A randomized controlled pilot study of acupuncture for postmenopausal hot flashes: effect on nocturnal hot flashes and sleep quality.

Huang MI, Nir Y, Chen B, Schnyer R, Manber R.
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA.

OBJECTIVE: To assess the effectiveness of acupuncture on postmenopausal nocturnal hot flashes and sleep. DESIGN: Prospective randomized placebo-controlled study. SETTING: Stanford University School of Medicine and private acupuncture offices. INTERVENTION(S): Active or placebo acupuncture was administered for nine sessions over seven weeks. MAIN OUTCOME MEASURE(S): Severity and frequency of nocturnal hot flashes from daily diaries and Pittsburgh Sleep Quality Index (PSQI). PATIENT(S): Twenty-nine postmenopausal women experiencing at least seven moderate to severe hot flashes daily, with E(2) <18 pg/mL and FSH 30.0-110.0 IU/L. RESULT(S): Nocturnal hot-flash severity significantly decreased in the active acupuncture group (28%) compared with the placebo group (6%), P=.017. The frequency of nocturnal hot flashes also decreased in the active group (47%, P=.001), though it was not significantly different from the placebo group (24%, P=.170; effect size = 0.65). Treatment did not differentially influence sleep; however, correlations between improvements in PSQI and reductions in nocturnal hot flash severity and frequency were significant (P<.026). CONCLUSION(S): Acupuncture significantly reduced the severity of nocturnal hot flashes compared with placebo. Given the strength of correlations between improvements in sleep and reductions in nocturnal hot flashes, further exploration is merited.

PMID: 16952511 [PubMed – indexed for MEDLINE]

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The Treatment of Menopausal Palpitations with Chinese Medicine

by Bob Flaws, Dipl. Ac. & C.H., FNAAOM

Many women in the Baby Boom generation are rapidly approaching menopause and are looking for alternatives to conventional Western medical care for this transition in life. More and more women are turning to Chinese medicine for a holistic alternative and complement to standard Western medicine. Chinese medicine is the oldest secular, literate, professional, continually practiced medicine in the world today and it is a holistic medicine par excellent. This is because professional practitioners of Chinese medicine don’t just treat diseases, they treat the whole person.

The methodology of Chinese medicine is based on bringing the person back to a state of healthy, dynamic balance. Symptoms of disease are indications of imbalance. Over 2,500 years, professional practitioners of Chinese medicine have identified approximately 300 different patterns of imbalance humans may manifest. Since these patterns often combine to form even more complex patterns, the possible patterns of imbalance humans can manifest is almost unlimited. Therefore, in Chinese medicine, every patient receives their own individualized treatment. Because that treatment is meant to bring all elements of their being back into balance, Chinese medicine heals without any intended or acceptable side effects. Side effects, whether short or long-term, are like robbing Peter to pay Paul. You cannot achieve true health by throwing one part of the body out of balance while trying to heal another.

Menopausal complaints, such as hot flashes, heart palpitations, night sweats, fatigue, depression, irritability, and irregular menstrual bleeding are all symptoms that something is out of balance in a woman’s body. Menopause itself is not a disease, and, in fact, many women go through menopause without any negative symptoms. When symptoms do accompany menopause, these indicate that this change in life is not going smoothly as it should – that the woman has gotten hung-up in the process and has not come out on the other side. According to Chinese medical theory, menopause or the climacteric is the body’s very wise attempt to slow down the aging process.

When Chinese doctors treat menopausal complaints, they must first determine how or where the woman has gotten stuck in this transition. Once they know this, then they can supply various natural therapies, such as acupuncture, Chinese herbs, and Chinese dietary therapy, in order to correct that imbalance and help the woman successfully complete this transition.

As mentioned above, Chinese medicine is a highly literate professional medicine, and there is a large body of published research reports on the Chinese medical treatment of menopausal complaints. Therefore, Western women do not simply have to try Chinese medicine “on a wing and a prayer.” For instance, Ma Yue-hong published an article on “The Treatment of 40 Cases of Female Climacteric Heart Palpitations with Bu Xin Dan Jia Jian (Supplement the Heart Elixir with Additions & Subtractions)” in the February 1998 issue of Beijing Chinese Medicine. Of the 40 women in this study, the youngest was 46 and the oldest was 55 years old. The shortest course of disease was four months and the longest was three years. Menstruation had ceased in 33 cases and was chaotic in the other seven. Most of the women were professionals, such as teachers and cadres. Electrocardiograms were performed on all the women and there were five cases of slight degree ST-T segment change and five cases of premature beats. In addition, there were four cases of high blood pressure. All the women were screened in order to rule out coronary artery and organic heart disease.

Clinically, the main symptoms were heart palpitations and lack of calm, hot flashes, sweating, scanty sleep, if severe, insomnia, dizziness, tinnitus, emotional lability, tension, agitation, and easy anger, either chaotic menstruation or cessation of menstruation, possible heat in the hands, feet, and heart, low back soreness and lower leg weakness, a red tongue or red tip with thin, yellow or scanty fur, and a bowstring and fine, fine and rapid, or fine and bound or regularly irregular pulse.

Based on the author’s belief that most menopausal palpitations involve a heart qi and yin vacuity, all the women in this study received various modifications of the Chinese herbal formula known as Heavenly Emperor Supplement the Heart Elixir (Tian Wang Bu Xin Dan). This basic formula consisted of uncooked Radix Rehmanniae (Sheng Di), Radix Angelicae Sinensis (Dang Gui), Tuber Ophiopogonis Japonici (Mai Dong), Semen Biotae Orientalis (Bai Zi Ren), Semen Zizyphi Spinosae (Suan Zao Ren), Radix Pseudostellariae (Tai Zi Shen), Radix Scrophulariae Ningpoensis (Xuan Shen), Radix Salviae Miltiorrhizae (Dan Shen), Sclerotium Poriae Cocos (Fu Ling), Radix Polygalae Tenuifoliae (Yuan Zhi), Fructus Schisandrae Chinensis (Wu Wei Zi), Bulbus Lilii (Bai He), and Concha Margaritiferae (Zhen Zhu Mu).

However, this basic formula was then modified to fit each individual woman’s own particular pattern. If there was more serious qi vacuity, Radix Astragali Membranacei (Huang Qi) was added. If there was simultaneous blood vacuity, Gelatinum Corii Asini (E Jiao) was added. If there was concomitant qi stagnation and blood stasis, Fructus Citri Aurantii (Zhi Ke) and Radix Ligustici Wallichii (Chuan Xiong) were added. If night sweats were severe due to vacuity heat, Fructus Levis Tritici Aestivi (Fu Xiao Mai) and Rhizoma Anemarrhenae Aspheloidis (Zhi Mu) were added. If there was high blood pressure due to hyperactivity of liver yang, Semen Cassiae Torae (Cao Jue Ming) and Spica Prunellae Vulgaris (Xia Ku Cao) were added. If heart vexation was severe and the pulse was rapid, racing, or irregular due to heart fire, Rhizoma Coptidis Chinensis (Huang Lian) and Radix Sophorae Flavescentis (Ku Shen) were added. If there was low back soreness and lower leg weakness due to kidney vacuity, Ramulus Loranthi Seu Visci (Sang Ji Sheng) and Radix Dipsaci (Chuan Duan) were added. One packet of these herbs was administered per day as a “tea” after being boiled in water.

In terms of treatment outcomes, cure was defined as disappearance of palpitations or heart arrhythmia and return to a normal ECG. Improvement meant that the heart palpitations had decreased or the duration between episodes had lengthened and ECG findings had improved. No effect meant that there were no turns for the better in either palpitations or ECG findings.

Based on the above criteria, 22 cases or 55% were judged cured, 17 cases or 42.5% were improved, and one case or 2.5% experienced no effect. Therefore, the total effectiveness rate was 97.5%. Of these, the smallest number of packets of Chinese herbs administered was 15 and the largest was 40. (Since one packet was given per day, this meant that cure was obtained in as little as 15 days!)

Representative case history:

The patient was a 50-year-old woman who had had heart palpitations in 1992 for five months and had been hospitalized with yet more serious palpitations for two months. A half year previously she had become forgetful and her emotions were not good. She experienced vexation and agitation and easy anger, recurrent hot flashes, heart palpitations, restlessness, sweating, and insomnia. For the past two months, the heart palpitations and insomnia had been severe. She had chest oppression (a feeling of weight or oppression on the chest making one want to sigh or breath more deeply) and felt like her heart was going to jump out of her chest. When she could go to sleep at night, she had excessive dreams. There was heat in her hands, feet, and heart, and sometimes she was sad and desired to cry for no reason. Finally, things had gotten so bad that she was hospitalized. She was treated with tranquilizers and vitamins but with no result. ECG showed 5-7 premature ventricular beats per minute. Her tongue was red with scant fur and her pulse was fine and rapid.

The patient’s Chinese medical pattern was categorized as kidney yin debility and vacuity with vacuity heat harassing the heart. Therefore, she was given Tian Wang Bu Xiin Dan with individualized additions and subtractions. In addition, each evening she was given one tablet of a sedative. After administering two courses of treatment, her heart palpitations and heart vexation had decreased and her sleep had improved. The sedatives were administered less often, and ECG showed her premature beats had lessened. Sometimes they were there and sometimes not. Administration of the above formula was continued with additions and subtractions according to the symptoms for another 15 packets. By then, the patient’s palpitations had basically disappeared, ECG showed the premature beats had disappeared, and the night-time sedatives were stopped after she was able to sleep five hours each night. The patient was judged cured and was discharged from the hospital. However, she was told to continue taking Tian Wang Bu Xin Dan to consolidate the treatment effect.

I believe the above research report is good evidence for the clinical effectiveness of Chinese medicine for menopausal heart palpitations. A total effectiveness rate of 97.5% is pretty good for any medicine, and especially with no side effects! I also think the accompanying case history gives a pretty good picture of how real-life menopausal patients are diagnosed and treated by professional Chinese medicine. For more information on the Chinese medical theory, diagnosis, and treatment of menopausal complaints, including a number of cheap and easy Chinese home remedies, readers should see Honora Lee Wolfe’s Managing Menopause Naturally with Chinese Medicine, published by Blue Poppy Press, Inc.

The Treatment of Menopausal Syndrome with Chinese Herbs

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Menopausal syndrome varies markedly among women. The most common symptoms include hot flushes (often called hot flashes, but the disorder involves red “flushing” of the skin), dryness and thinning of skin and vaginal wall, mood swings and depression, and insomnia. In addition, there is often a gradual weakening of the bones (reduction of bone density) known as osteoporosis that eventually leads to easy fracture. All of these symptoms are the result of declining levels of sex hormones, especially estrogens.

In seeking information about potential Chinese herbal therapies for menopause, one is directed to the modern rather than the traditional practices. This is because there is limited reference to this problem in older Chinese medical literature. As an example, in the highly respected 14th century book Danxi Zhifa Xinyao (1), there are chapters on gynecology and childbearing, but just a single mention of menopause, with reference to a problem of abdominal pain said to be the result of menopause.

It is unclear to what extent the various menopausal symptoms had been experienced by women in the Orient prior to the modern era. Several factors could have contributed to a low level of concern for menopausal symptoms. There are significant differences between Chinese women in past centuries and modern Western women, in dietary constituents, amount of manual labor, frequency of child bearing, and life span, affecting the incidence and nature of various menopausal symptoms. There could also have been a less frequent seeking of medical attention for menopausal syndrome which, even if the symptoms were significant, might not have been deemed serious enough to require treatment. By contrast, women today are asked to address the long-term implications of menopause, such as osteoporosis and the risk of heart disease, even if their symptoms of menopause are currently negligible. The occurrence of symptoms, even if not severe, simply increases the urgency of this already-expected seeking of assistance.

Although little valuable information about early treatments for menopause is available, we do have access to an ancient description of female aging and loss of fertility from the first pages of the Neijing Suwen (ca. 100 B.C.). The changes in the body are depicted in seven year intervals (2):

At 28 years, the bones and tendons are well developed and the hair and secondary sex characteristics are complete. This is the height of female development. At 35 years, the stomach and large intestine channels (yangming channels) that govern the major facial muscles begin to deplete: the muscles begin to atrophy, facial wrinkles appear, and the hair begins to thin. At 42, all the yang channels (taiyang, shaoyang, yangming) are exhausted, the entire face is wrinkled, and the hair begins to turn gray. At 49 years, the ren and chong channels are completely empty, and the tiangui has dried up. Hence, the flow of menses ceases and the woman is no longer able to conceive.

This description still applies reasonably well, though we know that each individual women ages differently and not precisely according to a set 7-year cycle. The main difference between modern experience and this description is that with skin care products, modern diet (rich in vitamins), and less sun exposure, fewer women have their entire face wrinkled by age 42. In the same text, there is an explanation for the rare cases where older men and women are still able to have children. This capability is said to be due to two factors:

These individuals inherited an unusual abundance of jing and also realized how to lead their lives properly and protect their vitality. At age 64 for males and 49 for females, these individuals still have excess kidney energy as well as qi and blood, so they still have the capacity to procreate.

For those who have not inherited an abundance of jing or have not protected it via their lifestyle, herbalists hold out some hope, if not for restoration of fertility, at least for fewer signs of the associated aging process, by providing tonics that nourish the kidney energy, the qi, and the blood. Such treatment may slow down the physiological changes that lead to uncomfortable menopausal symptoms.

Formulas Recommended for Menopause

Rehmannia, because it is said to nourish yin and blood, benefit the kidney and marrow, and reduce fevers (see: Rehmannia), is an herb commonly selected for treatment of menopause by modern Chinese doctors. This herb is often used in the context of a formula that is focused on nourishing kidney yin or kidney yang or both, depending on the needs of the individual. Following are several currently-recommended menopause formulas derived from several modern Chinese textbooks that have been translated to English, and from one article that presented a survey of several clinical practices in China. These formulas are described in terms of a one-day dose in decoction form; the amounts are in grams. Most herbs are prescribed in the standard doses of 9–15 grams, with larger amounts of the mineral materials (e.g., 30 grams for dragon bone, dragon tooth, oyster shell), and smaller amounts for strong-acting herbs, such as aconite, cinnamon bark, and coptis, or for herbs that are added to benefit the stomach function, such as ginger, jujube, and licorice (when licorice is not also a main herb of the formula). Rehmannia is sometimes used in heavy doses of 24 grams or more.


Clinic of Traditional Chinese Medicine (3):
From English-Chinese Encyclopedia of Practical Traditional Chinese Medicine (4):

Kidney Yin Deficiency Kidney Yang Deficiency
Rehmannia, cooked: 15 Rehmannia, cooked: 15
Dioscorea: 15 Dioscorea: 15
Cornus: 12 Cornus: 12
Hoelen: 12 Lycium: 15
Lycium: 18 Cinnamon bark: 6
Peony: 15 Aconite: 6
Licorice: 6 Cuscuta: 24
Dragon bone: 30 Antler gelatin: 12
Oyster shell: 30 Eucommia: 30
Deficiency of Kidney Yin Deficiency of Kidney Yang Deficiency of Yin and Yang
Rehmannia, cooked: 24 Rehmannia, cooked: 24 Rehmannia, cooked: 9
Dioscorea: 12 Cornus: 9 Tang-kuei: 9
Cornus: 9 Aconite: 6 Anemarrhena: 9
Lycium: 12 Cinnamon bark: 6 Phellodendron: 9
Peony: 12 Antler gelatin: 9 Curculigo: 9
Uncaria: 12 Eucommia: 9 Epimedium: 9
Tortoise shell: 9 Cuscuta: 9 Morinda: 9
Placenta: 12 Epimedium: 9 Ligustrum: 9
Ligustrum: 9 Codonopsis: 12 Eclipta: 9
Eclipta: 9 Atractylodes: 12
Ginger: 3
Baked licorice: 12

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