4

Fire Aboard

Hot Flashes

Mary’s hot flashes add pleasant warmth to her otherwise freezing body, while Denise’s overheat her already hot system. Donna is capable of ignoring her hot flashes, while Jeannie is stopped in her tracks by them. Justine’s hot flashes are worse when she feels stressed or embarrassed, while Vicky’s wake her up in the middle of the night. Marsha’s hot flashes leave her feeling drenched, as sweat pours from every inch of her body, while Michelle stays as dry as a bone. Heat triggers Renée’s hot flashes, yet Barbara could stand naked in the snow and still get them. Wendy breezed through menopause without a single hot flash, while Elaine experienced one every day. Terry’s hysterectomy at age forty-three was followed by three years of intense hot flashes. Amy, who underwent a hysterectomy at the same age, never felt a hot flash. Pat felt a tingling sensation through her body before a hot flash occurred, but Cindy’s came without warning. Heather could feel heat rising from her stomach to her head, while Kelly’s hot flashes felt like someone had lit her whole body on fire. Cathy’s hot flashes worsened with moderate exercise; Nancy’s, though, went away after she began a new workout routine.

These experiences amount to only a small fraction of the feedback I have received from my patients. To make matters worse, not only would these hot flash symptoms differ from patient to patient, but they also varied from day to day. Even though Mary experienced a pleasant hot flash on Monday, come Thursday it was flaming as hell! Marsha’s hot flash on Tuesday left her drenched, but after the one on Friday, not a drop of sweat emerged from her skin. If apples are apples and oranges are oranges, why can’t a hot flash be a hot flash? Why is the hot flash experience so different from one individual to another? Of course, estrogen and progesterone levels may play a role, but not a single study out there could verify a direct correlation between levels of hormone deficiency and hot flash intensity. Many postmenopausal women, with only a fraction of the hormones they once had, are hot flash free. Clearly, there is more to hot flashes than just hormones and other physiological changes that come with menopause. We each respond to the external (work, family, friends, and so on) and internal (fluctuating hormone levels) environments in different ways based on our past experience, health state, and, perhaps most influential of all, body type. Hence the hot flash experience also fluctuates according to the individual and how she reacts to the environment, which is influenced but not dictated by hormonal changes.

Hot flashes, also referred to as “hot flushes” or “vasomotor symptoms,” are among the most commonly reported menopause-related symptoms, occurring in seven out of ten menopausal women in the United States.¹ Hot flashes are usually marked by a sudden feeling of warmth that is most intense over the face, neck, and chest but can be felt throughout the body. These episodes are often followed by sweating as the body attempts to adjust the internal thermostat and cool the surface of the body. Sweating may be mild or completely absent during a hot flash in some women, and if it does occur, it is mostly experienced at night, interfering with sleep.

THE HOT FLASH EXPERIENCE

Many women are able to sense when a hot flash is about to happen by feeling an uncomfortably warm sensation in their abdomen, a headache accompanied by heart palpitations, a tingling sensation on their skin, and/or a general sense of discomfort, irritability, or hypersensitivity to stress. The hot flash sensation is usually due to a rise of temperature only at the skin level as the cutaneous vessels dilate and warm blood rushes outward to the surface. Finger temperature rises, offering researchers a valid objective tool to record the frequency and intensity of hot flashes. The pulse rate also increases an average of nine beats per minute, often triggering anxiousness and/or irritability.

While hot flash symptoms are easily detectable, their etiology is not well understood in modern medicine. One theory involves the effect of declining levels of estrogen, which elevate other hormones such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH), produced in the pituitary gland, situated directly below the hypothalamus. Increased levels of FSH and LH signal the hypothalamus to dilate the blood vessels, causing a rush of blood toward the skin and decreasing the core body temperature. Other explanations involve the estrogenic influence of hormones such as epinephrine and norepinephrine, which also control vaso-dilation, resulting in the sensation of heat at the skin level. While these theories may hold merit, scavenging the body for a single hot flash source has led us to the discovery of yet further potential scenarios. The more we discover about human biology, the more hot flash explanations we’ll find. Within each person exists a universe of infinitely integrated, constantly interacting components that cannot be singled out and accused of causing a hot flash single-handedly. We will soon discover how in Sasang medicine, our stronger and weaker organ systems and their correlating emotions play an integrative role in avoiding or instigating a hot flash.

What Is the Difference between Hot Flashes and Night Sweats?

Basically, just the name. Both are episodes of sudden flushing, heat, and potential sweat. The only difference is that hot flashes occur during the day, and night sweats happen at night, mostly between the hours of 3:00 and 5:00 a.m. Night sweats, however, often produce more sweat than hot flashes do. In Eastern medicine, this is thought to be due to the difference between yin and yang, where yin correlates with the evening and moisture, and yang with daytime and dryness. Yet there can still be ample sweating with hot flashes and reduced sweating with night sweats since no rule is ever set in stone and other factors, such as our yin yang body type, have a role to play. The term hot flash is often used to describe both daytime and nighttime flushes of heat.

Hot flashes are not exclusive to menopause, since certain types of chemotherapy, radiation, and androgen treatment for breast and/or prostate cancer may also spark them. They may occur at different times throughout one’s lifetime or be exacerbated by an imbalance of the monthly cycle, hot weather, stress, anxiety, smoking, and/or caffeine. The hot flash experience varies across different ethnicities, cultures, climates, lifestyles, diets, attitudes, and genetics, making some prone to symptoms and others symptom-free. African Americans tend to suffer more from hot flashes than most other ethnicities in America,² while Japanese Americans report having fewer hot flashes than those of European descent.³

WESTERN AND EASTERN PERSPECTIVES ON HOT FLASHES

Estrogen replacement is the most efficient Western medical approach to decreasing hot flashes, boasting a success rate of up to 90 percent in eliminating them altogether.⁴ Other approaches include the use of antidepressants and blood pressure and/or anti-seizure medication. Venlafaxine, an antidepressant, reduced hot flash symptoms in up to 60 percent of those who were tested.⁵ With these statistics, most women who deal with consistent hot flashes would likely leap for joy at the possibility of relief, yet fewer and fewer doctors are prescribing these medications, encouraging their patients to seek alternatives.

According to the Women’s Health Initiative (WHI)—a comprehensive study performed in 2004 that included over five thousand participants—the risk of breast cancer increases significantly in women from ages fifty to seventy-nine who have not had a hysterectomy and who take estrogen and progesterone together. Another study, including over ten thousand women who underwent hysterectomies and were taking estrogen, was terminated early because of the significantly higher occurrence of stroke during the trial. Before these studies, both estrogen and progesterone were viewed as relatively safe and prescribed freely; they were even compared to a fountain of youth by some doctors. Shock waves over these studies can still be felt, leaving both doctors and patients wary of hormone therapy following menopause.

Another issue with estrogen, not dealt with in the above trials, is that when treatment is ceased, there is an over 50 percent chance that hot flashes will return, often worse than before estrogen withdrawal.⁶ Hence many women who experience symptom relief are advised by their doctor to keep taking estrogen, years after their last hot flash.

The above trials do not paint the whole picture of hormone replacement treatment, nor do antidepressants always cause side effects. In her book The Wisdom of Menopause, Dr. Christiane Northrup points out that beginning hormonal treatment in lower doses soon after or during perimenopause would have likely reduced the risks of cancer and/or stroke among participants in the aforementioned trials. She is also a proponent of bioidentical soy- and yam-based estrogens, such as 17-beta-estradiol, estrone, and estriol, designed to match the structure of human hormones. Dr. Northrup also holds that side effects can be reduced by adjusting the dosage according to the individual through obtaining bioidentical hormones from a compounding pharmacy capable of acutely adjusting dosages and hormone ratios. This approach contrasts with the standard approach to hormone therapy, which uses estrogens that are not as compatible with the human body, such as Prempro, which is derived from pregnant mare urine.

The use of antidepressants for hot flashes has increased within the past few years, perhaps in response to WHI trial hormone-related fears. The exact reason why antidepressants reduce hot flashes in some women is still not clearly understood, but it may have to do with the suggestion that emotions have a role to play in hot flashes—a premise of the Sasang medical view. Menopausal women often report experiencing hot flashes when they are feeling stressed, nervous, excited, or aroused. The use of antidepressants to control emotion, however, frequently presents side effects such as nausea, weight gain, loss of sex drive, fatigue, drowsiness, and/or insomnia. Not knowing how or why antidepressants affect hot flashes even in women who are not depressed, coupled with a high risk of side effects, is enough to steer many women clear of this option. Still others may find that the lowest possible dose of antidepressants helps reduce acute hot flashes and can be tapered off slowly once things are under control. If you decide to take the antidepressant and/or hormone therapy approach, I recommend concurrently engaging in alternative methods such as diet, herbal therapy, acupuncture, exercise, and emotional balancing. Doing so will likely enhance the effects of hormone replacement therapy and/or antidepressants and potentially allow you to reduce medication dosages through time.

In Eastern medicine, hot flashes are referred to as “rebellious heat,” which rises from one or more organs within the body. Sasang medicine focuses on releasing this heat from each body type’s stronger organ system through foods, herbs, exercises, and, most important of all, emotional balance. The approach to addressing hot flashes varies significantly according to where the heat originates from. The Yang Type A’s heat accumulates within the spleen, the original source of bodily heat, resulting in a “fire feeding fire” scenario. Hence the Yang Type A’s hot flashes are often the hottest of all four body types. The Yin Type B’s heat accumulates in her stronger kidneys, the body’s original source of cool energy, making her hot flashes the least uncomfortable of the four body types. In some cases, the Yin Type B may actually look forward to getting a hot flash because it gives her long-awaited feelings of warmth!

Even though many women feel as if their body has turned into a furnace when suffering from a hot flash, body temperature does not actually increase. Instead heat is displaced and pushed out to the exterior. The monthly cycle is an opportunity to release this energy from the body and start anew. If a cycle is skipped or nonexistent—as in menopause—the body has to release heat in other ways. If there is significant heat accumulation within the body, hot flashes are sometimes the only option it has. Menopause is a time when women come face-to-face with the rebellious child within, who has reluctantly waited decades for the opportunity to grab their attention. It’s time to become a rebel and stretch the strict rules by which emotional and biological processes were bound. The uterus is no longer a compartment where the heat of excessive emotion can be stored and released during the monthly cycle. It is time to become the person you are completely capable of being, whether or not it is the “correct” thing to do. As discussed earlier, heat is yang, and yang is the spark that ignites passion, growth, and change.

Night Sweats

Hot flashes tend to be more intense at night than during the day, stirring up extreme heat and abundant sweat, often interrupting sleep. At first a woman may find the heat so unbearable that she throws off the covers, only to feel extremely cold from being drenched in sweat moments later. There has been great speculation over why hot flashes mostly take place between 3:00 and 5:00 in the morning, and why they are so powerful within this time frame. Modern medicine falls short of answering these questions, simply explaining how night sweats are due to an impairment of the sympathetic nervous system and its inability to regulate internal temperature. Yes, an imbalance of the sympathetic nervous system may indeed be involved, but that doesn’t explain why this system, involved in the fight-or-flight response, kicks in when we are asleep and supposedly most relaxed.

In Eastern medicine, bodily energy is said to flow from one organ to another every two hours, completing a full cycle between 1:30 and 3:30 in the morning, when energy flows from the liver, the last organ of the cycle, to the lungs, the first. Most of us are usually sound asleep during this time, with our conscious thoughts out of the way, giving our body the chance to recycle its energies efficiently without disruption. Yet the liver doesn’t always want to give up its place in the spotlight, especially if it’s constitutionally the strongest organ, as with Yin Type As, who either choose to stay up late or wake up easily during this time. In order for us to renew our energies, something must give, and training our strongest organs to loosen the reins is easier said than done. Menopause itself is a time for women to renew their energies, but they can only be balanced through weeding out unnecessary and unhelpful thoughts, acquaintances, activities, and material belongings. Table 4.1 provides the various pathways our body’s energy takes in the course of a day.

The reason hot flashes are more intense in the evening is different according to each of the body types. As discussed earlier, night correlates with yin, and yin with cold. If night is associated with cold, then why would hot flashes worsen? For the yin-deficient yang types, the evening may give yang energy the opportunity to dance wildly about, without constraint, as we feebly seek sleep. For the yin types, abundant evening yin energy may smother and irritate yang to the point that it escapes upward and outward, bringing heat and sweat along with it.

TABLE 4.1. PATH OF ORGAN ENERGIES THROUGHOUT A TWENTY-FOUR-HOUR CYCLE
Time	Organ
11:01 p.m.–1:00 a.m.	Gallbladder
1:01–3:00 a.m.	Liver
3:01–5:00 a.m.	Lungs
5:01–7:00 a.m.	Large intestine
7:01–9:00 a.m.	Stomach
9:01–11:00 a.m.	Spleen/pancreas
11:01 a.m.–1:00 p.m.	Kidneys
1:01–3:00 p.m.	Urinary bladder
3:01–5:00 p.m.	Small intestine
5:01–7:00 p.m.	Heart
7:01–9:00 p.m.	Pericardium
9:01–11:00 p.m.	Lymph system

THE YIN AND YANG OF HOT FLASHES

Yang energy, associated with progesterone and testosterone, causes heat to rise up from deep within the body, and yin energy, associated with estrogen, cools it and sends it back down. It is easier to imagine how excessive yang energy bullying its way through our bodies can bring about hot flashes, but how can this happen when yin gets out of hand? Let’s take a closer look at the hot flash process to find the answer.

Sasang and Chinese medicines differ slightly with regard to hot flashes. The latter associates them with a deficiency of yin, which gradually wanes as we age. You may recall from chapter 1 that yin and yang go through significant changes within the female body every seven years. During the seventh of the seven-year cycles, a woman experiences the most intense change in which her kidneys, the source of yin energy, begin to decline, making it difficult to root yang, which jumps at the opportunity to ascend. Hence treatment for hot flashes in Chinese medicine primarily involves supporting yin and restraining yang energy. The Chinese medical practitioner often prescribes herbs that are yin-natured, cooling, and cloying in order to accomplish this.

This method is often successful when addressing the hot flashes due to yin weakness and yang abundance, but not everyone fits this profile. Hence patients who still have sufficient yin energy may find such herbs too cooling, heavy, and difficult to digest. Worse yet, some individuals may experience even more hot flashes after taking these herbs because, according to Sasang medicine, excessive yin is capable of clamping down on and squeezing yang to the point that it oozes and retreats upward, bringing a flash of heat with it. Hence even though a loss of estrogen, correlating to a decrease in yin, is believed to be the primary hot flash trigger, excessive amounts may also lead to the same symptoms. During perimenopause, for example, there are times when estrogen levels spike and are deemed to be the culprit behind intense, sweaty hot flashes. This coincides with the Eastern medical theory that yin at its extreme transforms into yang and vice versa. Does this mean that estrogen alone is to blame for hot flashes? While a loss of estrogen is the most obvious hormonal indication of menopausal onset, and hence gets the most attention, in actuality, any hormone that acts out or lags behind the others can cause menopausal symptoms. Menopausal bliss depends on a balance between yin and yang and between estrogen, progesterone, and testosterone.

Before diving into body-type-specific approaches to hot flashes, let’s look at six general tips that anyone experiencing them may find useful.

Tip #1: Reduce Stress

A study conducted in 2011 that included 110 pre- and recently postmenopausal women revealed how a meditation known as Mindfulness-Based Stress Reduction (MBSR) significantly reduced the discomfort associated with hot flashes. Interestingly, participants didn’t record any changes in hot flash intensity, but they were less affected by them. These results compared promisingly with other medications that have been known to reduce hot flashes⁷ and show how meditation can change how we perceive hot flashes even if they still occur.

How we perceive hot flashes makes all the difference. Someone who is new to hot flash symptoms may be frightened, feeling as if the doom and gloom of menopause is about to swallow her whole. Others who have suffered from flashes of heat in the past may not even recognize the onset of a menopause-related hot flash. Acceptance is an essential component of the healing process. To accept does not mean to give up your faith that things will get better. Instead, it is the acknowledgment that hot flashes have arrived, and rather than curse, moan, and complain, one can have faith that when the time is ripe, they too will pass. But meanwhile, it is time to adjust, take action, rediscover yourself, and realize that hot flashes are not to be “defeated.” Listen to your hot flashes and get accustomed to their occurrence without becoming possessed by them.

It is easy to fall into the trap of expecting hot flashes to occur and then, once they do, feeling as if they will never go away. Many women begin to identify themselves and their lives with hot flashes, finding it difficult to imagine life without them. Stop yourself before letting the feeling of defeat settle in and try following these simple but effective steps:

1. Accept that you are having a hot flash instead of denying it, or worse, fighting it.
2. Throw away thoughts of defeat, anguish, or other negative ideas that hot flashes may conjure up. Hot flashes can be the perfect excuse to lash out at others, think unpleasant thoughts, and feel hopeless if you choose to.
3. Breathe and center yourself. (Follow the steps in Tip 5.)
4. Let go. Whether it was an intense or a mild hot flash, once it is gone, it’s time to move on. It is easy to get stuck in the healing process as we overanalyze why this or that symptom occurred, thinking that we have to solve it here and now. The onset of a hot flash in some cases may be obvious, such as an explosive argument with a spouse. The reason why a hot flash occurs in others may not be so obvious, though, leaving a feeling of cluelessness. Actually, all that needs to be done in such situations is to keep the channel of further discovery open, and eventually wisdom and balance will flow in. You may never find an answer as to why your hot flashes occurred and be pleasantly surprised when they no longer do! What could possibly have resolved such flaming intensity? Often it is nothing but time, resilience, patience, and the wisdom that you have accumulated throughout the process.
5. Record when the hot flash occurred. Did it occur upon awakening? At work? Before bed? While sleeping? Hot flashes that occur first thing in the morning may indicate the feeling of being overwhelmed with daily responsibility. Hot flashes before bed or while sleeping may act as a relief valve, letting out the steam of daily stress. If your hot flashes occur at specific times during the day or night, or after particular situations, then prepare beforehand with deep breathing and calming your mind.

Tip #2: Exercise

Moderate exercise can reduce hot flashes, but strenuous exercise can induce them. Not even the most skilled trainer or doctor could tell you exactly how much exercise is too much or not enough. Listen to your body during and after exercise and expand and/or cut back on your routine accordingly. An exercise that triggered a hot flash last week might be doable this week. Determining exactly which exercise triggers your hot flashes and how much exercise will help moderate them is an ongoing challenge that changes according to not only the person but also to her age and the time. It also takes a considerable amount of effort and self-reflection. If you are starting an exercise routine or have difficulty figuring out which one is best for you, try following these practical steps:

1. Start simple, increasing your workout time and intensity slowly but surely. While there are many potentially supportive training methods, many of my patients have had the most success with interval training—enhancing and decreasing the intensity of a workout at regular intervals within a training session. This method contrasts with the idea of pushing beyond one’s limits without giving the body a chance to recharge.
2. Stay consistent, convincing yourself to do at least some form of exercise five days a week.
3. Exercise primarily to stay healthy and balance your energies, rather than simply to lose weight, gain muscle, and so forth.
4. Pace your breathing. When engaging in cardiovascular exercise, maximize your lung capacity by inhaling and exhaling as deeply as possible. I recommend counting to the highest number you can while inhaling and repeating the same amount while exhaling. Try pacing your breaths with each repetition, so that if you are bicycling, for example, each cycle, whether initiated by the left or right foot, may count as one pace. Then it is up to you to determine how many paces per breath—five paces breathing in, five out . . . six paces in, six out, and so on. As your workout becomes more intense, it will naturally be difficult to keep the same breathing rhythm, so be sure to adjust it accordingly, so you don’t have to gasp for air.

Tip #3: Balance Food Intake

Hot flashes almost always originate from heat stagnation and accumulation in one or more digestive organs. For the yang types excessive heat is often generated from the esophagus and stomach, and for the yin types, the liver and kidneys are often its source. Sasang medicine emphasizes the importance of eating according to your body type. I suggest referring to the appendix in this book or to my other book, Your Yin Yang Body Type, for extensive body-type-specific dietary suggestions. Here are a few general guidelines.

What to Eat

In general, avoiding excessively spicy, fatty, sour, sweet, and salty foods is of fundamental importance in avoiding hot flashes. Each flavor has its own energy that, in turn, affects different areas of the body. Excessive intake of any of these flavors may overstimulate, stagnate, and congest their correlating body areas. Moreover, consuming foods that are not compatible for your type may also instigate the onset of hot flashes.

How Much to Eat

Too much of any type of food, even if it is compatible with your body type, may irritate the stomach and potentially instigate a hot flash. Also, the consistent churning of heavy, difficult-to-digest foods often gives rise to excessive heat from friction within the stomach and intestines. Insufficient food intake, on the contrary, may stir up stomach acid, giving rise to excessive heat in the upper body. Only you have the ultimate ability to determine how much is too much/too little food intake. Listen closely to what your stomach is telling you and try not to ignore the signal of hunger or contentment. The road to optimum health begins within, by developing the ability to hear what your body is telling you without ignoring or overreacting to its message.

When to Eat

As mentioned earlier in this chapter, every organ of the body has its own active and latent period throughout a twenty-four-hour cycle. The stomach is most active and ready to perform between the hours of 7:00 and 9:00 a.m. Our ability to digest food efficiently starts to wane as we get farther away from this time period. Stomach time is an opportunity to ingest our heartiest meal of the day, lessening the chance of feeling fatigued, bloated, or heavy after eating. Some of us may find a cup of coffee and piece of toast in the morning adequate, but this habit may leave us fatigued and in need of more caffeine to keep us going as the day progresses. As a light eater myself, I recall being overwhelmed when my Taiwanese friend offered me a breakfast the size of a dinner, explaining that it is customary to do so in his home country! After giving this method a whirl, I began to feel more energized through the day. Now I routinely consume at least 30 percent of my daily caloric intake during stomach time.

Eating a larger meal in the morning isn’t for everyone. Those who are active throughout the day need the extra calories in the morning to charge their batteries, while others who are more stationary may notice feeling/ looking heavier and bloated after eating a substantially sized breakfast.

Eating dinner after 7:00 p.m., when our yang (metabolic) energy retires and yin (resting) dominates, may result in unsettled digestive energy and hence a hot flash. If you digest foods rapidly, then not eating for three or more hours before bedtime, in itself, could trigger a hot flash as the stomach juices swoosh about wildly, begging for more food. Nibbling on a rice cracker or drinking a warm cup of almond/rice/goat’s milk an hour or so before bed may suffice. Keep in mind that drinking a substantial amount of fluid directly before sleeping may trigger the need to wake up and urinate.

How to Eat

Eating in a rush or while stressed, forgetting to chew your food slowly, or focusing on something other than food while eating can also initiate hot flashes. Relaxing the mind, as if meditating, enhances the process of digestion, whereas a cluttered and unsettled mind simply disrupts it.

Tip #4: Try Acupuncture and Acupressure

A study performed at Stanford University demonstrated how nine sessions of acupuncture over a seven-week period greatly reduced the intensity of hot flashes.⁸ Along with assisting the flow of energy throughout the body, acupuncture needle insertion is also a way to release excessive heat. Patients who receive acupuncture for hot flashes often feel a chill throughout the body during the treatment as the body attempts to adjust its internal thermostat.

I often utilize the points shown below to relieve hot flashes, since they have effectively provided relief for my patients over the years. These points correlate with different organs of the body that may absorb heat and have difficulty letting it go. They can be compared to relief valves that let out excessive steam from an engine, which in the human body can be done via energy meridians flowing from each organ to the surface of the body. These points are most effective if they are addressed daily, even when hot flashes are not present.

Please note that you do not need to insert a needle at these points for the treatment to be helpful. Using acupressure, or applying pressure to each point, often yields significant results. Applying significant pressure to each point until it feels tender often yields better results than a light touch. Avoid using sharp metal objects that could penetrate your skin or applying excessive pressure.

 LIV2 (SECOND POINT ON THE LIVER MERIDIAN): “MOVING BETWEEN”

This acupressure point is the second from the tip of the foot along the liver meridian, located between the first and second toes (see fig. 4.1 below). There is often a short crease that continues from the inner side of the big toe downward to the upper part of your foot. LIV2 is located at the point where this crease terminates. LIV2 releases heat from the liver, where hot flash heat often originates.

Fig. 4.1. LIV2, second point on the liver meridian

• Use your index finger to apply direct pressure to LIV2 while counting to ten and breathing slowly.
• Gently release and then switch to the other foot.
• Repeat this process up to five times.

 ST44 (FORTY-FOURTH POINT ON THE STOMACH MERIDIAN): “INNER COURT”

Fig. 4.2. ST44, forty-fourth point on the stomach meridian

This acupressure point is the second from the tip of the foot along the stomach meridian and is located between the second and third toes (see fig. 4.2 above). There is often a short crease from the outer side of the second toe downward to the upper part of your foot. ST44 is located where this crease terminates. This point is indicated for the release of heat from the stomach, where heat tends to accumulate before a hot flash.

• Use your index finger to apply direct pressure to ST44 while counting to ten and breathing slowly.
• Gently release and then switch to the other foot.
• Repeat this process up to five times.

HT9 (NINTH POINT ON THE HEART MERIDIAN): “LESSER SURGE”

Fig. 4.3. HT9, ninth point on the heart meridian

Imagine two lines, one from the tip of your pinky nail, located on the side facing the ring finger and extending straight downward, and another across the bottom of the nail perpendicular to the first line. HT9 is located where these two lines intersect (see fig. 4.3 above). I often utilize this point to promote calmness and release excessive heat from the heart, our emotional center.

• Use your fingernail, a toothpick, or a pen to apply pressure to HT9 while counting to ten and breathing slowly.
• Gently release and then switch to the other hand.
• Repeat this process up to five times.

Tip #5: Breathe

A study conducted in 1996 demonstrated how three weeks of consistent slow and deep breathing significantly reduced hot flash symptoms.⁹ Several of my patients have reported that they can prevent the onset of a hot flash by breathing deeply as soon as they feel it coming. Breathing is the first and last thing we do as humans and in my opinion is the most convenient balancing tool we have, since it can be done right away, wherever we are.

There are numerous breathing techniques, most of them developed from the ancient yogic practice of pranayama. A Chinese technique, referred to as dan tian breathing, has shown promising effects in reducing hot flashes among many of my patients.

 DAN TIAN BREATHING

• Lie down with your hands resting on your lower abdomen.
• Slowly inhale while gently pushing your lower abdomen outward, letting the ingoing air fill it up. Try to avoid filling your chest with air, focusing only on your lower abdomen.
• Exhale, simply releasing the air from your abdomen, letting it flow back upward. At the very end you may want to gently squeeze your abdomen to ensure that all of the air has been released.
• Repeat these steps every day for at least five minutes before getting out of bed in the morning and before going to sleep. Imagine that you are bringing energy and heat downward from your head to your feet when inhaling and then releasing all the tension in your body when exhaling.

Tip #6: Consume Hot-Flash-Reducing Foods and Vitamins

The internet is saturated with hot flash remedies, often accompanied by exaggerated claims. While many of these approaches are somewhat effective in relieving hot flashes, they do not work for everyone or in every situation and aren’t always backed by substantial research and/ or literature. Table 4.2 provides a list of six common hot-flash-relieving foods/supplements and the body type they are most compatible with. In the latter half of this chapter, I will present several herbal hot flash remedies in detail for each body type. The combination of eating according to your yin yang body type and supplementing with body-type-specific herbal hot flash remedies doubles your chances of reestablishing balance.

HOT FLASHES AND THE YIN YANG BODY TYPES

Hot flashes induced by excessive yin and weakened yang are more common among the yin types, while those arising from abundant yang and weakened yin are experienced more frequently among the yang types. From the Sasang point of view, the seventh cycle of the seven-year cycles in women is associated with not only a weakening of yin but also a fluctuation of yang energy. During this cycle, each yin yang body type must cultivate herself further in her own way by getting in touch with and balancing her innate physiological and psychological inclinations. If an individual is constitutionally more yin-natured, then she will be prone to yin symptoms such as hot flashes with cold spells, sluggish digestion, diarrhea, and/or depression, but if she is yang-natured, then yang symptoms such as frequent heat spells, skin dryness, and/or anger abound.

Hot Flashes and Emotion

In research, hot flash testing is usually separated into two categories: subjective and objective. The former category relies on the patient’s subjective recording of hot flashes, and the latter on measurements such as core body temperature, heart rate, and finger blood flow. A study conducted in 2005 demonstrated how women who reported being joyful and calm exhibited significantly fewer subjective hot flashes than those who were angry, frustrated, and/or stressed. This study also revealed how anger, frustration, and/or stress resulted in higher levels of subjectively recorded hot flashes even without increases in body-surface temperature, heart rate, or finger blood flow. Hence unbalanced emotions can trigger the feeling of a hot flash even if there are no objective findings to back them up! If you think that’s interesting, here’s the real punch: Even though the joyful and calm group reported fewer subjective hot flashes, both groups averaged the same amount of objective ones. Hence even if estrogen and the hypothalamus are going absolutely bonkers, joyfulness and calmness may be enough to keep them from fazing us!^*6

Sasang medicine holds that how we feel emotionally determines whether or not we have a smooth or rough menopausal transition. This may be hard to swallow, since it is easier to imagine that hot flashes influence how we feel emotionally than it is to convince ourselves that our emotions can induce and aggravate menopausal symptoms like hot flashes. Each emotion has its own temperature: anger, for instance, is hot, and calmness is cold. These emotional inclinations make certain body types more prone to hot flashes than others, depending on the setting of their internal thermostat. The yang types tend to express hotter emotions, and the yin types cooler ones. Yet all four of the yin yang body types may experience hot flashes, since hot emotions are not exclusive to the yang types. Actually, the yin types may occasionally find it more challenging to deal with hot flashes than the yang types since they have less experience dealing with pronounced heat and hot-natured emotions.

Let’s take a look at how to address hot flashes according to the unique requirements of each yin yang body type.

YANG TYPE A

Even when she is not experiencing a hot flash, the Yang Type A is prone to overheating thanks to her stronger spleen—the body’s source of heat. Her angry temperament, which triggers the release of heat from the spleen, can easily generate hot flashes. Comfort, on the other hand, which is associated with her weaker kidneys and the element of water, produces cold energy. The Yang Type A’s menopause-related issues and the stresses of daily life may take her past the boiling point, turning anger into rage and water into fire. Herbal treatment for the Yang Type A is aimed at cooling the spleen and supporting the kidneys.

The Yang Type A with hot flashes is not always a raging bull. Actually, she may present herself as joyful, gentle, or even calm! But this is often an attempt to conceal her true nature and avoid offending or disappointing others. Until this point in her life, the Yang Type A may have been able to suppress and conceal her anger, or at least keep it from exploding. Yet menopause creates an entirely different dynamic for her: as the energies shift within her body, so do emotions, demanding her attention. Sure, the Yang Type A is able to feel joyful and calm, but only through getting in touch with and balancing her anger. If something rubs her the wrong way, she is not able to simply brush it aside like the yin types, since anger will rapidly build up. Yet responding with excessive anger only fans the flames of rage. Anger does not have to be expressed with one’s fist; it can be a motivational force that leads to positive and effective action.

Di Gu Pi
(Common: Lycium Bark; Latin: Lycium chinense)

In Eastern medicine, Di Gu Pi, or lycium bark, is used to treat steaming bone syndrome, a condition in which excessive heat radiates outward from the depths of the body—a common hot flash dynamic. As a cold-natured herb, lycium bark doesn’t only cool the body, it also nourishes the Yang Type A’s deficient kidney yin. It focuses primarily on cooling the stomach, clearing heat stagnation, and enhancing digestion. Lycium bark also clears heat from the skin, where it accumulates during a hot flash. The Yang Type A may notice an uncomfortable or painful skin sensation preceding or during the onset of a hot flash. This, also addressed with lycium bark, comes from trapped heat as it gets pushed outward from the depths of the body.

Common Uses

Lycium bark relieves hot flashes, excessive sweating, dry/painful skin, and indigestion (due to heat stagnation).

Sources

A tincture of Di Gu Pi can be purchased from the Hawaii Pharm website.

Preparation and Dosage

Please follow the manufacturer’s suggestions.

Herbal Friend: Zhi Mu (Common: Anemarrhena; Latin: Anemarrhena asphodeloides)

Zhi Mu (meaning “mother’s wisdom”), or anemarrhena, is an herb that truly lives up to its name. While most cold-natured herbs have a tendency to be drying, this herb has the remarkable ability to moisten the bodily organs while efficiently clearing heat. This can be likened to a mother’s ability to nourish and calm a fussy infant. Zhi Mu and Di Gu Pi work together to nourish yin and clear heat, calming those fussy hot flashes. Zhi Mu can also be purchased as a tincture from the Hawaii Pharm website. Both herbs can be ingested together in equal doses. Please see the manufacturer’s dosage suggestions for further details.

YANG TYPE B

As mentioned above, both yang types tend to overheat since they lack yin cold energy. Yet the Yang Type B is not as prone to excessive heat-related issues as the Yang Type A. The former needs the cool energy of the liver to balance her warm lung energy, while the latter needs the ice-cold energy of the kidneys to douse the flames of her hot spleen energy. The Yang Type B is by no means incapable of experiencing acute hot flashes since sorrow, correlating with her stronger lungs, can easily morph into the heat of anger, associated with the spleen, and then into scorching hot flashes.

As with any of the other types, a hot flash can appear out of nowhere, making it difficult to trace or connect with our emotions. It is easier to hold hormones accountable for these otherwise spontaneous aggravations. Yet Sasang medicine holds that even these situations can be tied to our predominant emotions, which often hide below layers of coping skills. If the Yang Type B controls her tendency toward sorrow and distrust of others—a tendency related to her weaker liver—then her hot flashes will naturally lose their impetus as time goes by.

Balancing one’s predominant emotion is a process that takes a tremendous amount of sincerity, patience, and self-reflection. It is often difficult to get in touch with one’s inner feelings, since day-today emotions can conceal them. Even when they are discovered, there is no certainty that balance and harmony will naturally unfold. The Yang Type B may choose to avoid and/or suppress her sorrow, which simply makes her more sorrowful and angry. Sorrow brings about love and compassion when it is channeled in the right direction.

Zhu Ru
(Common: Bamboo Shavings; Latin: Bambusa supp.)

Bamboo plays an important role in Eastern philosophy because of its well-developed root structure and flexible stem, which give it the ability to bend without breaking. A person who is rooted, flexible, and capable of yielding to the winds of change without collapsing is often likened to the bamboo tree. As an herb, bamboo shavings clear uprooted heat from the chest, neck, and head. Anxiety and irritability are often a result of unsettled energy and excessive heat in the upper body. Hence bamboo is often prescribed for chronic anxiety and stress. It also quenches thirst by clearing heat from the stomach, where the yang types store plenty of hot yang energy. As an added benefit, a study performed in 2005 showed that bamboo has significant cholesterol-reducing effects.¹⁰ Another study, conducted in 2013, demonstrated how it is also capable of reducing inflammation and acting as an antioxidant.¹¹

Common Uses

Bamboo shavings relieve hot flashes, stomach acid, vomiting, nausea, gastroesophageal reflux, excessive sweating and/or thirst, irritability, and anxiety.

Sources

A tincture of Zhu Ru can be purchased from the Hawaii Pharm website.

Preparation and Dosage

Please follow the manufacturer’s suggestions.

Herbal Friend: Lu Gen (Common: Common Reed; Latin: Phragmites communis)

Lu Gen, also known as common reed, is often spotted close to rivers, streams, and marshes because of its strong affiliation with water. With a hollow stalk, common reed slurps up water as one does with a straw. As a medicine, it transports moisture to the upper body and moderates yang heat. It is often used to tame the excessive lung energy of the Yang Type B by transporting yin cool energy upward, while draining excess yang heat energy in the upper body. Hence common reed addresses upper body heat-related issues such as hot flashes, acid regurgitation, heartburn, and vomiting. A tincture of Lu Gen can be purchased from the Hawaii Pharm website. Equal doses of Lu Gen and Zhu Ru can be taken together in one serving to clear heat and address hot flashes.

YIN TYPE A

Even though she has more yin cold energy than the yang types, the Yin Type A is not immune to hot flashes. Actually, most of my clients who receive treatment for hot flashes are Yin Type As, in part because they have difficulty adjusting to unprecedented bursts of heat. The yang types easily overheat in general and are therefore less inclined to do anything about hot flashes. The Yin Type A’s liver is responsible for hot flashes despite being associated with cool bodily energy. How can the body’s source of cool energy produce so much heat? The stronger liver of the Yin Type A often bites off more than it can chew, absorbing excessive toxins from incompatible foods and uncomfortable experiences. Just as heat is produced by the microbial breakdown of a compost pile, the accumulation of toxins within the liver also yields warmth, and if substantial enough, even hot flashes.

The liver is stimulated and nourished by joy, an emotion so enticing that it’s hard to let go of, especially for the Yin Type A. What brings joy on one occasion, however, doesn’t always bring it on another. As life shifts gears during menopause, the Yin Type A’s definition of joy often transforms too, as she asks herself, “Is this what I really want out of (life, relationships work, etc.)?” She may feel something unexplainable brewing inside, leading to bouts of irritability, frustration, or unprecedented desires. Since joy is what makes or breaks the Yin Type A’s emotional and physical health, it is essential that she recognize and work with these feelings rather than simply suppress them.

The Yin Type A believes firmly in “give and take” and is capable of being the most generous of the four body types. By the time menopause kicks in, she has probably devoted every ounce of effort toward rearing children and taking care of other household duties, trusting that she will always, or at least eventually, receive something in return. Perhaps someday her children will thank her or her husband will start to cook and clean or give her foot massages. While these outcomes may come true in the future, menopause is a time when liver joy can no longer be placed on hold. The body is our greatest teacher, and through chronic hot flashes, pain, or fatigue, it tries to get our attention. We all have an alarm somewhere in our body that informs us when things are out of sync. Our first instinct is to fear it, fight it, or even try to ignore it rather than simply listen, learn, and find harmony here and now. This is a time for the Yin Type A to give to herself and receive the benefits of wellness and inner joy.

Sheng Ma
(Common: Black Cohosh; Latin: Actaea racemosa)

Sheng Ma, or black cohosh, is highly regarded in both Native American and Chinese medicines as an herb of many uses, and it has a wide reputation for addressing menopausal issues. Research has shown that black cohosh can alleviate hot-flash-related¹² and postmenopausal insomnia.¹³ In Sasang medicine, black cohosh is prescribed for its ability to clear congestion and heat from the Yin Type A’s hyperactive liver. Flaring heat and unsettled energy in the upper body make it difficult to sleep, possibly contributing to skin flushing, tinnitus, nausea, excessive stomach acid, acne, and fever. Black cohosh is also used to treat sore throat, coughing, and sinus congestion, which are instigated by the Yin Type A’s stronger liver, as it takes advantage of her weaker lung system.

Common Uses

Black cohosh relieves hot flashes, headaches, throat issues (sore or swollen throat, tonsillitis, swollen glands), coughing, acid stomach, acne, tinnitus, nausea, and sinus congestion (with heat signs, such as fever, sore throat, etc.).

Sources

With its common use for hot flashes and postmenopausal symptoms, black cohosh is readily available on the Nature’s Way and Planetary Herbals websites.

Preparation and Dosage

Please follow the manufacturer’s suggestions.

Caution

Black cohosh is a cold-natured herb. If you cannot drink cold fluids without getting a stomachache, diarrhea, indigestion, or sneezing, then black cohosh may not be suitable for you. These symptoms will occur after ingesting black cohosh if there is not enough heat in the body. Very high doses may cause a slower heart rate, lower abdominal cramps, dizziness, tremors, or joint pain.

Herbal Friend: Huang Qin (Common: Skullcap Root; Latin: Scutellaria baicalensis)

In Sasang medicine, Huang Qin, or skullcap root, is prized for its ability to resolve a variety of heat-related issues in the body, which can manifest as inflammation, hot flashes, anger, excessive appetite, or infection. Black cohosh and skullcap root enhance each other’s ability to clear heat and address these symptoms. Skullcap root extract is available from manufacturers such as New Chapter and Nature’s Way. Follow the manufacturer’s suggestions for appropriate dosage and ingest skullcap root and black cohosh together for optimum results.

YIN TYPE B

Among the four yin yang body types, the Yin Type B is the least prone to hot flashes, or to be precise, she is less concerned and affected by them. Since the Yin Type B’s stronger kidneys provide plenty of cold energy, heat is rarely an issue for her. Actually, an occasional hot flash could offer her relief, especially on a cold wintry day. Yet hot flashes aren’t always fun even for the Yin Type B, since in her case, a deficiency, rather than excess, of yang energy is to blame. During a hot flash, the Yin Type B’s excessive yin cold energy from her kidneys chases yang heat away from the lower body, pushing it upward. As yang heat rises from the kidneys, it stifles the heart, making anxiety and nervousness a common hot flash companion.

The Yin Type B’s hot flashes are rarely preceded by the sensation of heat in the abdomen—signaling yang heat accumulation—that is common among the other types. During a hot flash, the abdomen of the yang-heat-deficient Yin Type B is as cold as ice while her upper body feels hot and stuffy. Copious sweating for the Yin Type B is also different than it is for the other types, since it leaves her feeling drained and exhausted as abundant cold chases yang heat outward through the skin pores. I’ve met several Yin Type Bs who, after sweating excessively, were on the verge of collapsing. Clammy sweating throughout the body is an ominous sign for this type, often indicating other acute health issues and collapsing yang energy. Lee Je-ma says this can be avoided if the Yin Type B calms her tendency to overreact and become anxious over petty things. This is easier said than done because there’s a constant battle between her desire to be comfortable and her need to achieve lofty goals. This feeling is exacerbated during menopause, as the Yin Type B often feels as if the clock of life is ticking away, and her dream of the perfect life she once imagined is fading.

An Xi Xiang
(Common: Benzoin Oil; Latin: Styrax benzoin)

In Eastern medicine, An Xi Xiang (meaning “peaceful rest fragrance”), or benzoin oil, is often used as incense or as an ingredient in tea that includes other herbs to raise the spirit, uplift the mood, and promote balance and harmony of the emotions. Lee Je-ma credits An Xi Xiang with the ability to clear the body of pathogens and toxins, while balancing the heart and mind. Along with other Yin Type B herbs, this one also supports the digestive system, making it easier for the Yin Type B to digest not only food but life’s challenges, transforming them into a source of strength and well-being.

Common Uses

Benzoin calms anxiety, uplifts emotions, relieves indigestion, addresses pain in the chest/abdomen from food stagnation, and alleviates coughing.

Sources

Bulk Apothecary offers an essential oil of benzoin on its website.

Preparation and Dosage

I recommend dabbing a tiny bit of this essential oil under the nose with a cotton swab or ball. It may also be applied to the wrists or to armpits to prevent body odor. Several drops may be burned with a diffuser or oil burner. Benzoin can be applied topically several times a day to retain fragrance.

Caution

Although benzoin is used as an ingredient in medicinal teas, it is usually ingested only under the care of a professional. Most sources warn against ingesting it and recommend it for topical use only. Yet even topically, this potent medicinal has plenty of healing power. The application of essential oils directly onto the skin may produce localized skin sensitivity, such as rashes or redness. Try diluting the first few applications of benzoin with small amounts of water until your skin gets used to it. If your skin is not irritated, then try applying it directly.

Herbal Friend: Rou Gui (Common: Cinnamon; Latin: Cinnamomum cassia)

Rou Gui (gui means “to restore”), or cinnamon, replenishes the body’s yuan (source) energy, which is produced in the kidneys. It also warms up and enlivens the Yin Type B’s kidneys, which have a tendency to stagnate and freeze the energies of the body. Excessive kidney-induced cold may clamp down on the Yin Type B’s weaker yang energy, pushing it upward. Hence cinnamon helps restore kidney yang energy, preventing it from bombarding the upper body and alleviating the Yin Type B’s hot flashes and headaches. Together with the warmth of An Xi Xiang, cinnamon strongly reinforces the Yin Type B’s yang energy to improve digestion and harness escaping heat. Raw cinnamon bark can be purchased from most supermarkets and natural food stores. Suppliers such as Nature’s Answer, Solaray, and Gaia offer an extract of cinnamon in capsule form on their websites.

Raw cinnamon bark is prepared by boiling three (two- to three-inch) bark slices with two cups of water. Let simmer over low heat for fifteen minutes and drink it while it’s still warm. The exact amount of cinnamon may vary, depending on your taste preference. For capsules, refer to the manufacturer for dosage guidelines.