Perimenopause is a normal life stage that every woman must go through and a special transitional period inseparable from physical, psychological and social changes. Due to the decline of ovarian function and insufficient secretion of estrogen during this period, it causes an increased sensitivity to emotional changes and a significantly higher incidence of depression. According to the WHO
latest study, it is expected that by 2020
According to the latest WHO study, depression is expected to become the leading cause of disability, the second leading factor in the global burden of disease, and the second leading killer after cancer by 2020. Therefore, it is particularly important to seek safe and effective treatments for perimenopausal depression. Studies have shown that women with no history of depression have a 2- to 4-fold increased risk of developing depression after perimenopause; women with a history of depression have an approximately 5-fold increased risk of developing major depression after perimenopause.
Therefore, the fluctuating decrease in estrogen levels is closely associated with the development of perimenopausal depression. Of course, its increased incidence is also related to biological and environmental factors such as sleep disorders, stressful life events, socioeconomic status use of hormones and psychotropic medications, and decreased social support. So, to know what is perimenopausal depression? First of all, let’s understand the concept of perimenopause, the so-called perimenopause refers to the period when ovarian function starts to decline until 1 year after menopause.
The perimenopausal period is the period from the beginning of the decline of ovarian function until one year after menopause. Depression that first occurs during this period is called perimenopausal depression, which is a psychiatric disorder that often occurs around the age of 45 to 55 years before and after menopause.
The main clinical manifestations are emotional depression, anxiety, and stress. In addition, most patients have symptoms such as insomnia, somatic discomfort and vegetative disorders, and endocrine function, especially hypogonadism or aging. Studies in Europe and the United States have found that in the perimenopausal period, about
50% to 60% suffer from mild depression and 1% to 3% suffer from severe depression. According to statistics, depression in Chinese women during this period accounts for 5.8% of the total population.
5.8% of the total population. In order to better diagnose and treat this disease, we also need to introduce the concept and diagnostic criteria of depression, which is a common clinical psychological disorder characterized by depressed mood, manifested by sullenness or sadness and lasting at least
2 weeks
The symptoms must be accompanied by one of the following It must also be accompanied by 4 of the following symptoms: (1) loss of interest in daily life and no sense of pleasure; (2) significant loss of energy and persistent fatigue without cause; (3) psychomotor retardation or agitation; (4) low self-evaluation, or self-blame, or feelings of guilt; (5) difficulty in association and decreased ability to think for oneself; (6) recurrent suicidal thoughts; (7) insomnia, early awakening, or excessive sleep; (8 ) loss of appetite and significant weight loss; (9) significant loss of sexual desire. In clinical practice, patients who repeatedly visit the clinic complain of general discomfort, but cannot say exactly where the discomfort is, and often have multi-system symptoms at the same time, such as insomnia, dreaminess, headache in the nervous system;
The cardiovascular system includes chest tightness, chest pain, and panic;
In the digestive system, there are poor appetite, abdominal distension, diarrhea, constipation, swallowing obstruction, etc. Patients repeatedly undergo various clinical examinations, are overly concerned about their condition, and have used various conventional therapeutic drugs, but the effects are not obvious. In addition, some patients often complain of various chronic pains in the body or high work stress;
Some patients have adverse events in their lives, such as marital breakdown, death of a relative, retirement and layoff;
Some patients have chronic diseases, such as stroke, cardiovascular disease, malignant tumors, diabetes, or a history of previous depressive episodes. All patients encountered in this category should be alerted to the possibility of depression. Assessment tools for depressive disorders: depression self-rating scales, such as
Zung’s Depression Self-Rating Scale, Beck Depression Self-Rating Inventory (BDI21), Self-Rating Scale for Depression (SDS), and Self-Rating Anxiety and Depression Scale (HAD) Depression other rating scales, such as the Hamden Depression Inventory
(HAMD). The diagnosis of depression is established and the patient should be carefully assessed for suicide risk, studies have shown that 60% to 70% of depressed patients
Once suicidal ideation occurs, specialist treatment is needed. After understanding the diagnosis of perimenopausal depression, let’s learn about its treatment – estrogen therapy. The pathogenesis of depression in perimenopausal women is still unclear, but it is generally believed to be the result of a combination of factors, among which the fluctuating decline in estrogen levels that is unique to perimenopause is one of the more studied mechanisms. In recent years, research on the mechanism of estrogen replacement therapy for perimenopausal depression has become the focus of interdisciplinary research in gynecology and psychiatry Most scholars believe that estrogen binding to its receptors has multiple effects on central nervous regulation of mood, cognition, habituation and other functions. Physiological estrogen not only promotes neuronal growth, reduces brain amyloidosis, stops neuronal cell atrophy, and regulates synaptic cell plasticity, but also increases monoamine activity and postsynaptic 5-hydroxytryptaminergic effects, increases the number of 5-hydroxytryptaminergic receptors and neurotransmitter transport and uptake, inhibits monoamine oxidase activity, and reduces cortico-adrenergic receptor density, thus achieving the treatment of depression. The purpose of the treatment is to reduce the density of cortico-adrenergic receptors and thus to treat depression. Estrogen replacement therapy is an effective treatment for perimenopausal depression, and the combination of antidepressants is more effective in patients with severe depression. In perimenopausal women without contraindications to estrogen use, estrogen replacement therapy alone is generally chosen for mild and moderate depression, while the combination of antidepressants should be considered in patients with severe depression, especially those with combined hot flashes and genitourinary tract atrophy. Risk studies of estrogen replacement therapy have focused on breast cancer, endometrial cancer, and cardiovascular disease (
strokes and coronary events, pulmonary embolism or deep vein embolism)
The risk evaluation of long-term estrogen replacement therapy The risk of long-term estrogen use has been evaluated differently, and with regard to breast cancer risk, data from the Women’s Health Basic Intervention Study suggest that long-term use of a single estrogen not only does not increase the risk of breast cancer in North American women, but has a protective effect on the breast, whereas combined progestins or patients with a history of hormone use may increase the risk of breast cancer by less than 0.1% per year, and the risk is primarily related to The risk is mainly related to the dose and type of progestin and is lower than that brought about by lifestyle factors (
The risk is lower than that associated with lifestyle factors (e.g., obesity, alcohol abuse). It has also been shown through studies that the use of estrogen and progestin in combination therapy for more than 11 years does not increase the risk of breast cancer.
The risk of breast cancer is not increased by the application of combined estrogen and progestin therapy for more than 11 years. In terms of endometrial cancer risk, estrogen alone can cause dose-related endometrial irritation, so women with a uterus need to be treated with a combination of progestins to counteract the endometrial irritation of estrogen, and continuous combination estrogen and progestin therapy is associated with a lower incidence of endometrial hyperplasia and carcinogenesis compared to the normal population. With regard to the risk of cardiovascular disease, studies have shown that estrogen increases the risk of cardiovascular disease not only in relation to the dose and type of estrogen and the route of administration of the combined progestin, but also in relation to the age of the patient and the duration of initiation, and that estrogen replacement therapy in perimenopausal and early postmenopausal women without atherosclerosis or mild atherosclerosis (
Age < 60 years) is not only not risky but also cardiovascularly protective. In contrast, oral estrogen administration after age 60 may increase the risk of stroke and venous thrombosis.
The latest 2011 guidelines of the International Menopause Society recommend that hormone replacement therapy is part of an overall strategy to maintain the health of perimenopausal and postmenopausal women, and that healthy women aged <60 years should not be overly concerned about hormone replacement therapy.
Healthy women <60 years of age should not be overly concerned about the safety of hormone replacement therapy, and the potential benefits of short-term use of hormone replacement therapy during the first few years of menopause, when clearly indicated, are substantial and the risks are minimal. Age > 60
Hormone replacement therapy in women > 60 years of age should be initiated after weighing all the risks and benefits. The best time to start hormone replacement therapy is inconclusive. Some studies recommend that hormone replacement therapy should be initiated at the onset of perimenopausal signs (e.g., irregular menstruation)
Some studies suggest that hormone replacement therapy should be initiated at the onset of perimenopausal signs (e.g., irregular menstruation); others suggest that the “window of opportunity” for hormone replacement therapy is 50 to 59 years of age. The guidelines for estrogen replacement therapy recommend that early initiation, preferably within the first 5 years of menopause, is generally considered to be more beneficial than the potential benefits of hormone replacement therapy.
The potential benefits outweigh the potential risks. So, how do you use estrogen?
For non-menopausal women, Clomid (estradiol valerate tablets/estradiol cyproterone tablets combination) will be administered according to the following regimen: one tablet daily for 21 days without interruption, stopping until the fifth day after the onset of menstruation and starting a new cycle. For natural menopause and surgical menopause with the above mentioned symptoms, tibolone will be administered at the same time each day at a dose of 2.5 mg, one tablet daily. Symptoms usually improve within a few weeks, but optimal results can be obtained by taking it for at least 3 months. This product can be taken continuously for a long period of time. The drug should be discontinued immediately if any of the following conditions occur during the course of administration: pregnancy and lactation, undiagnosed vaginal bleeding, known or suspected breast cancer, known or suspected precancerous or malignant tumors affected by sex hormones, existing or previous history of liver tumors (benign or malignant), severe liver disease, acute arterial thromboembolic disease (e.g., myocardial infarction, stroke), active deep vein thrombosis thromboembolic disease. Patients should be closely monitored for the following conditions: A. renal disease, epilepsy, trigeminal neuralgia, or a history of these conditions, as the administration of hormonally active steroids may occasionally cause fluid retention; B. hypercholesterolemia, as lipid changes have been observed in those taking this product; C. impaired glucose metabolism, as this product may reduce glucose tolerance and therefore require increased dosage of insulin or other hypoglycemic agents. Antidepressant therapy: Paroxetine: selective 5-hydroxytryptamine reuptake inhibitor; Paroxetine: 20 mg daily, once in the morning, after 2-3 weeks, adjust the dose according to the condition, can be 10
mg increments after 2 to 3 weeks, with a maximum daily dose of 50 mg.
Paroxetine side effects: dry mouth, constipation, blurred vision, tremor, headache, nausea, weight gain, fatigue, insomnia, and sexual dysfunction. Rapid discontinuation of paroxetine may produce a discontinuation syndrome in which patients exhibit sleep disturbances, agitation, anxiety, nausea, sweating, confusion and other discontinuation reactions. The starting dose is 20 mg/day.
Although higher doses may increase the incidence of adverse effects, an increase in the dose of the drug should be considered if it is not effective after 3 weeks of treatment, and the WHO consensus is that antidepressant treatment should be continued for at least 6 months.
Adverse effects of fluoxetine include dizziness, nausea, anorexia, fatigue, and anxiety; mirtazapine: the starting dose of treatment should be 15 mg daily, and the dose should be gradually increased to obtain the best effect. The effective dose is usually 15-45 mg per day.
Common adverse effects of mirtazapine include 1) increased appetite and weight gain, and 2) drowsiness and sedation, usually within one week of taking the drug (note: a reduction in dose at this time will not moderate this adverse effect, but will affect the effectiveness of treatment for depression). Because of patients’ fear of antidepressants and estrogen side effects, they look to Chinese medicine for treatment, and this group of patients is growing, so Chinese medicine has become a hot research topic in this field. In ancient times, there was no name for perimenopausal syndrome in China, but it was classified under the categories of dirty agitation and depression. The main clinical symptoms are menstrual disorder or menopause, baking heat and sweating, dizziness and irritability, insomnia, palpitation and weakness, depressed mood
The main clinical symptoms are menstrual disorder or menopause, baking heat and sweating, dizziness and irritability, insomnia, palpitation and weakness, low mood, sadness, and depression. Menopausal depression patients have their own characteristics compared with general depression patients, namely kidney deficiency-based. According to Chinese medicine, the “arrival” and “depletion” of a woman’s “heavenly sap”, the onset and closure of menstruation, and the vigor and decline of female reproductive functions are all determined by the strength and weakness of the kidney. Most perimenopausal women are entering the seventh decade of life, when the essence of the kidney gradually transforms from the vigorous stage to the declining stage, and thus are prone to the pathological changes of kidney deficiency and essence deficit, imbalance of yin and yang, resulting in the loss of nourishment of the brain and disturbance of the nervous system, leading to depression. In the specific environment of perimenopause, the pressure from society and family is high, such as excessive mental tension or depression, which exceeds the psychological capacity of people, they can suffer from depression. Survey shows that the occurrence of depression disorder in perimenopausal women, pre-menopausal mental factors account for 33.3%, post-menopausal mental factors account for 52.1%. Pre- and post-menopausal psychiatric factors are most commonly associated with family problems, personal social life problems and the effects of menopause. In Chinese medicine, the treatment is mainly divided into three types of kidney deficiency and liver depression: Liu Wei Di Huang Wan and Bai He Di Huang Tang nourish water and wood, clear the heart and reach depression; Heart and spleen deficiency type, set up Gan Mai Da Zao Tang to strengthen the spleen and nourish the heart, calm the mind and resolve depression; Spleen deficiency and liver depression type, given to Free Yao San and Er Chen Tang to regulate the liver and support the spleen, resolve phlegm and resolve depression; because patients with perimenopausal depression are depressed due to illness and depression due to illness, and affect each other, vicious circle, so the treatment should be combined with the four diagnoses. Therefore, the treatment should be combined with the four diagnoses, pay attention to the deficiency and reality of the disease, and develop an individualized treatment plan according to the personality characteristics of the patient and the response to the disease, but without being bound to one side, one evidence, one type and flexible use. At present, the single antidepressant herbal medicine recorded in the literature is the total flavonoid component extracted from cottonseed, which has a good antidepressant effect. Ginkgo can effectively scavenge free radicals, have neuroprotective effects, and improve the cognitive function of depressed patients,
Improve the non-rapid eye movement phase sleep, has a good antidepressant effect. The water-soluble oligosaccharide of Bacopa monniera was isolated to have antidepressant effect,
The aqueous and alcoholic extracts of Acacia were screened for antidepressant activity, and it was found that the aqueous and alcoholic extracts of Acacia had significant antidepressant effects on animal models of desperate behavior. The antidepressant effect of Acacia spp.
The antidepressant effect of Acorus calamus was found. Both the aqueous and alcoholic extracts of Acorus calamus significantly reduced the immobility time of animals,
Both effects were comparable to those of the antidepressant fluoxetine. The aqueous extract of Acorus calamus had a therapeutic effect on the forced swimming model of depression in mice, the hanging tail model and the antagonistic model of depression caused by reserpine; the aqueous extract of licorice shortened the immobility time in male albino mice in the FST and TST experiments,
The mechanism may be monoamine oxidase inhibition. The ethanolic extract of Pueraria lobata significantly shortened the immobility time of FST and TST in cerebral ischemia-reperfusion model, and also reversed the immobility time of CIR
The ethanolic extract of Pueraria lobata significantly shortened the immobility time of FST and TST in a model of cerebral ischemia-reperfusion, and reversed the decrease of norepinephrine (NE) and 4-dihydroxyphenylacetic acid in the hippocampus and striatum of mice. The antidepressant formula: Chai Hu Daxing Liver San (柴胡疏肝散) is composed of fried Chen Pi in vinegar, Chai Hu,
This formula is composed of fried Chen Pi in vinegar, Chai Hu, Chuanxiong, bran fried Citrus aurantium, Paeonia lactiflora, roasted licorice, and Xiang Fu. This formula has the function of harmonizing qi and blood, resolving phlegm and depression, and calming the mind and spirit, and is widely used in clinical practice, especially for the treatment of depression,
It is considered to be one of the most suitable ancient formulas. Prosperity San and Danjuania Prosperity San: Prosperity San of Song Taiping Huimin and Pharmaceutical Bureau formula is composed of Chai Hu, Angelica Sinensis, Bai Shao, Fu Ling, Atractylodes Macrocephala and Licorice,
It has the function of detoxifying the liver and relieving depression, strengthening the spleen and the camp, nourishing blood and regulating menstruation. The formula Danjuania Yiuyao San is added with Dampi and Gardenia on this basis. Yue Ju Wan: From “Dan Xi Xin Fa” by Zhu Dan Xi of Jin Dynasty.
It is a representative formula for the treatment of depression, composed of Chuanxiong, Cangzhu, Xiangxiang, Shenqu, Gardenia and other medicines. It was found that Yue Ju Wan may exert its antidepressant effect by increasing the expression of hippocampal brain-derived neurotrophic factor. The effect of Yuejuwan on a chronic mild unpredictable stress depression mouse model was observed,
It was found that Echikuwan could effectively improve the performance of depression model mice with reduced voluntary activity and irritability, and its mechanism of treating depression was related to the increase of 5-HT content in the brain tissue of depression model mice,
The treatment of depression is related to the increase of 5-HT level and decrease of plasma cortisol level in brain tissue of depression mice. Glycyrrhiza macrophylla soup:
This formula consists of licorice, wheat and jujube, and is a combination of pulse and evidence from Zhang Zhongjing’s “Jin Kui Yao” of the Han Dynasty. To this basic formula, astragalus, yujin, aromatic herb, gangsong, calamus, asclepias, and black sophora were added to form Ganmai Dazao Tang with ten herbs. Ganmai Dazao Tang and its additive formula were able to correct behavioral changes in rats with depression model,
However, the mode of action of the herbs may be different. Han Xia Hou Pu Tang (Han Dynasty, China): This is a formula from Zhang Zhong Jing’s “The Essentials of the Golden Horoscope”, consisting of Han Xia, Hou Pu, Fu Ling, ginger and Su Ye, which is a classic formula for the treatment of depression with phlegm and qi stagnation (commonly known as Plum Qi).
It is a classic formula for the treatment of depression with phlegm and qi stagnation (commonly known as plum pei qi). Acupuncture treatment (the most common acupuncture method for depression is electroacupuncture). Common acupuncture points: the five visceral points (Lung Yu, Heart Yu, Liver Yu, Spleen Yu
Kidney Yu); the Governor acupuncture points (Baihui, Shenting, Fengfu, Shendao, Zhiyang); secondly, the head, heart meridian, pericardium meridian, liver meridian, and extremity acupuncture points: Yin Tang, Si Shen Cong, Sun, Rate Valley, Feng Chi, Wan Bone, Qu Chi, Neiguan, Shen Men, He Gu, Tai Chong, Foot San Li, and San Yin Jiao.
In addition, the treatment of depression should also focus on the patient’s dietary treatment. Such as eating more vitamin-rich foods, the content of vitamins and amino acids in food has an important impact on a person’s mood. Eat more vitamin B-rich
foods, such as coarse grains, fish, eggs and green vegetables. Eat more food containing calcium, which can improve appetite, promote digestion and absorption, and make it easy to maintain a happy mood. Therefore, depression patients should eat more calcium-containing foods. Calcium-containing foods include: soybeans and soy products, milk, fish, shrimp, dates, persimmons, leeks, celery, garlic, etc. Eat foods rich in amino acids often. For example, tryptophan is an important substance for the brain to produce neurotransmitters, and plays a very important role in uplifting people’s spirits. Tryptophan is abundant in sour milk, bananas, beef and chicken. Too little tryptophan can cause a drop in neurotransmitters in the brain, with the consequence of making people depressed. Psychotherapy. Due to a series of great physical and psychological changes, the patient’s personality tends to be irritable, sensitive, suspicious, stubborn, etc. Once stimulated by adverse factors, it is very easy to induce depression. Therefore, the prevention and treatment of menopausal depression is about emotional restraint and self-regulation. Keep your mind balanced, arrange your personal life regularly, and try to avoid bad mental stimulation. When encountering unavoidable negative life events, such as loss of spouse, separation of relatives or illness, you must face the reality, be calm and take your own health as the priority, do not worry about the consequences, which may trigger or aggravate depression. Emotional moderation: moderation of emotions, maintaining a harmonious balance of the psyche; emotional catharsis: the accumulation of depression in the heart of the bad emotions, through the appropriate way to declare, vent out; emotional transfer: change its surroundings, so that it is out of contact with adverse stimuli, factors, so as to free themselves from emotional entanglement, or transfer to something else.
Emotion over emotion method, is based on the emotions and the five organs and the principle of the five elements of yin and yang, “anger hurts
Liver, sadness overcomes anger”, “happiness hurts the heart, fear overcomes happiness”, “thought hurts the spleen, anger overcomes thought”, “worry hurts the lungs, happiness overcomes worry”, “fear hurts the kidneys, thought overcomes worry”. “Fear hurts the kidneys, thinking is better than fear”; using mutual restraint, mutual restraint of the emotions to divert and interfere with the original harmful to the body’s emotions, so as to achieve the purpose of harmonizing the emotions. I have seen some of these patients in the clinic and have accumulated some experience, so now I would like to share my treatment experience with you. In my opinion, the pathogenesis of this disease is based on the deficiency of kidney essence and blood, while the seven emotions are too extreme, leading to qi stagnation, phlegm condensation and blood stasis, and the occlusion of the orifices is its pathological process. Therefore, the identification treatment firstly identifies the location of the heart, liver, spleen and kidney, and then identifies qi, blood, phlegm, fire, stasis and deficiency and actual pathology, both of which are combined. The common types of symptoms are as follows: Liver and kidney yin deficiency: symptoms: anxiety, low mood, lack of energy, and lack of energy.
Emotional depression, lack of energy, also see physical wasting, dry mouth and throat, insomnia and dreaminess, zygomatic redness and low heat or five hearts, night sweating, short yellow urine, dry stool, red tongue with less fluid or less moss, thin pulse; treatment: nourish yin and tonify the kidney; prescriptions: nourish water and clear the liver drink, Liu Wei Di Huang Wan or two immortal soup; commonly used drugs: turtle version, Du Zhong, Zhi Mu, Gardenia, Dan Pi. Liver depression and qi stagnation, symptoms: emotional agitation and restlessness, mental depression, clinical manifestations are emotional agitation and restlessness, mental depression, chest tightness, good sighing, distension and pain in the ribs or less abdomen, belching and nausea, premenstrual breast distension and abdominal pain, breast lumps, menstrual irregularities in women, thin white tongue coating, string pulse, etc. Treatment: dredging the liver and relieving depression; treatment: dredging the liver and relieving depression; prescriptions: Yue Ju Wan, Xiao Chai Hu Tang, Chai Hu Dredging Liver Soup or Yi Yao San; commonly used drugs: Chai Hu, Yu Jin, Xiang Shen, Wu Yao, Buddha’s Hand. Fire in the heart and liver, symptoms: irritability and irritability, red eyes, vomiting, noisy and acid swallowing, stuffy feeling in the chest, constipation, bitter mouth, dry throat, red tongue with yellow fur and string pulse. Treatment: Clearing the heart and draining the liver, dispelling fire and relieving depression. Herbs: Dan Gardenia Progressive San; Commonly used drugs: Scutellaria baicalensis, Huang Lian, Sheng Di, Lian Zi, Zhi Mu, Dan Pi, Gardenia. Qi depression and phlegm obstruction, symptoms: listlessness, interest in solitude, depression, pharynx, obstruction, coughing, swallowing (i.e. plum kernel gas), stuffiness and distension in the chest, white and greasy tongue coating, slippery pulse; treatment: dredging liver and Qi, resolving phlegm and relieving depression; prescriptions: warm gall bladder soup, half-hsia and thick park soup; commonly used drugs: half-hsia, poria, Su stems, Buddha’s hand, Chen Pi, Wu Yao. Loss of nourishment of the heart and mind, symptoms: mental trance, restlessness of the will, hysteria, thoughts of the heart and mind, restlessness, inability to speak coherently, obvious impairment of logic, sadness and desire to cry, disturbed heart without sleep, palpitations, sitting and lying down, restlessness, pale tongue, faint pulse; treatment: nourishing the heart and nourishing the blood to calm the mind; prescriptions: Baihe Dihuang Tang, Sour Jujube Soup or Ganmai Da Zao Tang. Commonly used drugs: jujube seed, dragon bones, oyster, helianthus bark, and farro. Heart and spleen deficiency, symptoms: dullness, dizziness, insomnia, forgetfulness, poor appetite, diarrhea, fatigue, pale tongue, weak pulse. Treatment: Strengthening the spleen and nourishing the heart; prescriptions: nourishing the heart soup, spleen-giving soup; commonly used drugs: Radix et Rhizoma Ginseng, Atractylodes Macrocephala, Radix Angelicae Sinensis, Radix Astragali, Longan Pulp. Cold coagulation of the liver chakra, symptoms: anxiety,
Mood depression, lack of energy, hypochondriacal pain, cold extremities, localized acute cold pain, no thirst, pale tongue, white moist coating, tight pulse; treatment: warming the menstrual flow and dispersing cold, relieving liver depression; prescription: warming the menstrual flow and stagnation soup or regulating the menstrual flow and relieving depression soup; commonly used drugs: Wu Zhuyu, Angelica sinensis, Chuanxiong, Gui Zhi. Heart and gallbladder Yang deficiency, symptoms: headache, neurasthenia, irritability, sleeplessness, hysteria, fear of cold, cold limbs, unfavorable urination, thin stools, white face, pale fat tongue, white slippery coating, sunken and weak pulse; treatment: conciliate the lesser yang, detoxify the muscles and open the yang; prescription: Chai Hu Gui Zhi Tang; commonly used drugs: Chai Hu, ginseng, peony, dry ginger, cinnamon branch. In fact, in clinical practice, I commonly use nothing more than the kidney tonic with Wu Zi Tonic Kidney Pill, liver detoxification with Prosperity Pill, and warm gallbladder soup to resolve phlegm. I like to use the warm gall bladder soup, for cold phlegm on the original formula, hot phlegm to remove the half summer, add slippery stone, etc..
Acorus calamus Yujin, Radix Astragali Angelicae Sinensis, Zhi Mu Huang Bai, Cuscuta Epimedium, Chuan Xiong Shi Wei, Yuan Hu Chuan Neem. Emotional catharsis: venting emotions, such as crying and chatting; emotional transference: “the body is on the road, not the mind”; reverse thinking backwards results, truncating the patient’s confused thinking.