Archives of Gynecology and Obstetrics

, Volume 294, Issue 1, pp 193–200 | Cite as

Traditional Chinese medicine valuably augments therapeutic options in the treatment of climacteric syndrome

  • Sarah Eisenhardt
  • Johannes Fleckenstein
Gynecologic Endocrinology and Reproductive Medicine


Climacteric syndrome refers to recurring symptoms such as hot flashes, chills, headache, irritability and depression. This is usually experienced by menopausal women and can be related to a hormonal reorganization in the hypothalamic–pituitary–gonadal axis. In Traditional Chinese Medicine, originating 1000s of years ago, above-mentioned symptoms can be interpreted on the basis of the philosophic diagnostic concepts, such as the imbalance of Yin and Yang, the Zang-Fu and Basic substances (e.g. Qi, Blood and Essence). These concepts postulate balance and harmonization as the principle aim of a treatment. In this context, it is not astounding that one of the most prominent ancient textbooks dating back to 500–200 BC, Huang di Neijing: The Yellow Emperor’s Classic of Internal Medicine gives already first instructions for diagnosis and therapy of climacteric symptoms. For therapy, traditional Chinese medicine comprises five treatment principles: Chinese herbal medicine, TuiNa (a Chinese form of manual therapy), nutrition, activity (e.g. QiGong) and acupuncture (being the most widespread form of treatment used in Europe). This review provides an easy access to the concepts of traditional Chinese medicine particularly regarding to climacteric syndrome and also focuses on current scientific evidence.


Menopause Integrative medicine Acupuncture Chinese herbal medicine (CHM) Traditional Chinese medicine (TCM) Hormone therapy Physiologic mechanism Heat flush 



We thank Julia Fleckenstein, B.Sc., for her tremendous work in the conception and design of Fig. 2.

Compliance with ethical standards


No funding was obtained for this article.

Conflict of interest

Both authors declare to have no financial conflicts of interest.


JF is the Deputy Head of the Scientific Committee of the German Medical Acupuncture Association DÄGfA and both authors received honoraria from the DÄGfA for academic teaching. JF received honoraria for academic teaching from the Swiss Medical Association for Acupuncture, Chinese Medicine and Auriculomedicine SACAM and the Association of Swiss Acupuncture Societies ASA.

Human participant/animal statement

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Unschuld PU (2013) Antike Klassiker der Chinesischen Medizin. Cygnus Verlag, BerlinGoogle Scholar
  2. 2.
    Fleckenstein J, Trinczek K (eds) (2011) QuickStart Akupunktur, vol 1, 2nd edn. McGraw-Hill EducationGoogle Scholar
  3. 3.
    Kaptchuk T (2000) Chinese medicine: the web that has no weaver, vol 2. New YorkGoogle Scholar
  4. 4.
    Ni M (2011) Der Gelbe Kaiser (trans: Fischer-Schreiber I). Knaur Taschenbuch, MensSana Verlag, 1 edn. Maoshing NiGoogle Scholar
  5. 5.
    Maciocia G (2010) Diagnose in der Chinesischen Medizin. Verlag Systemische Medizin, Bad KötztingGoogle Scholar
  6. 6.
    Tu Y (2011) The discovery of artemisinin (qinghaosu) and gifts from Chinese medicine. Nat Med 17(10):1217–1220. doi: 10.1038/nm.2471 CrossRefPubMedGoogle Scholar
  7. 7.
    Zhao ZQ (2008) Neural mechanism underlying acupuncture analgesia. Prog Neurobiol 85(4):355–375. doi: 10.1016/j.pneurobio.2008.05.004 CrossRefPubMedGoogle Scholar
  8. 8.
    Peets JM, Pomeranz B (1978) CXBK mice deficient in opiate receptors show poor electroacupuncture analgesia. Nature 273(5664):675–676CrossRefPubMedGoogle Scholar
  9. 9.
    Pomeranz B, Chiu D (1976) Naloxone blockade of acupuncture analgesia: endorphin implicated. Life Sci 19(11):1757–1762CrossRefPubMedGoogle Scholar
  10. 10.
    Han JS (2004) Acupuncture and endorphins. Neurosci Lett 361(1–3):258–261. doi: 10.1016/j.neulet.2003.12.019 CrossRefPubMedGoogle Scholar
  11. 11.
    Zhang Y, Zhang RX, Zhang M, Shen XY, Li A, Xin J, Ren K, Berman BM, Tan M, Lao L (2012) Electroacupuncture inhibition of hyperalgesia in an inflammatory pain rat model: involvement of distinct spinal serotonin and norepinephrine receptor subtypes. Br J Anaesth 109(2):245–252. doi: 10.1093/bja/aes136 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Goldman N, Chen M, Fujita T, Xu Q, Peng W, Liu W, Jensen TK, Pei Y, Wang F, Han X, Chen JF, Schnermann J, Takano T, Bekar L, Tieu K, Nedergaard M (2010) Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nat Neurosci 13(7):883–888. doi: 10.1038/nn.2562 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Irnich D, Beyer A (2002) [Neurobiologische Grundlagen der Akupunkturanalgesie] Neurobiological mechanisms of acupuncture analgesia. Schmerz 16(2):93–102CrossRefPubMedGoogle Scholar
  14. 14.
    Langevin HM, Bouffard NA, Badger GJ, Churchill DL, Howe AK (2006) Subcutaneous tissue fibroblast cytoskeletal remodeling induced by acupuncture: evidence for a mechanotransduction-based mechanism. J Cell Physiol 207(3):767–774CrossRefPubMedGoogle Scholar
  15. 15.
    Dorsher PT, Fleckenstein J (2008) Trigger points and classical acupuncture points Part 1: qualitative and quantitative anatomic correspondences. Dt Ztschr f Akup 51(3):15–24CrossRefGoogle Scholar
  16. 16.
    Baeumler PI, Fleckenstein J, Benedikt F, Bader J, Irnich D (2015) Acupuncture-induced changes of pressure pain threshold are mediated by segmental inhibition-a randomized controlled trial. Pain 156(11):2245–2255. doi: 10.1097/j.pain.0000000000000283 CrossRefPubMedGoogle Scholar
  17. 17.
    Lin JG, Chen WL (2008) Acupuncture analgesia: a review of its mechanisms of actions. Am J Chin Med 36(4):635–645 S0192415X08006107 [pii] CrossRefPubMedGoogle Scholar
  18. 18.
    Huang W, Pach D, Napadow V, Park K, Long X, Neumann J, Maeda Y, Nierhaus T, Liang F, Witt CM (2012) Characterizing acupuncture stimuli using brain imaging with FMRI—a systematic review and meta-analysis of the literature. PLoS One 7(4):e32960. doi: 10.1371/journal.pone.0032960 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Ciechanowska M, Lapot M, Mateusiak K, Przekop F (2010) Neuroendocrine regulation of GnRH release and expression of GnRH and GnRH receptor genes in the hypothalamus–pituitary unit in different physiological states. Reprod Biol 10(2):85–124CrossRefPubMedGoogle Scholar
  20. 20.
    Wyon Y, Wijma K, Nedstrand E, Hammar M (2004) A comparison of acupuncture and oral estradiol treatment of vasomotor symptoms in postmenopausal women. Climact J Int Menopause Soc 7(2):153–164CrossRefGoogle Scholar
  21. 21.
    Johansson J, Stener-Victorin E (2013) Polycystic ovary syndrome: effect and mechanisms of acupuncture for ovulation induction. Evid Based Complement Altern Med eCAM 2013:762615. doi: 10.1155/2013/762615 CrossRefGoogle Scholar
  22. 22.
    Stener-Victorin E, Jedel E, Manneras L (2008) Acupuncture in polycystic ovary syndrome: current experimental and clinical evidence. J Neuroendocrinol 20(3):290–298. doi: 10.1111/j.1365-2826.2007.01634.x CrossRefPubMedGoogle Scholar
  23. 23.
    Stener-Victorin E, Waldenstrom U, Andersson SA, Wikland M (1996) Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Human Reprod (Oxford, England) 11(6):1314–1317CrossRefGoogle Scholar
  24. 24.
    Stener-Victorin E, Lundeberg T, Cajander S, Aloe L, Manni L, Waldenstrom U, Janson PO (2003) Steroid-induced polycystic ovaries in rats: effect of electro-acupuncture on concentrations of endothelin-1 and nerve growth factor (NGF), and expression of NGF mRNA in the ovaries, the adrenal glands, and the central nervous system. Reprod Biol Endocrinol 1:33CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Yu JS, Zeng BY, Hsieh CL (2013) Acupuncture stimulation and neuroendocrine regulation. Int Rev Neurobiol 111:125–140. doi: 10.1016/B978-0-12-411545-3.00006-7 CrossRefPubMedGoogle Scholar
  26. 26.
    Cvoro A, Paruthiyil S, Jones JO, Tzagarakis-Foster C, Clegg NJ, Tatomer D, Medina RT, Tagliaferri M, Schaufele F, Scanlan TS, Diamond MI, Cohen I, Leitman DC (2007) Selective activation of estrogen receptor-beta transcriptional pathways by an herbal extract. Endocrinology 148(2):538–547. doi: 10.1210/en.2006-0803 CrossRefPubMedGoogle Scholar
  27. 27.
    Grady D, Sawaya GF, Johnson KC, Koltun W, Hess R, Vittinghoff E, Kristof M, Tagliaferri M, Cohen I, Ensrud KE (2009) MF101, a selective estrogen receptor beta modulator for the treatment of menopausal hot flushes: a phase II clinical trial. Menopause 16(3):458–465. doi: 10.1097/gme.0b013e31818e64dd CrossRefPubMedGoogle Scholar
  28. 28.
    Dincer F, Linde K (2003) Sham interventions in randomized clinical trials of acupuncture—a review. Complement Therapies Med 11(4):235–242CrossRefGoogle Scholar
  29. 29.
    MacPherson H, Vertosick E, Lewith G, Linde K, Sherman KJ, Witt CM, Vickers AJ, Acupuncture Trialists C (2014) Influence of control group on effect size in trials of acupuncture for chronic pain: a secondary analysis of an individual patient data meta-analysis. PLoS One 9(4):e93739. doi: 10.1371/journal.pone.0093739 CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Irnich D, Salih N, Offenbacher M, Fleckenstein J (2011) Is sham laser a valid control for acupuncture trials? Evid Based Complement Altern Med eCAM 2011:485945. doi: 10.1093/ecam/neq009 CrossRefGoogle Scholar
  31. 31.
    Lee A, Fan LT (2009) Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev 2:CD003281. doi: 10.1002/14651858.CD003281.pub3 PubMedGoogle Scholar
  32. 32.
    Rithirangsriroj K, Manchana T, Akkayagorn L (2015) Efficacy of acupuncture in prevention of delayed chemotherapy induced nausea and vomiting in gynecologic cancer patients. Gynecol Oncol 136(1):82–86. doi: 10.1016/j.ygyno.2014.10.025 CrossRefPubMedGoogle Scholar
  33. 33.
    Lee A, Chan SK, Fan LT (2015) Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev 11:Cd003281. doi: 10.1002/14651858.CD003281.pub4 PubMedGoogle Scholar
  34. 34.
    Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, Sherman KJ, Witt CM, Linde K (2012) Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med 172(19):1444–1453. doi: 10.1001/archinternmed.2012.3654 CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Witt CM, Pach D, Brinkhaus B, Wruck K, Tag B, Mank S, Willich SN (2009) Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Forsch Komplementmed 16(2):91–97. doi: 10.1159/000209315 CrossRefPubMedGoogle Scholar
  36. 36.
    White A (2004) A cumulative review of the range and incidence of significant adverse events associated with acupuncture. Acupunct Med J British Med Acupunct Soc 22(3):122–133CrossRefGoogle Scholar
  37. 37.
    Kang HS, Jeong D, Kim DI, Lee MS (2011) The use of acupuncture for managing gynaecologic conditions: an overview of systematic reviews. Maturitas 68(4):346–354. doi: 10.1016/j.maturitas.2011.02.001 CrossRefPubMedGoogle Scholar
  38. 38.
    Kim KH, Kang KW, Kim DI, Kim HJ, Yoon HM, Lee JM, Jeong JC, Lee MS, Jung HJ, Choi SM (2010) Effects of acupuncture on hot flashes in perimenopausal and postmenopausal women—a multicenter randomized clinical trial. Menopause 17(2):269–280. doi: 10.1097/gme.0b013e3181bfac3b CrossRefPubMedGoogle Scholar
  39. 39.
    Azizi H, Feng Liu Y, Du L, Hua Wang C, Bahrami-Taghanaki H, Ollah Esmaily H, Azizi H, Ou Xue X (2011) Menopause-related symptoms: traditional Chinese medicine vs hormone therapy. Altern Ther Health Med 17(4):48–53PubMedGoogle Scholar
  40. 40.
    Nedeljkovic M, Tian L, Ji P, Deglon-Fischer A, Stute P, Ocon E, Birkhauser M, Ausfeld-Hafter B (2014) Effects of acupuncture and Chinese herbal medicine (Zhi Mu 14) on hot flushes and quality of life in postmenopausal women: results of a four-arm randomized controlled pilot trial. Menopause 21(1):15–24. doi: 10.1097/GME.0b013e31829374e8 CrossRefPubMedGoogle Scholar
  41. 41.
    Chiu HY, Shyu YK, Chang PC, Tsai PS (2015) Effects of acupuncture on menopause-related symptoms in breast cancer survivors: a meta-analysis of randomized controlled trials. Cancer Nurs. doi: 10.1097/ncc.0000000000000278 Google Scholar
  42. 42.
    Chiu HY, Pan CH, Shyu YK, Han BC, Tsai PS (2015) Effects of acupuncture on menopause-related symptoms and quality of life in women in natural menopause: a meta-analysis of randomized controlled trials. Menopause 22(2):234–244. doi: 10.1097/gme.0000000000000260 CrossRefPubMedGoogle Scholar
  43. 43.
    Krause MS, Nakajima ST (2015) Hormonal and nonhormonal treatment of vasomotor symptoms. Obstet Gynecol Clin N Am 42(1):163–179. doi: 10.1016/j.ogc.2014.09.008 CrossRefGoogle Scholar
  44. 44.
    Nonhormonal management of menopause-associated vasomotor symptoms (2015) 2015 Position statement of the North American menopause society. Menopause 22(11):1155–1174. doi: 10.1097/gme.0000000000000546 CrossRefGoogle Scholar
  45. 45.
    Scheid V, Tuffrey V, Weijburg T, Bovey M, Ward T (2015) Chinese medicine treatment for menopausal symptoms in the UK health service: is a clinical trial warranted? Maturitas 80(2):179–186. doi: 10.1016/j.maturitas.2014.11.006 CrossRefPubMedGoogle Scholar
  46. 46.
    Dodin S, Blanchet C, Marc I, Ernst E, Wu T, Vaillancourt C, Paquette J, Maunsell E (2013) Acupuncture for menopausal hot flushes. Cochrane Database Syst Rev 7:Cd007410. doi: 10.1002/14651858.CD007410.pub2 PubMedGoogle Scholar
  47. 47.
    Nachtigall LE (2010) Therapy: nonhormonal treatment of hot flashes-a viable alternative? Nature Rev Endocrinol 6(2):66–67. doi: 10.1038/nrendo.2009.269 CrossRefGoogle Scholar
  48. 48.
    Walker EM, Rodriguez AI, Kohn B, Ball RM, Pegg J, Pocock JR, Nunez R, Peterson E, Jakary S, Levine RA (2010) Acupuncture versus venlafaxine for the management of vasomotor symptoms in patients with hormone receptor-positive breast cancer: a randomized controlled trial. J Clin Oncol Off J Am Soc Clin Oncol 28(4):634–640. doi: 10.1200/JCO.2009.23.5150 CrossRefGoogle Scholar
  49. 49.
    Bokmand S, Flyger H (2013) Acupuncture relieves menopausal discomfort in breast cancer patients: a prospective, double blinded, randomized study. Breast 22(3):320–323. doi: 10.1016/j.breast.2012.07.015 CrossRefPubMedGoogle Scholar
  50. 50.
    Moegele M, Buchholz S, Seitz S, Ortmann O (2012) Vaginal estrogen therapy in postmenopausal breast cancer patients treated with aromatase inhibitors. Arch Gynecol Obstet 285(5):1397–1402. doi: 10.1007/s00404-011-2181-6 CrossRefPubMedGoogle Scholar
  51. 51.
    Cahill K (2012) The treatment of postmenopausal atrophic vaginitis and dyspareunia with acupuncture and Chinese herbs: a case study. J Chin Med 99:31–34Google Scholar
  52. 52.
    Jia M, Kluwe L, Liu HC, Tang QJ, Liu L, Wang ZZ, Tian LX, Zhao L, Chen YC, Friedrich RE, Sun ZJ, Xu LW (2015) Efficacy and side-effects of a semi-individualized Chinese herb mixture “Tiao Geng Tang” for menopausal syndrome in China. Vivo (Athens, Greece) 2(1):109–115Google Scholar
  53. 53.
    Fu SF, Zhao YQ, Ren M, Zhang JH, Wang YF, Han LF, Chang YX, Fan GW, Wang H, Huang YH, Zhai JB, Dong JY, Li X, Ai JQ, Zhang H, Zhu Y, Zhang BL, Sun LK, Fan X, Gao XM (2015) A randomized, double-blind, placebo-controlled trial of Chinese herbal medicine granules for the treatment of menopausal symptoms by stages. Menopause. doi: 10.1097/gme.0000000000000534 Google Scholar
  54. 54.
    Rao YQ, Li J, Wang WJ (2015) Effects of Gengnianchun on learning and memory ability, neurotransmitter, cytokines, and leptin in ovariectomized rats. Int J Clin Exp Med 8(6):8648–8660PubMedPubMedCentralGoogle Scholar
  55. 55.
    Wang S, Tong Y, Ng TB, Lao L, Lam JK, Zhang KY, Zhang ZJ, Sze SC (2015) Network pharmacological identification of active compounds and potential actions of Erxian decoction in alleviating menopause-related symptoms. Chin Med 10:19. doi: 10.1186/s13020-015-0051-z CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Taylor-Swanson L, Thomas A, Ismail R, Schnall JG, Cray L, Mitchell ES, Woods NF (2015) Effects of traditional Chinese medicine on symptom clusters during the menopausal transition. Climact J Int Menopause Soc 18(2):142–156. doi: 10.3109/13697137.2014.937687 CrossRefGoogle Scholar
  57. 57.
    Li CC, Wang JJ, Chen C, Li YF, Zheng QS, Yang J, Liu HX (2013) Treating menopause syndrome by kuntal capsule and hormone replacement therapy: a meta-analysis of efficacy and safety comparison. Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese journal of integrated traditional and Western medicine/Zhongguo Zhong xi yi jie he xue hui, Zhongguo Zhong yi yan jiu yuan zhu ban 33(9):1183–1190Google Scholar
  58. 58.
    Hachul H, Garcia TK, Maciel AL, Yagihara F, Tufik S, Bittencourt L (2013) Acupuncture improves sleep in postmenopause in a randomized, double-blind, placebo-controlled study. Climact J Int Menopause Soc 16(1):36–40. doi: 10.3109/13697137.2012.698432 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of TCM/Acupuncture, Institute of Complementary Medicine (IKOM)University BernBernSwitzerland
  2. 2.University Hospital of PsychiatryBernSwitzerland
  3. 3.Department of Sports Medicine, Institute of Sports SciencesGoethe-University FrankfurtFrankfurtGermany

Personalised recommendations