“Heart Fire” & Perimenopause in Summer

In Traditional Chinese Medicine (TCM), health is maintained by a balance between Yin (female, cool, moist, calm) and Yang (male, hot, dry, active).  During the menopause transition, generalized heat and hot flashes are due to Yang Excess (“full heat”) and night sweats are due to Yin Deficiency (“empty heat”).  Both types of heat often flare with the heat of summer and can particularly affect the Heart which, according to TCM, houses the mind and spirit.  So, it is not your imagination that your hot flashes and mood seem worse in the summer.  This article explains what happens with this particular Yin-Yang imbalance and what you can do to block its development.

Yang Excess develops with fast-paced schedules, mounting life stressors, alcohol or stimulant intake, tobacco use, and eating meat and spicy or ultra-processed foods.  Intense, suppressed, and unresolved emotions are often expressed as generalized heat or hot flashes.  Medical conditions like hyperthyroidism or toxin exposures also contribute.  Yang Excess is more likely to develop in overachievers. Highly sensitive (and, perhaps, other neurodivergent) individuals may be more susceptible to Heat’s influence with fewer provocations. 

Excessive Yang progressively takes its toll on Yin, generating or worsening existent Yin deficiency.  Yin Deficiency may already be present if self-care, sleep, and relaxation are postponed, and healthy food and proper hydration are lacking.  Generalized overwork, perhaps complicated by worry and stress depletes Heart Yin.  Medical conditions such as vitamin or mineral deficiencies and anemia also chip away at Yin. 

Unresolved emotional issues, chronic anxiety, depression, and feeling stuck lead to Qi (life force) stagnation and if prolonged, the blocked Qi flares into Heart Fire.  Yang factors such as erratic schedules, chaos at home and/or work, poor diet, worsening alcohol use, increased stimulant use, and exposure to hot environments contribute to this progression into Heart Fire.  Many of these features are frequently found in perimenopause which coincides with the time of career advancement often coupled with juggling busy child schedules, managing a household, and perhaps dealing with relationship or elderly parent issues.  Frustrations, anger, and resentment often simmer beneath these responsibilities and supply more fuel to Heart Fire. 

Besides worsening hot flashes, Heart Fire not only affects intrinsic heart function, but also the mind and spirit, evidenced as mood disorders.  Heart Fire is characterized by the exhibition of such symptoms as increased heart rate, palpitations, overactive thinking with racing thoughts, worsened irritability, increased anxiety, a high startle response, insomnia, disturbed dreams, hyperactivity, talking too much, rapid or loud speech, inappropriate or prolonged laughter, and of course, intensified hot flashes and night sweats.  These symptoms tend to flare in late summer and early autumn or when ambient temperatures are hot and/or humid.  So, think of peak hurricane season as the time when you may experience these bodily manifestations of a personal storm. (With the extreme heat in Texas and early development of tropical storms in the Atlantic basin, it seemed appropriate to share this information now.)

Heart manifestations of a rapid pulse and palpitations are troubling and should be checked out by your doctor.  In TCM, the tongue and face are anatomical features associated with the Heart, so Heart Fire is linked with oral ulcers, burning tongue sensations, or facial redness.  Emotions are a touchy subject, but if your friends or family suggest you see a physician or mental health professional, they may be observing symptoms that are affecting your life and well-being.  Please pay attention and get seen.  You can follow the recommendations below, but they are not a substitute for medical attention.

 Severe symptomatology of the menopausal transition (e.g., vasomotor symptoms, insomnia, mood disorders) often requires medication(s). Stopping treatment or tapering doses may be unsuccessful during the late summer.  Waiting for cooler weather is advised, if possible.

         So, what can you do for worsening vasomotor symptoms in late summer?  Lifestyle changes as well as a more intensive focus on dietary choices can help.  Heart Fire can be reduced by supporting Yin through getting enough sleep and meditating.  Exercise can help burn off pent-up energies of stress, frustration, and anger.  Here are some other suggestions:

Lifestyle Changes:

1. Learn to say “no” to demands of your time and energy.  (Lots of blogs and advice out there on establishing boundaries.  A therapist can offer guidance, too.)
2. Physical activity balances mental activity.  Outside activity balances indoor activity.  
3. Take frequent breaks from work especially if it is sedentary. (Go up and down the stairs a couple times to get the blood flowing, get something to drink, stroll around the office, the neighborhood, or your garden—you get the idea.)  
4. If you have an active job, taking a break by sitting. 
5. Support Yin by slowing down, taking time off (if you can), and adding structure to your life.
6. Quiet the mind.  Meditate despite difficulties focusing due to mental overactivity.  Do brief sessions if necessary. 
7. See a therapist or, at least, discuss situations with your supportive friends or family regarding unresolved emotional issues.
8. You might just need to leave a job, a relationship, or a situation involving too much toxicity or “drama.”
9. Avoid stimulants (unless prescribed and monitored) and energy drinks.  Drink less coffee and alcohol.
10. Consider seeing an OMD (Oriental Medical Doctor) who can perform acupuncture and prescribe herbs.

TCM assigns a thermal property to each food and your dietary choices play a role in combatting Heart Fire.  Eating “cooler” foods will dampen Heart Fire and avoiding “hot” foods while consuming fewer “warm” foods will remove its sustaining fuel.  (Check out Hot Flash Diet on Facebook (https://www.facebook.com/HotFlashDiet/) and @HotFlashDiet on Twitter and Instagram for more tidbits.

Dietary Recommendations:

1. Avoid “hot” spices such as black and red pepper, chili peppers, cinnamon, mustard, and horseradish or use much less spice and spicy condiments for cooking or eating.
2. Eat more “cooler” foods to quell Heart Fire. See list below.
3. Stay hydrated with water or teas.
4. Avoid tobacco and nicotine.
5. Avoid or drink much less coffee during the late summer.  Perhaps switch to teas like lemon balm, chamomile, and peppermint?
6. Avoid or drink much less alcohol.
7. Choose raw, steamed, poached, or lightly sautéed foods.
8. Eat fewer foods that are barbecued, grilled, roasted, deep-fried, or fried, especially meats.  (Awww, man…)
9. Eat less meat (Yang), especially red meat.
10. Eat more fruits and not-so-starchy vegetables (Yin).
11. Eat simpler dishes with fewer ingredients as complexity adds to overwhelm.

FOODS TO SUPPORT YIN & QUELL HEART FIRE [1] [2]

SEAFOOD/AQUATIC:  Clams, Crab

DAIRY:  Yogurt

GRAINS:  Barley, Millet, Teff, Wheat berries (farro), Wheat germ

BEANS:  Mung beans, Tofu

VEGETABLES:  Broccoli raab, Celery, Chicory, Cucumber, Dandelion greens, Endive & Escarole, Frisée, Lettuce, Mung bean sprouts, Tomatoes, Water chestnuts, Watercress

FRUITS:  Apple, Banana, Mulberries, Pear, Persimmon, Watermelon

BEVERAGES:  Chamomile Tea, Green Tea, Lemon Balm Tea, Non-alcoholic Beer, Non-alcoholic hoppy beverages, Peppermint Tea

SEAWEEDS: Kelp, Nori, Sea Lettuce/Laver, Wakame

Takeaways:

**Good health requires a balance between Yin and Yang.

**In the menopause transition, Yang Excess is felt as generalized heat or hot flashes and Yin Deficiency brings on night sweats.

**Heart Fire results from prolonged stagnant Qi which flares with contributions from Yang Excess.

**Overachievers as well as highly sensitive (and, perhaps, other neurodivergent) persons may be especially prone to developing Heart Fire.

**Heart Fire attacks the mind and spirit, resulting in irritability, overactive thinking with racing thoughts, insomnia, and pressured or loud speech among other symptoms.  

**Increased heart rate, palpitations, oral ulcers, burning tongue, and of course, increased body heat are other signs of Heart Fire.

**Emotions like anger, frustration, and resentment fuel Heart Fire.

**Medication, mental health therapy, or Chinese medicine may be needed for the symptoms of Heart Fire if they are troubling for you.

**Medical intervention is indicated for extreme Heart Fire symptoms: cardiac symptoms, paralyzing anxiety, sleep deprivation, intemperate stimulant use, or manic behavior.  Your friends and family may notice your need before you do.

**Avoiding “hot” foods, eating “cooler” foods, and exercising are helpful.

**If you are taking medications for perimenopausal symptoms, expect difficulties with stopping or tapering them from mid-summer to early autumn.  Wait until the weather cools.

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[1] Jake Schmalzriedt, “GENERAL DIETARY AND NUTRITIONAL GUIDELINES,” 2015, 12.

[2] Paul Pitchford, Healing with Whole Foods: Asian Traditions and Modern Nutrition, 3rd ed. (North Atlantic Books, 2002).