I. Epidemiology of insomnia
According to a statistical data published by the Ministry of Health of China in 2001, the number of people suffering from insomnia in China has reached 1.2 million to 2.4 million. Long-term insomnia is harmful to people’s physical and mental health, easily causing multiple organ dysfunction and decreased immune function, and has a certain correlation with depression, ulcer disease, hypertension, coronary heart disease, diabetes, cerebrovascular disease and other mental diseases.
II. Definition of insomnia
Insomnia is a state of unsatisfactory quality and quantity of sleep, a clinical symptom rather than a disease entity, and usually refers to difficulties in falling asleep and maintaining sleep.
Third, the manifestations of insomnia.
1.Difficulty in falling asleep: inability to fall asleep for 30 minutes after going to bed.
2. difficulty in maintaining sleep: waking up two and more times during the night.
3.Total sleep less than 6 hours.
4.Multiple dreams, especially frequent bad dreams, and no relief after waking up.
IV. Diagnostic criteria of insomnia
At present, there are three international criteria for the diagnosis of insomnia, namely the International Classification of Sleep Disorders (ICSD), the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), and the ICD-10 classification of mental and behavioral disorders. In China, the diagnostic criteria for insomnia (CCMD – 3) have also been developed according to international standards and domestic practice.
Although there are differences in the descriptions of the above criteria, they have the following points in common.
1. patients complain of insomnia, including difficulty in falling asleep, easy waking, dreaminess, early waking, difficulty in re-sleeping after waking or discomfort after waking.
2. Impaired social functioning and distress, including insufficient wakefulness or inability to regain energy in the morning or throughout the day, fatigue or desire to sleep during the day, poor concentration during the day, impairment of cognitive function that affects the ability to work or study during the day, concern about insomnia and worry about the consequences of insomnia and the resulting distress.
3.Insomnia of a duration of more than 1 month.
4.Excluding that it is caused by various mental, neurological and somatic disorders.
V. Insomnia classification of the most common types of insomnia in clinical practice.
1. transient insomnia: insomnia lasting less than one week.
2. short-term insomnia: insomnia lasting from one week to one month.
3, anxiety insomnia: that is, anxiety disorder-related insomnia, mainly difficulty falling asleep, anxiety symptoms are obvious, there are palpitations, panic and restlessness during the day, more obvious at night, once it gets dark, you can’t help but wonder whether you can sleep well tonight.
Sixth, the treatment of insomnia.
Chinese medicine generally identifies the following types of evidence, and then treats them separately.
1, the heart and kidney do not intersect: the evidence is seen in the heart, insomnia, dreamy, seminal emission, lumbar acidity and leg weakness, hot flashes and night sweats, red tongue without moss, thin pulse; treatment should be traffic heart and kidney, the formula with Huang Lian Agaricus Tang plus reduction.
2. Deficiency of both heart and spleen: palpitation and forgetfulness, insomnia and dreaminess, shortness of breath and fatigue, withered face, little food and tiredness, abdominal distension and loose stools, pale and tender tongue, white fur, and weak pulse; the remedy is to tonify the heart and spleen, with Gui Shen Tang.
3, Heart yin deficiency: palpitations and palpitations, insomnia, sleeplessness and dreaminess, fever, dryness of the throat and tongue, red tongue with little fluid, thin pulse; treatment is to nourish yin and calm the heart and mind, with Yi Qi and Shen Tang plus reduction.
4, deficiency of heart qi: insomnia, dreamy and easily startled, fatigue and sleepiness, short of breath, or happy and sad and weepy, mental trance, pale tongue, thin white fur, weak pulse; treatment is to nourish blood and benefit qi, calm the heart and tranquilize the mind, with Ginseng San plus or minus.
5, deficiency of heart blood: palpitations and palpitations, insomnia, sleeplessness, dreaminess, forgetfulness, dizziness, lack of color, pale tongue, thin pulse; to nourish blood and tranquilize the mind, using Siwu Tang with velvet sand, plus or minus.
6. Internal disturbance of phlegm and fire: insomnia, dizziness, palpitations, irritability, phlegm, chest tightness, red tongue, yellowish moss, slippery pulse; treatment is to clear heat and resolve phlegm; formula with Huang Lian Wen Gao plus or minus.
7, deficiency of heart and gallbladder qi: the evidence is palpitations and palpitations, timidity and fear, insomnia and dreaminess, chest tightness and shortness of breath, pale tongue, thin white fur, thin and stringent pulse; the treatment is to nourish the heart and benefit the qi, strengthen the gallbladder and suppress the panic, the formula is used to calm the heart.
In short, how to treat insomnia and dreaminess in Chinese medicine is often solved by identifying and classifying the symptoms, and then using the right medicine.
Seven, the treatment cycle of insomnia
Generally, it will be judged according to the individual differences of patients and the specific situation of taking medication. Combined with many actual cases, most of the insomnia patients should be treated for 3 to 6 months, of course, good prognosis requires the active cooperation and attention of patients, do not give up halfway or intermittently, the treatment effect will be greatly reduced.
VIII. Choice of treatment modality
Regular outpatient consultation is the best way to choose. It is recommended that patients who come from abroad should try to come to the clinic in the afternoon, where the number is relatively small and the time for analysis and explanation of the disease is more adequate.