InsomniaInsomnia

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 stress2. Improper diet3. Weak constitution4. Overworking

Main Points for differentiationMain Points for differentiation

A) Characters of insomniaA) Characters of insomnia

Dream-disturbed sleep: Young age people Dream-disturbed sleep: Young age people

» Liver & GB fire:Liver & GB fire: nightmare nightmare » Sp & ht. imbalance:Sp & ht. imbalance: Can't shut off mind Go over & over the same ground; Can't shut off mind Go over & over the same ground;

Walking in a maze; Reliving aspects of jobs or relationshipsWalking in a maze; Reliving aspects of jobs or relationships

Difficult falling asleep:Difficult falling asleep:

excess condition of Liver & GB.excess condition of Liver & GB.

Waking up easily:Waking up easily:

Deficiency Pattern: Ht. & Sp Def.Deficiency Pattern: Ht. & Sp Def.

Waking up at a specific time every nightWaking up at a specific time every night

Energy peak on 3:00 am at Liver MeridianEnergy peak on 3:00 am at Liver Meridian

Other SymptomsOther Symptoms

Liver fireLiver fire

Sp & Ht. def.Sp & Ht. def.

Kid & Ht. disharmonyKid & Ht. disharmony

B) Def. or ExcessB) Def. or Excess

Difficult falling asleep: Fire ( excess or def.)Difficult falling asleep: Fire ( excess or def.)

Waking up easily: def.Waking up easily: def.

waking up whole night & light sleeping: excess + def.waking up whole night & light sleeping: excess + def.

New disease: excessNew disease: excess

long time disease: excess + def.long time disease: excess + def.

TreatmentTreatment 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

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

Long Dan Xie Gan Tang

Long Dan Cao Huang Qin Cai Hu Bai Shao Zhi Zi

Che Qian zi Sheng Di Huang Ze Xie

Case History

1. Female 68 years Medical history:Medical history: The patient had insomnia for over 3 months because of the sudden death of her husband. First visiting: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 coatingPulse: 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

Case History

1. Male 40 years Medical history:Medical history: The patient had a hot temper. One year before, he got insomnia after a dispute with his colleague.First visiting: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 coatingPulse: 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

TreatmentTreatment 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

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

Weng Dan Tang

Chen Pi Ban Xia Zhi Shi Zhu Ru Sheng jiang Da Zao

Fu Ling

Case History

1. Male 35 years Medical history:Medical history:. First visiting: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 coatingPulse: 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

TreatmentTreatment 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

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

Huang Lian E Jiao Tang

Huang Lian A Jiao Huang Qin Ji Zi Huang Shao Yao

Case History

1. Male 37 years Medical history:Medical history: First visiting:First visiting:

Main complain: Insomnia with dream-disturbed sleepsymptoms 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

TreatmentTreatment 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

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

Gui Pi Tang

Dang Shen Huang Qi Bai zhu Fu Shen Suan Zhao ren Long Yan

Mu Xiang Zhi Gan Cao Dang Gui Yuan Zhi Shen Jiang Da Zao

TreatmentTreatment 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

Formula:

Modifications:

cold limbs:

--Gui Zhi, Zhi Gan Cao

Insomnia due to anxiety

-- Suan Zao ren tang

An Shen ding Zhi Wan

Fu Ling Fu shen Yuan zhi Shi chang pu

Ren shen Long Chi

Case History

1. Male 35 years Medical history: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: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

Case History

Male 35 years Second visiting: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

Depression (Depression (MelancholiaMelancholia))

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 Qi1. Angry caused disorder of liver Qi

2. Depression caused spleen 2. Depression caused spleen dysfunctiondysfunction

(All seven emotions) (All seven emotions)

Main Points for differentiationMain Points for differentiation

A) General causes of disease are mental A) General causes of disease are mental stimulation and impairing of 7 emotions.stimulation and impairing of 7 emotions.

B) Def. or ExcessB) Def. or Excess

Initial stage: mainly Liver Qi Stag. with Initial stage: mainly Liver Qi Stag. with phlegm-dampness, retention of food and heat phlegm-dampness, retention of food and heat stag.stag.

mainly mixing type of def. & excessmainly mixing type of def. & excess

C) Clinical feature C) Clinical feature

Liver Qi Stag. Liver Qi Stag.

No subjective sym. under examinationNo subjective sym. under examination

Principles of the treatmentPrinciples of the treatmentGeneral principle: General principle:

Regulating the circulation of QiRegulating the circulation of QiExcess Syn.Excess Syn.

Promoting the circulation of bloodPromoting the circulation of bloodResolving phlegmResolving phlegmRemoving dampnessRemoving dampnessClearing away heatClearing away heatPromoting digestionPromoting digestion

Def. Sym.Def. Sym.Supplementing Qi ( Spleen)Supplementing Qi ( Spleen)Enriching BloodEnriching BloodNourish Yin & heartNourish Yin & heartStrengthen the body resistanceStrengthen the body resistance

TreatmentTreatment 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

Formula:

Modifications:Depression:

--Yu Jin, Qin Pi, Fu Shou, Xiang YuanBelching & nausea

-- Xuan Fu Hua, Dai Zhe Shi, Shu Geng, Chen Pi

Food retention-- Shen Qu, Shan Zha, Mai Ya, Lai Fu zi, Ji nei

jinAbdomen distention & loose stools

-- Cang Zhu, Fu Ling, Hou PuFixed pain on hypochondrium area

-- Dang Gui, Dan Shen, Yi Mu Cao,Tao ren

Cai Hu Shu Gan San

Cai Hu Zhi Ke Shao Yao Gan Cao Xiang Fu Chuan Xiong

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

TreatmentTreatment 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

Formula:

Modifications:Clear St. heat

--Huang Lian bitter taste & yellow coating &

constipation-- Long dan Cao, Da huang

Dan Zhi Xiao Yao San

Dan Pi Shan Zhi Zi Cai Hu Bai Shao Bai Zhu Dang Gui

Fu Ling Gan Cao

TreatmentTreatment 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

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

Ban Xia Hou Pu Tang

Ban Xia Hou Pu Shen Jiang Fu Ling Zi Shu

TreatmentTreatment 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

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

Gan Mai Da Zhao Tang

Gan Cao Fu Xiao Mai Da Zhao

TreatmentTreatment 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

Formula:

Modifications:

Depression

-- Yu Jin, Xiang Fu, He Huan Hua

Gui Pi Tang

Dang Shen Huang Qi Bai zhu Fu Shen Suan Zhao ren Long Yan

Mu Xiang Zhi Gan Cao Dang Gui Yuan Zhi Shen Jiang Da Zao

TreatmentTreatment 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

Formula:

Modifications:

Depression-- Yu Jin, Xiang Fu, He Huan Hua

Nourish heart -- suan zhao ren

calm the mind-- ci shi, long gu , mu li,

Zi Shui Qin Gan Yin

Dang Shen Bai Shao Cai Hu Zhi Zi Suan Zhao ren Shen di

Shan yu rou Ze xie Dan pi Shan yao

Case History

1. Male 40 years Medical history: 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: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 SanDan 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