Menstruation, pregnancy, childbirth and lactation are unique to women. Menopause signifies a woman has completed her child-bearing years; her body undergoes a series of transformations in preparing for another life stage. During this transitional period, temporary internal disturbances occur from time to time, and the woman may be particularly vulnerable to various disharmonies.

According to traditional Chinese medicine (TCM), the kidney system is responsible for reproductive and menstrual functions. Around 2,000 years ago, TCM proponents realized that menopause belongs to a natural process of bodily development. The Bible of Chinese medicine, theHuang Di Nei Jing (The Yellow Emperor's Medicine Classic): "The kidney forms the foundation for the body's reproduction and development. As we age, essence stored in the kidney is depleted and when no more tian-gui is produced, the meridians in the pelvic region become empty and collapse, and thus women will lose the ability to menstruate and give birth." Furthermore, the kidney system is viewed as the root of life's activities and its weakness can easily lead to disturbances in supporting and promoting the other organ systems, resulting in the imbalance of yin and yang elements in the body. That is why, apart from changes in menstrual pattern, a wide range of symptoms are seen during menopause, depending on what organs are affected and the extent of external stimulation.

Kidney deficiency and essence depletion are at the core in the development of menopause disharmonies. When they disrupt the body's dynamic equilibrium, which leads to yin deficiency and creates virtual heat, a relative excess of yang develops into a hyperactive state inside the body. As a result, the primary signs of menopause problems include hot flushes, red face, hot sensations in the palms and soles, sweating, dizziness, ear ringing, lumbar soreness, menstrual irregularities and constipation. Since yin and yang mutually create and depend on each other, when a yang deficiency also develops, more complicated conditions such as cold limbs, chills, fatigue, gray pallor, puffiness, incontinence of urine and feces, sexual problems will occur.

And because TCM views the kidney as the center of the body's yin and yang, disharmony in the kidney will affect other organs. The following pathological changes may take place:

The liver stores blood and the kidney stores essence. The two organs are complementary with regards to physiology and pathology. One of the key relationships is that kidney-yin nourishes liver-yin making liver-yang unlikely to be hyperactive. When kidney yin fails to support the liver, then hyperactive liver-yang will lead to irritability, dizziness, blurred vision, headache, insomnia, chest discomfort, unstable blood pressure and menstrual irregularities. Women are also likely to develop liver qi stagnation; if this is the case, then there will be mood problems, abdominal distention, general aching and breast tenderness.

The heart and the kidney are closely related, with a mutually dependent and restrictive correlation within each other. When kidney yin is exhausted, the normal functional relationship between them has broken; a hyperactive heart and disturbed spirit will be resulted. There will be problems like dream-disturbed sleep, abnormal heartbeat, restless mind, panic attacks, poor memory, mouth sores, mouth dryness, scanty urine, and hot sensation in the palms and soles.

According to the five element theory, the kidney belongs to water and the lung belongs to metal; the two elements mutually generate each other. Kidney yin deficiency creates virtual fire that damages the lung, so symptoms like excessive sweating, night sweats, feelings of sadness or weeping without cause may occur.

While the kidney is regarded as the "congenital foundation" and origin of life, the spleen is regarded as the "acquired foundation" and source of blood and qi production. The two organs mutually nourish and promote each other. Once the kidney yang is deficient and fails to warm and propel the spleen, problems such as poor appetite, loose bowels, fatigue, limb coldness, heaviness in the head, puffiness and urinary frequency may occur. Sometimes, when the liver is overly active, the spleen will also be suppressed and not function to full capacity.

Furthermore, pathological products are formed during the above process; they can in turn act directly or indirectly on certain organs, and promote a further development into complex conditions. For example, liver disturbances lead to qi stagnation and blood stasis, could result in breath shortness, paleness, pain and a tingling sensation; if spleen weakness fails to control fluid metabolism and lead to dampness or phlegm production, there will be puffiness, obesity and excessive throat secretion. Serious blood deficiency leads to mental problems, dryness, abnormal sensations, skin rashes and dizziness.

In TCM experience, the causes of menopause symptoms are either internal metabolic disturbances or external negative stimulation. The basic pathologies formed inside the body are yin deficiency of the kidney and liver that leads to uncontrollable yang disturbing the upper body. Hyper-functioning or stagnation of the liver usually triggers the menopause symptoms to occur, and pathological products such as blood stasis, dampness or phlegm often precipitate their development or make the condition worse.

TCM views on the development of menopause problems