![]() The logic of this TCM diagnosis differs fundamentally from that of the western scientific thinking. Zheng differentiation (pattern differentiation, 辨证), a syndrome stratification according to traditional Chinese medicine (TCM) diagnosis methods, plays the central role in the concept and practice of TCM. On the other hand, randomized double-blind controlled trials in western medicine framework demand and favor homogeneity of participants, standardization of intervention, and quantitative measurements but lack consideration for Chinese medical Zheng features. Though there has been a large number of case reports and pilot clinical trials with various prescriptions in China in the past decades, they do not provide comparable, measurable, and reproducible evidence for efficacy of the treatments. However, in western society, the evidence of its efficacy is seen as unconvincing. Ĭhinese herbal medicine (CHM), one of these natural product treatments with less side effect, has been widely used to disperse menopausal problems in China and other Asian countries. ![]() In USA, 82% physicians recommend herbal remedies to their menopausal patients. Therefore, not only patients but also physicians are increasingly interested in complementary therapies using natural products with good effectiveness and fewer side effects. Furthermore, a significant proportion of menopausal women have contraindications to or are unwilling to use hormone therapy. Hormone therapy is taken to be the most effective treatment for menopausal syndrome, but various disadvantages and side effects have been reported, including increased risk of breast and ovarian cancer, endometrial hyperplasia and carcinoma, stroke, and venous thromboembolism, especially for long-term therapy. Among them, vasomotor symptoms, vaginal dryness, and sleep disturbance are most frequent and thus regarded as the most relevant problems, followed by mood symptoms and urinary complaints. Ĭlinical manifestations of menopausal syndrome have a multivariate feature, including vasomotor episodes, urogenital problems, sleep disturbance and mood disorders, uterine bleeding, somatic symptoms, vertigo and headaches, palpitations, skin formication, and sexual dysfunction. Menopausal syndrome not only has an impact on women's quality of life but also is associated with other health problems, for example, cardiovascular disease and osteoporosis in old age. Menopausal symptoms can last for 4-5 years or longer and can even be found in 9% of 72-year-old women. An American survey reports that approximately 25% of women require treatment. It has been reported that almost 80% of women in western countries and more than 60% of Chinese women suffer from menopausal problems. Women can experience menopausal symptoms beginning in their mid-to-late forties. (3) All these findings need to be confirmed in further well-designed comprehensive studies meeting the standard of evidence-based medicine and including Zheng-differentiation of traditional Chinese medicine. (2) Chinese herbal medicine may be effective for at least some menopausal symptoms while side effects are likely less than hormone therapy. Critical analysis revealed that (1) high-quality studies on efficacy of Chinese herbal medicine for menopausal syndrome are rare and have the drawback of lacking traditional Chinese medicine diagnosis (Zheng-differentiation). None of the studies investigated long-term side effects. CHM did not increase the endometrial thickness, a common side effect of hormone therapy. Only ten severe adverse events were reported, two with possible association with the therapy. Side effects and adverse events were generally mild and infrequent. ![]() ![]() Menopause was diagnosed according to western medicine criteria in all studies while seven Chinese studies and one non-Chinese study further stratified the participants using traditional Chinese medical diagnosis “Zheng differentiation.” Efficacy was reported by all 9 Chinese and 9/14 non-Chinese papers. This study evaluates 23 (9 Chinese and 14 non-Chinese) randomized controlled trials for efficacy and side effects of Chinese herbal medicine on menopausal symptoms. ![]()
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