1).General Description

Insomnia is characterized by inability to acquire nor-mal sleep, which results from the heart being deprived of nourishment or from mental disturbance. It is manifested as insufficient sleep, shallow sleep and failure to relieve fatigue and restore the physical and mental strength by sleep. Mild insomnia refers to difficulty to fall asleep, or broken sleep, or inability to resume sleep once waking up, while severe insomnia refers to inability to fall asleep the whole night.

The causes of insomnia include emotional disorder, improper diet, weak constitution after illness, infirmity of age, congenital insufficiency and timidness. It involves the heart and closely related to stagnation of liver qi, deficiency of the gallbladder, spleen and kidney and dysfunction of stomach qi. Its main pathogenesis associates with imbalance between yin and yang and disorder of qi and blood in the heart, gallbladder, spleen and kidney, resulting in the inadequate nourishment of the heart or mental disturbance.

The following description on the syndrome differentiation and treatment for insomnia can serve as reference for the diseases with insomnia as the chief symptom in Western medicine, such as neurosis, menopausal syndrome, sequela of brain concussion, hypertension, hepatopathy, hyperthyroidism, anemia, cerebral arteriosclerosis, chronic intoxication and schizophrenia in the early stage.

(1) Mild cases have difficulty to fall asleep, or liability to wake up, or inability to fall asleep again after waking up, for over 3 weeks. Severe cases cannot get to sleep all night.

(2) It is usually accompanied by headache, dizziness, palpitation, amnesia, lassitude, restlessness and dreamfulness.

(3) Some organic diseases with dyssomnia should be excluded by laboratory examinations.

3).Syndrome Differentiation and Treatment

It is important to differentiate between the deficiency type and excess type of insomnia. Syndromes such as hyperactivity of heart fire, liver qi stagnation turning into fire, and internal disturbance of phlegm-heat belong to the excess, while those such as hyperactivity of fire due to yin deficiency, deficiency of the heart and spleen, and deficiency of heart qi and gallbladder qi pertain to the deficiency. Treatments should be based on the principles of replenishing deficiency and purging excess, regulating yin and yang, and calming the heart and tranquilizing the mind. Patients of deficiency type should be treated with methods of reinforcing qi and nourishing blood, and tonilying the liver and kidney, while those of the excess type should be treated with methods of eliminating food retention and regulating the spleen and stomach, and clearing away fire and resolving phlegm. For patients complicated by both the deficiency and excess, the method of reinforcing and purging should be used in combination.

A. Hyperactivity of Heart Fire

Chief Manifestations: Restlessness, insomnia, anxiety, dry mouth and tongue, scanty dark urine, aphthous stomatitis, red tongue tip, yellow thin tongue coating, and forceful and rapid or thready and rapid pulse.

Therapeutic Methods: To clear away heart fire, tranquilize the mind and soothe the heart.

Prescription: Ginseng, Rhizoma Rehmanniae Praeparata, Rhizoma Alismatis, Poria, etc.

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B. Liver Qi Stagnation Turning into Fire

Chief Manifestations: Anxiety, irritability, dreamful sleep or even inability to fall asleep all night, accompanied by dizziness, distending sensation in the head, conjunctival congestion, tinnitus, dry and bitter mouth, poor appetite, constipation, dark urine, red tongue with yellow coating, and wiry and rapid pulse.

Therapeutic Methods: To clear the liver, reduce fire, and tranquilize the mind.

Prescription: Ginseng, Rhizoma Rehmanniae Praeparata, Rhizoma Alismatis, Poria, etc.

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C. Internal Disturbance of Phlegm-heat

Chief Manifestations: Feeling of oppression in the chest, restlessness, insomnia, nausea, belching, accompanied by heavy sensation in the head, dizziness, bitter mouth, red tongue with yellow greasy coating, and smooth and rapid pulse.

Therapeutic Methods: To clear away heat, re-solve phlegm, regulate the stomach and tranquilize the mind.

Prescription: Radix Notoginseng, Radix Paeoniae Alba, Fructus Lycii, Rhizoma Discoreae, etc.

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D. Hyperactivity of Fire due to Yin Deficiency

Chief Manifestations: Palpitation, restlessness, insomnia, lumbago, weak legs, dizziness, tinnitus, poor memory, seminal emission, dry mouth, dysphoria with feverish sensation in the chest, palms and soles, red tongue with little coating, and thready rapid pulse.

Therapeutic Methods: To nourish yin, reduce fire, clear heart fire and tranquilize the mind.

Prescription: Ginseng, Rhizoma Rehmanniae Praeparata, Rhizoma Alismatis, Poria, etc.

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E. Deficiency of the Heart and Spleen

Chief manifestation: Dreamful and restless sleep, palpitation, amnesia, poor appetite, dizziness, tired limbs, pale complexion, pale tongue with thin coating, and thready and weak pulse.

Therapeutic Methods: To nourish the heart, invig-orate the spleen and tranquilize the mind.

Prescription: Ginseng, Rhizoma Rehmanniae Praeparata, Rhizoma Alismatis, Poria, etc.

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F. Deficiency of Heart Qi and Gallbladder Qi

Chief Manifestations: Restlessness, insomnia, dreamful and restless sleep, frightened palpitation, short-ness of breath, spontaneous sweating, lassitude, pale tongue and wiry and thready pulse.

Therapeutic Methods: To replenish qi, relieve frightened palpitation and tranquilize the mind.

Prescription: Ginseng, Rhizoma Rehmanniae Praeparata, Rhizoma Alismatis, Poria, etc.

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