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Don't Rule Out TCM for Menopause Symptoms

Recently in a paper published in the Annals of Internal Medicine 2002;137:805-813, authors Fredi Kronenberg, Ph.D. and Adriane Fugh-Berman, M.D. made some sweeping conclusions about the effectiveness of CAM therapies on the treatment of menopausal symptoms. I would like to take issue primarily with their generalizations about the effectiveness of Traditional Chinese Medicine (TCM) in treating menopausal symptoms.

Based on a total of three very poorly designed clinical trials, two on single Chinese herbs and one on acupuncture, Dr.’s Kronenberg and Berman have downplayed the effectiveness of TCM by lumping it into a category of herbs and complementary and alternative medicines (CAM) therapies, that in their view, are not supported by clinical trials for the treatment of menopausal symptoms. The conclusions drawn by the authors were based on studies they found through a search of MEDLINE, the Alternative and Complementary Database of the British Library and their own “extensive files.” While the authors state that they did not limit their search to English-language literature, undoubtedly the wealth of studies that have been done in China and Japan could have been investigated before drawing any sweeping conclusions from such miniscule and faulty data.

The first of the two studies cited pertaining to the use of Chinese herbs on menopausal symptoms focused on the use of Dang Gui (Radix Angelica Sinensis) as a single herb for treatment of hot flashes. First of all, Dang Gui is rarely used as a single herb by qualified practitioners of TCM for the treatment of any condition, much less hot flashes. Why then cite a study on Dang Gui as a single herb for the treatment of hot flashes, and then use the results as a basis for conclusions about the effectiveness of Chinese herbs on menopausal symptoms? Although the authors mentioned in passing that it would be valuable to study TCM formulas in the context of TCM diagnostic methods, such lip service is hardly sufficient to counter balance the inadequacy and faulty use of the research cited. The authors then went on to point out the danger of using Dang Gui concurrently with warfarin therapy. The truth is drug-herb interactions with blood thinning agents are a real concern. Any qualified Chinese herbalist would be fully aware of this and exercise caution accordingly.

The second study cited focused on the use of Ginseng (Radix Ginseng), also as a single herb, for the treatment of general menopausal symptoms and quality of life measures. Although for certain conditions, ginseng would more likely be used as single herb than Dang Gui, it would not be prescribed singly to treat menopausal conditions. Truthfully, in order to make any valid statements on the efficacy of Chinese herbs on menopausal symptoms, it would not only be "interesting," but it would be imperative to study TCM herbal formulas in the context of TCM diagnostic methods.

The third and final study cited that related to TCM, focused on the use of acupuncture to treat hot flashes. 24 menopausal women were randomly assigned to either an electro-acupuncture group or to a control group where shallow needle insertion was administered on the same points. Essentially then, this study was looking at acupuncture versus electro-acupuncture on the treatment of hot flashes. According to Dr.’s Kronenberg and Fugh-Berman, the result was that both groups showed a significant decrease in hot flashes . Based on these results, imagine how effective acupuncture would prove to be when administered by qualified practitioners of TCM, using point selections individualized for each patient, and based within the context of TCM methodology. The authors then went on to state that acupuncture can cause occasional tissue trauma, and in rare instances, pnuemothorax and cardiac tamponade, and possibly transmission of hepatitis or other infectious disease. It is true that occasional tissue trauma is the most frequent complication of acupuncture, in other words: A bruise. As for instances of pnuemothorax and cardiac tamponade, they are so extremely rare that malpractice insurance for acupuncturists remains in the hundreds of dollars per year for $1,000,000 in coverage. As the authors themselves mention, the standard use of disposable needles in the U.S. eliminates any danger of the transmission of infectious disease.

The bottom line is that to date, not a lot of good research has been done on TCM in the United States, due primarily to a lack of funding. In spite of this, TCM has been refined and practiced for thousands of years to good effect, and to the benefit of millions of people over hundreds of generations. As TCM gains wider acceptance in the United States, patient testimony and consumer demand alone are ranking acupuncture and the use of Chinese herbs as effective and safe alternative treatments for many women’s health issues, including menopausal symptoms. While it is extremely difficult to devise randomized, placebo-controlled, double-blind clinical trials that can accurately reflect the effectiveness of TCM on menopausal symptoms, this research is forthcoming and will undoubtedly bear out the effectiveness of this time-tested tradition. In light of the early discontinuation of the National Institutes of Health’s (NIH) study on hormone-replacement therapy in July of this year, it is crucial that the benefits of TCM on menopausal symptoms be recognized. The NIH study was halted early due to findings of slightly increased risk of heart disease, blood clots, stroke and breast cancer.

By all indications, medicine in the 21st century is moving toward an integrative model that will encompass the best of all traditions. As consumer awareness and discernment continues to increase, practitioners of medicine from all fields are being called upon to embody the pure motives and ethical standards that have been codified in both the Hippocratic oath, and The Yellow Emperor’s Classic of Medicine. In other words, the health and safety of the public should always be more important than money, even multi-billion dollar pharmaceutical industries. Yes more research needs to be done in the field of TCM, but unfortunately it is not all that lucrative to prove the effectiveness of such natural and benign therapies. The research will be done however, as it is the nature of all true and good things to eventually be revealed for what they are. As practitioners of medicine, it’s time to clarify what our motives are. It’s time for us to put all misinformation and squabbling aside and stand together as the leaders we have promised the world we would be.

Terry Chen, L.Ac. is a graduate of Yo San University who practices acupuncture in Los Angeles, CA. In addition to mental and emotional wellness, Mr. Chen specializes in TCM gynecology. (310) 577-3006.

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