Pulse of Oriental Medicine: Alternative Medicine That Works for Regular Folks
Alternative Medicine That Works for Regular Folks

Updated February 18, 2003

Natural HRT Alternatives Part 2:

By Lynda Harvey-Carter, OMD, LAc

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 I.

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 symptoms.

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 quality

Fibrocystic breasts

Tongue: lateral redness, body may be pale, possible dusky purplish, may be swollen with a thick coating

Basic Herbal Formula:

Healthy Breast Formula

Other Formulas:

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 qi stagnation.
  • 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 blood stagnation.
  • 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 gynecology.

  • Chai Hu and Bai Shao disperse stagnation and regulate the Liver
  • 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 article.
  • For later stage perimenopause or menopausal syndrome, Hormonal Balancing Formula is better. That one's coming up in Part 4.
  • 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."


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  2. Clinical Therapeutics of East & West. Far East Summit. 2000.
  3. Bensky & Barolet. Chinese Herbal Medicine: Formulas & Strategies. Eastland Press, Seattle, 1990.
  4. Lu J, Jiang C. Antiangiogenic activity of selenium in cancer chemoprevention: metabolite-specific effects. Nutr Cancer. 2001;40(1):64-73. Review.
  5. Vinceti M, Rovesti S, Bergomi M, Vivoli G. The epidemiology of selenium and human cancer.Tumori. 2000 Mar-Apr;86(2):105-18. Review.
  6. 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.


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