Insomnia TCM Diagnoses and Treatments

1. Insomnia TCM Diagnoses and Treatments Chinese medicine sees insomnia as a symptom of an imbalance in either the fundamental substances of the body (Chi, Blood, Yin, Yang, Shen), or of the major organ systems (Lungs, Heart, Spleen, Liver, Kidneys). Insomnia most often results from imbalances of the Heart or Liver. Etiology & Pathology: 1. emotional stress 2. Improper diet 3. Weak constitution 4. Overworking

2. Main Points for differentiation A) Characters of insomnia Dream-disturbed sleep: Young age people • Liver & GB fire: nightmare • Sp & ht. imbalance: Can't shut off mind Go over & over the same ground; Walking in a maze; Reliving aspects of jobs or relationships Difficult falling asleep: excess condition of Liver & GB. Waking up easily: Deficiency Pattern: Ht. & Sp Def. Waking up at a specific time every night Energy peak on 3:00 am at Liver Meridian Other Symptoms Liver fire Sp & Ht. def. Kid & Ht. disharmony B) Def. or Excess Difficult falling asleep: Fire ( excess or def.) Waking up easily: def. waking up whole night & light sleeping: excess + def. New disease: excess long time disease: excess + def.

3. Treatment 1). Stag. Liver Qi transformed into fire Signs & Symptoms: • Main Sym. : Insomnia; night mare; hard to fall asleep • Concurrent sym.: Fidgeting, irritability, insomnia, a dry mouth with a bitter taste, headache, conjunctiva congestion, dark yellow urine, constipation, • Tongue: Red body with yellow coating • Pulse: wiry & rapid • Treatment Protocol: • Purge liver fire • Calm down the mind

4. Formula: Modifications: Calm down the mind -- Long Gu, Ci Shi Oppressed feeling in the chest or hypochondriac -- Yu Jin, Zhi ke Constipation -- Shen da huang

5. Case History 1. Female 68 years Medical history: The patient had insomnia for over 3 months because of the sudden death of her husband. First visiting: Main complain: Insomnia for 3 month She could only sleep for 1 hour or 2 hours each night, sometimes even kept sleepless for several days. Deeply grieved and mourn fully sighed, with fullness in the chest and hypochondrium, dry stool, Tongue: red tongue with thin-yellow coating Pulse: wiry. TCM diagnose: Stagnation of the liver Qi upward distrubing the mind Treatment protocol: --regulating the liver Qi --Tranquilize the mind Formula: Bai shao15, Chai Hu 10, DangGui 10, Fu Ling 15, Bo He 5 , Suan Zao Ren 20, Yu Jin 10, He Huan Pi 15, LongGu 15, Mu Li 30, HuangQin 10, Cao Jue Ming 25, Gan Cao 5, X 7 bags X 7 bags

6. Case History 1. Male 40 years Medical history:The patient had a hot temper. One year before, he got insomnia after a dispute with his colleague. First visiting: Main complain: Insomnia for 1 year dizziness with distention in the eyes, irritability and peevishness, bitter taste in the mouth, dark urine, constipation, Tongue: red body with yellow coating Pulse: wiry-rapid TCM diagnose: disturbed mind by liver-fire Treatment protocol: -- purging the liver of pathogenic fire -- Eliminate irritability & Tranquilize the mind Formula: Shi Jue Ming 30, Cai Hu 10, Huang Qin 10, Zhi Zi 10, LongDan Cao 6, Sheng Di Huang 15, Zhi Shi 10, LingYangJiao powder 0.6, X 7 bags

7. Treatment 2) Heat-Phlegm invading the heart Signs & Symptoms: • Main Sym. : Insomnia; difficult to fall asleep; light sleep; • Concurrent sym.: dizziness, a feeling of oppression in the chest, a bitter taste in the mouth, fidgeting, acid regurgitation, nausea, • Tongue: Yellow greasy coating • Pulse: slippery & rapid • Treatment Protocol: • Clear the heat • Resolve the phlegm • Harmonize the stomach • Tranquilize the mind

8. Formula: Modifications: Clear the fire -- Huang Lian, Shan Zhi Zi food retention due to St. disharmony -- Ban xia, Shu Mi, food retention: -- Bao He Wan Phlegm heat + constipation -- Meng Shi Gun Tan Wan + da huang

9. Case History 1. Male 35 years Medical history:. First visiting: Main complain: Insomnia for 4 years, got worse in recent half a year The patient had a history of intermittent insomnia for 4 years, which got worse in recent half a year due to frequent night shifts. There appeared even the whole-night sleeplessness. The other symptoms were irritability, changeable moodiness which affected his work, dry mouth and throat, yellow and scanty urine, Tongue: red tongue with thin-yellow coating Pulse: rapid TCM diagnose: Exuberant fire in the heart meridian disturbing the mind Treatment protocol: --Clear away the heart-fire & soothing the heart --Tranquilize the mind Formula: Huang Lian 25, Zhi Zi 10, Dan Zhu Ye 10, ShengDiHuang 25, Mai Dong 10, Bai Shao 15, Yu Jin 10, Fu Ling 15, Gan Cao 5 X 14 bags Tian Wang Bu Xin Dan Was cured in 2 month later

10. Treatment 3) Hyperactivity fire due to Yin def. Signs & Symptoms: • Main Sym. : Fidgeting, insomnia, difficulty to fall asleep; • Concurrent sym.: dizziness, tinnitus, a dry mouth and throat, a burning sensation in the palms and soles, lower back pain . • Tongue: red body with less coating • Pulse: thready & rapid • Treatment Protocol: • Nourish Yin • Removing fire

11. Formula: Modifications: Calm down the mind -- Mu Li, Long Gu, Zheng Zhu Mu Insomnia due to anxiety or other emotional instability -- Tian wang bu xin dan Kid yin def. -- Liu Wei Di Huang Wan

12. Case History 1. Male 37 years Medical history: First visiting: Main complain: Insomnia with dream-disturbed sleep symptoms occurred one year before when he was attending a training course and often stayed late studying. The accompanying symptoms were irritability and forgetfulness, inability to concentrate his mind, nocturnal emission, tinnitus, soreness and pain in the waist, dry mouth, and feverish sensation in the chest, palms and soles.. Tongue: red with thin-white coating Pulse: thready and rapid with a deep and thready chi pulse. TCM diagnose: Hyperactivity of fire due to Yin-deficiency, Incoordination between the heart and kidney. Treatment protocol: --Nourishing Yin to reduce pathogenic fire --Restoring coordination between the heart and the kidney Formula: Huang Lian 10, Rou Gui 5, Bie Jia 15, Niu Xi 10, Sang Ji Sheng 20, Sheng Di Huang 15, Shan Yu rou 10, Fu Ling 15, Long Chi 15, X 7 bags X 20 bags

13. Treatment 4) Spleen & heart Def. Signs & Symptoms: • Main Sym. : lots of dreams; easy to wake up; lightly sleep • Concurrent sym.: Palpitation, a poor memory, drowsiness, the propensity to be easily awakened at night, dizziness, lassitude, a loss of the sensation of taste, pallor, • Tongue: Pale body with thin white coating • Pulse: thready & weak • Treatment Protocol: • Tonify the heart & Spleen

14. Formula: Modifications: Dampness due to sp def. -- Fu Lin, Ban xia, Chen Pi, Hou Pu Tonify Ht. Yin -- Po Zi Ren, Wu wei zi Tonify Yang -- Rou Gui Appetite is poor & abdomen is distended -- reduce huang Qi ; Plus Shen qu

15. Treatment 5) Timidity due to def. of GB & heart Qi Signs & Symptoms: • Main Sym. : Nightmare • Concurrent sym.: Insomnia, absent-mindedness, the propensity to daydream, frequent awakenings from sleep which are due to fright, timidity, palpitation, spontaneous sweating, short breathing • Tongue: pale tongue with a thin white coating • Pulse: thready • Treatment Protocol: • Replenish Qi • Tranquilizes the mind

16. Formula: Modifications: cold limbs: --Gui Zhi, Zhi Gan Cao Insomnia due to anxiety -- Suan Zao ren tang

17. Case History 1. Male 35 years Medical history: Because of working hard & anxiety, being mentally and physically exhausted with the passing of time, often awake all the night, taking medicines of western medicine can sleep for a few hours, dreamy during sleep, feel fatigue after wake up. First visiting: Main complain: No sleep for 3 nights Since summer of this year, the sleeplessness became more serious, fail to respond to all previous treatments, no sleep for three nights, muddleheaded, loss of appetite, pale complexion but glowing with health, going on talking and laughing as if nothing had happened. Light conjunctival congestion, Tongue: dark lines on tongue edge Pulse: taunt & long guan pulse TCM diagnose: Stag. of Qi for long time and obstruction of blood circulation Treatment protocol: Moving Qi & blood Formula: Xue Fu Zhu Yu Tang Tao Ren 12, Hong Hua 9, Chuan Xiong 9, Niu Xi 9, San Qi 9, Sheng Di 9, Cai Hu 6, Chi Shao 9, Zhi Ke 6, Zhi Gan Cao 3; X 15 bags

18. Case History Male 35 years Second visiting: Main complain: insomnia Patient fell asleep easily after one bag herbs, no relapse after 15 bags. Patients asked for help two month later, complaining no sleeping again. The illness condition was milder than before,. With headache, conjunctival congestion and oppressed & pain feeling in the hypochondriac area Tongue: Pulse: taunt guan pulse TCM diagnose: Liver fire flaring-up. Treatment protocol: Clear the liver fire Formula: Long Dan Xie Gan Tang Huang Qin 9, Long Dan Cao 4.5, Shen Di 9, Ze Xie 9, Che qian Zi 9, Cai Hu 6, Shan Zhi Zi 9, Dang Gui 6, Mu Tong 9 X 5 bags

19. Depression (Melancholia) TCM Diagnoses and Treatments Melancholia is the disease caused by emotional stress & stagnation of functional activities of Qi Etiology & Pathology: 1. Angry caused disorder of liver Qi 2. Depression caused spleen dysfunction (All seven emotions)

20. Main Points for differentiation A) General causes of disease are mental stimulation and impairing of 7 emotions. B) Def. or Excess Initial stage: mainly Liver Qi Stag. with phlegm-dampness, retention of food and heat stag. mainly mixing type of def. & excess C) Clinical feature Liver Qi Stag. No subjective sym. under examination

21. Principles of the treatment General principle: Regulating the circulation of Qi Excess Syn. Promoting the circulation of blood Resolving phlegm Removing dampness Clearing away heat Promoting digestion Def. Sym. Supplementing Qi ( Spleen) Enriching Blood Nourish Yin & heart Strengthen the body resistance

22. Treatment 1) Liver Qi Stag. Signs & Symptoms: • Main Sym. : Distension, stuffiness & pain in chest, St., and hypochondrium ( not fixed) • Concurrent sym.:emotional instability, depression, unease, often signing, being liable to cry & apt to be angry, feel comfort after belching and break wind, or complicated by the incoordinate between St. & Sp., loss of appetite, abdominal distension • Tongue: “thin and whitish” or “thin and greasy fur” • Pulse: wiry or slippery • Treatment Protocol: • Smoothing the liver Qi • Alleviating of mental depression

23. Formula: Modifications: Depression: --Yu Jin, Qin Pi, Fu Shou, Xiang Yuan Belching & nausea -- Xuan Fu Hua, Dai Zhe Shi, Shu Geng, Chen Pi Food retention -- Shen Qu, Shan Zha, Mai Ya, Lai Fu zi, Ji nei jin Abdomen distention & loose stools -- Cang Zhu, Fu Ling, Hou Pu Fixed pain on hypochondrium area -- Dang Gui, Dan Shen, Yi Mu Cao,Tao ren

24. Liver Qi Stag. Treatment principles: (On the basis of the degree of distension & pain, the location) Slight distension: Xiang Yuan, Fu Shou, Lu E Mei Distension is not very serious: Xiang Fu, Chen Pi, Yu Jin, Chuan Lian Zi, Zhi Ke, Qin Pi, Hou Pu, Mu Xiang Distension and pain is serious: Zhi Shi, Chen Xiang, Tan Xiang, Jiang Xiang, Hong Hua, Dan Shen

25. Treatment 2) Stagnation of Qi turning into fire Signs & Symptoms: • Main Sym. : distension, stuffiness and pain in chest and hypochondrium, irritable, be liable to be angry • Concurrent sym.:headache, tinnitus, flushed face, conjunctival congestion, or dry and bitter taste in mouth, gastric discomfort with acid regurgitation, constipation • Tongue: red body with thin yellow fur • Pulse: wiry or rapid • Treatment Protocol: • Purging liver fire • Alleviating mental depression • Regulating the St. function

26. Formula: Modifications: Clear St. heat --Huang Lian bitter taste & yellow coating & constipation -- Long dan Cao, Da huang

27. Treatment 3) Stagnation of Qi & Phlegm accumulation Signs & Symptoms: • Main Sym. : discomfort in the throat, having foreign body sensation which could not be either expectorated or swallowed, stuffiness feeling in chest • Concurrent sym.:feeling of distension , stuffiness and pain in chest and hypochondrium • Tongue: greasy coating • Pulse: wiry or slippery • Treatment Protocol: • Resolving phlegm • Promoting flow of Qi • Alleviating depression

28. Formula: Modifications: Smoothing Qi --Xiang Fu, Zhi Ke, Fu Shou, Xiang Yuan Descending Qi -- Zi Shu Gen, Zi Shu Zi, Xuan fu Hua, Dai zhe Shi, bitter taste, thirsty, nausea, yellow fur -- Wen Dan tang

29. Treatment 4) Depression impairing the mental activity Signs & Symptoms: • Main Sym. : grief, depression, be liable to cry, sometimes loudly, sometimes weep in silence • Concurrent sym.: absentminded, feel uneasy or perturbed • Tongue: light tongue body, thin and whitish fur • Pulse: wiry or thready • Treatment Protocol: • Nourishing heart • Calm the mind

30. Formula: Modifications: Calm the mind --Po Zi Ren, Suan Zao ren, Fu Shen, He huan hua Irritability & insomnia -- A Jiao, Long Chi, Mu Li, Zheng Zhu Mu, dizziness & tinnitus -- Shen Shi Jue Ming, Dai Zhe Shi, Bai Ji Li

31. Treatment 5) Spleen & heart Def. Signs & Symptoms: • Main Sym. : palpitating and timid, over-deliberated • Concurrent sym.: short of sleep, amnesia, pale complexion, dizziness, loss of appetite • Tongue: light tongue body • Pulse: thready & weak • Treatment Protocol: • Nourishing heart & spleen • Replenishing Qi & enriching blood

32. Formula: Modifications: Depression -- Yu Jin, Xiang Fu, He Huan Hua

33. Treatment 5) Hyperactivity fire due to Yin def. Signs & Symptoms: • Main Sym. : dizziness, tinnitus, dysphoria, be apt to be angry, palpitating, short of sleep • Concurrent sym.: sour lower back, emission, or irregular menstruation • Tongue: red tongue body • Pulse: thready & rapid • Treatment Protocol: • Nourishing Yin • Clear away heat • Tranquilizing the mind

34. Formula: Modifications: Depression -- Yu Jin, Xiang Fu, He Huan Hua Nourish heart -- suan zhao ren calm the mind -- ci shi, long gu , mu li,

35. Case History 1. Male 40 years Medical history: 4 month ago, being angry for something, suddenly felt stuffy and suffocated in chest, dizziness, then fainted, and recoverd after a little while. Thereafter feeling of stuffiness and suffocation involving soreness of back occurred frequently. The feeling often related to emotional changes. First visiting: Main complain: Stuffy and suffocated in chest Recently occurred again due to anger, onset frequently, feeling of fullness and pain in right hypochondrium, light gloomy complexion, purple lips, Tongue: light fat body with tooth mark Pulse: wiry TCM diagnose: Stag. Liver Qi & blood stasis Treatment protocol: Soothing liver + alleviating depression + activating Qi + promoting blood circulation Formula: Xiao Yao San Dan Shen 30, Dang Gui 12, Chi Shao 12, Bai shao 12, Cai Hu 10, Fu Ling 30, Cang Zhu 10, Bai Zhu 10, Gan Cao 6, Shen Jiang 6, Bo He 3, Jiang Huang 10, Yu Jin 10, Chuan Xiong 10, Xiang Fu 10, Zhi ke 10, Chen Pi 10