CLINICAL APPLICATIONS

* Atrophic vaginitis or vulvovaginitis with vaginal dryness, itching, and burning sensations

* Vaginal dryness and atrophy due to hormonal irregularity, estrogen deficiency, or menopause

* Painful intercourse due to vaginal dryness and atrophy, or insufficient vaginal lubrication

 

WESTERN THERAPEUTIC ACTIONS

* Regulates and restores hormone balance

* Promotes health of soft tissues

* Phytoestrogen activity to treat vaginal dryness

* Phytoestrogen activity to treat irregular menstruation, menstrual pain, amenorrhea, and osteoporosis

 

CHINESE THERAPEUTIC ACTIONS

* Nourishes the blood to soften the Liver

* Strengthens the Spleen

* Tonifies Kidney yin and jing (essence)

* Moves blood to the lower jiao

 

DOSAGE

Take 3 to 4 capsules three times daily. Dosage can be increased up to 6 to 8 capsules three times daily. Most women see improvement within one to two months. Dosage then can be reduced to 1 to 2 capsules once or twice a day for maintenance.

 

INGREDIENTS

Bai Shao (Radix Paeoniae Alba)

Bai Zhu (Rhizoma Atractylodis Macrocephalae)

Chuan Xiong (Rhizoma Chuanxiong)

Dang Gui (Radix Angelicae Sinensis)

Fu Ling (Poria)

Shan Yao (Rhizoma Dioscoreae)

Wang Bu Liu Xing (Semen Vaccariae)

Ze Xie (Rhizoma Alismatis)

 

BACKGROUND

Vaginal dryness and atrophy is a common condition that affects approximately 40% of perimenopausal women and 55% of postmenopausal women. While most menopause symptoms such as hot flashes and night sweats last only for a few years, symptoms of vaginal dryness and atrophy often persist for decades after menopause. As the production of estrogen decreases with menopause, local genital tissues become dry and thin, which in turn leads to vaginal atrophy or atrophic vaginitis (inflammation of the mucosa). Vaginal dryness and atrophy is usually associated with symptoms of itching, discomfort, decreased elasticity of local tissues, painful intercourse, and increased risk of injury and infection with intercourse. In addition, vaginal dryness and atrophy will also affect urinary functions, causing symptoms such as irritation, dyspareunia, and dysuria. Lastly, vaginal dryness and atrophy presents physical as well as emotional challenges, as pain, injuries, and infections associated with intercourse discourage sexual activities and may cause a strain on personal relationships. In summary, this condition greatly affects the quality of life for women, and is a medical condition that requires effective treatment.

 

FORMULA EXPLANATION

In traditional Chinese medicine (TCM), menstruation begins after the 2^nd cycle of a woman’s life (14 years of age) and ends after the 7^th cycle (49 years of age), as each cycle is seven years. This occurs as Tian Kui (天癸), the substance that governs growth, maturation, and reproduction, gradually becomes depleted until menstruation stops and the uterus is no longer nourished by the blood. Other substances in the body also decline during this time, particularly the Kidney yin, yang, and jing (essence). Related symptoms may include hot flashes, irritability, night sweats, insomnia, vaginal thinning, and dryness.

        Balance Spring is an anti-aging formula designed to increase vaginal fluids by tonifying Kidney yin and jing (essence). By restoring the body’s own ability to provide lubrication naturally, Balance Spring offers a safe and effective solution to treat vaginal dryness and atrophy on a long-term basis.

        Dang Gui (Radix Angelicae Sinensis) tonifies the blood and activates blood circulation to the reproductive organs. This is the chief herb for any gynecological disorder and one of the best herbs to balance women’s hormones. Bai Shao (Radix Paeoniae Alba) nourishes the blood and consolidates yin. Shan Yao (Rhizoma Dioscoreae) tonifies Kidney yin. Bai Zhu (Rhizoma Atractylodis Macrocephalae) and Fu Ling (Poria) strengthen the Spleen so the body can extract, absorb, and utilize nutrients from the foods. Fu Ling (Poria) and Ze Xie (Rhizoma Alismatis) strengthen the Spleen and dispel water retention. Also, by tonifying the Spleen, it can in turn help produce more blood. Chuan Xiong (Rhizoma Chuanxiong) activates and regulates blood circulation. It also helps Dang Gui (Radix Angelicae Sinensis) regulate hormones. Wang Bu Liu Xing (Semen Vaccariae) activates blood circulation, opens channels, and has a uterine stimulant effect. Both of these herbs also serve as channel-guiding herbs to the Liver and the lower abdomen where more blood flow means better delivery of nutrients and tonics to the affected area.

        In summary, Balance Spring effectively treats vaginal dryness, atrophy, and many other menopausal symptoms by tonifying Kidney yin, yang, and jing (essence), nourishing blood, and improving blood circulation.

 

CAUTIONS & CONTRAINDICATIONS

* Because this formula aims to regulate women’s own ability to produce estrogen, menstruation may briefly return for some individuals in premenopausal or perimenopausal states. They should not be alarmed as this is part of the antiaging effect of this formula. However, if the patient notices abnormal or irregular bleeding, discontinue use and refer to a medical doctor for further testing.

* This formula is not recommended for lack of vaginal secretion due to radiation therapy, chemotherapy, and immunologic disorders.

* This herbal formula contains herbs that invigorate blood circulation, such as Dang Gui (Radix Angelicae Sinensis). Therefore, patients who are on anticoagulant or antiplatelet therapies, such as Coumadin (warfarin), should use this formula with caution, or not at all, as there may be a higher risk of bleeding and bruising.[1]^,[2],[3]

* The safety status of using Dang Gui (Radix Angelicae Sinensis) in individuals with hormone-dependent cancer is unclear.[4]^,[5],[6] According to one reference, use of Dang Gui (Radix Angelicae Sinensis) is not associated with thickening of the endometrium or vaginal cell maturation, both of which would indicate an estrogenic effect. Furthermore, there is no confirmation of the presence of a phytoestrogen component or effect on hormone-dependent cancer when ferulic acid is evaluated as the main component of Dang Gui (Radix Angelicae Sinensis).[7] According to another reference, the water extract of Dang Gui (Radix Angelicae Sinensis) has a weak estrogen-agonistic activity to stimulate the growth of breast cancer cells (MCF-7).[8] In summary, due to conflicting and insufficient data, use of Dang Gui (Radix Angelicae Sinensis) in patients with hormone-dependent cancer warrants caution pending further study.

 

CLINICAL NOTES

* In contrast with hormone replacement therapy, use of yam, such as Shan Yao (Rhizoma Dioscoreae) in this formula, is not only effective to treat menopause symptoms, but also safe in regards to risks of cancer and cardiovascular diseases. In one study, the extract of yam has been shown to act as a weak phytoestrogen and to protect against proliferation in human breast cancer (MCF-7) cells.[9] In another study, use of yam was found to reduce the risk of breast cancer and cardiovascular diseases in postmenopausal women.[10]

* Women with infection or inflammation of the urogenital regions should be properly treated first, prior to taking this formula.

* Normal vaginal secretion may briefly return after taking the herbs, and if so, patients are encouraged to participate in normal sexual activity as it invigorates and stimulates the Kidney jing (essence), which in turn has a positive effect on all the systems in the body.

 

Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:

* Small pulse, a thin and weak pulse, on the left chi

 

SUPPLEMENTARY FORMULAS

* With hot flashes and night sweats, add Balance (Heat) and/or Nourish.

* With vaginal or urinary tract infection and inflammation, add V-Support.

* With Kidney yin deficiency, add Nourish or Kidney Tonic (Yin).

* With Kidney yang deficiency or low libido, add Vitality or Kidney Tonic (Yang).

* With irritability and emotional swings, add Calm.

* With osteoporosis, add Osteo 8.

* With dry, brittle hair, add Polygonum 14.

* With insomnia, add Schisandra ZZZ.

* With forgetfulness, add Enhance Memory.

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Ququan (LR 8), Taixi (KI 3), Sanyinjiao (SP 6)

* Xingjian (LR 2), Fuliu (KI 7), Chize (LU 5), Lianquan (CV 23), Shenshu (BL 23)

 

Classic Master Tung's Points:

* General: Tianhuang (T 77.17), Dihuang (T 77.19), Renhuang (T 77.21), Tianhuang (T 88.13), Minghuang (T 88.12), Qihuang (T 88.14), Shuijin (T 1010.20), Zhenjing (T 1010.08), Xinling (T 33.17)*, Simashang (T 88.18), Simazhong (T 88.17), Simaxia (T 88.19)

* Vaginitis: Fuke (T 11.24), Huanchao (T 11.06), Jiemeiyi (T 88.04), Jiemeier (T 88.05), Jiemeisan (T 88.06), Libai (T 44.12), Yunbai (T 44.11), Jianzhong (T 44.06), Haibao (T 66.01), Renzong (T 44.08), Dizong (T 44.09), Tianzong (T 44.10). Bleed tender points on the sacral region with cupping. Bleed before needling for best result.

* Painful intercourse: Fuke (T 11.24), Tianhuang (T 77.17), Dihuang (T 77.19), Renhuang (T 77.21), Tianhuang (T 88.13), Minghuang (T 88.12), Qihuang (T 88.14)

 

Master Tung’s Points by Dr. Chuan-Min Wang:

* Vaginal dryness: Tianzong (T 44.10), Yunbai (T 44.11)

 

Balance Method by Dr. Richard Tan:

* Left side: Zusanli (ST 36), Lieque (LU 7)

* Right side: Hegu (LI 4), Yinlingquan (SP 9), Lougu (SP 7) or ah shi points nearby, Sanyinjiao (SP 6)

* Left and right sides can be alternated from treatment to treatment.

 

Ear Acupuncture:

* Uterus, Ovary, Endocrine, Shenmen, Subcortex, Sympathetic

 

Auricular Medicine by Dr. Li-Chun Huang:

* Uterus, Endocrine, Ovary, Pituitary, Sympathetic, Anxious, Gonadotropin

* Supplementary points: Kidney, Liver, Heart

 

NUTRITION

* Increase the intake of soy and red clover, which have estrogen-like properties (phytoestrogens). They are helpful for certain menopausal symptoms, including vaginal atrophy.

* Vitamin D helps with many conditions associated with menopause, including vaginal dryness and osteoporosis. Foods rich in vitamin D include fortified milk, breakfast cereals, and other fortified foods and supplements.

* Increase intake of nourishing, cooling foods, such as Mexican yams, wild yams, radishes, potatoes, carrots, melons, cucumbers, beets, turnips, malanga, celeriac, taro, and rutabaga.

* Avoid spicy foods, alcohol, and processed and deep-fried foods.

* Avoid spicy, pungent, and aromatic vegetables, such as pepper, garlic, onions, basil, rosemary, cumin, fennel, anise, leeks, chives, scallions, thyme, saffron, wormwood, mustard, chili pepper, and wasabi.

* Avoid alcohol, coffee, and any drinks that have a stimulant effect.

 

The Tao of Nutrition by Dr. Maoshing Ni and Cathy McNease:

* Increase the intake of black beans, sesame seeds, soybeans, walnuts, goji berries, mulberries, yams, licorice, Chinese black dates, lotus seeds, chrysanthemum flowers.

* Cook black beans with rice into porridge. Eat twice daily.

* Roast sesame seeds and add to rice porridge for breakfast.

* Steam chicken with goji berries and yam.

* Take walnuts, lotus seeds, and sunflower seeds and make porridge with rice.

* Stew millet, mulberries, lamb, and goji berries.

* Make tea from chrysanthemum and cassia seeds and drink three times daily.

* Make tea from licorice, Chinese black dates, and wheat. This will help to alleviate extreme mood swings and depression.

 

LIFESTYLE INSTRUCTIONS

* Avoid stress or tension if possible.

* Avoid scented soaps, lotions, perfumes or douches in the genital area to prevent irritation or possible infection.

* Adequate sleep of seven to eight hours daily starting before 10:00 p.m. is recommended.

* Engage in at least 30 minutes of daily mild exercises like tai chi chuan * tai ji quan], yoga, walking, or stretching.

* Regular sexual activity enhances blood flow to the vagina, which helps keep vaginal tissues healthy and decrease problems with vaginal atrophy.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Vaginal dryness and atrophy is a common condition that affects perimenopausal women and postmenopausal women. With decreased production of estrogen, vaginal and vulvar tissues become thin and dry, leading to vaginal atrophy or atrophic vaginitis (inflammation of the mucosa). Clinical manifestations include itching, discomfort, decreased elasticity of local tissues, painful intercourse, and increased risks of injury and infection with intercourse. As these symptoms can persist for decades after menopause, treatment is absolutely essential to maintain and improve quality of life. To effectively treat vaginal dryness and atrophy, Balance Spring uses herbs with marked effects to regulate and restore hormone balance and promote health of the soft tissues.

        Wild yam (Dioscorea spp., including Dioscorea alata, Dioscorea japonica, Dioscorea villosa and Dioscorea opposita) has been used as a “natural alternative” to estrogen therapy throughout the world. Diosgenin, the main active compound in wild yam, has been shown to have estrogen-like activity, and can be used to treat vaginal dryness, night sweats, hot flashes, and other symptoms associated with menopause.[11] In one study, the ethyl acetate extracts of various types of yam were found to activate estrogen receptors alpha and beta to various extents, thus providing basic evidence for the beneficial effect of yam for menopausal women.[12] According to another study in 24 postmenopausal women, daily ingestion of yam as food for 30 days was associated with an estrogenic effect. There were significant increases in serum concentrations of estrone (26%), sex hormone binding globulin (SHBG) (9.5%), and near significant increase in estradiol (27%). However, no significant changes were observed in serum concentrations of dehydroepiandrosterone sulfate, androstenedione, testosterone, follicular stimulating hormone, and luteinizing hormone.[13]

        In addition to yam, Balance Spring contains other herbs to regulate and restore hormone balance. The extracts of Wang Bu Liu Xing (Semen Vaccariae) have an estrogen-like activity,[14] and can be used to treat conditions such as irregular menstruation, menstrual pain, amenorrhea, and osteoporosis. In fact, the therapeutic benefits of Wang Bu Liu Xing (Semen Vaccariae) are comparable to 17beta-estradiol.[15] Specifically, segetalins G and H, cyclic peptides from Wang Bu Liu Xing (Semen Vaccariae), are compounds with estrogen-like activity.[16] In addition, administration of Chuan Xiong (Rhizoma Chuanxiong) is associated with progestogenic activity in vivo, and may have utility for progesterone-replacement therapy.[17] Lastly, according to a placebo-controlled experiment on 55 postmenopausal women who complained of hot flashes and refused hormonal therapy, use of a preparation with Dang Gui (Radix Angelicae Sinensis) showed decrease in number and intensity of hot flashes from baseline to completion of treatment (90-96% vs 15-25%, p < 0.001), when compared to placebo. In addition, there was also a marked alleviation of sleep disturbances and fatigue, and no apparent major adverse effects were noted. The researchers concluded that the herb treatment may be used as an important modality for menopausal women with contraindications for hormone replacement therapy.[18]

        Balance Spring utilizes many herbs with marked influences over soft tissues. Chuan Xiong (Rhizoma Chuanxiong) has a significant effect to promote blood circulation throughout the body to facilitate general healing.[19],[20] Chuan Xiong (Rhizoma Chuanxiong) also has marked influences to relax the smooth muscles.[21] In addition, Dang Gui (Radix Angelicae Sinensis) is an excellent herb to promote wound healing.[22] It has been shown to facilitate skin repair and regeneration by increasing type I collagen production in human dermal fibroblasts.[23] Lastly, in cases of injuries, use of Chuan Xiong (Rhizoma Chuanxiong) has been shown to suppress hypertrophic scarring.[24] Overall, these herbs all contribute to the health and healing of tissues throughout the body.

        In summary, Balance Spring is a great formula to treat vaginal dryness and atrophy associated with perimenopausal and postmenopausal women. It contains herbs with marked effects to regulate and restore hormone balance and promote health of the soft tissues.

 

COMPARATIVE ANALYSIS

Vaginal dryness and atrophy is a painful condition that affects the physical and emotional health of women during perimenopausal and postmenopausal time periods. Unlike most other menopause symptoms, such as hot flashes and night sweats, which last only for a few months to years, vaginal dryness and atrophy generally persists for decades after menopause. Therefore, treatment is essential to improve quality of life.

        In Western medicine, hormone replacement therapy (HRT) is long considered the standard treatment for menopause and its related conditions. However, there is no longer a consensus as to when and how to use these drugs. While these drugs may alleviate hot flashes and vaginal dryness, they significantly increase the risk of breast cancer, ovarian cancer, uterine cancer, stroke, heart attack, and have a number of significant side effects. For most physicians and patients, the risks are simply far greater than the potential benefits. The bottom line: synthetic hormones can never replace endogenous hormones. Therefore, no matter how or when they are prescribed, the potential for adverse reactions is always present.

        Traditional Chinese medicine offers a gentle yet effective way to address menopause and its related conditions. Chinese herbs have demonstrated via numerous in vivo and in vitro studies to have marked effects to alleviate vaginal dryness and atrophy, hot flashes, vasomotor instability, loss of bone mass, and other conditions associated with menopause. Most importantly, they are much gentler and safer on the body.

        Menopause is simply a transition in the journey of life. It is not a disease, and therefore, should not be treated with synthetic drugs that pose significant risks of cancer and other side effects. Herbs should be considered the primary option, and not the secondary alternative, as they are safe and natural, and more than sufficient to address almost all cases of menopause.