Insomnia+(Bu+Mian)

Insomnia refers to the inability to experience normal sleep.

In TCM, insomnia has a variety of meanings/presentations, including difficulty falling asleep, frequent waking during the night, difficulty returning to sleep after wakening, restless sleep, shallow sleep, frequent nightmares or dream-disturbed sleep, and in severe cases complete inability to fall asleep. Headaches, dizziness, palpitations, fatigue, and forgetfulness frequently accompany insomnia.

Insomnia in biomedical terms is a symptom that may result from a variety of causes: -Pain -Depression, anxiety, bipolar disorder -Sleep apnea -Caffeine use -Prescription medications and other drugs

TCM Etiology and Pathogenesis
The amount and quality of sleep is dependent on the state of the Shen, which is housed in the Heart and nourished by Heart Blood and Heart Yin. In general terms, insomnia is caused either by pathogenic factors agitating the Heart (repletion) or by malnourishment of the Heart (vacuity).

The Ethereal Soul (Hun) also plays an important role in the physiology and pathology of sleep. The Ethereal Soul (Hun) controls dreaming, and dream-disturbed sleep is often a result of this harmony in the The Ethereal Soul (Hun).

Adequate Liver-Blood or Liver-Yin is necessary to root the The Ethereal Soul (Hun). If Liver-Blood or Liver-Yin is vacuous, sleep becomes restless and dreams may be excessively vivid and disturbing. The Ethereal Soul (Hun) is affected not only by a vacuity of the Liver but may also be affected by pathogenic factors such as Heat/Fire.

Emotional stress: anger, frustration, irritability, or depression can injure the Liver and cause Liver Qi stagnation that, over time, may generate Heat or Fire that disturbs the Heart Shen.

Improper diet: overeating or excessive consumption of greasy, spicy food can result in Food Stagnation and Phlegm-Heat in the Stomach causing the Stomach Qi to rebel upwards and Phlegm-Heat to harass the Heart Shen.

Pensiveness: excessive rumination or over thinking injures the Spleen, leading to Qi and Blood vacuity which fail to nourish the Heart. Lack of Blood means the Shen has no residence, causing insomnia.

Congenital vacuity, aging, chronic illness, overwork, excessive sexual activity: Vacuous Kidney Yin fails to nourish Heart Yin causing Heart Yang to become hyperactive with empty Fire agitating the Heart Shen. Constitutional vacuity of both the Heart and Gallbladder can show in a personality that is timid, anxious, and indecisive. Sleep will be light with frequent waking during the night accompanied by panic, nightmares, and palpitations. Spleen Qi vacuity may result in Blood vacuity with failure to nourish the Heart. Lack of Blood means the Shen has no residence; this causes insomnia.

Diagnostic Pointers
It is imperative to determine whether or not a patient’s insomnia is secondary (caused by a known physical or mental condition) or primary; do not diagnose insomnia when sleep is disturbed by other illnesses such as asthma, cough, pain, or itching from a dermatological condition. Primary insomnia is not caused by a sudden change in weather, drinking caffeinated beverages before bedtime, emotional distress or excitement, noise or stimulation by bright light.

Difficulty falling asleep usually indicates Blood vacuity. Falling asleep easily but waking up frequently usually indicates Yin vacuity. Waking up early in the morning or waking up with a startle indicates Heart and Gallbladder Qi vacuity.

A certain amount of dreaming is normal; however, nightmares, anxious dreams, angry dreams or dreaming all night to the point where a person wakes feeling tired is considered abnormal in TCM.

Liver Depression Transforming into Fire
[Long Dan Cao (6g.), Chai Hu (6g.), Zhi Zi (9g.), Huang Qin (9g.), Dang Gui (3g.), Sheng Di Huang (9g.), Mu Tong (9g.), Che Qian Zi (9g.), Ze Xie (12g.), Gan Cao (3g.)]
 * Main Symptoms:** insomnia, irritability, propensity toward angry outbursts, unpleasant dreams or nightmares
 * Secondary Symptoms:** red/bloodshot eyes, chest or ribside distention, thirst, constipation, bitter taste in the mouth, dark urine
 * Tongue**: red with yellow coat
 * Pulse:** rapid, wiry
 * Treatment Principles:** Soothe the Liver, drain Fire, calm the Spirit
 * Herbal Treatment:** lóng dǎn xiè gān tāng (Gentiana Long Dan Cao Decoction to Drain the Liver)

An Mian Tang [Chai Hu (9g.), Bai Shao Yao (9g.), Chuan Xiong (9g.), Fu Ling (9g.), Chao Bai Zhu (12g.), Huang Lian (6g.), Chao Zhi Zi (9g.), Sheng Di Huang (9g.), Chao Suan Zao Ren (30g.), Ye Jiao Teng (30g.), Gan Cao (30g.)]

Phlegm-Fire Harassing the Interior
[Huang Lian (6g), Zhu Ru (Bamboo shavings) 6g, Zhi Shi (Unripe Bitter Orange) 6g, Ban Xia (Pinellia tuber) 6g, Chen Pi (Tangerine peel) 9g, Fu Ling (Poria) 4.5g, Gan Cao (Licorice root) 3g, Sheng Jiang (Fresh Ginger rhizome) 3-6g]
 * Main Symptoms:** insomnia, chest fullness with expectoration of copious phlegm, heaviness of the head
 * Secondary Symptoms:** aversion to eating, belching, acid regurgitation, nausea or vomiting, distention in the epigastrium, bitter taste in the mouth, irritability, dizziness
 * Tongue:** yellow, greasy coat
 * Pulse**: rapid, slippery
 * Treatment Principles:** Clear Heat, transform Phlegm, harmonize the Stomach, calm the Spirit
 * Herbal Treatment:** Huang Lian Wen Dan Tang (Coptis Warm the Gallbladder Decoction)

Food Stagnation
[Ban Xia (Pinellia) 10g, Fu Ling (Poria) 10g, Chen Pi (Tangerine Peel) 10g, Shan Zha (Hawthorn berry) 10g, Shen Qu (Medicated leaven) 10g, Lai Fu Zi (Raphanus) 10g, Lian Qiao (Forsythia) 10g, Zhi Gan Cao (Honey-Fried Licorice) 10g]
 * Main Symptoms**: insomnia with distending, epigastric pain which is worse with pressure; belching, acid regurgitation, halitosis
 * Secondary Symptoms:** nausea, vomiting of undigested food, epigastric pain relieved after belching or vomiting, anorexia, incomplete evacuation of stool or loose, foul-smelling stool or constipation with dry stool
 * Tongue:** thick, greasy coating
 * Pulse: slippery**
 * Treatment Principles:** Disperse food, eliminate stagnation, relieve pain, calm the Spirit
 * Herbal Treatment:** Bao He Wan (Harmony Preserving Pill)

Yin Vacuity with Effulgent Fire
[Huang Qin (Scutellaria root) 6g, Huang Lian (Coptis rhizome) 12g, E Jiao (Ass Hide glue) 9g, Bai Shao Yao (White Peony root) 9g, Ji Zi Huang (Egg yolk*) 2
 * Main Symptoms:** insomnia, irritability, restlessness
 * Secondary Symptoms:** dizziness, tinnitus, forgetfulness, palpitations, 5 Centers Heat, dry mouth, night sweats, sore low back
 * Tongue:** red with scanty or no coating
 * Pulse:** rapid, thin
 * Treatment Principles:** Nourish Kidney Yin, downbear Heart Fire, calm the Spirit
 * Herbal Treatment:** Huang Lian E Jiao Tang (Coptis and Ass Hide Glue Decoction)
 * Stirred in while cooling

Tian Wang Bu Xin Dan(Emperor of Heaven's Special Pill to Tonify the Heart) [Sheng Di Huang (Fresh Rehmannia root) 120g, Fu Ling (Poria)15g, Dan Shen (Salvia root) 15g, Ren Shen (Ginseng root) 15g, Dang Gui (Tangkuei) 30g, Bai Zi Ren (Arbor-vitae seed) 30g, Yuan Zhi (Polygala root) 15g, Suan Zao Ren (Zizyphus seed) 30g, Tian Men Dong (Asparagus tuber) 30g, Mai Men Dong (Ophiopogon tuber) 30g, Wu Wei Zi (Schisandra fruit) 30g, Xuan Shen (Scrophularia root) 15g, Jie Geng (Platycodon root) 15g, Zhu Sha (Cinnabar) 15g]

Liver/ Heart Blood Vacuity with Empty Heat
[Suan Zao Ren (Zizyphus seed) 15-18g, Chuan Xiong (Ligusticum root) 6g, Zhi Mu (Anemarrhena rhizome) 6g, Fu Ling (Poria) 6g, Gan Cao (Licorice root) 3g]
 * Main Symptoms:** difficulty falling asleep, frequent, vivid dreams
 * Secondary Symptoms:** irritability, headache, chest or hypochondriac distention or pain, palpitations, night sweats, dry throat and mouth, dizziness
 * Tongue:** red
 * Pulse:** wiry or thin, rapid
 * Treatment Principles:** Nourish Liver and Heart Blood, clear empty Heat, calm the Spirit
 * Herbal Treatment**: Suan Zao Ren Tang (Zizyphus Seed Decoction)

Heart and Spleen Vacuity
calm the Spirit Herbal Treatment: Gui Pi Tang (Spleen-Returning Decoction) [Ren Shen (Ginseng root) 9g, Huang Qi (Astragalus root) 9g, Bai Zhu (Atractylodis root) 9g, Fu Ling/Shen (Poria) 9g, Suan Zao Ren (Zizyphus Spinosa seed) 9g, Long Yao Rou (Arillus Euphoriae Longanae) 9g, Mu Xiang (Aucklandia Lappae root) 6g, Zhi Gan Cao (Honey-fried Licorice root) 6g, Dang Gui (Angelicae Tangkuei root) 6g, Zhi Yuan Zhi (Honey-fried Polygala root) 3g, Sheng Jiang (Fresh Ginger rhizome) 3g/5 slices, Da Zao (Jujube) 5 pcs.]
 * Main Symptoms:** difficulty falling asleep, light sleep, frequent and vivid dreams, palpitations, forgetfulness
 * Secondary Symptoms:** dizziness, fatigue, poor appetite, pale complexion
 * Tongue:** pale with thin coat
 * Pulse:** thin, weak
 * Treatment Principles:** Supplement the Heart and Spleen to promote the production of Qi and Blood,

Heart and Gallbladder Qi Vacuity
Herbal Treatment: An Shen Ding Zhi Wan (Spirit-Quieting Mind-Stabilizing Pill) [Fu Ling (Poria) 9g, Fu Shen (Poria root) 9g, Yuan Zhi (Polygala root) 6g, Ren Shen (Ginseng Root) 9g, Long Gu (Dragon Bone) 30g, Shi Chang Pu (Acorus rhizome) 6g]
 * Main Symptoms:** insomnia with light sleep, frequent and vivid (sometimes disturbing) dreams, tendency to wake with a start
 * Secondary Symptoms**: timidity, palpitations, easily frightened or startled, shortness of breath, fatigue, copious, clear urine
 * Tongue:** pale
 * Pulse:** thin, wiry
 * Treatment Principles:** Supplement Qi, stop fright, calm the Spirit, stabilize the Mind

Acupuncture for Insomnia

 * Basic Points:** HT7, SP6, An Mian, KI6, BL62
 * LV Fire:** LV2, LV3, BL18
 * Phlegm-Fire:** ST40, ST44, ST36, CV12, LU5
 * Food Stagnation**: Diamond tx, CV10, ST21, Li Nei Ting, ST44
 * HT/KI Yin xu:** BL15, BL23, KI3
 * HT/LV Blood xu:** BL15, BL18, LV3
 * HT/SP xu:** BL15, BL20, ST36, SP3
 * HT/GB Qi xu:** HT5, GB40, BL15, BL19

Ear Points: Sub Cortex, Brain, Shen Men, Sympathetic, Heart, Spleen, Endocrine

Clinical Tips
-For insomnia due to vacuity of Qi, Blood, and Yin, focus the treatment on the use of herbs to supplement the Heart, Blood, Qi, and Yin and add a small quantity of herbs to anchor, settle, and calm the Spirit. -For insomnia due to excess pathogenic factors that disturb the Spirit, focus the treatment on the use of herbs that anchor, settle, and calm the Spirit, and add a small quantity of herbs to nourish the Heart and calm the Spirit.

“Draining the South and tonifying the North” is a strategy appropriate for insomnia due to lack of communication between the Heart and Kidney. The Heart pertains to the south while the Kidney pertains to the North. With Kidney Yin vacuity, water fails to nourish the Heart and empty Fire flares; hyperactivity of Heart Fire leads to insomnia, mental restlessness, irritability and palpitations.

Insomnia is either the partial or complete loss of sleep. To be considered pathologic, this condition must have lasted for some time. It does not refer to a single night’s lost sleep. In the //Nei Jing// this is also referred to as “inability to close one’s eyes,” or “inability to lie down“. Insomnia is a secondary problem following any bodily disturbance.

Relevant Western Diseases: Insomnia can be found with depression, mania, schizophrenia, psychoneurosis, and reactive neurosis disorder as well as many physical situations

Diagnosis: A. Mild type has difficulty falling sleep, but stays asleep once fallen asleep B. Moderate type wakes easily or early, has disturbed sleep, tiredness in morning C. Severe type has no sleep overnight at all and may feel exhausted at morning D. Accompanied by bodily symptoms like headache, dizziness, weakness, lack of concentration, palpitations, forgetfulness, etc. E. Frequent dreams during the sleep, nightmare, anxiousness, fearful and scary dreams, wake up with crying or expressing extreme emotion F. Insomnia occurs three times or more in a week, continually over one month or more requires treatment G. Nervous system and laboratory examinations may be negative or positive Should have A, then refer other items to confirm the diagnosis

Prognosis: Insomnia can be life long, some patients suffer very severe insomnia if they have severe Shen disturbance Today a high percentage of people regulate their sleep using medications or herbs

Differential Diagnosis: Medical Disorders: A. Degenerative neurologic diseases including Parkinson’s Disease, Huntington’s Disease B. Alzheimer’s Disease and other dementias C. Seizure DisordersHistory of cerebrovascular accident (CVA) D. Sleep Apnea (Central or Obstructive) E. Restless Leg Syndrome Effects of Substances: A. Alcohol or illicit substance intoxication or withdrawal B. Side effects of medications Psychiatric Disorders: A. Panic Disorders B. Post-traumatic Stress Disorder C. Generalized Anxiety Disorder (GAD) D. Mood Disorders E. Schizophrenia and other psychotic disorders

TCM Etiology & Pathogenesis: “In Chinese medicine, sleep is seen as the sinking of the clear Yang Qi of the heart spirit back down and into the interior of the body to be covered and enfolded by Yin If the heart spirit ecomes disquieted either due to malnourishment or harrassment by evil Qi, it will not sink back down calmly and quietly as it should… The most common types of evil Qi harassing the heart spirit and causing insomnia are evil heat or fire and phlegm. Evil heat may include depressive heat, vacuity, phlegm fire, and heart fire effulgence.”1

“Insomnia can happen in many different situations: emotional disharmony, internal pathologic stagnation and internal evil Qi such as cold, heat or fire from Zang Fu disharmony weakened Yin creates vacuity heat and leads to Yang rising which can stir and affect brain Shen. In some severe cases Yin-Yang and Qi-Blood are exhausted; this condition causes disharmony between body and Shen and results in insomnia. External evil Qi, including the six evil Qi or toxic pathogens, can also cause insomnia because these pathogens can break the Shen house, the body aspect where Shen is located. For the eldery, the essence, Qi, blood and Zang Fu functions are getting weaker and are not harmonizing with Shen .”2

TCM Pattern Differentiation: Liver Blood Vacuity Transforming Vacuity Heat 1 Insomnia, vexation and agitation, disquieted emotions, irritability, heart palpitations, night sweats, dizziness and vertigo dry mouth and throat [Suan Zao Ren (12g.), Zhi Mu (10g.), Fu Ling (10g.), Gan Cao (3-10g.), Huai Xiao Mai (15-30g.)] - 2TTD (noon & bedtime) Night sweats: + Mu Li, Wu Wei Severe vacuity heat: + Han Lian Cao, Nu Zhen Zi, Bai Shao
 * Tongue:** pale tongue, red tip
 * Pulse:** fine, bowstring, rapid
 * Treatment Principles:** Nourish the Yin and clear heat, quiet the spirit and eliminate vexation
 * Acupuncture Treatment:** LR-8, KI-3, SP-6, BL-42, BL-47. Even technique
 * Herbal Treatment:** Suan Zao Ren Tang Jia Jian1
 * Modifications:**

Heart & Kidney Yin Deficiency Creating Deficient Fire, Affecting Shen 1,2 Insomnia, irritable, tossing and turning in bed, dizziness or tinnitus, hot feeling at night, 5-palm heat, night sweats, dream disturbed sleep, excess dreams, low energy, lower bache ache, sore legs and feet, emaciation, poor memory and concentration, yellow or scanty urination, constipation, scanty menses or amenorrhea, seminal emission -PC-7, KI-3, HT-7, KI-1. Even technique. Bathe feet in warm water & massage KI-1 before sleep. 1 -Tonify: KI-3, KI-6, SP-6; Drain: LR-2, KI-2; Even: HT-7, GB-20, Yintang2 - Huang Lian E Jiao Tang Jia Jian – [Huang Lian (6g.), E Jiao (6g.), Huang Qin (10g.), Bai Shao (0g.), Ji Zi Huang (2 pieces), Fu Shen (12g.), Suan Zao Ren (12g.), Rou Gui (3g.), Yuan Zhi (10g.)1 Severe insomnia1: + Zhu Sha, Hu Po; +An Mian Severe vacuity heat1: + Xuan Shen, Sheng Di; + ST-44 Dizziness1: + Zhen Zhu Mu, Long Gu; + GB-20 Tinnitus1: + Ci Shi; + SI-19 Seminal emission1: + Huang Bai, Zhi Mu; + BL-52
 * Tongue:** red tongue, scanty coat
 * Pulse:** thready or fine, rapid
 * Treatment Principles:** Nourish Yin and downbear fire, quiet the heart spirit and promote the interaction between the heart and kidneys
 * Acupuncture Treatment:**
 * Herbal Treatment:**
 * -**[Suan Zao Ren, He Shou Wu, Yuan Zhi, Long Gu, Mu Li, Wu Wei Zi, Niu Zhen Zi, Han Lian Cao, Huang Bai, Zhu Mu] 2
 * Modifications:**

Heart Yin Vacuity 1 Difficulty falling asleep, heart palpitations, vacuity vexation, impaired memory, dream emission, profuse dreams, afternoon tidal heat, night sweats, 5-palm heat, sores in the mouth and on top of tongue, dry mouth & throat, dry stools [Sheng Di (12g.), Dang Shen (10g.), Dan Shen (10g.), Xuan Shen (10-15g.), Fu Shen (12g.), Wu Wei ZI (10g.), Yua Zhi (10g.), Dang Gui (10g.), Tian Dong (12g.), Ma Dong (12g.), Bai Zi Ren (12g.), Suan Zao Ren (12g.)] Severe heart palpitations: + Long Chi; + PC-6 Night sweats: + Long Gu, Bai Shao; + BL-43 Sores in mouth & tip of tongue: + Dan Zhu Ye, Huang Lian; + PC-8, CV-23 Impaired memory: + BL-52 w/ moxa
 * Tongue:** red tongue, scanty coat
 * Pulse:** fine, rapid
 * Treatment Principles:** Supplement the heart and enruch Yin, nourish the blood and quiet the spirit
 * Acupuncture Treatment:** HT-6, BL-15, SP-6, KI-6. Even technique
 * Herbal Treatment:** Tian Wang Bu Xin Dan Jia Jian1
 * Modifications:**

Heart and Kidney Yang Deficiency, Damp Phlegm Misting Shen 2 Imsomia, tiredness, low energy, sleepy in the daytime, heavy head, dizziness, foggy head, poor memory, clouded mind, palpitations, heavy chest sensation, heavy limbs and body, lassitude, cold feet and hands, edema, shortness of breath, may wake during sleep with difficulty breathing, soreness of lower back and lower extremities
 * Tongue:** pale tongue, slippery white coat
 * Pulse:** wslow, weak
 * Acupuncture Treatment:** BL-15, BL-23, BL-43, BL-52, BL-20, GV-4, KI-3, SP-6, GV-17, GV-20
 * Herbal Treatment:** [Gui Zhi, Fu Zi, Sheng Jiang, Ban Xia, Chuan Xiong, Xiang Fu, Chen Pi, Fu Ling, Zhe Xie, Xie Bai, Du Zhong, Xu Duan, Du Huo, Gua Lou] 2

Heart Qi and Blood Stagnation, Clear Cavity Obstructed and Shen Irritable 2 Imsomnia, may be recurrent type w/ palpitations, may have chest tightness, heaviness or painful sensations, easily startled, wakes up at night, nightmares, headaches, worse at night, may be exacerbated by emotional changes, long term history of stress or emotional problems, may have Shen disturbance, purplish complexion, especially lips
 * Tongue:** purplish tongue, white coat
 * Pulse:** wiry, choppy, irregular and intermittent
 * Acupuncture Treatment:** HT-7, HT-5, CV-14, CV-17, LR-3, LR-14, BL-15, BL-17, BL-18, Taiyang, Yintang
 * Herbal Treatment:** [Tao Ren, Hong Hua, Shi Chang Pu, Yuan Zhi, Ban Xia, Chuan Xiong, Xiang Fu, Gui Zi, Jie Geng, Zhi Qiao, Chi Shao, Chai Hu, Chuan Niu Xi] 2

Heart-Gallbladder Qi Vacuity 1 Insomnia, fear of sleeping alone, timidity, paranoia, susceptibility to fright, heart palpitations, frequent sighing, dizziness, waking in a fright, possible profuse phlegm and/or plum pit Qi [Ren Shen (6-10g.), Fu Ling (10g.), Fu Shen (12g.), Shi Chang Pu (10g.), Yuan Zhi (10g.), Suan Zao Ren (12g.), Long Chi (12g.), Hu Po (1g.)]
 * Tongue:** pale tongue
 * Pulse:** fine, weak, bowstring, possibly slippery
 * Treatment Principles:** Supplement the gallbladder Qi, settle fright and quiet the spirit
 * Acupuncture Treatment:** PC-7, BL-42, G-24, SP-6, BL-15, BL-19. Even technique, alternate last two between treatments
 * Herbal Treatment:** Ding Zhi Wan Jia Jian1

Heart-Spleen Dual Vacuity 1 Difficulty falling asleep, profuse dreams, easily being awakened as one is falling asleep, sensitive to voices or sounds, heart palpitations, impaired memory and concentration, pale white or sallow yellow complexion, dizziness, lassitude of the spirit, shortness of breath, disinclination to talk, nervous and moody, sleepy in the daytime, prefers to lie down ,poor appetite, weight loss, reduced food intake, loose stools, pale complexion -BL-20, SP-6, HT-7, BL-15. Tonifying technique1 -BL-15, BL-20, BL-43, HT-7, HT-9, SP-6, An Mian, Si Shen Cong2 - [Huang Qi, Dang Shen, Dang Gui, Fu Shen, Suan Zao Ren, Yuan Zhi, Long Ran Rou, He Huan Pi, Ye Jiao Teng]2 Severe insomnia1: + Ye Jiao Teng, Bai Zi Ren Impaired memory1- Dang Shen; + Ren Shen, Shi Chang Pu Profuse dreams1: + Hu Po
 * Tongue:** pale tongue, thin coat
 * Pulse:** fine, weak, or weak, thready
 * Treatment Principles:** Fortify the spleen and boost the Qi, nourish the heart and supplement the blood
 * Acupuncture Treatment:**
 * Herbal Treatment:**
 * -**Gui Pi Tang Jia Jian1- [Bai Zhu (10g.), Fu Shen (12g.), Huang Qi (15g.), Dang Shen (10g.), Gan Cao (6g.), Dang Gui (6-15g.), Long Yan Rou (10g.), Suan Zao Ren (12g.), Yuan Zhi (10g.), Mu Xiang (6-10g.)]
 * Modifications:**

Liver Qi Stagnation, Phlegm Misting the Shen Irritable 2 Insomnia, overthinking, stressed out when going to bed, irritable, difficulty falling asleep, easily angered, depressed and moody, hypochondriac pain, feeling bloated an distended andomen, talkative, heavy head and headaches
 * Tongue:** pink tongue, thick coat
 * Pulse:** wiry, slippery
 * Acupuncture Treatment:** LR-3, LR-6, LR-14, ST-40, SP-9, PC-7, CV-17, GV-24, An Mian
 * Herbal Treatment:** [Huang Qin, Qing Meng Shi, Ban Xia, Hou Po, Chen Pi, Bai Zhi, Shi Chang Pu, Xiang Fu, Yuan Zhi, Gan Jiang, Su Gen]

Liver Fire Harrassing Internally 1 Difficulty falling asleep due to dizziness and headache, vexation, impatience, irascibility, chest and rib-side distention and fullness, frequent sighing, thirst, bitter taste in mouth, red eyes, dark urination, constipation [Long Dan Cao (6-10g.), Huang Qin (10g.), Zhi Zi (10g.), Da Huang (3-6g.), Chai Hu (3-10g.), Dang Gui (10g.), Chuan Xiong (6-10g.), Zhen Zhu Mu (15g.), Long Chi (15g.)] Severe dizziness: + GV-20 Tinnitus or red eyes: + Xia Ku Cao; + TW-17, TW-3 (tinnitus) or LI-5, Taiyang (red eyes) Damp heat in lower burner: + Mu Tong, Ze Xie Depressive heat (not severe): Use Dan Pi Sang Ye Fang – [Dan Pi (10g.), Ban Xia (10g.), Gou Teng (12-15g.), Sang Ye (10g.), Fu Ling (12g.), Ju Hong (6g.)]
 * Tongue:** red tip, yellow coat
 * Pulse:** bowstring, rapid
 * Treatment Principles:** Clear the liver, drain fire, and quiet the spirit
 * Acupuncture Treatment:** LR-2, GB-44, GB-20, HT-7. Draning technique
 * Herbal Treatment:** Xie Qing Wan Jia Jian1
 * Modifications:**

Phlegm Fire Harrassing Above 1,2 Difficulty falling asleep due to severe vexation, chest oppression, epigastric fullness, nausea, vomiting, heavy headedness, dizziness, bitter taste in mouth, snoring, shortness of breath, prefers spicy and junk food, phlegm sound when talking -ST-40, ST-44, CV-12, HT-7, GV-20. Draning technique1 -HT-5, HT-7, HT-8, PC-7, ST-25, ST-40, ST-44, SP-6, Yintang, Shan Yin Tang2 - Huang Lian Wen Dan Tang Jia Jian - [Huang Lian (3-6g.), Ban Xia (12g.), Fu Shen (12g.), Zhu Ru (12g.), Zhi Shi (6g.), Chen Pi (6-10g.), Shi Chang Pu (10g.), Yuan Zhi (10g.), Suan Zao Ren (15g.), Long Gu (15-20g.), Mu Li (15-20g.)] 1 -[Huang Lian, Huang Qin, Zhi Zi, Zhu Ru, Che Pi, Ban Xia, Jiu Hong, Fu Ling, Dan Zhu Ye, Tian Zhu Huang, Gan Cao] 2 Constipation: + Gua Lou Ren, Da Huang Food stagnation w/ stomach disharmony: - Ban Xia; + Ban Xia Qu, Shu Mi Nausea or vomiting: + PC-6 Vertigo: + Dan Nan Xing, Tian Ma Phlegm rheum w/ heat (dry throat, numb extremities, sudden startling, counterflow palpitations): Use Shi Wei Wen Dan Tang He Shu Mi Tang Jia Jian1 – [Ren Shen (6g.) Fu Ling (12g.), Suan Zao Ren (12g.), Zhi Mu (6-10g.), Zhu Ru (6-10g.), Ban Xia (10g.), Shi Mu (15g.)
 * Tongue:** red tip, slimy yellow coat
 * Pulse:** slippery, rapid
 * Treatment Principles:** Clear heat, transform phlegm, and quiet the spirit
 * Acupuncture Treatment:**
 * Herbal Treatment:**
 * Modifications:**

Heart Fire Effulgence 1 Insomnia, vexatious heat in chest & heart, thirst w/ desire for cold drinks, red complexion, sores in mouth or on tip of tongue, painful shot dark colored urination [Sheng Di (12g.), Mu Tong (6-10g.), Dan Zhu Ye (10g.), Gan Cao Shao (6g.), Deng Xin Cao (3g.)] Severe insomnia: + Hu Po, Huang Lian Painful urination: + Huang Bai, Zhi Zi Multiples sores in mouth & tip of tongue: + Lian Qiao, Huang Lian
 * Tongue:** red tip
 * Pulse:** rapid, forceful
 * Treatment Principles:** Clear the heart, drain fire, and quiet the spirit
 * Acupuncture Treatment:** HT-7, PC-8, HT-8, ST-41. Draning technique
 * Herbal Treatment:** Dao Chi San Jia Jian1
 * Modifications:**

Retained Heat 1 Vacuity vexation, Insomnia, fever, profuse sweating, chest and diaphragmatic oppression, thirst w/ a desire to drink, clamoring stomach, desire to vomit [Zu Ye (12g.), Shi Gao (20g.), Ban Xia (10g.), Mai Dong (12g.), Tai Zi Shen (10g.), Gan Cao (3-6g.), Geng Mi (10g.)] Severe vexation: + Zhi Zi, Dan Dou Chi
 * Tongue:** red tongue, scanty coat
 * Pulse:** fine, rapid
 * Treatment Principles:** Engender fluids and supplement the Qi, clear heat and eliminate vexation
 * Acupuncture Treatment:** LI-11, LI-4, ST-44, CV-12, HT-7. Even technique
 * Herbal Treatment:** Zhu Ye Shi Gao Tang Jia Jian1
 * Modifications:**

Food Stagnation 1,2 Insomnia, pain, distention and fullness in the stomach and abdomen, aversion to food, counterflow retching, nausea, tossing and turning in bed, constipation or diarrhea, irritable, busy mind, preferring sweets and junk food -PC-6, CV-12, LR-13, ST-44. Draining technique1 -PC-6, CV-12, ST-25, ST-40, SP-14, LR-3, Yintang, HT-7, Li Nei Ting2 -Bao He Wan Jia Jian - [Shen Qu (10g.), Fu Ling (10g.), Shan Zha (10g.), Lian Qiao (10g.), Chen Pi (10g.), Huo Po (10g.), Zhi Shi (10g.), Ban Xia (10g.), Da Huang (3g.)]1 - [Shan Zha, Shen Qiu, Mai Ya, Chen Pi, Mu Xiang, Ban Xia, Ji Nei Jin, Fu Shen, Bai Zhu, Cang Zhu, Zhu Ru, He Huan Pi, Ye Jiao Teng ] 2 Grain food stagnation: + ST-21 Meat food stagnation: + ST-24
 * Tongue:** possibly red tongue, thick, slimy coat
 * Pulse:** slippery, wiry
 * Treatment Principles:** Disperse food, harmonize the stomach, and quiet the spirit
 * Acupuncture Treatment:**
 * Herbal Treatment:**
 * Modifications:**

Severe cases: Suan Zao Ren (30g.), Chen Pi (15g.), Hu Po (15g.)

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 * IBIS:**

Definition:
Difficulty falling asleep (initial insomnia) and/or frequent awakenings with difficulty falling back asleep or subsequent sleep that is restless and unsatisfying (early morning awakening insomnia or maintenance insomnia).

Etiology:
In any year 30% of the population will experience insomnia with 4-6 million people a year receiving prescriptions for sedative hypnotics. Aging itself tends to decrease the total amount of sleep needed and the sleep garnered is more restless.

Causes of initial insomnia include: anxiety or tension; environmental change; emotional arousal; fear of insomnia; sleep phobia; disruptive environment; pain or discomfort; caffeine or alcohol ingestion.

Causes of maintenance insomnia include: depression; environmental change; sleep apnea; nocturnal myoclonus; hypoglycemia; parasomnias; pain or discomfort; drugs; alcohol.

However, the boundary between the causes of the two types of insomnia is not clearly established. Another cause for insomnia may be an inverted sleep rhythm, seen especially in the elderly and secondary to the inappropriate use of sedative hypnotics that are often prescribed to combat insomnia. Patients become sleepy in the morning, and sleep or catnap most of the day. This sets them up for interrupted and fitful sleep at night. The problem is made manifest when the medication is increased, and the patient wanders around in confusion or a stupor at night. If the medication is withdrawn, the patient experiences the rebound effect of wakefulness, which the patient interprets as a return of insomnia thus provoking a return to the sedatives.

Other factors can be involved in insomnia, so the conscientious physician will perform a detailed history and physical exam. The history should include a thorough checking for prescription, non-prescription and recreational drugs, to determine if the patient is taking a stimulant or any other substance known to interfere or interrupt sleep (such as diet pills; oral contraceptives; thyroid medicine; marijuana; beta-blockers; alcohol; chocolate; coffee, soda pop or tea). Eating or exercising late at night are also known to cause insomnia.

Somatic Therapies:
• aerobic exercise program • nourish breathing: before bed • qigong • tai qi chuan

Nutrition:
therapeutic foods: • increase foods that calm the Shen (Spirit), tonify the Heart, harmonize the Stomach and Spleen • foods high in tryptophan: nuts, eggs, meat, fish, dairy • if supplementing tryptophan: give with cofactors (Vitamins B3, B6, and C) and whole wheat toast, bananas, walnuts, pineapples that are high in serotonin • increase foods high in Vitamin C, Vitamin B-complex » insomnia due to Xue Xu (Blood Deficiency): chicken, duck, and other Xue (Blood)-building foods » insomnia due to Heart and Kidney Not Communicating: oysters, celery, sesame seeds, walnuts

fresh juices: • lettuce and celery (Shefi) • carrot and spinach (Walker, p. 144) • carrot and celery (Walker, p. 144)

specific remedies: • Liver Yang Rising Insomnia: celery juice or decoct fresh celery 15 minutes and drink • 2 oz. fresh walnuts, 2 oz. black sesame seeds, crush and mix together, make into 1/8 oz. pills. Take 3 pills three times daily (Butt and Bloomfield, p. 143) • 3 oz. wheat kernels, 15 dried dates, 1 oz. honey. Boil them together in 1 pt. water until reduced to half. Eat and drink the results of this. (Butt and Bloomfield, p. 143) • 3 oz. fresh oysters, 3 oz. peanuts, 2 oz. celery. Boil in 2 pt. water until reduced to half. Eat and drink half and of this twice daily. Continue for 7 to 14 days (Butt and Bloomfield, p. 143) • Boil 1 oz. fresh mulberries in 6 fl. oz. water until reduced to half. Drink and eat three times daily(Butt and Bloomfield, p. 143) • insomnia caused by anemia: 10 oz. duck meat, 4 oz. pork, 1/2 oz. fresh ginger. Boil in 2 pt. water until reduced by half. Eat and drink the results. Do this 2-3x/week. (Butt and Bloomfield, p. 144) • insomnia caused by hypertension: boil 4 oz. celery in 1 pt. water until reduced by half. Drink before bedtime. (Butt and Bloomfield, p. 144)

avoid: • meat, alcohol, hot sauces, spicy foods, fried foods, fatty foods, rich foods, salty foods, coffee, caffeine, sweet foods and sugar

Botanicals
• Anemone pulsatilla (toxic): according to indications • Avena sativa: frequent doses at short intervals (Priest and Priest, p. 79) • Chamomilla spp.: anxiety-induced; irritability, children ( NCNM Botanicals) • Gelsemium sempervirens (toxic): according to indications • Humulus lupulus: allays irritation, promotes sleep (Priest and Priest, p. 78), anxiety, dried hops pillow (Felter and Lloyd, p. 799) • Hyoscyamus niger (toxic): irritability, unrest, fright, terror in sleep, to subdue excitement and induce sleep, sleeplessness with pain, insomnia of the aged and infants (Mitchell, p. 64; Ellingwood, p. 109) • Leonurus cardiaca • Melissa officinalis: nervous heart, nervous stomach and difficulties going to sleep (Weiss, p. 286) • Nepeta cataria • Passiflora incarnata: relaxing nervine, disturbed sleep from mental worries, anxiety, geriatric cases where insomnia is due to fear (Ellingwood, p. 107; Mitchell, p. 65) • Piscidia erythrina (toxic): anodynal sedative; insomnia, general nervousness (Mitchell, p. 64) • Primula veris: anodynal sedative; induces sleep when pain is present (Mitchell, p. 64) • Scutellaria lateriflora: nightmares, restless sleep with Passiflora incarnata • Valeriana spp.: relaxing and stimulating nervine, nervous insomnia (with Humulus lupulus) (Priest and Priest, pp. 82-83)

Chinese Formulae
• Corydalis Yanhusus Analgesic Tablets (patent): insomnia due to pain (Zhu, p. 231) • Ginseng and Longan C. (Gui Pi Tang) (available as patent); Bai Zi Yang Xin Wan (patent): Heart Xue Xu (Blood Deficiency) with Spleen Qi Xu (Deficiency): poor appetite and memory, pale face, anemia (Ginseng and Longan C.: Hsu, 1980, p. 425; Yeung, p. 112; Dharmananda, 1986, p. 244; Bensky and Barolet, p. 255; patent: Zhu, p. 274; Fratkin, p. 214; Bai Zi Yang Xin Wan: Zhu, p. 322; Fratkin, p. 231) • Miao Xiang San: Heart Qi Xu (Deficiency): forgetfulness, spontaneous sweating, anxiety, restlessness (Bensky and Barolet, p. 381) • Ginseng and Zizyphus F. (Tian Wang Bu Xin Dan); An Mian Pian (patent): Heart Yin Xu (Deficiency): exhaustion due to excessive mental work; tossing and turning; also for patients on tranquilizers or sleeping pills for so long that they no longer have an effect (Ginseng and Zizyphus: Hsu, 1980, p. 270; Yeung, p. 231; Dharmananda, 1986, p. 244; Bensky and Barolet, p. 378; An Mian Pian: Zhu, p. 327; Fratkin, p. 225) • Coptis and Gelatin C. plus cinnamon bark (rou gui) (Huang Lian E Jiao Tang): Kidney and Heart Not Communicating: strong patient, so irritable they cannot even lie down in bed, dizziness, tinnitus (Hsu, 1980, p. 97; Yeung, p. 123; Bensky and Barolet, p. 382) • Baked Licorice C. (Zhi Gan Cao Tang) minus linum (huo ma ren) plus zizyphus (suan zao ren): Qi Xu (Deficiency) with Xue Xu (Blood Deficiency): slow, irregular or thin pulse, palpitations, shortness of breath, emaciation, dry mouth and throat, pale shiny tongue (Hsu, 1980, p. 529; Yeung, p. 291; Bensky and Barolet, p. 257; Dharmananda, 1986, p. 247) • Licorice and Jujube C. (Gan Mai Da Zao Tang): Shen Disturbance: absentmindedness, moodiness, crying spells, restless sleep (Hsu, 1980, p. 347; Yeung, p. 102; Dharmananda, 1986, p. 110; Bensky and Barolet, p. 383) • Ci Zhu Wan (patent): Kidney and Heart not Communicating. (Zhu, p. 329; Fratkin, p. 232) • Bupleurum and Peony F. (Jia Wei Xiao Yao San): Liver Qi Stagnation with Yin Xu (Deficiency): menopausal or menstrual difficulties (Hsu, 1980, p. 87; Yeung, p. 72; Dharmananda, 1986, p. 177; Bensky and Barolet, p. 148) • Coptis and Scute C. (Huang Lian Jie Du Tang): Fire Toxin: irritability, severe hypertension or severe menopausal symptoms, dark urine, dry mouth and throat, red tongue with yellow coat (Hsu, 1980, p. 175; Yeung, p. 124; Dharmananda, 1986, p. 295; Bensky and Barolet, p. 78) • Qing Ying Tang: Ying Level Heat: insomnia, rashes, severe irritability and restlessness, fever, thirst, delirium, fidgeting, dark red dry tongue (Bensky and Barolet, p. 75; Yeung, p. 178). • Xue Fu Zhu Yu Tang: Xue Yu (Blood Stasis): depression, very angry, headache, insomnia, poor memory, chest or abdominal pain, purple tongue (Bensky and Barolet, p. 314; Yeung, p. 269). • Zizyphus C. (Suan Zao Ren Tang): Liver Xue Xu (Blood Deficiency) with Liver Yang Rising: insomnia causes by deficiency and overwork, indecision, many dreams, dry mouth and throat, night sweats; also with chronic illness (Hsu, 1980, p. 355; Yeung, p. 225; Bensky and Barolet, p. 379) • Gentiana C. (Long Dan Xie Gan Tang): Liver Qi Constraint transforming to Liver Fire: insomnia, anxiety, easily angered, thirst for cold drinks, red eyes, bitter taste in mouth, yellow urination, constipation (Bensky and Barolet, p. 96; Yeung, p. 154; Hsu, p. 181). • Bupleurum and Dragon Bone C. (Chai Hu Jia Long Gu Mu Li Tang); Jian Ling Tang; Ardisia 16 (patent); Du Zhong Pian (patent): Liver Wind Arising From Liver Yang Rising: dream-disturbed sleep, muscle spasms (Bupleurum: Hsu, 1980, p. 340; Dharmananda, 1986, p. 154; Bensky and Barolet, p. 387; Jian Ling: Bensky and Barolet, p. 403; Du Zhong: Zhu, p. 177) • Qin Lian Si Wu Tang: Xue Xu (Blood Deficiency) with Shi (Excess) Heat: short menstrual cycle with heavy flow, dizziness, irritability, greenish hue to the complexion, blurred vision (Bensky and Barolet, p. 250) • Bamboo and Hoelen C. (Wen Dan Tang) plus succinum (hu po), zizyphus (suan zao ren) and oyster shell (mu li): Gall Bladder Damp-Heat: thirst, neurotic hypersensitivity, gastric distress, spontaneous sweating or night sweats (Hsu, 1980, p. 114; Yeung, p. 241; Dharmananda, 1986, p. 305; Bensky and Barolet, p. 435) • Bamboo Leaf and Gypsum C. (Zhu Ye Shi Gao Tang): Qi-level Heat Lingering in the Lungs and Stomach: lingering fever from a febrile disease with irritability, vomiting, thirst, parched mouth, lips and throat; choking cough, stifling sensation in the chest, insomnia, restlessness (Bensky and Barolet, p. 72; Hsu, p. 220; Yeung, p. 298). • Gardenia and Soja C. (Zhi Zi Dou Chi Tang): insomnia with tossing and turning in bed and very restless sleep thereafter, irritability, slightly rapid pulse and slightly yellow tongue coat (Hsu, 1980, p. 162, Dharmananda, p. 284; Bensky and Barolet, p. 73) • Bamboo and Ginseng C.: Insomnia during/in recovery from common cold, pneumonia etc. with Heat in chest (Hsu, 1980, p. 90; Dharmananda, 1986, p. 247) • Fu-shen 16 (patent): Shen Disturbance (Dharmananda, 1990, p. 68) • Zizyphus 18 (patent): Kidney and Heart Not Communicating with Shen Disturbance (Dharmananda, 1990, p. 29)

Acupuncture
after assessing the person and palpating, consider these patterns: Shen Disturbance; Kidney and Heart not Communicating; Heart Qi Xu (Deficiency); Heart Yin Xu (Deficiency); Qi Xu (Deficiency) with Xue Xu (Blood Deficiency); Heart Xue Xu (Blood Deficiency) with Spleen Qi Xu (Deficiency); over-thinking leading to Qi and Xue Xu (Blood Deficiency) and harming Heart and Spleen; Spleen Xu (Deficiency); dysfunction of the Stomach; Stomach Phlegm Fire; Liver Qi Stagnation with Yin Xu (Deficiency); Xue Yu (Blood Stasis); Liver Xue Xu (Blood Deficiency) with Liver Yang Rising; Liver Qi Constraint transforming to Liver Fire; Liver Wind Arising From Liver Yang Rising; Fire Toxin; Upward disturbance of the Liver and Gall Bladder; Gall Bladder Damp-Heat; Emptiness of the Gall Bladder in cold weather; Shi (Excess) of the Du Mai (Governing Vessel); Shi (Excess) of the Yang Qiao Mai (Yang Motility Vessel) and/or Xu (Deficiency) of the Yin Qiao Mai (Yin Motility Vessel); Xiao Yang Xu (Deficiency); Yang Xu (Deficiency) (rare)

» illustrative combinations: • Ht-7 and Sp-6 for insomnia; also consider Lv-3 with restlessness; PC-6 and UB-15 with palpitation; and/or yin tang with vertigo (Liu, p. 335) • Ht-7, Sp-6, Sp-9, Sp-1 and PC-6 for insomnia (A. Chamfrault as per Mann, p. 117) • yi ming, yin tang, PC-6 and Sp-6 for insomnia (Shanghai, p. 162) • UB-62, GB-41 and Lu-9; St-36, TW-19 and St-27; UB-13, UB-30 and GB-17; Lu-1 for insomnia (Mann, p. 117) • UB-15, UB-20, Ht-7, Sp-6 and St-36 for insomnia due to Heart and Spleen Xu (Deficiency) (Qiu and Su, p. 34) • PC-7, Ht-7, Kd-3 and Kd-6 for insomnia due to Kidney Yin Xu (Deficiency) causing Heart Heat (Qiu and Su, p. 35) • CV-12, St-36, St-40, St-44 and St-45 for insomnia due to internal Phlegm-Heat (Qiu and Su, p. 35) • Sp-1 and St-45 (D): drain perverse Heat and cure excess of dreams and light sleep (Finkelstein, p. 25) • UB-62 and SI-3: open the Yang Qiao Mai (Yang Motility Vessel) which transports Yang and controls the opening and closing of the eyes, and for which insomnia is a Shi (Excess) symptom • Kd-6 and Lu-7: open the Yin Qiao Mai (Yin Motility Vessel) which transports Yin and controls the opening and closing of the eyes, and for which insomnia is a Xu (Deficiency) symptom • SI-3 and UB-62: open the Du Mai (Governing Vessel) for which Shen disorders are a symptom of Shi (Excess) • consider treatment for "Internal Dragons" or "External Dragons"; External Dragons: GV-20, UB-11, UB-23, UB-61; Internal Dragons: Master point 1/4" below CV-15, St-25, St-32, St-41; In both treatments, sedate first. If the person and the pulses change, fine. If no change with sedation, then tonify. (Worsley) • CV-14, CV-15, St-19 and Lv-14 (-): reduce stifling sensation in epigastric and hypochondriac regions (Serizawa, p. 181) • CV-3 and UB-23 (+): strengthen and stabilize Kidney; relieve frequent urination • GV-20 and UB-10 (-): calm nerves; relieve associated headache • PC-6 and Ht-7 (-): clear Fire from Heart; calm the Shen; soothe the Heart • UB-17 and UB-18 (-): relieve mid-back tension; calm emotions

Homeopathy
• Aconitum napellus: sleeplessness after midnight with anxiety and nervous fear; restlessness; skin hot and dry; thirst increased • Arsenicum album: sleeplessness after midnight; nervous exhaustion; restlessness and prostration; due to nausea and gastric troubles; fear of death or of being left alone • Belladonna: sleeplessness of nervous excitement; flushed face; starting on first falling to sleep; sleep interrupted by talking, startings, muscular jerkings and spasmodic motions; head hot and throbbing; < noise and light • Calcarea carbonica: troubled by phantoms; by frightful images which appear as soon as the eyes are shut • Chamomilla: due to irritability; complaints of bowels and flatulence; sleeplessness due to pain; teething in children, wants to be carried • Cinchona: sleeplessness from exhausting diseases; the mind indulges in castle building; pressive pain in the head; starting with fright on going to sleep • Coffea: due to exciting, agreeable causes; cannot switch off; all senses are more acute; sleeplessness during convalescence from acute diseases • Hyoscyamus: sleeplessness from nervous excitement with bewildering ideas and images; tossing about • Ignatia: sleeplessness from grief, fright or suppressed mental suffering; hysteria • Lachesis: excessive mental exertion; particularly at climacteric period with frequent hot flushes and heat at top of head • Nux vomica: involuntary crowd of ideas; night-watching; when late reading or singing is followed by wakefulness; awakes from anxiety and frightful dreams; after use of drugs, strong coffee, and/or tobacco • Opium: various figures and visions appear before the eyes; terrible or frightful events • Pulsatilla: wakeful until early morning, then sound asleep, wake unrefreshed; < at time of menses; mild, timid women; from indigestion, > cool air • Rhus toxicodendron: extremely restless with general soreness; < getting wet, > heat, exercise dreams of walking, climbing • Sulphur: involuntary crowd of ideas; mind cluttered with arithmetic figures; short periods of sleep, wakes frequently or sleeps all day and is sleepless at night

Subtle Support
• Mi (Gardner, p. 72, 78) • Fa# (Gardner, p. 82, 87)

mental/emotional: • rhythmic folk songs • County Derry • songs of Steven Foster • Spanish tangos • Brahms' Hungarian dances • Sousa's marches • Strauss' waltzes • Gilbert and Sullivan • Indian Love Call • My Wild Irish Rose • Wishing • Estrellita (Heline, p.18)

Mind/Body
• Inability to forget the day may be due to guilt. (Epstein, p. 138) • Fear of death, since sleep can be equated to death. (Epstein, p. 139) • Depression. (Epstein, p. 138) • Habit-bound insomnia. (related materia medica listings: insomnia guidelines) • Fear. Not trusting the process of life. Guilt. (Hay, 1988, p. 44) • Insomniacs are afraid of the night, of passivity. Transitoriness and death are important issues for them. They are lacking in native trust and the capacity for self surrender, and are usually identified with their active pole, the 'doer'. (Dethlefsen, p. 232-5)

Chinese psychophysiology: • Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores and cleanses the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); opens into the eyes; expresses itself in the nervous system; and reflects emotional harmony and movement. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Xu (Deficiency) signs include impotence; frigidity; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry eyes, skin, and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down. Liver Xue Xu (Blood Deficiency) predisposes to Xue Yu (Blood Stasis). Liver Yin Xu (Deficiency) predisposes to the Shi (Excess) conditions of Liver Wind, Liver Yang Rising, and Liver Fire Blazing. » Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216) » Liver Shi (Excess) signs include discontent; anger; pain in lumbar region and genitals (Seem, p. 28); muscular tension; excessive sex drive; insomnia; moodiness; excitability; genital diseases; red, tearing eyes; compulsive energy; and bitter taste in the mouth. Chronically suppressed anger can implode and give rise to Fire in the Liver and Gall Bladder with symptoms of irritability, bitter taste, headaches, etc.

• Heart ~ Xin houses the Shen (Spirit) and reveals itself through the brightness in the eyes; governs Fire and Heat; rules the Xue (Blood) and its vessels and directs the circulation; opens into the tongue and controls speech; and relates to the integration of the organs and the personality. » Healthy expressions are warmth, vitality, excitement, inner peace, love, and joy. » Heart Xu (Deficiency) signs include sadness; absence of laughter; depression; fear; anxiety; shortness of breath (Seem, p. 28); cold feeling in the chest and limbs; palpitations; cold sweat; inability to speak; memory failure; nocturnal emissions; and restless sleep. Yin Xu (Deficiency) predisposes to Empty Fire, acute and chronic. » Heart Shi (Excess) signs include false or facile laughter; sobbing; agitated spirit; insomnia (Seem, p. 28); frightful dreams; anxiety; tongue feels numb and heavy; heavy chest; hot sweat; and orange-colored urine. » The Heart is the Emperor of the bodily realm so that when the Heart is disturbed all the other organs will be disrupted. » Mental signs of Heart channel disorders include insomnia, anxiety, and all Shen disturbances. (Seem, p. 28)

• Spleen ~ Pi governs digestion and manifests in the muscle tissues; transforms food into Qi and Xue (Blood); governs the Xue (Blood); and relates to the ability to assimilate, stabilize, and feel centered and balanced. » Healthy expressions are fairness, openness, deep thinking, and reminiscence. » Spleen Xu (Deficiency) signs include slightness (deficient "form"); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; pale lips; loose stools; muscular weakness; and, indirectly, obesity. » Spleen Shi (Excess) signs include heaviness (excess "form"); large abdomen; great sighing; sadness; obsessions and nightmares (Seem, p. 28); abdominal pain; irregular appetite; stickiness in the mouth and on lips; red lips; chest congestion; fatigue; and constipation. » The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen and may lead to Xue Yu (Blood Stasis). This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise and excess consumption of sweet and/or Cold foods will also deplete the Spleen. » Mental signs of Spleen channel disorders include mental sluggishness; vertigo; melancholia; obsessions turned toward the past; fixed and rigid ideas; sleepwalking; agitated sleep; and nightmares. (Seem, p. 27)

Integrative Therapies
This is difficulty falling asleep or staying asleep. Insomnia is very common and is associated with depression, emotional problems, and difficulty in performing work duties.

Problems arise from many of the over-the-counter sleeping pills. Some contain drugs that are harmful to the body, even carcinogenic or cancer causing. Many sleep medications contain barbituates, which are also considered to be "street drugs" and are addicting. People find it hard to stop using them after starting because the insomnia often comes back with restless sleep and nightmares.

It is important to find the cause of the insomnia. Make sure the bedroom is quiet, without a TV or radio going, and that the bed has a comfortable mattress. Many people experience insomnia because they take in stimulants such as coffee, black tea, sodas, cigarettes, and alcohol. These must be eliminated from the diet. Coffee can be gradually eliminated over several days so headaches don't occur from sudden quitting. Remember that alcohol is a stimulant for many people. If used in the large amounts necessary for sleep, it can cause the hangover feeling and great difficulty waking the next morning.

It is not good to overeat at supper or eat late at night because this usually causes sleep problems. The last meal should be 3 to 4 hours before bedtime. Hypoglycemia, or unstable blood sugar levels, is a common cause of difficulty for people who awaken in the middle of the night.

High or lowered thyroid levels can cause sleep problems as can a weakened heart, which causes shortness of breath and breathing difficulties when lying down at night. See a doctor to determine if these things apply to you.

The most common cause of insomnia is stress, mental or physical tension, and the inability to relax. If the environment at home or at work is upsetting, seek counseling.

THE FOLLOWING SUPPLEMENTS CAN BE TAKEN UNTIL SYMPTOMS IMPROVE: 1. Calcium – 1,000 milligrams per day 2. Magnesium – 500 milligrams per day 3. Vitamin B-complex – 50 milligrams twice a day 4. Additional Vitamin B6 – 50 milligrams twice a day If there is no allergy or sensitivity to dairy products, a glass of warm milk before bed provides tryptophan, which aids in relaxation.

HERBS USED FOR INSOMNIA: The following herbs used alone or in combination can help to induce quality sleep without prod-ucing the groggy, hard-to-awaken feeling the next morning that is common with sleeping pills:

• Chamomile • Hops • Passion Flower • Skullcap • Valerian (which is a strong sedative)

If used as a tea, combine 1 tablespoon of herb per cup of boiling water. Steep 20 minutes and drink 1/2 hour before bedtime. If used as a tincture, which is a liquid herbal extract, 30 to 60 drops of any combination are taken with a little water.

HOMEOPATHY: From the following homeopathic remedies, the one that best matches the symptoms is chosen. Dissolve 3 pellets under the tongue. • Coffea cruda 12C: For insomnia with constant thoughts running through the mind or insomnia from excitement. Taken before bedtime. • Arsenicum album 12C: Especially for insomnia with excess worry and restlessness. Taken 3 times a day for 10 days. Note: A wide range of homeopathic medicines can be helpful for individuals with sleeping disorders. Consultation with a health care professional trained in homeopathic prescribing will usually be the best way to select the correct medicine.

AS AN ADDITIONAL MEASURE FOR INSOMNIA: Regular physical exercise improves the health in general, releases stress, and makes it easier to relax at night. Some sort of aerobic exercise such as stair climbing, dancing, sports, jogging, or aerobics for about 20 to 30 minutes a day will be helpful.

Just before bedtime, do the following exercise of contracting then relaxing your muscles:

While lying down, take 5 or 6 deep, slow breaths. Then tighten up the muscles of your face and neck into an ugly grimace for about 2 seconds. Then let go and relax. Then hunch your shoulders and tighten up the muscles of your arms. Let go and relax. Follow this pattern with the stomach muscles, legs, and then feet and toes. Then contract all the muscles of your body and relax. Repeat this whole sequence 2 or 3 more times, putting attention on deep breathing.

If stress is a major cause of the insomnia, refer to the article on stress reduction.

=
============================================================== =Treatment= -Hot Bath

Dietary Recommendations
Avoid too much coffee, tea, tobacco, cola; do not eat big meals in the evening; No stimulants(tea, coffee,medication); drink a glass of warm milk before going to bed; Calming herbal teas (lime, orange and hawthorne blossom, passionflower)

Recommended Minerals
-Phosphorus -Lithium (Anxious)

Orthomolecular Treatment
-Tryptophan -5-HTP

Ayurvedic Recommendations
Coleus Forskohlii

Prescription
Adult: Bedtime: Tilia Tomentosa D1, 75 drops

Child under 8: Bedtime: Tilia Tomentosa D1, 40 drops