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The so-called "deficiency vexation" (Xu Fan) refers to a state of mental restlessness and agitation in the chest and heart region. This is mostly caused by physical weakness, improper care, leading to disharmony of Ying and Wei Qi (Defensive and Nutritive Qi), resulting in an excess of either Yin or Yang.

It may be that Yin is deficient while Yang is excessive, or that Yin is excessive while Yang is deficient. The *Neijing* states: "Yin deficiency leads to internal heat; Yang deficiency leads to external cold. Yang excess leads to external heat; Yin excess leads to internal cold." These conditions all cause people to experience deficiency vexation. Most cases of deficiency vexation are caused by Yin deficiency generating internal heat. Patients with consumptive diseases (Xu Lao) have a deficiency of Kidney Water, causing Heart Fire to steam internally; their vexation must be accompanied by restlessness. After vomiting and diarrhea, when body fluids are depleted, one experiences vexation accompanied by thirst. Only in cases of deficiency vexation following Shanghan (Cold Damage) or major illnesses is Huoluan (Cholera-like disease) absent; clinical judgment should be careful. Chao Yuanfang stated in *Zhubing Yuanhou Lun*: "Vexation causing inability to sleep is due to Heart Heat. But pure deficiency vexation causing inability to sleep is due to Gallbladder Cold."

One discussion addresses deficiency vexation and insomnia after major illness, as well as symptoms of Heart and Gallbladder deficiency and timidity, easily startled by events, shortness of breath, palpitations, or recurrent spontaneous sweating.

Calm the Gallbladder Decoction (Wendan Tang)
Pinelliae Rhizoma Preparatum (soaked in hot water, 7 qian) Zhuru (Bambusae Folium) Zhishi (Fructus Aurantii Immaturus, bran-fried, each 3 qian) Chenpi (Pericarpium Citri Reticulatae, 4.5 qian) Baifuling (Poria, peeled, 2.5 qian) Gancao (Licorice Root, honey-fried, 2.5 qian)
Crush the above ingredients, divide into two doses, decoct with Shengjiang (Fresh Ginger) and Dazao (Jujube). Another formula adds Suanzaoren (Semen Ziziphi Spinosae, fried), Yuanzhi (Radix Polygalae, heart removed), Wuweizi (Fructus Schisandrae), Shudihuang (Rehmanniae Radix Praeparata), and Renshen (Ginseng Radix et Rhizoma) in equal parts.

One discussion addresses the condition after major illness where both exterior and interior are deficient, lacking internal body fluids, presenting with vexation, thirst, and mental agitation, along with various deficiency-type vexatious heat. This resembles Shanghan but without aversion to cold or body pain; sweating and purging methods are contraindicated. It is appropriate to take Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). (Formula see Shanghan section)

Insomnia (Bumei) has two types. One type occurs after illness due to weakness, or in elderly people due to declining Yang Qi. The other type is caused by phlegm obstructing the Gallbladder Meridian, preventing the Shen (Spirit) from residing in its house, also leading to insomnia. For deficiency patterns, use Liujunzi Tang (Six Gentlemen Decoction) with added fried Suanzaoren and Huangqin (Scutellariae Radix). For phlegm patterns, use Wendan Tang, reducing Zhuru by half, adding Nanxing (Arisaematis Rhizoma) and fried Suanzaoren. Insomnia caused by Shanghan should be sought within this chapter (Shanghan section).

One discussion addresses Heart and Gallbladder deficiency causing day-and-night insomnia, unresponsive to various methods. Taking this formula yields miraculous results.

High Pillow Without Worry Powder (Gaozhen Wuyou San)
Renshen (5 qian) Ruan Shigao (Soft Gypsum, 3 qian) Chenpi Banxia (Pinelliae Rhizoma, ginger-fried) Baifuling (Poria, peeled) Zhishi (Fructus Aurantii Immaturus, bran-fried) Zhuru Sanyeqia (Ophiopogonis Radix, heart removed) Suanzaoren (Semen Ziziphi Spinosae, fried) Gancao (Licorice Root, each 1.5 qian)
Crush the above ingredients for one dose. Add five Longyanrou (Longan Aril), decoct with water, and take.

One discussion addresses overthinking, excessive phlegm, little sleep, and unsettled Shen.

Nourish the Heart Decoction (Yangxin Tang)
Renshen Sanyeqia (Ophiopogonis Radix, heart removed) Huanglian (Coptidis Rhizoma, lightly fried) Baifuling (Poria, peeled) Baifushen (Poria cum Pino, wood removed) Danggui (Angelicae Sinensis Radix, wine-washed) Baishao (Paeoniae Radix Alba, wine-fried) Yuanzhi (Radix Polygalae, heart removed) Chenpi Baiziren (Platycladi Semen) Suanzaoren Gancao (Licorice Root, equal parts)
Crush the above ingredients. Add five lotus seeds (Lianrou) with hearts removed. Decoct with water and take warm.

Calming Spirit and Restoring Sleep Decoction (Anshen Fushui Tang)
Danggui Chuanxiong (Ligustici Chuanxiong Rhizoma) Baishao (Paeoniae Radix Alba, wine-fried) Shudihuang (Rehmanniae Radix Praeparata) Yizhiren (Alpiniae Oxyphyllae Fructus) Suanzaoren (Semen Ziziphi Spinosae, fried) Yuanzhi (Radix Polygalae, soaked in Licorice water, heart removed) Shanyao (Dioscoreae Rhizoma) Longyanrou (Longan Aril, equal parts)
Crush the above ingredients. Decoct with Shengjiang and Dazao and take.

One discussion addresses insufficient Heart Qi, mental恍惚 (fluctuation/unsteadiness), and forgetfulness, or Gallbladder cold due to overworking the mind, preventing sleep at night. This medicine can calm the spirit and stabilize the will.

Modified Dingzhi Pill (Jiawei Dingzhi Wan)
Renshen (3 liang) Baifushen (Poria cum Pino, peeled and wood removed, 2 liang) Yuanzhi (Radix Polygalae, soaked in Licorice water, heart removed) Shichangpu (Acori Tatarinowii Rhizoma, each 2 liang) Suanzaoren (Semen Ziziphi Spinosae, fried, 2 liang) Baiziren (Platycladi Semen, fried and shelled, 2 liang)
Grind into fine powder. Form pills using refined honey, size of Sophora japonica seeds. Coat with Zhusha (Cinnabar) and Rushiang (Frankincense). Take 50 pills per dose before bed, delivered with Jiantang (Jujube decoction).

Appendix: Sleeping Method
Sleeping does not dislike curling up; waking does not dislike stretching. Curling up means bending the knees and drawing in the abdomen, lying on either side—this is what cultivators call the "Lion's Sleep." This fills the Qihai (Sea of Qi) and keeps the Dantian warm, facilitating the generation of Kidney Water and benefiting the person. Lying stretched out allows Qi to circulate freely but scatters it, causing the Shen to disperse rather than submerge. Therefore, one should only stretch the body upon waking.

Cai Jitong of Xishan quoted the sleeping prescription from *Qianjin Fang*: "When sleeping, one must lie on the side; when awake, lie straight and stretch. Observe morning and evening times. First let the Heart sleep, then let the eyes sleep." Hui'an (Zhu Xi) considered this an unfathomable secret of ancient and modern times.

One discussion addresses Gallbladder deficiency causing restless sleep and frequent palpitations. Take 1 liang of Suanzaoren, fry until fragrant, grind into powder. Take 2 qian per dose, at any time, delivered with Zhuye Tang (Bamboo Leaf Decoction).

One case treated palpitations in the epigastrium, loud snoring immediately upon falling asleep, and insomnia upon waking. I used Lingyangjiao (Saiga Antelope Horn) and Wuxijiao (Black Rhinoceros Horn), ground separately in water to make concentrated juice, added to the previously mentioned Yangxin Tang or Anshen Fushui Tang. Immediate effect was achieved. Snoring during sleep is caused by Fire in the Heart and Lungs.

One case addressed Gallbladder deficiency causing constant fear and dread, inability to sleep alone, feeling like being hunted, with unclear head and eyes.
Renshen Zhike (Aurantii Fructus) Wuweizi (Schisandrae Fructus) Guixin (Cinnamomi Cortex, each 3 fen) Baiziren (Platycladi Semen, 1 qian) Ganjuhua (Chrysanthemi Flos) Baifuling (Poria) Gouqizi (Lycii Fructus, each 3 fen) Shanzhuyu (Corni Fructus, 5 fen) Shudihuang (Rehmanniae Radix Praeparata, 5 fen)
Grind into powder. Take 2 qian per dose, mixed with warm wine.