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Chinese Medicine And Menopause Question: Discuss about the Chinese Medicine And Menopause.     Answer: Understanding Concepts: Menopause and Symptoms: Menopause of the permanent stoppage of menstrual cycle due to a reduction of hormone levels in the blood. This generally happens at ages between 49 to 52 years, due to the depletion of oocytes in the ovary, thereby causing the depletion of ovarian steroidal hormones (Follicle Stimulating Hormone or FSH and Leutinizing Hormone or LH). Surgical removal of ovaries (or oophrectomy), fallopian tubes or uterus (or hysterectomy) can also cause menopause. The changes in the bleeding pattern during transition to menopause reflects the change in the levels of FSH and Inhibin B, and can be an indicator of the onset of menopause (Garcia et al., 2005). The symptoms include hot flushes (lasting 30 seconds to 10 minutes), accompanied by shivering, sweating and redness of the skin. The hormonal fluctuation can also cause changes in mood (anxiety, irritability depression), behavior and sleeping patterns. Additional symptoms can include vaginal dryness, weakening of bladder muscles. Menopause also can place post menopausal wemen at risk of developing osteoporosis, cardiovascular diseases, obesity, hypertension, diabetes, and elevated risks of stroke or heart attack (, 2017).   Traditional Chinese Medications: Traditional Chinese Medicine (TCM) is a style of treatment based on 2500 years of traditional medical practice, and includes herbal medication, acupuncture, cupping, or moxabustion. The therapy is essentially based on the idea of the circulation (via various meridians) of the vital energy of the body, known as chi or qi, and targets to change the flow of the energy to treat diseases (Lao, Xu and Xu, 2012). It should however be noted that traditional medications rejects the concept of randomized trials with placebo control or double blind experiment, on the ethics that placebo should not be administered to a sick patient (Oshima et al., 2015). This undermines the criticality of placebos in trial. Studies by Hall et al., 2015, on genetics and placebo effect, shows genetic predisposition of the subjects can change the placebo effects and is a complex interplay between the placebo and molecular pathways of the drug. Which means, different people can respond differently to the same drug, and a placebo acts as a contol group for the test. Increasing body of evidences in the field of neuroscience suggests that the placebo effect is inclusive of different phenomenon that can explain the efficacy of therapeutic treatment which can affect the perception of the symptoms associated with a disease (Lucas & Booth, 2014). Herbal Medication utilizes various herbs administered orally, via medications. Herbs contains different alkaloids, that can have biomedical properties, and can be utilized to manage symptoms. Acupuncture method uses thin metal needles inserted through the skin, through specific points, and can be used to treat chronic pain (Vickers 2014). Moxabustion is a kind of heat therapy, and uses dried plant materials (moxa) burned close to the skin surface, which is supposed to rejuvenate the flow of vital energy. Cupping method uses glass cups, placed on the skin by vacuum suction, which is created by burning of cotton kept in the cup. The vacuum inside the cup is supposed to regulate the flow of the vital energy.   Herbal Products And Management Of Menopausal Symptoms: Studies by Rhonda et al. on the usage and efficacy of hermal medication (like phytoestrogens, St John’s wort, ginseng and ginkgo) to provide relief from menopausal symptoms, published on the Journal or Wemen’s Health (Vol 12, November 7th, 2003), done on 462 women aged between 40-55 (35.5% African American, 60.2% Caucasian) shows the following results: A) Patients who experience the common symptoms, tend to use herbal products that are known to reduce the symptoms. B) 68% of the users said the herbs improved the symptoms. C) Wemen who were administered phytoestrogens showed more likelihood, than non users to report sadness or depression, faster heartbeat, hot flushes, itching and irritability, along with pain in the muscles or joints, loss of sexual interest, loss of memory, night sweat, dryness of vagina, fatigue and weakness. D) Users of St John’s wort has higer incidence of developing sadness or depression, sleep difficulty, night sweat accompanied by fatigue and weakness. E) Users of gengko or ginseng mostly reported only one symptom-  night sweats. F) Most of the herb users showed curiosity about the herbal products that can help their symptoms. G) 50% of the test subjects believed that the herbs work (Johnson et al., 2000). Sirotkin and Harrath (2014) suggested that phytoestrogens can have an effect on different types of physiological as well as pathological processes (reproduction. Remodeling of bones, epithelial, nervous, cardiovascular and immune systems, and metabolism). This can make phytoestrogens and useful for various types of treatament like for menopausal symptoms, aeginf og skin, osteoporosis, neurodegenerative, cardiovascular or immune disorders. The phytoestrogens are estrogens derived from plant, they are less potent than estradiol but can still bind to estrogen receptors thereby functioning as antagonist or agonists of natural estrogens (Lagari & Levis, 2014). However, caution must be taken while using phytoestrogens, since they act as endocrine disruptors, and can have either deletrous effect of reproduction or beneficial effect for patients with steroid deficiency (Bennetau-Pelissero 2016). Overall, phytoestrogens appears to alleviate the hot flush frequency experienced by post menopausal wemen (Chen, Lin & Liu, 2015).   Acupuncture And The Treatment Of Post Menopausal Symptoms: Baccetti et al., (2014) experimentally concluded that acupuncture, integrated with diet therapy and Tuins self message reduced the occurance of hot flushes significantly, and slightly alleviated other symptoms like sleep disorders, irritability, depression, tightness of chest and pain in the bones. This type of therapy can be used for women for whom Hormonal Replacement Therapy (HRT) cannot be adopted for oncological risks or due to an ongoing or recently diagnosed oncological pathology. Extreme precaution must however be taken to prevent the usage of infected needles, thereby causing sepsis, as studies done by Horibe and Constantine (2016), shows. Also, studies by Abdo, Kha and Bhardwaj (2016) shows that Acupuncture therapy can can cause pheumothorax as a possible complication in rare cases. Additional complications can include syncope or dizziness, vomiting or nausea, epilepsy, reduced movement of bowels, artrioventricular blockage, Bell’s palsy aggeravion, factitial panniculitis, galatorrhea, minor pain, aphonia and vasovagal reaction (Chan et al., 2017). However, no deaths have ever been reported. Du et al., concludes that a combination of Chinese herbal medication with acupuncture can provide the same resultas hormonal therapy, and works beter than only herbal treatment, and can be effective for women who cannot opt for hormonal therapy. As per the World Health Organization, acupuncture and moxibustion can be used for pain management, substance abuse, organic lesions, psychiatric and neurological issues, and gynecological disorders (De & De 2015).   Moxibustion And The Treatment Of Post Menopausal Symptoms: Moxibustion have shown to be effective in reducing the frequency and severity of hot flushes in peromenopausal and postmenopausal wemen (Park et al. 2009). However the research still recommends the usage od larger sample and inclusion of placebo control for further studies, which potentially undermines the veracity of the study. A novel sham moxibustion pillars can be used to provide placebo-control in moxibustion research, thereby fulfilling the need for the double blind protocol (Zhao et al., 2006). This treatment can also provide positive results for treating primary osteoporosis (POP), however the efficacy could not be concluded definitely (Xu et al., 2017).  Sudies have also shown that Moxibustion used with Electroacupuncture can be used to treat psychiatric conditions, as they can have an antidepressive action by the regulation of HPA axis as well as affect the hippocampus and influence the dipaminergic and serotonergic systems of the body (Kim et al., 2017). Cupping And The Treatment Of Post Menopausal Symptoms: The earliest records for the usage of cupping dates back to the Greek historian Herodotus (400 BC), used for the treatment of headaches, appetite loss, digestion problems, fainting, narcolepsy, and abcesses. Dry and wet cupping techniques were commonly practiced using cups of glass, horn or brass (Mehta & Dhapte, 2015). Adverse effects of cupping were reported in studies, but have been shown to be rare, and emphasizes the treatment be administered by only medical experts, and be compliant of the guidelines for safety (Kim et al., 2014). Also, a control of the negative pressure produced inside the cups can prevent negative effects like dermatitis bullae (Peng, How & Bullae, 2013). Cupping can also decrease the ODI and VAS scores for LBP patients (Wang et al., 2017).   References: Abdo, T., Kha, V., Bhardwaj, H., & Youness, H. (2016). ID: 58: ACUPUNCTURE THERAPY, AN UNDERREPORTED CAUSE OF PNEUMOTHORAX. Baccetti, S., Da Fre, M., Becorpi, A., Faedda, M., Guerrera, A., Monechi, M. V., … & Parazzini, F. (2014). Acupuncture and traditional Chinese medicine for hot flushes in menopause: a randomized trial. The Journal of Alternative and Complementary Medicine, 20(7), 550-557. Chan, M. W., Wu, X. Y., Wu, J. C., Wong, S. Y., & Chung, V. C. (2017). Safety of Acupuncture: Overview of Systematic Reviews. Scientific Reports, 7. Chen, M. N., Lin, C. C., & Liu, C. F. (2015). Efficacy of phytoestrogens for menopausal symptoms: a meta-analysis and systematic review. Climacteric, 18(2), 260-269. De, A., & De, A. (2015). Acupuncture and Modern Medicine. Crossing the Border: International Journal of Interdisciplinary Studies, 3(1), 99-106. De, A., & De, A. (2015). Acupuncture and Modern Medicine. Crossing the Border: International Journal of Interdisciplinary Studies, 3(1), 99-106. Du MSc, L., Bahrami-Taghanaki, H., & Azizi, H. (2011). Menopause-related symptoms: traditional Chinese medicine vs hormone therapy. Alternative therapies in health and medicine, 17(4), 48. Gracia, C. R., Sammel, M. D., Freeman, E. W., Lin, H., Langan, E., Kapoor, S., & Nelson, D. B. (2005). Defining menopause status: creation of a new definition to identify the early changes of the menopausal transition. Menopause, 12(2), 128-135. Hall, K. T., Loscalzo, J., & Kaptchuk, T. J. (2015). Genetics and the placebo effect: the placebome. Trends in molecular medicine, 21(5), 285-294. Horibe, K., & Constantine, S. (2016, May). RISKS OF ALTERNATIVE MEDICINE: A CASE REPORT OF SEPSIS DUE TO MULTIPLE MSSA SUBCUTANEOUS ABSCESSES CAUSED BY INFECTED ACUPUNCTURE NEEDLES. In JOURNAL OF GENERAL INTERNAL MEDICINE (Vol. 31, pp. S720-S721). 233 SPRING ST, NEW YORK, NY 10013 USA: SPRINGER. Kim, M., Choi, E. J., Kim, S. P., Kim, J. E., Park, H. J., Kim, A. R., … & Kim, J. H. (2017). Electroacupuncture plus moxibustion therapy for patients with major depressive disorder: study protocol for a randomized controlled trial. Trials, 18(1), 16. Kim, T. H., Kim, K. H., Choi, J. Y., & Lee, M. S. (2014). Adverse events related to cupping therapy in studies conducted in Korea: a systematic review. European Journal of Integrative Medicine, 6(4), 434-440. Lao, L., Xu, L., & Xu, S. (2012). Traditional chinese medicine. In Integrative pediatric oncology (pp. 125-135). Springer Berlin Heidelberg. Lucas, V., & Booth, S. (2014). The importance of placebo effects in enhancing palliative care interventions. BMJ supportive & palliative care, bmjspcare-2013. Mehta, P., & Dhapte, V. (2015). Cupping therapy: a prudent remedy for a plethora of medical ailments. Journal of traditional and complementary medicine, 5(3), 127-134. Oshima, E., Wang, J., Stiles, B., Thurston, D. E., Rotella, D., Saw, C. L. L., … & Guccione, S. (2015). Traditional Chinese medicine: scientific basis for its use. Royal Society of Chemistry. Park, J. E., Lee, M. S., Jung, S., Kim, A., Kang, K., Choi, J., … & Choi, S. M. (2009). Moxibustion for treating menopausal hot flashes: a randomized clinical trial. Menopause, 16(4), 660-665. Peng CZ, How CK. Bullae (2013) Secondary to Prolonged Cupping. The American Journal Medical Sciences; 346(1):65. Vickers, A. J., & Linde, K. (2014). Acupuncture for chronic pain. Jama, 311(9), 955-956. Wang, Y. T., Qi, Y., Tang, F. Y., Li, F. M., Li, Q. H., Xu, C. P., … & Sun, H. T. (2017). The effect of cupping therapy for low back pain: A meta-analysis based on existing randomized controlled trials. Journal of Back and Musculoskeletal Rehabilitation, (Preprint), 1-9. (2017). What are the symptoms of menopause?. Retrieved 17 October 2017, from Xu, F., Huang, M., Jin, Y., Kong, Q., Lei, Z., & Wei, X. (2017). Moxibustion treatment for primary osteoporosis: A systematic review of randomized controlled trials. PloS one, 12(6), e0178688. Zhao, B., Wang, X., Lin, Z., Liu, R., & Lao, L. (2006). A novel sham moxibustion device: a randomized, placebo-controlled trial. Complementary therapies in medicine, 14(1), 53-60.

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