Insomnia, also referred to in ancient texts as “bu-mei,” “bu-de-mei,” or “bu-de-wo,” refers to the inability to achieve normal sleep. Mild cases involve difficulty falling asleep or waking frequently during the night, while severe cases may result in being unable to sleep at all throughout the night. Insomnia is often accompanied by symptoms such as headaches, dizziness, palpitations, forgetfulness, fatigue, and restlessness. Insomnia is commonly seen in cases of neurosis where insomnia is the primary symptom.
I. Causes of Insomnia
(1) Deficiency of the Heart and Spleen: Excessive worry and fatigue damage the heart and spleen. Damage to the heart leads to blood depletion and a restless mind; damage to the spleen prevents it from generating and transforming essential nutrients, thereby failing to nourish the heart. This results in mental restlessness and causes insomnia.
(2) Yin Deficiency with Excessive Fire: In individuals who are physically weak due to illness or a constitutional weakness, Kidney Yin is depleted and cannot ascend to support the Heart. When the Heart and Kidney fail to communicate, Heart Fire becomes excessively vigorous, leading to mental restlessness; or, when the five emotions become extreme, Heart Fire burns intensely internally and cannot descend to communicate with the Kidney. The failure of Heart-Kidney communication causes Heart Fire to become excessive, resulting in mental restlessness and insomnia.
(3) Heart Deficiency and Timidity: Sudden fright or emotional tension disturbs the mind; or, due to inherent deficiency of the heart and gallbladder, the person is easily startled and fearful, leading to restless sleep at night, or to scant sleep accompanied by frequent dreams and waking with a start.
(4) Stomach Disharmony: Due to irregular eating habits, the stomach and intestines are damaged; undigested food stagnates, impairing the functions of transformation and transportation; this accumulates as phlegm-heat, which becomes trapped in the middle burner, leading to disharmony of the stomach qi. This disturbs the mind and prevents restful sleep, resulting in insomnia.
Modern medicine classifies insomnia as follows:
- Initial Insomnia: Difficulty falling asleep, especially during the first half of the night; often caused by mental stress;
- Intermittent insomnia: Sleep is interrupted, with frequent awakenings and vivid dreams; commonly seen in middle-aged individuals with indigestion;
- Terminal insomnia (early awakening): Falling asleep is relatively easy, but the person wakes up very early; commonly seen in the elderly, those with hypertension, and those with depression.
II. Treatment of Insomnia
- Differential Diagnosis and Treatment in Traditional Chinese Medicine
(1) Deficiency of the Heart and Spleen: Frequent dreaming and easy awakening, palpitations, forgetfulness, mental fatigue and physical weakness, poor appetite, and a lackluster complexion. Treatment should focus on tonifying the heart and spleen to generate qi and blood; Gui Pi Tang with modifications is used.
(2) Yin Deficiency with Excessive Fire: Restlessness and insomnia, dizziness and tinnitus, dry mouth and insufficient body fluids, heat in the palms and soles, nocturnal emissions and seminal leakage, palpitations, forgetfulness, and soreness in the lower back and weakness in the knees. Treatment should focus on nourishing kidney yin, clearing heart fire, and lowering it; treat with modified Tianwang Buxin Dan.
(3) Heart Deficiency and Timidity: Palpitations, frequent dreaming, tendency to wake easily, prone to startle and fear, shortness of breath, and timidity. Treatment should focus on tonifying qi, calming startle reactions, soothing the spirit, and stabilizing the will; treat with Anshen Dingzhi Wan or He Suanzaoren Decoction.
(4) Stomach Disharmony: Insomnia, epigastric fullness with belching, difficult bowel movements, and epigastric and abdominal distension and pain. Treatment should focus on harmonizing the stomach, promoting digestion, resolving phlegm, and clearing heat; treat with a modified version of Baohe Pills. - Auricular Acupoint Pressure Therapy: Select primary acupoints such as Shenmen, Heart, Subcortical, and Occipital. Combine with acupoints such as Spleen, Liver, Gallbladder, and Kidney.
- Acupuncture: Select acupoints based on the patient’s symptoms.
- Other Methods
① Practice qigong regularly to maintain a positive mindset;
② Minimize overthinking before bedtime and avoid coffee, alcohol, and strong tea;
③ Engage in moderate exercise, progressing gradually;
④ Practice Tai Chi.
Relying solely on medication while neglecting mental and lifestyle adjustments often yields poor therapeutic results.