The condition of insomnia is a common clinical encounter and one in which I have addressed previously. Due to receiving a large amount of positive feedback on this article, I will continue to address some deeper issues which are related to the condition of insomnia and its role in the overall health and vitality of patients and clinicians alike.
The fundamental TCM diagnostic connection related to the presentation of insomnia is the substance of the Heart and Liver Blood and the grounding effect these respective substances have upon the Shen (Mind) and Hun (Ethereal Soul).
Consequently, inquiring about the sleep quality and sleep hygiene of the patient is an extremely important diagnostic litmus test of the state of the Blood and Yin. These substances are crucial for navigating the waters of life and allowing the body and mind to fluidly adapt to stress and volatile life situations.
Patterns of Disharmony
The substances of Blood and Yin are intimately related to the TCM viscera: Spleen, Heart, Liver and Kidneys. It’s important to note that these TCM organs express patterns of disharmony which are directly related to what the modern "pop medicine" zeitgeist refers to as "adrenal fatigue."
I have addressed this vague and nebulous term in a past article, "The Roots of Insomnia" and will not address this controversial concept here except to once again state clearly and firmly: TCM practitioners do not need generic herbal or nutritional supplements to treat such conditions rather they must embody the practice of resolving pattern disharmonies.
Behind every diagnosis of insomnia or related "adrenal fatigue" is a TCM pattern of disharmony, and a concomitant formula / acupuncture protocol which can be implemented to return the patient to a state of balance.
One of the key concepts to keep in mind when treating the varied TCM patterns behind the presentation of insomnia is that the night is a Yin time-period. The Shen and Hun return to the source of the Heart / Liver Blood and Yin during the restful hours of night and are anchored by these substances.
Therefore, if there is a deficit of any of these substances due to stress, worry, improper diet or lifestyle, various patterns of insomnia will inevitably appear. Many patients will "learn to live" with many facets of insomnia patterns and therefore the clinician must be sure to inquire in-depth when asking about the quality of sleep and the sleep hygiene habits of patients even when insomnia is not the main presenting complaint.
Assuring that patients have deep restful sleep is a fundamental aspect for nourishing Heart / Liver Blood and supplementing Yin and is far more important than herbal tonics in the long term for reestablishing patterns of health.
Quality Matters
The clinician should ask patients about the quantity and quality of sleep and educate patients on the important rejuvenating qualities of sleep in relation to the TCM substances of Blood and Yin. Any long- term condition, regardless of the pattern of disharmony, if left unresolved will eventually deplete and consume Blood and Yin leading to more serious recalcitrant health issues.
These important ideas must be considered when the clinician is treated any condition which is directly related to stress, anxiety, worry, or chronic fatigue. In such conditions, it is very common to see such patterns as Liver / Spleen disharmony, Spleen Qi vacuity, Liver Qi stagnation with Depressive Heat prior to any deeper issues of Heart / Liver Blood vacuity.
A Place for Herbal Remedies
It is also common to see complex combination patterns such as Liver / Spleen disharmony with Heart Blood vacuity or Liver / Spleen disharmony with Depressive Heat and Liver Yin vacuity.
In all these patterns, from the most basic to the most complex, deep quality sleep is one of the most important factors in long-term resolution of the patterns of disharmony. No acupuncture treatment or herbal formula can replace 8 hours of deep quality sleep. Clinicians must remember this and make efforts to teach patients this important idea.
This does not mean that TCM herbal formulas have no place in treating insomnia. On the contrary, the medicinals and formulas of Chinese medicine offer powerful solutions to sleep issues however they must be used to supplement overall lifestyle changes and improve sleep quality over time not seen as magic quick fixes to an unnatural lifestyle.
Formula Suggestions
My favorite TCM formula to use in cases of insomnia due to Heart Blood / Liver Yin vacuity is Tian Wang Bu Xin Dan. This formula calms Shen, clears heat, nourishes Heart Blood, supplements Yin and boosts Qi. I use this formula extensively in almost all cases of insomnia, both chronic and acute and typically in conjunction with formulas with harmonize the Liver and Spleen.
This is because so many cases of insomnia are related to some sort of stress and this is almost always related to some type of stagnation in the mind, in the life and the body. In TCM verbiage, we would connect this to Liver Depression Qi Stagnation and this is intimately involved with the function of the Spleen and its ability to function in harmony with the Heart and Liver to produce Blood.
Tian Wang Bu Xin Dan contains medicinals which nourish Blood but lacks herbs to effectively course the Qi. Due to this issue, I often use Tian Wang Bu Xin Dan in conjunction with Chai Hu Shu Gan Wan, Xiao Yao Wan, and Jia Wei Jiao Yao Wan.
The combination of formulas to course the qi and harmonize the Liver and Spleen with Tian Wang Bu Xin Dan can target a large array of patterns of disharmony which contributes to the complex condition of insomnia and the varied pattern combinations which can cause sleep disturbances.
The formula Tian Wang Bu Xin Dan is a slow acting formula and must be used over weeks and months to effect changes in sleep quality but when combined with formulas to course the qi and harmonize the Liver / Spleen, changes can be seen in much quicker time frames. As the herbal formulas are used to shift the respective patterns of disharmony, the clinician can use acupuncture to help more effectively improve sleep quality and overall health and vitality.
The integral approach of teaching sleep hygiene, using appropriate herbal formulas and acupuncture protocols can for an exquisite approach to targeting the challenging issue of insomnia and clinicians should use this integral approach to effect long-term health and vitality of the patient by improving sleep quality regardless of the presenting condition. In all cases of stress and insomnia, the clinician must protect and nourish the Blood and Yin. This is effectively treating the root before the branches can sprout and this is the true "magic" of Traditional Chinese Medicine.
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