Insomnia is a kind of sickness that can not get normal sleep, mainly the lack of sleep time, depth and fatigue elimination, which belongs to the category of “sleeplessness”, “no sleep”, “no sleep” and “no sleep” in Chinese medicine. With the accelerated pace of life and increased pressure of life, insomnia has become a major disorder that affects the life and health of modern people. Chinese medicine has a long history of treating insomnia and has accumulated rich clinical experience, and in recent years, the majority of medical workers have conducted relevant research on insomnia from the theoretical and clinical perspectives.
1.Methods and ideas of research on etiology and pathogenesis
In recent years, the research on the etiology and pathogenesis of insomnia is mainly based on the “Yellow Emperor’s Classic of Internal Medicine” and the “Treatise on Typhoid Miscellaneous Diseases”, and some new ideas have been proposed by combining the clinical experience of medical doctors, mainly including the following three aspects.
1.1 Summary of the etiology and pathogenesis of insomnia in the Huangdi Neijing
Dong’s [1] treated insomnia from the perspective of the Nei Jing, which states that “if the stomach is not in harmony, one will not be able to lie down”, and differentiated the evidence from deficiency to reality. Han [2] analyzed the contents of the Nei Jing on insomnia and summarized the mechanism of insomnia from the following aspects: Yang Sheng and Yin deficiency, weakening of Ying Qi, Yang Ming Qi rebellion, liver depression and Qi rebellion, and injury of essence in five organs. Wang’s [3] discussed the insomnia theory of the Nei Jing and concluded that the mechanism of insomnia occurs as follows: Wei Qi does not enter Yin at night, Yang F pulse is strong; Ying Qi is weakened and weak, and Wei Qi is disturbed internally; the stomach is restless if it is not in harmony; liver heat and Qi stagnation cause insomnia, which is a summary of the insomnia theory of the Nei Jing. Teng [4] summarized the theory of insomnia in the Neijing and concluded that the abnormal circulation of Ying and Wei, including the excess of Wei Qi, which does not enter Ying-Yin, and the excess of Ying Qi, which is less, and the internal destruction of Wei Qi, as well as the damage to the internal organs, can cause insomnia, and advocated the use of the theory of Yin and Yang in the Neijing and the method of regulating the spirit to assist in the treatment of insomnia. Gu [5] and others discussed the relationship between the abnormal ying-wei and sleep disorders in the Neijing and concluded that: the production of ying-wei is related to the spleen and stomach, and any disharmony of the spleen and stomach and internal disturbance of phlegm, dampness and food stagnation can lead to dysfunction of the spleen and stomach and abnormal operation of ying-wei, resulting in insomnia during the day and night; on the other hand, they also recognized that the deficiency of ying-wei, the weakening of ying-wei qi, the imbalance of the relative balance of qi, blood, yin and yang, and the disturbance of the mind are also the basic pathogenesis of insomnia. The treatment should be in accordance with the “Ling Shu? The treatment should be in accordance with the so-called “supplement its deficiencies, diarrhea its excesses, adjust its deficiencies and realities, in order to pass its way and remove its evil’, and “determine the congestion, the meridians and collaterals are greatly open, and yin and yang are harmonized”, and explain that emotional and mental disorders can also lead to insomnia. Wang’s [6] believes that the operation of Wei Qi is closely related to sleep, and insomnia occurs when Wei Qi is not operating properly, and insomnia occurs when it stays in Yang for a long time, while insomnia occurs when it stays in Yin for a long time. Therefore, in the treatment, the main method of treatment is to regulate yin and yang, focusing on the relationship between F pulse and sleep.
1.2 Analysis of the etiology and pathogenesis of insomnia in the Treatise on Typhoid Miscellaneous Diseases
The theory and method of treating insomnia in the Nei Jing was enriched and developed by Zhang Zhongjing’s Treatise on Miscellaneous Diseases of Typhoid Fever in the Han Dynasty, and the idea of discriminatory treatment established by him has opened up ideas for the treatment of insomnia by later medical practitioners. Wu [7] and others summarized the rule of discriminative treatment of insomnia by Zhongjing into seven methods: (1) clearing and promoting depression and heat, removing annoyance and tranquilizing the mind, and Gardenia sour soup is the main method. ②Transferring the heart and kidneys, lowering fire and calming the mind, mainly with Huang Lian Agaricus Tang. ③Nourishing Yin and clearing heat, promoting water and tranquilizing the mind, mainly with pig ling Tang. ④Nourishing Yin and clearing heat, moistening dryness and tranquilizing the mind, with Lily Zhi Mu Tang, Lily Di Huang Tang and Lily Chicken Root Soup. ⑤ Nourishing the blood, regulating the liver, calming the heart and tranquilizing the mind, with Sour Date Soup. (6) Benefiting the heart and submerging the Yang, cleansing phlegm and calming the mind, with Gui Zhi, removing Peony and adding Shu Qi, Oyster and Dragon Bone to save the rebellion. (7) To reconcile the pivot and calm the mind, Chai Hu plus Dragon Bone and Oyster Soup is indicated. Huang [8] and others analyzed the pathogenesis of insomnia in the Treatise on Typhoid and concluded that it mainly involves heat disturbing the chest and diaphragm, internal heat burning, yin deficiency and fire, loss of stomach and fluid, deficiency of yin and blood, yang deficiency and yin, and yin and yang loss, and pointed out the corresponding prescriptions for treatment. Jiang [9] and others categorized and analyzed the articles on insomnia in the Treatise on Miscellaneous Diseases of Typhoid Fever and pointed out that the etiology and pathogenesis of insomnia in the Treatise on Miscellaneous Diseases of Typhoid Fever are: insomnia caused by heat, insomnia caused by yin deficiency, insomnia caused by yang deficiency, insomnia caused by blood deficiency, insomnia caused by internal organs, and insomnia caused by yin and yang leaving the decision to be irritable and unable to sleep, and pointed out that there is a difference between high and low levels of insomnia, and there is a difference between deficiency and reality, and the treatment varies according to the evidence, either clearing or lowering, or nourishing or warming. This laid a solid theoretical foundation for the treatment of insomnia in future generations.
1.3 Etiology and pathogenesis of insomnia based on clinical experience
Based on the discussion of insomnia in Huangdi Neijing and Typhoid Miscellaneous Diseases, modern medical practitioners have also proposed some new pathogenesis of insomnia based on their clinical experience. Wang [10] and others believe that the current conventional thinking of Chinese medicine in the treatment of insomnia is to focus on “heat”, but in fact, Yang deficiency and internal cold are also common causes of insomnia, and identifying and treating the deficiency-cold type of insomnia is an effective way to improve the efficacy and shorten the course of the disease. . Based on clinical experience, Zhang [11] et al. concluded that phlegm, heat and stasis cause insomnia, and clinical evidence-based treatment has achieved better results. Xu [12] and others emphasized the dominant role of yin and yang in sleep, and believed that if the yin and yang of the human body are not harmonized, the sleep will be restless. The treatment of insomnia focuses on the heart, liver, kidney, spleen, stomach and gallbladder organs, and the “Nei Jing”, which states that “to nourish its deficiencies, to exacerbate its excesses, and to regulate its deficiencies and realities, in order to pass through its channels and remove its evil will be cured”. In the heart, it nourishes heart yin and heart blood, clears the heart and calms the mind; in the liver, it nourishes liver blood, nourishes liver yin, calms the liver; in the kidney, it nourishes yin and submerges yang, and communicates with the heart and kidney; in the spleen, it strengthens the spleen and benefits qi, nourishes blood and calms the mind; in the stomach, it warms the gallbladder and stomach, resolves phlegm and calms the mind. Chen [13] proposed that the treatment of insomnia should be “treated from the liver, as all five organs have insomnia”, emphasizing that in modern society, emotional and mental disorders tend to lead to insomnia, and classifying the evidence types for clinical guidance, which has a deep meaning. Lu [14] elaborated the relationship between the five organs and insomnia from the physiopathology of the five organs, and identified insomnia from the deficiency and reality of the five organs, and considered the pathogenesis causing insomnia comprehensively and meticulously; among the five organs, especially the liver and heart have the closest relationship with sleep, and the other three organs are all affected by the liver and heart causing insomnia. Liu [15] listed five types of insomnia caused by “stomach disharmony”, including food stagnation, phlegm-heat obstruction, middle-jiao blockage, middle-jiao deficiency cold, and stomach-yin deficiency, and focused on regulating the spleen and stomach, based on the discussion of “stomach disharmony is restlessness” in the Nei Jing. He also suggested that the clinical evidence should identify the causes, examine the causes and treat them, and reasonably dispatch the prescriptions to obtain good results. Li [16] believed that the spleen and stomach are connected to the heart meridian, and that the malfunction of the spleen rising and stomach lowering is an important mechanism of insomnia. According to Teng [17] and others, the pathogenesis of insomnia is caused by internal injury to the emotions and the mind, with the liver being the source of the disease and the heart being the place of transmission, so the treatment of insomnia should start from both the heart and the liver and regulate them together. It can be clinically divided into heart-liver qi stagnation, heart-liver blood stasis, liver fire disturbing the heart, heart-liver blood deficiency, and yin deficiency and fire. Yang [18] and others believe that the treatment of intractable insomnia should be based on the perspective of “long-standing disease entering the ligament”, recognizing that long-standing disease can cause phlegm and stagnant blood in the body, and in the clinical treatment of intractable insomnia, we can recognize, analyze and study the pathological characteristics of phlegm and stagnant blood, and apply the method of activating blood and removing stagnant blood and dispelling phlegm to treat intractable insomnia. treatment of intractable insomnia, opening up a new way of thinking. Jiang [19] quoted from the “Theory of Blood Evidence”: “The liver harbors the soul; when one is awake, the soul travels to the eyes, and when one is asleep, it returns to the liver”, and believed that the liver plays a major role in regulating human sleep. The normal function of “liver collects the soul” is directly reflected in the quality of sleep. Sleep is closely related to people’s spiritual and emotional activities and thinking activities, and the good or bad of spiritual and emotional activities directly affect sleep activities. It can be seen that the liver’s influence on sleep is mainly through the liver qi draining and regulating, liver blood moistening, liver yin restraint, the soul is peaceful sleep, such as dysfunction of the liver physiology, it is easy to lead to insomnia.
2.Methods and ideas of evidence-based treatment research
In recent years, many doctors have been exploring the mechanism of insomnia from clinical practice, and have proposed some new treatment methods and ideas. They are described as follows.
2.1 Treatment from the heart
According to Cui [20], insomnia is a disease of the heart and mind, and it occurs in two categories, namely, loss of nourishment of the heart and mind and disturbance of the heart and mind. In addition to the deficiency of the heart and mind, the pathogenesis of insomnia due to disturbance of the heart and mind is related to the loss of intercourse between yin and yang, Yang not entering Yin, Yang Sheng or Yang Sheng and Yin failure, and its pathogenicity is mostly fire, and the clinical treatment of insomnia is mostly based on the method of clearing the heart and lowering fire, which is very effective. Xu [21] treated 156 cases of insomnia with Tianwang Tonic Heart Dan plus flavor, and the total effective rate was 96.15%. Yu’s [22] treated 32 cases of women with menopausal hypochondriacal insomnia by using Baihe Qingxin Tiaozhi Tang, with a total effective rate of 93.8%.
2.2 Treatment from the liver
Some physicians observed that most patients with insomnia are mainly caused by emotional changes and mental stimulation, and the liver is the main organ of draining and regulating the emotions, so they believe that insomnia should be treated mainly from the liver; for example, Liu [23] and others believed that the pathogenesis of insomnia should be considered more as a result of the disturbance of the mind caused by liver disorder. The total effective rate was 92.31% in 117 patients with insomnia treated with the addition and subtraction of Chai Hu Dao Huan San as the basic formula. Ye [24] and others believed that insomnia was closely related to mental and emotional conditions, and treated 50 cases of insomnia with the self-formulated Liver Dredging and Tranquilizing Soup starting from regulating the liver, with a total effective rate of 91.33%. Jiang’s [25] treated 37 cases of intractable insomnia with the use of liver-quenching and wind-quenching soup, curing 21 cases, improving 9 cases and not curing 7 cases. Yu’s [26] et al. treated 46 cases of insomnia of the type of liver stagnation and fire with the addition of gentian and liver diarrhea soup, and the total effective rate reached 91.3%.
2.3 Treatment from the spleen
Some physicians suggested that insomnia is caused by “the failure of qi and blood, the weakening of ying qi and the internal fracture of guard qi, and the failure of the gods to guard the house”, and the spleen is the source of qi and blood biochemistry, so the treatment of insomnia should start from the spleen, and the actual one should be drained and the deficient one should be tonified. Li’s [27] believes that too much thought and labor will injure the heart and spleen, and if the heart is injured, the yin and blood will be depleted, and the mind will not guard the house; if the spleen is injured, the food will be scarce and the stomach will be dull, and the source of biochemistry will be insufficient, and the blood will be deficient and cannot be served to the heart, which will lead to insomnia, and the efficiency rate is 90% when 30 patients are treated with Gui-Spleen Tang. Zhao [28] et al. treated 56 cases of insomnia of the heart and spleen deficiency type with the use of GUI-Spleen Tang with addition and subtraction, and the total effective rate reached 87.5%.
2.4 Treatment from the stomach
Most of the reports of treating insomnia from the stomach have applied the theory of “restlessness when the stomach is not in harmony” in the Nei Jing. Shen [29] and others believed that the accelerated pace of life and the increased pressure of life could easily lead to the discomfort of the liver and gallbladder, and the earth of the spleen and stomach could easily be depressed due to the depression of wood. The treatment was based on the principle of “when the evil is removed, the right is at peace”. Wang’s [30] et al. treated 75 cases of insomnia with a total effective rate of 90.7% by using warm gall bladder soup with flavour. There are many other reports of treating insomnia from the stomach, reflecting the position of the stomach as the hub of the middle jiao in the treatment of insomnia.
2.5 Treatment from the kidney
In recent years, the literature reporting treatment of insomnia from the kidney is relatively small compared with other internal organs, focusing mainly on regulating kidney yin and kidney yang, and most of the reported cases are related to insomnia in the elderly. Zhou [31] believed that the kidney energy of the elderly is gradually declining, the kidney essence is insufficient, the true yang does not rise, the heart fire is vigorous, the true yang does not descend, water and fire do not help, and the heart yang is so hyperactive that the mind does not guard the house, resulting in insomnia, so the rule of tonifying the kidney and nourishing the heart is used to treat 65 cases of insomnia of the elderly type by using Liu Wei Di Huang Wan and Zhu Sha An Shen Wan, and the total effective rate was 96.9%. Zhang [32] used the treatment method of inducing fire to return to the original source and treated one case of insomnia with Jin Kui Kidney Qi Wan plus reduction, with good clinical efficacy.
2.6 Treatment from stasis
When Wang Qingren discussed Blood Mansions and Stasis Soup in the Medical Forest Correction, he pointed out, “For those who cannot sleep at night, and whose treatment with tranquilizing and nourishing medicines does not work, this formula is if God.” Many physicians have used the method of invigorating blood and resolving blood stasis in clinical practice to treat patients with chronic insomnia, with more satisfactory results. Wang’s [33] followed Wang Qingren’s “Medical Lin Correction” to treat 38 cases of persistent insomnia with Blood Mansions and Blood Stasis Soup, with a total effective rate of 92.11%, following the saying that “the evidence of insomnia is Qi and blood stagnation. Kong [34] believed that insomnia should be treated from the stasis of the liao and took stasis of blood as the core of treatment, and treated 69 cases of long-term insomnia with a total effective rate of 95.65%. It was realized that insomnia caused by stagnant blood stasis blocking the meridians in prolonged disease, so that Yang does not enter Yin and the heart and kidney do not intersect is not uncommon in clinical practice. These patients have insomnia for a long time, the effect of using various prescriptions is not obvious, the two orbital areas of the eyes are obscure or blue, the face is not flashy, the tongue is light and clear or there are stasis points, the pulse is thin and astringent, etc., are all symptoms of stagnant veins and ligaments, the initial disease is in the meridian, the long-term disease will enter the ligaments, the main qi of the meridian is Yang, the main blood of the ligaments is Yin, when the ligaments are stagnant, the Yang of the meridian is blocked and cannot enter Yin, it can cause insomnia.
2.7 Treatment from phlegm
Phlegm, as a special medical term, was first found in the Jin Kui Yao, which laid the theoretical foundation for the application of the phlegm method, and the application of the phlegm method in intractable insomnia gradually matured in the Qing Dynasty. Le’s [35] use of phlegm-cleansing soup to treat 52 cases of phlegm-heat insomnia, with a total efficiency of 96%, provided a good example of the phlegm-cleansing method for the treatment of intractable insomnia. Ma [36] and others used Pores and Phlegm Pill to cure a case of intractable insomnia according to the theory of “all diseases are caused by phlegm”.
2.8 Treatment from Yang deficiency
Bao et al [37] considered that intractable insomnia was quite common in the elderly, and they experienced in the clinic that many intractable insomnia caused by neurasthenia and geriatric depression in the elderly belonged to the Yang deficiency and loss of supernatural. Tan [38] and others used the method of warming yang and calming the mind to treat 38 cases of yang deficiency insomnia, and the total effective rate reached 97.36%.
3. Methods and ideas of research on the treatment of proprietary Chinese medicines
In recent years, due to the development of Chinese medicine preparation technology, clinical reports on the use of Chinese patent medicines to treat insomnia are not uncommon. Zhao’s [39] et al. treated 128 cases of neurasthenia by intravenous application of Acanthopanax injection, in which symptoms such as insomnia and dreaminess, palpitations and palpitations, and tiredness were significantly improved without adverse effects, and the total effective rate of insomnia cure was 95.41%. Qian [40] et al. refined a compound jujube capsule with the extract of sour jujube and Jin Bu Bu Bu Bao as the main ingredients, and treated 100 cases of insomnia with it for 14 days, with an overall efficiency of 85% and no drug dependence and no toxic side effects.
4. Methods and ideas of single-medicine treatment research
Wang [41] and others found that peanut leaves have the phenomenon of “day opening and night closing” and the law of yin and yang in nature, human sleep and wakefulness have the same phenomenon, through research and observation, peanut leaves for the treatment of insomnia is more effective. Wang et al [42] treated 72 cases of insomnia patients with the preparation of groundnut branches and leaves, and the total effective rate was 73.6%, which was better than the control group. Li et al [43] showed that the experimental study on the hypnotic effect of raw and fried sour date kernel showed that raw and fried sour date kernel aqueous decoction had hypnotic effect, and the hypnotic effect of raw date kernel was faster than that of fried date kernel. Wang [44] used 3 grams of cicada molasses, added 250 grams of water, and boiled it for 15 minutes on a gentle fire, then took the juice and drank it, and it worked repeatedly. Wang’s [45] et al. treated 60 cases of insomnia with Ganoderma lucidum mushroom solution, and the total effective rate was 86.67%. Xu [46] used a cup of Epimedium in lieu of tea in clinical practice for those who have been weak and cold for a long time, starting with 10 grams of decoction daily, and increasing to 15 grams after 1 week and 20 grams after 2 weeks if there is no discomfort; Fu [47] and others formulated their own prescriptions for insomnia: (1) Wu Wei Zi: 30-60 grams pounded, decocted in water, taken every morning on an empty stomach; (2) fried sour date seeds: 30-90 grams, decocted in water, taken every night before bedtime (2) fried sour date seeds: 30-90 grams, decocted in water and taken every night before bedtime, can be used to relieve patients’ insomnia symptoms.
In summary, from the summary of modern literature reports and clinical treatment experiences of insomnia in recent years, the occurrence of this disease is widespread, but the reports of theoretical research are less than clinical, and the theories are mostly analytical summaries of relevant insomnia articles in Nei Jing, Typhoid Miscellaneous Diseases, etc., and complete theoretical research data on the mechanism of insomnia occurrence in Chinese medicine are missing. Although individual doctors have proposed theories of insomnia due to Yang deficiency, insomnia from the liver, and insomnia caused by all five organs based on clinical experience, which have expanded the clinical research ideas, it is still not enough to explore the rules of evidence-based treatment, and there is a lack of unified typology, and clinical research is still in the primary stage, and there is a lack of multi-level and multi-angle research. If we can keep up with modern medical understanding of insomnia, combine advanced and scientific testing methods, explore the mechanism of action of TCM in treating insomnia at the molecular biology level, and systematically summarize and analyze the mechanism of insomnia and the related organ systems involved, so as to provide better methods and ideas for the research of TCM evidence-based treatment of insomnia.