A 48-year-old woman with a three-year history of severe insomnia, low-grade fever, and anxiety triggered by family stress was managed using a Yin-nourishing and Yang-anchoring herbal strategy.

Case ID: CHC-0043

Case Summary

This case describes a 48-year-old woman presenting with chronic insomnia, low-grade fever, and a haggard mental state following long-term family stress. The original report documented a conventional diagnosis of an anxiety and depression state and a TCM assessment of Depression Syndrome (Yu Bing) driven by Kidney Yin insufficiency with floating empty fire. She was managed with a modified Qinghao Biejia Tang to deeply nourish Kidney Yin, clear the hidden heat, and physically anchor her agitated spirit.

Patient Presentation & Examination

• Patient: 48-year-old female (Surname: Li).
• Main Complaint: Severe insomnia, forgetfulness, and shortness of breath, accompanied by a low-grade fever.
• History: The patient sought consultation on August 12, 2021. Three years prior, family issues triggered long-term insomnia, forgetfulness, shortness of breath, and a persistent low-grade fever. She had used spirit-calming medications that temporarily improved her sleep, but stopping them exacerbated the insomnia. She could only sleep 3 to 4 hours per night. Associated symptoms included “five-center heat” (heat in the palms, soles, and chest), sweating, and frequent dreams. Mentally, she appeared absent-minded, haggard, and often hesitated to speak (欲语又止).
• Conventional Diagnosis: Anxiety and depression state.
• TCM Tongue and Pulse: The tongue body was red-purple with no coating and a lack of saliva (少津). The pulse was sunken, fine, and rapid (脉沉细带数).

TCM Assessment & Treatment

The original practitioner interpreted the presentation as Depression Syndrome driven by Kidney Yin Insufficiency and Floating Empty Fire (郁病 – 肾阴不足，虚火上越).

According to the core principles of yin and yang Chinese Medicine long-term mental overexertion and emotional stress severely consume the body’s foundational Yin fluids (specifically Kidney Yin). When Kidney Yin is depleted, it fails to anchor and control Yang, leading to the generation of internal “empty fire.” This fire floats upward, causing the low-grade fever, five-center heat, and sweating. Furthermore, the lack of Yin means the Heart and Mind are deprived of physical nourishment and are constantly harassed by the floating heat, resulting in severe insomnia and a haggard presentation. The red-purple tongue with no coating is a classic objective sign of severe Yin depletion.

Treatment Approach & Herbal Formula The primary treatment principle was to nourish Yin and tonify the Kidneys, anchor Yang and calm the spirit (滋阴补肾，潜阳安神). The practitioner prescribed a 13-herb decoction (7 daily doses, taken warm morning and evening) centered around the classical formula Qinghao Biejia Tang.

• Nourishing Yin and Clearing Heat: Bie Jia (Soft Turtle Shell, 30g, decocted first), Qing Hao (Artemisia Annua, 30g), Sheng Di Huang (10g), Zhi Mu (10g), and Mu Dan Pi (10g) synergistically nourish Kidney Yin while venting and clearing the hidden, smoldering heat from the deepest levels of the body.
• Anchoring the Spirit: Sheng Long Gu (Raw Dragon Bone, 30g, decocted first) and Sheng Mu Li (Raw Oyster Shell, 30g, decocted first) are heavy minerals that forcefully anchor the floating Yang and settle the agitated mind.
• Nourishing Heart and Regulating Emotions: Fu Shen (30g) and Suan Zao Ren (10g) nourish Heart blood to treat the insomnia, while Yu Jin (10g) and He Huan Pi (Albizia Bark, 10g) soothe the Liver and relieve emotional constraint.
• Guiding Downward: Chuan Niu Xi (10g) directs the blood and floating fire downward, and Gan Cao (10g) harmonizes the decoction.

Follow-Up & Clinical Reasoning

Follow-Up: At the second visit on August 19, 2021, the source reported a rapid recovery. After just seven doses, the patient’s low-grade fever had completely resolved, her sleep returned to normal, and her mood became significantly more stable. An additional seven doses were prescribed to consolidate the therapeutic effect.

Why This Case Is Interesting: This case highlights the physical consequences of chronic emotional distress. The patient’s three-year reliance on standard sedatives failed to resolve her condition because those medications could not physically rebuild her exhausted Yin reserves. By recognizing the root cause as “Yin deficiency with floating empty fire,” the practitioner physically “cooled down” the internal engine and rebuilt the fluids. Once the physical Yin was restored and the empty heat was cleared, the nervous system naturally calmed down.

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Source

• Original source: Qingyuan Maternal and Child Health Hospital / Guangdong Provincial Administration of Traditional Chinese Medicine
• Original title: 【以案说医】曾宪进：青蒿鳖甲汤加减治疗焦虑抑郁状态案
• Practitioner: Professor Zeng Xianjin (曾宪进)
• Publication date: September 20, 2024
• Original language: Chinese
• ChineseHerb.org version: English translation and editorial adaptation