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Zhang, female, 43 years old, first consultation on March 14, 1964. She reported that three months ago, she experienced dizziness and poor sleep, accompanied by irritability and a quick temper. Two months later, her insomnia worsened, with feelings of internal heat, dizziness, and blurred vision. She became sensitive to sunlight during the day, experienced dry eyes, and felt restless whether sitting or lying down. At night, her restlessness intensified, tossing and turning, finding it difficult to fall asleep. Even when she managed to doze off, she would wake up after about two hours and could not fall back asleep. The next morning, she felt exhausted and listless. Over the past 20 days, her condition worsened further, with a bitter and sticky taste in her mouth, dry lips and throat, coughing, and involuntary enuresis during coughing. She also felt discomfort in her lower abdomen and had difficulty with bowel movements, leading to severe insomnia, sometimes staying awake all night.

Examination revealed a pale complexion, red eyes, a red tongue with a yellow, greasy coating, and a deep, thin, and rapid pulse. This is a case of Shaoyin yin deficiency with yang hyperactivity insomnia. The treatment principle is to clear heat and enrich yin. The prescribed formula is a modified Coptis and Ass Hide Glue Decoction:
Coptis Rhizome 12g, Skullcap Root, Unprocessed Rehmannia Root, Gardenia, Donkey-hide Gelatin 15g each (melting), Peony Root 24g, Liquorice Root 9g, egg yolk 2 pieces (added when slightly cool and mixed well).
Two doses were prescribed. On March 17, during the follow-up visit, the internal heat and bitter taste in the mouth had slightly improved, and her sleep had improved, allowing her to sleep for four hours that night. Her pulse was deep, thin, rapid, and weak, with a pale red tongue and a slightly yellow, non-greasy coating. The treatment continued with the previous formula, but with reduced dosage:

Coptis Rhizome, Skullcap Root, Liquorice Root 9g each, Peony Root, Unprocessed Rehmannia Root, Donkey-hide Gelatin, Chinese Angelica 15g each, egg yolk 2 pieces.
On March 21, during the follow-up visit, the internal heat and restlessness had disappeared, bowel movements were normal, the dry lips and bitter taste in the mouth were gone, and she could sleep for six hours. The dry eyes and redness had also disappeared. Her pulse was thin and slow, and her tongue was pale red. The original formula was adjusted by doubling the amount of Chinese Angelica and reducing the amount of Coptis Rhizome. After taking three more doses, her sleep returned to normal, and all symptoms disappeared. Follow-up confirmed that the condition did not recur.