Menopausal+Syndrome

Concept: Menopause is the time when menstruation stops permanently -Age 45-55, average 51 in the US

Symptoms
-Irregular or no periods -Hot flashes -Night Sweats -Change in sleep patterns -Dizziness -Headaches -Muscle and Joint Pain -Dry Skin -Palpitations -Tiredness -Vaginal dryness, sometimes causing pain/discomfort during sex -More frequent urination or urinary leakage -More frequent minor vaginal and urinary infections -Loss of sexual desire -Anxiety -Depression -Tearfulness and irritability -Sleeplessness -Loss of sexual desire -Lack of concentration -Trouble remembering things
 * Phyiscal:**
 * Psychological**

TCM Etiology and Pathogenesis
Simple Question: "at age 49 in a woman the Ren vessel becomes deficienct, the Chong vessels depleted, the heavenly Gui dries up, the fluids in the channels are exhausted, her body becomes old and she can no longer become pregnant." Kidney Qi declines gradually Chong & Ren meridians become more deficienct Tiankui (heaven dew) diminishes gradually -Deficiency of Kidney Yin -Deficiency of Kidney Yang

Differentiation Diagnosis
-Rule out internal diseases such as dizziness, palpitations and edema -Rule out abdominal masses (tumor, cancer, or carcinoma)

Kidney Yin Deficiency
Late or scanty periods, red colored menstrual flow or no periods, scanty leukorrhea, vaginal dryness Dizziness, tinnitus, insomnia, dream-disturbed sleep, itchy skin, frequent feverish sensation over the whole body followed by perspiration, paroxysmal flushing of the face, 5-palm heat, sore/weak loins and knees
 * Tongue:** red tongue; little coat
 * Pulse:** fine, rapid
 * Treatment Principles:** Nourish Kidney Yin, Suppress Yang
 * Acupuncture:** //BL-23, KI-3, SP-6, BL-15//, CV-4, HT-6, LR-3
 * Herbal Treatment:** //Zuo Gui Yin// OR //Zhi Bai Di Huang Wan//

Kidney Yang Deficiency
Irregular menstrual cycle, heavy periods, flooding & trickling or no period Loin & knee soreness/weakness, aversion to cold, cold limbs, dark face, puffy face & limbs, poor appetite, loose stools, frequent clear & profuse urination or urinary incontinence Li Zhong Wan: [Ren Shen (6g.), Bai Zhu (9g.), Gan Jiang (5g.), Gan Cao (6g.)] can add Fu Zi
 * Tongue:** Pale & tender tongue w/ teeth marks; thin white coat
 * Pulse:** Deep fine or fine weak
 * Treatment Principles:** Warm Kidney Yang, Warm middle jiao and strengthen Spleen
 * Acupuncture:** //LR-3, PC-6, GB-34, LR-14, CV-12, ST-36//, GB-24
 * Herbal Treatment:** //You Gui Wan & Li Zhong Wan, or Ji Sheng Shen Qi Tang//

Yin and Yang Deficiency
Both Yin & Yang deficiency, sometimes aversion to cold, sometimes tidal fever & sweating, tinnitus, soreness of loins and knees, lassitude [Xian Mao (10g.), Xian Ling Pi [Yin Yang Huo] (10g.), Ba Ji Tian (10g.), Dang Gui (8g.), Huang Bai (10g.), Zhi Mu (10g.)] + [Nu Zhen Zi (10g.), Han Lian Cao (10g.)]
 * Tongue:** Thin white coat
 * Pulse:** Fine
 * Treatment Principles:** Supplement Kidney Yang, Nourish Yin & Supplement Chong & Ren
 * Acupuncture:** //BL-23, KI-3, SP-6, GV-4, BL-15//, KI-6, KI-7, ST-36
 * Herbal Treatment:** //Er Xian Tang// + //Er Zhi Wan//

Geng Nian Kang (Liang Jianbo) [Xuan Shen (10g.), Dang Shen ( 10g.), Mai Men Dong (5g.), Shu Di Huang (12g.), Suan Zao Ren (10g.), Dang Gui (3g.), Fu Xiao Mai (10g.), Yuan Hu Suo (6g.), Mu Li (15g.), Jie Geng (5g.), Dan Shen (10g.), Tian Men Dong (5g.), Sheng Di Huang (12g.), Bai Zi Ren (12g.), Yuan Zhi (5g.), Fu Ling (10g.), Bai Shao (10g.), Long Gu (15g.), Wu Wei Zi (5g.)]

More HT/emotional directed: Qing Xin Ping Gan Tang (Clear heart and calm the Liver Decoction) from Qiu Xiaomei [Huang Lian (3g.), Mai Men Dong ( 9g.), Bai Shao (9g.), Bai Wei (9g.), Dan Shen (9g.), Long Gu (15g.), Suan Zao Ren (9g.)]

Sheng Hua Tang (Generate Transformation Decoction) for women following child birth, generally not taken longer than 1 week: [Dang Gui (g.), Chuan Xiong (g.), Tao Ren (g.), Pao Jiang (g.), Gan Cao (g.)]

To treat or prevent osteoporosis - risedronate (Actonel), alendronate (Fosamax), raloxifene (Evista) Weight-bearing exercise such as walking regularly Calcium supplement with vitamin D
 * Osteoporosis** is associated with low estrogen

-Regular exercise A healthy, calcium-rich diet that includes foods with estrogen-like substances - soybean products and whole grain -Reduce stress -Hot Flashes: progesterone, clonidine, or combination of belladonna alkaloids & phenobarbital may be take Estrogen-like plants: soybean products, rhubarb, carrots, whole grains
 * Lifestyle change**