abstracted & translated by
Bob Flaws, L.Ac.

On page 388 of issue 6, 2009 of Shi Yong Zhong Yi Yao Za Zhi (Journal of Practical Chinese Medicine & Pharmacology), Wang Shu-li published an article titled, “Observations on the Integrated Chinese-Western Medical Treatment of 50 Cases of Perimenopausal Syndrome.” A summary of this article is presented below.

Cohort description:

For the purposes of this study, the perimenopausal period was defined as occurring from the onset of symptoms of the decline in ovarian function to one year after the cessation of menstruation. Altogether, 90 patients with perimenopausal syndrome were enrolled in this two-wing comparison study. All cases were seen in the Gynecology & Obstetrics Department at the Shanxi Chinese Medical College’s Affiliated Hospital between 2007- 2008. These 90 cases were randomly divided into a treatment group of 50 cases and a comparison group of 40 cases. In the treatment group, the oldest patient was 56 and the youngest was 38 years old. The longest course of disease was two years and five months, while the shortest was 3.5 months. In the comparison group, the oldest patient was 55 and the youngest was 39. The longest duration of disease in this group was three years and one month and the shortest was four months. Therefore, there were no significant differences in age and duration of disease in these two groups which were judged statistically comparable for the purposes of this study (P ≥ 0.05).

These patients’ main symptoms were emotional lability, restlessness, depression, and vexation and agitation. Accompanying symptoms included hot flashes, sweating, insomnia, and headache. Diagnostic criteria included clinically significant low serum estradiol (E2) and abnormally high follicle-stimulating hormone (FSH). Patients with other systemic diseases, organic diseases of the reproductive organs, or functional sexual diseases were excluded from this study.

Treatment method:

All members of the comparison group were orally administered one milligram of supplemental estrogen two times per week along with 20 milligrams each of a multivitamin and vitamin B1TID. Twenty days administration equaled one course of treatment, and two successive courses were given.

All members of the treatment group received the same Western medical regimen described above plus Xiao Yao San Jia Jian (Rambling Powder with Additions & Subtractions) as follows:

Chai Hu (Radix Bupleuri)
Fu Ling (Poria)
stir-fried Bai Zhu (Rhizoma Atractylodis Macrocephalae)
stir-fried Dang Gui (Radix Angelicae Sinensis), 12g each
mix-fried Gan Cao (Radix Glycyrrhizae), 15g
Bo He (Herba Menthae Haplocalycis), 4g
Pao Jiang (blast-fried Rhizoma Zingiberis), 6g
Shan Yao (Radix Dioscoreae Oppositae)
Shan Zhu Yu (Fructus Corni), 10g each

If there was headache and dizziness, 15 grams each of Sheng Di Huang (uncooked Radix Rehmanniae), Shu Di Huang (cooked Radix Rehmanniae), Nu Zhen Zi (Fructus Ligustri Lucidi), and Mo Han Lian (Herba Eclpitae) and 12 grams each of Gou Teng (Ramulus Uncariae Cum Uncis) and Ju Hua (Flos Chrysanthemi Morifolii) were added.

If there was vexation and agitation and easy anger, 10 grams each of Long Dan Cao (Radix Genitanae), stir-fried Zhi Zi (Fructus Gardeniae), Zhi Mu (Rhizoma Anemarrhenae), and Huang Bai (Cortex Phellodendri) were added.

For mental-emotional lability with great sorrow and laughing and crying without constancy, 30 grams of Xiao Mai (Fructus Tritici), 10 grams of mix-fried Gan Cao (Radix Glycyrrhizae), 12 grams of Mai Men Dong (Tuber Ophiopogonis), and 20 grams of Da Zao (Fructus Jujubae) were added.

If insomnia was severe, 15 grams each of Sun Zao Ren (Semen Zizyphi Spinosae) and He Huan Pi (Cortex Albiziae) and 30 grams of Ye Jiao Teng (Cualis Polygoni Multiflori) were added.

One packet of these medicinals was decocted in water and administered in two divided doses per day, with 20 days equaling one course of treatment and two successive courses being given.

Study outcomes:

Cure was defined as complete disappearance of all symptoms with no recurrence within three months of stopping treatment. Marked effect was defined as basic disappearance of such main symptoms as low back and knee soreness, limpness, and lack of strength, hot flashes, sweating, vexation and agitation, and easy anger with no recurrence within four weeks of stopping treatment. Some effect meant that clinical symptoms decreased and got milder; however, 1-2 symptoms persisted. No effect meant that there was no changes in symptoms. The following table shows the outcomes in the two groups based on these criteria.

 
Thus the group treated with a combination of Western and Chinese medicine got a much better overall clinical outcome than did the group only treated with Western medicine.

Discussion:

According to Dr. Wang, The liver is categorized as wood and governs wind. Its body or substance is yin, but its function is yang. It is enriched and nourished by water and sprinkled and nourished by earth. It is the viscus which stores the blood. Its nature has a predilection for up-bearing, scattering, spreading, and extending. If it becomes depressed, the qi mechanism is no longer smoothly or easily flowing. The qi becomes depressed and the blood becomes stagnant. This is a common occurrence in females. In women, the blood is the former heaven, and the liver is the viscus which stores the blood. The liver’s duty is to insure the flow of blood since it rules coursing and discharge. In women, the pouring downward of blood to the chong and ren makes for menstruation. Hence Dr. Wang thinks that the liver is the main viscus involved in perimenopausal syndrome. Therefore, she prescribes Xiao Yao San which courses the liver and resolves depression, fortifies the spleen and harmonizes the constructive. However, to this base, she adds ingredients which also supplement liver blood and kidney yin.

Within her modified Xiao Yao San, Chai Hu courses the liver and rectifies the qi. Fu Ling fortifies the spleen and supplements the center. Bai Shao enriches yin and supplements the blood. Bai Zhu supplements and boosts the spleen and stomach. Bo He emolliates the liver and rectifies the qi. Dang Gui supplements the blood. Gan Cao supplements the center and boosts the qi. Pao Jiang warms the stomach and harmonizes the center. Shan Yao and Shan Zhu Yu enrich and supplement the liver and kidneys. Sheng Di Huang, Shu Di Huang, Nu Zhen Zi, Mo Han Lian, Gou Teng, and Ju Hua enrich and nourish the liver and kidneys, calm or level the liver and extinguish wind. Long Dan Cao, stir-fried Zhi Zi, Zhi Mu, and Huang Bai clear and discharge liver fire, enrich and nourish the liver and kidneys, calm or level the liver and subdue yang. Xiao Mai, mix-fried Gan Cao, Mai Men Dong, and Da Zao nourish the heart and quiet the spirit, harmonize the center and relax urgency. Suan Zao Ren, Ye Jiao Teng, and He Huan Pi constrain yin and quiet the spirit. Experimental research has shown that Xiao Yao San can raise endogenous estrogen levels at the same time as lowering FSH.

N.B. Some of Dr. Wang’s descriptions of the above medicinals’ function are non-standard, for instance, Bo He emolliating the liver. However, I believe these descriptions should not be dismissed out of hand as wrong but should be given more thought and consideration.

Dr. Wang believes that the integration of Chinese and Western medicine in this protocol achieves relatively good improvement in symptoms and prevents any side effects from the Western drugs. Therefore, she thinks it is a relatively good method of treatment for women with perimenopausal syndrome.

Personally, I agree with Dr. Wang on her emphasis on liver depression in the disease mechanisms of perimenopausal and menopausal syndromes. Most Chinese doctors emphasize (I would say over-emphasize) kidney yin vacuity. While Dr. Wang takes liver blood-kidney yin vacuity into account in her protocol, she uses a liver-spleen harmonizing formula as her base. Based on my 30 plus years clinical experience practicing Chinese medical gynecology, I believe the severity and duration of peri- and menopausal syndrome are directly correlated to the degree and duration of liver depression qi stagnation, not to yin vacuity. It is liver depression inhibiting the qi mechanism that I believe prevents the change in life from completing itself which, by itself, should result in the automatic recuperation of yin-blood. In my experience, the women with the longest history and the worst symptoms of PMS are the same women with the worst symptoms and longest duration of peri- and menopausal syndrome.

Copyright © Blue Poppy Press, 2009. All rights reserved.