這是一位52歲的男性上班族，四年前始擔任部門主管，工作壓力大，常熬夜加班、應酬、吃宵夜，特別喜愛麻辣、烤炸食物及啤酒。因公務繁忙，導致睡覺時仍思考公事而不易入睡且多夢。不規律的作息之下，病患便開始覺得疲倦及口乾。半年前調整工作為幕僚，壓力減輕，睡眠情況略有改善，但仍多夢，口乾、疲倦仍持續。望之面色略黯偏白，身材略胖，舌暗紅苔白，中根厚膩，舌尖紅，有津。問之疲倦、口乾喜喝冰水，飲不解渴，每日飲水1500 c.c.，有一半為冰水。此外，並伴有頸項僵硬痠痛，頭脹痛，眼睛痠澀，模糊，腰酸，耳鳴等情形。食慾及食量皆正常，喜食燒烤炸辣食物；睡眠不易入睡，淺眠而多夢；排便日一行，軟散成形；小便白天正常，夜尿1~2行。3年前體檢時發現血壓、膽固醇、三酸甘油脂升高，並服藥控制膽固醇及三酸甘油脂，平素舒張壓約在90上下，每分鐘心跳90下，雙肩部有緊繃感，雙寸脈較浮而有力，右脈尺沉澀無力，左脈尺沉無力。中醫辨證屬腎陽虛，心火上炎。治則採溫補腎陽，健脾益氣，瀉心火，交通心腎。處方以補中益氣湯合濟生腎氣丸加減，睡前另服黃連、肉桂。服藥七日後回診，口乾、身倦、淺眠改善，舌苔仍白膩，故增加白朮1g加強健脾燥濕。第二次回診症狀持續改善，效不更方。第三次回診身倦已無，淺眠已無，口乾減，病患至今仍持續於門診追蹤。此案例為心腎不交的表現，補中氣兼溫腎陽，而非滋陰清熱，辨證正確，多年的眠差、疲倦及口乾快速改善。

This man aged 52 began to be the manager of his department four years ago. Under the stress, he often worked overtime, attended social activities and ate midnight snack, especially spicy, roast, fried food and beer. Because working overload, he still thought about it and became insomnia and dreamful. Due to the irregular life style, he started feeling tired and thirsty. To relieve his stress from work, he adjusted his job position a half year ago. Then he could sleep better but still dreamful, thirsty and tired. In our inspection, the dark and pale face was visible. His tongue was dark and red, especially on the tip. The tongue fur was white but thick and slimy in the middle and root. The fluid of the tongue was normal. In the inquiry, he felt so tired and thirsty that he wanted to drink 1500 c.c. water a day, half of which was cold water. Besides, the associated symptoms were stiff neck, distention in the head, dry eyes, blurred vision, aching lumbus and tinnitus. His appetite was normal and he liked spicy, roast, fried food. Insomnia and profuse dreaming was told. Defecation and urination was normal but he urinated twice at night. The blood pressure, cholesterol and triglyceride were out of the normal range and he has begun the medication. The diastolic blood pressure was around 90 mmHg and his pulse rate was 90 bpm. Besides, his shoulders were stiff. The right and left inch pulse were floating and forceful but the two cubit pulse were deep and forceless.In the Chinese Medicine differential diagnosis, the patient was belonging kidney Yang Vacuity and hyperactive heart fire. In the treatment, by warming kidney and spleen and drain heart fire, non-interaction of the heart and kidney would be restored. In the prescription, Buzhong Yiqi Decoction was with Jih Sheng Shenn Chin Wan add and plus. Huanglian and Rougui was taken at bedtime. In the return visit 7 days after medication, dry mouth, fatigue and insomnia were improved, but the tongue fur was still white and slimy. Therefore, the bai zhu 1 g was increased to