More on hormones and TCM

[Guest guest]

This is an excellent article from the acupuncture.com website. Since

is addresses so many of issues raised in the original post, I'm

forwarding it onto this list.

 

Victoria

 

Recognition and Prevention of Herb-Drug Interaction

 

by Harriet Beinfield, L.Ac.,

and Efram Korngold, L.Ac., OMD

Homepage | Herbal Index

 

 

 

Coauthors of Between Heaven and Earth, A Guide to ,

and Chinese Modular Sollutions Handbook for Health Professionals.

 

Most gynecologists have a knee-jerk reaction: if it's menopause, its

time for Premarin. While this bay ball right for some women, some of

the time, it is not for all owmen all of the tiem. Most women wnat to

heed their doctors - some seek to be educated about alternative

points of view. Although hormone supplementation may be useful and

warranted, conventional pharmaceuticals (like Premarin, Provera,

Estraderm, Estrace) are not the only nor necessarily best choice.

When combined, acupunctueherbal formulas, and natural hormone creams

can be of enormous benefit.

 

Western and Chinese medical paradigms are quite parallel in th e way

they describe the menopausal process. One speaks through the language

of hromones and their interaction wthih the reproductive organs and

the other uses the vacabulary of Essence and its relationship wiht

the Kidney. Understanding hormone supplementation wiht the context of

Chinese medical theiking will maximize our ability to treat

menopausal women effectively. Translating from West to East, steriod

hormones can be regarded as Essence (jing) tonics.

 

The Western Vocabulary of Hormones

Derived from the Greek word hormon, meaning to urge on, excite, or

stimulate, hormones are chemical messengers disseminated via the

bloodstream to regulate cell physiology. They interact with and

counterbalance each other. In the follicular phase. the ovaries

secrete estradiol to produce eggs. After ovulation, the space once

occupied by the egg becomes the corpus luteum which produces

progesterone, about 20 mg/day. During pregnancy the uterus and

placenta produce up to 400 mg/day of progesterone (pro-gestation).

Progesterone can be considered a precursor hormone, meaning that it

occupies the headwaters from which flow a stream of steroid hormones

including cortisol, androstenedione, testosterone, and the estrogens

(estrone, estradiol, estriol). The ovaries, along with the thyroid

and adrenals, form an integral part of the hypothalamic-pituitary

axis responsible for the fundamental regulatory processes of

reproduction, growth, maturation, metabolism, maintenance of

temperature and pressure, red blood cell production, and adaptation

to stressors like infection, trauma, and other environmental

influences.

 

In spite of the recognized complexities of hormonal dynamics,

disturbances that occur in menopausal women are simplistically

attributed to the decline of ovarian function and the consequent

cessation of estradiol secretion. A complex chronological,

biological, and cultural event has been reduced to a single problem:

estrogen deficiency-with an apparently uncomplicated and obvious

solution: estrogen replacement.

 

The current medical wisdom is the product of an industrially

manufactured consciousness. In 1966 Searle, Upjohn, and Wyeth-Ayerst

pathologized the perception of menopause, transforming it from a

transitional life stage into a chronic disease process by hiring a

Brooklyn physician named Robert A. Wilson to write a book called

Feminine Forever, proclaiming that estrogen would protect a woman's

youth and save her from " living decay. " The book injected fear by

insisting that without estrogen replacement therapy (ERT), bones

would dissolve, hearts clog, vaginas shrivel, breasts sag, skin

crinkle, and minds deteriorate.

 

Estrogen became perceived to be the miracle antidote to loss. The

marketing campaign worked. Menopause is now universally and virtually

unanimously treated with estrogen. Estrogen sales jumped from $17

million in 1966 to $83 miilion in 1976, and in 1990 sales swelled to

$460 million. This in spite of the NIH Consensus Conference on

Estrogen Use and Postmenopausal Women that concluded: " Given the

current state of knowledge, no general recommendation, applicable to

all postmenopausal women, can be made...(HRT is a) promising but

unproven approach to prevention. "

 

The Chinese Vocabulary of Essence

While Western doctors define the problems associated with menopause

as stemming solely from estrogen deficiency, in Chinese medicine

estrogen, along with other hormones, is subsumed within the larger

category of internal secretions known as Essence (jing). Estrogen is

a kind of Essence, just like carrots are a kind of vegetable; but

just as all vegetables are not carrots, not all Essence is estrogen.

 

In John Lee, M.D.'s descriptive definition, it is striking how easily

the term Essence (jing) can be substituted for steroid: " Steroid

[hormones] stabilize, energize, nurture our cells and tissues, ensure

repair and replication of vital tissue, protect us against damage,

and foster the genesis and development of a new life to carry on our

species. " The same functions performed by the hypothalamic-pituitary

axis-the capacity to grow, mature, reproduce, maintain stability,

generate blood and marrow, adapt to stress, repair body tissues-are

governed by the Kidney. Inherited and acquired Essence, pooled within

the reservoir of the Kidney, are stored and dispensed as needed. All

other organ systems live downstream from this inland sea, dependent

on its supply.

 

When Essence is plentiful, our ability to resist disease and adapt to

change is optimal. With age, fundamental resources ebb, and these

capacities decline. In youth it is possible to compensate for

spending more biological cash than is returned to our reserve Essence

account, but as this principal diminishes over time, we become less

able to push ourselves without receiving notice of insufficient

funds. If throughout our lives we run the body economy at a deficit,

the dearth of resources eventually catches up with us. Menopausal

complaints are the outcome of deficit spending: the debt can no

longer be rolled over, because there's no longer a cushion of funds

from which to draw. Menopausal problems result from the diminution of

Essence and a consequent deficiency of Qi and Blood.

 

Stored by the Kidney, Essence is the origin of all Yin (Blood and

Moisture) and Yang (Qi and Warmth). Loss of libido, stamina, hearing,

vision, lower back pain, sore hips or knees, apathy, despair, dull

mindedness, memory problems, vaginal dryness and atrophy, thinning of

bones, deterioration of teeth and gums are all symptoms of deficient

Essence.

 

When Essence becomes depleted, so do Blood and Qi, Yin and Yang. Lack

of Qi produces fatigue, weakness, dull thinking, melancholy, and

decreased motivation. Deficiency of Blood leads to weak vision,

dizziness, night sweats, irritability, and restless sleep. Lack of

Blood deprives muscles, tendons, and ligaments of sufficient

nourishment and suppleness, so they become tight and inflamed,

leading to muscle cramps, joint pain, and neck tension. The organism

responds to this state of scarcity with anxiety and lability. for

lack of Blood disrupts the smooth flow that preserves elasticity of

tissue and emotional flexibility. As Kidney Essence declines, a

domino effect engenders down line deficiencies that eventually impact

the Liver, Heart, Spleen, and Lung.

 

Hot flashes are a consequence of the inability of Yin to restrain

Yang, so heat flares upward uncontrollably. Yin deficiency of the

Liver and Heart can trigger hyperactivity that leads to rising Heat.

But hot flashes may also be a consequence of Kidney Yang deficiency,

or weakened Life Gate Fire. When Kidney Yang is weak, the Spleen

becomes unable to extract the necessary nutrients to generate

adequate Moisture and Blood. This results in Dryness (dry eyes, skin,

hair, and vagina, brittle nails, constipation, even cystitis). This

in turn undermines shen-jing, the unified relationship between Heart

and Kidney, Mind and Essence. Kidney Yang deficiency engenders Spleen

weakness, causing symptoms such as lethargy, weakness, easy bruising,

poor concentration, fluid retention, indigestion and bloating. It

also leads to a weakening of the Kidney's capacity to anchor the Qi,

permitting True Yang to leave its proper place in the Lower Burner

and surge upward, producing agitation, flushing and perspiration,

followed by chilliness, weakness, and fatigue.

 

In sum, labile emotions and unpredictable surges and lapses of

physical and mental energies result from the attrition of Yin and

Yang Essences of the Kidney, causing the Qi of the Liver, Heart and

Spleen to become erratic and insufficient. Many women have signs of

both Kidney Yin and Yang depletion. But because hot flashes,

sweating, agitation, and dryness (Kidney Yin Deficient symptoms) are

more attention-getting, herbs that treat Kidney Yin deficiency are

often overemphasized at the expense of those that restore the true

Yang of the Life Gate, an equally important goal.

 

Diet and Menopause

Dietary changes can be profoundly helpful. Many menopausal women

become lactose intolerant and eliminating milk products can

dramatically reduce symptoms of indigestion like bloating and gas. In

general, high carbohydrate consumption can be problematic.

Carbohydrates are broken down into glucose, which triggers insulin

production. Excessive carbohydrates lead to excessive levels of

insulin which reduces the cell's ability to respond to hormone

stimulation. While foods with a sweet flavor tonify Qi and Blood and

strengthen the Spleen, excess sweetness will produce dampness and

stagnation. This results in feelings of heaviness, lethargy,

distension, constipation, diarrhea, muscle soreness. and puffiness.

Spleen Qi stagnation leads to Liver Qi stagnation, resulting in

irritability, frustration, hypersensitivity, cramps, swollen breasts,

mood swings, and headaches.

 

By reducing carbohydrate intake, one reduces the level of circulating

insulin, enabling the cells to respond normally to thyroxin,

progesterone, estrogen, testosterone, cortisol, and other hormones.

This disturbed carbohydrate-insulin dynamic interferes with the

liver's ability to detoxify excess estrogen: women with symptoms of

Liver Qi and Blood stagnation are likely to be estrogen dominant.

These women will benefit by restricting carbohydrate consumption

(grains, cereal, bread, potatoes. pasta, fruit or fruit juice) to one

meal a day, preferably dinner. Digestive aids such as pancreatin and

plant-based enzymes as well as friendly intestinal microtlora

(probiotics) will also help to normalize the function of the Stomach

and Spleen.

 

The Yin and Yang of Estrogen and Progesterone

The life process demands the capacity for proliferation and

restraint, growth and its regulation-both are necessary for

conception, gestation, birth, and development. Ordinarily estrogen is

considered to be a Yin-promoting agent because it relieves conditions

of Yin deficiency (hot flashes, dryness) as well as producing

conditions of Yin excess (Dampness, Blood stasis). Progesterone could

easily be considered a Yang agent because of its ability to enhance

fat metabolism and thyroid function, as well as improving circulation

of Blood and distribution of fluids.

 

However. in the context of developmental cycles. estrogen acts like a

Yang agent because it promotes cell division and rapid growth,

whereas progesterone acts like a Yin agent because it moderates

growth by promoting cell differentiation and maturation. Pregnancy

requires cell proliferation, differentiation, and maturation-both Yin

and Yang functions. The dynamic of estrogen and progesterone can be

compared to that of the sheng (engendering) and ke (controlling)

sequence. In later life we are not supposed to continue to

proliferate tissue at a rapid rate, grow, and accumulate mass, but

rather to mature.

 

Because of Western medical education and research, we are aware of

the benefits of estrogen and uninformed about the value of

progesterone. Whereas estrogen levels decline by 50 per cent at

menopause, progesterone levels can drop nearly to zero. Even though

the ovaries cease producing estradiol, estriol continues to be made

by the adrenal glands and in fat cells. Canadian endocrinologist

Jerilynn Prior has found that athletes with low progesterone levels

but high estrogen showed signs of osteoporosis, provoking her to

speculate that it is perhaps progesterone deficiency, not estrogen

depletion, that is the true culprit. It is also not widely known that

lifelong exposure to xenoestrogens (estrogen-like compounds found in

petrochemicals) destroys follicular function, preventing the

development of the corpus luteum, resulting in massive estrogen

dominance and profound progesterone deficiency. Excess estrogen,

whether endogenous (produced by the body) or exogenous (from outside

the body), creates Qi and Blood stagnation, particularly affecting

the Liver and Spleen.

 

Phytosterols

There is no direct evidence that plants contain compounds that are

the same as estrogens. Norman Farnsworth, an internationally renowned

pharmacognosist, states that because plants have been used

successfully to induce ovulation and increase fertility, it's logical

but not necessarily correct to infer that it must be because they

contain substances that are equivalent to human and animal hormones.

Yet a great variety of plant constituents are similar in their

molecular structure to human steroid hormones. The implications of

this are still under investigation in an attempt to explain the

mechanism by which herbs affect hormones. It is speculated that

herbal agents: stimulate endogenous hormone production; sensitize

and/or increase hormone receptors; inhibit steroid degradation by

altering the rate of catabolism in the liver (producing the net

effect of more circulating hormones in the blood stream). Also, we

now know that compounds such as genistein in soy and red clover

occupy estrogen receptor sites, compounds in licorice can occupy

receptors for cortisol, and dang gui appears to contain compounds

that occupy progesterone receptors.

 

Herbs are complex biological substances with incompletely understood

mechanisms of action, sometimes producing paradoxical, normalizing

effects. Genistein simultaneously acts as a weak estrogen, anti-

estrogen, angiogenesis inhibitor, and anti-oxidant. Perhaps Japanese

women do not complain of hot flashes because their soy-based diet

contains high levels of genestein, which buffers the loss of estrogen

by binding to the same receptor sites on cells, easing the panic of

the hypothalamus in response to declining estrogen. It is curious

that Asian women have lower levels of estrogen and a lower incidence

of estrogen-deficiency symptoms. According to Subhuti Dharmananda,

Ph.D.. licorice not only mimics cortisol, but also acts as a

modulator of estrogen activity, inhibiting or enhancing its effects.

Many herbs are adaptogenic, enhancing the body's self-regulatory

capacities. They can affect not only the quantity of hormones

circulating in the blood, but also the body's ability to respond to

those hormones. A term for describing how estrogen receptors respond

to exogenous and endogenous compounds is selective estrogen receptor

modulator (SERM).

 

Natural Progesterone Cream

Natural progesterone differs significantly from Provera

(medroxyprogesterone acetate), properly referred to as a progestin,

not progesterone. What is meant by a natural hormone is a substance

that precisely matches in molecular configuration what the body

itself produces. Natural has less to do with where it comes from, and

everything to do with its biochemical structure. The naturally

occurring plant sterol diosgenin from Mexican yams can be converted

through a simple laboratory process called hydrolyzation into a

steroid compound molecularly identical to human progesterone.

Transdermal (topically applied) natural progesterone creams, gels,

and patches do not have the side effects associated with Provera and

other progestins. Possible side effects of Provera include fluid

retention, weight gain, depression, fatigue, nausea, acne, migraine,

breast tenderness, spotting between periods. Unusual but possible

side effects include: liver toxicity, thrombophlebitis, pulmonary

embolism, stroke, or retinal thrombosis.

 

Hormones taken orally enter the bloodstream from the small intestine,

and go directly to the liver. Because the liver is not accustomed to

receiving large amounts of hormones, it begins to break them down,

leaving only a small percentage of the ingested hormone available to

cells. Transdermal delivery circumvents the digestive system -- cells

absorb hormones more efficiently, rapidly dispersing them into the

blood via capillary beds in skin and muscle. Martha Howard, M.D.

says, " oral pharmaceuticals can be harmful to the liver and gall

bladder. Oral administration is outmoded. Plant-derived creams fit

better in the body's receptors. I prefer transdermal delivery systems-

it's safer and more natural. "

 

Progesterone has a broad spectrum of action, relieving symptoms of

Qi, Blood, and Essence deficiency-normalizing estrogen levels (Yin)

and thyroid function (Yang)-without causing stagnation. When

progesterone supplementation is inadequate in relieving hot flashes,

sweating, and vaginal dryness, herbs that tonify Yin, dispell Heat,

and astringe Moisture should be used. Another option is to use a

transdermal preparation marketed as a phytoestrogen cream (containing

extracts of ginseng, dang gui, chaste tree berry, red clover, black

cohosh, pomegranate, black walnut, borage and grape seed) that may

help to relieve hot flashes and vaginal dryness.

 

Women concemed about or diagnosed with breast cancer wonder whether

they should use natural progesterone cream. A Johns Hopkins study

published in 1981 found that women with low progesterone levels had a

5.4 times greater incidence of breast cancer and a 10 times greater

incidence of general malignancy. This makes sense since progesterone

encourages cell differentiation and malignancy is a phenomenon in

which undifferentiated cells multiply. One study showed that

transdermal progesterone reduced the risk of breast cancer by

decreasing the rate of division of breast epithial cells, and

inhibited the estrogen-induced proliferative response in cancerous

cell lines. It has also been reported that women whose breast tumor

surgeries were performed in the early luteal phase (the early part of

the last half of the cycle) had better outcomes. This is when

progesterone is dominant, and estrogen levels are relatively lower.

 

If hormones and Essence are virtual synonyms, then hormones can be

used in the same manner as Essence-replenishing herbs. In the spirit

of integrative medicine, Chinese medicine can expand its thinking and

practice to include natural hormone therapy as a complementary

modality.

 

 

 

Harriet Beinfield, L.Ac., and Efrem Korngold, L.Ac., OMD are co-

authors of " Behveen Heaven and Earth: A Guide to " :

the " Chinese Modular Solutions Handbook for Health Professionals " :

the pamphlet " : How It Works " and many articles. For

25 years, they have been engaged in the active practice of

acupuncture and Chinese herbal medicine and were among the first to

become licensed by the State of California in 1976. Currently on the

faculty of the American College of Traditional . They

have taught and lectured at medical schools, hospitals, acupuncture

colleges and conferences.

 

Harriot Beinfeld is also the author of " Chinese Modular Solutions;

Handbook for Health Professionals " , " , How It Works "

and " Simple Solutions for Stress " .

 

She can be contacted at Kanherb

 

http://acupuncture.com/Herbology/menopause.htm