Hot flashes, night sweats, heart palpitations, insomnia, and irritability towards everyone – this is the reality for many menopausal women. When estrogen fluctuations meet hyperactive Liver Fire, difficulty falling asleep, easy awakening, irritability, and outbursts become the norm, even triggering family conflicts. How to break this "menopausal curse"?
The root cause of menopausal insomnia and irritability lies in "Exuberant Fire and Blood Deficiency".
Singapore Gong Fang Tang TCM gynecology expert Dr. Que Poh Yuen Albert that when women reach the "qiqi" age (around 49 years old), Kidney Qi gradually declines, the Chong and Ren meridians become deficient, and the internal balance of Yin and Yang is disrupted. At this stage, if compounded by stress, staying up late, and consuming spicy foods, it easily forms a vicious cycle of "Yin Deficiency with Effulgent Fire, Blood Failing to Nourish the Heart":
Hyperactive Liver Fire: Insufficient Kidney Water fails to nourish Liver-Wood, leading to ascendant Liver Yang → Irritability, outbursts, headaches, red eyes.
Heart Fire Disturbing the Spirit: Deficient Fire scorches the Heart, the Spirit loses nourishment → Insomnia, dream-disturbed sleep, heart palpitations, night sweats.
Blood Deficiency Failing to Moisten: Deficiency of Essence and Blood fails to nourish the skin and organs → Dry skin, forgetfulness, fatigue.
"Nourishing Yin without clearing Fire is like adding cold water to boiling water – it treats the symptoms but not the root cause!" emphasized Physician Qiu. "Clearing Fire + Nourishing Blood must be done simultaneously to achieve both root and branch treatment."
How can TCM effectively regulate menopausal insomnia, irritability, and anger?
For menopausal insomnia of the "Exuberant Fire and Blood Deficiency" type (symptoms: insomnia, dream-disturbed sleep; heart vexation, bitter taste in mouth; hot flashes, night sweats; early periods with heavy flow; red tongue with yellow coating), Physician Dr. Que Poh Yuen Albert highly recommends the famous formula from the Ming Dynasty's "Golden Mirror of Medicine" (Yizong Jinjian) – Qin Lian Si Wu Tang (Scutellaria & Coptis Four Substances Decoction). This formula combines Si Wu Tang (Four Substances Decoction - nourishes blood) + Huang Qin & Huang Lian (Scutellaria & Coptis - clear fire), directly targeting the core pathogenesis.
Qin Lian Si Wu Tang consists of 6 herbs: Shu Di Huang (Prepared Rehmannia Root), Dang Gui (Chinese Angelica Root), Bai Shao (White Peony Root), Chuan Xiong (Szechuan Lovage Root), Huang Qin (Baical Skullcap Root), and Huang Lian (Golden Thread / Coptis Root).
Shu Di Huang (Prepared Rehmannia Root): Nourishes Yin, tonifies Blood, replenishes Essence, and fills the Marrow. It can replenish the physical deficiency in menopausal women caused by Qi and Blood insufficiency.
Dang Gui (Chinese Angelica Root): Tonifies Blood, invigorates Blood circulation, regulates menstruation, and alleviates pain. It both improves menstrual irregularities and promotes Qi and Blood flow, ensuring adequate nourishment to all organs.
Bai Shao (White Peony Root): Nourishes Blood, regulates menstruation, astringes Yin to stop sweating, soothes the Liver to alleviate pain. It is very effective in relieving mood swings, hot flashes, and sweating.
Chuan Xiong (Szechuan Lovage Root): Invigorates Blood, moves Qi, dispels Wind, alleviates pain. It helps improve blood circulation and reduce bodily pain.
Huang Qin (Baical Skullcap Root): Clears Heat, dries Dampness, drains Fire, and resolves toxicity. It is especially skilled at clearing deficient Fire within the body, alleviating menopausal symptoms like insomnia and hot flashes caused by Yin Deficiency with Effulgent Fire.
Huang Lian (Golden Thread / Coptis Root): Has an even stronger ability to clear Heat, dry Dampness, drain Fire, and resolve toxicity. Combined with Huang Qin, it enhances the Heat-clearing and Fire-draining effect, significantly improving sleep.
Modifications & Applications:
Severe hot flashes and night sweats: Add Di Gu Pi (Lycium Root Bark) 12g, Fu Xiao Mai (Blighted Wheat) 30g.
Heart palpitations, chest tightness: Add Long Gu (Dragon Bone) 30g (decoct first), Suan Zao Ren (Spine Date Seed) 15g.
Constipation, dry mouth: Add Mai Dong (Ophiopogon Root) 15g, Xuan Shen (Figwort Root) 10g.
Sore and weak lower back and knees: Add Sang Ji Sheng (Mulberry Mistletoe Stem) 15g, Du Zhong (Eucommia Bark) 12g.
Medical Case
Patient: Ms. Lin, 52 years old, teacher
Chief Complaint: Menopause for 1 year, insomnia for 2 years worsening. Slept only 2-3 hours per night, hot flashes occurred over 10 times daily, frequent irritability and anger leading to conflicts with family, accompanied by heart palpitations, bitter taste in mouth, constipation.
Initial Consultation: Flushed face, deep red tongue with dry yellow coating, taut, thready, and rapid pulse.
Pattern Differentiation: Kidney Yin deficiency, Heart and Liver Fire blazing (Exuberant Fire and Blood Deficiency pattern).
Prescription: Modified Qin Lian Si Wu Tang.
Herbs: Huang Qin (Scutellaria) 9g, Huang Lian (Coptis) 6g, Dang Gui (Angelica) 12g, Chuan Xiong (Lovage) 6g, Bai Shao (Peony) 15g, Shu Di Huang (Rehmannia) 15g. Added Suan Zao Ren (Spine Date Seed) 15g (calms spirit), Di Gu Pi (Lycium Bark) 12g (clears deficiency heat), Mai Dong (Ophiopogon) 15g (moistens dryness).
Medical Advice: Eat millet and lily congee for dinner, be in bed before 10 PM.
Result: By day 3, hot flashes reduced to 3 times daily, time to fall asleep shortened; By day 7, could sleep 5 hours per night, mood significantly calmer; By day 14, sleep reached 6-7 hours, hot flashes and night sweats disappeared, tongue turned pale red.
