Featured Conference Speaker Cara Frank article on Chinese Herbal Strategies for the Treatment of Estrogen Dominance

Chinese Herbal Strategies for the Treatment of Estrogen Dominance

Cara O. Frank, L.OM.

Many Chinese herbal formulas date back centuries, if not millennia. They are well documented historically and endure to this day based on their efficacy. They work and surpass the test of time. Despite a wide range of doctors, currents of thought, herbs, formulas, strategies, and diseases, the core architecture of well written Chinese herbal formulas incorporates a kind of synchronous harmony of qi mechanisms: of building and clearing; of holding and moving; of ascending and descending; of expansion and contraction. Herbs are relational: they enhance one another; they control one another, and often they become more than the sum of their parts together.

For practitioners specializing in gynecology, one common complaint we encounter are a cluster of signs and symptoms that collectively represent a common hormonal imbalance called estrogen dominance, which refers to a hormonal imbalance where estrogen is imbalanced relative to progesterone. Perimenopausal women in their 30’s and 40’s are especially vulnerable to this.

Estrogen dominance is a term first coined by Dr. John Lee who championed the use of natural progesterone in the 1990’s. It describes a condition where a woman can have deficient, normal or excessive estrogen, but has little or no progesterone to balance its effects in the body. Even a woman with low estrogen levels can have estrogen dominance symptoms if she doesn’t ‘t have sufficient progesterone to balance her hormones.

Common symptoms that women may experience include :

  • Decreased sex drive
  • Irregular or otherwise abnormal menstrual periods
  • Bloating (water retention)
  • Breast swelling and tenderness
  • Fibrocystic breasts
  • Headaches (especially premenstrually)
  • Mood swings (most often irritability and depression)
  • Weight and/or fat gain (particularly around the abdomen and hips)
  • Cold hands and feet (a symptom of thyroid dysfunction)
  • Hair loss
  • Thyroid dysfunction
  • Sluggish metabolism
  • Foggy thinking, memory loss
  • Fatigue
  • Trouble sleeping/insomnia
  • PMS

In Chinese medicine, we might diagnose Qi Stagnation with retention of damp, blood stasis, as well as qi and yang vacuity. We might break this diagnosis into two main presentations: The first emphasizing dampness and the second emphasizing qi stagnation causing heat.

The first is Li Dong Yuan’s Lǐ Shì Qīng Shŭ Yì Qì Tāng (Summerheat-Clearing Qi-Boosting Decoction). This large and complex formula is a variation of Li’s most iconic formula: Bŭ Zhōng Yì Qì Tāng (Center-Supplementing and Qi-Boosting Decoction). It includes all the hallmarks of his formula construction: Gé gēn, shēng má and huáng qí raise the clear yang; huáng qí, bái zhú and zhì gān căo supplement the qi and strengthen the spleen; huáng băi, cāng zhú and zé xiè clear heat and dry dampness; shén qū, chén pí and qīng pí regulate the qixī yáng shēn, mài mén dōng and wŭ wèi zĭ nourish the yin and generate fluids.

Despite the original intention of the formula to treat Summerheat invasion,

in fact, when deconstructed, we can easily see how it can address the qi dynamics and pathologies that manifest as symptoms of estrogen dominance.

Lǐ Shì Qīng Shŭ Yì Qì Tāng (Summerheat-Clearing Qi-Boosting Decoction)


黄芪 huáng qí 9-12g Radix Astragali
西洋参 xī yáng shēn 3-4.5g Radix Panacis Quinquefolii
苍术 cāng zhú 4.5-g Rhizoma Atractylodis
bái zhú 4.5-6g Rhizoma Atractylodis Macrocephalae
mài mén dōng 9-12g Radix Ophiopogonis
五味子 wŭ wèi zĭ 3-6g Fructus Schisandrae Chinensis
葛根 gé gēn 6-9g Radix Puerariae Lobatae
chén pí 3-6g Pericarpium Citri Reticulatae
青皮 qīng pí 3-6g Pericarpium Citri Reticulatae Viride
dāng guī 6-9g Radix Angelicae Sinensis
升麻 shēng má 3-6g Rhizoma Cimicifugae
zé xiè 6-9g Rhizoma Alismatis
黄柏 huáng băi 6-9g Cortex Phellodendri Chinensis
神曲 shén qū 6-9g Massa Medicata Fermentata
炙甘草 zhì gān căo 2-3g Radix et Rhizoma Glycyrrhizae Praeparata cum Melle

The actions of the formula are: to clear summerheat, supplement the qi, strengthen the spleen and dry dampness. The symptoms include: fever, headaches, thirst, sweating, a sensation of heaviness and loose stools.

Formula Analysis:

  • Xī yáng shēnmài mén dōng and wŭ wèi zĭ create the formula Shēng Mài Sǎn Pulse-Engendering Powder which preserves yin, supplementsqi, calms the spirit and stops excessive sweating.
  • Huáng qí and xī yáng shēn boost the qi and reduce fatigue.
  • Cāng zhú and huáng băi create the mini formula Er Miào Sǎn Mysterious Two Powder, which clears heat and dries dampness, especially in the lower burner. This herbal pair can be especially helpful for treating bacterial vaginosis, which frequently occurs in menopausal women as a consequence of vaginal dryness.
  • Huáng băi and zé xiè are featured together in the formula Zhī Bǎi Dì Huáng Wán Anemarrhena, Phellodendron, and Rehmannia Pill. While the first herb is bitter and cold and the latter is sweet and bland, they both settle ministerial fire, thus clearing deficiency heat. For severe sweating, Li also suggests that one add zhī mǔ Anemarrhenae Rhizoma, (along with wŭ wèi zĭ)” to restrain and gather in.”
  • All citrus parts regulate the qi. Here, chén pí and qīng pí dry dampness and reduce stagnation. Qīng pí enters the liver channel, and is notable for scattering and lump reducing qualities, making it helpful for breast lumps and ovarian cysts
  • Gé gēn along with huáng qí and shēng má, boost and lift the qi. Gé gēn is one of my favorite herbs. The range of its applications is broad, so I will limit my comments about how it can be helpful for brain-fog. We know that gé huā; the flower of gé gēn is used to treat alcohol toxicity. Therefore, gé gēn can be used for feeling dizzy and confused. Modern studies show that it can increase cerebral blood flow. In my practice, I include it in most of my formulas for patients with dementia and Alzheimer’s. So, within the context of this discussion, gé gēn may help alleviate brain fog. The second point of interest is that gé gēn is filled with isoflavones: mainly puerarin, methylpuerarin, daidzein, daidzin, and daidzein glucopyranoside. These are some of the same isoflavones that are found in soybeans. They are especially cardio protective, but the weak effect on hormones may act as an estrogen agonist, thus balancing the estrogen dominance.

To further  illustrate how wide ranging this formula is, in my book, Case Studies: Eye, Ear, Nose and Throat DisordersLǐ Shì Qīng Shŭ Yì Qì Tāng is used to treat a case of Ménière’s Disease. It is interesting to consider other disorders that share similar symptoms and indication a need for this formula such as chronic fatigue syndrome, gastroenteritis, environmental allergies, SIBO, and many others.

How can a formula, originally written to treat summerheat pathogen, and not gynecology, be helpful to a perimenopausal, estrogen dominant woman? The answer is simple: when the pathomechanisms of a disorder are deconstructed, the formula is spot on. Treat the pattern.

A second perspective:

One of my favorite formulas for the mixed patterns of qi stagnation, heat, and blood deficiency and stagnation is Jīng Jiè Lián Qiào Tāng, Schizonepeta and Forsythia Decoction. This formula was first recorded in the Wondrous Lantern for Peering into the Origin and Development of Miscellaneous Diseases (Zá Bìng Yuán Liú Xī Zhú, 杂病源流犀烛) published in 1773

荆芥 jīng jiè 3g Herba Schizonepetae
连翘 lián qiào 3g Fructus Forsythiae
防风 fáng fēng 3g Radix Saposhnikoviae
当归 dāng guī 3g Radix Angelicae Sinensis
川芎 chuān xiōng 3g Rhizoma Chuanxiong
白芍 bái sháo 3g Radix Paeoniae Alba
柴胡 chái hú 3g Radix Bupleuri
枳壳 zhĭ qiào 3g Fructus Aurantii
黄芩 huáng qín 3g Radix Scutellariae
栀子 zhī zĭ 3g Fructus Gardeniae
白芷 bái zhĭ 3g Radix Angelicae Dahuricae
桔梗 jié gĕng 3g Radix Platycodonis
甘草 gān căo 1.5g Radix et Rhizoma Glycyrrhizae

The formula is usually placed with formulas that dispel wind-heat pathogen. The actions of the formula are to dispel wind, clear heat, clear toxicity and reduce stagnation.

Formula Analysis:

  • Jīng jiè and lián qiào are the chief medicinals that dispel wind and clear heat. You can find this pair in Yin Qiao San as well. Both are light and ascending.Jīng jiè enters the blood, to vent heat from the blood, while lián qiào can clear wei level heat.
  • Bái sháo, chái hú, zhĭ qiào and gān căo create the formula Si Ni San– Four Frigid Extremities powder, which regulates the qi, clears constraint, and spreads liver qi.
  • Huáng qín and zhī zĭ clear heat. This pair is featured many formulas that clear fire.
  • Dāng guī and chuān xiōng harmonize the blood.
  • Bái zhĭ might be paired with lián qiào to clear toxic heat. It might also be paired with jié gĕng for this same purpose.
  • Gān căo harmonizes the formulas and, along with jié gĕng, benefits the throat.
  • Chái hú and jié gĕng have an ascending directional energy, while zhĭ qiào descends. The use of these three opens the chest and alleviates depression. Another formula that features these medicinals is Xuè Fǔ Zhú Yū Tāng House of Blood Stasis-Expelling Decoction.

In relation to our discussion, the list of common symptoms of perimenopausal, estrogen dominant women includes: Breast swelling and tenderness, anxiety and mood swings, “fuzzy thinking,” irritability, fatigue, loss of ambition, slow metabolism, water retention, loss of libido, PMS, weight gain, insomnia, thickening of endometrial lining, clotted menses, increased risk of uterine fibroid, increased incidence of ovarian cysts.

Let’s review how Jīng Jiè Lián Qiào Tāng might address these symptoms:

  • PMS, mood swings, breast swelling and tenderness, along with irritability are easily treated with Si Ni San.
  • Anxiety, irritability and insomnia can be treated with lián qiào and zhī zĭ, both of which clear heat form the heart and alleviate vexation.
  • Bleeding irregularities such as cramps or clotty menses can be treated with dāng guī and chuān xiōng and to a certain extent jīng jiè and huáng qín.
  • Ovarian cysts and breast lumps can be treated with bái zhĭ.
  • Acne is treated with jīng jièlián qiàofáng fēng, jié gĕng and bái zhĭ. 

Thus, the formula addresses nearly every symptom that might be encountered for a woman presenting with estrogen dominance. In contrast to Qīng Shŭ Yì Qì TāngJīng Jiè Lián Qiào Tāng is more effective for regulating the liver, harmonizing the blood and clearing heat, while Qīng Shŭ Yì Qì Tāng is more effective for spleen deficiency with retention of dampness combined. If we were to think about the directional energy of the formulas, Qīng Shŭ Yì Qì Tāng is uplifting, while Jīng Jiè Lián Qiào Tāng uses both ascending and descending herbs to open and regulate the qi.

What is the takeaway? The takeaway is to honor this statement: Tóng bìng yì zhì yì bìng tóng zhì. Same disease, different treatments. Different diseases, same treatment. As long as we treat the pattern, not the western diagnosis, we can nearly guarantee clinical results.

About Cara Frank, L.OM.

Cara Frank, L.OM. was raised by in a health food store in Brooklyn NY. When she was 8 she cartwheeled 5 miles from Greenwich Village through Soho and Chinatown and across the Brooklyn Bridge. For over 33 years she has had the same crazy passion for Chinese medicine. At 17 she had her first acupuncture treatment. At 20 she enrolled in acupuncture school. In 1998 she went to China to study where she fell deeply in love with Chinese herbs. Since then, she has devoted her life to studying and teaching the topic.

Cara is the founder of Six Fishes Healing Arts in Philadelphia where she maintains a busy acupuncture practice and acts as the head fish of warm and lively office. She is also the president of China Herb Company. You can read her full bio or schedule an appointment.