A 55-year-old woman with a three-year history of severe insomnia, hot flashes, and emotional distress was managed using a Liver-soothing and Heart-clearing herbal strategy.

Case ID: CHC-0050

Case Summary

This case describes a 55-year-old woman suffering from a three-year history of severe sleep disturbances, hot flashes, and systemic discomfort that recently worsened due to family stress. The original report documented a conventional diagnosis of Menopausal Syndrome and a TCM assessment of Zang Zao (Visceral Agitation) driven by Liver Qi Stagnation. She was managed through a dynamic herbal approach designed to soothe the Liver, clear Heart fire, and calm the spirit, achieving significant relief within two weeks.

Patient Presentation

• Patient: 55-year-old female (Surname: Li).
• Main Complaint: Severe insomnia (difficulty falling asleep, waking easily, and sometimes awake all night) accompanied by irritability.
• History: The patient sought consultation on March 16, 2022. She reported that her severe sleep issues began in 2019 without an obvious trigger. Despite prior treatments with both Chinese and Western medications, her symptoms fluctuated. Recently, family matters triggered a significant exacerbation of her condition. Associated symptoms included hot flashes with sweating, chest tightness and pain (which was slightly relieved by sighing), lower back pain, stomach distension, belching, red eyes with excess discharge, and generalized body aches.

Examination and Diagnosis

• Conventional Diagnosis: Menopausal Syndrome.
• TCM Tongue and Pulse: The tongue body was pale red with a thin, white coating. The pulse was stringy (脉弦).

TCM Assessment

The original practitioner interpreted the presentation as Zang Zao (Visceral Agitation) driven by Liver Qi Stagnation (脏躁 – 肝郁气滞).

According to the holistic principles of yin and yang Chinese Medicine the Liver governs the smooth flow of emotions. The original report noted that the patient’s emotional distress and frustration severely injured her Liver, causing its Qi to stagnate. Over time, this stagnation transformed into pathological fire. This “evil fire” floated upward to harass the Heart and disturb her spirit (Shen), directly causing her severe insomnia and irritability. The chest tightness that improved with sighing, along with the stringy pulse, are classic textbook signs of trapped Liver Qi. Furthermore, the localized heat caused her red eyes, hot flashes, and sweating.

Treatment Approach

The primary treatment principle was to soothe the Liver, resolve depression, clear the Heart, and calm the spirit (疏肝解郁，清心安神). The strategy aimed to “untie” the trapped emotional energy and extinguish the internal fire so the nervous system could finally rest.

Herbal Formulas and Modifications

• Initial Formula (March 16, 2022): An 18-herb decoction focused on venting the Liver and settling the Heart.
  • Soothing Liver and Clearing Heart: Bei Chai Hu (10g) and Huang Lian (10g) formed a core pair to vent the stagnant Liver Qi, clear Heart fire, and calm the spirit.
  • Resolving Depression and Calming Mind: He Huan Pi (10g), Lian Zi (10g), Bai He (10g), and Yu Jin (10g) worked synergistically to relieve irritability, resolve emotional constraint, and deeply settle the mind.
  • Nourishing Yin and Stopping Sweat: Suan Zao Ren (10g) used its sour and sweet properties to nourish Yin and blood to calm the spirit, while Fu Xiao Mai (10g) specifically targeted and stopped the menopausal hot flashes and sweating.
  • Regulating Qi and Digestion: Herbs such as Chen Pi (10g), Lai Fu Zi (10g), Jiang Hou Po (10g), Bai Zhu (10g), Fu Ling (10g), and Sha Ren (5g, added near the end of decocting) were included to unblock the digestive tract, descend rebellious Qi (stopping the belching and stomach distension), and protect the Spleen. Zhi Gan Cao (10g) harmonized the decoction.
  • Administration: 7 doses, 1 dose daily, boiled in water and taken warm morning and evening.
• Second Visit (March 23, 2022): After 7 doses, the patient’s mood and irritability improved, but her sleep and appetite remained poor, and she occasionally experienced palpitations. Recognizing that her long-term condition had depleted her Heart’s Yin and Blood, the practitioner added heavy, anchoring minerals: Sheng Long Gu (15g) and Sheng Mu Li (15g) to strongly settle the palpitations and anchor the spirit. Jiao San Xian (20g each of Charred Hawthorn, Medicated Leaven, and Malt) was added to vigorously stimulate her appetite and aid digestion. (7 doses prescribed).
• Third Visit (March 30, 2022): The patient’s mental state was significantly improved. Her appetite returned (“eating with relish”), and her internal irritability was completely resolved.

Why This Case Is Interesting (Clinical Reasoning)

The commentary references the classic text Jin Gui Yao Lue (Essential Prescriptions from the Golden Cabinet), which describes Zang Zao (Visceral Agitation) as a condition where a woman feels overwhelming sorrow, desires to cry, and acts as if possessed by a spirit.

In modern terms, this closely mirrors the severe mood swings and nervous system dysregulation of Menopausal Syndrome. The practitioner successfully managed this by avoiding heavy, sedating pharmaceuticals and instead treating the body’s internal “pressure cooker.” By combining Liver-venting herbs (Chai Hu) with Heat-clearing herbs (Huang Lian) and specifically addressing her digestion, the treatment stopped the cycle of stagnant Qi generating fire, completely restoring her sleep, appetite, and emotional stability.

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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：疏肝解郁，清心安神法治疗更年期综合征案 Practitioner: Professor Zeng Xianjin (曾宪进) Publication date: September 13, 2024 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation