TCM and Menopause:
How Does TCM Understand and Treat Symptoms?

Menopause is a natural phase of a woman's life. As ovarian function gradually declines and oestrogen levels change, women may experience hot flushes, night sweats, sleep disturbances, mood changes, fatigue, joint discomfort and urogenital symptoms.

Modern medicine focuses primarily on ovarian function, hormonal changes and associated physiological mechanisms. TCM offers a complementary perspective — one that focuses not only on what hormones have changed, but on what specific combination of symptoms this produces in a particular individual.

1. Classical TCM Understanding of Menopause

The modern concept of "menopause" did not exist in ancient Chinese medicine, but the Huangdi Neijing (Yellow Emperor's Classic) describes how reproductive function changes with age, summarised in the famous passage about the seventh seven-year cycle (age 49): the Ren Mai and Chong Mai weaken, Tiangui is exhausted, and menstruation ceases.

Tiangui is a TCM concept linked to the kidney-essence system governing growth, maturation and reproduction. It should not simply be equated with oestrogen — the two belong to different medical frameworks. [1]

2. "Kidney Deficiency" Does Not Mean Kidney Disease

A key concept in TCM menopause theory is Kidney Deficiency (Shen Xu). This does not refer to kidney disease in the biomedical sense. In TCM, the "Kidney" is a functional system linked to growth, reproduction, ageing, fluid metabolism and the regulation of yin and yang. [1,2]

3. Why Do Some Women Feel Hot While Others Feel Cold?

TCM distinguishes different symptom patterns. Women with predominant hot flushes, night sweats, inner heat, insomnia and irritability may be associated with a Yin Deficiency pattern. Women with predominant cold sensitivity, fatigue, low energy and cold limbs may be associated with a Yang Deficiency pattern. This is the principle of individualised pattern diagnosis (辨证论治, Biànzhèng Lùnzhì). [1,2]

4. Acupuncture for Menopausal Symptoms

A meta-analysis of 12 randomised controlled trials (869 women) found that acupuncture was associated with reduced frequency and severity of hot flushes and improvements in some menopausal symptoms. However, the difference versus sham acupuncture was substantially smaller than versus no treatment, suggesting that non-specific effects contribute to the observed benefit. [3,4]

5. Chinese Herbal Medicine

A Cochrane review of Chinese herbal medicine for menopausal symptoms concluded that the available evidence was insufficient to draw definitive conclusions about efficacy and safety. A later systematic review of 19 RCTs (2,469 women) found some positive signals for hot flushes, but considerable heterogeneity across formulas and studies. More recent analyses continue to accumulate evidence for individual formulas. [5,6,7]

6. TCM and Modern Medicine Are Not Mutually Exclusive

A woman can receive appropriate gynaecological examination and modern medical treatment while also accessing acupuncture or other TCM care according to her needs. For abnormal bleeding, severe or new symptoms, or signs suggesting other conditions, appropriate medical evaluation remains essential. TCM treatment should not replace necessary diagnostic investigation.