After menopause, GnRH secretion increases and balances with LH. 5. Inhibin

After menopause, GnRH secretion increases and balances with LH. 5. Inhibin After menopause, the concentration of inhibin in women's blood decreases, earlier and more noticeably than E2, potentially serving as a more sensitive indicator of declining ovarian function. II. Clinical manifestations

1. Symptoms (1) Recent symptoms ① Menstrual irregularities: Changes in the menstrual cycle are the earliest symptoms appearing during the menopausal transition, due to the absence of ovulation, manifesting as irregular cycles, prolonged periods, and increased or decreased menstrual flow. ② Vasomotor symptoms: Mainly hot flashes and sweating, characteristic symptoms of declining estrogen levels. They are characterized by repeated brief episodes of flushing on the face, neck, and chest, accompanied by heat, followed by sweating. Typically last 1–3 minutes, occurring several times a day, even more than ten times, and easily triggered at night or during stress. These symptoms can persist for 1–2 years, sometimes up to 5 years or longer. ③ Autonomic nervous system dysfunction symptoms: Often include palpitations, dizziness, headaches, insomnia, tinnitus, etc. ① Psychoneurological symptoms: Difficulty concentrating, memory decline, significant mood swings. Manifestations include irritability, anxiety, low mood, depression, and lack of self-control. (2) Long-term symptoms ① Urogenital symptoms: Appearance of vaginal dryness, difficulty with intercourse, recurrent vaginal infections, and other urogenital atrophy symptoms, as well as frequent urinary tract infections, including difficulty urinating, pain during urination, and urgency. ② Osteoporosis: After menopause, women experience increased bone resorption due to estrogen deficiency, leading to rapid loss of bone mass and osteoporosis. More than half of women over 50 develop osteoporosis, usually 5–10 years after menopause, most commonly affecting the vertebrae. ③ Alzheimer's disease: A major type of senile dementia. After menopause, women have a higher incidence than elderly men, possibly related to declining estrogen levels. ④ Cardiovascular diseases: After menopause, women experience significantly more arteriosclerosis and coronary heart disease than before, possibly due to low estrogen levels and increased androgen activity.
2. Physical signs As the number of years since menopause increases, gynecological examinations reveal varying degrees of atrophy in both internal and external genital organs, with reduced cervical and vaginal secretions. III. Diagnosis (1) Medical history. Most cases occur between ages 45 and 55; if onset occurs before age 40, premature ovarian failure should be considered. Pay attention to asking whether there were any special changes in work or lifestyle before onset, whether there was psychological trauma, or a history of bilateral oophorectomy or radiation therapy. (2) Clinical manifestations. Along with menstrual irregularities or menopause, vasomotor symptoms, psychoneurological symptoms, and urogenital atrophy symptoms also appear. (3) Gynecological examination. Shows varying degrees of atrophy in internal and external genital organs, with reduced cervical and vaginal secretions. (4) Laboratory tests. Elevated serum FSH levels, decreased E2 levels, and vaginal exfoliative cytology showing varying degrees of estrogen deficiency—all of which are helpful for diagnosing this condition. IV. Western medical treatment
3. Hormone replacement therapy (HRT) Indications: ① Patients with unstable vasomotor function and urogenital atrophy symptoms. ② Those with low bone mass and postmenopausal osteoporosis. ③ Patients with psychoneurological symptoms. 2. Non-hormonal medications For patients with vasomotor symptoms and psychoneurological symptoms, oral paroxetine hydrochloride 20mg can be taken once daily; calcium supplements (such as calcium carbonate, calcium phosphate, calcium chloride, calcium citrate, etc.) and vitamin D, calcitonin, bisphosphonates, and other preparations can be used to prevent and treat osteoporosis. V. Treatment experience of Professor Pei Zhengxue Menopausal syndrome does not have an independent disease name recorded in ancient medical texts; according to its clinical manifestations, it is scattered across discussions of conditions such as "zang zao," "nian lao xue beng," "bai he bing," "yu zheng," and "bu mei." Professor Pei Zhengxue believes that around the time of menopause, women's kidney qi gradually declines, the Chong and Ren channels become deficient, Tian Gui is about to run out, essence and blood are insufficient, yin-yang balance is disrupted, resulting in kidney yin deficiency, yang hidden, or kidney yang deficiency and the meridians losing their warming and nourishing functions—manifestations of kidney yin and yang imbalance. This leads to dysfunction of the internal organs, so kidney deficiency is the root cause of the disease. Due to differences in physical constitution, clinical presentations vary: some have kidney yang deficiency, others have kidney yin deficiency, and some have both kidney yin and yang deficiency, with kidney yin deficiency being the most common. The kidneys govern bones and produce marrow, serving as the foundation of innate constitution. Kidney yin and yang are the roots of the body's yin-yang balance; once they are deficient, all internal organs and meridians lose their nourishment and warmth. Modern medical research proves that tonifying the kidneys plays an important regulatory role in the human endocrine system, especially the pituitary-adrenal cortex system, the pituitary-gonadal system, and the internal environment. Therefore, treatment of perimenopausal syndrome should also focus on regulating the yin-yang balance of the kidneys. The liver and kidneys share the same origin of Tian Gui; women take the liver as their innate organ and store blood, all of which belongs to the Chong and Ren channels. When the Chong and Ren channels are weak, it leads to dysfunction of the internal organs, especially when menstruation is about to stop or has already stopped—the liver is the dominant site of disease. In addition, the liver governs emotions; when liver qi is released appropriately, emotions are smooth, but when liver qi is stagnant, emotions become depressed or irritable. Clinically, psychoneurological symptoms are one of the main manifestations of perimenopausal syndrome in women, so treatment should also focus on soothing the liver. Furthermore, the gradual decline of the spleen and stomach is also an important factor leading to women's menopause. During the aging process, kidney deficiency can cause spleen deficiency, and spleen deficiency can also cause kidney deficiency. Therefore, Professor Pei Zhengxue believes that the etiology and pathogenesis of this disease are mainly due to kidney deficiency, with kidney yin deficiency, kidney yang deficiency, or both kidney yin and yang deficiency affecting the heart, liver, spleen, and stomach, leading to various pathological changes. Because of the imbalance of yin and yang in the kidneys, kidney yin is insufficient, water cannot nourish wood, and liver yang rises excessively; or kidney essence is insufficient, kidney water cannot ascend to nourish the heart, resulting in disharmony between heart and kidney; moreover, the liver and kidneys share the same origin, so when kidney essence is insufficient, the liver fire lacks nourishment, liver qi stagnates, and cannot circulate smoothly; the spleen and stomach are acquired organs that mutually nourish each other, but when kidney yang declines, water cannot warm wood, leading to spleen and kidney yang deficiency; or excessive thinking and overwork harm the heart and spleen, resulting in both heart and spleen deficiency, disrupting qi and blood, affecting the Chong and Ren channels. The fundamental pathogenesis is due to kidney deficiency and yin deficiency, harming the heart, liver, and spleen. Treatment focuses on tonifying the yin and yang of the kidneys, soothing the liver and resolving stagnation, and harmonizing Ying and Wei. VI. Differential diagnosis and treatment by Professor Pei Zhengxue
4. Kidney yin deficiency Symptoms: Around menopause, dizziness, tinnitus, lumbago, leg weakness, hot flashes and sweating, five heart-flares, insomnia and vivid dreams, dry mouth and throat, or skin itching, menstrual irregularities, scanty or heavy flow, bright red menstrual blood; red tongue, thin coating, fine and rapid pulse. Treatment principle: Nourish kidney yin and benefit yin, cultivate yin and conceal yang. Prescription: Liu Wei Di Huang Wan with modifications. Shu Di Huang 12g, Shan Yao 10g, Shan Zhu Yu 6g, Fu Ling 12g, Dan Pi 6g, Ze Xie 10g, Di Gu Pi 10g, Mai Dong 10g. If there is bitter taste in the mouth, dry throat, and five heart-flares, add Huang Lian and Tian Hua Fen to nourish yin and clear heat; If constipation and dry tongue coating, add Dang Gui and Rou Cong Rong to nourish yin and moisten dryness. If both eyes are dry and irritated, add Goji berries and Chrysanthemum flowers; if headache and dizziness are severe, add Tian Ma, Gou Teng, and Pearl Mother.
5. Both kidney yin and yang deficiency Symptoms: Around the time of menopause, sometimes hot flashes and sweating, sometimes feeling cold and having cold limbs, lumbago and fatigue, dizziness and tinnitus, edema, menstrual irregularities, excessive or insufficient menstrual flow, continuous dripping, or sudden torrential flow, pale or dark menstrual blood. Pale tongue, thin coating, weak and slow pulse. Treatment principle: Tonify both yin and yang. Prescription: Er Xian Tang with modifications. Xian Mao 10g, Yin Yang Huo 10g, Ba Ji Tian 10g, Zhi Mu 10g, Huang Bai 6g, Dang Gui 10g, Nu Zhen Zi 15g, Goji Berries 15g. If there are hot flashes and night sweats, add Qing Hao, Bie Jia, and Di Gu Pi to nourish yin and clear heat; if insomnia, add Suan Zao Ren, Bai Zi Ren, He Huan Pi, and Ye Jiao Teng; if lower back pain, add Du Zhong, Niu Xi, and Sang Ji Sheng; If sweating is excessive, add Floating Wheat, Gan Cao, Da Zao, and Raw Oyster.
6. Disharmony between Ying and Wei Symptoms: Around menopause, limb soreness, alternating hot and cold, headache and dizziness, excessive sweating, mental restlessness, poor sleep, scanty and difficult menstruation, pale red tongue, thin white coating, floating and slow pulse. Treatment principle: Harmonize Ying and Wei. Prescription: Gui Zhi Tang with additions of Gan Mai Da Zao Tang. Gui Zhi 10g, Bai Shao 15g, Sheng Jiang 6g, Da Zao 10g, Gan Cao 6g, Floating Wheat 30g, Mai Dong 10g, Wu Wei Zi 6g, Sheng Long Gu 15g. If sleep is poor, add Suan Zao Ren, Bai Zi Ren, He Huan Pi, and Ye Jiao Teng; if headache and dizziness are severe, add Tian Ma, Gou Teng, and Chrysanthemum flowers; if palpitations, add Zao Ren and Gui Yuan Rou; if shortness of breath, add Huang Qi and Dang Shen.
7. Disharmony between heart and kidney Symptoms: Around menopause, irritability and insomnia, easy startle response, even emotional disturbances, menstrual irregularities, scanty or heavy flow, bright red menstrual blood, dizziness and forgetfulness, lumbago and fatigue; red tongue, thin coating, fine and rapid pulse. Treatment principle: Nourish yin and replenish blood, nourish the heart and calm the spirit. Prescription: Tian Wang Bu Xin Dan with modifications. Dang Shen 10g, Xuan Shen 10g, Dang Gui 10g, Tian Dong 10g, Mai Dong 10g, Dan Shen 10g, Fu Ling 12g, Wu Wei Zi 3g, Yuan Zhi 10g, Ju Jing 15g, Suan Zao Ren 15g, Sheng Di Huang 12g, Zhu Sha 2g, Bai Zi Ren 15g.
8. Liver stagnation and qi blockage Symptoms: Around the time of menopause, intermittent hot flashes and sweating, irritability and anger, abnormal emotions, dizziness and tinnitus, breast tenderness, restlessness and insomnia, menstrual irregularities, or chest tightness and sighing. Pale or slightly dark red tongue, thin white coating, string-like and fine pulse. Treatment principle: Soothe the liver and resolve stagnation, harmonize the liver and gallbladder. Prescription: Chai Hu plus Long Gu and Oyster Soup with modifications. Chai Hu 10g, Sheng Long Gu 15g, Oyster 15g, Da Zao 10g, Huang Qin 10g, Gui Zhi 10g, Fu Ling 12g, Dai Zhe Shi 15g, Dang Shen 10g, Ban Xia 6g, Da Huang 6g, Sheng Jiang 6g. If breast and chest tenderness is obvious, add Chuan Lian Zi and Yan Hu Su to regulate qi and relieve pain; if menstrual period is prolonged and flow is difficult, add Yi Mu Cao and Ze Lan to activate blood circulation and regulate menstruation; if sleep is poor, add Suan Zao Ren, Bai Zi Ren, He Huan Pi, and Ye Jiao Teng. VII. Analysis of prescriptions used by Professor Pei Zhengxue Professor Pei Zhengxue treats both kidney yin and yang deficiency with Er Xian Tang, which originates from the "Chinese Herbal Formula Handbook" and consists of Xian Mao, Yin Yang Huo, Ba Ji Tian, Zhi Mu, Huang Bai, and Dang Gui. Among them, Xian Mao and Yin Yang Huo are the principal herbs, Ba Ji Tian is the assistant herb, and all three herbs are warm in nature, belonging to the liver and kidney meridians, tonifying kidney yang and benefiting essence. Modern pharmacological research shows that they can enhance the secretion of the hypothalamus-pituitary-gonadal axis, thereby regulating ovarian function and promoting estrogen secretion, exhibiting hormone-like effects without hormone-like side effects. Zhi Mu and Huang Bai are bitter and cold in nature, belonging to the kidney meridians; they can both drain liver fire and nourish kidney yin, while also mitigating the pungent and drying nature of Xian Mao and Yin Yang Huo, thus serving as auxiliary herbs. Dang Gui is warm in nature and belongs to the liver meridians, warming and nourishing blood, regulating the Chong and Ren channels,

making it a complementary herb. The entire formula embodies the principle of "seeking yang within yin, seeking yin within yang." It is believed that Gui Zhi Tang has the effect of "harmonizing Ying and Wei externally, calming the internal organs internally." Professor Pei Zhengxue believes that the essence of this effect is that the formula regulates the autonomic nervous system, metabolic system, endocrine system, and immune system. Gan Mai Da Zao Tang originates from Zhang Zhongjing's "Jin Gui Yao Lue · Women's Miscellaneous Diseases," which records that "women with zang zao feel sad and want to cry, as if possessed by spirits, often stretching and yawning,"

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Furthermore, it further elaborates on the timing and nature of pain: "Abdominal pain after menstruation indicates deficiency of qi and blood; pain before menstruation indicates stagnation of qi and blood. Qi stagnation causes abdominal distension, while blood stagnation leads to pain. It is even more important to distinguish between deficiency and excess, cold and heat." Meanwhile, the "Women's Gynecology Guide" recognizes that "excessive worry, rumination, anger, and rage can all lead to qi stagnation; when qi stagnates, blood also stagnates. Intense anger or rage can cause qi to become blocked, which in turn causes blood to become blocked as well. When qi and blood are stagnant, they cannot flow smoothly." "Blood moves with qi; when qi flows, blood flows; when qi stops, blood stops; when qi flows smoothly, blood flows smoothly; when qi flows in reverse, blood flows in reverse," thus meticulously explaining the relationship between the seven emotions and the mechanism of dysmenorrhea.

Modern literature research shows that different medical practitioners have their own interpretations of the etiology and pathogenesis of dysmenorrhea: