Menopausal Support and HRT Alternatives

Kit Li

A month ago, a female patient at 54 years-old who had been using Hormones Replacement Therapy (HRT) (1) patches for over 5 years to manage menopausal symptoms.  She consulted me seeking a Traditional Chinese Medicine (TCM) approach due to persistent symptoms, including breast tenderness, night sweats, constipation, and emotional discomfort.

HRT is  a medical treatment designed to relieve menopause symptoms, such as hot flushes, night sweats, mood swings, vaginal dryness, low libido;  also prescribed for women experiencing  premature menopause or early ovarian insufficiency.  It is claimed to help protect bones and prevent osteoporosis in postmenopausal women.  It works by replacing hormones that the body produces less of during menopause, primarily oestrogen, and sometimes progesterone or testosterone, depending on the individual's needs.

There are three common types of HRT:

• Oestrogen-only HRT: for women who have had a hysterectomy
• Combined HRT (oestrogen + progesterone): for women with an intact uterus, to reduce the risk of endometrial cancer.
• Testosterone therapy: sometimes prescribed to improve libido, energy, and cognitive function.

However, the risk factors are:

• Slightly increased risk of breast cancer (mainly with combined HRT)
• Slightly increased risk of blood clots or stroke (especially if started later in life)
• Not suitable for women with a history of certain cancers, blood clots, or liver disease

Following a thorough consultation, I prescribed a modified Geng Nian Kang (更年康) (2) to help alleviate her symptoms and gently support the body's transition throughout the menopausal, this herbal formula addresses common menopausal symptoms (3) and also work synergistically to: 

• Nourish Yin and Blood
• Tonify Qi in the Spleen and Lung
• Invigorate the Kidney and Liver
• Calm the Shen (spirit)
• Clear internal heat

After four weeks of treatment, her condition has significantly improved.  She now sleeps better, no longer experiences night sweats, and reports feeling noticeably calmer and more balanced.

From a TCM perspective, menopausal symptoms are primarily associated with imbalances in the Kidney, but also involve the Liver, Heart, Spleen, and sometimes the Lung. These imbalances are often categorized into distinct patterns:

1) Liver and Kidney-yin deficiency: 'The Liver and Kidney share the same source' (肝肾同源).  When Kidney-yin deficiency, it often affects Liver-yin, leading to: dry eyes, blurry vision,  dizziness, irritability, insomnia, menstrual irregularities or infertility in women.

2) Heart and Kidney disharmonized (心肾不交): Kidney-yin helps anchor the Heart-Yang and calm the spirit (Shen), if Kidney-yin is weak, Heart-yin may also become deficient, leading to palpitations, anxiety, insomnia with vivid dreams, and poor memory or concentration.

3) Lung and Kidney-yin deficiency: 'Kidney grasps the Qi'  (肺肾阴虚), especially in respiratory issues,  they  work together to regulate fluid metabolism and breathing, deficiency in both leads to dry cough or chronic dry throat, shortness of breath and wheezing, scanty or sticky sputum, tendency toward yin-type asthma or chronic respiratory issues.

4) Spleen-yin or -qi deficiency (脾气或脾阴虚): chronic Spleen-deficiency (especially Spleen-yin or qi) can eventually affect Kidney-yin through exhaustion of postnatal energy sources.  In reverse, Kidney-yin deficiency may dry fluids, affecting digestion and leading to constipation or dry stools.  

Chinese Herbal Medicines offer a gentle, tailored approach that works in harmony with the body's natural rhythms.  Used under proper guidance, it may serve as a preventive and supportive therapy, particularly for women seeking non-hormonal options or looking to transition off HRT safely.

References: 

1) Hormones Replacement Treatment (HRT)  

Study provides new estimates of breast cancer risks associated with HRT (Oct 2020)

 https://bmjgroup.com/study-provides-new-estimates-of-breast-cancer-risks-associated-with-hrt/#:~:text=A%20new%20study%20published%20by%20The%20BMJ%20today,risks%20of%20breast%20cancer%2C%20particularly%20for%20older%20women.

HRT, menopause and breast cancer Tiphaine Boulin, Isla Whitcroft, Hannah Moody Peer reviewed by two members of Breast Cancer UK independent Science Panel (Feb 2024)

https://cdn.breastcanceruk.org.uk/uploads/2024/02/Breast-Cancer-UK_HRT-and-Breast-Cancer-Review-2024.pdf

2) Modified Geng Nian Kang (更年康):

Shudihuang (Radix Rehmanniae Preparata): nourishing yin and blood

ShanYao (Chinese Yam): tonifies qi in Lung and Spleen

Zhimu (Anemarrhena asphodeloides Bunge): expels heat

Danggui (Chinese Angelica Root): nourishing blood

etc....

3) What is menopause?

https://cdn.breastcanceruk.org.uk/uploads/2024/02/Breast-Cancer-UK_HRT-and-Breast-Cancer-Review-2024.pdf (Page2)

A Rebirth of the Body: The Wisdom of Postpartum Confinement

Kit Li

Recently, a widely discussed topic among my patients is 'How women care for themselves emotionally and physically after giving birth?'  As someone who supports patients through pre- and post-IVF acupuncture treatments, I've noticed this conversation resonates deeply, and it's far from over.  Interestingly, many men are also engaging in this dialogue, making it a truly shared and evolving topic.

Once, my grandma said, 'Giving birth is an intense and transformative experience, often described as a journey to the edge of life. The confinement period that follows is a sacred time for restoration, a chance to gently bring vitality, balance, and life back to the mother’s body and spirit.'

She was right, postpartum confinement is a woman's reconciliation with her body and destiny, it's a kind of 'Rebirth of the body'.  Traditional Chinese Medicine (TCM) teaches that childbirth greatly weakens a woman’s vitality. Her qi and blood become deficient, the uterus needs healing, and the digestive system needs strengthening. Confinement isn’t about blindly supplementing, it's about adjusting slowly, using stillness and time to nourish.

I used to think postpartum confinement was just about resting in bed and drinking some homemade soups.  But when my daughter was born three months prematurely, I truly came to value that period of time.  I also saw some of my friends, who didn't take proper care of themselves after childbirth, often due to different cultural backgrounds and suffer from long-term issues.  Within a few years, many experienced back pain, joint problems, irregular menstruation, arthritis and even hair loss.   They hadn't restored their Qi and Blood during confinement.  That's when I realised postpartum care is so much more than I had ever imagined.

“Your first child drained your vitality. Don’t be reckless with the second. Women who rush around during confinement, by spring, their roots are already withered.” Grandma said.

During the confinement, the body needs some time to recuperate and rejuvenate.  It's not just about slowing down, it's about allowing energy and blood to  back on the  track again.  We often prepare herbal drinks to dispel blood stasis from the uterus and restore Qi and Blood.  For instance: 

1) Shenghua Tang (生化汤)*: a classic formula often used during the postpartum period to promote blood circulation, dispel blood stasis, and aid uterine recovery.  Taking 3 - 5 consecutive days ideally.

2) Juyuan Jian (举元煎)*: primarily used to tonify Qi, especially spleen and lung qi, and to raise sinking Yang-Qi. Often prescribed for prolapse, fatigue, or chronic diarrhoea due to Qi deficiency.

3) Buzhong Yiqi Tang (补中益气汤)*: a famous classic formula by Li Dongyuan (李东垣), used to strengthen the Spleen and Stomach, raise sunken Yang, and augment Qi, especially helpful in cases of fatigue, prolapse, or chronic loose stools.

In TCM,  'Warmth is the Foundation of Recovery'.  It's about balancing our internal and external.  We never let cold enter the body during confinement. Once cold gets into the bones, your life force scatters.  After childbirth, Yang energy is depleted, and the body is like an open door, cold can easily sneak in.   

We also prepare some warming teas, such as: 

1) Ginger with brown sugar Tea (薑红茶)* : to dispel cold

2) Chenpi (Aged Tangerine Peel) and Roasted Rice Tea (陳皮炒米茶)* : to warm the Stomach, strengthen the Spleen, and  supports Upright Qi.   

Confinement isn’t just about healing the body; it’s also about helping the heart find its warmth again.

We all know that physical wounds can be healed through Qi and Blood, but emotional wounds can last a lifetime. Most new mothers are fragile and delicate during this period, which makes  postnatal depression quite common.  From a TCM perspective,  when emotions are disturbed, Liver-Qi stagnates, as a result, breast milk may not flow, and deeper damage can follow.  Emotional and physical support from family is essential during this time.

Another helpful formula is:  Ziru Tang (滋乳汤)*: which promotes breast milk production, nourish Qi and Blood,  and supports women experiencing low milk supply due to Qi and Blood deficiency. 

For a new mother, if confinement is done right, a child is a blessing. If not,  the child may feel like a burden.  It's not about weakness, it’s about investing a month for a lifetime of strength.  Confinement is about storing: storing Energy, storing Yang, storing the foundation of a woman’s lifelong vitality.

References:

1) Shenghua Tang (生化汤): Danggui (Chinese Angelica Roots),  Chuangxiong (Ligusticum Root), Taoren (Peach Kernel), Paojiang (Charred Ginger), Zhigancao (Honey-Fried Licorice Root)

2) Juyuan Jian (举元煎): Renshen (Ginseng), HuangQi (Milkvetch Roots), Gancao (Liquorice), Baizhu (Atractylodes Rhizomes), Shengma (Bugbane Rhizomes)  

3) Buzhong Yiqi Tang (补中益气汤): Renshen (Ginseng), Gancao (Liquorice), Baizhu (Atractylodes Rhizomes), Danggui (Chinese Angelica Roots), Chenpi (Aged Tangerine Peel), HuangQi (Milkvetch Roots), ChaiHu (Bupleurum Roots), ShengMa (Bugbane Rhizomes)

4) Ziru Tang (滋乳汤): HuangQi (Milkvetch Roots), Danggui (Chinese Angelica Roots), Zhimu (anemarrhena rhizome), XuanShen (Ningpo figwort root), Lulutong (Sweetgum fruit), Wanbuliuxing (Vaccaria seeds)

5) Ginger with Brown Sugar Tea (薑红茶): 

Slice 4-5 pieces of ginger, put them into a pot with about 500ml of water. Boil for 2-3 minutes, then add brown sugar 10g and continue boiling for another 2-3 minutes. It’s ready to serve.

6) Chenpi (Aged Tangerine Peel) and Roasted Rice Tea (陳皮炒米茶): 

Ingredients: 4 measuring cups of rice, 4 pieces of aged tangerine peel (Chenpi)

Instructions:

1) Soak the dried tangerine peel until soft, then scrape off the pith and finely chop it. Set aside.

2) No need to wash the rice. Add it directly to a dry wok along with the chopped tangerine peel. Dry roast (no oil or water) over high heat, stirring from the bottom up, until the ingredients are cooked.

3) When the rice turns white and the tangerine peel becomes crispy, reduce to medium-low heat. Continue roasting until the rice turns yellow and slightly puffs up. Then turn off the heat and let it cool.

4) Soaked the roasted Chenpi and rice in a flask for 15 minutes before drinking.

"Health Preservation Surpasses Cure” - The Legacy of Deng Tietao

Let's explore the principles behind longevity in the philosophy of Dr. Deng Tietao.

“Health preservation is more important than cure” 

This was the lifelong credo of Deng Tietao, a revered Grandmaster of Traditional Chinese Medicine. As early as 1986, Professor Deng called upon the public to elevate health awareness to a spiritual pursuit. He envisioned building a personal “health garden” -  a harmonious space incorporating qigong, literature, music, dance, therapeutic cuisine, medicinal diets, natural environments, and even the nourishing power of dreams, all contributing to a joyful and holistic life.

With unwavering dedication, he championed traditional preventive methods: food therapy, physical cultivation, and seasonal living. Drawing on TCM theory, he emphasized strengthening the body’s core, dispelling internal imbalances, and preventing illness at its roots. Remarkably, he remained clear-minded, bright-eyed, quick-witted, and vigorous in spirit until his passing at the age of 104, a living testament to the power of sustained well-being.

I. A Daily Diet: Simple in Form, Profound in Essence

Though his meals appeared modest, Deng’s dietary habits were steeped in deep yin-yang balance and the five elements of TCM. His nutrition philosophy blended ancient insight with modern sensibility.

“Omnivorous and Unbiased”

When asked the secret to his longevity, Deng often answered with just four words:

“Omnivorous and unbiased.”

This ideal rooted in classical texts, encourages a varied, seasonally balanced diet in harmony with the elements.

“Five grains for nourishment, five fruits for support, five animals for strength, five vegetables for fullness, all blended to nourish the essence.” - The Yellow Emperor’s Inner Classic

His meals were:

• Light and nourishing, with emphasis on digestion

• Based on rice, occasionally complemented by whole grains like sweet potatoes, taro, oats, or steamed buns

• Rich in vegetables, fruits, legumes, milk, eggs, and walnuts

• Balanced animal protein: fish, shrimp, chicken, and beef in moderation

II. Moderation in Eating: 70% Full, 100% Health

Deng firmly believed in protecting the spleen and stomach — the foundation of digestion and vitality in TCM. He followed the principle of eating to “seven-tenths full.”

“Overeating or irregular meals damage the spleen and stomach. Once they're weakened, illness follows.” - Deng Tietao

III. A Daily Glass of Milk: A Gentle Nourishment

Every morning, for over a decade, Deng drank a glass of milk — a ritual he maintained with quiet devotion, even after late-night returns.

He regarded milk as:

• Replenishing deficiencies

• Strengthening the lungs and stomach

• Moistening the intestines and calming the spirit

Modern science, too, confirms its value in calcium absorption and osteoporosis prevention.

IV. Two Walnuts a Day: Brain Food with Heart

For decades, Deng enjoyed 1–2 walnuts daily, his preparation was simple:

1. Place walnut kernels in a bowl

2. Add a pinch of salt and a bit of water

3. Microwave for 2 minutes

4. Let cool before eating

“Walnuts look like the brain, and they help the brain! Salt supports digestion and kidney function. They ease night urination and promote smooth mornings.”

In TCM, walnuts are known to:

• Nourish kidneys and brain

• Warm the lungs and relieve asthma

• Moisten the bowels and ease constipation

In his later years, he enjoyed them with rice, gentle on the teeth, yet deeply restorative.

V. Fish, 3 - 4 Times a Week: Light, Vital Protein

Deng favored fish as a source of high-quality, easily digestible protein and healthy fat.

He especially valued:

• Crucian carp: Boosts qi, supports spleen, reduces swelling

• Grass carp: Warms digestion and spleen

• Bighead carp: Rich in collagen; nourishes skin and connective tissues

His Signature Dish: Bighead Carp & Huaishan Pork Spleen Soup

Ingredients:

• 1 bighead carp

• 15g Chinese yam (Huaishan)

• 1 piece pork spleen

• 3 slices fresh ginger

Method:

1. Clean and slice the carp. Salt lightly, then pan-fry until golden.

2. Add yam, pork spleen, and boiling water.

3. Simmer for 20 minutes, season, then transfer to a stew pot.

4. Cook slowly until flavours harmonize.

“Pork spleen nourishes digestion and lungs. Chinese yam boosts the spleen and replenishes yin. This soup is perfect for those with weak digestion or loose stools.”

Final Reflections: Longevity Rooted in Joy and Balance

Professor Deng Tietao’s life was a living embodiment of consistency, moderation, simplicity, and joyful engagement with life. Through mindful nourishment, physical cultivation, and emotional serenity, he illuminated a path of true wellness.

“A happy heart and a balanced life, these are just as important as food and medicine.”

His gentle wisdom continues to inspire generations seeking vibrant health, not merely as the absence of disease, but as a radiant state of being in tune with nature and spirit.

References:

Dr Deng Tietao: https://en.wikipedia.org/wiki/Deng_Tietao

The original article: https://mp.weixin.qq.com/s/OFluxPyZfFGpsXiUIwlHww

Cool the Inner Fire: A Healing Soup for Yin Deficiency

Kit Li

Do you feel hot and thirsty all the time, even though you drink lots of water? Or feel fatigued after sweating a lot?

Recently, a very active 49 year-old friend complained of feeling easily tired, even though he eats well and exercises regularly. However, his primary concern is persistent thirst, despite drinking around 1.5 to 2 litres of water daily.

From a Traditional Chinese Medicine (TCM) perspective, this is known as Yin-deficiency. Regardless of age or gender, many of us experience some level of yin deficiency. But what is yin deficiency? It refers to an excess of internal heat in the body. This heat dries up body fluids, leading to symptoms like hot flushes, thirst, dry skin, irritability, and even fatigue.

I suggested him to make a cooling and yin-nourishing soup made with winter melon for heat-clearing and yin-replenishing properties, making it ideal for hot summer days when sweating more. It helps reduce the dryness and internal heat that often follow excessive sweating.

Winter Melon Soup with Dried Scallops, Dried Shrimps, and Diced Pork

Ingredients:

Winter melon                         500g

Dried scallops                         4–5 pieces

Dried shrimps                        4–5 pieces

Dried shiitake mushrooms     7–8 pieces

Lean pork                              200g

Ginger                                    2 slices 

Water 1000ml

Making this soup doesn’t take much time, what really takes time is soaking the dried shiitake mushrooms.

Cooking Method:

1. Soak the shiitake mushrooms (with stems removed), dried scallops, and dried shrimps for several hours until softened.

2. Put all the ingredients into a pressure cooker and set it to 'Soup' mode for 30 minutes.

And it's ready! I hope you enjoy this nourishing and refreshing soup.

References:

Winter Melon: Neutral and slightly cool in nature, sweet in taste and acts on our Lungs, Bladder, Large Intestine and Small Intestine, also helps with detoxifying, clearing out mucus and phlegm and promotes digestion.

Dried Shiitake Mushrooms: Tonify Qi and Blood, it also helps to strengthen the stomach, relieve toxicity, promote healing and resolve phlegm.

Dried Scallops: Sweet, salt, slightly warm. Nourish yin, tonify blood, replenish the kidney, regulate the spleen and stomach. Poor appetite, kidney deficiency with frequent urination, diabetes. Cook it for eating, 10~25 g. https://www.webmd.com/diet/scallops-health-benefits

Dried Shrimp: Tonify qi and yang. It also helps to regulate blood circulation, eliminate cold and resolve phlegm. In general the ancient Chinese medical texts cite that it enters the stomach spleen, kidney, and liver.  https://www.nutritionvalue.org/Shrimp%2C_dried_26319170_nutritional_value.html

Ginger: Promotes Qi circulation, disperses cold, expels wind and resolves phlegm. If you often feel cold, ginger is a recommended ingredient to add.