Yi-Po Anthony Wu, MD, M.P.H.
Medical Director and founder of PCMC

• Western medical training at National Taiwan University, Worcester City Hospital, University of Massachusetts Medical Center
• Masters degree in Public Health, University of Hawaii
• Diplomate, American Board of Internal Medicine
• Acupuncture training in Taiwan and at New York University
• Director of Pacific Pain Clinic 1988-93
• Director of Pacific Complementary Medicine Center since 1999
  

Recently, through many phone calls, office visits and social occasions, my female patients have raised questions regarding hormone replacement therapy (HRT). The questions are: Should I be on Premarinor Prempro? What would I do if I were to get off?

For almost a decade, estrogen(alone or combined) has become the most prescribed medicine in America. However, a recent study showed that 20% of women who received a prescription never bothered to fill it. Of those who began taking HRT, one third stopped within nine months, and half had quit by the end of a year. Why?

Estrogen was coined “The Spring of Youth” in Time magazine, April 16, 1965. A year earlier, Newsweek magazine carried a story entitled “No More Menopause?” Since then, we understand that estrogen is essential for our body and that the lack, or excess of it causes many symptoms, e.g. hot flashes, water retention, weight gain, insomnia, night sweats, fatigue, dry skin, vaginal dryness, atrophy, depression and bone mineral loss (osteoporosis). If so, why do women choose to refrain from it in spite of their physician’s influence?

The answers are complex. The most cited one by women is the fear of side effects from the prescribed synthetic estrogen. The debates of risks vs. benefits have taken place for four decades since pharmaceutical companies (especially Wyeth-Ayers, who produces Premarin and Prempro) began to market the drugs. On July 17, 2002, JAMA(The Journal of the American Medical Association) carried an original article by the Women’s Health Initiative on “Risks and Benefits of Estrogen plus Progestin in Healthy Postmenopausal Women”. Estrogen plus progestin is Prempro. The study was conducted through 40 clinical centers nation-wide involving over 16,000 subjects for a long term of 8 years, double blind and federally funded.

Findings in the fifth year showed an increased risk of the use group in the doubling of pulmonary emboli (blood clots in the lung) and deep vein thrombosis (blood clots in the legs), 41% had increased risk of stroke, 29% of heart attack, 26% of invasive breast cancer and 22% of other cardiovascular diseases. The study did, however, show benefits in preventing colon cancer and hip fracture. The study was terminated prematurely due to its obvious and substantial risks.

This study may not settle the debate of four decades and, in fact, most physicians continue to prescribe these hormones. At least this important study confirms views of many grass root movements that synthetic hormones are dangerous and extra caution should be applied when using them. It also opens up the hormone therapy approach to other options.

Wise choice of hormone therapy begins with a sound knowledge of our hormone system, individual constitution and need, and healthy lifestyle. As this is beyond the scope of this brief article, I will simply focus on some of the commonly used alternatives.

“Natural” (or bio-identical) sexual hormones include estrogen (estrone, estradial and estriol), progesterone and testosterone. These hormones are also synthetic, but their molecules are identical to that of humans. Some (especially estrone, estradial andtestosterone) carry higher risks; others (estriol and progesterone) carry lower risks. Under doses or over doses are still problematic to our bodies. “Natural” progesterone creams, available at health food stores, are usually safe and effective. Dr. John Lee has advocated these creams for years. The quality, inevitably, varies among manufacturers and usually its concentration is much lower than prescribed. “Natural” hormones, due to their complexity of dosage, compounding, individualization, testing and follow-up, still require a prescription and monitoring by a knowledgeable healthcare provider. It is necessary to find a compound pharmacy to fill these prescriptions. Locally, Green Brothers Pharmacy can do it.

Herbs or plant adaptogens are gaining in popularity. Chasteberry, Black Cohosh, DangGui (Angelica Sinesis), Ginseng and Licorice can be purchased over the counter and, in reasonable dosages, used safely. In Traditional Chinese Medicine (TCM), herbs are preferred in a combined formula, usually 6-12 herbs blended together for synergetic results. According to the individual’s constitution and energy pattern, different formulas are prescribed by TCM practitioners. Usually, they are more effective than single herbs. (See Yoshiko Kage’s article).

Acupuncture could be quite beneficial in people who need additional help, when other methods are not effective in restoring balance. (See Doral Rotar and Michael Shi’s articles).The safety of needling, skill of diagnosing and selection of acupuncture points are some of the criteria one should use in choosing an acupuncturist.

Proper diet with high phytoestrogen, e.g. soy and flaxseed, and healthy life styles are no less important than any treatment. Knowledge of these factors is helpful in building a solid foundation for hormonal balance. It will also motivate you to place the responsibility of your health in your own hands. If you should need guidance or counseling on HRT, you can be an active partner with the treatment team instead of just a passive recipient.

Whatever your choice, at Pacific Complementary Medicine Center, we can provide a wide spectrum of medical services. I can work with your primary care doctor or gynecologist to help develop a treatment plan most beneficial to your needs. PCMC acupuncturists, health exercise instructors (Tai Chi, Qi Gong or Liu Tong Exercise), and staff at the clinic as well as the PCMC Herb Center are standing by to help you achieve and maintain a healthy and balanced hormone system.

 In Peace & Health,

          Yi-Po Anthony Wu, MD

RESTORING BALANCE - A Case Study
Michael Nian-Peng Shi, L. Ac.

A 51-year-old homemaker complains of menopausal symptom of mood swings and severe hot flashes. This particular patient has a relatively healthy medical history. She came to our office through a referral from a friend who is also a patient.

In traditional Chinese medical terms, her condition of menopausal symptoms was one of yin deficiency with deficient heat.

She started on a treatment course with acupuncture and herbs. After one and a half months she is completely free of hot flashes and her general moods have also improved.

She now continues to use TCM herbs to periodically balance her yin energy.

Chinese Herbs for Treating Osteoporosis
by Yoshiko Kage, L. Ac.

According to Traditional Chinese Medicine(TCM) theory, at the age of 49, a woman’s childbearing age is over: the Directing Vessel is empty, the Penetrating Vessel depleted, dew of Heaven dries up, the uterus is not open, and infertility sets in. Menopause, however, is never treated as a disease in TCM.

By stopping the monthly blood loss, the consumption of both Blood and Essence/Jing is slowed. Because Blood is no longer sent to the uterus each month, it is now free to flow to the Heart to nourish Spirit/Shen. Menopause is a necessary mechanism, and it is a time for women to achieve and pursue more spiritual aspects of life, a time to grow inner wisdom.

Estrogen is analogous to Essence/Jing, an organic substance which forms the basis of growth, reproduction and development in TCM. Since Essence is the source of Yin (Blood) and Yang (Qi and warmth), we should nurture it through diet - nutrition and herbs. Depletion of the Essence will cause menopausal symptoms such as hot flashes, night sweats, low back pain, memory problems, bone degeneration, hair loss, hearing problems, lack of libido, and vaginal dryness.

Hormone Replacement Therapy (HRT) forces a woman’s body to bleed longer, and this places a big burden on the kidney Qi in order to keep the Directing Vessel and the Penetrating Vessel function, and the Spleen and Liver to store more Blood. Bleeding longer does not necessarily mean the body keeps its youth. On the contrary, the burden created by HRT weakens the system even though some menopause symptoms such as hot flashes may go away.

For decades, women were told that HRT would preserve their youth, but a large, federally funded study done by the Women’s Health Initiative found that, though HRT does keep bones from becoming brittle and reduces the risk of fracture, HRT clearly causes an increase of heart attacks and breast cancer. (See Newsweek: Beyond Hormone Therapy, July 22, 2002 and TIME: The Truth about Hormones, July 22, 2002)

If a woman is concerned about the risks of HRT but wants the benefit of bone protection, what can she do? I strongly recommend Chinese medicine. It should be understood that osteoporosis is not merely a bone problem. It is deeply connected to the whole menopausal change in a woman’s body and it cannot be isolated from the general health condition.

In Japan, the Chinese herb formula Gui Pi Tang* is commonly used for improving the conditions of Heart Blood Deficiency and of Spleen Qi Deficiency, such as anemia, reduced appetite, insomnia, mental fatigue, forgetfulness, anxiety and palpitation. Also used is the formula Jia Wei Gui Pi Tang with two additional herbs: chai hu and shan zhi zi, which clears the fire that is causing hot flash, night sweat, anxiety, insomnia and mental confusion. This formula increases the function of digestion.

Some very interesting scientific data regarding the effect of Jia Wei Gui Pi Tang on osteoporosis was reported in Japan in 1998. The study was designed and experimented by the Research Institute of Oriental Medicine at Kinki University in Japan. The hypothesis was that the herb formula would benefit the treatment of Osteoporosis for women going through menopause. The target population was 83 women (age 59 to 89), who visited the Institute for low back pain as a chief complaint. Those women were divided into three groups: a group that received Vitamin D, a group that received the herb formula, and the control group that received only painkiller. Here are their findings:

	Bone Mass After 1 year	Bone Mass After 2 year	Red Blood Cell Count	Menopausal Syndrome
Vitamin D Group			NC	NC
Herbal Formula Group		NC
Control Group	NC	NC	NC	NC

The Chinese herbs produced the best result of increasing bone mass, increasing red blood cell count and decreasing menopause symptoms, while the control group showed no change. A remaining question is why the herb group stopped increasing bone mass after two years as opposed to the Vitamin D group. My interpretation is that the Chinese herbs work on the body in a holistic way.

By taking this formula, the participants’ general health was improved. As a result, they could eat better, sleep better, and be out in the sun more. All these are essential for nurturing Blood and Qi, as well as for bone formation. The bone mass was not changed much after two years probably because it was no longer necessary for a body which has reached homeostasis and balance.

*Ingredients of Gui Pi Tang include 10 herbs: dang gui, yuan zhi, fu ling, baizhu, long yan rou, dang shen, suan zao ren, huang qi, mu xiang, and gan cao.

The Treatment of Menopausal Syndrome with Chinese Medicine
by Dorel Rotar, L.Ac.

According to Chinese medical theory, menopause occurs when, because of the natural aging process, a woman's body no longer produces sufficient blood to sustain a monthly period with blood loss draining on her body and particularly on her kidneys, which is the organ Chinese Medicine sees as the root of life and longevity.

The body in its wisdom reverses the flow of a channel in the center of the body, which sends blood down to the uterus from the heart. Rather, blood and essence from the kidneys are shunted up to the heart in order to nourish the woman’s spirit.

Thus, in the Chinese Medicine, menopause is seen as true change in life from mother of biological children to mother of the community. This is why, in traditional cultures, post-menopausal women are regarded as wise women, since their heart spirit is now nourished and enlightened in a way it was not before.

Therefore, menopause—jing duan, in Chinese—in itself is not a disease but a normal physiological change in life. It is nature’s way of slowing down the aging process in women past childbearing age. Unfortunately, many women do not traverse this cusp quickly and smoothly. Rather they get stuck in the middle of this change. When they do, they may experience a wide range of unpleasant symptoms.

Using herbs and acupuncture, the Traditional Chinese Medicine practitioner seeks to supplement the liver and kidneys, boost the qi and fortify the spleen, nourish the heart and quiet the spirit, clear pathogenic heat and downbear yang, thus restoring balance to the woman’s entire organism.

Yang Qing-fang, writing in Yunnan Traditional Chinese Medicine, (Nr. 5, 1993, P. 27-8), reports on the treatment of 31 cases of menopausal syndrome with ear acupuncture. These women suffered from menstrual irregularity, hot flashes, night sweats, heart palpitations, dizziness, emotional depression, uterine bleeding, and vexation and agitation. Tiny intradermal needles were embedded in acupoints in their ears over a period of 1 month.

Eighty-seven percent of the women in the study registered significant improvement from this cheap and easy therapy. Likewise, research in Japan has shown that menopausal and post-menopausal women using Chinese herbs had greater bone density than women in a comparison group. (see Yoshiko Kage’s article on Page 4)

Western acupuncturists and Traditional Chinese Medicine practitioners not only use acupuncture and Chinese herbs to treat menopausal complaints but also typically advise patients on diet, exercise and lifestyle, thus treating the whole person and bringing balance to every aspect of the patient’s life. These therapies are without side effects.

So why not try these natural and effective, low cost and safe traditional therapies before resorting to hormone replacement therapy and other expensive, high-tech therapies with unknown risks, especially now when the effectiveness of estrogen replacement therapy (ERT) is questioned even by Western scientists.