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Archive for the ‘Menopause’ tag

Infertility and TCM: Part 9: Tong Bing Yi Zhi.

By David Kreiner MD

June 29th, 2014 at 8:34 am

 

image courtesy of stuart miles/ freedigitalphotos.net

According to Western Medicine, a particular disease is caused by a specific pathogen and the Western Medicine treatment is directed at that pathogenic factor. However, Traditional Chinese Medicine (TCM) recognizes that two people may react differently to that same pathogen.  They refer to this as Tong Bing Yi Zhi.  For example, in one individual the symptoms may appear as Damp heat syndrome and in another as Yin deficiency with false heat syndrome. In TCM, despite the common pathogen, patients would be treated differently depending on the syndrome identified. Syndrome identification is based on 4 diagnostic methods: inquiring, palpation, inspection and listening/smelling. This information is gathered and analyzed to identify the syndrome that a patient is experiencing.

 

On the other hand, two people with two different Western diagnoses such as menopause and hyperthyroidism may experience the same TCM syndrome from their respective pathologic conditions, Yin deficiency with false heat. This is also referred to as Tong Bing Yi Zhi.  In this case it refers to treating different diseases the same because they result in the same TCM syndrome.  In the first case TCM treats the same disease differently because as a result of the varying natures and constitutions of patients the symptoms resulting from the same pathologic condition often varies. To clarify, we do not need to know in TCM what diseases the patients have. We treat them according to TCM by their syndrome diagnosis.

Syndromes are differentiated based on several different factors. There are eight principles of paired opposing conditions including; Exterior and Interior, Cold and Heat, Deficiency and Excess, and Yin and Yang. These general principles are the basis for categorizing all the syndromes. The other syndromes are differentiated according one of the following  theories such as; Qi, blood and body fluids, the theory of the Zang-Fu organs, the theory of the six channels or meridians of Qi, the four levels of heat invasion, and the three burners or sections of the body.

It is through the four diagnostic methods above that the practitioner identifies the syndrome affecting the patient. He/she will choose the particular treatment specific for the syndrome modified by the age and health of the patient. This can include Tui-Na massage, acupuncture, moxibustion, cupping, and herbal medicine all directed at specific points in the body depending on the syndrome.

To me, as a Western physician trained to direct treatment for a particular pathogen or disease, I am very attracted to differentiating treatment based on its specific effect on the individual patient. We know that the same disease can have different resulting effects on people and that different diseases can affect some individuals in the same way. Therefore, the concept of directing therapy based on the effect the pathogenic factor has on the individual appears to me to be an effective way to treat a patient. If a physician were to combine the Western pathogen-directed therapy with TCM treatment based on the syndrome affecting the individual then the East-West combination therapy I believe should be most ideal.

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Does the Western pathogen-based treatment plan seem sufficient or does the idea of blending it with Eastern principles of syndrome-based treatment seem like it’d be a complementary bonus?

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When Will You Be in Menopause? Do You Even Want to Know?

By Pamela Madsen

September 27th, 2010 at 8:22 am

As a peri-menopausal woman – the answer is yes. In fact I would like to know in advance that the period I am getting is my last one – so I can celebrate it. But the way things stand now – I won’t know that I am getting my last period until a year passes.  Kind of takes a lot of the ritual possibilities out of it. My girlfriend has a "Goddess Party" for her daughters when each of the got their first period – why shouldn’t we celebrate the last?

Now a new study released during 26th annual meeting of the European Society of Human Reproduction and Embryology in Rome  states that researchers  have developed an  accurate way to predict the age when women will hit the menopause using a simple blood test.

The average difference between the predicted age and the actual age that the women in their study reached the menopause was only a third of a year, and the maximum margin of error was between three and four years.

The  implications of this test for women and their doctors; if the results of the research are supported by larger studies,  means that women will be able to discover early on in their reproductive life what their expected age at menopause will be, so that they can plan when to start a family.

Knowing you fertility life span – is huge for women. That’s why Dr. David Kreiner at East Coast Fertility and I have been trying to get the word out about "Fertility Evaluations". Right now we can’t predict when a woman will hit menopause but technology does exist right now for women to get a reading on where they are now in their own biological clock.

In this new study – they are taking blood samples from 266 women, aged 20-49, who had been enrolled in the much larger Tehran Lipid and Glucose Study, Dr Ramezani Tehrani and her colleagues were able to measure the concentrations of a hormone that is produced by cells in women’s ovaries – anti-Mullerian Hormone (AMH). AMH controls the development of follicles in the ovaries, from which oocytes (eggs) develop and it has been suggested that AMH could be used for measuring ovarian function. The researchers took two further blood samples at three yearly intervals, and they also collected information on the women’s socioeconomic background and reproductive history. In addition, the women had physical examinations every three years. The Tehran Lipid and Glucose Study is a prospective study that started in 1998 and is still continuing.

Dr Ramezani Tehrani, who is President of the Reproductive Endocrinology Department of the Endocrine Research Centre and a faculty member and Associate Professor of Shahid Beheshti University of Medical Sciences in Tehran, Iran, said: "We developed a statistical model for estimating the age at menopause from a single measurement of AMH concentration in serum from blood samples. Using this model, we estimated mean average ages at menopause for women at different time points in their reproductive life span from varying levels of serum AMH concentration. We were able to show that there was a good level of agreement between ages at menopause estimated by our model and the actual age at menopause for a subgroup of 63 women who reached menopause during the study. The average difference between the predicted age at menopause using our model and the women’s actual age was only a third of a year and the maximum margin of error for our model was only three to four years.

"The results from our study could enable us to make a more realistic assessment of women’s reproductive status many years before they reach menopause. For example, if a 20-year-old woman has a concentration of serum AMH of 2.8 ng/ml [nanograms per millilitre], we estimate that she will become menopausal between 35-38 years old. To the best of our knowledge this is the first prediction of age at menopause that has resulted from a population-based cohort study. We believe that our estimates of ages at menopause based on AMH levels are of sufficient validity to guide medical practitioners in their day-to-day practice, so that they can help women with their family planning."

Dr Ramezani Tehrani was able to use the statistical model to identify AMH levels at different ages that would predict if women were likely to have an early menopause (before the age of 45). She found that, for instance, AMH levels of 4.1 ng/ml or less predicted early menopause in 20-year-olds, AMH levels of 3.3 ng/ml predicted it in 25-year-olds, and AMH levels of 2.4 ng/ml predicted it in 30-year-olds.

In contrast, AMH levels of at least 4.5 ng/ml at the age of 20, 3.8 ngl/ml at 25 and 2.9 ng/ml at 30 all predicted an age at menopause of over 50 years old. The researchers found that the average age at menopause for the women in their study was approximately 52.

Dr Ramezani Tehrani concluded: "Our findings indicate that AMH is capable of specifying a woman’s reproductive status more realistically than chronological age per se. Considering that this is a small study that has looked at women over a period of time, larger studies starting with women in their twenties and following them for several years are needed to validate the accuracy of serum AMH concentration for the prediction of menopause in young women."
Who knows – maybe one day we will be able to celebrate our last period – just as some people celebrate the first.

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