CLINICAL APPLICATIONS

* Amenorrhea

* Polycystic ovarian syndrome (PCOS)

* Infertility 

* Irregular, delayed or scanty menstruation 

* Period with dark blood or clots

* Conditions above should be accompanied by dark purple tongue and cold signs and symptoms

 

WESTERN THERAPEUTIC ACTIONS

* Restores normal menstruation by removing physical obstructions

* Restores normal menstruation by regulating the hormones

* Relieves pain

 

CHINESE THERAPEUTIC ACTIONS

* Warms the ming men (life gate) fire, tonifies Kidney yang

* Nourishes the womb and the chong (thoroughfare) and ren (conception) channels

* Invigorates blood circulation in the lower jiao and the womb

* Tonifies Liver blood

* Tonifies yuan (source) qi

 

DOSAGE

Take 3 to 4 capsules three times daily on an empty stomach with warm water. Dosage may be increased to 6 to 8 capsules three times daily, if necessary. The minimum period for treatment with this formula is one to three months. For treatment of infertility, advise the patients to stop taking the herbs immediately once pregnancy is confirmed.

 

INGREDIENTS

Bai Shao (Radix Paeoniae Alba)

Chai Hu (Radix Bupleuri)

Chi Shao (Radix Paeoniae Rubrae)

Chuan Niu Xi (Radix Cyathulae)

Chuan Xiong (Rhizoma Chuanxiong)

Dang Gui (Radix Angelicae Sinensis)

Di Huang (Radix Rehmanniae)

Fu Ling (Poria)

Fu Zi (Radix Aconiti Lateralis Praeparata)

Gan Cao (Radix et Rhizoma Glycyrrhizae)

Gan Jiang (Rhizoma Zingiberis)

Gui Zhi (Ramulus Cinnamomi)

Hong Hua (Flos Carthami)

Mai Dong (Radix Ophiopogonis)

Mo Yao (Myrrha)

Mu Dan Pi (Cortex Moutan)

Pu Huang (Pollen Typhae)

Ren Shen (Radix et Rhizoma Ginseng)

Rou Gui (Cortex Cinnamomi)

Shan Yao (Rhizoma Dioscoreae)

Shan Zhu Yu (Fructus Corni)

Sheng Jiang (Rhizoma Zingiberis Recens)

Shu Di Huang (Radix Rehmanniae Praeparata)

Tao Ren (Semen Persicae)

Wu Zhu Yu (Fructus Evodiae)

Xiao Hui Xiang (Fructus Foeniculi)

Yan Hu Suo (Rhizoma Corydalis)

Ze Xie (Rhizoma Alismatis)

Zhi Qiao (Fructus Aurantii)

 

BACKGROUND

Amenorrhea, polycystic ovarian syndrome (PCOS), infertility, and irregular or scanty menstruation are common menstrual abnormalities. Though the disease names and the exact etiologies differ in Western medicine, these disorders all share in common hormonal imbalances and menstrual dysfunction. From perspectives of traditional Chinese medicine, such conditions are often diagnosed as patterns of ¡§Kidney yang deficiency and blood stagnation.¡¨

 

FORMULA EXPLANATION

Menatrol is designed to treat amenorrhea and other gynecological disorders with underlying Kidney yang deficiency and blood stagnation. In addition, Menatrol also addresses such conditions as irregular menstrual cycles, delayed menstruation, spotting or scanty menstruation, weakness and soreness of the low back and knees, coldness of the extremities, accompanied by a pale purplish tongue.

        If the Kidney is deficient, reproductive function will be impaired. This results in symptoms such as amenorrhea, irregular menstruation, vaginal dryness, infertility, decreased libido, habitual miscarriage, hair loss and fatigue. The Kidney also controls the ¡§sea of marrow,¡¨ that is, the brain, where the hypothalamus and pituitary gland are located. Kidney deficiency can be correlated with the inability of the hypothalamus to signal the pituitary gland to release hormones that cause ovaries to release eggs. In other words, the normal menstrual cycle will be disturbed. Therefore, optimal treatment requires use of herbs that tonify Kidney yang, yin, and jing (essence).

        Fu Zi (Radix Aconiti Lateralis Praeparata) and Rou Gui (Cortex Cinnamomi) restore depleted Kidney yang, augment ming men (life gate) fire, and warm and open the channels to treat obstruction due to coldness. Gan Jiang (Rhizoma Zingiberis) enhances the warming action and decreases the toxicity of Fu Zi (Radix Aconiti Lateralis Praeparata). Xiao Hui Xiang (Fructus Foeniculi) and Wu Zhu Yu (Fructus Evodiae) are used to warm the Liver channel where it circulates around the genital organs.

        Chi Shao (Radix Paeoniae Rubrae), Gui Zhi (Ramulus Cinnamomi), Mu Dan Pi (Cortex Moutan), Tao Ren (Semen Persicae), Hong Hua (Flos Carthami), Chuan Niu Xi (Radix Cyathulae), Pu Huang (Pollen Typhae), Mo Yao (Myrrha), Yan Hu Suo (Rhizoma Corydalis) and Chuan Xiong (Rhizoma Chuanxiong) are indispensable herbs for treating any obstetric/gynecologic disorders involving blood stagnation. Together, they invigorate blood circulation, dispel blood stasis, clear blood clots and relieve pain that may be caused by blood stagnation. The use of these herbs follows the same principles as the famous formulas Gui Zhi Fu Ling Wan (Cinnamon Twig and Poria Pill) and Shao Fu Zhu Yu Tang (Drive Out Blood Stasis in the Lower Abdomen Decoction).

        The chong (thoroughfare) channel is known as ¡§the sea of all twelve channels,¡¨ and as ¡§the sea of blood.¡¨ The ren (conception) channel is known as ¡§the sea of all yin channels.¡¨ Therefore, in order to regulate menstruation and treat infertility, the chong (thoroughfare) and ren (conception) channels must be nourished. Dang Gui (Radix Angelicae Sinensis), Bai Shao (Radix Paeoniae Alba) and Shu Di Huang (Radix Rehmanniae Praeparata), the chief ingredients in Si Wu Tang (Four-Substance Decoction), are used to tonify blood. In addition, Shan Zhu Yu (Fructus Corni), Shan Yao (Rhizoma Dioscoreae) and Di Huang (Radix Rehmanniae) tonify Liver blood, replenish Kidney jing (essence) and nourish the chong (thoroughfare) and ren (conception) channels. Other tonic herbs here include Ren Shen (Radix et Rhizoma Ginseng) to tonify the yuan (source) qi, Mai Dong (Radix Ophiopogonis) to nourish yin, and Fu Ling (Poria) to strengthen the Spleen.

        Zhi Qiao (Fructus Aurantii) and Chai Hu (Radix Bupleuri) are used to regulate Liver qi to ensure smooth flow. They are used to enhance the effectiveness of the blood invigorating herbs and also to prevent stagnation that may be caused by the tonic herbs. Sheng Jiang (Rhizoma Zingiberis Recens) and Gan Cao (Radix et Rhizoma Glycyrrhizae) are used to harmonize the formula.

        In conclusion, Menatrol tonifies Kidney yang and eliminates blood stasis to treat amenorrhea and other gynecological disorders.

 

CAUTIONS & CONTRAINDICATIONS

* This formula is contraindicated during pregnancy and nursing.

* This formula is contraindicated in cases of heat and deficiency heat, and in cases of infection or inflammation.

* 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]

* Patients who wear a pacemaker, or individuals who take antiarrhythmic drugs or cardiac glycosides such as Lanoxin (digoxin), should not take this formula. Fu Zi (Radix Aconiti Lateralis Praeparata) may interact with these drugs by affecting the rhythm and potentiating the contractile strength of the heart.[4]

 

CLINICAL NOTES

* Patients can massage the lower abdomen to increase blood circulation and warm the womb. Instruct the patient to fold her hands together [overlapping Laogong (PC 8)] and place her palm on her lower abdomen [at Guanyuan (CV 4)] and massage in a circular motion, moving clockwise 36 times and counterclockwise 36 times. Practice twice daily, once when waking in the morning and once before going to bed at night. Ideally, a male practitioner (yang energy) should massage the patient¡¦s abdomen (influencing yin). During massage of the abdomen, the patient should feel the pressure, but not pain or discomfort.

* Moxa the lower abdomen for at least 30 minutes every night to warm the uterus and dispel stasis.

* Patients with a long history of back pain may need additional diagnostic workups to rule out structural damage to the vertebrae causing amenorrhea, infertility or irregular menstruation.

* Patients with infertility should check to see if chlamydia is the cause. Scarring and inflammation of the tubes may be a cause of blockage leading to infertility.

* Patients experiencing infertility should monitor basal body temperature to track ovulation. If there is no change in the temperature profile after the patient has been taking herbs for two months, the practitioner should re-evaluate and consider modifying or changing the formula to properly address the patient¡¦s condition. If the patient does become pregnant, herbs should be stopped immediately as there are blood-invigorating herbs that may be too strong for the patient. Please refer to Blossom (Phase 1-4) for additional information on female infertility.

* Patients with infertility should not go on strict diets or exercise excessively. They should also be advised not to use a douche.

 

Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:

* Endometriosis, adhesions, ovarian cysts, fibroids: ren pulse, a thin, long, straight, wiry pulse on and proximal to the left chi that is deep to the bone. It is one of the eight extra meridians.

* Polycystic ovaries: turtle pulse, a convex-shaped pulse, on the left chi.

* Blood stasis: dispersing pulse on the left chi.

 

SUPPLEMENTARY FORMULAS

* For female infertility, add Blossom (Phase 1-4).

* For polycystic ovaries, endometriosis or fibroids, combine with Resolve (Lower).

* For severe Kidney yang deficiency, add Kidney Tonic (Yang).

* For severe Kidney yin deficiency, add Kidney Tonic (Yin).

* For lower abdominal pain during the period, use with Mense-Ease.

* For menopause, use with Balance (Heat).

* For fatigue and overall weakness, use with Imperial Tonic.

* For amenorrhea due to stress, tension or Liver qi stagnation, use with Calm.

* For amenorrhea due to Liver fire, use with Gentiana Complex.

* For hyperthyroidism, combine with Thyrodex.

* For severe blood stagnation, add Circulation (SJ).

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Needle Sanyinjiao (SP 6), Geshu (BL 17) and Xuehai (SP 10). Apply moxa to Zusanli (ST 36).

* Qihai (CV 6), Shenque (CV 8), Xiawan (CV 10), Zhongwan (CV 12), Neiguan (PC 6), Gongsun (SP 4), Mingmen (GV 4), Sanyinjiao (SP 6), Dahe (KI 12), Zhongji (CV 3)

 

Classic Master Tung's Points:

* Amenorrhea: Fuke (T 11.24), Jiemeiyi (T 88.04), Jiemeier (T 88.05), Jiemeisan (T 88.06), Tianhuang (T 77.17), Dihuang (T 77.19), Renhuang (T 77.21), Tianhuang (T 88.13), Minghuang (T 88.12), Qihuang (T 88.14)

* Polycystic ovarian syndrome (PCOS): Huanchao (T 11.06), Waisanguan (T 77.27), Yizhong (T 77.05), Erzhong (T 77.06), Sanzhong (T 77.07), Jiemeiyi (T 88.04), Jiemeier (T 88.05), Jiemeisan (T 88.06)

* Infertility (deficiency): Fuke (T 11.24), Huanchao (T 11.06), Tongshen (T 88.09), Tongbei (T 88.11), Tianhuang (T 77.17), Dihuang (T 77.19), Renhuang (T 77.21), Jiemeiyi (T 88.04), Jiemeier (T 88.05), Jiemeisan (T 88.06), Mufu (T 88.38)*, Tianhuang (T 88.13), Minghuang (T 88.12), Qihuang (T 88.14). Moxa the lower abdomen.

* Infertility (damp): Fuke (T 11.24), Huanchao (T 11.06), Jiemeiyi (T 88.04), Jiemeier (T 88.05), Jiemeisan (T 88.06), Mufu (T 88.38)*, Tianhuang (T 77.17), Dihuang (T 77.19), Renhuang (T 77.21), Tianhuang (T 88.13), Minghuang (T 88.12), Qihuang (T 88.14). Bleed dark veins on the sacral area, BL and ST channels on the lower limbs. Bleed before needling for best result.

* Menstruation (scanty): Fuke (T 11.24), Wanshunyi (T 22.08), Wanshuner (T 22.09), Jiemeiyi (T 88.04), Jiemeier (T 88.05), Jiemeisan (T 88.06), Tianhuang (T 77.17), Dihuang (T 77.19), Renhuang (T 77.21), Tianhuang (T 88.13), Minghuang (T 88.12), Qihuang (T 88.14)

* Menstruation (delayed): Linggu (T 22.05), Renhuang (T 77.21), Sihuashang (T 77.08), Menjin (T 66.05). Moxa the sacral area.

* Dysmenorrhea: Fuke (T 11.24), Linggu (T 22.05), Tianhuang (T 77.17), Dihuang (T 77.19), Renhuang (T 77.21), Tianhuang (T 88.13), Minghuang (T 88.12), Qihuang (T 88.14), Simazhong (T 88.17), Sihuashang (T 77.08), Menjin (T 66.05), Sihuashang (T 77.08), Tianshu (ST 25), Zhongji (CV 3)  

 

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

* Amenorrhea, PCOS, infertility: Huanchao (T 11.06), Fuke (T 11.24)

 

Balance Method by Dr. Richard Tan:

* Left side: Yinlingquan (SP 9), Diji (SP 8), Sanyinjiao (SP 6), Hegu (LI 4), Linggu (T 22.05)

* Right side: Zusanli (ST 36) or ah shi points nearby, Chize (LU 5), Kongzui (LU 6) or ah shi points nearby, Diwuhui (GB 42)

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

 

Ear Acupuncture:

* Uterus, Ovaries, Pituitary Gland, Hypothalamus

* Embed steel balls or needles. Switch ears every five days.

 

Auricular Medicine by Dr. Li-Chun Huang:

* Menstrual disorder (menoxenia): Gonadotropin, Uterus, Kidney, Liver, Pituitary, Ovary, Endocrine

* Amenorrhea and hypomenorrhea: Uterus, Ovary, Gonadotropin, Exciting Point, Pituitary Point, Endocrine, Kidney, Liver, Sympathetic, Coronary Vascular Subcortex, Nervous Subcortex

* Dysmenorrhea: Uterus, Pelvic, Liver, Sympathetic, Kidney, Ovary, Endocrine, Pituitary, Lower Jiao

 

NUTRITION

* Eat cooked food and drink warm or room temperature beverages.

* Foods that are warm, such as lamb, beef, chives, cinnamon and pepper are recommended. Nuts and seafood such as oyster, lobster and shrimp should be included, as they tonify the Kidney. Alcohol can be consumed in small amounts (1 oz.) daily, as it invigorates the blood and warms the body.

* Ensure there is an adequate intake of vitamin B complex and vitamin E, which are important for production of sex hormones. Deficiency in zinc may also contribute to irregular menstruation.

* Avoid raw or cold foods such as sushi, salad, cucumber, tomatoes, ice cream, and refrigerated or iced drinks. Excessive intake of fruits also may cause coldness. Refrain from eating sour fruits, such as grapefruit and oranges.

 

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

* Irregular menstruation due to coldness: Stew together lamb, baked tofu, and ginger.

 

LIFESTYLE INSTRUCTIONS

* Avoid sports that may expose the body to cold environment, such as skiing or cold-water sports.

* Stress can sometimes lead to irregular or absence of menstruation. Avoid stressful situations, or engage in stress-reducing activities, whenever possible.

* A regular and healthy lifestyle with adequate rest and relaxation is the basic requirement for a normal menstrual cycle.

* Hot compresses on the abdomen increase blood circulation, relax abdominal muscles, and relieve pain.

 

CASE STUDIES

* A 41-year-old female presented with infertility and depression. Her practitioner diagnosed her as having Kidney deficiency and Liver qi deficiency. Poor egg quality was a secondary explanation to her infertility. The patient¡¦s treatment consisted of acupuncture once a week and Menatrol (4 capsules three times daily). Shortly after the treatment started, the patient¡¦s cold symptoms abated and her menstrual cycle became regular (from 32 days to 28 days). She became pregnant after only two months of treatment. Submitted by L.M., San Diego, California.

* A 15-year-old female student presented with irregular periods for almost two years. Her period interval was noted to be eight days every four months. Tongue body appeared enlarged and purple with the sides slightly more pale. She also had a thick, white tongue coating and a ¡§rolling¡¨ pulse. Her condition was diagnosed as damp stagnation with underlying deficiency. After being treated with Menatrol for two months, the patient started having her menses. Her period interval has changed from eight days every four months to five to seven days every one to one and one-half months. Submitted by T.G., Albuquerque, New Mexico.

* M.C., a 33-year-old female, presented with irregular menstruation for the past five years (about two to three times a year each time lasting four to five days). She complained of cramping pain, fatigue, lower back pain, bloating, poor circulation, dry skin and lips, and brittle nails. Her blood pressure was 139/90 mmHg and her heart rate was 92 beats per minute. Her tongue was slightly dusky, pale to pink in color, moist with a thin white coat. Her pulse was slippery. Her diagnosis was amenorrhea with blood deficiency, blood stagnation, and Spleen qi deficiency with phlegm and damp accumulation. Menatrol was prescribed. The patient¡¦s last period was in early January. After starting Menatrol, she menstruated again the second week of February, which was an exciting and positive sign because she usually menstruates once every five to six months. She will continue taking Menatrol until her cycle becomes regular. She also received weekly acupuncture treatments and began walking three to four times a week. Submitted by J.C., Whittier, California.

* J.W., a 44-year-old patient, presented with infertility and a history of miscarriage. She experienced high stress which she ¡§bottles up¡¨ inside. Her hands and feet were cold. She also had back pain, low energy, severe menstrual cramps and premenstrual syndrome (PMS). Her tongue was pale and purplish, swollen with teeth marks. The tip was red. Pulses were wiry on both sides and slippery on the right. Her blood pressure was 125/86 mmHg and heart rate was 83 beats per minute. Lab report showed she had low FSH levels. The diagnosis was Spleen and Kidney yang deficiencies with Liver qi and blood stagnation. Menatrol was prescribed. After one month on Menatrol, the patient reported her menstrual cramping ¡§miraculously disappeared¡¨ and her estrogen levels increased dramatically. She was afraid the herbs would interfere with her in vitro fertilization (IVF) procedure so she stopped taking them for six weeks. After the IVF was not successful and her tongue color became very purple in the center, the practitioner suggested she take the formula Calm. She was open to it. Within a week, her stress level decreased and her energy level increased. Her tongue color changed from purple to pink and slightly dusky. She is presently continuing to take Calm and is actively trying to conceive naturally. Submitted by J.C.O., Whittier, California.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Amenorrhea is defined as the absence or abnormal stoppage of the menses.[5] Other than pre-puberty, pregnancy, early lactation, and after menopause, amenorrhea is considered a pathologic condition and must be addressed.[6] Etiologies of amenorrhea include anatomical obstruction (such as stagnant accumulation of menstrual blood) and physiological abnormality (such as hormonal imbalance).[7] Therefore, optimal treatment must address both of these causes.

        The excessive accumulation of menstrual blood leading to obstruction and pain is one of the most common presentations of amenorrhea. To address this condition, herbs are prescribed to eliminate the accumulated blood, improve blood circulation, and relieve pain. To eliminate accumulation of blood and clots, herbs with antiplatelet, anticoagulant, and thrombolytic functions are prescribed. Herbs with such functions include Chi Shao (Radix Paeoniae Rubrae), Tao Ren (Semen Persicae) and Hong Hua (Flos Carthami).[8]^,[9]^,[10] In fact, in one study, researchers found that herbs that activate blood circulation and eliminate blood stasis proved effective in inhibiting the formation of clots in 73.4% of the test cases.[11] Lastly, to improve circulation, Chuan Xiong (Rhizoma Chuanxiong) is added. Chuan Xiong (Rhizoma Chuanxiong) is one of the most effective herbs to improve the circulation of blood to the body¡¦s periphery.[12]

        Because the accumulation of blood often leads to severe abdominal pain, herbs are prescribed to alleviate pain and discomfort. There are many herbs with marked analgesic effects, including (but not limited to) Fu Zi (Radix Aconiti Lateralis Praeparata), Chuan Niu Xi (Radix Cyathulae), Dang Gui (Radix Angelicae Sinensis), Bai Shao (Radix Paeoniae Alba), Gan Cao (Radix et Rhizoma Glycyrrhizae), and Yan Hu Suo (Rhizoma Corydalis), which have shown excellent in vitro and in vivo effects.[13]^,[14]^,[15]^,[16]^,[17] Of all these herbs, Yan Hu Suo (Rhizoma Corydalis) is especially effective against visceral pain, and its analgesic effect has been compared with that of morphine. Though morphine is still more potent and has a faster onset of action, Yan Hu Suo (Rhizoma Corydalis) has far fewer side effects, slower development of tolerance, and has shown no evidence of creating dependence.[18] Furthermore, it has synergistic effects in combination with electro-acupuncture.[19] Overall, these herbs offer safe, effective, and reliable pain relief.

        Hormonal imbalance is another common cause of amenorrhea. Chronic anovulation may be caused by polycystic ovarian disease where there is an acyclic production of estrogen, or it may be due to hypogonadism where there is a low or absent production of estrogen. In either case, proper balance and regulation of the endocrine system is necessary to restore normal menstruation. Herbs in this formula have a two-directional effect on the endocrine system. They balance and regulate the endocrine system to restore equilibrium. Di Huang (Radix Rehmanniae), Ren Shen (Radix et Rhizoma Ginseng) and Gan Cao (Radix et Rhizoma Glycyrrhizae) have all shown marked regulatory influence on the endocrine system. Di Huang (Radix Rehmanniae) and Gan Cao (Radix et Rhizoma Glycyrrhizae) are more specific to the adrenal glands,[20]^,[21] while Ren Shen (Radix et Rhizoma Ginseng) has a more general influence on the entire endocrine system.[22] Specifically, administration of these herbs has been shown to regulate and balance the endocrine system by directly affecting the hypothalamus and the pituitary glands.[23]

        Overall, Menatrol is an excellent formula to regulate the hormones and remove physical obstructions to treat conditions such as amenorrhea, polycystic ovarian syndrome, and infertility.

 

COMPARATIVE ANALYSIS

Amenorrhea and dysmenorrhea are conditions that almost all women suffer on an occasional basis. As common as the conditions are, there are few drug treatments available. On one hand, hormone drugs, such as birth control pills and patches, are prescribed to regulate menstrual cycles. Though they are more effective, they often cause serious side effects, such as weight gain, hyperkalemia, clotting disorders, retinal thrombosis, cancer, liver damage, hypertriglyceridemia, hypertension, bleeding, and fertility impairment. On the other hand, those with dysmenorrhea may take non-steroidal anti-inflammatory agents (NSAIDs) to relieve pain and reduce inflammation and swelling. Though effective, they cause such serious side effects as gastric ulcer, duodenal ulcer, gastrointestinal bleeding, tinnitus, blurred vision, dizziness, and headache. In short, drug treatment options are very limited between those that treat only symptoms and do not work well, and those that work well but may have significant side effects.

        Herbal therapy is extremely effective to regulate menstruation and treat amenorrhea and dysmenorrhea. These herbs have analgesic effects to relieve pain, anti-inflammatory effects to reduce swelling and inflammation, and antispasmodic effects to relieve cramping. Furthermore, many herbs have been shown to have a marked effect to regulate hormones to promote normal menstruation. However, this effect requires continuous use of herbs for at least one to two cycles. In short, herbal therapy is extremely beneficial for treatment of menstrual disorder as it treats both the symptoms and the cause of PMS and dysmenorrhea.

        Drugs offer limited options for treatment of amenorrhea and dysmenorrhea. Birth controls are effective, but these drugs carry significant short- and long-term side effects. NSAIDs relieve pain, but should be used as needed for only a short period of time. Herbs, on the other hand, are extremely effective for both immediate and prolonged benefits. Furthermore, they are very safe and are associated with few or no side effects. Individuals with such menstrual disorders should definitely explore these non-drug treatment options.