Herbs to Treat Perimenopause

Dr. Brian Grosam, Ph.D., TCMD, L.Ac.

In Chinese medicine, the most common treatment for perimenopause is to harmonize the energetics of the heart and kidney organs. To illustrate this disharmony, the kidney water naturally rises to cool the heart fire, while the heart fire descends to warm the kidney. This is a yin-yang relationship. As everyone grows older, the kidney energy naturally declines. In many cases, and often seen in women, the kidneys will be unable to cool the heart, thus leading to exhuberant fire. This fire causes many common symptoms such as hot flashes, night sweats, insomnia and anxiety. This doesn’t mean that all one needs to do is drink more water. It means that we need to deeply nourish the kidney water (yin), and once it is sufficient it will then naturally flow back upwards, like a spring from the ground, to quell the heart fire (yang). This can easily be done with Chinese herbal therapy. One common formula is called Zhi Bai Di Huang Wan (Six Ingredient Anemarrhena Phellodendron & Rehmannia Pill). Also, the patient should eat more root vegetables and beans, which nourish the kidneys, and eat cooling foods like green leafy vegetables or celery to cool the heart. Drinking Suan Zao Ren (Zizyphus or Sour-Date) tea or Ling Zhi (Reishi Mushroom) tea will help calm the spirit and improve sleep. However, the herbal formula Zhi Bai Di Huang Wan will often give the fastest results for the hot flashes or feverish sensations.

Common challenges faced in the clinic are not only due to a natural decline in the body, but also due to our own control over emotional and dietary habits. Emotions such as stress, irritability, anger, sadness or depression will cause the liver to disrupt the smooth movement of Qi (or energy pathways) through the body. The natural flow of Qi helps bring nutrition, Qi and blood, and fresh, vibrant energy to the organs, brain, and every tissue in the body. So when Qi is not flowing, our entire body is deprived.

Another important point is when Qi is not flowing properly; it causes stagnation, which inevitably leads to pain. This is the main cause behind headaches, fibromyalgia, arthritis and body aches during perimenopause. To further add to the problem, when Qi cannot move smoothly, this causes the vital energy of the body (ministerial fire) to stagnate as well, leading to a surplus of fire. This surplus then harasses the heart and spirit, exacerbating the heart fire mentioned earlier. As you can see, now the treatment must be different. Not only do the kidneys need to be nourished, but also the liver Qi needs to be soothed, and the fire surplus must be extinguished. A common formula called Jia Wei Xiao Yao San (Free and Easy Wanderer Formula) can be added to the original formula to help treat the liver Qi stagnation and emotional problems. One can also drink chrysanthemum flower tea, found at any Asian market, to calm the spirit and relax Qi. In this situation, one should stay away from hot and spicy foods and caffeine.

Regarding diet, too often overeating and a diet poor in nutrition are seen in the clinic. This all affects the digestion, or in Chinese medicine we talk about the spleen and stomach energetics. If we look at the digestive tract as a river, the food, like the water flowing along a river, should naturally pass into, through, and out with little effort. But if we add bad foods such as processed foods, overly refined foods, junk foods, greasy and fatty foods and/or have a diet without fruits and vegetables, heavy in meats and starches, or if we over consume food, our digestion will dam up, just like a river. When our digestion is dammed up, our spleen and stomach become weak. The digestive tract is in charge of making new Qi and blood and transporting it to the heart and every tissue of the body. So when the spleen and stomach are weak, so is our body. Not to mention, with weakened and blocked digestion an excess of damp-phlegm will build up, much like debris builds up in a river. The result is fatigue, tiredness and weakness, which are common problems during perimenopause. The buildup of damp-phlegm, which is now considered a pathogenic factor, will not only further hinder the liver Qi circulation, but it will inhibit the natural flow of yang Qi to the brain, thus causing poor concentration, brain fog and dizziness. One formula that can be added to the main formula would be Liu Jun Zi Tang (Six Gentlemen Decoction). This will help tonify the weak spleen and stomach, dissolve the excess damp-phlegm, and return the digestion to normal. One can also drink hawthorn berry tea, astragalus tea or ginseng tea, also found at any Asian market, to promote digestion and to support the spleen and stomach. Refraining from overeating, adding more fruits and vegetables to the diet, and exercising regularly will also greatly help.

By discovering and treating the correct disharmonies, it is easy to treat many of the common perimenopausal symptoms. By nourishing the kidneys, we can calm the heart fire; by maintaining a healthy digestive tract, we ensure healthy Qi and blood flow to the rest of the organs and brain; and by maintaining a smooth flow of liver Qi, we ensure proper circulation of Qi and blood throughout the entire