East Asian Medicine for the treatment of Menopausal symptoms

CASE STUDY 

 Patient: 48, F

 Her symptoms including:

  • Hot flushes

  • Night sweats

  • Frequent urination, waking up 2-3 times at night to urinate

  • Insomnia

  • Backache

  • Hair loss, nails breaking easily

  • Anxiety and mood swings

  • Poor memory

  • Slightly cold feet

  • Tongue: Red tongue with a slightly rootless coating

  • Pulse: Weak and Deep pulse on both Rear positions, Rapid and Overflowing on both Front positions

 Case History:

A 48-year-old female patient, visited our clinic for her menopausal problem of two years. Her gynecologist recommended HRT (Hormone replacement therapy).  She tried it for three months before she could no longer tolerate its severe side effects, such as stomach cramps, headache, and nausea. (HRT involves replacing estrogen and progesterone through pills and patches. While it helps many get through menopause, health risks include increased breast and endometrial cancer and cardiovascular diseases. Also, the side effects may affect some women).

 TCM Diagnosis:

Most of this patient's symptoms are due to deficiency of Kidney-Yin with Empty Heat affecting the Heart and harassing the Mind. The symptoms of Kidney-Yin deficiency are hot flushes, Night sweating, Red tongue with a slightly rootless coating, and a Weak and Deep pulse on both  Rear positions. The symptoms of Empty Heat affecting Heart and harassing the Mind are depression, anxiety, mood swings, insomnia and a pulse that is Rapid and Overflowing on both Front positions. In this case, there is an overlapping of Kidney-Yin and Kidney-Yang deficiency; although the primary condition is one of Kidney-Yin deficiency, there is also some Kidney Yang deficiency as evidenced by the slightly cold feet and frequent urination.

 Treatment principle:

 The treatment principle adopted was to nourish Kidney- and Heart-Yin, clear Heart Empty Heat, and calm the Mind; a secondary aim was to tonify Kidney-Yang. She was treated with acupuncture and Herbal medicine.

1.    Acupuncture

 Acupuncture is a technique for balancing the flow of energy - a life force (chi or qi) that flows through pathways (meridians) in the body, inserting thin needles into specific points on the skin. Acupuncture is known to be effective for reducing the frequency of menopausal symptoms. A recent study found that five weeks of acupuncture reduced hot flashes, night sweats, mood swings, and sleep disruptions in women dealing with menopause.

 Acupuncture points selected, including:

  •  LU-7 Lieque and KI-6 Zhaohai  - to regulate the Directing Vessel, strengthen the Uterus and nourish Kidney-Yin.

  • Ren-15 Jiuwei -  to calm the Mind and clear the Heart.

  • Ren-4 Guanyuan -  to nourish the Kidneys and calm the Mind.

  • Du-24 Shenting and G.B.-13 Benshen -  to calm the Mind.

  • Du-20 Baihui to lift depression.

  • HE-6 Yinxi and KI-7 Fuliu  - to stop night-sweating and clear Heart Empty Heat.

  • SP-6 Sanyinjiao  - to nourish Yin, calm the Mind and promote sleep.

—We scheduled weekly Acupuncture treatment for the patient. After four weeks, her symptoms improved significantly besides occasional Hot flashes. So we added Herbal therapy to her.

 

2. Herbal Therapy:

Base formula: Zhi Bai Di Huang Wan- 知柏地黃丸 - Anemarrhen Rehmannia Eight Formula

 Formula Principles:

  • Enriches Yin, Nourishes the Essence of the Liver and Kidneys, Reduces Deficiency Fire

 Ingredients:

  • Shu Di Huang  Rehmannia Root

  • Shan Zhu Yu   Cornus Fruit

  • Shan Yao         Dioscorea Rhizome

  • Ze Xie             Alisma Rhizome

  • Mu Dan Pi     Moutan Bark

  • Zhi Mu          Anemarrhena Rhizome

  • Huang Bai       Phellodendron Bark

  • Fu Ling            Poria

TCM Pattern:

  • Kidney Yin deficiency with Fire flaring

  • Fire flaring with liver and kidney Yin deficiency

  • Steaming bone disorder

  • Damp-Heat in the lower Jiao

Dosage (for pills):

  • 5-7 pills 2-3 times daily before meals, Take with warm water

Course of treatment

  • 1-2 months

Cautions & Contraindications

  • Use with caution in those with spleen and stomach deficient cold.

 —-After a month of Herbal therapy along with Acupuncture, the patient’s Hot flushes reduced by 50%.

 3.    Healthy Diet

 During the patient’s visits, we advised her what and how should be eaten to keep her body warm and healthy. A healthy, balanced diet can provide a rich supply of calcium, magnesium, vitamin D, and other nutrients required for women going through menopause.

Foods can help strengthen bones and relieve Menopausal symptoms:

  • Dark green leafy vegetables (spinach and kale)

  • Yogurt, Cheese, and Soy milk

  • Fresh Fish (Bluefish, Mackerel, Salmon, and Sardine), Shellfish, and Seaweeds

  • Flax, Chia Seeds, Sesame seeds and Nuts

  • Broccoli, Cauliflower, Carrot, Onion, Ginger,  and Mung bean sprouts

  • Blueberries and other dark berries

  • Soybeans (Miso soup, Natto-fermented soybeans)

  • Multi-grain rice and/or Brown rice

 Foods that may worsen Menopausal symptoms”

  • Processed foods

  • Spicy foods

  • Fast food

  • High-sodium foods

  • Alcohol

  • Caffeine

  • Sweets

  • Raw foods

  • Refined carbohydrates

4.    Daily Exercise

We also gave her advice on simple daily exercise. That helped her to keep muscle and bone strong, increased flexibility, and improved balance. Exercise even kept her mind clear and relieved her symptoms like poor memory and anxiety.

We recommend her:

  • Walking, Yoga, Stretching, Swimming, Water workout, Tai Chi, and Meditation

References:

  • Maciocia, Giovanni, Kaptchuk, Ted J., Obstetrics and Gynecology in Chinese Medicine - 2nd Edition, Churchill Livingstone, June 3, 2011  p. 741-762