Yin	Deficiency of Kidney Yang	Deficiency of Yin and Yang
Rehmannia, cooked: 24	Rehmannia, cooked: 24	Rehmannia, cooked: 9
Dioscorea: 12	Cornus: 9	Tang-kuei: 9
Cornus: 9	Aconite: 6	Anemarrhena: 9
Lycium: 12	Cinnamon bark: 6	Phellodendron: 9
Peony: 12	Antler gelatin: 9	Curculigo: 9
Uncaria: 12	Eucommia: 9	Epimedium: 9
Tortoise shell: 9	Cuscuta: 9	Morinda: 9
Placenta: 12	Epimedium: 9	Ligustrum: 9
Ligustrum: 9	Codonopsis: 12	Eclipta: 9
Eclipta: 9	Atractylodes: 12
	Ginger: 3
	Baked licorice: 12

From English-Chinese Encyclopedia of Practical Traditional Chinese Medicine (4):

Kidney Yin Deficiency	Kidney Yang Deficiency
Rehmannia, cooked: 15	Rehmannia, cooked: 15
Dioscorea: 15	Dioscorea: 15
Cornus: 12	Cornus: 12
Hoelen: 12	Lycium: 15
Lycium: 18	Cinnamon bark: 6
Peony: 15	Aconite: 6
Licorice: 6	Cuscuta: 24
Dragon bone: 30	Antler gelatin: 12
Oyster shell: 30	Eucommia: 30

From Clinical Manual of Chinese Herbal Medicine and Acupuncture (5):

Deficiency of Kidney Yin	Deficiency of Kidney Yang
Rehmannia, cooked: 10	Rehmannia, raw: 10
Dioscorea: 10	Cornus: 10
Cornus: 10	Hoelen: 10
Lycium: 10	Lycium: 10
Uncaria: 15	Epimedium: 6
Maurita shell (zibeichi): 15	Curculigo: 6
Lotus plumule: 3	Codonopsis: 10
	Atractylodes: 10
	Uncaria: 10
	Maurita shell: 10
	Ginger: 6
	Citrus: 6

From A Clinical Guide to Chinese Herbs and Formulas (6):

Deficiency of Kidney Yin Hyperactive Liver Yang	Deficiency of Spleen and Kidney
Rehmannia, raw: 15–30	Rehmannia, cooked: 15–30
Dioscorea: 15	Dioscorea: 15
Cornus: 10	Cornus: 10
Hoelen: 10	Lycium: 10
Moutan: 10	Aconite: 2–5
Lycium: 10–15	Cinnamon bark: 2–5
Tortoise shell: 10–15	Deer antler: 5–10
Anemarrhena: 10	Cuscuta: 15
Phellodendron: 10	Tang-kuei: 10
Dragon bone: 15	Codonopsis: 10
Oyster shell: 15–20	Atractylodes: 10

In Treatment of Knotty Diseases with Chinese Acupuncture and Chinese Herbal Medicine (11): the author suggests the bolus of Rehmannia Six Formula (Liuwei Dihuang Wan) with Bupleurum and Tang-kuei Formula (Xiaoyao Wan), each one 6 grams each time, three times daily, for predominance of yin deficiency.  Alternatively, for predominance of yang deficiency, use the bolus of Rehmannia Eight Formula (Jingui Shenqi Wan) with the bolus of Ginseng Spleen Tonic Pills (Renshen Jianpi Wan), each one 6 grams each time, three times daily.  Alternatively, he recommends the following general formula, a modification of Rehmannia Six Formula called Zishui Qinggan Yin, which is designed to specifically aid psychological distress as a manifestation of menopause:

Rehmannia (half raw, half cooked): 20

Dioscorea: 12–15

Cornus: 10

Moutan: 10–12

Alisma: 12

Hoelen: 15

Epimedium: 12

Bupleurum: 10–12

Zizyphus: 30

Lily: 21–24

Gardenia and peony could be added to this prescription for symptoms of irritability and prolonged feeling of heat.  The large dose of zizyphus and lily is directed at treating insomnia and night sweating.  Further modifications of the formula are recommended for various syndromes; for example, if there is yin deficiency of liver and kidney, one can add anemarrhena, scrophularia, tortoise shell, dragon’s tooth, and magnetite. 

From Menopause syndrome treated by traditional Chinese medicine (7):

The author reports that "the classic formula" and "the one considered most effective for menopausal syndrome" is Zuogui Yin modified with tortoise shell, ligustrum, and epimedium, as follows:

Rehmannia, cooked: 15

Dioscorea: 20

Cornus: 15

Hoelen: 20

Lycium: 15

Tortoise shell: 30

Ligustrum: 15

Epimedium: 6

Baked licorice: 5

He then relayed the recommendations at several hospitals and colleges around China.  Some examples of those treatments follow.

The Shanghai College of Traditional Chinese Medicine recommends three formulas:

Deficiency of Kidney Yin	Deficiency of Kidney Yang	Deficiency of Yin and Yang
Rehmannia, raw: 15	Ginseng: 9	Rehmannia, cooked: 20
Dioscorea: 15	Tang-kuei: 6	Dioscorea: 10
Cornus: 10	Atractylodes: 9	Cornus: 15
Hoelen: 12	Hoelen: 12	Lycium: 15
Alisma: 9	Zizyphus: 12	Tortoise shell: 20
Moutan: 6	Ginger, fresh: 3	Anemarrhena: 9
Anemarrhena: 9	Aconite: 3	Phellodendron: 9
Phellodendron: 9	Astragalus: 12	Aconite: 6
Magnetite: 20	Longan: 12	Cinnamon bark: 3
Shen-chu: 12	Saussurea: 6	Licorice, baked: 6
Cinnabar: 3	Polygala: 9
	Licorice, baked: 6
	Jujube: 5

Beijing City Hospital of Traditional Chinese Medicine recommends these formulas:

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Deficiency of Liver and Kidney	Deficiency of Kidney Yang	Kidney and Heart not Communicating
Rehmannia, raw: 15	Curculigo: 15	Rehmannia, raw: 15
Rehmannia, cooked: 15	Epimedium: 15	Rehmannia, cooked: 15
Lycium: 15	Morinda: 15	Cornus: 10
Tortoise shell: 20	Tang-kuei: 15	Fu-shen: 10
Morus fruit: 15	Codonopsis: 15	Lycium: 15
Oyster shell: 30	Deer antler: 15	Ligustrum: 10
Dragon bone: 30	Fenugreek: 15	Asparagus: 10
	Cuscuta: 15	Lily: 10
		Lotus heart: 6
		Dragon teeth: 30
		Scrophularia: 15
		Ophiopogon: 10
		Polygala: 6
		Coptis: 5

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