Menopausal Hot Flash Case Study Presented by Michael Peluso, M.S., L.Ac.
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Menopausal Hot Flash Case Study
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Presented by Michael Peluso, M.S., L.Ac.
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© 2019 Michael J. Peluso/TCM Gynecology No part of this slideshow may be reproduced, copied, or shared without written permission.
TCM Methodology• TCM as the foundation of professional standards for
this class and all TCM Gynecology programs.
• Standardized Methodology -Bian Bing Lun Zhi -Bian Zheng Lun Zhi
• Standards of Diagnosis -Patterns of signs and symptoms
© 2019 Michael J. Peluso/TCM Gynecology No part of this slideshow may be reproduced, copied, or shared without written permission.
Perimenopausal Syndrome• Many common symptoms of Menopausal Syndrome
- Insomnia - Moodiness - Memory problems - Vaginal dryness - Loss of bone mass/density - Joint/muscle pain - Headaches - Weight gain - And of course, the big one…
© 2019 Michael J. Peluso/TCM Gynecology No part of this slideshow may be reproduced, copied, or shared without written permission.
“Hot Flashes/Flushes”
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Hot Flashes• One of many symptoms of “menopausal syndrome”
• Sensations of heat spontaneously rising, generally in the upper part of the body, chest, neck, face.
• Flushing of the cheeks and chest is not uncommon
• Sweating frequently accompanies the flashing/flushing
© 2019 Michael J. Peluso/TCM Gynecology No part of this slideshow may be reproduced, copied, or shared without written permission.
Hot Flashes• Very common for the woman to feel cold right after
the hot flash or the sweating abates.
• Episodes last anywhere from 30 seconds to 10 minutes and can be infrequent (daily, or every other day) or frequent (sometimes several times per day)
• Hot flashes can occur day or night or both.
© 2019 Michael J. Peluso/TCM Gynecology No part of this slideshow may be reproduced, copied, or shared without written permission.
TCM View of Menopause
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TCM Menopause
•“We are not treating a disease, rather we are facilitating a transformation” -Bob Flaws
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TCM Menopause• Not a disease
• jing duan “Cessation of Menstruation”
• Nei Jing 7X1 Yangming
• Nei Jing 7X2 Arrival of Tian Gui
• Nei Jing 7X5 Yang Ming decline
• Nei Jing 7X7 Tian gui ceases
© 2019 Michael J. Peluso/TCM Gynecology No part of this slideshow may be reproduced, copied, or shared without written permission.
TCM Menopause
• Self-preservation
• Heart/Bao Mai Reversal
• Should be a smooth, relatively uneventful process
© 2019 Michael J. Peluso/TCM Gynecology No part of this slideshow may be reproduced, copied, or shared without written permission.
Menstrual Physiology
© 2019 Michael J. Peluso/TCM Gynecology No part of this slideshow may be reproduced, copied, or shared without written permission.
© 2019 Michael J. Peluso/TCM Gynecology No part of this slideshow may be reproduced, copied, or shared without written permission.
Perimenopausal Syndrome
• The central, confounding role of the Liver
© 2019 Michael J. Peluso/TCM Gynecology No part of this slideshow may be reproduced, copied, or shared without written permission.
Spleen
Blood Vacuity
Kidney Yang Vacuity
Liver
Faulty Diet
Affect Damage
Lungs
Heart
Qi Vacuity
Qi VacuityBlood Vacuity
Affect Damage
Damp
Phlegm
Age
Kidney Yang Vacuity
Kidney Yin Vacuity
Environment
Wei Qi Vacuity
© 2019 Michael J. Peluso/TCM Gynecology No part of this slideshow may be reproduced, copied, or shared without written permission.
Perimenopausal Syndrome
• “The major clinical signs and symptoms of perimenopausal syndrome often manifest as those of deficiency patterns. Even if the pattern is one of excess, it is usually root deficiency combined with branch excess”1
© 2019 Michael J. Peluso/TCM Gynecology No part of this slideshow may be reproduced, copied, or shared without written permission.
Perimenopausal Syndrome
• Liver/KD Yin Vacuity
• Spleen/KD Yang Vacuity
• HT/SP Vacuity
• Dual Kidney Yin/Yang Vacuity
• Hyper-ascendent Liver Yang
• Dampness/Phlegm Heat/Blood Stasis
Common Pathomechanisms of Perimenopausal Syndrome
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Steps Toward Diagnosis
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Constitutional Diagnosis
• Shao Yang -healthy
• Shao Yin -Skinny, prone to Yin/Blood vacuity from birth
• Tai Yang -apple shape, top heavy, skinny legs, prone to heat, damp, phlegm accumulation, obesity above.
• Tai Yin -pear shape more prone to SP/KD Yang vacuity, cold, damp, obesity below.
© 2019 Michael J. Peluso/TCM Gynecology No part of this slideshow may be reproduced, copied, or shared without written permission.
Common Single-Patterns Resulting in Hot Flashes
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TCM Hot Flashes
• Liver Depression Depressive Heat - S/S: Hot Flashes, red face, red eyes, mostly during the day when emotions are most labile, irritability, loud voice, “11” lines between eyebrows, -Tongue: Inflated rim of the tongue possibly with red tip. -Rx: Jia Wei Xiao Yao San
Common Single Patterns & Symptoms
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TCM Hot Flashes
• Kidney Yin Vacuity -S/S: Dizziness, tinnitus, dry skin, itching, hot flashes, night sweats -Tongue: No coating or red Rx: Zuo Gui Wan
Common Single Patterns & Symptoms
© 2019 Michael J. Peluso/TCM Gynecology No part of this slideshow may be reproduced, copied, or shared without written permission.
TCM Hot Flashes
• Yin Vacuity with Vacuity Heat -S/S: Hot Flashes, night sweats, vaginal dryness, dry throat, tinnitus, possibly constipation. -Tongue: Red with scanty yellow fur Rx: Zhi Bai Di Huang Wan
Common Single Patterns & Symptoms
© 2019 Michael J. Peluso/TCM Gynecology No part of this slideshow may be reproduced, copied, or shared without written permission.
TCM Hot Flashes
• Hyper-Ascendent Liver Yang -S/S: Hot flashes (especially in the body and face in the afternoon) dizziness, irritability, headaches, night sweating, -KD Yin vacuity signs may be present as well. -Tongue: red Rx: Qi Ju Di Huang Wan (Liu Wei Di Huang Wan plus Gou Qi Zi + Ju Hua)
Common Single Patterns & Symptoms
© 2019 Michael J. Peluso/TCM Gynecology No part of this slideshow may be reproduced, copied, or shared without written permission.
Spleen
Blood Vacuity
Kidney Yang Vacuity
Liver
Faulty Diet
Affect Damage
Lungs
Heart
Qi Vacuity
Qi VacuityBlood Vacuity
Affect Damage
Damp
Phlegm
Age
Kidney Yang Vacuity
Kidney Yin Vacuity
Environment
Wei Qi Vacuity
© 2019 Michael J. Peluso/TCM Gynecology No part of this slideshow may be reproduced, copied, or shared without written permission.
TCM Menopause
•We are not treating a disease, rather we are facilitating a transformation
Remember…
© 2019 Michael J. Peluso/TCM Gynecology No part of this slideshow may be reproduced, copied, or shared without written permission.
TCM Menopause
•Therapy can be effective in as little as 2 weeks, or it may take up to 8-12 weeks. We are just trying to move a natural process along. Be patient and encourage patience from your patients.
Remember…
© 2019 Michael J. Peluso/TCM Gynecology No part of this slideshow may be reproduced, copied, or shared without written permission.
TCM Menopause
•Encourage patients to take it easy, to ease into this chapter of life. Show them basic ways to manage stress, encourage exercise and good eating, stress-reduction habits, positive reading material and podcasts. Encourage fresh thinking and time in nature.
Remember…
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• F/44 (LV/SP/KD) • Taiyin body type (Damp/Phlegm)
• Hot Flashes • Insomnia • Brain Fog • Forgetfulness • Fatigue
Patient
Chief Complaint(s)
• Weight around mid-section (Damp/Phlegm) • Incontinence (Kidney Qi/Yang Vacuity) • Insomnia (many potential reasons) • Tickle in throat (Yin vacuity or Phlegm) • Frequent urination, nocturia (KD Yang Vacuity) • Vivid dreams (many potential reasons) • Stress (Liver Qi stagnation) • Fatigue (Spleen Qi Vacuity) • Thinking at night (many potential reasons) • Worsening eyesight (Liver Blood Vacuity) • Easily dizzy (Spleen Qi Vacuity/Blood
Vacuity/Liver Yang Rising) • Dry skin (many potential reasons) • Headaches: one-sided, temple, behind
eyes. Better with pressure. (Liver Yang Rising)
• Did have very heavy menses with big clots
• No mood swings with menses • 3 periods in 2019 -What causes delayed or blocked menstruation?
What’s Relevant?
Tongue• Inflated rim (LV Qi stagnation/
stagnant heat) • Red tip and sides (LV heat. heat
in the upper jiao) • Pale body (blood vacuity) • Puffy Body/Scallops (Spleen
Vacuity)
Add it up! What patterns are manifesting?
• Liver Depression Qi Stagnation • Depressive Heat • Liver Yang Rising • Liver Blood Vacuity • Spleen Qi Vacuity • KD Yang Vacuity • Damp/Phlegm
• Liver Signs: 5-6 • Spleen Signs: 4 • KD Yin Signs: nothing definitive. • KD Yang Signs: 2 • Damp/Phlegm: 1
Order from most to least symptoms
List Treatment Principles for primary pattern of LV/SP disharmony
• Course the Liver, rectify the Qi, resolve depression, clear heat,fortify the Spleen, and drain damp.
© 2019 Michael J. Peluso/TCM Gynecology No part of this slideshow may be reproduced, copied, or shared without written permission.
Reference Materials• Bensky, Dan et. al., Chinese Herbal Medicine: Formulas and Strategies Eastland Press. Seattle, WA 2009
• Flaws, Bob Menopause & Chinese Medicine Blue Poppy Press Boulder, CO 2015
• Flaws, Bob et. al., A Handbook of TCM Patterns & Their Treatments Blue Poppy Press Boulder, CO 2015
• Flaws, Bob A Compendium of Chinese Medical Menstrual Diseases Blue Poppy Press Boulder, CO 2005
• Liang, Lifang Contemporary Gynecology: An Integrated Chinese-Western Approach Blue Poppy Press Boulder CO 2017
• Maciocia, Giovanni Obstetrics and Gynecology in Chinese Medicine Churchill Livingstone Elsevier New York 2011
• Sionneau, Philippe et. al. The Treatment of Disease in TCM Volumes 1 & 7 Blue Poppy Press Boulder, CO 2018
• Yi, Si-tu et. al., The Clinical Practice of Chinese Medicine: Menstrual Disorders II: Premenstrual Syndrome, Dysmenorrhea & Perimenopause People’s Medical Publishing House Beijing 2008
• Zhang, Ting-liang et. al, A Handbook of Traditional Chinese Gynecology Blue Poppy Press Boulder, CO 1998
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