Most women reach menopause between the ages of 45 and 55, however, the entire transition period can take 10 to 15 years. Because the hormonal changes are so erratic, a host of signs can appear and interfere with day-to-day life.

Menopause should be treated as a natural event, not a medical crisis. From a TCM perspective, menopause symptoms are the result of a disrupted balance between the internal organs, and therapies should be aimed to motivate the organs to shift into a new balance. The multiple components of herbal remedies can target the internal disharmony through different aspects of the body, such as various metabolic processes in the hypothalamus-pituitary-sex gland axis, and thus create a comprehensive regulating effect to maintain the stability of internal environment, ensure a slow, gentle and smooth hormonal transition.

Generally, TCM believes that principles like nourishing yin and tonifying kidney are essential to every treatment; when dealing with menopause symptoms, dispelling liver stagnation and reinforcing the spleen are important; while activating blood and qi (vital energy), as well as dissolving phlegm and stasis are necessary for complex conditions.

Commonly used ingredients

gou qi chi	Chinese wolfberry fruit		Fructus Lycii
he shou wu	tuber fleeceflower root		Radix Polygoni Mulitflori
shan zhu yu	cornus fruit		Fructus Corni
sheng di	rehmannia root		Radix Rehmanniae
shu di	processed rhemannia rhizome		Rhizoma Rehmanniae Praeparatae
bai shao	white peony root		Radix Paeoniae Alba
Sample prescription: Linking Decoction

Therapeutic principle	Warming and augmenting the kidney and spleen
Indications	A dull facial complexion, lassitude, depressive mood, breath shortness, sensitive to low temperatures, lumbar soreness, limb coldness, loose bowels, abdominal distention, poor appetite, puffiness, poor control of urination or passing stools. There may also have excessive thin vaginal discharges, prolonged or heavy menses flow which is thin in nature, bulky, glossy and pale tongue

Commonly used ingredients

dang shen	pilose asiabell root		Radix Codonopsis Pilosulae
bai shu	largehead atractylodes rhizome		Rhizoma Atractylodis Macrocephalae
fu zi	monkshood		Radix Aconiti
rou gui	cassia bark		Cortex Cinnamomi
du zhong	eucommia bark		Cortex Eucommiae
tu si zi	dodder seed		Semen Cuscutae
Sample prescription: Aconite Pill for Regulating the Middle

Therapeutic principle	Nourishing blood and yin, calming the heart and benefiting the spleen
Indications	Dizziness, blurred vision, palpitations, poor memory, insomnia or dream-disturbed sleep, panic, lethargy, fatigue, breath shortness, pale complexion, hot flashes, pale and bulky tongue

Commonly used ingredients

ren shen	ginseng		Radix Ginseng
fu ling	poria		Poria
shan yao	Chinese yam		Rhizoma Dioscoreae
shi chang pu	acorus		Rhizoma acori tatarinowi
suan zao ren	sour jujube seed		Semen Ziziphi Spinosae
yuan zhi	polygala poot		Radix Polygalae
long yan rou	longan aril		Arillus Longan
Sample prescription: Sedative and Heart Invigorating Pill

Therapeutic principle	Communicating the kidney and heart, nourishing yin and depressing virtual fire
Indications	Palpitations, insomnia or dream-disturbed sleep, irritability, mood swings, poor memory, hot flashes, sweating, dizziness, ear ringing, lumbar and knee weakness, mouth dryness or mouth sores, scanty urine and red tongue

Commonly used ingredients

wu wei zi	schisandra		Fructus Schisandrae
niu xi	achyranthes root		Radix Achyranthis Bidentatae
zhi mu	anemarrhena rhizome		Rhizoma Anemarrhenae
tian dong	cochinchinese asparagus root		Radix Asparagi
sheng di	rehmannia root		Radix Rehmanniae
dan shen	red sage root		Radix Salviae Miltiorrhizae
Sample prescription: Communicating and Tranquilizing Pill

Therapeutic principle	Dispelling liver stagnation, harmonizing spleen, and regulating qi
Indications	Depression, irritability, easily angered, belching, sighing, chest discomfort, distending pain in the lower abdomen, poor appetite, loose bowels, menstrual irregularities or severe PMS syndromes, red or bulky tongue with coarse coating

Commonly used ingredients

chai hu	bupleurum root		Radix Bupleuri
dang gui	angelica root		Radix Angelicae Sinensis
fu ling	poria		Poria
bai shu	largehead atractylodes rhizome		Rhizoma Atractylodis Macrocephalae
bai shao	white peony root		Radix Paeoniae Alba
chen pi	dried tangerine peel		Pericarpium Citri Reticulatae
xiang fu	nutgrass flatsedge rhizome		Rhizoma Cyperi
Sample prescription: Free and Easy Wanderer Plus

Therapeutic principle	Nourishing blood, enriching yin, preserving body fluids, and lubricating
Indications	Emotional or mental disorders such as anxiety, depression, and paranoia; insomnia, yawning, restless, palpitations, lassitude, constipation, a pale tongue with coarse coating

Commonly used ingredients

sheng di	rehmannia root		Radix Rehmanniae
gan cao	liquorice root		Radix Glycyrrhizae
fu xiao mai	shriveled wheat		Fructus Tritici Levis
da zao	common jujube fruit		Fructus Ziziphi Jujubae
bai he	lily bulb		Bulbus Lilii
wu wei zi	schisandra		Fructus Schisandrae
dang gui	angelica root		Radix Angelicae Sinensis
Sample prescription: Lily Bulb and Rehmannia Decoction

Therapeutic principle	Reinforcing yang and replenishing yin
Indications	Alternating hot flashes and chills, red cheeks, weakness, lumbar soreness, palpitations, excessive sweating, dizziness, ear ringing, hot sensations in the palms and soles, insomnia, paleness, fatigue, poor appetite, urinary dripping, low libido and menstrual irregularities, pale tongue

Commonly used ingredients

xian ling pi	epimedium		Herba Epimedii
ba ji tian	morinda root		Radix Morindae Officinalis
Xian mao	common curculigo rhizome		Rhizoma Curculiginis
mo han lian	yerbadetajo herb		Herba Ecliptae
nu zhen zhi	glossy privet fruit		Fructus Ligustri Lucidi
rou cong rong	cistanche		Herba Cistanchis
shu di	processed rhemannia rhizome		Rhizoma Rehmanniae Praeparatae
Sample prescription: Promoting Yin and Yang Decoction

Therapeutic principle	Invigorating kidney, regulating extra meridians
Indications	Irregular periods, absentmindedness, fatigue, lumbar and knee soreness, discomfort in the lower abdomen, limb coldness, poor appetite, irritability, dizziness, ear ringing, occasional hot flashes, pale or bulky tongue

Commonly used ingredients

tu si zi	dodder seed		Semen Cuscutae
rou gui	cassia bark		Cortex Cinnamomi
xu duan	himalayan teasel root		Radix Dipsaci
bai shao	white peony root		Radix Paeoniae Alba
lu jiao jiao	Deer antler glue		Colla Cornus Cervi
shan yu rou	cornus fruit		Fructus Corni
Sample prescription: Consolidating Thoroughfare Vessel Decoction

Therapeutic principle	Resolving stagnation and phlegm, promoting qi circulation
Indications	Mood swings, depression, anxiety or paranoia, sleeping difficulties, chest tightness, suffocating sensation in the throat, excessive throat secretion, obesity, weakness, belching and abdominal distention, bulky pale tongue with white greasy coating

Commonly used ingredients

chen pi	dried tangerine peel		Pericarpium Citri Reticulatae
ban xia	pinellia tuber		Rhizoma Pinelliae
fu ling	poria		Poria
zhi shi	immature bitter orange		Fructus Aurantii Immaturus
hou po	magnolia bark		Cortex Magnoliae Officinalis
ku xing ren	bitter apricot kernel		Semen Armeniacae Amarum
Sample prescription: Four Herbs Decoction for Clearing Stagnation

Therapeutic principle	Activating blood, dissolving stasis, and removing meridian obstructions
Indications	Slow mental response, anxiety, headache, chest oppression, pain in the chest or abdomen, dull complexion, general aching, insomnia or sleepiness, itchiness, limb numbness or joint stiffness, dark tongue/tongue with purplish spots

Commonly used ingredients

chuan xiong	Sichuan lovage		Rhizoma Ligustici Chuanxiong
dan shen	red sage root		Radix Salviae Miltiorrhizae
shao yao	peony		Radix Paeoniae
tao ren	peach kernel		Semen Persicae
hong hua	safflower		Flos Carthami
dang gui	angelica root		Radix Angelicae Sinensis
Sample prescription: Unblock the Orifices and Invigorate the Blood Decoction

Because of the wide variety of menopause symptoms, some herbs are added for relieving specific serious complaints. For example:

Excessive sweating or vaginal discharge

long gu	fossil bone	Os Draconis
mu li	oyster shell	Concha Ostreae

Sleeping difficulties

ye jiao teng	tuber fleeceflower stem	Caulis Polygoni Multiflori
he huan pi	mimosa tree bark	Cortex Albiziae

uneasy mind

long chi	fossil teech	Dens Draconis
hu po	amber	Succinum

Severe body heat

huang qin	baical skullcap root	Radix Scutellariae
huang lian	golden thread rhizome	Rhizoma Coptidis

Hot sensation in the palms and soles

di gu pi	wolfberry root-bark	Lycii Radicis Cortex
bai wei	blackend swallowwort root	Radix Cynanchi Atrati

Diarrhea or loose bowels

bu gu zhi	psoralea	Fructus Psoraleae
rou dou kou	nutmeg	Semen Myristicae

Skin itchiness

chan tui	cicada slough	Periostracum Cicadae
bai xian pi	dictamnus root bark	Cortex Dictamni Dasycarpi Radicis

Heavy menses

bu gu zhi	psoralea	Fructus Psoraleae
ai ye tan	artemisia leaf (charred)	Folium Artemisiae Argyi

Night urination

yi zhi ren	sharpleaf glangal fruit	Fructus Alpinae Oxyphylae
sang piao shao	mantis egg-case	Os Sepiellae Seu Sepiae

Dizziness and headache

tian ma	tall gastrodia tuber	Rhizoma Gastrodiae
gou teng	gambir vine stem	Ramulus Uncariae cum Uncis

Rich in clinical experience, TCM has formulated many herbal prescriptions for various health problems in women. Among those prescriptions for menopause, herbs for dispelling liver and regulating reproductive system such as white peony root, angelica root, rehmannia root and bupleurum root are the ones most selected; herbs for invigorating kidney such as epimedium and common curculigo rhizome are the second most popular choices, which help reinforce overall endocrine activities; herbs for invigorating the spleen such as largehead atractylodes rhizome, poria and liquorice root are also useful and can ensure material transformation. Other popular selections include herbs for suppressing hot flushes, such as anemarrhena rhizome and rehmannia root; herbs for nourishing heart and calming the spirit, include sour jujube seed, Chinese arborvitae kernel and polygala poot; abalone shell, nacre and oyster shell are for soothing the liver which helps stabilize the cardiovascular and neural functions.

Although TCM herbal remedies have not undergone full clinical trials, experiences over the centuries have testified to their efficacy. Nevertheless, herbs should be used cautiously, as they may contain potent ingredients that can cause a variety of harmful reactions, including diarrhea, allergic reactions and sometimes hallucinations. Always use herbs in moderation and under the guidance of professionals.

White peony root		Angelica root		Rehmannia root