Laura Camus
December 2006

The translation of an article on menopause due to a liver stasis and qi stagnation pattern:

It is common to see patients with this pattern, the clinical manifestation is primarily changing emotions (mood swings).  This includes, vexation, easily angered, sweating, dim spirit, sadness with a desire to cry, vexing heat in the five soles (five hearts), accompanied with non-fixed pain (traveling pain), heart palpitations, insomnia, and abnormal language or behavior etc.  The treatment for this kind of pattern is to course the liver, resolve the depression, and move the qi and stop pain.  The formula often used to treat this problem is chai hu shu gan san or xiao yao san modified.  Herbs normally used are chai hu, yu jin, xiang fu, ba yue zha, bai shao, chuan xiong, dang gui, fo shou, dan shen, and lu e mei (green plum).

A typical case: Shi XX, female, 49 years old, she “appeared with symptoms of vexation and agitation, easily angered, and hot flashes with sweat for a half month,” on March 7th 2001 she came to the hospital clinic for treatment.  The patient stated: in the recent half month there appeared vexation and agitation with restlessness, easily angered, or feelings of depression, she tends to sigh often, is accompanied with hot flashes, a red face and sweating, and a non-fixed pain on the back of the body.  Sometimes the symptoms come and go, or sometimes she has chest oppression and heart palpitations.  She has an irregular menstrual cycle, where the (blood) quantity is scant and the color is dark.  She has a lack of appetite, and her stool tends to be dry (one bowel movement a day).  The color of the tongue body is dull with a thin white fur, and the pulse is wiry and rapid.  The formula prescribed is: chai hu 9g, yu jin 15g, xiang fu 15g, dang gui 9g, bai shao 18g, fu ling 15g, chao bai zhu 15g, di gu pi 15g, bo he 6g (put in at the end), huo ma ren 30g, dan shen 30g, and zhi gan cao 6g.  One half month after taking the herbs, she revisited (the clinic) and her hot flashes, red face, and sweating had obvious improvement, still she has vexation and agitation with restlessness, she is easily angered, and once in a while she still has pain on the back and palpitations.  Her food intake is okay, her stool is regular, her tongue body is red with a thin white coat, and her pulse is wiry.  Therefore, fo shou 9g, and lu e mei 10g is added to the above formula.  One half month later she revisited (the clinic), her symptoms of vexation and agitation, and being easily angered have decreased, yet sometimes there is still vexation and restlessness, the non-fixed pain has disappeared, and there are no more symptoms.  She continued to take the same formula.  Another visit at the end of April shows the patient is recovered. 

A patient with this pattern normally has liver qi that is not smooth, therefore the qi mechanism is not smooth, and the person can not get used to the physiological change of kidney qi vacuity and decline during menopause, leading to the liver and kidney functioning abnormally, the kidney is not able to grasp the qi, the liver looses it’s normal smooth flow, and qi becomes depressed and blood stagnates.  When treating this pattern there is emphasis on using chai hu, chen pi, and xiang fu to smooth the liver, move the qi and resolve depression; using chuan xiong with dang gui to move the qi and invigorate the blood; using bai shao with dang gui to nourish the blood and soften the liver, and relieve spasm and pain; using bai zhu with fu ling to strengthen the spleen, dispel damp and regain the transporting and transforming function (of the spleen), thus providing the source of qi and blood; using zhi gan cao to boost the qi, tonify the middle, and harmonize the liver; using a small amount of bo he to assist the chai hu to resolve the heat caused by liver depression, these are the assistant herbs yet they have a supportive function.  In the clinic, if the patient has more severe vexation and agitation, pain, and qi depressed (stagnation) symptoms you can add fo shou, lu e mei, and hou po hua to move the qi and release the depression; if accompanied with palpitations you can add gua lou, dan shen, jiang xiang, etc. to invigorate the blood and open the collaterals; if the patient has severe insomnia you can use bai zi ren, chao suan zao ren, ye jiao teng etc. to nourish the heart and calm the spirit.



Bibliography:
Article Title: Wei Pin Kang’s Experience in Treating Climacterium Syndrome
Authors: Xiao Yan and Zou Zhi Feng
Publication: Journal of Traditional Chinese Medicine. October 2002. Vol. 43. No. 10.
Page 742-743.