Menopausal+Disorder+(Jue+Jing+Qian+Hou+Zhu+Zheng)

Persisting psychosomatic symptoms that begin shortly before or after onset of menopause.

Relevant Western Diseases: Menopausal syndrome, menopausal depression, menopausal psychosis, hormonal dysfunction, menstrual disorder, fatigue syndrome, fibromyalgia

Diagnosis: A. Around age 49 in females and 64 in males, may vary B. Impotence, low sexual desire and irregular menstruation C. Depression, moody, suspiscious, anxiety, jealous and nervous D. Weakness, tiredness and emaciation E. Hot flushes, irregular or improper sweating F. Complicated physical symptoms G. Hallucination and illusion H. Laboratory examination evidence in menopausal syndrome Should have A, B, C and then refer others to confirm the diagnosis

Prognosis: In general menopausal syndromes are the second most dramatic crisis time during human life, following adolescence. During menopause the body functions are getting weak and activities are slowing down. After the menopausal period, the body is reorganized on a new harmonious level, albeit a lower energy level than before menopause. In other words, the body will be harmonized in its new situation, but totally changed; the patient is no longer a youg person and the body is ready to undergo the aging process. In almost all cases, people understand and accept this reality as a natural phenomenon which follows life principles. Along with the physical changes of menopause the state of Shen is also changing. According to individual personal experiences, Shen activity and processing become more complex; thus, thinking, emotion, and motivation are recognized in a more matured state2

Differential Diagnosis: Medical Disorders: A. Alheimer’s Disease and other dementias B. Brain tumors, including tumors of the pituitary C. Other primary CNS diseasesHypoparathyroidism or Hyperparathyroidism D. Hypothyroidism E. CNS effects of diabetes Effects of Substances: A. Alcohol or illicit substance intoxication or withdrawal B. Side effects of medications Psychiatric Disorders: A. Major Depressive Episode B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> Dysthymia C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> Cyclothymia D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> Bipolar Disorder (I or II)

TCM Etiology and Pathogenesis: “After the energetic peak of the 4th life cycle, the body energy starts to get weaker and slows down, especially the Liver and Kidneys; so when the female reaches 49 and males reach 64, tis is the most common for menopausal syndromes according to TCM (after 7 life cycles for women and 8 for men). Personal stress levels, growth environment, lifestyle, and disease history can dramatically accelerate or delay the onset of menopausal symptoms. At the same time Shen and emotional disharmonies accompany the organ disharmony in leading to the middle age Shen crisis Middle aged adults are under very heavy pressure from society, family, and their own bodily changes; in general, the stress level during this time in life is high.”2

“The weakening and decline of the kidneys by themselves are not sufficient to create the kinds of symptoms one finds in women with perimenopausal syndrome, and this is especially so when it comes to perimenopausal mood disorders. While some perimenopausal essence spirit disturbances may be due to insufficient nourishment and construction of the heart spirit by essence and blood, most are complicated by one or more species of evil Qi. These evil Qi include Qi stagnation, blood stasis, phlegm turbidity, depressive heat, damp heat, and/or vacuity heat. Evil heat harasses the spirit causing it to be restless, while phlegm turbidity and blood stasis mist the clear orifices and obstruct the network vessels respectively.” 2

TCM Pattern Differentiation: Kidney and Liver Yin Deficiency, Shen Irritable 2 Hot flashes, feeling of heat in body, 5-palm heat, dry mouth and thirst, yellow and scanty urination, symptoms worse in afternoon and night, weakness and emaciation, irritable, easy waking, moody and depressed, low sexual desire, irregular menstruation, vaginal dryness, lower back sore & achy, constipation, insomnia, dry mouth w/out desire to drink, blurred vision, dizziness, tinnitus, menses sometimes profuse sometimes scanty, possible spotting without cessation, pale red blood -KI-3, SP-6, CV-4, BL-23, HT-7, PC-6. Even technique1 -KI-2, KI-3, KI-6, LR-3, LR-8, HT-6, PC-7, Yintang2 -//Geng Nian An Tang// – [Sheng Di (12-24g.), Shu Di (12-24g.), He Shou Wu (12-24g.), Ze Xie (10g.), Fu Ling (10-15g.), Dan Pi (6-10g.), Xuan Shen (10-15g.), Mai Dong (10-12g.), Wu Wei Zi (10-12g.), Shan Zhu Yu (10g.)]1 Profuse sweating1: + Fu Xiao Mai, Kang Gu Lao; + LI-4, KI-7 Heart vexation1: + Zhi Zi, Dan Dou Chi Profuse dreams1: + Bai Shao, Mu Gua Insomnia1: + Ci Shi, Zhen Zhu Mu, Ye Jiao Teng Headache1: + Man Jing Zi, Bai Zhi, Ju Hua Dizziness1: + Shi Hu, Jie Geng, Gan Cao Complicated by fire effulgence1: Use //Zhi Bai Di Huang Wan Jia Wei// – [Shu Di (12-24g.), Shan Zhu Yu (10g.), Shan Yao (10g.), Fu Ling (10-15g.), Ze Xie (10g.), Dan Pi (10g.), Huang Bai (10-12g.), Zhi Mu (10-12g.), Mu Li (12-30g.), Long Gu (12-30g.)1
 * Tongue:** dry red tongue, scanty or no coat
 * Pulse:** thready, rapid, bowstring
 * Treatment Principles:** Enrich Yin and nourish the liver
 * Acupuncture Treatment:**
 * Herbal Treatment:**
 * -**[Gou Qi Zi, Ju Hua, She Di Huang, Shan Yu Rou, Sha Yao, Shan Zhu Yu, Ze Xie, Fu Ling, Mu Dan Pi, Zhi Mu, Gui Ban]2
 * Modifications:**

Kidney and Spleen Yang Deficiency, Shen Weakness 1,2 Cold extremities and body, especially lower limbs, sluggish, retardation, low energy and appetite, loose stools or diarrhea, lower back sore and achy w/ cold feeling, may be swollen, pale complexion, Shen is weak, timid and depressed, low libido, impotence, dysmenorrhea and irregular menstruation, pale colored menses, profuse white watery vaginal discharge -BL-20, BL-21, BL-23, GV-4, CV-8, ST-36. Moxa1 -KI-3, KI-7, SP-3, SP-5, CV-4, CV-6, ST-36, GV-20, GV-242 Diarrhea/abdominal distention due to liver-spleen disharmony1: - Dang Gui; + Bai Zhu, Chen Pi, Fang Feng, Bai Shao Profuse menstruation or flooding1: + Ce Bai Ye, Zong Lu, San Qi Edema of face and feet1: - Shu Di; + Fu Ling Pi, Huang Qi, Feng Ji
 * Tongue:** pale puffy tongue w/ teeth marks, white slippery coat
 * Pulse:** deep, weak or deep, fine, forceless
 * Treatment Principles:** Warm and supplement the kidneys and spleen
 * Acupuncture Treatment:**
 * Herbal Treatment:**
 * -** //You Gui Wan Jia Wei// – [Shu Di (12-24g.), Fu Zi (6-10g.), Rou Gui (6-10g.), Dang Shen (10-18g.), Bu Gu Zhi (10g.), Xian Mao (10-15g.), Xian Ling Pi (10-15g.), Shan Zhu Yu (10g.), Gou Qi Zi (10g.), Shan Yao (10g.), Du Zhog (10-12g.), Dang Gui (10g.), Tu Si Zi (10g.), Lu Jiao Jiao (10g.)] 1
 * -**[Shu Fu Zi, Rou Gui, Shu Di Huang, Shan Yao, Du Zhong, Xu Duan, Yin Yang Huo, Fu Ling, Ze Xie, Yi Yi Ren]2
 * Modifications:**

Heart and Kidney not Communicating 1 Scanty menses that is pale red in color or blocked menstruation, dizziness, tinnitus, vexation and agitation, insomnia, heart palpitations, impaired memory, low back and knee soreness and weakness, tidal heat, night sweats, constipation, short redish urination, flushed red complexion, dry throat with no desire to drink [Shu Di (12-24g.), Shan Zhu Yu (9g.), Shan Yao (9g.), Fu Ling (9-15g.), Dan Pi (9g.), Ze Xie (9g.), Huang Lian (6-15g.), E Jiao (9g.), Huang Qin (9-12g.), Bai Shao (9g.), Ji Zi Huang (2-3 pieces)]
 * Tongue:** red tongue tip with possible sores, scanty or no coat
 * Pulse:** fine rapid or fine, weak, rapid
 * Treatment Principles:** Enrich Yin, tranquilize the heart, quiet the spirit and promote interaction between heart and kidneys
 * Acupuncture Treatment:** Drain: HT-7, PC-7, BL-15; Tonify: KI-3, SP-6, BL-23
 * Herbal Treatment:** //Liu Wei Di Huang Tang He Huang Lian E Jiao Tang//1

Kidney Yin and Yang Dual Vacuity 1 Dizziness, vertigo, tinnitus, low back soreness and lack of strength, lack of warmth in the four extremities, alternating hot and cold sensations or hot above and cold below, decreased libido, nocturia [Xian Mao (10-15g.), Xian Ling Pi (10-15g.), Dang Gui (10g.), Zhi Mu (10-12g.), Huang Bai (10-12g.), Nu Zhen Zi (12-15g.), Huan Lian Cao (12-15g.)] Night sweats, heart vexation or palpitations: + //Gan Mai Da Zao Tang// Increase heart nourishing and spirit quieting: + Bai Ren, Suan Zao Ren, Fu Shen With spleen vacuity: + Huang Qi, Dang Shen, Gan Cao With liver depression: + Chuan Lian Zi, Mu Xiang
 * Tongue:** pale tongue, red tip or red tongue and scanty coat
 * Pulse:** deep, fine bowstring or vacuous, surging, possibly rapid
 * Treatment Principles:** Supplement both kidney Yin and Yang aided by descending fire
 * Acupuncture Treatment:** Tonify: KI-3, SP-6, LR-8; Drain: HT-6, HT-7, GV-20; Moxa: BL-23, GV-4
 * Herbal Treatment:** //Er Xian Tang He Er Zhi Wan Jia Jian//1
 * Modifications:**

Liver Wind Stirring Internally 1 Dizziness, vertigo, headache, tics and spasms, tremors, easy anger, vexation and agitation [Shan Yang Jiao (12-15g.), Sang Ye (10g.), Chuan Bei Mu (10g.), Sheng Di (12-24g.), Gou Teng (10-12g.), Fu Ling (10-15g.), Ju Hua (10-15g.), Gan Cao (6g.), Zhu Ru (10-12g.), Bai Shao (10-18g.)]
 * Tongue:** red tongue, scanty coat
 * Pulse:** fine, bowstring, rapid
 * Treatment Principles:** Level the liver and extinguish wind
 * Acupuncture Treatment:** Tonify: KI-3, SP-6, CV-4, BL-23; Drain: GB-20, GV-20, GV-16, Yintang
 * Herbal Treatment:** //Ling Yang Gou Teng Tang//1
 * Modifications:** Hypertension: + Huai Niu Xi, Bai Ji Li

Heart-Spleen Dual Vacuity 1 Heart palpitations, shortness of breath, impaired memory, insomnia, sallow yellow complexion, listless spirit, fatigue, lack of strength, reduced appetite, stomach and abdominal distention [Ren Shen (10-18g.), Bai Zhu (10-15g.), Fu Ling (10-15g.), Huang Qi (10-60g.), Gan Cao (6-18g.), Dang Gui (10g.), Long Yan Rou (10-12g.), Suan Zao Ren (12-25g.), Yuan Zhi (6-10g.), Mu Xiang (6-10g.), Sheng Jiang (2-3 slices), Da Zao (2-12 pieces)] Kidneys also vacuous: + Shu Di Profuse menstrual bleeding or flooding: + Di Yu, Long Gu, Mu Li
 * Tongue:** pale, fat, enlarged tongue with teeth marks, thin coat
 * Pulse:** fine, soggy
 * Treatment Principles:** Supplement the heart and nourish the blood, fortify the spleen and boost the Qi
 * Acupuncture Treatment:** BL-15, BL-17, BL-20, HT-7, ST-36. Tonifying technique
 * Herbal Treatment:** //Gui Pi Tang//1
 * Modifications:**

Heart and Liver Excess Fire, Shen Irritable 2 Red face and eyes, feeling of heat in the body, prefers cold food and drinks, bitter taste in the mouth, yellow and burning urine, constipation, insomnia, frequent dreams and disturbed sleep, irritable, hypochondriac discomort and aching, busy mind, headache, dizziness, moody and anxious
 * Tongue:** reddish tongue, yellow dry coat
 * Pulse:** slippery, rapid
 * Acupuncture Treatment:** HT-6, HT-7, LR-2, LR-3, LI-4, LI-11, ST-25, GB-13, GB-43
 * Herbal Treatment:** [Dan Shen, Dan Pi, Long Dan Cao, Lu Hui, Tao Ren, Huang Qin, Huang Lian, Huang Bai, Yuan Zhi, Shi Hu, Mai Men Dong, Zhen Zhu Mu]

Liver and Stomach Fire Burning, Shen Irritable 2 Depressed, irritable, feels hungry all the time, eats large amounts of food, hot body and dry mouth, frequently thirsty an drinks a lot, has regurgitation, belching, acid reflux and feels burning along the digestive tract, nausea and vomiting, food is often first reaction to stress, moody and angry
 * Tongue:** reddish tongue, thick yellow coat
 * Pulse:** slippery, wiry, rapid
 * Acupuncture Treatment:** LR-2, LR-3, LR-6, ST-25, ST-42, ST-44, LI-11, LI-4, SP-15, Yintang
 * Herbal Treatment:** [Huang Lian, Shi Gao, Hu Po, Zhi Zi, Tian Men Dong, Huang Bai, Shi Hu, Dan Zhu Ye, Zhu Ru, Yu Zhu, Shan Zha]

Liver Qi Stagnation and Damp Phlegm Accumulation, Shen Irritable 2 Hypochondriac aching and distention, sighing, depressed and moody, bloated lower abdomen, eats junk food, overweight, sensation of heavy body and clouded mind, sluggish, easily angered, low appetite, irregular menstruation, low sexual desire
 * Tongue:** pink tongue, thick white coat
 * Pulse:** wiry, slippery
 * Acupuncture Treatment:** LR-3, LR-13, LR-14, ST-8, ST-25, ST-40, CV-12, PC-6, CV-17
 * Herbal Treatment:** [Chai Hu, Huang Qin, Chuan Bei Mu, Ban Xia, Shi Cang Pu, Fu Ling, Mu Xiang, Chen Pi, Zi Su Ye, Dan Shen, Xiang Fu, Yi Mu Cao]

Phlegm and Qi Mutually Binding 1 Obesity, chest oppression, profuse phlegm, possible plum pit Qi, abdominal distention, belching, nausea, lack of appetite, edema, loose stools [Ban Xia (10-12g.), Hou Po (10g.), Fu Ling (10-12g.), Sheng Jiang (2-3 slices), Su Ye (10g.)] Severe Qi stagnation: + Chai Hu, Yu Jin, Xiang Fu, Qing Pi Vomiting: + Sha Ren, Bai Dou Kou Pain or swelling in throat: + Yuan Shen, Jie Geng
 * Tongue:** slimy white coat
 * Pulse:** sippery or slippery and bowstring
 * Treatment Principles:** Rectify the Qi, transform phlegm, and fortify the spleen
 * Acupuncture Treatment:** ST-40, CV-12, PC-6, CV-17. Draining technique
 * Herbal Treatment:** //Ban Xia Hou Po Tang//1
 * Modifications:**

Phlegm Heat Harrassing Upward 1 Vexation and agitation, profuse yellow phlegm, palpitations, insomnia, profuse dreams, chest oppression, nausea, vomiting [Ban Xia (10-12g.), Chen Pi (10g.), Fu Ling (10-12g.), Zhi Shi (6-10g.), Zhu Ru (10g.), Gan Cao (3-6g.), Da Zao (2-3 pieces)] Bitter taste in mouth: + Huang Lian //(Huang Lian Wen Dan Tang)// Headache, dizziness, vertigo, nausea, vomiting: + Huo Xiang, Shi Chang Pu Dampness and heat: + Qing Hao, Huang Qin Abdominal distention: Da Fu Pi, Lai Fu Zi Indigestion due to food stagnation: + Shen Qu, Nei Jin Phlegm misting portals of the heart: + Nan Xing, Shi Chang Pu
 * Tongue:** red tongue, slimy yellow coat
 * Pulse:** bowstring, slippery, rapid
 * Treatment Principles:** Clear heat and transform phlegm, course the liver and eliminate vexation
 * Acupuncture Treatment:** CV-12, ST-40, CV-17, PC-7, LR-2. Draining technique
 * Herbal Treatment:** //Wen Dan Tang//1
 * Modifications:**

Liver and Gallbladder Heat/Ascendant Liver Yang 1,2 Hypochondriac pain w/ burning and heat, bitter taste in mouth, dry mouth and thirst, red face and eyes, prefers cold drink, easily angered, headache, constipation, tinnitus, sweating, insomnia, frequent dreaming, loss of emotional control, impulsive behavior, profuse menstrual bleeding or lingering menstrual flow -KI-3, SP-6, CV-4, BL-23, GB-20, GV-20, Taiyang1 -LR-1, LR-2, LR-3, GB-13, GB-15, GB-40, GB-41, GB-44, GV-202 //- Tian Ma Gou Teng Ying// – [Tian Ma (10g.), Gou Teng (10-15g.), Shi Jue Ming (12-24g.), Sang Ji Sheng (12-15g.), Du Zhong (10g.), Chuan Niu Xi (10g.), Zhi Zi (10g.), Huang Qin (10-12g.), Yi Mu Cao (10g.), Fu Shen (10-15g.)]1
 * Tongue:** red tongue, dry yellow or scanty coat
 * Pulse:** wiry, rapid
 * Acupuncture Treatment:**
 * Herbal Treatment:**
 * -**[Long Dan Cao, Zhi Zi, Huang Qin, Chai Hu, Mu Dan Pi, Fu Ling, Ze Xie, Che Qian Zi, Mu Tong, Dan Shen, Da Huang, Hou Po]2

Liver Qi and Blood Stagnation, Shen Irritable 1,2 Improper emotional expression, sensitive and vulnerable to general stimulation, crying, moody, sighing, has negative ideas, thoughts and depression, feeling of pain in the body and aggravated by emotional changes, headache and hypochondriac pain more frequent, easily angered, may have horrible emotional activity, dysmenorrhea, and irregular menstruation -Drain: LR-3, LI-4, PC-6; Tonify: ST-361 -LR-3, LR-6, LR-8, SP-8, SP-10, HT-7, CV-17, CV-17, GV-19, GV-20, GV-212 -//Xiao Yao San// – [Chai Hu (10g.), Dang Gui (10g.), Bai Shao (10-15g.), Bai Zhu (10g.), Fu Ling (10-15g.), Gan Cao (6-10g.), Sheng Jiang (2 slices), Bo He (3-6g.)]1 Transforming into heat: - Sheng Jiang, Bo He; + Dan Pi, Zhi Zi //(Dan Zhi Xiao Yao San)// Severe blood and Yin vacuity: + Shu Di //(Hei Xiao Yao San)//
 * Tongue:** purplish tongue, white coat
 * Pulse:** wiry, choppy
 * Treatment Principles:** Course the liver and rectify the Qi
 * Acupuncture Treatment:**
 * Herbal Treatment:**
 * -**[Chi Shao, Wu Yao, Tao Ren, Hong Hua, Mu Dan Pi, Yan Hu Suo, Bai Shao, Yu Jin, Chuan Xiong, Chai Hu, Long Gu]2
 * Modifications:**

Qi and Blood Deficiency and Ying Wei Disharmony, Shen Irritable 2 Constantly changing body temperature, or body is hot but sensitive to cold or vice versa, weak and low energy, light menstrual flow or irregular menstruation, sensitive to weather changes, moody and anxious, soreness and aches all over, numbness and weakness of the body, pale complexion
 * Tongue:** pale tongue, thin coat
 * Pulse:** deep, weak
 * Acupuncture Treatment:** SP-3, SP-6, SP-10, HT-7, ST-36, CV-6, CV-11, CV-17, GV-20, LI-4, TW-5
 * Herbal Treatment:** [Chai Hu, Dang Gui, Ji Xue Teng, Gui Zhi, Bai Shao, Gan Jiang, Da Zao, Huang Qin, Chuan Xiong, Gan Cao]

Blood Stasis Obstructing the Network Vessels 1 Heart vexation, irritability, possible painful lumps in the breasts, possible flooding and leaking with dark colored blood containing clots, possible uterine myomas, rib-side and abdominal distention and pain, palpitations, insomnia, hot flashes, worse at night, dark dusky complexion, visible broken capillaries or varicosities, chloasma (“liver spots”) on face and skin black spots or floating threads in the visual field [Gui Zhi (6-10g.), Fu Ling (10-12g.), Chi Shao (10g.), Dan Pi (10g.), Tao Ren (10g.), Hong Hua (10g.), Dang Gui (10g.), Chuan Xiong (10g.), Chuan Niu Xi (10-12g.), Chai Hu (3-10g.), Jie Geng (6g.), Zhi Ke (6-10g.), Sheng Di (12-15g.), Gan Cao (3-6g.)] Lower abdominal pain: + ST-29, ST-25, CV-3, CV-4, CV-6 Chest pain: + CV-17, PC-6 Marked spirit unrest: + HT-7 <span style="font-family: "Calibri","sans-serif"; font-size: 11pt; line-height: 115%;">Agitated stirring: + GV-26, Shi Xuan
 * Tongue:** purple or dark tongue, possible static spots or macules, thin dry coat
 * Pulse:** bowstring, fine, choppy, and/or deep
 * Treatment Principles:** Quicken the blood and dispel stasis
 * Acupuncture Treatment:** SP-6, SP-10, LR-3, LI-4. Draining technique
 * Herbal Treatment:** //Gui Zhi Fu Ling Wan He Xue Fu Zhu Yu Tang//1
 * Modifications:**