General
Introduction
Insomnia is generally called “sleeplessness”. The name of the disease “no sleep” was first appeared in an ancient book “Nan Jing”. The disease is characterized by the patient usually being unable to get to normal sleep. The manifestations of the disease involve the following types according to the illness condition. First, the patient has no sleepiness in the initial stage after getting in bed, the condition is called “difficult to sleep”. Second, the patient is liable to wake up in the sleep, and then doesn’t go to sleep again, called “early awake”. Third the patien in a state between sleep and wake and could not get a deep sleep, or having a nightmare, called “light sleep”. Fourth, the patient lies awake all through the night, called “awake all night”. If the sleeplessness is caused by temporary causes, such as exciting, terror, anxiety, grief, or by environmental factors, such as noise, bright lamp light, and there is no other associated symptoms, it will take a turn for the better after these factors been removed. If the sleeplessness is caused other illness, such as fever, cough, pain ,these causes should be treated first. The sleeplessness will be on the mend. Don’t attend to trifles to the neglect of essentials. The sleep time of the people is different from one to another. If one who takes a short sleep everyday, but in a cheerful spirit, the situation is normal and should not be recognized as morbid state. The insomnia may onset singly or complicated by headache, dizziness, palpitation and amnesia. In chinical practice, it is treated in the light of related diseases.
Insomnia is different from the illness that the patient is unable to lie down or go to sleep by other diseases.
The prognosis of insomnia is good for most of the patients. Only for those who has severe insomnia with amentia, necessary measures should be employed to avoid accidents.
The diseases in western medicine, such as neurosis, hypertension, cerebral arteriosclerosis, anemia, hepatitis, menopausal syndrome and several mental diseases which have the symptoms of sleeplessness can be treated in the light of the disease mentioned in this chapter.
MAIN
POINTS OF DIAGNOSIS
DIFFERENTIATION
AND TREATMENT OF COMMON SYNDROMES
The causes of insomnia is related to the factors of emotional stress, imbalance between work and leisure, excessive eating and drinking,and usually weak constitution, or prolonged illness not been recovered. The main pathogenesis involves the followings: anxiety and tiredness, heart and spleen impairing, thus yang could not be entering yin, causing breakdown of the normal physiological coordination between the heart and kidney; stagnation of qi transforms into fire, then the liver-yang is disturbed; deficiency of heart-qi causes restlessness; indigestion and phlegm-heat causes disorder of the stomach-qi. All of these will disturb the mind and result in insomnia. The clinical syndromes involve both deficiency and excess which may transform mutually or mixed up with each other.
1.Emotional stress: Anxiety and anger impair the normal functions of the liver, hence making the liver-qi stagnated. The stagnated qi transforms into fire which attacks the mind due to its tendency of flaring up. The irritability of disturbed mind results in sleeplessness. The fire may also be formed by overacting of five emotions. The flame of the heart-fire causes the breakdown of the normal physiological coordination between the heart and the kidney. So the heart-fire is flaring and disturbing the mental activity, and finally resulting sleeplessness. Violent terror may cause emotional stress which gradually makes the patient be timid and restless, and results in sleeplessness finally. Or, the excessive anxiety impairs the heart and spleen. The impaired heart callses the yin-blood consumed and mentel deranged The impairment of the spleen causes loss of appetite, insufficiency of the sources of growth and development, deficiency of yin-blood and the heart not be nourished, and inducing sleeplessness finally.
2. Immoderate diet: Addiction of pungent, spicy, fried, fat and greasy food, or eating and drinking too much at one meal, and immoderate diet result in impairment of the intestine and stomach. Retention of food brings about phlegmheat which accumulated in the middle energizer and then causes the disorder of stomach-qi. The phlegm-heat disturbs upwards inducing sleeplessness.
3. Weak constitution, prolonged illness or during the convalescence of serious diseases: Insufficeiency in natural endowment, aged, weakness and not been recovered all bring about impairment of the kidney. The depleted kidney-yin could not nourish the heart and the discordance between water and fire all cause the hyperactivity of heart-yang and mental derangement. The insomnia caused by this pathogenesis is of the breakdown of normal physiological coordination between the heart and kidney. In addition, the weak and aged person who had undergone illness, post-delivery or blood loss, may suffer from insufficiency of heart-blood and failure of heart to be nourished and finally be filling ill at ease. This is another cause of insomnia. If a weak and timid person is frightened suddenly, his heart-qi will be more deficient and his mind is in unease state, the insomnia occurs. Therefore, frightening and deficiency may be reciprocally causation, and all can cause insomnia.
4. Imbalance between work and leisure: Overwork induce consumption of qi and undue easy and leisure causes dysfunction of the spleen. Thus the spleen could not transport the essentials from foodstuff and transform them into qi and blood, so the deficiency of blood makes the failure of heart to be nourished and insomnia occurred. Or , intemperance in sexual life and sexual indulgence will be causing hyperactivity of liver-qi and accumulation of qi in the chest and diaphragm. The blood is going upwards along with the ascending qi, thus causing dizziness, even being faint. The disease is also alleviated when qi and blood restored to normal state. The disease is also related to mental disorder and so belonging to the syndrome of liver stagnancy. The stagnation enters the blood from qi system, thus forming dim complexion and purple lips. Therefore the disease is treated with the prescriptions of soothing liver, alleviating depression, activating qi and promoting blood circulation. If the tongue proper is bulgy with teeth prints on its border, it indicates the spleen is deficient, then the astragalus root should be added to invigorate the spleen functions.
Melancholia is a category of diseases that are caused by mental stress and stagnation of functional activities of qi.The causes involve anger, depression, excessive deliberation and melancholy. The deficiency caused by consumption of essence and blood, and of heart-qi; excess caused by excessive phlegm-fire attacked inwards by pathogenic factors. Among them, deficiency is the principle, and excess the less important. If the patient is in convalescence after prolonged illness, the deficiency syndrome is often mixed up with the excess, and they have the relation of reciprocal causation hence resulting in intractable insomnia.
Therapeutic Principle
Replenishing qi and tonifying the blood, invigorating the spleen and nourishing the heart, relieving palpitation and tranquilizing the mind, resolving phlegm and drying dampness.
Recipe
Ginseng, Astragalus root, White atractylpdes, Loquorice, Chinese angelica root, Poria, Longan arit, wild or sping Jujube seed, Arborritae seed, Dragon’s bone, Oyster shell, Chuanxiong rhizome, Pinellia tuber, Dodder seed & etc.