Menopausal Hot Flushes and Insomnia: Natural Alternatives When Hormone Therapy Is Not Suitable

Menopause often referred to in Traditional Chinese Medicine (TCM) as "symptoms appearing before and after age changes", describes a series of somatic and psycho-emotional symptoms caused by the fluctuation or decline of hormones during this transitional period. Its clinical symptoms primarily manifest as palpitations and insomnia, dizziness and tinnitus, hot flushes and sweating, vexation and irritability, or depression and forgetfulness, tidal fever, general body aches, and oedema of the limbs.

The Su Wen (The Basic Questions), in the chapter ‘Treatise on the Innocence of Antiquity’, records that for a woman, at the age of "seven times seven" [49 years], the Ren meridian becomes deficient, the Taichong meridian depletes and weakens, the Tiankui [menstrual essence] is exhausted, and the earth passage is blocked; hence the body declines and she can no longer bear children. Furthermore, the Jin Gui Yao Lue (Synopsis of the Golden Chamber), in the chapter ‘Pulse Patterns and Treatment of Women’s Miscellaneous Diseases’, notes that women with visceral agitation (Zang Zao) are prone to grief and a desire to weep. Among these manifold symptoms, insomnia is the most prominent and common presentation. The underlying cause is that throughout a woman’s life, she undergoes menstruation, pregnancy, childbirth, and breastfeeding, repeatedly injuring Yin and Blood, leaving her easily in a state of "constant Yin insufficiency". Regarding this, the Su Wen chapter ‘Major Treatise on Yin-Yang and Corresponding Manifestations’ states: "At the age of forty, the Yin Qi is halved, and daily activity declines."

The Kidney is the foundation of the congenital constitution, governing the storage of Essence, as well as growth, development, and reproduction. At the age of seven times seven, as Kidney Essence and Kidney Qi decline, the Chong and Ren meridians become deficient and damaged, and the Tiankui gradually dries up. Women take Blood as their foundation; the Liver governs the storage of Blood, while the Kidney governs the storage of Essence, and Essence and Blood mutually generate one another. Therefore, the decline of Kidney Essence inevitably leads to a deficiency of Liver Blood. With Yin deficiency internally and mental exertion externally, compounded by the hidden consumption of Nutritive Blood, the Zang-Fu organs lose their nourishment and deficiency-heat disturbs the interior, manifesting as menopausal insomnia.

Treatment Principles: Nourishing Yin to Submerge Yang, Calming the Heart to Soothe the Spirit

Based on the understanding of the aetiology and pathogenesis of menopausal insomnia, the fundamental principle of "nourishing Yin to submerge Yang, and calming the Heart to soothe the Spirit" is consistently applied throughout the acupuncture treatment process. The basic therapeutic aim is to guide the imbalanced Yin, Yang, Qi, and Blood towards equilibrium. Point selection focuses primarily on the Back-Shu points, combined with key points for treating the brain and the Spirit (Shen), modified according to specific symptoms.

Acupuncture points selections

Practitioners commonly select Ganshu, Shenshu, Dazhui, Fengchi, Shenmen, Neiguan, and Sanyinjiao. Back-Shu points are specific sites where the Qi of the Zang-Fu organs infuses into the back; they are closely related to the internal organs and possess the function of directly regulating organ function. Since this condition arises from a deficiency of Liver and Kidney Essence-Blood leading to deficient Yang disturbing the Spirit upwards—causing restlessness and an inability to sleep, selecting the Back-Shu points of the Liver and Kidney (Ganshu and Shenshu) can tonify the Liver and Kidney, nourish Yin to submerge Yang, and stabilise the mind and will. Dazhui, a point on the Governor Vessel, can diffuse Yang and drain heat, unblock the Governor Vessel to sedate, and balance Yin and Yang, thereby quieting the Spirit. Fengchi is a point on the Gallbladder Meridian of Foot-Shaoyang, located behind the brain; it can clear and benefit the head and eyes, and wake the brain to improve mental acuity. Sanyinjiao is the intersection point of the three Yin meridians of the foot; it can nourish the Liver and Kidney and strengthen the Spleen to generate Blood. The Su Wen chapter ‘Treatise on the Secret Canon of the Spiritual Orchid’ states: "The Heart is the official functioning as the monarch, from whom the Spirit originates." Therefore, by using the Yuan-Source point of the Heart Meridian (Shenmen) and the Luo-Connecting point of the Pericardium Meridian (Neiguan) together, one achieves the combined effect of clearing Heart-fire and soothing the Spirit.

Add-on acupuncture points

The aetiology and pathogenesis of menopausal insomnia are relatively complex, with numerous accompanying symptoms. In addition to the main points, acupoints should be added or subtracted based on the patient’s specific presentation. For dizziness and headache, Taiyang and Baihui are added to clear the head and eyes, strengthen the brain, and calm the Spirit. For hot flushes and sweating, Hegu and Fuliu are combined to support the Upright Qi, expel pathogens, consolidate the Wei-defence, and astringe Yin. For agitation and irritability, Yanglingquan and Taichong are used to course the Liver and rectify Qi, guiding fire downwards. For timidity, palpitations, and being easily startled, Xinshu and Danshu are added to strengthen the Heart and Gallbladder and stabilise the Spirit and will. For physical weakness, gastric weakness, abdominal distension, and poor appetite, Zusanli is selected to fortify the Spleen and harmonise the Stomach, dissolving food stagnation.

As early as the Ling Shu chapter on ‘Nine Needles and Twelve Yuan-Source Points’, it is stated: "In the use of acupuncture... if deficient, tonify it; if excess, drain it." Addressing the pathogenesis of menopausal insomnia, the main prescription employs specific techniques: Ganshu, Shenshu, and Sanyinjiao are treated with the tonifying method; Dazhui and Fengchi with the draining method; and Shenmen and Neiguan with the even method (balancing tonification and draining). Manipulation for other acupoints follows the principle of tonifying deficiency or draining excess as required by the condition. Appropriately selecting the needle manipulation according to therapeutic needs can accelerate and enhance the effects of tonification or sedation, thereby stimulating the body’s self-regulating mechanisms to improve clinical efficacy.

Combination of Treatment and Lifestyle Care

Patients should strive to maintain a cheerful and relaxed mental state, avoiding the stimulation of adverse emotions such as excessive excitement, depression, or anxiety, and approach sleep with a relaxed mindset. It is important to maintain a regular daily routine, avoid being overly hungry or overly full, refrain from drinking coffee or tea, keep the bedroom environment quiet, and place emphasis on physical exercise.