I often write about practitioners reading new allopathic medical research through the "lens of Chinese medicine." This past week, I was excited to practice this method, exploring a fascinating new study1 presented at the American College of Cardiology's Annual Scientific Session together with the World Congress of Cardiology.
The study reveals that young people who have quality sleep habits are incrementally less likely to die early. The data also suggests that close to 8% of deaths from any cause could be attributed to poor sleep quality. To quote the author of the study, Dr. Frank Qian:
"We saw a clear dose-response relationship, so the more beneficial factors someone has in terms of having higher quality of sleep, they also have a stepwise lowering of all cause and cardiovascular mortality."
Researchers involved in the study used five factors to determine sleep quality: 1) ideal sleep duration of seven to eight hours a night; 2) difficulty falling asleep no more than two times a week; 3) trouble staying asleep no more than two times a week; 4) not using sleep medication; and 5) feeling well rested after waking up at least five days a week.
I was very excited to both read this important study and also to see the more nuanced differentiation of potential characteristics of poor sleep quality. The implications of quality sleep and longevity have almost unlimited connections to fundamental concepts within traditional Chinese medicine.
It's Time to Ditch the "Melatonin Mindset"
I often encourage practitioners to move away from a "melatonin mindset" and not use predictable and generic acupuncture protocols for patients experiencing sleep disorders. For example, the emotions often play a role in sleep disturbances. In TCM, anger damages the liver, excessive joy damages the heart, sorry and worry damage the lungs, thought damages the spleen, and fear damages the kidneys. Any of these emotional challenges can cause sleep disturbances; and each one can have an extensive amount of nuanced pattern presentations.
Liver Blood Deficiency
While reading this new sleep study, a TCM statement of fact came to mind: "The Liver is the root of resistance to extreme fatigue." This statement from the Nei Jing refers to the concept that liver's ability to tolerate physical fatigue is related to its blood-storing and qi-coursing functions.
These two functions of the liver are often overlooked in cases of sleep disturbances. When considering these two functions, practitioners should consider the implications of how qi stagnation in the liver / gallbladder meridians and potential concomitant blood stasis could contribute to sleep quality.
To be able to withstand the constant stress of life manifesting as "extreme fatigue," the liver uses blood / yin, which over time becomes depleted, ultimately leading to liver depression. These two patterns are often overlooked in cases of sleep disturbances.
Liver blood deficiency can often manifest as such symptoms as dry eyes, poor night vision, chronic tense muscles, restless leg syndrome, and poor sleep. The tongue is typically pale with potential cracks and often shakes; pulse is typically wiry or weak. In such cases of sleep disturbance, the following acupuncture point prescription can be utilized:
Point Combination: BL 18 + Liv 8 + Sp 6 + Du 20
Bladder 18, in the back shu point of the liver, nourishes the liver / gallbladder, moves stagnant qi, benefits the eyes, and expels wind. Liver 8 is the he-sea point of the liver meridian and nourishes liver blood, relaxes the sinews and muscles, benefits the urinary bladder, and resolves dampness in the lower jiao.
Spleen 6 nourishes the blood and yin, courses the qi, benefits urination, moves and cools the blood, stops pain, and calms the mind. Du 20 calms the mind, expels wind, raises spleen yang, and promotes resuscitation.
When these four points are combined, almost all potential complications of liver blood deficiency and its relation to sleep disturbances are addressed.
Liver Qi Stagnation With Liver Blood Deficiency / Blood Stasis
This complex and complicated pattern is extremely common in clinical presentations of sleep disturbance. Often clinicians are quick to diagnose liver qi stagnation, but miss or do not consider how chronic qi stagnation drains / depletes blood and contributes to blood stasis.
Treating only the qi stagnation will provide temporary or no relief. Often the predictable signs of liver qi stagnation are predominant; at other times the predictable signs of liver blood deficiency and blood stasis are present. The following acupuncture point prescription can be utilized in such cases:
Point Combination: BL 17 + BL 18 + Liv 8 + Liv 3 + Sp 6
Bladder 17 nourishes and invigorates the blood, clears heat, calms the mind, and soothes the stomach qi. Bladder 18 courses the qi, benefits the liver / gallbladder meridians, benefits the eyes, clears wind, and resolves damp heat.
Liver 8 is the he-sea point of the liver meridian and nourishes liver blood, relaxes the sinew and muscles, benefits the urinary bladder, and resolves dampness in the lower jiao. Liver 3 courses the qi, dispels wind, removes obstructions of the liver channel, and harmonizes ascending and descending of qi. Spleen 6 nourishes liver blood / yin, courses the qi, benefits urination, moves and cools the blood, stops pain, and calms the mind.
When combined, this five-point acupuncture point prescription is extremely effective for targeting this complex pattern. Extra points can be added as needed to calm the mind or target other unique pattern presentations.
Take Sleep Seriously
I hope this short exploration of point combinations inspired by unique research on sleep disturbances inspires you to always take in account the important implications of sleep quality; and how potential sleep disturbances can impact the lives of your unique patients.
Reference
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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