TCM and Insomnia
By Dr. Hong-Yen Hsu
In modem medical theory, normal patterns of sleeping and wakefulness are controlled by the brain through a sleep center and a waking center, and insomnia is the result of a breakdown of this regulatory function. Insomnia can occur as a result of psychic, social, physical or health-associated (e.g., cerebral arteriosclerosis, psychosis) stimulation of the pathways that control sleep. Chinese herbal medicine attributes insomnia to overworking of the mind, fright, deficiency of the viscera (heart, spleen, liver and kidney), irregular or uncontrolled eating and drinking, physical asthenia, and prolonged illness.
Chinese herbal medicine treats insomnia according to the specific cause of the insomnia, and in regard for the patient's conformation of deficiency or excess - which usually fall within the following conformations.
1. Deficiency of heart and spleen: marked by insomnia or dreaminess, fitful sleep, amnesia, palpitation, fatigue, weakness, anorexia, poor facial complexion, pale tongue, and a thready and weak pulse. Commonly treated with Ginseng and Longan Combination to nourish the heart and invigorate the spleen. Recent studies have found this formula to regulate mental excitability, and to promote digestion. For frequent insomnia, schizandra, polygonum stem, biota, dragon bone and oyster shell can be added; and if there is also a poor appetite, add shen-chu.
2. Hyperactive fire due to yin deficiency: marked by anxiety, insomnia, dizziness, tinnitus, feverish sensation in the palms and soles, dry mouth with little saliva, nocturnal emissions, spermatorrhea, premature ejaculation, palpitation, amnesia, soreness at the waist, red tongue, and thready and rapid pulse. Most commonly indicated is Coptis and Gelatin Combination and/or Ginseng and Zizyphus Formula. If the patient is persistently bothered by insomnia, dragon bone and oyster shell should be added. Ginseng and Zizyphus Formula is more effective in regulating mental disturbances which affect sleep, and it can tranquilize without causing restlessness.
3. Fright caused by deficiency of heart qi: marked by insomnia, anxiety, palpitation, dreaminess, fitful sleep, easily frightened, neurosis, and taut and thready pulse; Zizyphus Combination or Ginseng and Acorus Combination is commonly used. Research has shown Zizyphus Combination to be effective in inducing sleep and bringing down fever. Astragalus and Zizyphus Combination can also be used.
4. Stagnation of liver-qi· marked by mental depression with a tendency to lose temper, anxiety, vertigo, blurred vision, fullness in the abdomen, eructation, anorexia, feeling of oppression in the chest, hypochondriac pain, irregular menstruation, taut pulse; Bupleurum and Cyperus Combination is commonly recommended. If there is also upflushing fire marked by bitter taste in the mouth, restlessness, headache, conjunctival congestion, yellowish tongue fur and taut rapid pulse, moutan, gardenia, chrysanthemum and gambir should be added.
5. Disorder of stomach-qi: marked by insomnia with symptoms of indigestion including stuffiness and fullness in the epigastrium, distention in the abdomen with periodic pain, regurgitation of stomach acid, eructation with fetid odor, loss of appetite, nausea or vomiting, greasy and yellowish tongue fur and slippery pulse; Citrus and Crataegus Formula is commonly used for resolving such a retention of food.
6. Uprising phlegm-heat: marked by insomnia with symptoms of anxiety, vertigo, palpitation, oppressed sensation in the chest, vomiting, copious phlegm, gastric discomfort with acid regurgitation, bitter taste in the mouth, yellow greasy tongue fur, and slippery rapid pulse; Hoelen and Bamboo Combination and Bamboo & Ginseng Combination are usually recommended. These formulas have effects in tranquilizing the mind, and coordinating the functions of the vegetative nerve.
7. Other formulas commonly used for the treatment of insomnia:
(1) Bupleurnm and Dragon Bone Combination: indicated for palpitation, chest and subcardiac distention, dreaminess, feelings of insecurity, agitation, irritability, melancholy and worry.
(2) Tang-kuei and Cyperns Formula: indicated for insomnia with menopausal symptoms such as tidal fever with flushed face, paroxysmal feverishness with sweating, tension, depression, irritability and a tendency to anger. Dragon bone and gambir may also be included in the prescription.
(3) Licorice and Jujube Combination: indicated for persistent depression resulting in impairment of mental functions characterized by insomnia, withdrawal, dysphoria, sadness and melancholy and a tendency to cry, and unfounded fear. This formula nourishes the heart to tranquilize the mind. Zizyphus, biota, dragon bone, albizzia and turmeric may also be included in the prescription.
(4) Pinellia and Licorice Combination: indicated for excess conformation of average constitution with symptoms of insomnia, distention beneath the heart, dysfunction of the gastrointestinal system and/or mental instability. The formula is effective in relieving inflammation, tranquilizing the mind and regulating the functions of the gastrointestinal tract.
(5) Bupleurum Formula or Bupleurum, Citrus and Pinellia Formula: indicated for excitability caused by liver- qi disturbance with symptoms of nervousness, irritability and insomnia.
(6) Cinnamon and Coptis Combination: indicated for insomnia caused by imbalance between heart-yang and kidney-yin marked by worry, palpitation, tidal fever, night sweats, tinnitus, dizziness, lumbago, spermatorrhea, empty and quick pulse, and red tip of the tongue.
8. The most commonly used herbs for treatment insomnia are:
Polygala - to relieve mental distress, tranquilize the mind, and remove phlegm.
Biota - to nourish the heart and tranquilize the mind.
Polygonum stem - to tranquilize the mind and nourish the blood.
Zizyphus - to nourish the heart, tranquilize the mind and tonify yin.
Albizzia - to promote blood circulation and tranquilize the mind.
Dragon bone, oyster shell - to calm the liver and suppress hyperactivity of liver-yang & sedate and tranquilize.
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