Abstract： Perimenopausal women experience a decline in physiological functions due to aging， and symptoms such as insomnia during this period exhibit complexity and diversity. Based on the Chinese medicine theory of "Shaoyin as the pivot"， the authors propose that insomnia in perimenopausal women arises from the gradual exhaustion of reproduction-stimulating essence， kidney yin depletion， and dysfunction of the Shaoyin pivot-closing mechanism， which makes yang fail to enter yin； impaired Shaoyin pivot function further obstructs qi movement， leading to pathological products such as phlegm-damp that disturb the heart spirit and exacerbate insomnia. The core pathogenesis of this condition includes kidney yin depletion，impaired Shaoyin pivot function，and internal disturbance of phlegmheat. Key therapeutic strategies involve nourishing and supplementing kidney yin， restoring pivot function， and clearing heat and resolving phlegm. Huanglian Ejiao Decoction serves as the foundational prescription，and its modified application in clinical practice has achieved satisfactory outcomes in treating perimenopausal insomnia.