Around the time of menopause, women may experience a number of menopause-related symptoms, such as dizziness, tinnitus, sweating, palpitations, insomnia, irritability, hot flashes, menstrual irregularities, emotional instability, loss of appetite, loose stools, increased skin temperature and numbness in the fingers, and lower limb edema. These symptoms are collectively referred to as menopausal syndrome. Simply put, “menopause” refers to the period during the human life cycle when one transitions from middle age to old age. “Menopausal syndrome” is a term from modern medicine, though some practitioners of Traditional Chinese Medicine (TCM) now use it as well; in TCM, it is referred to as “various symptoms before and after the cessation of menstruation” or “various symptoms surrounding menopause.” Historically, the term “menopause” referred exclusively to women; however, in recent years, some experts have recognized that men also experience a menopausal phase. Consequently, the term “menopause” is now generally used to include men as well. This article focuses solely on female menopause.
I. Age of Onset and Duration of Menopause
For most women, menopause occurs between the ages of 45 and 50, with an average age of around 47. The age of onset—whether early or late—and the severity of symptoms vary from person to person. A small number of women enter menopause as early as age 40 or even earlier, experiencing a range of symptoms, while others do not experience menopausal symptoms until age 55.
According to medical statistics, girls who experience their first menstrual period early tend to enter menopause later, while those who experience it later tend to enter menopause earlier. Women who have never given birth tend to enter menopause earlier, whereas those who have had multiple children tend to enter menopause later. Additionally, the timing of menopause is often closely related to family history, living environment, work patterns, and nutritional status.
The duration of menopause varies; it can be as short as about one year or as long as several years. Symptoms range in severity and appear intermittently; in severe cases, they can significantly impact daily life and work.
II. Etiology and Pathogenesis of Menopausal Syndrome
According to Traditional Chinese Medicine (TCM), around the time of menopause, a woman’s kidney qi gradually declines, the Chong and Ren meridians become deficient, and the “Tian Gui” (a concept referring to the essence of female reproductive vitality) gradually depletes. As menstruation ceases and menopause sets in, reproductive capacity diminishes until it disappears. This is a natural physiological process for women; however, due to individual constitutional differences and environmental factors, some women are unable to adapt to this physiological transition. This leads to an imbalance between yin and yang qi and a lack of harmony among the zang-fu organs, qi, and blood, resulting in a series of clinical manifestations.
Modern medicine posits that the etiology of menopausal syndrome lies in the fact that, after a woman enters menopause, ovarian function begins to decline, estrogen secretion decreases, and the coordination of the hypothalamic-pituitary-ovarian axis changes, leading to excessive secretion of pituitary follicle-stimulating hormone (FSH), thyroid-stimulating hormone (TSH), growth hormone (GH), and adrenocorticotropic hormone (ACTH). This results in endocrine dysfunction, which in turn causes disturbances in the autonomic nervous system, manifesting as a series of symptoms. The most prominent of these is autonomic nervous system dysfunction, leading to symptoms such as facial flushing, sweating, palpitations, headaches, and dizziness, followed by mood changes, irritability, impatience, emotional instability, insomnia, and suspiciousness, among others.
III. Treatment of Menopausal Syndrome
Modern medicine views the series of discomforting symptoms that occur during menopause as non-organic conditions and a normal physiological phenomenon in women. If symptoms are mild, treatment is not necessary; simply paying attention to daily routines and maintaining a positive mindset can help women smoothly navigate menopause. For those with more severe symptoms, appropriate sedatives, such as Librium or Valium, may be prescribed. Although estrogen therapy produces relatively quick results, it carries side effects and may promote tumor growth; therefore, it must be used under strict medical supervision.
Traditional Chinese Medicine (TCM) Differential Diagnosis and Treatment: Women experiencing severe menopausal symptoms may be treated with herbal medicine. This condition is primarily characterized by kidney deficiency; symptoms vary depending on whether the deficiency is kidney yin deficiency, kidney yang deficiency, or a deficiency of both yin and yang, and may also involve the heart, liver, and spleen. Therefore, TCM classifies and treats it according to the following types:
(1) Kidney Yin Deficiency Type: Patients present with dizziness, tinnitus, paroxysmal hot flashes in the head and cheeks, sweating, heat in the palms and soles, and soreness in the lower back and knees. Menstruation may be early or late and irregular, with bright red blood and variable flow. Other symptoms may include dry skin, itching, dry mouth, constipation, scanty and yellow urine, a red tongue with a thin coating, and a fine, rapid pulse. The treatment principle is to nourish kidney yin, supplemented by subduing yang. Zuo Gui Decoction with modifications may be used, or Zhi Bai Di Huang Decoction with modifications.
(2) Kidney Yang Deficiency Type: Patients present with a sallow and dull complexion, listlessness, aversion to cold with cold extremities, soreness and weakness in the lower back and knees, fatigue and weakness, poor appetite and abdominal distension, loose stools, heavy menstrual flow with blood clots, facial and limb edema, frequent urination at night, a pale tongue with a thin white coating, a plump and tender tongue with tooth marks, and a deep, fine, and weak pulse. The treatment principle should be to warm the kidneys and support yang, supplemented by warming the middle burner and strengthening the spleen. Formulas such as You Gui Jiu He or He Zhong Jiu may be used.
(3) Liver-Kidney Yin Deficiency Type: In addition to the symptoms of the Kidney Yin Deficiency type, patients may also exhibit irritability and short temper, distending pain in the chest and flanks, a bitter taste in the mouth, insomnia with frequent dreams, or depression, with a string-like pulse. The treatment principle is to nourish the kidneys and soothe the liver, nurture yin, and subdue yang. The formula Zuo Gui Yin combined with Er Zhi Jiu, with appropriate modifications, may be used for treatment.
(4) Heart-Kidney Disharmony Type: Patients present with dizziness, tinnitus, dry mouth, heat in the palms and soles, palpitations and restlessness, insomnia with frequent dreams, forgetfulness, and even emotional instability, such as unpredictable crying or laughing, accompanied by a fine and rapid pulse. The treatment principle is to nourish the kidneys, calm the heart, and soothe the spirit. Treatment may involve Tianwang Buxin Dan or Dingzhi Jiu.
Other Treatment Methods
① Empirical Formula: Mainly treats symptoms such as hot flashes, sweating, dizziness, palpitations, chest tightness, and insomnia with vivid dreams in menopausal women. Prescription: 12 grams each of raw Rehmannia root (Sheng Di), white peony root (Bai Shao), and ligustrum fruit (Nuzhenzi), Hangju, Huangqin, and roasted Zaoren (each 9 g), and Sheng Longchi (30 g). Decoct in water and take one dose daily, divided between morning and evening.
② Qigong Therapy: The “Chong-Ren-Du-Dai Guiding Exercises” yield good results, as this practice regulates the functions of the four extraordinary meridians: the Chong, Ren, Du, and Dai meridians.
Practice:
There are two types: morning practice (seated) and evening practice (reclining). For the morning practice, upon waking early in the morning, sit upright on the bed with both legs crossed, the soles of the feet facing each other and separated by a fist’s width. Cross your hands in front of your chest, place both hands gently on your breasts, and keep your eyes slightly open, gazing at the tip of your nose. Regulate your breathing and enter a state of stillness. Focus your mind on the Dantian (3 cun below the navel), press your tongue against the roof of your mouth, and clack your teeth 36 times until your mouth is filled with saliva. Use your intention to guide the saliva along the pathways of the Chong and Ren meridians into the lower Dantian. After a moment, use your intention to guide the qi, for men, guide the qi from the lower Dantian to the left; for women, to the right, following the path of the Dai Meridian to complete one full circuit. Channel the qi into the Blood Sea (within the womb), then return to the perineum, pause briefly, and guide the qi through the coccyx and sacrum, ascending along the spine. Follow the Du Meridian path past the neck to the crown of the head, pausing briefly at the Baihui acupoint. At this point, use your intention to guide the qi from the crown back into the mouth, where it transforms into yin fluids (saliva). This completes one cycle; repeat this process 14 more times. Upon completion of the exercise, gently massage both breasts for 4 minutes. Next, use your left hand to massage the Dantian (lower abdomen) and your right hand to massage the waist, rubbing in opposite horizontal directions 50 times each. Switch hands and rub another 50 times. Afterward, use the index finger of your right hand to massage the Yongquan acupoint on your right foot, and the index finger of your left hand to massage the Yongquan acupoint on your left foot, 18 circles each. At this point, conclude the practice and get out of bed.
For the evening practice, lie flat on your back in bed before going to sleep with both legs straight and the big toes of both feet touching. The rest of the routine is the same as the morning practice, except do not support your lower back and do not massage the Yongquan acupoints. You may then go to sleep.