By Lia Andrews, DAOM, LAc
“The superior physician treats that which is not yet ill. The inferior physician treats that which is already ill.”
–Ling Shu Chapter 55
Every practitioner of Traditional Chinese Medicine is armed with this famed quote in school, yet we quickly finds him or herself out in the real world of paying bills and unrealistic patient expectations. It always seems to come back to this fundamental question: “How do we practice this incredible art in a chaotic, imperfect world?” In regards to the above quote, how do we treat what has yet to manifest when our patients come to us seeking immediate results for current symptoms? As good Daoists, we utilize what is given to us and transform it to a higher end.
Chinese medicine scholar Z’ev Rosenberg explained during a recent lecture that one of the key differences between our medicine and modern Western medicine is the sense of time. When we see a patient we see them with their present symptom, just like Western medicine. Unlike Western medicine, however, we see that moment in time within the context of the season, patient lifestyle and emotions, phase of life, childhood experiences, and their ancestral inheritance. We use several tools to predict what will happen in the future, both in terms of progression of current symptoms and those of yet unmanifested disharmonies. The right actions will affect the trajectory of that patient’s health for the rest of his or her life and onward to what is inherited by future generations.
Use the symptom. Human nature often requires desperation to bring us to the point of change. Let that bring your patient in the door. Give them relief and then open the door for what their lives can be. The system I have created for my practice and my series of books takes inspiration from several schools of thought on women’s longevity practices.
First and foremost, patient attitude, diet, and lifestyle comprise the foundation of health. The act of giving patients health homework empowers them to take responsibility for their own health. Next I incorporate the philosophy of Dr. Shuqi Zhuang, a renowned Taiwanese TCM physician of women’s health, who teaches that there are three golden opportunities for women to change their constitutions: regulating menstruation, recovering from childbirth, and balancing the menopausal transition. Additionally, I recommend sexual cultivation exercises as a means of circulating jing to promote longevity.
Give Daily Self-Care Homework
When treating a patient for the first time, it should be explained that all the actions of the TCM practitioner (acupuncture, cupping, moxa, herbs, etc.) are attempts to stimulate their system to correct itself. If they do not already have a meditation practice, you can give them a simply breathing exercise at the beginning of the acupuncture treatment that subsequently becomes the foundation of a daily practice. During the consultation or after treatment, you can explain the importance of Yin and Yang balance in their lives as a balance between rest and activity. Explain the ideal hours of sleep, eating with the seasons, and other basic concepts, then offer them dietary recommendations for their particular imbalance. For patients who do not already have some kind of relaxation practice, recommend they take a class (or video or podcast) in meditation, qigong, tai chi, yoga, or other similar practice. Most patients are already aware how diet and stress contribute to their symptoms; they just need guidance on the first step.
Take Advantage of the “Golden Opportunities”
Jing preservation is the primary goal when we discuss longevity. Jing can be leached away through overwork, regular stress, and poor diet, but is lost in greater quantities during procreation, or the potential for procreation, through the egg and sperm. Thus, men lose jing through ejaculation and women through menstruation and pregnancy. Most traditional cultures have prescribed ritual rest around menses and the postpartum month to protect women. On the one hand, modern women enjoy greater freedom and gender equality, but on the other, there is no medical or cultural framework that acknowledges women’s transitions and cycles. I have seen in my practice infertility and premature menopause result from this lack.
TCM practitioners are in a key position to educate the public on this matter. Symptoms during menses, after childbirth, and during peri-menopause are what most often bring women through the door. Fertility issues are typically linked to the menstrual cycle, and they may be complicated by poor recovery from a previous pregnancy.
Monthly menses signals more than just blood loss. The link between menstruation and longevity is seen in the concept of tian gui. The tian gui is related to hormonal and endocrine system maturation, manifesting in the sperm in men and in the menstrual blood and ova in women. Tian gui is intimately tied to jing essence and the ministerial fire; women must carefully mitigate blood and jing loss during menses, and supplement afterwards. Menstrual care practices include diet and lifestyle. Women are advised to rest, stay warm, eat foods that support blood flow and nourish the body, and promptly address any imbalances in the menstrual cycle or flow with acupuncture and herbal treatment.
Pregnancy, childbirth, and breastfeeding represent a major depletion in kidney qi, blood, and jing. Postpartum care, known as zuò yuèzi 坐月子, is one of the single most important practices for a woman’s health. Like menstrual care, postpartum care includes diet and lifestyle recommendations, but stricter and lasting for the first month or more after delivery. Postpartum women are to rest, bind their abdomens, and eat special foods. This facilitates the passage of lochia, the return of the uterus and waist to normal size, and the production of healthy breast milk.
A major obstacle to peri-menopausal care is that most women refuse to associate with that term until their periods have stopped and their symptoms are unmanageable, while peri-menopausal care should begin much earlier. The Huangdi Neijing outlines womens’ seven year jing cycles and notes that jing begins to decline during the fifth cycle, at age 35. If a woman begins rejuvenation practices at this age she can delay menopausal symptoms and minimize their severity. She will reduce the temptation to use oral contraception to halt her periods as she approaches menopause, which is becoming common practice. She will be less likely to rely on Hormone Replacement Therapy and cosmetic procedures. It is also easier for the practitioner, as the patterns are less entrenched, complicated, and difficult to resolve.
Treating Pre-Menopausal Jing Decline
In addition to the above mentioned practices, herbal medicine is very effective to promote longevity and rejuvenation. Perhaps the easiest way for patients to incorporate this on a daily basis is by using food herbs, also known as medicated diet or yàoshàn 药膳. Food herbs are can be taken long-term without side effects, they taste good, and they are less intimidating to those afraid of “herbs”. There are a number of food herbs I recommend to women beginning at the age of 35 including shan yao (Rhizoma dioscoreae), hei zhi ma (Semen sesame nigrum), gou qi zi (Fructus lycii) and long yan rou (Arillus longan).
In addition to food herbs, tonic herbs and formulas are required. One of the most effective anti-aging herbs is ren shen (Radix Ginseng). TCM Dermatology and Cosmetology expert Dr. Yueying Yi, OMD recommends that women begin taking 1 gram of ren shen daily beginning at age 35 to delay onset of menopause and mitigate symptoms.  There are studies showing marked improvement in menopausal symptoms with Korean red ginseng at slightly higher daily doses, even after the onset of menopause.
A 1990 study on the effects of Korean red ginseng and menopause used 47 female subjects diagnosed with menopausal disorder. Each subject took 4.5-6.0 g/day of red ginseng powder orally for 8 weeks. By the end of the study, the women showed a marked increase in blood flow to the ovaries. The study concluded that Korean red ginseng powder was effective to treat anxiety, dizziness, ovarian dysfunction (promoted secretion of estrogen), digestion disorder, sexual function, and depression associated with menopause. A 2002 study demonstrated significant relief in 30 menopausal subjects with a mean age of 57.3 years, taking 3g/day red ginseng powder with dang gui (Radix angelicae sinensis) and bai shao (Radix paeoniae alba) powder for 12 weeks. A third, randomized, placebo-controlled, double-blind study in 2012 studied 72 women ages 45-60. The subjects took 3 g/day of red ginseng in capsule form for 12 weeks. The study analyzed changes in menopausal symptoms using the Kupperman index. Subjects showed remarkable improvement, particularly a decrease in cardiovascular risk factor and increase in estradiol level.
As women near menopause it is common to experience increasingly irregular, and often heavy, menstrual cycles. The decline in Jing, which characterizes the onset of menopause, allows other imbalances to surface. Symptoms experienced during peri-menopause are key to resolving a woman’s primary imbalances before she enters the latter half of her life.
Peri-menopausal women typically present complex and changing patterns and thus need to rely more on TCM practitioners to guide them on diet and lifestyle and offer appropriate treatments and herbal medicine. As jing declines it can manifest as a yin and/or yang deficiency. Yin deficiency is more prevalent amongst women as they age, which is why hot flashes and dryness symptoms are almost universal during menopause.
Self-care becomes paramount with age. Women must practice daily stress relief such as qigong, tai chi, meditation, and yoga. Additionally, they must balance rest with work and play. Women can no longer live an unbalanced lifestyle without consequences. As women enter the post-menopausal phase of life, generalized jing deficiency becomes more pronounced and emphasis is placed on tonification.
Promote a Different Model of Sexuality
Sexual cultivation offers a model of sexuality that is distinct from both the religious sexual shaming and pornographic disempowerment that are rampant in our culture. It transforms sexuality into a balancing force in one’s life. Women are far less at risk of injuring their jing during sex than men. They are advised to practice moderation in sexual frequency and avoid intercourse when intoxicated or during menstruation.
Though women are biologically resistant, cultural constructs surrounding women and sexuality can be highly injurious to health. Sexual intercourse before sexual maturity can deeply injure yin and affect menstruation and fertility later on in life. Prostituted women, sexual violence victims, and molested girls are greatly injured by sex. Many women who have avoided these experiences may still suffer from body image issues or the burden of pleasing others.
If women are taught to have sex only when their bodies, hearts, and minds are all in agreement, this naturally leads to sexual moderation that is appropriate for their bodies and lifestyles without the imposition of arbitrary rules. In addition to this attitude change, women’s sexual cultivation practices typically include breast massage, ovarian massage, vaginal strengthening, and the circulation of sexual energy throughout the body. The stimulation and circulation of sexual energy has a rejuvenative effect on the body and stimulates hormonal balance.
Longevity medicine is the foundation of our medicine, particularly in the specialties of cosmetic acupuncture, fertility treatments, and menopausal care. If TCM practitioners are to do more than offer relief from symptoms, we must educate our patients on how to live better. Longevity practices need to be taken from theory into practices that can be incorporated into patient lifestyle.
Dr. Lia Andrews, DAOM, LAc is an educator, author, and practitioner of Longevity Medicine. Her books include 7 Times a Woman, The Postpartum Recovery Program™, and Secrets of the Daoist Courtesan. She co-owns Cinnabar Acupuncture and co-produces The Lia Andrews Show.
 Dr. Shuqi Zhuang, and her daughter Shoumei Zhuang, authored a series of books on this topic, and offer classes and services in Taiwan. The author submitted a partial translation of one of their works as her doctoral capstone, entitled The Postpartum Recovery Method, ISBN 957-8807-32-5.
 Kim-Goodwin, Yeoun Soo (2003). Postpartum Beliefs and Practices Among Non-Western Cultures. Retrieved September 20, 2007, from www.Nursingcenter.com
 TCM Gynecology. Giovanni Maciocia. Class notes.
 “What are the options for providing contraception to perimenopausal women?”. Ikhena, D. and Johnson, J. Menopausal Medicine. Vol. 20, Num. 3. Aug 2012.
 Yueying Li. “TCM Cosmetology.” (lecture, Yo San University, Los Angeles, June 6, 2003).
 Ren shen (Radix ginseng) is categorized by country of origin (commonly China, Korea, and Japan), wild versus cultivated roots, and processing. Ren Shen (Radix ginseng) grown in Korea is considered more potent. Red ginseng, or Hong Shen, is ginseng that has undergone a special steaming process that activates the ginsenosides and makes them more bioavailable. Korean red ginseng is far more potent as a Qi and Yang tonic than other types of ginseng but must be treated with respect. For example, it should be balanced with Yin nourishing herbs, particularly in women.
 Ogita et al., J Ginseng Res Vol. 14, No. 2, 162-166 (1990).
대한폐경회지, 5(1), 56-58 (2002).
 The Journal of The North American Menopause Society, Vol. 19, No. 4, pp. 461/466 (2012).
 Reference – maybe scholars video