Yao Jing’s Experiences in the Treatment of Menopausal Hypertension

abstracted & translated by
Bob Flaws, L.Ac., FNAAOM (USA), FRCHM (UK)

Keywords: Chinese medicine, Chinese herbal medicine, gynecology, cardiovascular disease, menopausal hypertension

Menopausal hypertension is due to decline in ovarian function which causes a loss of regulation in the function of the hypothalamus-pituitary-adrenal axis which, in turn, results in a disturbance in the function of the vegetative nervous system. Thus it is categorized as a species of neurological hypertension. It is characterized by fluctuations in blood pressure following the aggravation of clinical symptoms which include headache and dizziness, hot flashes, heart vexation, insomnia, chaotic menstruation, and low back soreness and knee limpness. In Chinese medicine, this condition is categorized as dizziness, headache, visceral agitation, and/or lily disease. It is mostly due to liver-kidney yin vacuity with inability of yin to control yang. Thus there is ascendant liver yang hyperactivity which results in hypertension. However, to reduce all hypertension to ascendant liver yang hyperactivity is an oversimplification, especially when many hypertensives do not manifest its hallmark symptoms of dizziness and/or headache. In issue #2, 2007 of the Zhe Jiang Zhong Yi Za Zhi (Zhejiang Journal of Chinese Medicine), Yao Jing of the Wenzhou Municipal Integrated Chinese-Western Medicine Hospital in Zhejiang published an article titled “The Treatment of Climacteric Period Hypertension Based on Pattern Discrimination.” A summary of this article is presented below.

1. Liver-kidney yin vacuity

The symptoms of this pattern are abnormally high blood pressure accompanied by dizziness, tinnitus, vexation, agitation, and irritability, hot flashes, sweating, vexation heat in the five hearts, low back and knee soreness and limpness, decreased ability to remember, fatigue, somnolence, and a desire to lie down, a dry mouth and parched throat, dry, bound stools, chaotic menstruation, possible ceaseless leakage and dripping, a purplish red menstruate which is thick in consistency, a red tongue with scanty fur, and a fine, rapid pulse. In this case, Dr. Yao says the treatment principles should be to enrich the kidneys and nourish the liver, foster yin and subdue yang. For this, Dr. Yao suggests using Zhen Gan Xi Feng Tang (Settle the Liver & Extinguish Wind Decoction) plus Zhi Bai Di Huang Wan (Anemarrhena & Phellodendron Rehmannia Pills) with additions and subtractions:

Dai Zhe Shi (Haemititum)
uncooked Long Gu (Os Draconis)
uncooked Mu Li (Concha Ostreae), 30g each
Gou Teng (Ramulus Uncariae Cum Uncis), 18g
Niu Xi (Radix Achyranthis Bidentatae), 24g
Gui Ban (Plastrum Testudinis)
Shan Zhu Yu (Fructus Corni)
Gou Qi Zi (Fructus Lycii)
Huang Qin (Radix Scutellariae)
Dan Pi (Cortex Moutan), 12g each
Fu Ling (Poria)
Ze Xie (Rhizoma Alismatis)
Zhi Mu (Rhizoma Anemarrhenae)
Huang Bai (Cortex Phellodendri), 10g each
Gan Cao (Radix Glycyrrhizae), 6g

If there is heart vexation and insomnia, add 12 grams each of Lian Zi Xin (Plumula Nelumbinis), Bai He (Bulbus Lilii), and sitr-fried Suan Zao Ren (Semen Zizyphi Spinosae).

If there is headache, add 10 grams each of Man Jing Zi (Fructus Viticis) and Ju Hua (Flos Chrysanthemi Morifolii).

If the menses dribble and drip unceasingly, add 12 grams each of Qian Cao (Radix Rubiae) and Han Lian Cao (Herba Ecliptae).

For hot flashes and night sweats or vexation heat in the five hearts, add 12 grams each of Xuan Shen (Radix Scrophulariae) and Bie Jia (Carapax Trionycis).

2. Yin & yang dual vacuity

In this case, there are occasional hot flashes and sweating alternating with occasional fear of chill, dizziness, tinnitus, insomnia, profuse dreams, heat in the hearts of the hands and feet, heart palpitations, spontaneous perspiration, decreased intake, loose stools or constipation, lassitude of the spirit, swollen extremities, low back and knee soreness and limpness, chaotic menstruation, a pale tongue with white fur, and a deep, fine pulse. In this case. Dr. Yao says to supplement the kidneys and support yang, enrich and nourish the chong and ren. The formula she suggests for these purposes is Er Zhi Wan (Two Ultimates Pills) plus Er Xian Tang (Two Immortals Decoction):

Xian Mao (Rhizoma Curculiginis)
Han Lian Cao (Herba Ecliptae)
Dang Gui (Radix Angelicae Sinensis)
Bai Ji Tian (Radix Morindae Officinalis), 10g each
Xian Ling Pi (Herba Epimedii)
Nu Zhen Zi (Fructus Ligustri Lucidi), 12g each
Huang Bai (Cortex Phellodendri)
Zhi Mu (Rhizoma Anemarrhenae), 6g each

For loose stools and superficial edema, add 12 grams each of Dang Shen (Radix Codonopsis), Bai Zhu (Rhizoma Atractylodis Macrocephalae), and stir-fried Yi Yi Ren (Semen Coicis) and 10 grams of Che Qian Zi (Semen Plantaginis).

For dripping urine that does not stop, add 12 grams of Bu Gu Zhi (Fructus Psoraleae), 15 grams of Huang Qi (Radix Astragali), and six grams of Sheng Ma (Rhizoma Cimicifugae).

For chaotic menstruation, add 12 grams of Wu Yao (Radix Linderae) and 10 grams each of Xiang Fu (Rhizoma Cyperi), Bai Shao (Radix Alba Paeoniae), and Yi Mu Cao (Herba Leonuri).

3. Heart-spleen dual vacuity

In this pattern, the signs and symptoms are dizziness and vertigo, vexation, agitation, and disquietude, heart palpitations, insomnia, profuse dreams, easy fright, lassitude of the spirit, bodily fatigue, shortness of breath, scanty eating, a someber white facial complexion, a pale, white tongue with thin, white fur, and a fine, weak pulse. Dr. Yao’s treatment principles for this pattern are to fortify the spleen and boost the qi, supplement the heart and nourish the spirit. The formula she suggests in this case is Gui Pi Tang (Restore the Spleen Decoction) with additions and subtractions:

Huang Qi (Radix Astragali)
Suan Zao Ren (Semen Zizyphi Spinosae), 20g each
Dang Shen (Radix Codonopsis)
Bai Zhu (Rhizoma Atractylodis Macrocephale), 15g each
Dang Gui (Radix Angelicae Sinensis)
Long Yan Rou (Arillus Longanae)
Yuan Zhi (Radix Polygalae), 10g each
Fu Shen (Sclerotium Paradicis Poriae)
Che Qian Zi (Semen Plantaginis), 30g each
Mu Xiang (Radix Auklandiae), 6g
Gan Cao (Radix Glycyrrhizae), 3g

If there are facial region hot flashes, add 10 grams each of Zhi Mu (Rhizoma Anemarrhenae) and Huang Bai (Cortex Phellodendri).

If there is vexation, agitation, irritability, and a dry mouth, add 10 grams of Long Dan Cao (Radix Gentianae).

If there is leakage of blood which dribbles and drips ceaselessly, add 10 grams each of carbonized Ai Ye (Folium Artemisiae Argyii) and carbonized Jing Jie (Herba Schizonepetae).

If there is lassitude of the spirit and bodily fatigue, add 12 grams of Xian Ling Pi (Herba Epimedii).

For insomnia and easy fright, add 30 grams each of uncooked Long Gu (Os Draconis) and Mu Li (Concha Ostreae) and two grams of Hu Po (Succinum) swallowed with the decocted liquid.

4. Liver depression & phlegm binding

The signs and symptoms of this pattern are emotional depression, psychological inflexibility, a liking for certitude and stability, lots of anxiety, insomnia, chest oppression, an uncomfortable feeling as if something were stuck in the throat, lots of hacking of phlegm, a fat body, lack of strength, repeated hiccup or burping, abdominal distention and discomfort, a pale tongue with white, slimy fur, and a bowstring, slippery pulse. The treatment principles given by Dr. Yao for this pattern are to course the liver, resolve depression, and transform phlegm, move the qi and scatter binding. The formula she suggests for this is Xiao Yao San (Rambling Powder) plus Dao Tan Tang (Abduct Phlegm Decoction) with additions and subtractions:

Ban Xia (Rhizoma Pinelliae)
Chen Pi (Pericarpium Citri Reticulatae)
Fu Ling (Poria)
Shi Chang Pu (Rhizoma Acori Tatarinowii)
Yu Jin (Tuber Curcumae)
Chai Hu (Radix Bupleuri), 12g each
Bai Shao (Radix Alba Paeoniae), 20g
Dang Gui (Radix Angelicae Sinensis)
Zhi Shi (Fructus Immaturus Aurantii)
Tian Nan Xing (Rhizoma Arisaematis), 10g each
Gou Teng (Ramulus Uncariae Cum Uncis)
Ju Hua (Flos Chrysanthemi Morifolii)
Shi Jue Ming (Concha Haliotidis)
Gua Lou (Fructus Trichosanthis), 15g each
Gan Cao (Radix Glycyrrhizae), 6g

For heart spirit disquietude, add 12 grams of Yuan Zhi (Radix Polygalae) and 15 grams each of calcined Long Gu (Os Draconis) and calcined Mu Li (Concha Ostreae).

For abdominal distention and burping, add 12 grams of Xiang Fu (Rhizoma Cyperi) and 10 grams of Wu Yao (Radix Linderae).

For a fat body, lack of strength, and profuse phlegm, one can use Xiang Xia Liu Jun Zi Tang (Auklandia & Amomum Six Gentlemen Decoction).

Discussion:

According to Dr. Yao, this disease is closely associated with the liver and kidneys. Therefore, the main thrust of its treatment involves regulating and rectifying the liver and kidneys. In addition, because the spleen is the source of engenderment of the blood and the qi and blood typically becomes vacuous at menopause, treatment also commonly must nourish the spleen. However, heart vexation, insomnia, and profuse dreams are all heart channel symptoms. The heart governs the spirit brilliance, while wood is able to engender fire. If liver fire is effulgent, this can lead to stirring of heart fire which then results in lack of calm of the heart spirit and lack of the spirit keeping to its abode. Therefore, one must also commonly use spirit-quieting, heart-calming medicinals on top of a basis of liver, kidney, and spleen ingredients. Further, if there is long-term lack of regulation of yin and yang with qi and blood counterflow and chaos, this will lead to the production of blood stasis and phlegm turbidity. In this case, on top of a basis of regulating and balancing yin and yang, one must also quicken the blood and transform stasis, eliminate phlegm and downbear turbidity as necessary.

Copyright © Blue Poppy Press, 2007. All rights reserved.