A 32-year-old woman with a half-year history of severe insomnia, massive hair loss, and fatigue was successfully managed using a Liver and Kidney-tonifying, Wind-dispelling herbal strategy—notably curing her insomnia without the use of a single “spirit-calming” (sedative) herb.

Case ID: CHC-0086

Case Summary

This case describes a 32-year-old woman who presented with a six-month history of severe insomnia, massive hair loss, extreme fatigue, and scanty menstruation triggered by high work stress. Despite pursuing treatment at another TCM hospital for half a year, her condition failed to improve. The original report documented a conventional diagnosis of insomnia and a TCM assessment of Sleeplessness (Bu Mei) driven by Liver and Kidney Yin Deficiency complicated by the Upward Disturbance of Wind Pathogens. She was managed by Professor Hu Shiping using a highly targeted approach that strictly addressed the root pathogenesis—nourishing the Yin and Blood to extinguish the internal wind—resulting in a rapid resolution of her insomnia, hair loss, and systemic weakness in just one month.

Patient Presentation

• Patient: 32-year-old female (Surname: Su).
• Main Complaint: High work stress, poor sleep quality, massive hair loss, and fatigue for half a year.
• History: The patient sought consultation on December 15, 2022. For the past six months, she had been under significant work pressure, leading to persistent insomnia (difficulty falling asleep and easily awakened). This was accompanied by massive hair loss, with her remaining hair becoming sparse, dry, and dull. She felt easily exhausted after exertion, suffered from a sore lower back, and had scanty menstruation with premenstrual chest, rib, and breast distension and pain. She had previously undergone six months of continuous treatment at another TCM hospital with no effect. A recent medical checkup revealed mild anemia.
• Associated Symptoms: Severe anxiety, fatigue, and lethargy.

Examination and Diagnosis

• Conventional Diagnosis: Insomnia.
• TCM Tongue and Pulse: The tongue body was pale red with a thin, white coating. The pulse was sunken, fine, and weak (脉沉细弱).

TCM Assessment

The practitioner interpreted the presentation as Sleeplessness driven by Liver and Kidney Yin Deficiency and Wind Pathogen Disturbance Upward (不寐 – 肝肾阴虚，风邪上扰).

According to the holistic principles of Chinese Medicine, the Liver and Kidneys are the foundational sources of Yin and Blood. Chronic stress severely depleted her Liver and Kidney essence. Because the Kidney essence and Liver blood were deficient, they could not properly “house the mind and ethereal soul” (御神藏魂), directly leading to the severe insomnia and anxiety. Furthermore, the lack of blood meant her meridians were empty and malnourished, causing the premenstrual breast and rib pain.

Crucially, Chinese medicine states that “Hair is the surplus of blood.” Because her blood was depleted, her hair lost its nourishment (becoming dry and falling out). This empty, blood-deficient state allowed internal heat to generate. This heat stirred up internal “Deficient Liver Wind,” which rushed upward to disturb the head. Because “wind is active by nature,” it violently shook the hair roots, causing the massive hair loss. Additionally, the Liver/Kidney deficiency led to a disharmony of the Chong and Ren vessels, depriving her uterus of blood, causing the scanty menses and sore lower back. Her pale red tongue and sunken-fine-weak pulse provided objective confirmation of this profound systemic depletion.

Treatment Approach

The primary treatment principle was to nourish and tonify the Liver and Kidneys, nourish blood and dispel wind (滋补肝肾，养血祛风). The strategy specifically avoided the symptomatic treatment of the insomnia (no sedatives) and instead focused on the core physiological breakdown: rebuilding the body’s blood reservoir so that the internal wind would naturally extinguish.

Interventions and Herbal Formulas

• Initial Herbal Formula (December 15, 2022): A 13-herb decoction modifying the classical Sheng Yu Tang (Sagely Healing Decoction) and Er Zhi Wan (Two Ultimate Pill).
  • Nourishing Yin/Blood and Extinguishing Wind: Dang Gui (15g), Shu Di Huang (Prepared Rehmannia, 20g), and Bai Shao (White Peony, 20g) deeply nourish the Yin and Blood. This relies on the classical principle: “To treat wind, first treat blood; when the blood flows, the wind will extinguish itself” (治风先治血，血行风自灭).
  • Tonifying Liver/Kidneys and Descending Fire: He Shou Wu (Polygonum multiflorum, 15g), Sang Shen (Mulberry, 20g), Nu Zhen Zi (Privet Fruit, 20g), Han Lian Cao (Eclipta, 20g), and Gou Qi Zi (Goji Berry, 25g) form a massive Yin-nourishing matrix to rebuild essence and anchor the floating deficient heat.
  • Boosting Qi and Soothing the Liver: Huang Qi (Astragalus, 30g) boosts Spleen Qi to help generate new blood, while Xiang Fu (15g) gently soothes the Liver to relieve the breast/rib pain and anxiety.
  • Dispelling Wind: Fang Feng (30g) is a “moistening agent” among wind herbs, and Bai Ji Li (Tribulus, 30g) is a key herb to soothe the Liver and dispel head wind. Both work synergistically to clear the wind from the scalp to stop the hair loss. Gan Cao (5g) harmonizes.
  • Administration: 14 doses, water decocted, taken warm after breakfast and dinner.
• Second Visit (December 30, 2022): After 14 doses, the patient’s emotional state stabilized, her insomnia markedly improved, and the hair loss decreased. She only experienced occasional lower back soreness.
  • Formula Adjustment: To address the remaining lower back soreness, Du Zhong (15g) and Xu Duan (15g) were added to the original formula to strengthen the Kidneys and lower back. (14 doses).
  • External Therapy Added: A scalp wash using 2000g of Ce Bai Ye (Biota Leaves) was prescribed to directly stimulate local hair growth.
• Third Visit (January 15, 2023): The patient only had a tiny amount of remaining hair loss and reported absolutely no other discomfort. Her sleep and energy had returned to normal. She was instructed to continue the external Ce Bai Ye wash to consolidate the hair regrowth.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is Professor Hu Shiping’s successful application of the “treating by not treating” (不治之治) philosophy for severe insomnia.

When a patient complains of a half-year history of debilitating insomnia, almost all practitioners—even experienced TCM doctors—will immediately prescribe heavily sedating or “spirit-calming” (安神) herbs, such as Suan Zao Ren (Sour Jujube Seed), Ye Jiao Teng (Fleeceflower Stem), Long Gu (Dragon Bone), or Mu Li (Oyster Shell). However, Professor Hu recognized that the insomnia was merely a symptom of a deeper crisis: her body was completely drained of Blood and Essence, which had triggered an internal wind storm.

By refusing to recklessly prescribe sedatives and instead focusing purely on refilling her internal reservoirs (using Sheng Yu Tang and Er Zhi Wan to nourish Blood and Extinguish Wind), he solved the root of the problem. As the original commentary notes: “Although insomnia was the main complaint, not a single spirit-calming herb was seen in the formula. He did not treat her heart [mind], yet her heart and mind naturally calmed.” This case perfectly demonstrates that accurately targeting the pathogenesis yields far superior results than merely chasing symptoms.

Source Original source: Shenzhen Hospital of Beijing University of Chinese Medicine (Longgang) / Traditional Chinese Medicine Bureau of Guangdong Province Original title: 【以案说医】胡世平：审证求机愈失眠，不可妄用安神属 Practitioner: Professor Hu Shiping (胡世平) Publication date: August 07, 2024 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation