CMAC311 Session 11 Miscellaneous disorders Menopause Chinese Medicine Department www.endeavour.edu.au
Session Contents Discuss the main aetiology and pathology factors menopause of Discuss the pattern differentiation & the treatments principle & methods, precautions & prevention of menopause Endeavour College of Natural Health www.endeavour.edu.au 2
Learning Outcomes After this session study, students should be able to: Understand the differences between menopause problems and menopause syndrome Outline the main TCM aetiology and pathology factors of menopause syndrome Discuss the pattern differentiation & the treatments principle & methods, precautions & prevention of menopause. Endeavour College of Natural Health www.endeavour.edu.au 3
MENOPAUSAL SYNDROME
WESTERM VIEWPOINTS OF MENORPAUSE SYMDROME o Menopause indicates: the complete or permanent cessation of menstruation; the phase in a women s life during which she makes the transition from a reproductive to a non-productive stage. This transition usually spans 2-5 years around the menopause. o Median age of menopause: Around 51. o Menopause Syndrome: Climacteric syndrome, refers to the discomfort and symptoms appearing during these years. Endeavour College of Natural Health www.endeavour.edu.au 5
MENOPAUSAL SYNDROME A 6-12 month period is usually necessary to make a diagnosis. Signs and symptoms include: o Vexation, agitation, and easily angered o Depression o Dizziness o Palpitations o Loss of sleep o Dry mouth and parched throat o No flavour of food Endeavour College of Natural Health www.endeavour.edu.au 6
TCM VIEWPOINTS OF MENOPAUSAL SYNDROME At about 50, the Ren Mai becomes empty, the Sea of Blood debilitated and scanty and the tian gui is exhausted o Due to decline of Kidney Essence, Chong and Ren Xu the menses stop. o Some women experience no signs and symptoms as their menstrual flow changes, some do, either before or after menopause. When they do it is termed menopausal or climacteric syndrome. o Generally occurs between 48-55 years. Maciocia, G 2011 Obstetrics and Gynecology in Chinese Medicine 2 nd Ed, Elsevier, London Endeavour College of Natural Health www.endeavour.edu.au 7
TCM SYMPTOMS OF MENOPAUSAL SYNDROME o 5 Hearts Hot, hot flushes o Tinnitus o Poor memory o High blood pressure o Low back soreness and upper back pain o Itching skin o Mental/emotional disturbances if severe Severity and duration vary, if severe can last from 3-5 years Endeavour College of Natural Health www.endeavour.edu.au 8
Menopause rating scale (MRS) Menopause rating scale (MRS) The MRS is a symptom questionnaire that rates the severity of menopausal symptoms a lady may be experiencing. This tool is easy to administer and use. It can be utilised as a screening tool or to monitor treatment outcomes. It should take around 2-5 minutes to complete. http://www.biomedcentral.com/content/supplementary/1477-7525-1-28-s3.pdf Endeavour College of Natural Health www.endeavour.edu.au 9
TCM Aetiology and pathogenesis of menopausal syndrome emotional stress: worry, fear, anxiety overwork; multiple births/too close together weaken kidney & deplete yin kid yin fails to nourish ht yin ht yin xu & ht xu heat menopausal syndrome Endeavour College of Natural Health www.endeavour.edu.au 10
Maciocia s DIFFERENTIAL DIAGNOSIS OF MENOPAUSAL SYNDROME
KIDNEY & LIVER YIN XU (with Yang rising) Hot flushes with sweating; irritable; dry eyes; dry skin; night sweats; aching joints; insomnia; constipation Accompanying S/S KIDNEY YIN &YANG XU (can also be just Yin or Yang Xu) KIDNEY YIN XU & HEART XU HEAT KIDNEY & HEART NOT HARMONISED ACCUMULATION OF PHLEGM AND STAGNATION OF QI BLOOD STASIS Hot flushes but cold hands and feet, chilliness; sometimes hot flushes, night sweats; neck flushing when talking; slightly agitated; lack of strength, Accompanying S/S: Hot flushes; insomnia; palpitations; night sweats; anxiety; mental restlessness; poor memory Accompanying S/S: Hot flushes, palpitations, insomnia, night sweats, dizziness, tinnitus, mental restlessness, poor memory, dry stools, Accompanying S/S: Obesity, oppressive feeling in the chest, sputum in the chest, full feeling epigastrium, breast distension, belching, nausea, Accompanying S/S: Hot flushes, mental restlessness, menopause preceded by a period Endeavour College of Natural Health www.endeavour.edu.au 12
Patterns Treatment o Please outline the herbal treatment, acupuncture treatment, dietary advice for each patterns of the menopause syndrome. Endeavour College of Natural Health www.endeavour.edu.au 13
Notes of TCM Treatment o Chinese medicine can help minimise the problems in this transition period in a women s life. o Herbal treatment is essential, usually more effective than acupuncture, because herbs are better at nourishing the essence. o The severity of menopause symptoms depends on the pre-existing condition of kidneys and therefore on the diet and lifestyle throughout her lifetime. Thus, it s important to educate the patient that TCM treatments (herbs, acupuncture, dietary therapy, Tai Chi or Qi Gong, etc.) can help her in this transition period in a slow and gradually way. Endeavour College of Natural Health www.endeavour.edu.au 14
HRT / ERT o Please briefly introduce the Hormone Replacement Treatment (HRT), emphasizing on the updated research on the side effects of HRT when comparing its quick results with the slow results of TCM treatments. Endeavour College of Natural Health www.endeavour.edu.au 15
Break Endeavour College of Natural Health www.endeavour.edu.au 16
Practical section Endeavour College of Natural Health www.endeavour.edu.au 17
Session 11 Practical Activity o Session review questions: TCM assessment, diagnosis and management plan for menopause. o Case study based practical skills building up Endeavour College of Natural Health www.endeavour.edu.au 18
Case Study o Female 48 years with menstrual irregularity for 1 year, sometimes twice in one month, sometimes no period for 3 months. Flow varied, often very heavy. Past three months: low grade fever in pm; frequent hot flushes; restlessness & irritability; emotional; dizzy; blurred vision; tinnitus; palpitations; insomnia; forgetfulness, hot palms & soles; sore, weak low back & knees and severe itching sensation over body. Tongue: red no coat. Pulse: wiry, thin and ra Endeavour College of Natural Health www.endeavour.edu.au 19
Case questions o What is the diagnosis? o What is the treatment principle? o Choose five points to treat this condition based on your diagnosis. o Give rationale & method. o Recommend any lifestyle/dietary advice for this condition. o pid. Blood pressure: 180/110 Endeavour College of Natural Health www.endeavour.edu.au 20
References o Lyttleton J, 2004 The Treatment of Infertility with Chinese Medicine Churchill Livingstone o West Z, 2008 Acupuncture in Pregnancy and Childbirth, 2 nd edition Churchill Livingstone o Maciocia, G 2011 Obstetrics and Gynecology in Chinese Medicine 2 nd Ed, Elsevier, London o Betts, D 2006 The essential guide to Acupuncture in Pregnancy and Childbirth, Eastland Press, USA Endeavour College of Natural Health www.endeavour.edu.au 21