Menopause: Does this disease exist in Chinese medicine literature

While it may be true that there is no classical CM disease called "menopause", there are certain symptoms that tend to be more prevalent in women over the age of about 45 (or 49 if we are adhering strictly to the Classics). I guess if we really want to get philosophical about it we could argue that menopause is part of the natural proces of decline of Yin, Yang, Qi, Blood, Essence etc., and therefore is not really a disease at all.

That being said, my feeling is that if a particular patient population is dealing with some unpleasant symptoms that we know we can be of assistance with, then we ought to treat them. It really doesn't matter to me whether there exists a "classical" disease category called "menopause". All that matters is that someone has a health concern, and I believe I might be of help to them. If one is to suggest, as your potential lecturer suggests, that "Each symptom that we think of as due to "peri-menopause" really needs to be approached as a symptom in it's own right, not part of a syndrome per se", then I think we could have some very interesting discussions.

Ultimately, in classical CM, we treat what we see, and in this particular demographic, there is undoubtedly a preponderance of night sweats, hot flashes, insomnia and anxiety. For example, let's look at the very common complaint of night sweats. I have heard some very senior CM practitioners suggest that this symptom can only be possible in Kidney-Yin deficiency patterns. Therefore, on this basis, it would suggest that if your "menopausal" patient has this particular symptom, then they must also have some Kidney-Yin deficiency.

Assuming that this patient also has insomnia, which we know is a classical CM disease category, then we do our due diligence and determine then underlying pattern. Maybe it's Kidney-Yin deficiency, maybe it's Heart-Yin (or Blood) deficiency, maybe it's Heart-Fire. We pattern discriminate and determine precisely what is going on.

Sure, the "menopause" label could be having a potentially negative impact on some women, but, for the sake of marketing (which, let's face it, is the reason we would do a public lecture on any topic), what do we call this particular collection of signs and symptoms? I think we have to use a term that people are familiar with - Western medicine has called it "menopause", and women know what that means. It is somewhat more complicated to say "Dr Smith lecturing on Traditional Chinese Medicine and the treatment of Kidney-Yin and Essence deficiency with a preponderance of Heart-Fire, and phlegm-Heat harassing the Interior". Ultimately, we are lecturing to a Western audience, and maybe sometimes we can break from tradition, and use the "accepted" western term.

As an interesting side-debate, the is no Classical CM disease called "cancer" either, so does that mean that it is a taboo subject to lecture on from the TCM viewpoint as well?

Brad Matthews
Dr TCM
www.nswellness.ca

From my clinical experience and that of some of my teachers, I would have to argue that night sweats are not only due to Kid yin vacuity. Actually I would have to say that these can be due to Qi level heat and damp heat as well, and in my clinical practice I would have to say that I see these as the common cause more than yin vacuity. Quite often the people I see complaining of night sweats also have a big thirst, big pulse or even soft (dampness), a flushed face, and may even have a heavier body type. I find draining the heat to be more effective than nourishing yin.
When I treat patients with eczema one of the symptoms that I was taught to ask was whether they sweat or not, especially at night. This helps me decide the subtype of eczema and how to treat it. If they sweat then I can assume there is damp heat and so my medicnals will reflect that more than if they don't. Ie I will use herbs to drain dampness and eliminate wind like Hai tong Pi and Xi Xian cao when there is obvious sweating and they have itch. Otherwise I would use more strickly wind clearing medicinals like jing jie and fang feng when there is no sweating and an itch. If I miss this symptom there is the possibliity of making the eczema worse, even promote folliculitis. It is my experience that sweating at night is much more than just kid yin vacuity. Of course if they continue to sweat over a long time then I would assume that the yin will be damaged, but I don't instantly think that night sweat= kid yin vacuity from the first look, no matter what their age.

My thoughts,
Trevor

Menopausal syndrome (jing jue xian hou zhu zheng) or climateric syndrome (geng nian zhu zheng) are disease categories added to Chinese medical gynecology (specifically under the menstrual disease category) in the second half of the 20th century. that being said, they have been a standard diagnostic disease category ever since the early 1980s at the least. This is similar to the incorporation of PMS (xian hou jing xing zhu zheng) into the menstrual disease category. However, Chinese medicine has treated menopausal syndrome under the rubric of zang zao (visceral agitation) since the late Han dynasty where this "disease" appears in the miscellaneous diseases of gynecology in the Jin Kui Yao Lue. In the same way, Chinese medicine has always treated the manifestations of PMS under the rubric of the various jing xing or menstrual movement diseases.

While Volker Scheid's original article on this issue makes a number of valid points, I find it quite biased in its presentation. Unfortunately, if you haven't read the Chinese language sources, Volker's argument looks very convincing. However, he presents a number of half-truths or misreadings to support his thesis. For sure Volker has an ax to grind. For a more (from my POV) complete discussion of menopausal syndrome within contemporary standard professional Chinese medicine, you might want to see my book on this subject.

Further, would one want to be treated by "classical" Western medicine, meaning the scholastic medicine prior to the second half of the 19th century? I doubt it. So why do so many Westerners persist in talking about "classical" Chinese medicine as if this was somehow a superior kind of Chinese medicine. IMO, this is Golden Age romantic Orientalism, and is a symptom of the holier-than-thou attitude of recent converts. While I am one of the most guilty parties within our profession in establishing this misinformed point of view in the late 70s and early 80s, I have long since grown out of it through my reading of the Chinese literature itself in its original language and my continued experience of Chinese medicine in China and the West. I see this attitude as a real impediment to the maturation of our profession in the West. We need to get over it. It is a symptom of our ignorance of Chinese medicine in China due to our general lack of ability to access primary source materials in their original language.

Perfect timing. Today I received in the mail my September addition of The Lantern out of Australia. There is a relevant article by Degmar Hemm called Menopause:natural process or disease? What the Classics say.

Here are a few quotes... taken out of context of course :o)

"AT this point we should note that the Traditional Chinese Medicine to which we reverently attribute a 200o year history is a construction of the Chinese Republic with the consequence that it has lost most of its true values. IN the middle of the 20th century Chinese medicine was cleansed of its "feudalistic", shammanistic and religious elements. What remained were zang-fu syndromes, often based on western disease categories, for which as we will see below, we cannot find no reference in the classical texts, because it did not have any clinical relevance."

The article does on to discuss several case studies with treatment plans. Interesting article and good read.

So I am starting understand now how this discussion all started with me being a little to sarcastic (kind off rude) to my colleague about her point of view on the word "menopause" I do see her point. I do not want to get too hung up on the word though. The classics do have lots to say about how to treat the symptoms that many women in their mid 40's and older experience even if it has been incorrectly labeled as menopausal syndrome according to the purist.

Actually, here are some of the disease categories the classics discussed which is now labeled by western medicine as menopause.

Jing Bi - Amennorhea
Lao Nian Jing Duan Fu Xing - Menstrual bleeding returning in old age
Lao Nian Nu Yin Gan Se - Vaginal dryness in old age
Lao Nian Xue Beng - Hemorrhage in old age
Lao Nian Pi Fu Sao Yang Zheng - Itchy skin disease in old age
Jue Jing Huo Gu Zhi Shu Song Zheng - reduced bone density after menopause
Zang Zao - Dry organ disease, hysteria, internal turmois/palpitations of the heart

Anyway, great article.

Lorne
www.acubalance.ca
www.prodseminars.com

Needle Doc,

We will never know. The only thing we can do is top play the ball where it lies. Personally, after studying and practicing this medicine for 30+ years, I'm happy that Chinese medicine did encounter modern Western medicine and I believe Chinese medicine is better for it. the longer you practice Chinese medicine, the more you will realize the limitations of our medicine. Personally, my opinion is that it is both inevitable and desirable that eventually the standard of care in professional Chinese medicine (at least in Asia) will be integrated Chinese-Western medicine" (zhong xi yi jie he). This is because practitioners in Asia have more training and experience and, therefore, a less romantic and naive notion of our medicine.

What is wrong with defining a set of symptoms by a name like menopause or menopausal syndrome? Who cares if that name did not exist in the classical literature? Does that mean that this phenomena does not exist because it is not written in the old books?? Hundreds of women come in for menopausal syndrome treatment because this is what they are experiencing and need help. The name helped them get to the "alternative" CM practitioners office in the first place. Is there any harm in this? Even with a name we still have to do pattern differentation and apply an individually based treatment plan. The name helps us communicate with our peers and with your patients. I think that the practitioners of old would have been greatly disappointed if a new name for an undeniably obvious set of signs and symptoms were thrown out by there collegues as proposperous. Medicine of all kinds evolves just like everything else in the universe does, lets keep up and be present with our times! Are we to believe that other planets in our solar system don't exist because they weren't written about in the Mawangdui tombs??
Many new disease titles are applied to western and chinese medicine all the time. The skin disease Perioral dermititis is another example of a disorder that wasn't really recognized as such until only the last few decades. Looks like acne in some ways, but lacks the typical open and closed commedones. So what do you do? Treat it like acne and it doesn't get better. Practitioners had to look at the patterns and understand how this lesion behaved. Then a series of protocols were established and now it is a lot easier to treat. A process of growing and learning. Is this not what we do all the time?
I think that practitioners should stop being anthropolgists and start seeing how CM as practiced today continues to get excellent results. Be knowledgable of the classics, but don't be limited by them.

Trevor

Hello Everyone,

Wow what a great thread of comments. My views about the TCM tx of the "symptoms" are largely represented here by several commentors: the points about it not only being about KI yin vacuity, and often seeing some LV qi stag, Ht fire etc and Bob's comments about newer 20th disease categories. So I will mainly comment on the language we use with American patients and the impact it may have.

Many US health practitioner's still have no idea about how powerful on an impact thier words have on thier patients. In my book on TCM weight loss I ask that practitioners always speak with the greatest compassion to patients. Our word is our wand. Patients listen to us very closely, so we must be very aware and mindful each time we speak with our patients. (My personal goal is to altogether stop using the word "infertility" even when speaking with other practitioners because 85% of the fertility patients I treat become pregnant and have babies even when thier MD told them it was nearly impossible or impossible. I occasionally slip as I did in my interview podcast posted on this board. I cringed when I said it and again when I listened the other day. I must be more mindful.)

When a patient comes to me and says, I think I am going thru menopause (this comes from women of that age range and young women who have similar symptoms but who are no where near the end of thier mentruating years), I take care to acknowlege thier symptoms as really happening to them, and being annoying- at best. As well as to help them feel empowered by explaining the TCM pattern dx they present. Then I explain how we (me, the TCM practitioner with the herbs and needles, and they, the patient with tools of self care that I teach) can resolve the situation.

I often explain that, "This change is occuring for a very wise reason. Your body is protecting your life, and increasing your longevity by stopping the monthly flow of blood. Because where the qi flows the blood flows and vice versa. So the more we bleed the more qi we lose and when all our qi is drained there is no more life. And as we age we need to preserve the qi, blood and body fluids which can expended by our menses as well as more pregnancies and birth. So the body basically says "Thanks but no thanks. I've had enough". You are YOUNG still with many beautiful years to live and much to accomplish. Your body supports your future by stopping the period. Men do not need this process because they do not bleed. And the great news is that you do not have to suffer hot flashes and irritablity because acupuncture, Chinese Herbs and simple diet changes, along with your self-care and the VIP honor and compassion you give to this health providing change can halt these symptoms within weeks.

They get excited "Within weeks? I have been dealing with this for months!" (My patients MUST take the herbs to get this result, and they do. Quickly.)

Be Well,
Juliette Aiyana
http://www.amazinghealing.com