A female patient in her early 50s came to the school clinic while I was doing an internship for the herbalist program. It was a hot day in the spring. She was still wearing winter clothes and two pairs of pants.
She explained that she woke up from a hot flash leading to sweating every night for the past 2 months. After the hot flash, her body temperature would drop and get extremely cold. On a daily basis, when she went to bed, she had to cover herself really well with the blankets and sleep with a heating pad. And it would take a long time before she was warm.
Her abdominal palpation told me that she had some muscle tension around her umbilicus shaped like a disk, especially on her left side. This disk-like tension is a telltale sign of cold and fluid accumulation straight from the book of Jin Gui Yao Lue, "氣分，心下堅，大如盤，邊如旋杯，水飲所作，桂枝去芍加麻辛附子湯主之." I didn't prescribe herbs but only used acupuncture.
At night time, Yang (active and warming energy) is supposed to be stored inside the body, gets recharged, and then released during the day to maintain our daily activities. Because "inside" of her body was already taken by this cold and fluid accumulation, Yang had nowhere to go but revert to "outside" of her body. This Yang manifested as hot flash in her body, and she was losing energy without being able to recharge.
Just like when you are out of the home working all day, you need to go back home at night to rest and sleep before you can go to work again the next morning. But when you come home at night, you found something has already taken your home, and you can't get it out of your home. Instead of sleeping at home, you are forced to stay outside and crash somewhere if you are lucky.
So the first priority is to remove whatever was taking up the space inside her home, in this case, cold and fluid accumulation. This was the main focus of the treatment. Needling with moxibustion was used around her umbilicus on Ren 4, Ren 12, St 25 both sides.
After 3 treatments, she was able to sleep through the night without any hot flashes. Her intolerance of cold had improved slightly as well.