Insomnia has different patterns: difficulty in falling asleep after retiring, early awakening, intermittent waking through the period of attempted sleep, and even inability to sleep all night.
Insomnia is often accompanied by dizziness, headache, palpitation, poor memory and mental disorders.20.1 Etiology and Pathogenesis
A] Anxiety and overwork damage the heart and spleen. Blood is exhausted and the mind is disturbed in case of damage of the heart, while qi and blood production becomes poor in case of deficiency of the spleen qi. Blood deficiency is unable to nourish the heart, leading to insomnia. Just as Zhang Jingyue described. “Overwork and anxiety cause exhaustion of blood and disturb the mind. As a result, insomnia follows” (20.1)
B] Congenital deficiency, indulgent sexual activity, or a prolonged illness damages the Kidney Yin. The Kidney water fails to ascend smoothly to the heart to check the heart fire and the heart Yang is therefore hyperactive alternatively. A violent emotional fit can induce flaring of the heart fire which fails to descend to the Kidney to control the Kidney water. The Kidney Yin is therefore deficient. Deficiency of Kidney Yin injures the will and excess of the heart fire disturbs the mind. In either case, there is a disharmony between the heart and the Kidney, and hence insomnia.
C] Emotional depression causes the stagnation of qi in the Liver. The stagnant qi of long duration is transformed into fire, which flares up to disturb the mind, and then insomnia occurs.
D] Irregular food intake damages the spleen and stomach. “The accumulated undigested food produces phlegm heat in the middle jiao, which in turn causes dysfunction of the stomach and insomnia, as stated in internal classic that sleep is disturbed if the function of the stomach is in disharmony.” (20.2)
In summary, insomnia is related to dysfunction of the heart, spleen, Liver, and Kidney, although there are many other causative factors. Blood is made from food essence and supplies the heart with nourishment. Blood is stored in the Liver and the Liver is soothed by the blood. Blood is controlled by the spleen, where the production of essence from blood continues. The essence is stored in the Kidney. When the Kidney essence ascends to the heart and the heart qi descends to the Kidney. With harmonious conditions between the heart and Kidney, the mind is at ease. Whenever there is anxiety, depression or overwork to damage the heart, spleen, Liver or Kidney, essence and blood are consumed and mutually affected, resulting in insomnia.20.2 Differentiation
A] Deficiency of both the heart and spleen qi: Main manifestations: Difficulty in falling asleep, dream – disturbed sleep, palpitation, poor memory, lassitude, listlessness, anorexia, sallow complexion, pale tongue with a thin coating, thready, weak Pulse. Analysis: When there is impairment of the heart and spleen, blood is insufficient to house the mind, so dream –disturbed sleep, poor memory, and palpitation occur. The sallow complexion and pale tongue are manifestations of poor blood supply which is unable to nourish the upper part of the body. Dysfunction of the spleen and stomach in transportation and transformation causes anorexia. Deficiency of qi and blood leads to qi declining and blood shortage, resulting in lassitude, listlessness, thready and weak Pulse.B] Disharmony between the heart and Kidney:
Main Manifestations: Restlessness insomnia, dizziness, tinnitus, dry mouth with a little saliva, burning sensation of the chest, palms and soles, red tongue, thready rapid Pulse, or nocturnal emission, poor memory, palpitation, low back pain.
Analysis: Restlessness, poor memory, palpitation, nocturnal emission, and low back pain are due to deficiency of the Kidney and hyperactivity of the heart fire. Dry mouth with a little saliva, burning sensation of the chest, palms and soles, red tongue and thready rapid Pulse and are the signs of Yin deficiency in the lower jiao with fire flaring up. Dizziness and Tinnitus result from the flaring up of the ministerial fire due to deficiency of the Kidney Yin.C] Upward disturbance of the Liver fire:
Main manifestations: irritability , dream – disturbed sleep, fright and fear accompanied with headache, distending pain in the coastal region, bitter taste in the mouth and string –taut Pulse. Analysis: The Liver fire flares up to disturb the mind, causing dream –disturbed sleep , fright, and fear .when the flaring fire of the Liver attacks, a headache occurs. The Liver qi in long stagnation is transformed into fire, leading to irritability. The Liver fire flares up with the upward flow of the bile, producing a bitter taste in the mouth. When the fire stagnates in the Liver Meridian, there is distending pain in the coastal region. The string –taut Pulse is a sign of hyperactivity of the Liver.D] Dysfunction of the stomach:
Main manifestations: Insomnia, suffocating feeling and distending pain in the epigastric region, belching or difficult defecation, sticky tongue coating and rolling Pulse.
Analysis: With the dysfunction of the spleen and stomach in transportation and transformation the food accumulates in the middle jiao, obstructing the passage and thus giving rise to suffocating feeling and distending pain in the epigastric region and difficulty in defecation. Therefore sleep is disturbed. The undigested food staying in the middle jiao forms dampness and produces phlegm, so the tongue coating is sticky and Pulse rolling.
20.3 Case no 22Patient’s Name: Joshi Kashmira Address: Aditya Shagun Bavdhan NDA Pashan RD Near Chandni Chowk C/o : Difficulty in falling asleep, dream – disturbed sleep, palpitation, poor memory, lassitude, listlessness, anorexia, sallow complexion, pale tongue with a thin coating, thready, weak Pulse. Pulse Pattern: H ↓ Sp↓ Liv ↓ K↓
Treatment:Method: Points of the Heart Meriadian are selected as the main points to calm the heart and soothe the mind. Deficiency of the heart and spleen: Reinforcing method with moxibustion in combination is apllied to strengthen the heart and spleen. Disharmony between the heart and Kidney: Even movement is applied to harmonize the heart and Kidney. Upward disturbance of the Liver fire: reducing is applied to subdue the Liver fire. Dysfunction of the stomach: Reducing is applied to regulate the stomach: Reducing is applied to regulate the stomach qi. Prescription: Shenmaen (H 7), SanYinjiao (Sp 6), Anmian (Extra)
Supplementary points:Deficiency of the heart and spleen: Pishu (B 20), Xinshu (B 15), Yinbai (Sp 1 moxibustion with small moxa cones). Disharmony between the hearts Kidney: Xinshu (B 15), Shenshu (B 23), Taixi (K 3). Upward disturbance of the Liver fire: Ganshu (B 18), Danshu (B 19), wangu (G 12). Dysfunction of the stomach: Weishu (B 21), Zusanli(S 36).
Explanation: Shenmen (H 7), The Yuan-(Primary) point of the heart Meridian, calms the heart Meridian, calms the heart soothes the mind. SanYinjiao (Sp 6), the crossing point of the liver, spleen Kidney meridians regulate the three meriadians. Anmian (Extra) is an extra point for insomnia.
Xinshu (B 15) , the back –(Shu) point of the heart and Pishu(B 20), The back –(Shu) point of the spleen are combined to reinforce the spleen and nourish the heart. Yinbai (Sp 1), the Jing –(well)point of the spleen meridian, is effective for dream – disturbed sleep . Xinshu (B 15) reduces heart. Fire. Shenshu (B 23) and Taixi (K 3) reinforce Kidney water. The combination of these points is to harmonize the heart and Kidney. The combination of Ganshu (B 18), Danshu (B 19) And Wangu (G 12) is to subdue the fire of the Liver and gallbladder. The combination of Weishu (b 21 and Zusanli (S 36) is to regulate the stomach and soothe mind.