Menopause

See also menopausal disorder

//Western Diagnosis// physiologic cessation of menses as a result of decreasing ovarian function no menses for 1 yr

Etiology
1. decreased ovarian response to FSH, LH 2. shorter follicular phases: shorter cycles initially 3. fewer ovulations 4. decreased estrogen 5. more cycle irregularity 6. decreased estrogen 7. longer cycles

Signs & Symptoms
1. average age of 50 2. climacteric: transitional phase from before menopause to after it during which a woman passes from reproductive stage 3. vasomotor instability ---hot flashes ---75% ---may last up to 1 yr, can last 5 yrs 4. depression, fatigue, irritability, nervousness 5. insomnia, dizziness, paresthesias 6. palpitation, tachycardia 7. urinary incontinence, cystitis, vaginitis 8. N, C, D 9. osteoporosis

Diagnosis
1. clinical

Treatment
1. estrogen: alfalfa, soy, flax seed meal 2. vitamin E 400-800 mg/d 3. vitamin B6 150 mg/d 4. bioflavonoids 1-3 gm/d 5. black cohosh, vitex 6. Diet: protein - need some but not too much; phosphorus levels from carbonated drinks 7. Premarin [estradiol], Provera - side effects hyperlipidemia, weight gain, headache 8. Bio-identical hormone therapy (Tri-est) [10% estradiol, 10% estrone, 80% estriol] 9. DHEA [androgen, estrogen, progesterone precursor that tends to increase bone mass]

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============================================================================= //TCM Pathology// 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**

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 * IBIS:**

Definition:
The time in a women's life after her menses has stopped. The time before the total cessation of menses when periods are irregular is termed the "climacteric". Menopause is also termed "the Change of Life".

Etiology:
Menopause may be natural (between 40 and 52 years old), premature (under 40) or induced (by surgical removal or irradiation of the ovaries; or radium implantation in the uterus). During the climacteric there is gradually decreasing ovarian function and often physical, endocrinal, and mental/emotional diseases/imbalances arise at this time. The average age of menopause is 50-51 years old.

Nutrition:
eating principles: • low fat, low animal protein diet

therapeutic foods: • black beans, sesame seeds, soybeans, walnuts, lycium fruit, mulberries, yams, licorice, black jujube, lotus seeds, chrysanthemum flowers (Ni, 147.) • estrogenic foods: animal products, apples, cherries, olives, plums, carrots, yams, nightshade family, peanuts, soy products, coconut, brown rice, barley, oats, wheat • See: Foods that contain estrogen-like sterols in Materia Medica

fresh juices: • carrot, celery, spinach, and parsley (Walker, 146.) • carrot and spinach (Walker, 146.) • carrot, beet, lettuce, and turnip (Walker, 146.)

specific remedies: • cook black beans with rice into porridge and eat twice daily (Ni, 147.) • steam chicken with lycium fruit and yam (Ni, 147.) • porridge from rice, walnuts, lotus seeds and sunflower seeds (Ni, 147.) • hot flashes: simmer 60 g celery and 30 g Leonurus cardiaca (Motherwort) then serve (Chao-liang, Qing-rong, Bao-zhen, 47.)

avoid: • meat, alcohol, fried foods, fatty foods, rich foods, salty foods, coffee, caffeine, sweet foods and sugar, alcohol, cow's milk and other dairy products, white bread, refined foods, processed foods, smoking • if hot flashes: hot sauces, spicy foods, hot drinks, especially coffee

Botanicals
• Arctium lappa: alterative, estrogenic • Angelica sinensis: digestive, anti-spasmodic, hormonal tonic with analgesic, uterine-relaxing properties (Anderson Geller; Heron; Mitchell, p. 78) • Cimicifuga racemosa: highly effective in relieving menopausal symptoms such as hot flashes, profuse perspiration, depressive mood, prolapse, headaches and ringing of the ears; has compared favorably with conjugated estrogens with regard to menopausal symptoms; enduring effects noted by 6-8 weeks, but continued use without monitoring is not recommended longer than 6 months. • Dioscorea villosa: anti-spasmodic, digestive that contains phytoprogesterones: pregnenolone and diosgenin; spastic contractions and nausea in the abdomen; yellow skin and conjunctiva; boring pain radiating from the umbilicus, and tenderness better with pressure (Felter, p. 344; Mowrey, pp. 151-156) • Glycyrrhiza glabra: Contains phytoestrogens and steroidal estrogenic saponins capable of balancing female hormones; best limited to the first half of menstrual cycle or menopausally 2-3 weeks out of the month to avoid bloating and water retention (Heron) • Humulus lupulus: a bitter, digestive herb that contains phytoestrogens (Heron) • Leonurus cardiaca: specifically indicated for uterine pain or atony associated with anxiety and tension (Felter; Mitchell, p. 78) • Medicago sativa: nutritive, contains phytoestrogens capable of providing some estrogenic activity when estrogens are low, and competes for estrogen binding sites when estrogens are high (Heron) • Piper methysticum (Kava): beneficial for associated anxiety. • Salvia officinalis: rich in flavonoids and phytosterols, calcium, magnesium, zinc and thiamine, saponins, fatty acids and essential oils, garden sage eliminates night sweats, cold sweats and hot flashes, regulates hormonal change, eases irritated nerves, banishes depression, relieves dizziness, trembling and emotional swings, eliminates headaches, strengthens the liver, aids digestion, and decreases gas, relieves menstrual cramps and flooding, and other therapeutic effects (Weed, p. 111-112) • Senecio aureus: long-term tonic can produce favorable results with small doses of the blossom tincture; eliminates severe menstrual pain, nausea and debility, tonifies the uterine muscle, regulates the menstrual cycle, slows flooding, cures anemia, soothes the nerves, moderates emotional swings, relieves PMS symptoms, increases libido, and other beneficial effects (Weed, p. 109-110) • Vitex agnus-castii: a slow-acting tonic, lacking phytosterols, but capable of enhancing progesterone, leutinizing hormone and luteotroic hormone, while also inhibiting FSH and prolaction; reduces and eliminates hot flashes and dizziness, relieves chronic menstrual cramps, eliminates flooding, spotting and irregular cycles, redirects hysteria into focused action and emotional calm, clears skin problems, relieves hormone-related constipation and digestive distresses, relieves water retention and tissuye distension, along with other therapeutic benefits. (Weed, p. 107-108)

Chinese Formulae
• Er Xian Tang: Kidney Yang Xu (Deficiency) with Kidney Yin Xu (Deficiency) with Empty Fire Blazing: menopause with amenorrhea, hot flashes, fatigue, irritability, lassitude, depression, insomnia, urinary frequency, may be hypertension (Yeung, p. 91; Bensky and Barolet, p. 282) • Zuo Gui Yin; Restorative Tablets (patent) plus Tang Kuei 18 (patent); Da Bu Yin Wan (patent); Chih Pai Di Huang Wan (Eight Flavor Tea) (patent): Kidney Yin Xu (Deficiency) with Empty Fire Blazing: low back soreness, night sweats, dry mouth, thirst (Zuo Gui Yin: Yeung, p. 301; Dharmananda, 1986, p. 264; Bensky and Barolet, p. 266; Restorative Tablets and Tang Kuei 18: Dharmananda, 1990, p. 25; Da Bu: Fratkin, p. 202; Chih Pai: Zhu, p. 289) • Placenta Restorative Pills (patent): Kidney Qi Xu (Deficiency) with Kidney Yin Xu (Deficiency) (Fratkin, p. 207) • Bupleurum and Peony F. (Dan Zhi Xiao Yao San or Jia Wei Xiao Yao San); Xiao Yao Wan (patent): Liver Qi Stagnation with Liver Xue Xu (Blood Deficiency): spontaneous or night sweats, headache, blood-shot eyes, restlessness, irregular menstruation, irritability (Bupleurum: Hsu, 1980, p. 87; Yeung, p. 72; Dharmananda, 1986, p. 177; Bensky and Barolet, p. 148; Xiao Yao: Zhu, p. 227) • Bamboo and Hoelen C. (Wen Dan Tang): Gall Bladder Damp-Heat: timidity, insomnia, nightmares, spontaneous sweating including night sweats, dizziness (Hsu, 1980, p. 114; Yeung, p. 241; Dharmananda, 1986, p. 305; Bensky and Barolet, p. 435) • Ginseng and Longan C. (Gui Pi Tang): Spleen Qi Xu (Deficiency) with Heart Xue Xu (Blood Deficiency): palpitations, poor memory, insomnia, anxiety, reduced appetite (Hsu, 1980, p. 425; Yeung, p. 112; Dharmananda, 1986, p. 244; Bensky and Barolet, p. 255) • Tian Wang Bu Xin Dan (patent): Heart Yin Xu (Deficiency) with Heart Fire Blazing (Zhu, p. 321) • Ding Xin Wan (patent): Heart Xue Xu (Blood Deficiency) (Zhu, p. 326) • Tang Kuei and Cyperus F.: Xue Xu (Blood Deficiency) with Liver Qi Stagnation: flushing, anxiety/depression, low back pain (Hsu, 1980, p. 394) • Lindera and Cyperus F.: Liver Qi Stagnation (Hsu, 1980, p. 369; Dharmananda, 1986, p. 227) • Bupleurum Formula (Yi Gan San): Liver Invading Spleen with extreme emotional lability, panic, grinding teeth (Hsu, 1980, p. 343; Bensky and Barolet, p. 147) • Pinellia and Magnolia C. (Ban Xia Hou Po Tang): Liver Qi Stagnation: plumpit Qi, insomnia, edema (Hsu, 1980, p. 395; Yeung, p. 42; Dharmananda, 1986, p. 226; Bensky and Barolet, p. 291) • Bupleurum and Dragon Bone C. (Chai Hu Jia Long Gu Mu Li Tang): Liver Qi Stagnation with Shen Disturbance: nervousness, constipated, hypertension (Hsu, 1980, p. 340; Dharmananda, 1986, p. 154; Bensky and Barolet, p. 387) • Licorice and Jujube C. (Gan Mai Da Zao Tang): Shen Disturbance: absentmindedness, moodiness, crying spells, restless sleep (Hsu, 1980, p. 347; Yeung, p. 102; Dharmananda, 1986, p. 110; Bensky and Barolet, p. 383)

Acupuncture
» prefatory note: While menopause is a "condition" in a woman's personal evolution, it is in no way implied or considered necessary that menopause is a "disease" or state of ill health. At its healthy best, menopause has always been recognized as a flowering of maturation, a liberation, a graduation of sorts, wherein a woman moves beyond the middle phase of her life preoccupied as it often is with the responsibilities of relationship, whether with children and the raising of a family and/or the establishment of a social role in terms of a career. Many cultural traditions have honored the cessation of the menses as a stepping forth into spiritual profundity and personal wisdom where the power previously released through the monthly flow is now kept within, nurtured and cultivated. The changes that come upon a woman as she settles into this phase of her life, often associated with the waning moon, have been revered, honored and feared. In our patients, and in ourselves, menopause, and the changes it introduces, needs most of all to be respected. Nevertheless, when this transition is distressful and debilitating we will certainly want to offer our assistance to balance the process and support the woman.

after assessing the person and palpating, consider these patterns: Xue Xu (Blood Deficiency) with Liver Qi Stagnation; Liver Yang Rising; Heart Yin Xu (Deficiency) with Heart Fire Blazing; Heart Xue Xu (Blood Deficiency); Phlegm Accumulation with Qi Stagnation; Kidney Yin Xu (Deficiency) with Empty Fire Blazing; any of above with Shen Disturbance

» illustrative combinations: • CV-4, CV-3, St-29, St-28, Sp-6, Lv-5 and Lv-6 for menopausal syndrome; also consider St-30 with lower abdominal pain; UB-23 and UB-32 with low back pain; Sp-13 with lower abdominal mass; and/or Sp-8, Sp-9 and GB-26 with leukorrhea (Liu, p. 406) • Lv-3, Kd-3, GV-20, GB-20, PC-7, Kd-6, Kd-1 and UB-23, yao yang for Liver Yang Rising contributing to menopausal symptoms (Qiu and Su, p. 24-25) • UB-15, UB-20, UB-23, Sp-6 (can also add: an mian, Ht-7, PC-8, GV-26, PC-7) for Heart Xue Xu (Blood Deficiency) contributing to menopausal symptoms (Qiu and Su, p. 25-26) • CV-17, CV-12, CV-6, TW-6, St-40 and Sp-6 (=) for Accumulation of Phlegm and Stagnation of Qi contributing to menopausal symptoms (Qiu and Su, p. 26) • UB-1 and Kd-18: regulate menopausal transition (Finkelstein, p. 37) • Kd-8, UB-1, Kd-18 and CV-9: regulate menopausal functions (Finkelstein, p. 54) • Kd-8, UB-1, Kd-18, CV-9, Lu-7 and Kd-6: reduce bloating during menopause caused by excess gonadotrophic hormones and deficient sex hormones (Finkelstein, p. 54) • Kd-7 and Ht-6: regulate sweating, esp. menopausal hot flashes (Levine; Finkelstein, p. 54) • Lv-13, GB-41 and TW-5 (=): influence liver's ability to neutralize unemployed sex hormones (Finkelstein, p. 75) • UB-31, Sp-6 and GB-3: has strong hormonal action on women (Finkelstein, p. 46) • PC-7 and GV-26 (-): cool Heat in the Xue (Blood); calm Shen; resolve mental disturbances • UB-14 and UB-15 (+): pacify the Heart • UB-20 and UB-23 (+ and D): tonify the Spleen and Kidney

Homeopathy
• Actea racemosa: violent headache, as if top of head is torn off; neck, back muscles sore • Arsenicum album: insomnia; anxiety on going to sleep • Calcarea carbonica: pale, flabby, relaxed, cold, tiresome from overwork; as an intercurrent remedy • Camphora: flushes of heat and sweat in a warm room; limbs and abdomen very cold; suffers from cold when uncovered and copious sweat when covered • Folliculinum: history of birth control pills and/or estrogen replacement therapy, esp. bad reaction, i.e., estrogen poisoning; tendency to put others' needs before her own, and then become resentful later; woman has lost touch with her own inner rhythms and her reference has become external rather than internal; often best used in a single dose, or repeated every two weeks, possibly at new and full moons • Glonoinum: hammering of head, < warm room, heat of sun; can't lie in bed • Lachesis: a main remedy; severe headache radiating from occiput to front of head; palpitation of heart and pulsations of body; hypersensitive to touch; flushing • Oophorinum: nervous; acne rosacea or other skin problems • Pulsatilla: irritable temper, changeable; weeps telling symptoms • Sepia: cold, fidgety, spiteful, tired of affection, dislikes sympathy; sudden hot flashes with sweat, weakness and tendency to faint • Sulphur: tiresome; losing weight; skin coarse and dirty; as an intercurrent remedy

Subtle Support
• notes: A, A#, B, C, C#, D, E, F, G, G#

• chords: A minor, C minor, D minor, D# minor, tonic (Gimbel, p. 116)

Mind/Body
• "Children are grown. The paths of the parents change. The Old Gods are reexamined: Saturn makes the second return to his natal place; Persephone retires underground for the season. The dance of estrogen slows from strutting to self reflection. As we pause at the center of our lives, with time, we will learn to balance between our living and our dying." - J. Parvati (Bauman, p. 334) • Menopause is an initiation, a rite of passage. "We should not forego this just because men don't consider their own change of life as important." J. Parvati. (Bauman, p. 337) • Just how great the problems and complaints of the change of life turn out to be depends to a large extent on how the woman has succeeded in fulfilling her femininity up to menopause. If she has not done so, unfulfilled desires accumulate in the form of fears of being neglected, and lead to panic and attempts to 'catch up'. (Dethlefsen, p. 191) • Fear of no longer being wanted; fear of aging; self-rejection; not being good enough. (Hay, 1984, p. 174) • Menopause has been observed to begin earlier and with more intense reactions among women who have not had children than among women who have. In a study by T. Benedek, the better the personality was integrated and the less the woman's personality was affected by the hormonal changes of the menstrual cycle, the more easily she went through menopause. Women who were unable to adapt to the monthly premenstrual hormone decline and had premenstrual depression and dysmenorrhea were more apt to suffer from discomforts through menopause. (Mehl, p. 177)

• Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Zhi (Will); expresses ambition and focus; governs Water to regulate body fluids; nourishes the brain to sustain concentration, clear thinking, and memory; carries the constitutional endowment from the parents; manifests through the reproductive function, and governs the process of passing on life to offspring; and displays the effects of aging, overwork, chronic degenerative processes, and extreme stress. » Healthy expressions are gentleness, groundedness, and endurance. » Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); fearfulness; apathy; chronic fatigue; discouragement; scatteredness; lack of will; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch. As always, Yin Xu (Deficiency) predisposes to Empty Fire. » Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).
 * Chinese psychophysiology:**

• Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores and cleanses the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); has an intimate relationship with the genitals and Lower Warmer; and reflects emotional harmony and movement. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Xu (Deficiency) signs include frigidity; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry eyes, skin, and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down. Liver Yin Xu (Deficiency) predisposes to the Shi (Excess) conditions of Liver Wind, Liver Yang Rising, and Liver Fire Blazing. » Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is restricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216) » Liver Shi (Excess) signs include discontent; anger; pain in lumbar region and genitals (Seem, p. 28); muscular tension; excessive sex drive; insomnia; moodiness; excitability; genital diseases; red, tearing eyes; compulsive energy; and bitter taste in the mouth. Chronically suppressed anger can implode and give rise to Fire in the Liver and Gall Bladder with symptoms of irritability, bitter taste, headaches, etc.

• Heart ~ Xin houses the Shen (Spirit) and reveals itself through the brightness in the eyes; governs Fire and Heat; rules the Xue (Blood) and its vessels and directs the circulation; opens into the tongue and controls speech; and relates to the integration of the organs and the personality. » Healthy expressions are warmth, vitality, excitement, inner peace, love, and joy. » Heart Xu (Deficiency) signs include sadness; absence of laughter; depression; fear; anxiety; shortness of breath (Seem, p. 28); cold feeling in the chest and limbs; palpitations; cold sweat; inability to speak; memory failure; and restless sleep. Yin Xu (Deficiency) predisposes to Empty Fire, acute and chronic. » Heart Shi (Excess) signs include false or facile laughter; sobbing; agitated spirit; insomnia (Seem, p. 28); frightful dreams; anxiety; tongue feels numb and heavy; heavy chest; hot sweat; and orange-colored urine. » The Heart is the Emperor of the bodily realm so that when the Heart is disturbed all the other organs will be disrupted. » Mental signs of Heart channel disorders include insomnia, anxiety, and all Shen disturbances. (Seem, p. 28)

Integrative Therapies
Menopause is the transitional phase in a woman's life when her menstrual cycle and the ability to give birth come to an end. It lasts approximately one to three years. During menopause, menstrual flow first becomes irregular, diminishes, and then is finally completely absent. When no menstrual bleeding has occurred for one year, the menopausal transition is finished. Any vaginal bleeding after this time should be checked by a physician.

Menopause results from the body's decreased production of the female sexual and reproductive hormones, which begins sometime after the age of 42. Strictly speaking, the menopausal woman is not sick. However, poor diet, lack of exercise, stress, and other factors may aggravate the symptoms and discomforts associated with the changes going on in her body.

During menopause, a woman may be more sensitive emotionally, have headaches, stomach pains, nosebleeds, frequent bruises, varicose veins, extreme fatigue, and insomnia. Other possible problems are night sweats, dryness or soreness during sexual intercourse, and the sudden rush of blood which results in "hot flashes." If such symptoms persist or if discomfort is great, consult your physician.

If the transition of menopause becomes too emotionally or mentally stressful, then psychological counseling or support is recommended.

THE FOLLOWING SUPPLEMENTS ARE USED FOR MENOPAUSE AND CAN BE TAKEN UNTIL SYMPTOMS IMPROVE: 1. Vitamin E – 600 Units daily. Vitamin E normalizes estrogen levels. Cold-pressed wheat germ oil is one of the best sources. 2. Vitamin B6 – 100 milligrams per day. 3. PABA – Up to 60 milligrams per day. 4. Folic acid – 5 milligrams per day. 5. Pantothenic acid – 100 milligrams per day. 6. Vitamin A – 25,000 Units per day. 7. Vitamin C – 1,000 milligrams per day. 8. B vitamin complex – 50 milligrams per day. 9. Kelp – Up to 5 tablets or 1 teaspoon of the granules daily. 10. Calcium – 750 milligrams per day. This is used in combination with 400 milligrams of magnesium per day. The best sources of calcium are calcium citrate, amino acid chelate, and calcium derived from oyster shells. 11. Zinc – 15 milligrams per day can help ease depression and moodiness. 12. Betaine Hydrochloride – 1/8 teaspoon, 3 to 4 times daily with meals. It aids in digestion as well as in the absorption of minerals. Because of the acidity of betaine hydrochloride, do not use it if you are experiencing heartburn or "acid indigestion."

THE PROPER DIET FOR MENOPAUSE WILL INCLUDE: 1. An overall healthy diet. This means using fresh foods as close to the natural, unprocessed state as possible. Avoid processed and prepackaged foods. A healthy diet includes leafy green vegetables, whole grains, fruit, and proteins with a minimum of animal fat. Keep your intake of sugar foods and refined carbohydrates, such as processed flours and grains, white bread, and white rice, to a minimum. For more information on healthy diet, listen to our Healthy Diet program (number 343). 2. Be sure to get enough high-quality protein. Replace red meat with fish and chicken as much as possible and include beans, nuts, and seeds in the diet.

HERBS FOR MENOPAUSE: 1. Dong Quai, a Chinese herb also called Angelica sinensis, is one of the most effective herbal tonics for the female organs and is a hormonal regulator. To avoid stomach distress, it is best to take Dong Quai as a tincture, which is a liquid herbal extract, combined with other herbs such as Licorice and Comfrey. The usual dose is 15 to 25 drops of the liquid herbal extract per day in a small amount of water or juice. 2. Ginseng root can be used for relief from hot flashes. It also helps balance the hormones. Take 1 standard dose twice daily (see the product label). Chewing on a piece of the root as needed is helpful. Daily doses of vitamin C heighten the effect of the Ginseng. However, Ginseng and vitamin C should be taken at separate times of the day. Avoid using commercial teas, which are less effective. Ginseng should be taken on an empty stomach. 3. Motherwort – 5 to 20 drops of the tincture in a glass of water. It can be quite bitter if taken as a tea. It is especially good for dryness of the vagina.

HOMEOPATHY From the following homeopathic medicines, the one that best matches the symptoms is choosen. Dissolve 3 pellets under the tongue. • Lachesis 12C: For a woman who is too sensitive to touch or finds tight clothes uncomfortable. She is very talkative and feels worse after resting. Taken 2 times per day. • Sepia 12C: For a woman that is cold, easily depressed, and prefers to be left alone. She experiences sudden hot flashes with weakness and sweating. Taken 2 times per day. Note: A wide range of homeopathic medicines can be helpful for women during menopause. Consultation with a health care professional trained in homeopathic prescribing will usually be the best way to select the correct medicine.

ADDITIONAL MEASURES FOR MENOPAUSE INCLUDE: 1. EXERCISE – It is important to exercise regularly. At least 30 minutes 3 times per week should be engaged in the types of physical exercise that get the heart moving, such as brisk walking, aerobics, swimming, or tennis. 2. Acupuncture has been found to be quite helpful in relieving the negative symptoms associated with menopause. Look for a licensed practitioner in your area.

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Dietary Recommendations
Avoid junk and toxic food such as meat and meat products, pastry, ect. Avoid alkaloids such as tea or coffee. Recommended foods: fruits and vegetables, preferably raw, as well as garlic and parsley.

Recommended Minerals
-Zinc - menopause related disorders

Orthomolecular Treatment
-Isoflavones

Phytotherapeutic Recommendations
-Ginko Biloba (pre and post-menopausal problems)