Cool Lady: Menopausal Hot Flash Formula

Ingredients:

Bie jia – 
Amyda sinensis turtle shell

Qing hao – 
Artemisia annua herb

Sheng di huang – 
Rehmannia glutinosa root (uncured)

Shu di huang – 
Rehmannia glutinosa root (cured)

Yin chai hu – 
Stellaria dichotoma root

Di gu pi – 
Lycium chinense bark

Han lian cao – 
Eclipta prostrata herb

Mu dan pi – 
Paeonia suffroticosa root bark

Zhi mu – 
Anemarrhena asphodeloides rhizome

Bai shao – 
Paeonia alba root

Water

Ethanol

Effects:

Eliminate or reduce perimenopausal and menopausal hot flashes and night sweats.  In Chinese medical terms, this formula primarily cools vacuity heat and secondarily nourishes the yin.  Cool Lady may also help with excessive menstrual bleeding, which is often due to too much “heat,” and there are herbs here that clear heat and stop bleeding.

Dosage:

Start with four full squirts of the dropper, twice a day.  This should eliminate or reduce your hot flashes quickly, within a matter of days.  If not, try more – five or six squirts.  Once you are feeling better, start reducing the twice-daily dose. Play around with the dosage, constantly trying to achieve your minimum effective dose.  After several weeks of being blissfully hot flash free, try weaning yourself completely and then use Cool Lady only on an as-needed basis.  I recommend thinning it down in a small glass of water, mostly because I personally can’t stand the taste of mu dan pi (tree peony root bark), which predominates.  Squirt the tincture into a cup of freshly boiled water to evaporate most of the alcohol if you wish to avoid alcohol. 

Background:

The Chinese talk a lot about yin and yang – you could say that it is the fundamental organizing principle behind all forms of classical Chinese culture, from painting to warfare to medicine.  In the human body, yin is the soft parts, the interior, the lower portion, and yang is the hard parts, the exterior, the upper portion.  Most importantly for our present purposes, yin is the watery, fluid aspect of ourselves – the ocean that we internalized when we crawled out of the sea many eons ago.  And yang is the fiery aspect – the flame of digestion, the heat of passion, the slow burn of life and growth.  Modern life is extremely yang: full force, relentless forward movement, constant stimulation and activity with too little time for the quintessential yin “activities” of sleep and rest.  The result is that we almost literally burn out, like soup that has been left on the fire too long.  Add to that the fact that both yin and yang naturally get depleted with age, and that women lose some of their yin on a monthly basis (blood is a subset of yin in the body), and you end up with a deficit of both – and for many women, a comparatively larger deficit of yin.  So, even though the yang fire is low, the yin water is even lower so the fire appears to flare.  This flaring, known as “yin vacuity fire,” can manifest as a hot flash.  What I love about this description of what’s going on in the body is that although it appears to be so poetic and metaphorical, it is actually extremely accurate and useful: the medicine that evolved from this way of thinking really works.  I would go so far as to say that this is why Chinese medicine truly shines when it comes to women’s health.  Yin-yang theory is an excellent basis for understanding much of nature, but it is especially good for diagnosing and treating women, who with their monthly cycles embody the ebb and flow of yin and yang, making them easier to treat.

Product Description:

This formula is a variation of Qing Hao Bie Jia Tang (“Artemisia and Turtle Shell Decoction”), first put down in writing in 1798 in a book on infectious disease.  The original formula was designed to treat injury to the yin in the wake of a febrile disease, with night fevers that recede in the morning.  My friend and teacher Andy Ellis first suggested to me years ago that I use it to treat hot flashes, saying it was stronger and more effective than most of the usual menopause formulas.  I’ve found him to be right!  And I am especially happy with this particular version, since it works so well.

The original formula consists of bie jia (turtle shell), qing hao (artemisia herb), sheng di huang (uncured rehmannia root), zhi mu (anemarrhena root), and mu dan pi (tree peony root bark).  The crux of this formula is the pairing of turtle shell, which is deeply yin-nourishing, with artemisia, which clears heat.  Note that this is Artemisia annua, the source of the sesquiterpene lactone artemisinin (widely used in combination malaria treatments and off-label as a cancer treatment), not the Artemisia absinthium that shows up in my home-made absinthe or the Artemisia vulgaris that I use for making moxa.  Although sheng di huang (uncured rehmannia root) and zhi mu (anemarrhena root) are considerd to be somewhat yin-nourishing, they are primarily heat-clearing herbs, as is mu dan pi (tree peony root bark), the remaining herb in the original formula.  Therefore, you can see that this formula is more about clearing the vacuity heat than it is about nourishing yin per se.

To make my version of this formula more yin-nourishing, I have added shu di huang (cured rehmannia root), which strongly nourishes the yin and the blood, and han lian cao (eclipta herb), which also tonifies the yin while at the same time clearing vacuity heat (eclipta also has the reputation, both in Chinese medicine and in Indian Ayurveda, of turning grey hair black again).  Additionally, the herbs di gu pi (lycium bark) and yin chai hu (stellaria root) are included for their specific effect of clearing yin vacuity heat.  Finally, a small amount of bai shao (peony root) is included to “preserve the yin.”  Bai shao has an astringency that hold the yin in and helps prevent night sweats.  It is also a major blood-tonifying herb that regulates the menses and smoothes the qi and blood in conditions such as abdominal pain, cramps, and all-around yuckiness-feeling.  Bai shao is one of my favorite herbs.

It is not uncommon for women to experience excessive menstrual bleeding during the transition to menopause.  This is because, as it heats up, the blood turns "reckless" and overflows.  Fortunately, many of the herbs here help stop menstrual bleeding: sheng di huang, mu dan pi, di gu pi, han lian cao, yin chai hu, and bai shao all help in some way to regulate and stop menstrual bleeding.  For this reason, this formula can be very useful not just for perimenopausal and menopausal women, but for any woman who experiences heavy periods due to heat in the blood.  It is possible to suffer from menorrhagia due to other causes, so if you are experiencing heavy menstrual bleeding with no hot flashes or other menopausal symptoms, you should get checked out by a practitioner of Chinese medicine to determine the cause of your heavy bleeding.  Or you can try some Cool Lady and, if it works, conclude that you have some sort of blood heat or yin vacuity heat going on.

Production Notes:

2.5 liters of an alcohol-water blend was slowly percolated through one kilogram of pre-moistened ground-up herbs to produce about 2 liters of tincture.  A second percolation of 500 ml. boiling water was performed to better extract the more water-soluble yin-nourishing herb constituents, and the resulting fluid was added to the main tincture.  Strength of the final tincture is 1:2.5. 

I can’t help but put in a plug here for Spring Wind Herbs, the source for most of the dried bulk herbs that go into my tinctures (and owned and run by the aforementioned Andy Ellis).  A lot of bulk Chinese herbs out there are in pretty sorry shape.  Not only is misidentification and mislabeling of herbs a problem in the industry; even if the herb is the correct plant, there’s a lot of dusty musty stuff out there whose colors and aromas are indistinct and which has probably sat in a warehouse for months, being nibbled on by rats and bugs.  Not so Spring Wind Herbs!  Opening the sealed plastic bags of Spring Wind herbs is a feast for the senses.  The qing hao in this formula is the freshest, most vibrant qing hao I’ve ever seen: so green, so fragrant!  And the mu dan pi, also so strongly aromatic (if yuckily so).  The sheng di huang and shu di huang are notoriously difficult to grind, so I was extremely pleased to be able to get them pre-ground to a fine powder (how do they do it? first freeze-dry, then grind?).  Thank you Spring Wind!

Other Considerations:

You shouldn’t rely exclusively on Cool Lady to nourish your yin and clear your heat.  Stop being so yang’d out.  Slow down.  Rest more.  Spend time communing with earth and ocean.  Incorporate more yin-nourishing foods into your diet, like seaweeds (wakame, kombu, hijiki), leafy greens, mung beans, oysters, fish, mushrooms.  Drink enough water.  Cut down on, or eliminate, things that burn the yin, like alcohol, cigarettes, and spicy fried foods.  Because Cool Lady is more heat-clearing than yin-nourishing, you may find that it gets rid of your hot flashes, but when you stop taking it the hot flashes come back.  If you follow the dosage recommendations above and find that your hot flashes return after you have weaned yourself from the herbs, you should take a more straightforwardly yin-nourishing formula such as Liu Wei Di Huang Tang (available in most natural food stores in pill form) in conjunction with Cool Lady.  Take the Liu Wei Di Huang Tang regularly and long-term, adding Cool Lady at low dose or as needed.  Cool Lady is not meant to be used long-term, as the preponderance of cooling herbs may dampen the digestive fire and end up causing loose stools or diarrhea.  If your digestion is weak to begin with, try smaller doses and take them after meals rather than before.  If this doesn’t work for you, let me know, and we can discuss herbal strategies for protecting the digestion while concurrently nourishing yin and clearing vacuity heat.