According to traditional Chinese medicine, reproductive function is governed by the kidneys. Sufficient energy in a woman's kidneys is necessary for fertility, libido, regeneration of the entire body, and tissue elasticity and strength.

At puberty, a woman's kidney energy increases, sending excess blood to the uterus. During her reproductive years, the kidneys supply enough blood for fertility, but as a woman matures, the blood flow from her kidneys diminishes, leading to menopause. Menopausal problems occur when kidney energy is depleted and cannot sustain the rest of the body. In other words, the body's vital life energy, or qi, (in particular the kidney energy) is out of balance.

During the perimenopausal years the Chinese believe that there is an increase in the active, dry, hot element called yang energy. Before thirty-five, a woman is more yin (moist, receptive, passive) but during the change of life her yang begins to express itself She becomes more passionate about ideas, quicker to anger, faster to defend herself or others. As more "hot" yang energy begins to move through the acupuncture meridians, at first the flow is kind of jerky as we get accustomed to using the new energy. Those jerky manifestations of rising yang give rise to hot flashes. But as the meridians open to the yang energy and we get used to using it, so the theory goes, the flow stabilizes.

According to the forty-nine different cultural traditions that base their medicine on life-force energy, when we have a lot of stress, either through poor diet and lack of exercise, or because of poor coping skills, the life-force energy can't flow smoothly through the meridians. In that case the flow of energy would have a hard time stabilizing and hot flashes would persist.

This imbalance may be corrected by any combination of herbal therapy, acupuncture, moxibustion, dietary changes, and qigong. Hot flashes and anxiety are considered a weakness of the heart; irregular menstrual flow and irritability a weakness of the liver; heavy menstrual bleeding and food cravings a weakness of the spleen.

In traditional Chinese medicine, numerous herbal formulas reportedly can alleviate hot flashes and other menopausal symptoms such as fatigue, headache, and menstrual irregularities. In TCM, herbal formulas resorted to for hot flash relief- such as Two Immortal Decoction, Rehmannia Six Formula, and Geng Nian Formula-aren't employed simply for the relief of an isolated symptom, it is used to treat the whole person. Traditionally, the prescribing of these formulas is based on a constellation of signs and symptoms that a person presents. For a woman complaining of hot flashes, a recommended formula might depend upon whether she also displayed an agitated or subdued manner, a pale or pink tongue, robustness or weakness, and numerous other features that indicate her overall health.

Most Chinese formulas are available in pill form and contain natural ingredients such as rehmannia (a yam species), dong quai, oyster shell mineral, white peony (from the tree), and ophiopogon (a variety of asparagus root). Their mixtures have been handed down, generation to generation, for centuries, but they have received little scrutiny from Western medicine.

Acupuncture is particularly effective in easing annoying hot flashes and night sweats.