David and/or Wendy, I have a patient who has the classic backstory of poor blood sugar regulation and fried adrenals. Not surprisingly, she is having a horrible time transitioning into menopause and has significant vasomotor symptomology. The most bothersome for her is excessive sweating and nighttime waking. She has poor cortisol awakening response, her cortisol spikes around noon, and she has higher cortisol in the evening and in the middle of the night. I am treating her blood sugar dysregulation and am working on a formula for her adrenals and vasomotor symptomology (the poor lady needs some relief!), but I am wondering, in your experience, what you tend to gravitate towards in your approach when night sweats and nighttime waking are the number one complaint. I bog myself down going through all the herbs I could be using for her individual profile and end up with an "everything but the kitchen sink" list!! Astragalus, White Peony, Sage, Hops, Shatavari, Milky Oat, Zizyphus Seed, Siberian Rhubarb, Hops, etc.? One tincture or two? Motherwort, Hops, and Passionflower for nighttime? I'm driving myself crazy, so thought I would share the wealth. She is 47. Considering her age, would it be prudent to advise her to look into HRT due to such extreme symptomology while working on her underlying blood sugar and adrenal issues? Any thoughts on the matter would be helpful. Thank you:) Jami

I have not had any patients with peri-menopausal nighttime walking, but that would be considered disturbed shen, I would think about  Suan Zao Ren (also good for nightsweats), maybe Hops, Biota seed, Passionflower, Gou Teng, White Peony   For the night sweats - Astragalus, Chinese Cornus fruit, Sage, Chaste Tree and the forementioned Suan Zao Ren.