Natural HRT Alternatives
Perimenopause Symptoms, Types, and Chinese Medicine
In the first part, I covered what perimenopause is, what its
symptoms are, differential diagnoses, and an overview of 4 types
of perimenopause. For that information, go to Part
Early Perimenopausal Syndrome, Physiological Type
In this article, I will cover a type of perimenopause that occurs
early on, and manifests with primarily physical symptoms. Next
time, I will talk about early perimenopause with mostly psychological
Here is a quick look at the information we'll cover:
Zang Fu Patterns
Distinctive Symptoms and Signs
Herbal Formula and Vitamins
Early Perimenopausal Syndrome, Physiological Type
Liver qi stagnation
General qi and blood stagnation
Damp phlegm accumulation due to underlying Sp qi deficiency
Epigastric distention, gas, abdominal bloating
Headaches usually with a muzzy or heavy
Tongue: lateral redness, body may
be pale, possible dusky purplish, may be swollen with a
Basic Herbal Formula:
Healthy Breast Formula
Minor Bupleurum Formula
Carthamus & Persica Combination
Vitamins & Minerals:
Vitamin E 400-800IU daily at bedtime
Pyridoxine (B6) promotes
Folic acid 5 mg daily
Correlation of Zang Fu Patterns, Symptoms, and Signs
- The fibrocystic breasts usually are due to a combination
of Liv qi yu and the dampness/phlegm from Sp qi xu
- Headaches tend to be muzzy and heavy when due
to dampness or phlegm. Any damp or phlegm can obstruct the flow
of qi and thus create pain. Liver qi yu adds to this potential
for qi yu and pain.
- Epigastric distention, gas, and bloating generally
are due to qi yu in the middle jiao. When the Sp qi is deficient,
qi can stagnate. Also, a stagnant Liver can attack the middle
jiao. Dampness and phlegm can stagnate qi in the middle jiao.
- Lateral redness of tongue: This means the sides of
the tongue are red. This is the area that corresponds to the
Liver. Redness here indicates Liver heat, usually from Liver
- Pale Tongue: This can be due to several things, but
in this case it is from the Spleen qi deficiency.
- Dusky or Purple Tongue: These both indicate generalized
stagnation. Usually, dusky means purplish but pale, and is more
likely qi stagnation, while straight Purple is darker, and is
- Swollen Tongue with thick coating: A swollen tongue
indicates Spleen qi deficiency (and dampness). A thick coating
is also indicative of dampness.
Treatment - Herbs, Vitamins & Minerals
The basic formula mentioned above is Far East Summit's Healthy
Breast Formula. It contains the chinese herbs:
- Chai Hu (Bupleurum Root)
- Zhi Ke (Mature Bitter Orange Fruit)
- Chi Shao (Red Peony Root)
- Bai Shao (White Peony Root)
- Qing Pi (Green Citrus Peel)
- Ju He (Tangerine Seed)
- Si Gua Lou (Loofa Plant)
- Chuan Lian Zi (Melia toosendan)
- Yu Zhu (Polygonatum odoratum)
- Sha Ren (Cardamon Fruit)
- Dang Shen (Codonopsis)
- Gan Cao (Licorice Root)
- Chuan Xiong (Ligusticum Wallichi)
Understanding the Herbal Formula
Far East Summit recommends this formula for breast cancer, but
it has wider applications. Breast cancer is often due to hormonal
imbalance, and these herbs traditionally have an impact on female
- Chai Hu and Bai Shao disperse stagnation and regulate
- Qing Pi, Zhi Ke, and Ju He disperse qi and masses
- Si Gua Lou, Yu Zhu, Chuan Lian Zi, and Chuan Xiong
circulate the blood (for blood stagnation), and soften masses
- The combination of Yu Zhu and Ju He dissolves cysts,
aids hepatic function, and smooths the flow of qi
- Dang Shen boosts the Spleen qi
- Cardamon Fruit regulates the Spleen and Stomach
- Si Gua Lou, according to recent pharmacologic studies,
softens breast tissue, prevents fibrosis, and is used prophylactically
for CA especially of the breast
- Chuan Lian Zi and Yu Zhu can cause distention, so they
are balanced by Cardamon (warmer).
- Cardamon also directs Si Gua Lou to the breast
Who Isn't this Formula For?
Not all herbs are good for everyone. This formula moves the blood,
so it could interfere with blood thinning medications like coumadin
(warfarin). Generally, the less drugs and herbs you combine, the
better. Even taking gingko biloba at the same time might prove
to be too much. If you work with a chinese herbalist, you can
usually get most of your health concerns treated. However, in
some situations, drugs are indispensable- check with your practitioner
about whether an herb or herb formula would interact with your
medications. For more on drug/herb interactions, read "Are
My Herbs and Drugs Dangerous Together?"
Other Formulas for Different Perimenopausal Presentations
- If you have serious emotional symptoms, the OB/GYN
PMS formula might be better. We'll cover that one in the next
- For later stage perimenopause or menopausal syndrome,
Hormonal Balancing Formula is better. That one's coming up in
- For amenorrhea or anemia due to deficiency, Menstrual
Restorative is a good choice.
- Carthamus Persica Combination (Tao Hong Si Wu Tang) is for
amenorrhea from stagnation.
- When muscle tension predominates, think of Minor Bupleurum
Formula (Xiao Chai Hu Tang).
- Ge Xia Zhu Tu Tang (Remove Blood Stag Below the Diagphragm)
treats increased pain from blood stagnation.
Vitamins and Minerals
- Vitamin E (400-800IU daily at bedtime) may help modulate
LH and FSH, decrease breast tenderness, and alter progesterone
to estradiol ratio. Don't take it though if you have thrombophlebitis
or high blood pressure.
- Vitamin A, selenium, and carotenoids may protect against
breast cancer, but studies are not yet conclusive.
If you don't have a CM practitioner, read the Pulse article,
"Finding an Acupuncturist."
- Lush DT. Preventing heart disease and cancer. What randomized,
primary-prevention studies show. Postgrad Med. 1999 Oct 15;106(5):143-8.
- Clinical Therapeutics of East & West. Far East Summit.
- Bensky & Barolet. Chinese Herbal Medicine: Formulas &
Strategies. Eastland Press, Seattle, 1990.
- Lu J, Jiang C. Antiangiogenic activity of selenium in cancer
chemoprevention: metabolite-specific effects. Nutr Cancer. 2001;40(1):64-73.
- Vinceti M, Rovesti S, Bergomi M, Vivoli G. The epidemiology
of selenium and human cancer.Tumori. 2000 Mar-Apr;86(2):105-18.
- Carolin KA, Pass HA. Prevention of breast cancer. Crit Rev
Oncol Hematol. 2000 Mar;33(3):221-38. Review.
Lynda Harvey, OMD, LAc, PhD(c) is a doctor of oriental
medicine, licensed acupuncturist, chinese herbalist, clinical
nutritionist, and Ph.D. candidate in clinical psychology
and with over 18 years experience in women's health.
You can reach her at in the San Diego area at 619-322-9200.