Western medicine and traditional Chinese medicine (TCM) have different approaches to insomnia. To Western doctors, insomnia is the inability to sleep soundly. If there is no obvious physical reason, such as pain, for the sleeplessness, it will usually be seen as an emotional problem such as stress, anxiety, or depression. A patient with a mild case of insomnia is told to "relax more, cut back on caffeine, try a hot bath or warm milk before bedtime." For chronic insomnia, the usual response is sleeping pills or anti-depressants.

In TCM, a primary concept is the idea of "root and branch." Symptoms like insomnia are considered to be the branches of a disease. The root of a disease is a dysfunction or imbalance of the fundamental substances (Chi, blood, Yin, Yang, Jing, Shen), or of the major organ systems (Lungs, Heart, Spleen, Liver, Kidneys). When a person suffers from insomnia, the two organs most often out of balance are the Heart and the Liver. Each of these two organs houses a specific aspect of the spirit. If these organs are out of balance, they will not be able to house the spirit properly, and the spirit will wander. (TCM, although a very complex medical system, had its origins in Taoism, and before that in shamanism. Therefore, there is a spiritual consciousness built into TCM theory.) A wandering spirit, or Shen disturbance, can manifest in a number of ways, including mood disorders and heart palpitations, but insomnia is one of the commonest symptoms.

There is a lot of space devoted to insomnia in classical Chinese medicine textbooks. Several different types of insomnia are noted, and the differences point to different origins of the problem. The commonest types of insomnia are as follows:

Dream-disturbed sleep: Nightmares normally indicate a disorder of the Gall Bladder meridian. Dreams in which we go over and over the same ground, walking in a maze, reliving aspects of our jobs or our relationships generally are due to a Spleen/Heart imbalance. People with this problem say, "I can?t shut my mind off."

Difficulty falling asleep: This is usually related to an excess condition of the Liver or Liver and Gall Bladder. People will lie awake, tossing and turning for hours.

Waking up easily: Many people can fall asleep easily, but then they wake up later and find it difficult to go back to sleep again. They may be awake for an hour or so, or may not go back to sleep at all. These people have a deficiency pattern, often a Heart/Spleen deficiency.

Waking up at a specific time every night: For example, some people regularly wake up at three o?clock in the morning. In Chinese medicine theory, the body's energy (Chi) circulates through the twelve principal meridians over a 24-hour period. Each meridian relates to an internal organ. If a person wakes or has some unusual symptoms at the same time every day, it is probable that there is an imbalance in the organ system that is "highlighted" at that time of day. Energy peaks in the Liver meridian at 3:00 a.m., which is why people often wake up then. Liver problems can result from unexpressed anger, stress triggering Liver Chi stagnation, and Liver Fire.

Other symptoms: When a Chinese medicine practitioner is analyzing a patient's sleeping problems, he narrows down the possibilities by looking for other symptoms that are characteristic of a particular disorder. For example, people with the Liver Fire pattern get angry easily, and have Heat signs such as a red face, dark yellow urine, and dry bowel movements. People with Spleen/Heart deficiency tend to be forgetful, have poor concentration, feel very fatigued, and are always worrying about something. People with a Kidney/Heart disharmony can have tinitus, palpitations, weakness in the low back, feel light-headed, and get flushed easily. Chinese medicine practitioners also examine their patients? tongues and feel the pulse for further indications of which particular pattern is predominant.

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