Herbal Medicine on Menopausal Syndrome: A Case Report
Here, to introduce a case who was prescribed with two classical CHM formulae combined together-Lily Bulb and Rehmannia Decoction and Xiaoyao powder to treat her menopausal syndrome (Niu, 2015).
Patient, female, 49 years old, retired, first visit on Mar 5, 2014.
Chief complaint: Hot flashes and night sweats, irritation for 1 year, and foreign body sensation in the throat for 1 month
History of present illness: One year ago, the patient began to have hot flashes and night sweats, and got easily irritated, but didn’t pay attention to her symptoms. One month ago, above mentioned symptoms got worse and she felt foreign body in the pharynx. She explained that after she was retired that she wasn’t happy.
Current symptoms in TCM: hot flashes and night sweats, irritation, foreign body sensation in the pharynx, waist and knee weakness, less sleep and more dreams, irregular menstruation, large volume or little, with blood clots, dry stool, mildly yellow urine.
Past medical history: Healthy. No family hereditary disease history. No hepatitis or tuberculosis history.
Physical examination: Tonsils are not swollen or congested. Thyroid palpation was normal, blood pressure 128/88 mmHg. Fat tongue with teeth marks on sides. Mild yellow and greasy tongue coating. String-like pulse.
Auxiliary examination: ECG, 2-D echo with doppler, Uterus and bilateral attachments ultrasound were normal. Hormone tests: Estrogen (E2) 67pg/ml, FSH 21U/L, LH 12 U/L.
TCM diagnosis: Yu zheng (depression pattern) – deficiency of liver and kidney; stagnation of phlegm and qi
Western diagnosis: Menopausal syndrome
Treatment: nourish live and kidney, course liver, strengthen spleen and transform phlegm
Medicinal formula: Lily Bulb and Rehmannia Decoction, combined with Xiaoyao powder: Lily 20g, Rehmannia 30g, cornus 30g, dioscoreae 20g, salivia chinensis 15g, bupleurum 10g, Poria 15g, atractylodes 15g, Radix Paeoniae Alba 15g, Chinese angelica 15g, tangerine peel 15g, gardenia15g, fermented soybean 15g, wheat 15g, glycyrrhiza 15g. Made into decoction, once dose per day, for seven days.
After 10 days, follow-up visit: hot flashes and night sweats, and irritation were improved, but foreign body sensation in the throat remained. Physical examination: fat tongue with teeth marks on sides, greasy tongue coating, fine pulse. Get rid of bupleurum, plus citron and bergamot 15g of each, other ingredients not changed. One dose per day, for 10 days.
The third visit on Apr 1, 2014, all the symptoms disappeared. Stopped the above herbal medicine. The patient might take Xiaoyao Wan to maintain the treatment if possible.
Discussion: this patient had typical symptoms of menopausal syndrome, and the diagnosis was clear. The kidney is the root of earlier heaven, and the store of essence. The patient was 49 years old, and the menses was gradually reaching to the end, and at the stage of “deficiency of Yin, surplus of Yang”. If the Yin of kidney is insufficient, the balance of Yin and Yang is broken, and the fake Yang will be obvious, and the Jin (liquid) will then be forced out, which is seen as symptoms of hot flashes and sweating. Liver and kidney are of the same source. If kidney essence is deficient, kidney can’t nourish the liver, and liver Yang will then be hyperactive. In addition, the patient couldn’t adapt to her life of retirement, and caused severe stagnation of liver qi, thus the symptom of irritation came out. Liver is the body of Yin blood, and the place where thoroughfare and controlling vessel merge. If essence-blood is insufficient, the thoroughfare and controlling vessels will be insecure, and the symptom of irregular vaginal bleeding will develop. Liver can’t course the spleen, which causes liquid overflow and phlegm-damp in production. Then phlegm obstructs the throat, which causes the symptom of foreign body sensation in throat. Tongue and pulse signs also supported the pattern: deficiency of liver and kidney, and stagnation of phlegm and qi.
Niu XL. Prof. Zhang Lan's Experience in Treating Menopausal Syndrome. Liaoning University of Traditional Chinese Medicine. 2015 (in Chinese).
Utian WH. Psychosocial and socioeconomic burden of vasomotor symptoms in menopause: a comprehensive review. Health Qual Life Outcomes. 2005, 3:47.
Woods NF, Mitchell ES. Symptoms during the perimenopause: prevalence, severity, trajectory, and significance in women’s lives. Am J Med. 2005,118(Suppl 12B):14–24.
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