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| GUIDELINE |
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| Year : 2021 | Volume
: 7
| Issue : 2 | Page : 276-279 |
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International clinical practice guideline of chinese medicine climacteric syndrome
| Date of Submission | 23-Sep-2020 |
| Date of Acceptance | 23-Nov-2020 |
| Date of Web Publication | 24-May-2021 |
Correspondence Address:
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/wjtcm.wjtcm_85_20
How to cite this article:
. International clinical practice guideline of chinese medicine climacteric syndrome. World J Tradit Chin Med 2021;7:276-9 |
| Foreword | |  |
International TCM Clinical Practice Guidelines˙Menopausal Syndrome was based on Diagnosis and Treatment Guidelines of Common Disease of TCM Gynaecology˙ Climacteric Syndrome (standard number: ZYYXH/T 218-2012) published by the China Association of Chinese Medicine in 2012. Combining with the clinical research evidence at home and abroad in recent years, evidence classification and recommendation opinions were reached, and through expert discussion, this International TCM Clinical Practice Guidelines of Climacteric Syndrome was formed.
This guide replaces ZYYXH/T218-2012 Climacteric Syndrome and the main technical changes from ZYYXH/t218-2012 are as follows:
—The diagnostic significance of FSH value in the determination of reproductive endocrine hormones in the key points of diagnosis was modified (see 3.1.4.2 of 2012 edition).
—The following prescriptions in the treatment of liver–kidney yin deficiency syndrome was modified (see 5.2.1, 2012 edition).
The main drafting unit of this standard: Dongzhimen Hospital of Beijing University of TCM
The units involved in drafting this standard: The First Affiliated Hospital of Guangzhou University of TCM; The First Affiliated Hospital of Heilongjiang University of TCM; The Affiliated Hospital of Chengdu University of TCM; The First Clinical Medical College of Nanjing University of TCM; China-Japan Friendship Hospital; College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, The First Affiliated Hospital of Tianjin University of TCM, Beijing Hospital of TCM of Capital Medical University, Chinese Academy of TCM; Guang' Anmen Hospital of Chinese Academy of TCM
Main drafters of this standard: Cheng-Cong Xiao, Yan-Feng Liu, Tie-Feng Wang, Meng-Bai Xu
Drafters and reviewers of this standard (in alphabetical order by last name):
China: Hui-Lan Du, Yan-Hua Han, Ji-Ling Jin, Hua Lu, Song-Ping Luo, Kun Ma, Yong Tan, Xin Xu, Hong Zhao, Rui-Hua Zhao
Singapore: Su-Li Gao
Iran: Hoda Azizi
Japan: Yoshikawa Junko
H. K. China: Ying-Yi Qian
The drafting procedures of this standard comply with SCM 0001-2009 standard formulation and publication work specification issued by the World Federation of Chinese Medicine Societies.
This standard is issued by the World Federation of Chinese Medicine Societies. The copyright belongs to the World Federation of Chinese Medicine Societies.
International Clinical Practice Guideline of Chinese Medicine Climacteric Syndrome
| 1. Scope | | |
This Guidelines specifies the diagnosis, syndrome differentiation, and treatment of climacteric syndrome.
| 2. Normative References | | |
Pharmacopoeia of the People's Republic of China, 2015 edition, compiled by the State Pharmacopoeia Committee, was published by China Medical Science and Technology Press.
GB/T 12346-2006 Name and Location of Acupoints
GB/T 30233-2013 Acupoint Indications
| 3. Terms and Definitions | | |
For the purposes of this document, the following terms and definitions apply.
3.1. Climacteric syndrome
A series of symptoms of vegetative nervous system dysfunction with neuropsychological symptoms, which is due to the decreasing function of ovary in premenopausal and postmenopausal female patients
Note: Also known as “perimenopausal syndrome”, “menopausal syndrome”. Traditional Chinese medicine calls it “postmenopausal disorders”, also known as “perimenopausal disorders”.
| 4. Diagnosis | | |
4.1. Main point of diagnosis
4.1.1. Medical history
Women aged 40–60 years had menstrual disorders or amenorrhea or had a history of bilateral ovaries function injury caused by surgical removal of bilateral ovaries and other factors.
4.1.2. Symptoms
4.1.2.1. Menstrual changes
Menstrual disorders, such as advanced menstruation, more or less, menostaxis, metrorrhagia, or retarded menstruation, amenorrhea.
4.1.2.2. Vasodilation symptoms
Fever and sweating, dizziness, palpitation, etc.
4.1.2.3. Psychiatric and neurological symptoms
Dysphoria and irritability, depression, insomnia and dreaminess, amnesia, and suspiciousness.
4.1.2.4. Urogenital system symptoms
Urinary frequency and urgency or urinary incontinence, vaginal dryness, burning, pruritus vulvae, pain of sexual intercourse, prone to recurrent cystitis in postmenopause.
4.1.2.5. Skin symptoms
Dry skin, itching, paresthesia, or sense like ants crawling around.
4.1.2.6. Bone and joint muscular symptoms
Muscle and joint pain, low back pain, heel pain, prone to fracture, etc., in postmenopause.
4.1.3. Signs
Gynecologic examination showed atrophy of vulva and vagina, decrease of vaginal secretion, disappearance of vaginal folds, and atrophy of cervix and uterus in postmenopause.
4.1.4. Accessory examination
4.1.4.1. Vaginal cytological smear
Vaginal exfoliated cells mainly consist of basal and middle layers.
4.1.4.2. Reproductive and endocrine hormones determination
Serum FSH > 10 U/L during menopause suggests decreased ovarian reserve function. Amenorrhea, FSH > 40 U/L, and E2 < 10 ~ 20 pg/ml suggested ovarian failure.
4.2. Differential diagnosis
4.2.1. Hypertension
Diastolic and systolic blood pressure increased continuously (>140/90 mmHg), often accompanied by heart, brain, kidney, and other organ lesions. The blood pressure of patients with climacteric syndrome was unstable and fluctuated.
4.2.2. Coronary artery heart disease
Abnormal electrocardiogram and symptoms of front part of chest pain can be alleviated by taking nitroglycerin, while taking nitroglycerin is ineffective in climacteric syndrome patients with chest tightness and chest pain.
4.2.3. Hyperthyroidism
Serum TSH decreases and FT4 increases in patients with hyperthyroidism, while thyroid function is normal in patients with climacteric syndrome.
4.2.4. Climacteric psychosis
Climacteric psychosis patients have neuropsychiatric symptoms as the main clinical manifestations, while neuropsychiatric symptoms are more serious for climacteric psychosis patients than those with climacteric syndrome.
| 5. Syndrome Differentiation | | |
5.1. Main point of syndrome differentiation
Climacteric syndrome is based on kidney deficiency, which often affects heart, liver, spleen, and other Zang-Fu viscera. The syndrome differentiation should pay attention to the accompanied symptoms of fluid dampness, phlegm turbidity, and static blood.
5.2. Syndrome
5.2.1. Syndrome of yin deficiency of liver and kidney
For premenopausal and postmenopausal female patients, menstrual disorders, premature menstruation, more or less, bright red menstruation; fever and sweating, dizziness and tinnitus, dry eye, dysphoria with feverish sensation in chest, dry mouth and throat, insomnia and dreaminess, amnesia, soreness and pain of waist and knees, pudendal dryness, or dry skin, itching and abnormal sensation, yellow urine and constipation, red tongue, little coating, thin and fast pulse.
5.2.2. Syndrome of kidney deficiency of liver depression
For premenopausal and postmenopausal female patients, menstrual disorders, fever and sweating, depression, oppression in chest and sigh, dysphoria and irritability, sleep disturbance, dry stool with runny stool; red tongue, thin white or yellow coating, sunken and taut pulse, or thin and taut pulse.
5.2.3. Syndrome of disharmony between heart and kidney
For premenopausal and postmenopausal female patients, menstrual disorders, fever and sweating; palpitation and severe palpitation, upset, insomnia and amnesia, dreaminess and fright, weakness of waist and knees, distractions, slow thought; red tongue, little coating, thin pulse, or thin and fast pulse.
5.2.4. Syndrome of deficiency of both yin and yang of kidney
For premenopausal and postmenopausal female patients, menstrual disorders, menstrual color is dark or reddish, sometimes hot, sometimes fear of cold; spontaneous sweating, night sweating, dizziness and tinnitus, insomnia and amnesia, cold and pain of waist and back, heel pain, edema and loose stool, frequent micturition; pale tongue, white coating, sunken, thin and feeble false.
| 6. Treatment | | |
6.1. Therapeutic principles
Regulate yin and yang in kidney.
6.2. Treatment based on syndrome differentiation
6.2.1. Syndrome of yin deficiency of liver and kidney
Treatment method: Nourishing liver and kidney, nourishing yin for suppressing hyperactive yang.
Main prescription: Qiju Dihuang Pills (Yi Ji) to remove Alismatis Rhizoma
Lycii fructus, Chrysanthemi flos, Rehmanniae radix praeparata, Dioscoreae rhizoma, Corni fructus, Moutan cortex, Poria, Alismatis rhizoma.
6.2.2. Syndrome of kidney deficiency of liver depression
Treatment method: Nourishing kidney yin, dispersing stagnated liver qi for relieving qi stagnation.
Main prescription: Yiguan decoction (Xu Mingyi Lei'an)
Rehmanniae radix, Glehniae radix, Ophiopogonis radix, Angelicae sinensis radix, Lycii fructus, Toosendan fructus.
6.2.3. Syndrome of disharmony between heart and kidney
Treatment method: Nourishing yin for lowering fire, nourishing kidney, and tranquilizing the mind
Main prescription: Tianwang Buxin Pills (Shesheng Mipo) to remove Ginseng Radix Et Rhizoma, Cinnabaris and to plus Pseudostellariae Radix, Mori Fructus.
Scrophulariae Radix, Angelicae Sinensis Radix, Asparagi Radix, Salviae Miltiorrhizae Radix Et Rhizoma, Poria, Schisandrae Chinensis Fructus, Polygalae Radix, Platycodonis Radix, Ziziphi Spinosae Semen, Rehmanniae Radix, Platycladi Semen, Pseudostellariae Radix, Mori Fructus.
6.2.4. Syndrome of deficiency of both yin and yang of kidney
Treatment method: Invigorating the kidney, strengthening thoroughfare and conception channels.
Main prescription: Erxian Decoction (Clinical Manual of Chinese Medicine Prescription) and Erzhi Pills (Yifang Jijie)
Curculiginis rhizoma, Epimedii folium, Morindae officinalis radix, Phellodendri chinensis cortex, Anemarrhenae rhizoma, Angelicae sinensis radix; Ligustri lucidi fructus, Ecliptae herba.
6.3. Chinese patent medicine
Gengnian'an Tablets: Suitable for syndrome of endogenous heat due to yin deficiency.
Liuwei Dihuang Pills: Suitable for syndrome of kidney yin deficiency.
Qiju Dihuang Pills: Suitable for syndrome of liver–kidney yin deficiency.
Kunbao Pills: Suitable for syndrome of liver–kidney yin deficiency.
Kuntai Capsule: Suitable for syndrome of disharmony between heart and kidney.
Longfeng Bao Capsule: Suitable for syndrome of kidney yang deficiency.
Nvzhen Granules: Suitable for syndrome of liver–kidney yin deficiency and syndrome of exuberant fire of heart–liver.
6.4. Acupuncture and moxibustion therapy
Selection of acupoints Taixi, Taichung, Guanyuan, Shenmen, Sanyinjiao, Xinyu, Shenyu, Ganyu, etc., Even reinforcing-reducing method.
| Annex A | | |
(Normative Appendix)
| Menopause-Related Staging Definition | | |
The World Health Organization Special Program Committee on Human Reproduction recommended the use of premenopause, menopause, postmenopause, menopause transition, perimenopause, and other terms related to menopause at the meeting on the progress of Research on Menopause in the 1990s held in Geneva in 1994.
| 1. Premenopause | | |
The period during which the ovaries are active, including the period from puberty through menopause, namely the period before the last menstrual period.
| 2. Menopause Transition | | |
The period that ovarian function begins to decline until the last menstrual period, namely a period of significant change from the menstrual cycle to premenopause.
| 3. Menopause | | |
It refers to a woman's last period. During menopause, ovarian function really fails and menstruation stops.
| 4. Menopause Transition | | |
That is the transition from menopause to 1 year after menopause. It refers to a period of time before and after menopause, including clinical features, endocrine and biological began to appear menopause trend (that is, ovarian function began to decline) to the last menstrual period within 1 year.
| 5. Postmenopause | | |
After the last menstrual period until the end of life in this period.
In 1999, International Menopause Society recommended that the names of climacteric and climacteric syndrome be retained.
| Bibliography | | |
- WFCMS. SCM 0008-2011 International TCM Physicians Classification Standard of Professional and Technical Titles. People's Medical Publishing House; 2011.
- Xiao CC. TCM Gynecology Clinical Research. Beijing: People's Medical Publishing House; 2009:123-130.
- Xie X, Kong BH, Duan T. Obstetrics and Gynecology. 9th ed. Beijing:People's Medical Publishing House; 2018:353-356.
- Liu YF, Xiao CC, Wang TF, Zhang LH, Ding KJ. Menopause syndrome of traditional Chinese medicine drug characteristics, symptoms and syndrome type distribution of modern literature analysis. J Beijing Univ Chin Med 2008;31:125-30.
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