Many books on western herbs describe the gynecological patterns for which various herbs are appropriate in terms of hormonal profiles: estrogen excess, progesterone deficiency, androgen excess, etc. The meaning of these terms might be standard knowledge to some of you, but not for me. The following is a record of my attempt to understand these indications. I do draw rough parallels between these hormonal patterns and familiar CM patterns. I do not mean to establish any one-to-one relationships between biomedical diagnoses and CM pattern differentiations. These comparisons are offered only as an initial attempt to reckon with the hormonal patterns. (Also it would be rather strange if these common hormonal patterns were not reflected some way in our system.)
There are three major hormone groups involved in the menstrual cycle (and gynecology generally): androgens, estrogens, and progesterone. The androgens are generated in the ovaries, adrenal cortex, and fat cells. They are precursors for the other two.
Estrogens are generated primarily in the ovaries, but also in the adrenals, and, during pregnancy, in the placenta. Estrogen is primarily generated during the follicular phase and is considered an anabolic hormone.
Progesterone is dominant during the luteal phase. It is relatively catabolic, but is in fact more regulating than one-sidedly catabolic. It promotes an increased body temperature as the body prepares to incubate a fertilized egg.
Production of both estrogen and progesterone decrease with age. The balance between the two is often more important than absolute levels, although absolute levels are also relevant. Thus we have either four or six different hormonal patterns:
Estrogen dominance
estrogen excess
progesterone deficiency
Progesterone dominance
estrogen deficiency
progesterone excess
Androgen excess
Androgen deficiency
*
Estrogen dominance is the most widely discussed hormone imbalance. It is considered the classic PMS pattern, and indeed it sounds a lot like the classic “Liver qi stagnation” pattern of dysmenorrhea.
Looking more specifically at estrogen excess, general constitutional signs include: overweight, red flushed face, and warm. Specific menstrual tendencies include: cramping, heavy bleeding. Other signs include gallbladder problems and anxious depression. That sounds a lot like a stagnant and flaring ministerial fire.
Progesterone Deficiency is less obvious. It is typified by irregular periods, clots, heavy bleeding, slow onset of menstruation, water retention, cramps, breast pain, and cyclical headaches. If progesterone is low enough it can lead to anovulation.
During his discussion of Pennyroyal, Michael Moore mentions that progesterone production can be thrown off by a cold, either in the same month or in the preceding month. That reminded me of a Wuling San pattern discussed by Dr. Zeng. Indeed almost all these symptoms, except possibly the cyclical headaches, could be directly explained by an excess or external cold affecting menstruation. There are probably other ways to look at this pattern.
Progesterone dominance is normally seen only perimenopausely, or if there has been a hysterectomy, etc. Estrogen deficiency can also occur in women who are significantly underweight.
Estrogen deficiency is marked by vaginal dryness, an increased incidence of UTIs (because of dryness also affecting the urethra), dry skin, night sweats, panic attacks, and lethargic depression. This constitutes much of the standard menopausal syndrome, which, as we know, is given a number of different CM diagnoses, primarily yin deficiency, blood deficiency, and blood stagnation. My understanding however is that treating this as a Wen Jing Tang pattern is generally more effective than as Liu Wei Dihuang Wan pattern.
Excessive progesterone is characterized by mid-cycle pain (mittelschmerz), decreased quantity of menstrual blood, increased sweating, possible urinary incontinence. Other symptoms include backache, headache, constipation, joint pain, muscular pain, nausea, vomiting, dizziness, hot flashes, palpitations, possible easy bruising, and possible insomnia in long-standing cases.
I do not see this pattern as a clear match for any particular CM diagnosis. My attempts to diagnose this pattern are further complicated by the fact that I have had difficulty discovering which of these symptoms seem to be the most characteristic. The combination of excess sweating and urinary incontinence strongly suggests that taiyang is failing to control the surface, etc. The various types of body pain can also be explained from a taiyang perspective, but I dont think this explains every symptom.
In both cases estrogen disregulations have had a shaoyang-jueyin connection, while progesterone disregulations have had a taiyang connection.
Symptoms of excessive androgenism include periods that are irregular or absent, acne, male hair patterns (hair on the face, thinning hair on the head), chills, and PCOS.
Androgen deficiency is normally only seen around menopause. Its symptoms are rather vague: low libido, fatigue, decreased sense of well-being, and an increased susceptibility to bone disease. If those were the only symptoms, I would probably diagnose a shaoyin pattern.
Of course we should remember that hormones are not the only biomedical factor affecting menstruation. Among other things, our diagnoses must also reckon with issues such as the quality and balance of the nervous tone and possible changes in the tissue of the reproductive organs.
Please share any other information or perspectives.
There are three major hormone groups involved in the menstrual cycle (and gynecology generally): androgens, estrogens, and progesterone. The androgens are generated in the ovaries, adrenal cortex, and fat cells. They are precursors for the other two.
Estrogens are generated primarily in the ovaries, but also in the adrenals, and, during pregnancy, in the placenta. Estrogen is primarily generated during the follicular phase and is considered an anabolic hormone.
Progesterone is dominant during the luteal phase. It is relatively catabolic, but is in fact more regulating than one-sidedly catabolic. It promotes an increased body temperature as the body prepares to incubate a fertilized egg.
Production of both estrogen and progesterone decrease with age. The balance between the two is often more important than absolute levels, although absolute levels are also relevant. Thus we have either four or six different hormonal patterns:
Estrogen dominance
estrogen excess
progesterone deficiency
Progesterone dominance
estrogen deficiency
progesterone excess
Androgen excess
Androgen deficiency
*
Estrogen dominance is the most widely discussed hormone imbalance. It is considered the classic PMS pattern, and indeed it sounds a lot like the classic “Liver qi stagnation” pattern of dysmenorrhea.
Looking more specifically at estrogen excess, general constitutional signs include: overweight, red flushed face, and warm. Specific menstrual tendencies include: cramping, heavy bleeding. Other signs include gallbladder problems and anxious depression. That sounds a lot like a stagnant and flaring ministerial fire.
Progesterone Deficiency is less obvious. It is typified by irregular periods, clots, heavy bleeding, slow onset of menstruation, water retention, cramps, breast pain, and cyclical headaches. If progesterone is low enough it can lead to anovulation.
During his discussion of Pennyroyal, Michael Moore mentions that progesterone production can be thrown off by a cold, either in the same month or in the preceding month. That reminded me of a Wuling San pattern discussed by Dr. Zeng. Indeed almost all these symptoms, except possibly the cyclical headaches, could be directly explained by an excess or external cold affecting menstruation. There are probably other ways to look at this pattern.
Progesterone dominance is normally seen only perimenopausely, or if there has been a hysterectomy, etc. Estrogen deficiency can also occur in women who are significantly underweight.
Estrogen deficiency is marked by vaginal dryness, an increased incidence of UTIs (because of dryness also affecting the urethra), dry skin, night sweats, panic attacks, and lethargic depression. This constitutes much of the standard menopausal syndrome, which, as we know, is given a number of different CM diagnoses, primarily yin deficiency, blood deficiency, and blood stagnation. My understanding however is that treating this as a Wen Jing Tang pattern is generally more effective than as Liu Wei Dihuang Wan pattern.
Excessive progesterone is characterized by mid-cycle pain (mittelschmerz), decreased quantity of menstrual blood, increased sweating, possible urinary incontinence. Other symptoms include backache, headache, constipation, joint pain, muscular pain, nausea, vomiting, dizziness, hot flashes, palpitations, possible easy bruising, and possible insomnia in long-standing cases.
I do not see this pattern as a clear match for any particular CM diagnosis. My attempts to diagnose this pattern are further complicated by the fact that I have had difficulty discovering which of these symptoms seem to be the most characteristic. The combination of excess sweating and urinary incontinence strongly suggests that taiyang is failing to control the surface, etc. The various types of body pain can also be explained from a taiyang perspective, but I dont think this explains every symptom.
In both cases estrogen disregulations have had a shaoyang-jueyin connection, while progesterone disregulations have had a taiyang connection.
Symptoms of excessive androgenism include periods that are irregular or absent, acne, male hair patterns (hair on the face, thinning hair on the head), chills, and PCOS.
Androgen deficiency is normally only seen around menopause. Its symptoms are rather vague: low libido, fatigue, decreased sense of well-being, and an increased susceptibility to bone disease. If those were the only symptoms, I would probably diagnose a shaoyin pattern.
Of course we should remember that hormones are not the only biomedical factor affecting menstruation. Among other things, our diagnoses must also reckon with issues such as the quality and balance of the nervous tone and possible changes in the tissue of the reproductive organs.
Please share any other information or perspectives.
Thanks for this, Solomon, and thanks for including me amongst the authors here. I too am interested in women's health and feel there is work to be done in drawing parallels between the biomedical descriptions of estrogen, progesterone, or androgen dominance and our CM patterns.
ReplyDeleteOne interesting connection in this regard comes via Matthew Wood, who associates androgen dominance with depression, cystic acne, and what sounds like an overall stagnant qi picture. He points out that androgens are broken down in the liver, which can get bogged down or overwhelmed by the these hormones. His remedies for androgen-dominant conditions are the strong bitters, like Wild Lettuce, Hoarhound, and Wormwood (and other Artemisia species). It's not so much a CM idea, I guess, but Ayurveda firmly associates the bitter flavor with the liver. Matthew talks about a dead/absent liver pulse as a specific indication for Wormwood in particular...which suggests that Wu Zhu Yu/Evodia formulas might also be appropriate for these "deep cold"/"cold in the liver" conditions. Interestingly, spearmint is well-known to be effective for hyperandrogenism in women (and I've seen it work in a mild case of female facial hair)--it's not a strong bitter, but it is an herb that frees constrained liver qi.
It may be of interest, too, that Matthew uses Peony root (Western peony, though I understand it's very similar to the Chinese species) as his main remedy for estrogen excess. His understanding of the condition may be idiosyncratic, however. I have noted Bai Shao abdominal pattern (tight rectus abdominis) in a young woman who looked much more like an estrogen deficiency case, with a weak/Gui Zhi constitution and PCOS and endometriosis.