Sleeplessness

Also insomnia. Total or partial reduction in sleeping time. Sleeplessness may take the form of difficulty getting to sleep (initial insomnia), tendency to awake and difficulty getting back to sleep, or tendency to sleep on and off through the night (failure to sleep soundly). In severe cases, there may be nightlong sleeplessness. Sleeplessness arises through a variety of pathomechanisms most of which involve insufficiency of heart blood, heart-spleen vacuity, qì vacuity and blood depletion, water qì intimidating the heart, noninteraction of the heart and kidney, heart-gallbladder qì vacuity, yīn vacuity with effulgent fire, intense heart fire, liver depression transforming into fire, gallbladder fire, or phlegm-heat harassing the inner body.

Patterns

Insufficiency of heart blood (心血不阻 xīn xuè bù zú) sleeplessness arises when insufficiency of yīn-blood deprives the heart of nourishment. It is associated with signs of yīn-blood insufficiency and vacuity fire such as vexing heat in the five hearts, profuse sweating, dry mouth and red tongue, and a fine rapid pulse. There may be kidney yīn vacuity signs such as lumbar pain, dizziness, and tinnitus, or signs of noninteraction of the heart and kidney, such as dream emission.

Medicinal therapy: Enrich yīn and boost the kidney; drain fire and quiet the spirit. Use Coptis and Ass Hide Glue Decoction (黄连阿胶汤 huáng lián ē jiāo tāng), Heart-Supplementing Elixir (补心丹 bǔ xīn dān), Cinnabar Spirit-Quieting Pill (朱砂安神丸 zhū shā ān shén wán), and Celestial Emperor Heart-Supplementing Elixir (天王补心丹 tiān wáng bǔ xīn dān).

Acumoxatherapy: Base treatment for sleeplessness mainly on HT and the three yīn channels of the foot. Main points: Alert Spirit Quartet (四神聪 sì shén cōng), HT-7 (Spirit Gate, 神门 shén mén), and SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo). For yīn-blood depletion, add BL-15 (Heart Transport, 心俞 xīn shù), BL-20 (Spleen Transport, 脾俞 pí shù), BL-17 (Diaphragm Transport, 膈俞 gé shù), CV-14 (Great Tower Gate, 巨阙 jù què), and CV-6 (Sea of Qì, 气海 qì hǎi); needle with supplementation. Acupuncture treatment for sleeplessness is most effective when applied in the afternoon or in the evening before bed. If yīn-blood depletion is accompanied by hyperactive vacuity fire, add BL-23 (Kidney Transport, 肾俞 shèn shù), KI-1 (Gushing Spring, 湧泉 yǒng quán), KI-6 (Shining Sea, 照海 zhào hǎi), and PC-8 (Palace of Toil, 劳宫 láo gōng).

Center qì vacuity (中气虚 zhōng qì xū) sleeplessness is insomnia accompanied by lassitude and lack of strength and reduced appetite. If there is copious phlegm, signs include nausea and vomiting, oppression in the chest, a slimy tongue fur, and slippery pulse.

Medicinal therapy: Supplement qì with Six Gentlemen Decoction (六君子汤 liù jūn zǐ tāng). For copious phlegm, base treatment on transforming phlegm using Gallbladder-Warming Decoction (温胆汤 wēn dǎn tāng) or Center-Supplementing Qì-Boosting Decoction (补中益气汤 bǔ zhōng yì qì tāng).

Acumoxatherapy: Use the main points for insomnia given above, and add BL-15 (Heart Transport, 心俞 xīn shù), BL-20 (Spleen Transport, 脾俞 pí shù), CV-6 (Sea of Qì, 气海 qì hǎi), and ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), needling with supplementation and adding moxa. For copious phlegm, use the main points for insomnia combined with ST-40 (Bountiful Bulge, 丰隆 fēng lóng), CV-12 (Center Stomach Duct, 中脘 zhōng wǎn), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), and PC-6 (Inner Pass, 内关 nèi guān), needling with drainage.

Heart-spleen vacuity (心脾虚 xīn pí xū) causes sleeplessness characterized by failure to sleep soundly, sleeping on and off, profuse dreaming, heart palpitation, forgetfulness, dizziness, fatigued limbs and lassitude of the spirit, tastelessness of food, lusterless complexion, pale tongue with thin fur, and a fine weak pulse. The heart governs the blood, and the spleen is the source of blood production. Vacuity of the heart and spleen creates blood vacuity that deprives the heart of nourishment, so the spirit does not keep to its abode. Excessive thought can damage both the spleen and heart, and tends to prevent the heart spirit from returning to its abode, hence the tendency to profuse dreaming. Sleeplessness due to dual vacuity of the heart and spleen is treated by boosting qì and fortifying the spleen and by nourishing the heart and quieting the spirit.

Medicinal therapy: Supplement the heart and spleen with Spleen-Returning Decoction (归脾汤 guī pí tāng). For pronounced insufficiency of heart blood, cooked rehmannia (Rehmanniae Radix Praeparata, 熟地黄 shú dì huáng), white peony (Paeoniae Radix Alba, 白芍药 bái sháo yào), and ass hide glue (Asini Corii Colla, 阿胶 ē jiāo) may be added. For pronounced sleeplessness, heart-nourishing spirit-quieting medicinals such as schisandra (Schisandrae Fructus, 五味子 wǔ wèi zǐ) and arborvitae seed (Platycladi Semen, 柏子仁 bǎi zǐ rén), spirit-quieting medicinals such as silk tree bark (Albizziae Cortex, 合欢皮 hé huān pí) and flowery knotweed stem (Polygoni Multiflori Caulis, 夜交藤 yè jiāo téng), or heavy settlers such as dragon bone (Mastodi Ossis Fossilia, 龙骨 lóng gǔ) and oyster shell (Ostreae Concha, 牡蛎 mǔ lì) can be added. Another formula used to treat sleeplessness due to heart-spleen vacuity is Spleen Longevity Brew (寿脾煎 shòu pí jiān).

Acumoxatherapy: To the main points for sleeplessness add BL-15 (Heart Transport, 心俞 xīn shù), BL-20 (Spleen Transport, 脾俞 pí shù), LR-13 (Camphorwood Gate, 章门 zhāng mén), CV-6 (Sea of Qì, 气海 qì hǎi), needling with supplementation and adding moxa.

Qì vacuity and blood depletion (气虚血亏 qì xū xuè kuī) is a common cause of sleeplessness in the elderly.

Medicinal therapy: Supplement qì or the blood. Use the formulas for qì vacuity given above for insufficiency of yīn-blood and center qì vacuity.

Acumoxatherapy: To the main points for sleeplessness add CV-6 (Sea of Qì, 气海 qì hǎi), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), LR-3 (Supreme Surge, 太冲 tài chōng), BL-20 (Spleen Transport, 脾俞 pí shù), BL-21 (Stomach Transport, 胃俞 wèi shù), and BL-17 (Diaphragm Transport, 膈俞 gé shù). Supplement and add moxa.

Water qì intimidating the heart (水气凌心 shuǐ qì líng xīn) causes sleeplessness accompanied by stirring palpitation below the heart.

Medicinal therapy: Free yáng and disinhibit water with Poria, Cinnamon Twig, White Atractylodes, and Licorice Decoction (苓桂朮甘汤 líng guì zhú gān tāng) or variations.

Acumoxatherapy: To the main points for sleeplessness add BL-15 (Heart Transport, 心俞 xīn shù), BL-21 (Stomach Transport, 胃俞 wèi shù), BL-23 (Kidney Transport, 肾俞 shèn shù), BL-22 (Triple Burner Transport, 三焦俞 sān jiāo shù), PC-6 (Inner Pass, 内关 nèi guān), CV-17 (Chest Center, 膻中 shān zhōng), CV-9 (Water Divide, 水分 shuǐ fēn), CV-6 (Sea of Qì, 气海 qì hǎi), and ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ); needle with drainage and add moxa. See also liver fire sleeplessness.

Noninteraction of the heart and kidney (心肾不交 xīn shèn bù jiāo) is characterized by difficulty getting to sleep or, in severe cases, nightlong sleeplessness, associated with dizziness, tinnitus, tidal heat, night sweating, vexing heat in the five hearts, forgetfulness, limp aching lumbus and limbs, seminal emission, red tongue with scant fur, and rapid fine pulse.

Medicinal therapy: Enrich kidney water, downbear heart fire, and promote heart-kidney interaction. Use Coptis and Ass Hide Glue Decoction (黄连阿胶汤 huáng lián ē jiāo tāng) combined with Peaceful Interaction Pill (交泰丸 jiāo tài wán). Medical Discussions of the Cold Shack (冷庐医话 lěng lú yī huà) recommends using pinellia (Pinelliae Rhizoma, 半夏 bàn xià) and prunella (Prunellae Spica, 夏枯草 xià kū cǎo) to promote heart-kidney interaction. These medicinals can be combined with the formulas suggested.

Acumoxatherapy: To the main points for sleeplessness add BL-15 (Heart Transport, 心俞 xīn shù), BL-23 (Kidney Transport, 肾俞 shèn shù), and PC-7 (Great Mound, 大陵 dà líng), needling with even supplementation and drainage. For pronounced yīn vacuity, add KI-6 (Shining Sea, 照海 zhào hǎi). For profuse dreaming, add GB-44 (Foot Orifice Yīn, 足窍阴 zú qiào yīn) and ST-45 (Severe Mouth, 厉兑 lì duì).

Heart-gallbladder qì vacuity (心胆气虚 xīn dǎn qì xū) causes sleeplessness with profuse dreaming and a tendency to awake with fright. Signs of gallbladder vacuity include susceptibility to fright and fear, lack of decisiveness, and a tendency to get nervous about small matters. Signs of qì vacuity include shortness of breath, fatigue, and long voidings of clear urine. Qì-blood vacuity and gallbladder involvement are reflected in a pale tongue and a fine stringlike pulse.

Medicinal therapy: Boost qì and settle fright; quiet the spirit. Use formulas such as Spirit-Quieting Mind-Stabilizing Pill (安神定志丸 ān shén dìng zhì wán).

Acumoxatherapy: To the main points add BL-15 (Heart Transport, 心俞 xīn shù), BL-19 (Gallbladder Transport, 胆俞 dǎn shù), GB-34 (Yáng Mound Spring, 阳陵泉 yáng líng quán), and GB-40 (Hill Ruins, 丘墟 qiū xū), needling with supplementation.

Effulgent yīn vacuity fire (阴虚火旺 yīn xū huǒ wàng) patterns are marked by heart palpitation, dizziness, tinnitus, forgetfulness, lumbar pain, dry mouth with little liquid, vexing heat in the five hearts, red tongue, and a fine rapid pulse.

Medicinal therapy: Enrich yīn and downbear fire; clear the heart and quiet the spirit. Use Six-Ingredient Rehmannia Pill (六味地黄丸 liù wèi dì huáng wán) combined with Coptis, Ass Hide Glue, and Egg Yolk Decoction (黄连阿胶鸡子黄汤 huáng lián ē jiāo jī zǐ huáng tāng).

Acumoxatherapy: To the main points add BL-15 (Heart Transport, 心俞 xīn shù), BL-23 (Kidney Transport, 肾俞 shèn shù), and KI-6 (Shining Sea, 照海 zhào hǎi), needling with even supplementation and drainage.

Intense heart fire (心火炽盛 xīn huǒ chì shèng) is characterized by agitation, dry mouth and tongue, possibly with sores, short voidings of reddish urine, red-tipped tongue, and thin yellow tongue fur.

Medicinal therapy: Clear heat and drain fire; quiet the heart and spirit. Use Cinnabar Spirit-Quieting Pill (朱砂安神丸 zhū shā ān shén wán) plus scutellaria (Scutellariae Radix, 黄芩 huáng qín), and gardenia (Gardeniae Fructus, 山栀子 shān zhī zǐ).

Acumoxatherapy: To the main points add PC-8 (Palace of Toil, 劳宫 láo gōng), CV-14 (Great Tower Gate, 巨阙 jù què), PC-4 (Cleft Gate, 郄门 xī mén), and HT-5 (Connecting Lǐ, 通里 tōng lǐ), needling with drainage. Prick HT-9 (Lesser Surge, 少冲 shào chōng) to bleed.

Liver depression transforming into fire (肝郁化火 gān yù huà huǒ) causes sleeplessness with impatience, agitation, and irascibility, the classic signs of liver depression. Fire harassing the upper body can cause red eyes. When liver qì invades the stomach, there is no thought of food and drink. Thirst with desire for fluids, reddish urine, constipation, bitter taste in the mouth, red tongue with yellow fur, and a rapid slippery stringlike pulse indicate heat.

Medicinal therapy: Treat by clearing the liver and draining fire, supported by quieting the spirit. Use variations of Gentian Liver-Draining Decoction (龙胆泻肝汤 lóng dǎn xiè gān tāng). For oppression in the chest and sighing, add cyperus (Cyperi Rhizoma, 香附子 xiāng fù zǐ), curcuma (Curcumae Radix, 郁金 yù jīn), and bitter orange (Aurantii Fructus, 枳壳 zhǐ ké). If the formula fails to deal with the sleeplessness, add abalone shell (Haliotidis Concha, 石决明 shí jué míng), mother-of-pearl (Concha Margaritifera, 珍珠母 zhēn zhū mǔ), loadstone (Magnetitum, 磁石 cí shí), and dragon tooth (Mastodi Dentis Fossilia, 龙齿 lóng chǐ).

Acumoxatherapy: To the main points add BL-18 (Liver Transport, 肝俞 gān shù), LR-3 (Supreme Surge, 太冲 tài chōng), PC-6 (Inner Pass, 内关 nèi guān), LR-2 (Moving Between, 行间 xíng jiān), GB-34 (Yáng Mound Spring, 阳陵泉 yáng líng quán), and PC-7 (Great Mound, 大陵 dà líng), needling with drainage.

Gallbladder fire (胆火 dǎn huǒ) sleeplessness results from depressed gallbladder qì transforming into fire, usually stemming from emotional depression or anger or dietary irregularities causing phlegm and heat to gather in the gallbladder. The sleeplessness is accompanied by rib-side distension and fullness, heart vexation, yellow or red eyes, and stringlike pulse.

Medicinal therapy: Clear and drain the liver and gallbladder with Gentian Liver-Draining Decoction (龙胆泻肝汤 lóng dǎn xiè gān tāng), Sweet Wormwood and Scutellaria Gallbladder-Clearing Decoction (蒿芩清胆汤 hāo qín qīng dǎn tāng), or Bovine Bezoar Heart-Clearing Pill (牛黄清心丸 niú huáng qīng xīn wán).

Acumoxatherapy: To the main points add BL-19 (Gallbladder Transport, 胆俞 dǎn shù), GB-43 (Pinched Ravine, 侠溪 xiá xī), and GB-34 (Yáng Mound Spring, 阳陵泉 yáng líng quán), needling with drainage.

Phlegm-heat harassing the inner body (痰热内扰 tán rè nèi rǎo) causes sleeplessness with dizziness and heavy-headedness. This is a phlegm-food pattern that develops when abiding food engenders phlegm, which in turn engenders heat. Abiding food and phlegm manifest as oppression in the chest. Phlegm-heat causes sleepless and vexation, dizziness, heavy-headedness, and canthus discharge. Phlegm heat also accounts for a slimy yellow tongue fur and a slippery rapid pulse. Phlegm-food stagnating in the center burner causes stomach qì to ascend counterfow, manifesting in signs such as aversion to food, belching, nausea, and vomiting. For this reason, this pattern falls into the category of unquiet sleep due to stomach disharmony. Phlegm-heat sleeplessness is treated by transforming phlegm and clearing heat, and by harmonizing the stomach and quieting the spirit. An appropriate formula is Gallbladder-Warming Decoction (温胆汤 wēn dǎn tāng) plus coptis (Coptidis Rhizoma, 黄连 huáng lián) and gardenia (Gardeniae Fructus, 山栀子 shān zhī zǐ). For heart palpitation and susceptibility to fright, add dragon tooth (Mastodi Dentis Fossilia, 龙齿 lóng chǐ), mother-of-pearl (Concha Margaritifera, 珍珠母 zhēn zhū mǔ), loadstone (Magnetitum, 磁石 cí shí), and lily bulb (Lilii Bulbus, 百合 bǎi hé). For severe phlegm-damp, Chlorite/Mica Phlegm-Rolling Pill (礞石滚痰丸 méng shí gǔn tán wán) can be considered.

Acumoxatherapy: To the main points add ST-40 (Bountiful Bulge, 丰隆 fēng lóng), CV-12 (Center Stomach Duct, 中脘 zhōng wǎn), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), LI-4 (Union Valley, 合谷 hé gǔ), PC-6 (Inner Pass, 内关 nèi guān), sCV-17 (Chest Center, 膻中 shān zhōng), and ST-8 (Head Corner, 头维 tóu wéi), needling with drainage.

See also internal damage sleeplessness and external contraction sleeplessness.

Etymology

Chin 不寐 bù mèi means literally not sleep; 不得眠 bù dé mián, cannot sleep; 不得卧 bù dé wò, cannot lie/sleep. The last of these terms is ambiguous, and in some contexts it denotes inability to lie flat. 失眠 shī mián is the equivalent of insomnia in Western medicine and is now the term most commonly used in modern Chinese medical literature literature. danhuobudewo