By Dr. Dongfeng Zhou – Insomnia is a sleep disorder where people have trouble sleeping. It is characterized as difficulty falling asleep, staying asleep, or waking up often during the night and having trouble going back to sleep. Insomnia is typically accompanied by symptoms like daytime drowsiness, low energy, irritability, and depression. Insomnia can be short term, lasting for days or weeks, or long term, lasting more than a month. Insomnia is a very common disorder, with half of American adults dealing with insomnia in a given year.
Causes of acute insomnia can include significant life stress, illness, menopause, emotional or physical discomfort, environmental factors as well as some medications that may interfere with sleep. Eating too late in the evening or consuming too much caffeine could contribute to difficulty fall asleep.
People who have long-term sleep disorders could have a lower quality of life. Also, insomnia can cause poor performance at work or school, poor focus and memory, risk of machinery operation and driving accidents, anxiety and depression, and chronic health problems such as high blood pressure and heart disease. Recent studies have also shown a connection between poor or limited sleep with weight gain and elevated cortisol levels.
In the Unites States, treatments for insomnia include behavioral or cognitive change, lifestyle change, and prescribed medications and supplements. Doctors recommend using sleeping pills for short-term insomnia because there is potential for dependency and side effects. This is why medications are not the first choice for treating chronic insomnia. Natural supplements such as melatonin and valerian can effectively help with healthier sleep cycle and are generally safe.
Good sleep habits, also call sleep hygiene, can help prevent insomnia and promote sound sleep:
- Keep your bedtime and wake time consistent every day, 7 days a week. Changing sleep and wake times on the weekends is not as healthy as keeping a regular schedule.
- Stay active during daytime. Sunlight can help with formation of melatonin at night and promote a good night’s sleep.
- Avoid strenuous exercise at least 3 hours before bedtime.
- Avoid naps during day time.
- Avoid or limit stimulants such as caffeine and alcohol, and nicotine.
- Eat light meals at dinner time, and do not eat late.
- Make your bedroom comfortable, dark, and quiet for sleep. Avoid using the cell phone or watching TV 2 hours before bed.
- Create a relaxing bedtime ritual such as taking a warm bath, reading, or listening to soft music.
Traditional Chinese Medicine (TCM) approach to Insomnia
History and Overview
As early as 221 BC, Huang Di Nei Jing (Yellow Emperor’s Internal Classic), considered the Bible of TCM, stated that “disharmony of stomach leads to insomnia” which refers to an inappropriate diet affecting sleep quality. Dr. Zhang Zhong Jing in Han dynasty, author of Shang Han Lun (Treatises of Cold disease), described that over-draining of the body’s vital energy is the cause of deficient heat and insomnia.
In the TCM point of view, our bodies contain two types of energies: yin and yang. In general, yin is the cool, calm, nourishing energy, while yang is warm, activating, and exciting. According to TCM theory, insomnia is associated with agitation of the shen, a name for the spirit or mind. Shen plays a key role in the higher mental functions associated with the intellect and the spiritual aspects of consciousness. Shen is light, subtle and easily disturbed; therefore, it must be anchored by the yin energy and the blood. The shen must be calm at night and housed by the heart during sleep. If this is disturbed, it will result in troubled sleep and insomnia.
In Chinese medicine, sleep happens when one’s yang energy moves inward to be contained by yin at night. Insomnia, therefore, is a dysfunction in the interchange of yang entering yin. When yang energy is excess, person will have difficulty falling asleep; when yin energy is deficient, a person will show difficulty staying asleep.
There are few key organ systems in TCM that are involved in insomnia: heart, liver, spleen and gallbladder. The heart system is the most important one because the heart houses the shen. The spleen is the source of formation of blood, which nourishes the heart. If the spleen is weak, it can lead to blood deficiency. Blood is the “yin” energy that anchors the mind. Frustration, anger, resentment, emotional turmoil and repressed emotions can all lead to the stagnation of liver qi. Over time, stagnation of qi causes poor nourishment of the heart blood and generates heat, which further agitating the heart and the shen. The heat does not allow the shen to settle at night, resulting in insomnia.
TCM Syndrome Differentiation and Herbal Medicine for Insomnia
- Liver Fire 肝火上炎 – Clinical manifestation: Insomnia with vivid dreams, irritability, headache with dizziness, excessive anger, constipation and dark urine, possibly subcostal pain, and bitter taste in mouth. Representative herbal formula: Long Dan Xie Gan Tang 龙胆泻肝汤. This formula is able to drain liver fire rapidly and reduce the agitation of the shen (mind), hence, restoring one’s sense of calm and tranquility. For severe agitation and a racing mind, add Long Gu and Mu Li to settle the shen (mind).
- Phlegm Heat 痰热扰心 – Clinical manifestation: Insomnia with phlegm signs – sensation of fullness in the chest, poor digestion or appetite, dizziness, nausea along with heat signs such as a bitter taste in the mouth. Representative herbal formula: Huang Lian Wen Dan Tang 黄连温胆汤. The key herb, Huang Lian, is the best herb to drain heart fire and down-bear nausea. In the case of indigestion, the formula Bao He Wan can be combined with this formula.
- Spleen Qi & Heart Blood Deficiency 心脾两虚 – Clinical manifestation: Insomnia, usually with dreams, along with deficiency signs such as poor appetite, soft stools, dizziness, pale complexion, poor memory, fatigue, and palpitations. Representative formula: Gui Pi Tang 归脾汤. In Chinese medicine, abundance of blood is closely linked to the quality of memory and mental abilities; blood is also important for the heart to anchor or “house” the shen (mind). This formula has ingredients to aid the digestive functions and help with the formation of blood such as Ren Shen, Gan Cao, Dang Gui and Huang Qi. Other herbs in this formula that specifically calm the mind are Long Yan Rou, Suan Zao Ren, and Yuan Zhi. Modern research shows that Yuan Zhi has an active ingredient to reduce stress and brain fog – triterpenoid saponin; and another active ingredient, 3,6-disinapoyl, named Yuanzhi-1, shows potent sedative and tranquilizing effects.
- Kidney and Heart Failing to Communicate due to Yin Deficiency 心肾不交 – Clinical manifestation: Insomnia with difficulty falling asleep and/or waking often along with Yin deficiency signs such as heat in the five centers (hands, feet, and chest), palpitations, night sweats, night thirst, dizziness, poor memory, irregular menses in women and low libido in men, sore lower back or knees. Representative formulas: Tian Wan Bu Xin Dan天王补心丹 and Liu Wei Di Huang Wan 六味地黄丸. Herbs in this formula such as Sheng Di Huang, Mai Men Dong are so-called “yin tonics” because these herbs replenish the body’s cooling system and fluids, clear the deficiency heat, thereby reducing the heat symptoms like night sweats and five-center heat as well as improving sleep by fixing the root of the problem. Clinical studies also show that the extract of the key herb in this formula, Wu Wei Zi, can prolong barbiturate-induced sleep time in mice. This effect is believed to be due to inhibition of barbiturate metabolism in liver. This formula is ideal for elderly and women who suffer from menopause.
- Heart & Gall Bladder Deficiency 心胆气虚 – Clinical manifestation: Insomnia with an overall timid nature such as easily frightened, inability to make decisions, general fatigue, shortness of breath and spontaneous sweating. Representative formulas: Ren Shu San 仁熟散 and Suan Zao Ren Tang 酸枣仁汤. Ren Shu San is typically used to treat children who have insomnia with social anxiety. Laboratory studies show that one of the key herbs, Suan Zao Ren, contains 12 different alkaloids, which are the active ingredients producing sedative actions, and it can significantly increase sleep time induced by hexobarbital.
In summary, TCM treats Insomnia as internal disharmony of the shen (mind) and the organs. Chinese herbs aim to gently and effectively correct the body’s imbalance and restore normal function. Herbal formulas will often include a variety of herbs tailored to a particular patient’s state. However, it’s important to consult a qualified acupuncturist or herbalist for an accurate TCM diagnosis and formula developed specifically for the individual patient. One should realize that chronic insomnia takes more than just drugs or herbs. It’s a combination of life-style changes, cognitive and behavioral therapies, nutritional support, and meditation will be more powerful in one’s journey of healing. Call us today to schedule an herbal consult with Dr. Dongfeng Zhou, acupuncturist and herbalist in Margate / Coral Springs Florida.
- “Acupuncture for Insomnia.” Yin Yang House, 2018, www.theory.yinyanghouse.com/treatments/acupuncture_for_insomnia.
- Bouhdili, Nadia. “Natural Way to Treat Insomnia: Chinese Herbal Medicine.” Transformational Acupuncture, 12 Nov. 2015, www.dc-acupuncture.com/stress-emotional-health/chinese-herbal-medicine-for-insomnia.
- Ellis, Andrew. Notes from South Mountain: A Guide to Concentrated Herb Granules. Thin Moon, 2003.
- Huang, Kee Chang. The Pharmacology of Chinese Herbs. CRC Press, 1999.
- “Insomnia.” Mayo Clinic, 2018, www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes/syc-20355167.
- “TCM Treatment Principles for Insomnia.” TCM Treatment Principles for Insomnia, Integrated Chinese Medicine, 2005, www.shen-nong.com/eng/lifestyles/tcmrole_sleep_treatment.html. 周肿瑛， 中医内科学，中国中医药出版社，2007.