patterns and treatments of - tcm hub

Patterns and Treatments of Menopausal Hot Flashes

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Presented by Michael Peluso, M.S., L.Ac.

© 2019 Michael J. Peluso/TCM Gynecology No part of this slideshow may be reproduced, copied, or shared without written permission.

TCM Methodology• TCM as the foundation of professional standards for

this class and all TCM Gynecology programs.

• Standardized Methodology -Bian Bing Lun Zhi-Bian Zheng Lun Zhi

• Standards of Diagnosis-Patterns of signs and symptoms


TCM Methodology• Western Diseases Diagnosis

- Steps for moving from Western disease toward Chinese pattern.

• Chinese Disease Categories (Bian Bing) -Chinese disease names

• Treatment Based on Patterns (Bian Zheng Lun Zhi)-Constellations of signs/symptoms, tongue and pulse associated with the Chinese medical diseases


Menopause


Menopause• Not a disease

• Permanent cessation of menstruation for one year

• Ovaries become unresponsive to rising FSH

• Estradiol and progesterone levels drop

• Cycle become increasingly erratic and eventually ceases


Menopause• Average age in the West is 51

• Can occur as young as 40

• Under 40 is considered premature ovarian failure or premature menopause

• Perimenopause can last 2-10 years with the average being 4.


Perimenopausal Syndrome• Many common symptoms of Menopausal Syndrome - Insomnia - Moodiness - Memory problems - Vaginal dryness - Loss of bone mass/density - Joint/muscle pain- Headaches - Weight gain- And of course, the big one…


“Hot Flashes/Flushes”


Hot Flashes• One of many symptoms of “menopausal syndrome”

• Sensations of heat spontaneously rising, generally in the upper part of the body, chest, neck, face.

• Flushing of the cheeks and chest is not uncommon

• Sweating frequently accompanies the flashing/flushing


Hot Flashes• Very common for the woman to feel cold right after

the hot flash or the sweating abates.

• Episodes last anywhere from 30 seconds to 10 minutes and can be infrequent (daily, or every other day) or frequent (sometimes several times per day)

• Hot flashes can occur day or night or both.


Hot Flashes

• Mainline interventions from biomedicine are:

• HRT (Hormone Replacement Therapy)

• Estrogen/Progestin (has risks)

• SERMs (Selective Estrogen Receptor Modulators)


TCM View of Menopause


TCM Menopause

•“We are not treating a disease, rather we are facilitating a transformation” -Bob Flaws


TCM Menopause• Not a disease

• jing duan “Cessation of Menstruation”

• Nei Jing 7X1 Yangming

• Nei Jing 7X2 Arrival of Tian Gui

• Nei Jing 7X5 Yang Ming decline

• Nei Jing 7X7 Tian gui ceases


TCM Menopause

• Self-preservation

• Heart/Bao Mai Reversal

• Should be a smooth, relatively uneventful process


Perimenopausal Syndrome

• The central, confounding role of the Liver


Spleen

Blood Vacuity

Kidney Yang Vacuity

Liver

Faulty Diet

Affect Damage

Lungs

Heart

Qi Vacuity

Qi VacuityBlood Vacuity

Affect Damage

Damp

Phlegm

Age

Kidney Yang Vacuity

Kidney Yin Vacuity



• Not a traditional disease category

• Reflects influence of Western medicine

• jing duan qian hou “pathologies before and after the cessation of menstruation”

• Increasingly common and usual but still not normal

• Can be prolonged over many years


Perimenopausal Syndrome• Many common symptoms: - Insomnia - Moodiness - Memory problems - Vaginal dryness - Loss of bone mass/density - Joint/muscle pain- Headaches - Weight gain- Hot flashes



• “The major clinical signs and symptoms of perimenopausal syndrome often manifest as those of deficiency patterns. Even if the pattern is one of excess, it is usually root deficiency combined with branch excess”1



• Liver/KD Yin Vacuity

• Spleen/KD Yang Vacuity

• HT/SP Vacuity

• Dual Kidney Yin/Yang Vacuity

• Hyper-ascendent Liver Yang

• Dampness/Phlegm Heat/Blood Stasis

Common Pathomechanisms of Perimenopausal Syndrome


Steps Toward Diagnosis


Constitutional Diagnosis

• Shao Yang -healthy

• Shao Yin -Skinny, prone to Yin/Blood vacuity from birth

• Tai Yang -apple shape, top heavy, skinny legs, prone to heat, damp, phlegm accumulation, obesity above.

• Tai Yin -pear shape more prone to SP/KD Yang vacuity,cold, damp, obesity below.


TCM Hot Flashes

• Don’t exist in a vacuum

• Often accompanied by many other symptoms

• Must be reframed in Chinese disease category(ies)


TCM Hot Flashes

• Head Sweating (Tou Han)

• Head Heat (Tou Re)

• Hot Flashes in the Head and Face (Tou Mian Hong Re)

• Red Facial Complexion (Mian Se Hong)

Potential TCM Disease Categories


TCM Hot Flashes

• Redness Above the Cheekbones (Quan Hong)

• Tidal Hectic Fever (Fa Re Ding Shi)

• Vexatious Heat in the Five Hearts (Wu Xin Fan Re)

• Night Sweats (Dao Han)

Potential TCM Disease Categories


Common Single-Patterns Resulting in Hot Flashes


TCM Hot Flashes

• Liver Depression Depressive Heat - S/S: Hot Flashes, red face, red eyes, mostly during the day when emotions are most labile, irritability, loud voice, “11” lines between eyebrows, -Tongue: Inflated rim of the tongue possibly with red tip. -Rx: Jia Wei Xiao Yao San

Common Single Patterns & Symptoms


TCM Hot Flashes

• Kidney Yin Vacuity-S/S: Dizziness, tinnitus, dry skin, itching, hot flashes, night sweats -Tongue: No coating or redRx: Zuo Gui Wan



TCM Hot Flashes

• Yin Vacuity with Vacuity Heat-S/S: Hot Flashes, night sweats, vaginal dryness, dry throat, tinnitus, possibly constipation.-Tongue: Red with scanty yellow fur Rx: Zhi Bai Di Huang Wan



TCM Hot Flashes

• Yin Vacuity with Internal Heat -S/S: Night sweats, tidal fever, red facial complexion, dry mouth/lips, irritability -Tongue: Thin, with slimy yellow coating Rx: Dang Gui Liu Huang Tang Dang Gui Sheng Di Shu Di


Huang LianHuang QinHuang BaiHuang Qi


TCM Hot Flashes

• Hyper-Ascendent Liver Yang-S/S: Hot flashes (especially in the body and face in the afternoon) dizziness, irritability, headaches, night sweating, -KD Yin vacuity signs may be present as well. -Tongue: red Rx: Qi Ju Di Huang Wan (Liu Wei Di Huang Wan plus Gou Qi Zi + Ju Hua)



Spleen

Blood Vacuity

Kidney Yang Vacuity

Liver

Faulty Diet

Affect Damage

Lungs

Heart

Qi Vacuity

Qi VacuityBlood Vacuity

Affect Damage

Damp

Phlegm

Age

Kidney Yang Vacuity

Kidney Yin Vacuity


Common Multi-Pattern Presentations Resulting in Hot Flashes


TCM Hot Flashes

• Dual Yin and Yang Vacuity with Vacuity Heat-S/S: Hot flashes, night sweats, tinnitus, dry throat, irritability, cold feet, frequent urination and nighttime urination-Tongue: Variable depending on which vacuity is more dominantRx: Er Xian Tang + Er Zhi Wan

Common Multi-Pattern Presentations


TCM Hot Flashes

• Kidney Yin and Yang Vacuity, Vacuity Heat, Heart Blood Spleen Qi Vacuity, and Liver Depression -S/S: Hot flashes, night sweats, 5 hearts heat, vaginal dryness, tinnitus, dizziness, fatigue, emotional lassitude, insomnia, low back aching or soreness, cold feet, decreased libido, frequent urination, nighttime urination, fatigue, dizziness on standing, palpitations, poor memory, irritability. Rx: Er Zhi Xian Fang (“Two Ultimates” from Blue Poppy)



Er Zhi Xian Fang (Two Ultimates)

Fu Xiao Mai Mu Li Long Gu Ye Jiao Teng He Huan Pi Nu Zhen Zi Han Lian Cao Da Zao Fu Ling

Supplements the Heart Stops Night Sweating

Quiets Spirit & downbears counterflowSecures and astringes aids Fu Xiao Mai to stop sweating

Quiet the SpiritCourse the Liver and Rectify the Qi

Two Ultimates (Er Zhi Wan):Enriches Yin without damaging the Spleen

with Fu Xiao Mai to supplement both Heart and SP

Enriches Kidney Yin and clears vacuity heat

Clears Vacuity Heat

Two Immortals (Er Xian Tang):Nourish Liver Blood, Invigorate KD YangCourses the Liver and resolves depression.

Fu Ling promotes urination. Guides ministerial fire down

Zhi Mu Huang BaiXian Mao Yin Yang Huo Dang Gui Gan CaoShan Yao Chuan Lian Zi Ren Shen

Nourishes the Blood with Da Zao, Fu Ling and Fu Xiao Mai nourish HT & SP

Fortifies and Supplements all 5 viscera

Courses the Liver/Rectifies Qi without plundering Yin Supplements Spleen and Kidneys


TCM Hot Flashes

• Phlegm Obstruction & Qi Stagnation (also can present with Dual KD Yin and Yang Vacuity S/S as well)-S/S: Obese, irritability, moodiness, depression, low appetite, insomnia, hot flashes, can ask about “post-nasal drip” (Plum Pit Qi), ask if they feel “phlegmy”-Tongue: Puffy, swollen, teeth marks, thicker yellow coating, can be slimy or dry Rx: Wen Den Tang or Zhu Ru Wen Den Tang



TCM Hot Flashes• Blood Stasis (also can present with Dual KD Yin and Yang

Vacuity S/S as well as all other patterns discussed above) -S/S: Anger, irritability, hot flashes, breast lumps, dysfunctional uterine bleeding (Beng Lou) with clots, menses stopping and starting over a prolonged period of time, palpable fibroids, heart palpitation, insomnia, pain with symptoms worse at night, and all other s/s associated with the presence of Blood Stasis. -Tongue: Purple Rx: Depending on other concomitant root patterns Ge Xia Zhu Yu Tang, Xue Fu Zhu Yu Tang, Shao Fu Zhu Yu Tang, Wen Jing Tang, or just individual Blood Quickening or Blood Breaking medicinals to existing formula.



TCM Menopause

•We are not treating a disease, rather we are facilitating a transformation

Remember…


TCM Menopause

•Therapy can be effective in as little as 2 weeks, or it may take up to 8-12 weeks. We are just trying to move a natural process along. Be patient and encourage patience from your patients.

Remember…


TCM Menopause

•Encourage patients to take it easy, to ease into this chapter of life. Show them basic ways to manage stress, encourage exercise and good eating, stress-reduction habits, positive reading material and podcasts. Encourage fresh thinking and time in nature.

Remember…


TCM Menopause

Q & A


Reference Materials• Bensky, Dan et. al., Chinese Herbal Medicine: Formulas and Strategies Eastland Press. Seattle, WA 2009

• Flaws, Bob Menopause & Chinese Medicine Blue Poppy Press Boulder, CO 2015

• Flaws, Bob et. al., A Handbook of TCM Patterns & Their Treatments Blue Poppy Press Boulder, CO 2015

• Flaws, Bob A Compendium of Chinese Medical Menstrual Diseases Blue Poppy Press Boulder, CO 2005

• Liang, Lifang Contemporary Gynecology: An Integrated Chinese-Western Approach Blue Poppy Press Boulder CO 2017

• Maciocia, Giovanni Obstetrics and Gynecology in Chinese Medicine Churchill Livingstone Elsevier New York 2011

• Sionneau, Philippe et. al. The Treatment of Disease in TCM Volumes 1 & 7 Blue Poppy Press Boulder, CO 2018

• Yi, Si-tu et. al., The Clinical Practice of Chinese Medicine: Menstrual Disorders II: Premenstrual Syndrome, Dysmenorrhea & Perimenopause People’s Medical Publishing House Beijing 2008

• Zhang, Ting-liang et. al, A Handbook of Traditional Chinese Gynecology Blue Poppy Press Boulder, CO 1998

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