When menopausal symptoms occur long before the age of 50, it is standard practice from the perspective of Western medicine to order a gynecological hormone diagnosis. Occasionally, this might be only a temporary phase of menopausal complaints, which subsequently recede again; such patients then return to a normal menstrual cycle for any number of years. In this context, typical complaints of early menopause are hot flashes and irregular and/or weakening menstrual periods. A complete absence of menstruation is not rare either. Furthermore, we see occasional night sweating, mood swings, and internal disquietude. In combination with these typical symptoms, the diagnosis is made by means of key laboratory parameters: a lowered estradiol-2 level in conjunction with an elevated FSH level. In pathophysiological terms, this means a decrease in ovarian function in women who are markedly younger than 45–50.

In so-called early menopause, the key symptoms are typically an absent or markedly irregular menstrual period. Alternatively, the period can arrive in very large intervals only and be very weak.

Additional symptoms can be sensation of internal heat, hot flashes, sudden sweating or night sweating, general signs of increasing dryness like dry skin, hair loss, a dry vagina, or dry constipation.

From the TCM perspective, early menopause can have a variety of causes. Accordingly, different types of disharmony patterns can be at the root of these complaints. We distinguish between vacuity patterns and repletion patterns:

• insufficiency of blood (and qi)
  
• insufficiency of kidney yin
  
• insufficiency of kidney yang
  
• insufficiency of essence

• liver qi stagnation
  
• blood stasis
  
• damp-heat in the lower burner
  
• phlegm accumulation

Exhaustion of the blood (xue) is often rooted in chronic overwork. Especially when subjected to permanent hectic or stress, women clearly use up more blood than men. The female physiology is a “physiology of blood,” as is stated in many Chinese texts. Women of childbearing age are furthermore especially in need of a healthy and individually targeted diet. The spleen is tied closely to the production of blood in its function of transforming food into new qi and clarified juices. Women who, for example, start their day without breakfast in the morning run the risk of gradually steering their body into blood vacuity. In addition, strict vegetarians occasionally develop an insufficiency of blood if they fail to pay attention to the type, composition, preparation, and timing of their diet.

Needle Manipulation

Supplement at all points.

Rx. Ba Zhen Tang (Eight Gem Decoction):

• ren shen (Ginseng radix), 3 g or dang shen (Codonopsis radix), 9 g
  
• bai zhu (Atractylodis macrocephalae rhizoma), 9 g
  
• fu ling (Poria), 9 g
  
• gan cao (Glycyrrhizae radix), 4 g
  
• shu di huang (Rehmanniae radix praeparata), 12 g

In the psychological arena, a possible cause of blood vacuity can be a pronounced loss of self-esteem. Because every person’s self-confidence resides in the blood, hurtful separations from a partner can result in blood vacuity in women.

In the system, the blood has the function of “nurturance.” Insufficiency of blood can therefore lead to symptoms like paleness with a withered lusterless complexion, exhaustion, tendency to internal disquietude, and weakened self-esteem. An insufficiency of blood and the resulting insufficient nurturance affects all aspects of the body, for example, dry skin, lusterless dull hair, hair loss, brittle nails, tendency to constipation, tendency to a dry vagina, muscle cramps, feeling of numbness, and weak, delayed, or absent menstrual periods.

• Tongue body: pale, possibly small or flat.
  
• Tongue fur: normal to reduced.
  
• Pulse: fine, forceless.
  
• dang gui (Angelicae sinensis radix), 6 g
  
• bai shao yao (Paeoniae radix alba), 6 g
  
• chuan xiong (Chuanxiong rhizoma), 4 g

Effect

Supplements qi and nourishes blood.

Indication

Combined insufficiency of qi and blood.

Suggested Use

Dosage for 2 days, decocted twice: take one cup three times a day at body temperature.

Insufficiency of kidney yin constitutes exhaustion on a fundamental level. Kidney energy represents our yin pool in the system. As a rule, such a lack of energy can develop in women as the result of numerous births that were spaced too close together. In addition, the functional system kidney is weakened by years and years of continuous overstrain, sleep deficit, or chronic disease. This far-reaching exhaustion is often connected to a feeling of internal disquietude and a lack of feeling rooted in the body, and to a tendency to internal heat.

The mood is often easily frightened. It is possible that long-lasting fears or a single shock event or trauma have damaged the energy of the kidneys. In reverse, an energetic vacuity of the kidney leads to an increase in fears. One patient realized, for example, after childbirth, which had greatly weakened her kidney energy, that she now disliked going into the dark basement, even though it had never bothered her before. In this sense, changes in a patient’s emotional balance are valuable diagnostic hints pointing to the functional system of the kidney.

When it is primarily the weakened functional system of the kidney that lies at the root of early menopause, specific symptoms of kidney vacuity tend to complete the clinical picture: typical symptoms of kidney vacuity are located in the area of the lower spinal column and the lower extremities. Patients therefore often complain of symptoms in the area of the lumbar spinal column (LSC) or the knee. The kidney supplies the ears. Impaired hearing and tinnitus are therefore typical kidney symptoms. In insufficiency of kidney yin, we see great dryness because the kidney is seen as the “lower source of water.” Typical manifestations are hence dry skin and mucous membranes, constipation, dry throat, and thirst. The kidney supplies the hair on the head. Hence, hair loss may arise. The unbridled and no longer rooted yang leads to ascending heat sensations, a red face with hot flash symptoms, and disquietude. This heat is classically known as the “fire of the five hearts”: a sensation of heat in the soles, palms, and the center of the chest. This feeling of internal heat typically increases in the late afternoon or night. In addition, we frequently find a tendency to night sweating. In patients with an insufficiency of kidney yin, the hot flashes, disquietude, and night sweating are most pronounced.

• Tongue body: reduced, shrunken, and cracked.
  
• Tongue fur: reduced or often completely absent.
  
• Pulse: fine, as well as forceless especially in the third position; pulse tends to be accelerated and in some cases superficially palpable.

Supplement at all points.

Rx. Liu Wei Di Huang Wan (Six Ingredient Rehmannia Pill):

• shu di huang, 12 g
  
• shan zhu yu (Corni fructus), 6 g
  
• mu dan pi (Moutan cortex), 6 g
  
• shan yao (Dioscoreae rhizoma), 6 g
  
• ze xie (Alismatis rhizoma), 6 g
  
• fu ling, 6 g

Effect

Supplements kidney yin.

Indication

Insufficiency of kidney yin.

Suggested Use

Dosage for 2 days, decocted twice: take one cup three times a day at body temperature.

Insufficiency of kidney yang is closely related to insufficiency of kidney yin. In the kidney’s functional system, yin and yang are intimately interconnected; hence a weakness of one of them over time always leads to a weakness of the other side. If the lack of yang forces predominates, we primarily see cold symptoms.

The causes are again similar to those of insufficiency of kidney yin: numerous or very exhausting pregnancies and births, long-term overstrain, lack of sleep, or chronic disease. Kidney yang is also very specifically affected negatively by excessive physical exertion, as is common in competitive sports.

Patients with an insufficiency of kidney yang suffer from a weakened ministerial fire. The kidney is the source of all yang in the body and is also referred to as the “lower fire” of life. Such women therefore suffer from great inner cold, which is particularly pronounced in the area of the lower half of the body. This leads to cold feet and to a feeling of cold in the LSC area or buttocks. Additionally, the fire is lacking in the realm of sexuality, which results in apathy and lacking libido. Because the kidney constitutes the will (zhi), we often see a weakened willpower.

Other typical symptoms of kidney yang vacuity concern three areas in particular:

• the LSC area and the lower extremities
  
• urination
  
• the genital area

Especially common complaints of kidney yang insufficiency are therefore lumbar pain, weakness, cold, or pain in the lumbar region that can also radiate outwards, knee problems, cold feet, also weakness of the lower extremities, and frequent urination with large amounts of clear and uncon-centrated urine. Occasionally, this is accompanied by incontinence, that is, the inability to hold urine or stool, because the kidney governs the two “lower openings.” In the genital area, the weakened fire is especially noticeable. In women, this results in reduced libido with a tendency to increased whitish vaginal discharge. Possibly premature graying of the hair on the head. In patients with early menopause due to kidney yang vacuity, we find only a minor tendency to hot flashes. Instead, the lack of libido and internal cold are emphasized.

• Tongue body: can still look relatively normal, but tends to be pale and swollen.
  
• Tongue fur: relatively normal to slightly more whitish.
  
• Pulse: especially in the third position weak and forceless, as well as slow.

Needle Manipulation

Supplement at all points.

In this pattern, moxibustion on all points—especially BL-23, GV-4, and CV-4—is highly recommended.

Rx. Jin Gui Shen Qi Wan (Golden Coffer Kidney Qi Pill):

• shu di huang, 12 g
  
• shan zhu yu, 6 g
  
• mu dan pi, 6 g
  
• shan yao, 6 g
  
• ze xie, 6 g
  
• fu ling, 6 g
  
• rou gui (Cinnamomi cortex), 2–6 g
  
• fu zi (Aconiti radix lateralis praeparata), 1–6 g

Effect

Supplements kidney qi and yang.

Indication

Insufficiency of kidney yang.

Suggested Use

Dosage for 2 days, decocted twice: take one cup three times a day at body temperature.

Insufficiency of essence is a form of energetic kidney deficiency. A deficiency of essence manifests differently in children and adults.

In children, insufficiency of essence is very often congenital, which is to say that the child is born with it. Essence deficiency can be traced back to a weakness of parental jing at the time of conception. A difficult pregnancy can contribute to an insufficient development of the embryo as well. After birth, the essence controls development and growth. The kidney is responsible for the marrow and brain: children with insufficient essence are therefore characterized by delayed bone growth and neurological development.

In adults, jing depletion is generally the result of chronic long-lasting intensive overwork or sport-related extreme strain. Jing depletion in adults thus represents rather a premature consumption of essence.

Typical symptoms of essence insufficiency are in children: delayed fontanel closure, “weak” fragile bones, and a delay in motor and linguistic development.

Needle Manipulation

Supplement at all points.

Rx. Zuo Gui Yin (Left-restoring [Kidney Yin] Beverage):

This formula represents a modification of Liu Wei Di Huang Wan:

• shu di huang, 12 g
  
• shan zhu yu, 6 g
  
• shan yao, 6 g
  
• gou qi zi (Lycii fructus), 6 g
  
• fu ling, 6 g
  
• gan cao, 4 g

Effect

Supplements kidney essence, kidney qi, and kidney yin.

Indication

Insufficiency of kidney essence.

Suggested Use

Dosage for 2 days, decocted twice: take one cup three times a day at body temperature.

• Tongue body: can look relatively inconspicuous. If the yang aspect of the kidney is affected more strongly, the tongue tends more towards paleness and dampness. If the yin aspect is more involved, the tongue tends more towards redness and shrinking.
  
• Tongue fur: can be normal
  
• Pulse: forceless in the third position.

The most common cause of liver qi stagnation is emotional strain, which can disrupt the free flow of qi in the liver. When such strain persists over a longer period of time, it begins to manifest in the physical realm as well.

Typical symptoms of liver qi stagnation are feelings of pressure and oppression. These result from the blocked flow of qi, which is no longer able to move freely. Frequent complaints include pressure on the right or left costal arch, cramping or colic in the abdominal space, pulling on the lumbus, and lateral headaches. Cold extremities and a general feeling of exhaustion can also be manifestations of the blocked flow of qi.

In the psychological realm, we see an irritated or frustrated basic mood, which is often projected outwards and hence leads to various forms of assigning blame to the person who might have caused the patient’s own misfortune.

• Tongue body: prominent and reddish on the margins; the margins are often slightly “rolled up” and tensed.
  
• Tongue fur: mostly normal.
  
• Pulse: stringlike, tight, as well as forceful.

Needle Manipulation

Harmonize at all points.

Rx. Chai Hu Shu Gan San (Bupleurum Liver-coursing Powder):

This formula constitutes a modification of Si Ni San (Counterflow Cold Powder):

• chai hu (Bupleuri radix), 6 g
  
• bai shao yao, 6–9 g
  
• chen pi (Citri reticulatae pericarpium), 6 g
  
• zhi ke (Aurantii fructus), 6 g
  
• xiang fu (Cyperi rhizoma), 6 g
  
• chuan xiong, 6 g
  
• gan cao, 3 g

Effect

Regulates liver qi.

Indication

Liver qi stagnation.

Suggested Use

Dosage for 2 days, decocted twice: take one cup three times a day at body temperature.

Blood stasis can develop out of chronic qi stagnation because the qi moves the blood. Blood stasis is also facilitated by blood deficiency since this means that only a limited amount of blood is available, which is more likely to be blocked than a large full stream. In addition, blood stasis patterns can arise after surgery or due to injury or the use of an IUD.

Typical symptoms of blood stasis are severe to very severe pain. If the patient still has occasional menstrual periods, the menstrual blood is dark, livid, and clotted. The nature of the pain is typically piercing or stabbing and often localized.

• Tongue body: livid, the sublingual network vessels are congested.
  
• Tongue fur: rather unchanged and only reduced in concomitant blood vacuity.
  
• Pulse: stringlike, rough, forceful.

Needle Manipulation

Harmonize at all points.

Rx. Xue Fu Zhu Yu Tang (House of Blood Stasisexpelling Decoction):

• dang gui, 6–9 g
  
• chi shao yao (Paeoniae radix rubra), 6 g
  
• sheng di huang (Rehmanniae radix exsiccata seu recens), 6 g
  
• tao ren (Persicae semen), 3–9 g
  
• hong hua (Carthami flos), 6–9 g
  
• chuan xiong, 3–6 g
  
• huai niu xi (Achyranthis bidentatae radix), 6–9 g
  
• chai hu, 3 g
  
• zhi ke, 6 g
  
• jie geng (Platycodonis radix), 6 g
  
• gan cao, 3 g

Effect

Regulates the blood and resolves blood stasis.

Indication

Blood stasis.

Suggested Use

Dosage for 2 days, decocted twice: take one cup three times a day at body temperature.

Modifications

The following formula is a modification of this formula. It targets the lower abdomen in particular and expels cold from the inside.

Rx. Shao Fu Zhu Yu Tang (Lesser Abdomen Stasisexpelling Decoction):

• xiao hui xiang (Foeniculi fructus), 3–6 g
  
• rou gui, 2–6 g
  
• gan jiang (Zingiberis rhizoma), 26 g
  
• dang gui, 6–9 g
  
• chuan xiong, 3–6 g
  
• mo yao (Myrrha), 3 g
  
• wu ling zhi (Trogopteri feces), 3–9 g
  
• yan hu suo (Corydalis rhizoma), 3–6 g
  
• chi shao yao, 6 g
  
• pu huang (Typhae pollen), 3–9 g

Effect

Regulates the blood, disperses blood stasis, and expels cold from the inside.

Indication

Blood stasis and cold.

Suggested Use

Dosage for 2 days, decocted twice: take one cup three times a day at body temperature.

Heat and dampness are pathogenic factors that can arise externally and internally. Damp-heat frequently develops out of residual dampness. This results in a blocked energy flow, which over time can gradually cause the formation of heat. Dampness usually arises internally in the center burner, as the result of a faulty diet or weakened spleen. When dampness is compounded by heat, the pathogens often “sink” into the lower burner. Furthermore, emotional factors like stress cause a blocked qi flow. Any stagnation that persists for a longer period of time can generate heat and impede the downward drainage of the waterways. This means that dampness can cause heat and that heat can also conversely cause dampness.

Needle Manipulation

Harmonize at all points.

Rx. Jia Wei Er Chen Tang (Supplemented Two Matured Ingredients Decoction):

• ban xia (Pinelliae rhizoma), 6 g
  
• chen pi, 6 g
  
• fu ling, 6 g
  
• bai zhu, 6 g
  
• huang bai (Phellodendri cortex), 6 g
  
• huang qin (Scutellariae radix), 5 g
  
• huang lian (Coptidis rhizoma), 4 g
  
• dang gui, 5 g

A typical symptom in patterns affected by the pathogens heat and dampness is white to yellow vaginal discharge. This can often lead to itching and burning. The external genitals are reddened. In addition, genital eczema can arise as well. In this pattern, the heat leads to sensations of warmth and burning, while the dampness aspect leads to sensations of heaviness or localized fullness or pressure. Internal inflammations in the genital and lower abdominal area can also arise in this context, as well as adnexitis or inflammatory bowel disease.

• Tongue body: reddened and swollen; possibly dental impressions on the margins.
  
• Tongue fur: increased and yellowish.
  
• Pulse: stringlike, forceful.
  
• bai shao yao, 5 g
  
• gan cao, 3 g

Effect

Drains dampness, clears heat, transforms phlegm, and gently supports the spleen and blood.

This is the recommended treatment for collection of damp-heat when heat and dampness are present in relatively equal amounts.

Suggested Use

Dosage for 2 days, decocted twice: take one cup three times a day at body temperature.

Phlegm disorders are frequently rooted in spleen pathologies. Spleen qi vacuity is rooted in years of malnourishment. Especially energetically and physically cold foods like raw foods or an excessive consumption of dairy products can harm the spleen’s ability to transform. In addition, sweets, alcohol, and late night dinners strain the spleen. Phlegm is often referred to as a so-called “secondary pathogen.” Phlegm frequently blocks the free flow of energy.

Needle Manipulation

Harmonize at all points, supplement at BL-20.

Rx. Er Chen Tang (Two Matured Ingredients Decoction):

• ban xia, 12 g
  
• chen pi, 12 g
  
• fu ling, 8 g
  
• gan cao, 4 g

Effect

Eliminates dampness, transforms phlegm, and regulates qi.

Indication

Collection of phlegm-damp.

Typical symptoms of phlegm accumulation are feelings of pressure and fullness in the thorax and upper abdomen. We often also see increased phlegm in the throat area. These symptoms tend to be compounded by continuous increased white vaginal discharge. The spirit (shen) is dull, lethargic, and dazed. Dizziness occurs and the face can appear swollen. In the extremities, swelling and edemas arise in combination with a feeling of heaviness.

• Tongue body: enlarged; shows dental impressions on the margins.
  
• Tongue fur: thick and sticky.
  
• Pulse: slippery, stringlike, forceful.

Suggested Use

Dosage for 2 days, decocted twice: take one cup three times a day at body temperature.

Modifications

A common modification and expansion of this formula is presented by the following formula:

Rx. Xiang Sha Liu Jun Zi Tang (Costusroot and Amomum Six Gentlemen Decoction):

• ren shen, 3 g or dang shen, 9 g
  
• bai zhu, 9 g
  
• fu ling, 8 g
  
• ban xia, 12 g
  
• chen pi, 12 g
  
• mu xiang (Aucklandiae radix), 6 g
  
• sha ren (Amomi fructus), 6 g
  
• gan cao, 4g

Strengthens the spleen, eliminates dampness, transforms phlegm, and regulates qi.

Indication

Accumulation of phlegm-damp, with a weakness of spleen qi at the root of the condition.

Suggested Use

Dosage for 2 days, decocted twice: take one cup three times a day at body temperature.

It is often possible to reestablish the menstrual cycle by means of Chinese medicine. Nevertheless, it is important to recognize that this requires time. Two to 3 months of treatment are often the minimum time needed. During this period, the predominant pattern can gradually change. Therefore, the practitioner should carefully reevaluate the patient’s state in each session. If done correctly, the supplementation of deficiencies or elimination of pathogens will eventually show effects and, if possible, sometimes reestablish the menstrual cycle.

Literature