A Combined Acupuncture & Chinese Medicinal Protocol for the Treatment of Perimenopausal Syndrome

abstracted & translated by

Bob Flaws, Lic. Ac., Dipl. Ac. & C.H., FNAAOM, FRCHM

While the routine combination of Chinese herbs and acupuncture is the de facto standard of care in the practice of Chinese medicine in North America, Europe, Australia, and New Zealand, it is not the standard of care in the People's Republic of China where these two modalities tend to be practiced by specialists. The following clinical trial, therefore, is somewhat unusual in the contemporary Chinese medical journal literature since it describes such a combination therapy. It was written by Dr. Su Si-jie of Kunming and appeared in issue #4, 2003 of the Yun Nan Zhong Yi Zhong Yao Za Zhi (Yunnan Journal of Chinese Medicine & Chinese Medicinals) on pages 26-27. The original title of the Chinese study was "An Analysis of the Therapeutic Efficacy of Liu Wei Di Huang Tang (Six Flavors Rehmannia Decoction) Combined with Acupuncture in the Treatment of 50 Cases of Climacteric Syndrome."

Cohort description

All the patients enrolled in this study were seen as out-patients at the Chinese author's hospital and were all 42-57 years of age. In 26 cases, menstruation had already ceased, while in the other 26, it had yet to. The shortest course of disease was 15 days and the longest was three years. Clinical symptoms included hot flashes, sweating, vexation, agitation, and irritability, vexatious heat in the five hearts, dizziness, tinnitus, heart palpitations, insomnia, low back and knee soreness and limpness, fatigue, and lack of strength. Therefore, these patients' Chinese medical pattern presentation was categorized as liver-kidney yin vacuity. Diagnostic criteria were based on the 1994 edition of Zhong Yi Bing Zheng Zhen Duan Liao Xiao Biao Sun (Criteria for the Chinese Medical Diagnosis & Treatment of Diseases & Patterns and Their Outcomes) for perimenopausal syndrome.

Treatment method

Chinese medicinal treatment consisted of Liu Wei Di Huang Tang Jia Jian (Six Flavors Rehmannia Decoction with Additions & Subtractions): cooked Radix Rehmanniae Glutinosae ( Shu Di ), 30g, Fructus Corni Officinalis ( Shan Zhu Yu ), 15g, Radix Dioscoreae Oppositae ( Shan Yao ), 15g, Rhizoma Alismatis ( Ze Xie ), 15g, Cortex Radicis Moutan ( Dan Pi ), 15g, Sclerotium Poriae Cocos ( Fu Ling ), 15g, plastrum Testudinis ( Gui Ban ), 15g, and Fructus Lycii Chinensis ( Gou Qi Zi ), 15g. If there was yin vacuity with internal heat, 15 grams each of Cortex Phellodendri ( Huang Bai ), Rhizoma Anemarrhenae Aspheloidis ( Zhi Mu ), and Cortex Radicis Lycii Chinensis ( Di Gu Pi ) were added. If the essence was deplete and the blood was withered, 15 grams of processed Radix Polygoni Multiflori ( He Shou Wu ) and 10 grams of Gelatinum Corii Asini ( E Jiao ) were added. If there was yin vacuity and liver effulgence, 10 grams each of Flos Chrysanthemi Morifolii ( Ju Hua ) and Spica Prunellae Vulgaris ( Xia Ku Cao ), 15 grams of Radix Albus Paeoniae Lactiflorae ( Bai Shao ), and 20 grams of Carapax Amydae Sinensis ( Bie Jia ) were added. For yin vacuity with blood dryness, 25 grams of Radix Angelicae Sinensis ( Dang Gui ), 20 grams of uncooked Radix Polygoni Multiflori ( He Shou Wu ), and 10 grams of Radix Ledebouriellae Divaricatae ( Fang Feng ) were added. If there was kidney vacuity with liver depression, 10 grams each of mix-fried Radix Bupleuri ( Chai Hu ) and Cortex Albizziae Julibrissinis ( He Huan Pi ) and 15 grams of Tuber Curcumae ( Yu Jin ) were added. If there was heart-kidney noninternaction, 15 grams each of Fructus Schisandrae Chinensis ( Wu Wei Zi ), Semen Zizyphi Spinosae ( Suan Zao Ren ), and Sclerotium Pararadicis Poriae Cocos ( Fu Shen ), and eight grams each of Rhizoma Coptidis Chinensis ( HuangLian ) and Plumula Nelumbinis Nuciferae ( Lian Zi Xin ) were added. If menstruation was excessively profuse, 25 grams of Herba Agrimoniae Pilosae ( Xian He Cao ) and 15 grams of carbonized Cacumen Biotae Orientalis ( Ce Bai Ye ) were added. One packet of these medicinals was decocted in water and administered per day in two divided doses, morning and evening, with 10 days equaling one course of treatment. Four such course were given.

Acupuncture consisted of needling Zu San Li (St 36), Guan Yuan (CV 4), San Yin Jiao (Sp 6), and Da Zhui (GV 14) as the main points. If there was yin vacuity with internal heat, He Gu (LI  4) and Tai Xi (Ki 3) were added. If there was essence depletion and blood withering, Ge Shu (Bl 17) and Zhong Ji (CV 3) were added. If there was yin vacuity and liver effulgence, Tai Chong (Liv 3) was added. If there was kidney vacuity and liver depression, Tai Chong (Liv 3) and He Gu (LI 4) were added. If there was yin vacuity and blood dryness, Xue Hai (Sp 10), Yu Ji (Lu 10), and Tai Xi (Ki 3) were added. If there was noninteraction of the heart and kidneys, Nei Guan (Per 6), Xin Shu (Bl 15), Pi Shu (Bl 20), and Shen Shu (Bl 23) were added. Acupuncture was given once per day, with 10 days equaling one course of treatment and four such courses being given. It was done using 1-2 cun fine needles with even supplementing-even draining technique and needle retention for 20 minutes each time.

Treatment outcomes

Cure was defined as disappearance of clinical symptoms with no subsequent recurrence with half a year. Marked effect was defined as disappearance of the main symptoms but recurrence within a half year. No effect meant that there was no improvement in clinical symptoms. Based on these criteria, 41 cases were judged cured, eight were marked improved, and only one got no effect. Therefore, the total effectiveness rate was reported as 98%.

Discussion

This is yet another discussion of perimenopausal syndrome primarily from the point of view of a liver-kidney yin vacuity. As such, it is a little simplistic in my opinion. Nevertheless, even such a relatively simple protocol was able to achieve remarkably good outcomes. However, Western readers should note the dosages of the medicinals and the frequency of the acupuncture. Both were much stronger than what most Western practitioners of Chinese medicine use.

Copyright © Blue Poppy Press, 2004. All rights reserved.

For more information on the Chinese medical treatment of perimenopausal syndrome, see Bob Flaws' A Handbook of Menstrual Diseases in Chinese Medicine available from Blue Poppy Press.