Traditional Chinese medicine: perspectives on and treatment of menopausal symptoms

Globally, menopause occurs at approximately 50 years of age.Menopause results from the dynamic recession of ovarian function, including declining ovarian reserves and fluctuating levels of reproductive hormones manifest as changes in menstrual regularity, decline in fecundity, the gradual appearance of menopausal symptoms, and increased risk of various chronic diseases 1 .Menopausal symptoms are most common in women of 40-60 years of age, with 84.2% of women experiencing menopausal symptoms during this period.Menopausal symptoms arise as a consequence of reduced estrogen secretion from the ovaries, leading to autonomic nervous system dysfunction, including hot flushes and sweats, emotional disorders, insomnia, fatigue, headache, dizziness, palpitations, formication, musculoskeletal pain and genitourinary symptoms 2 .Although the age of menopause differs between regional and cultural contexts, the types and severity of menopausal symptoms are generally similar.No specific reference on menopausal symptoms is found in Traditional Chinese medicine (TCM).However, according to their etiology and characteristics, menopausal symptoms can be categorized into 'visceral agitation', 'lily disease', 'metrorrhagia and metrostaxis', 'depression syndrome', 'palpitation', and 'insomnia', which are altogether referred to as 'perimenopausal syndrome' 3 .In TCM, the female life is divided into cycles, with one cycle occurring every 7 years.This is termed 'Tiangui', or 'heavenly tenth', which generally conforms to the stages of a woman's life in modern medicine.With the onset of mental and physical exhaustion by the seventh cycle (49 years), the human body normally ages and the functions of various organs decline, particularly the kidney.From a TCM perspective, menopause is associated with 'kidney deficiency or dysfunction', since, in TCM, the kidney is conceptualized as a system rather than an organ that is responsible for temperature, fertility and sterility, and fluid balance regulation.Qi is also a TCM concept that refers to the maintenance of activities of daily life, visceral function, and metabolism.Yin and Yang, two opposite, complementary, and inter-related components of matters in nature, ensure that every system functions smoothly through the balance of Qi and blood.During perimenopause, women experience a gradual reduction in kidney Qi, essence, and blood, thereby leading to an imbalance between Qi and blood, kidney Yin-Yang disharmony with subsequent visceral organ dysfunction.TCM treatment