天津徐××，年六十六岁，于季春得不寐证。
病因 因性嗜吟咏，暗耗心血，遂致不寐。
证候 自冬令间有不寐之时，未尝介意，至春日阳生病浸加剧，
迨至季春恒数夜不寐，服一切安眠药皆不效。精神大为衰惫，心中时常发热，懒于饮食，勉强加餐，
恒觉食停胃脘不下行。大便干燥，恒服药始下。其脉左部浮弦，右脉尤弦而兼硬，一息五至。
诊断 其左脉浮弦者，肝血虚损，兼肝火上升也，阴虚不能潜阳，是以不寐。其右脉弦而
兼硬者，胃中酸汁短少更兼胃气上逆也。酸汁少则不能化食，气上逆则不能息息下行传送饮食，
是以食后恒停胃脘不下。而其大便之燥结，亦即由胃腑气化不能下达所致。治此证者，宜清肝火、生
肝血、降胃气、滋胃汁，如此以调养肝胃，则夜间自能安睡，食后自不停滞矣。
处方 生怀山药（一两） 大甘枸杞（八钱） 生赭石（六钱轧细） 玄参（五钱）
北沙参（五钱） 生杭芍（五钱） 酸枣仁（四钱炒捣） 生麦芽（三钱）
生鸡内金（钱半黄色的捣） 茵陈（钱半） 甘草（二钱）
共煎一大盅，温服。
复诊 将药煎服两剂，夜间可睡两三点钟，心中已不发热，食量
亦少加增，大便仍滞，脉象不若从前之弦硬，遂即原方略为加减俾再服之。
处方 生怀山药（一两） 大甘枸杞（八钱） 生赭石（六钱轧细） 玄参（五钱）
北沙参（五钱） 酸枣仁（四钱炒捣） 龙眼肉（三钱） 生杭芍（三钱）
生鸡内金（钱半黄色的捣） 生远志（钱半） 茵陈（一钱） 甘草（钱半）
共煎汤一大盅，温服。
效果 将药连服三剂，夜间安睡如常，食欲已振，大便亦自然通下。惟脉象仍有弦硬之意，遂
将方中龙眼肉改用八钱，俾多服数剂以善其后。
帮助 人禀天地之气化以生，是以上焦之气化为阳，下焦之气化为阴。当白昼时，终日言语
动作，阴阳之气化皆有消耗，实赖向晦燕息以补助之。诚以人当睡时，上焦之阳气下降潜藏与下焦
之阴气会合，则阴阳自能互根，心肾自然相交。是以当熟睡之时，其相火恒炽盛暗动（得心阳之助），
此心有益于肾也。至睡足之时，精神自清爽异常（得肾阴之助），此肾有益于心也。由斯知
人能寐者，由于阳气之潜藏，其不能寐者，即由于阳气之浮越，究其所以浮越者，实因脏腑
之气化有升无降也。是以方中重用赭石以降胃镇肝，即以治大便燥结，且其色赤质重，
能入心中引心阳下降以成寐，若更佐以龙骨、牡蛎诸收敛之品以镇安精神，则更可稳睡。而方
中未加入者，因其收涩之性与大便燥结者不宜也。又《内经》治目不得瞑，有半夏秫米汤原甚
效验，诚以胃居中焦，胃中之气化若能息息下行，上焦之气化皆可因之下行。半夏善于降胃，秫米善于
和胃，半夏与秫米并用，俾胃气调和顺适不失下行之常，是以能令人瞑目安睡。方中赭石与山
药并用，其和胃降胃之力实优于半夏秫米，此乃取古方之义而通变化裁，虽未显用古方而不啻用古方也。
天津人徐××，六十六岁，在晚春时节患上了失眠证。
病因 因为性格喜好吟诗咏唱，暗中耗损了心血，从而导致失眠。
证候 从冬季开始偶尔出现失眠的情况，当时并未在意；到了春季阳气升发时病情逐渐加重；等到晚春时节，连续几夜无法入睡，服用各种安眠药都无效。精神非常疲惫衰弱，心中时常感觉发热，懒得进食，勉强多吃一点，总觉得食物停滞在胃脘部不能下行。大便干燥，经常服药后才能排便。脉象左侧浮而弦，右侧脉象尤其弦且兼有硬象，一呼一吸之间脉搏跳动五次。
诊断 他的左脉浮弦，是肝血虚损，兼有肝火上升的表现；阴虚不能潜藏阳气，所以导致失眠。右脉弦而兼硬，是胃中酸汁（消化液）短少，更兼有胃气上逆的表现。酸汁少则不能消化食物，气上逆则不能使饮食气息不断下行传送，所以饭后食物常停滞在胃脘部不下行。而他的大便燥结，也是由于胃腑的气化功能不能下达所致。治疗这个证候，应当清泻肝火、滋生肝血、降逆胃气、滋润胃汁，这样调养肝胃，夜间自然能安稳睡眠，饭后自然不再停滞。
处方 生怀山药（一两） 大甘枸杞（八钱） 生赭石（六钱，轧细） 玄参（五钱） 北沙参（五钱） 生杭芍（五钱） 酸枣仁（四钱，炒后捣碎） 生麦芽（三钱） 生鸡内金（钱半，黄色的捣碎） 茵陈（钱半） 甘草（二钱）
共煎煮一大盅，温服。
复诊 将药煎服两剂后，夜间可以睡两三个小时，心中已不发热，食量也稍微增加，但大便仍然滞涩，脉象不像从前那样弦硬，于是就在原方基础上稍作加减，让他继续服用。
处方 生怀山药（一两） 大甘枸杞（八钱） 生赭石（六钱，轧细） 玄参（五钱） 北沙参（五钱） 酸枣仁（四钱，炒后捣碎） 龙眼肉（三钱） 生杭芍（三钱） 生鸡内金（钱半，黄色的捣碎） 生远志（钱半） 茵陈（一钱） 甘草（钱半）
共煎汤一大盅，温服。
效果 将药连续服用三剂后，夜间像往常一样安稳睡眠，食欲已经恢复，大便也自然通畅排出。只是脉象仍有弦硬的意味，于是将方中的龙眼肉改为八钱，以便多服几剂以巩固疗效。
帮助 人禀受天地之气化而生，所以上焦的气化为阳，下焦的气化为阴。在白昼时，整天说话动作，阴阳的气化都有消耗，实在依赖夜晚休息来补助它。确实，人在睡觉时，上焦的阳气下降潜藏与下焦的阴气会合，则阴阳自然互根，心肾自然相交。所以在熟睡之时，相火常常炽盛暗动（得到心阳的帮助），这对肾有益处。等到睡醒充足时，精神自然清爽异常（得到肾阴的帮助），这对心有益处。由此可知，人能入睡，是由于阳气的潜藏；不能入睡，是由于阳气的浮越。探究其之所以浮越的原因，实在是因为脏腑的气化只有升发没有下降。所以方中重用赭石来降胃气、镇肝阳，同时也用于治疗大便燥结，而且赭石色赤质重，能入心经，引导心阳下降以促成睡眠，如果再佐以龙骨、牡蛎等收敛的药物来镇安精神，则更能安稳睡眠。而方中没有加入这些药物，是因为它们的收涩之性与大便燥结的患者不宜。另外，《内经》治疗眼睛不能闭合入睡（失眠），有半夏秫米汤原本非常有效，确实因为胃居中焦，如果胃中的气化能不断下行，上焦的气化都可以因此下行。半夏善于降胃气，秫米善于和胃气，半夏与秫米并用，使胃气调和顺适不失下行的常态，所以能让人闭目安睡。方中赭石与山药并用，它们和胃降胃的力量实际上优于半夏秫米汤，这是取古方的意义而进行通变化裁，虽然没有明显使用古方，但无异于使用了古方。
Tianjin resident Xu XX, aged sixty-six, suffered from insomnia (Insomnia) in late spring.
Etiology Due to a habit of reciting poetry and chanting, which secretly consumed heart blood (Heart Blood), leading to insomnia.
Symptoms Occasional insomnia began during winter, which was initially disregarded. By spring, as yang qi (Yang Qi) rose, the condition worsened. By late spring, he could not sleep for several consecutive nights; all sedatives were ineffective. He exhibited severe mental and physical fatigue, frequent sensations of heat in the chest, loss of appetite, and a feeling of food stagnation in the epigastrium after eating. His stool was dry, requiring medication to pass. The pulse on the left side was floating and wiry (Wiry Pulse); the right side was particularly wiry and hard, with five beats per respiration cycle.
Diagnosis The floating and wiry pulse on the left indicates liver blood deficiency (Liver Blood Deficiency) accompanied by rising liver fire (Liver Fire). Yin deficiency fails to anchor yang, resulting in insomnia. The wiry and hard pulse on the right indicates insufficient gastric acid juice and rebellious stomach qi (Rebellious Stomach Qi). Insufficient acid juice impairs digestion; rebellious stomach qi prevents the downward transmission of food, causing postprandial stagnation in the epigastrium. The dry constipation is also caused by the failure of stomach fu organ qi transformation to descend. Treatment should focus on clearing liver fire, nourishing liver blood, descending stomach qi, and moistening stomach fluids. By regulating the liver and stomach, normal sleep and digestion will be restored.
Prescription Raw Huai Yam (Shan Yao, Dioscoreae Rhizoma) 1 liang, Large Sweet Goji Berry (Gou Qi Zi, Lycii Fructus) 8 qian, Raw Ocher Stone (Zhe Shi, Haematitum) 6 qian (finely ground), Scrophularia Root (Xuan Shen, Scrophulariae Radix) 5 qian, Glehnia Root (Bei Sha Shen, Glehniae Radix) 5 qian, Raw Hang Peony Root (Bai Shao, Paeoniae Radix Alba) 5 qian, Sour Jujube Seed (Suan Zao Ren, Ziziphi Spinosae Semen) 4 qian (stir-fried and crushed), Raw Malt (Mai Ya, Hordei Fructus Germinatus) 3 qian, Raw Chicken Gizzard Lining (Ji Nei Jin, Endothelium Corneum Gigeriae Galli) 1.5 qian (yellow variety, crushed), Artemisia Capillaris (Yin Chen, Artemisiae Scopariae Herba) 1.5 qian, Licorice Root (Gan Cao, Glycyrrhizae Radix et Rhizoma) 2 qian.
Decoct together in one large cup of water, take warm.
Second Visit After two doses, nighttime sleep improved to 2-3 hours, chest heat subsided, and appetite slightly increased, but bowel movements remained sluggish. The pulse was less wiry and hard than before. The original prescription was slightly modified for continued use.
Prescription Raw Huai Yam (Shan Yao, Dioscoreae Rhizoma) 1 liang, Large Sweet Goji Berry (Gou Qi Zi, Lycii Fructus) 8 qian, Raw Ocher Stone (Zhe Shi, Haematitum) 6 qian (finely ground), Scrophularia Root (Xuan Shen, Scrophulariae Radix) 5 qian, Glehnia Root (Bei Sha Shen, Glehniae Radix) 5 qian, Sour Jujube Seed (Suan Zao Ren, Ziziphi Spinosae Semen) 4 qian (stir-fried and crushed), Longan Aril (Long Yan Rou, Euphorbiae Longan Arillus) 3 qian, Raw Hang Peony Root (Bai Shao, Paeoniae Radix Alba) 3 qian, Raw Chicken Gizzard Lining (Ji Nei Jin, Endothelium Corneum Gigeriae Galli) 1.5 qian (yellow variety, crushed), Polygala Root (Yuan Zhi, Polygalae Radix) 1.5 qian, Artemisia Capillaris (Yin Chen, Artemisiae Scopariae Herba) 1 qian, Licorice Root (Gan Cao, Glycyrrhizae Radix et Rhizoma) 1.5 qian.
Decoct together in one large cup of water, take warm.
Outcome After three consecutive doses, normal nighttime sleep was restored, appetite recovered, and bowel movements became natural. However, the pulse still showed signs of wiriness and hardness. The amount of Longan Aril (Long Yan Rou, Euphorbiae Longan Arillus) was increased to 8 qian to be taken for several more doses to consolidate the effect.
Discussion Humans are born from the qi transformation of heaven and earth; thus, the qi transformation of the upper jiao (Upper Burner) is yang, and that of the lower jiao (Lower Burner) is yin. During the day, constant speech and movement consume both yin and yang qi, necessitating rest at night to replenish them. When sleeping, yang qi of the upper jiao descends and merges with the yin qi of the lower jiao, allowing yin and yang to root each other and the heart and kidney to interact naturally. During deep sleep, ministerial fire (Ministerial Fire) often flares up subtly (assisted by heart yang), benefiting the kidney. Upon waking fully, spirit is refreshed (assisted by kidney yin), benefiting the heart. Thus, the ability to sleep depends on the anchoring of yang qi; insomnia results from the floating of yang qi. This floating occurs because the qi transformation of the zang-fu organs ascends without descending. Therefore, the prescription heavily uses Ocher Stone (Zhe Shi, Haematitum) to descend stomach qi and calm liver yang, treating constipation simultaneously. Its red color and heavy nature allow it to enter the heart channel, guiding heart yang down to induce sleep. If combined with astringents like Dragon Bone (Long Gu, Os Draconis) and Oyster Shell (Mu Li, Ostreae Concha) to settle the spirit, sleep would be more stable. These were omitted because their astringent nature is unsuitable for constipation. Furthermore, the *Neijing* prescribes Banxia Shumi Tang (Pinellia and Sorghum Decoction) for insomnia, which is effective because the stomach resides in the middle jiao; if stomach qi descends, upper jiao qi follows. Pinellia Tuber (Ban Xia, Pinelliae Rhizoma) descends stomach qi, and Sorghum Grain (Shu Mi, Sorghi Fructus) harmonizes the stomach. Together, they ensure smooth downward movement. In this prescription, Ocher Stone (Zhe Shi, Haematitum) combined with Huai Yam (Shan Yao, Dioscoreae Rhizoma) harmonizes and descends stomach qi more effectively than Banxia Shumi Tang. This applies the principle of ancient formulas through flexible modification, achieving the effect of using an ancient formula without explicitly employing it.