The clinical identification of sleeplessness should follow three points.
First, to identify the severity of the disease
The lightness or severity of insomnia is related to its cause and duration, and should be distinguished by different clinical manifestations. The lighter the evidence, the less sleep or sleeplessness, the heavier the all-night sleeplessness; the lighter the few days of peace, the heavier the adults and months of unresolved, suffering from the difficulty of falling asleep.
Secondly, to identify deficiency and reality
The pathology of sleeplessness has the difference between deficiency and reality. The deficiency is due to the deficiency of Yin and blood and the loss of nourishment for the heart and brain, which is manifested as thinness, lack of color, fatigue and laziness, palpitation and forgetfulness, mostly due to the spleen losing its source of transformation, the liver losing its blood collection, the kidney losing its essence collection, and the brain being empty. The actual symptoms are fire disturbing the heart or blood stagnation, manifesting as irritability, bitter mouth and dry throat, constipation and red urine, chest tightness and pain, mostly due to hyperactive heart fire, liver depression and fire, phlegm and fire stagnation, and qi and blood stagnation.
Third, identify the internal organs affected by the disease
The main disease location of sleeplessness is in the heart and brain. Sleeplessness is caused by disturbance of the heart and mind or loss of nourishment of the heart and mind, and the mind does not guard the house. Insomnia is also caused by deficiency of kidney essence, loss of nourishment in the brain, and lack of vigilance of the mind. At the same time, other organs such as liver, gallbladder, spleen, stomach and kidney can also disturb the mind and brain and cause insomnia due to imbalance of yin and yang. For example, those who are restless and irritable and do not sleep are mostly disturbed by liver fire; those who are easily awakened after sleep are mostly suffering from heart and gall bladder deficiency and timidity; those who are sleepless with less color and tired limbs are mostly suffering from spleen deficiency and lack of transportation and nourishment of the heart and mind.
Three key points of treatment
First, focus on adjusting the yin and yang of the viscera and qi and blood
As insomnia is mainly due to the imbalance of yin and yang of the internal organs and the loss of harmony between qi and blood, the mind is restless and sleepless. Therefore, the first treatment should be from the root, focusing on regulating the diseased internal organs, their qi and blood and yin and yang. The function of the internal organs is restored to normal. If the heart and mind are kept in check, sleeplessness can be cured.
Second, the basic treatment is to calm the mind and calm the will
The key to the pathogenesis of insomnia lies in the restlessness of the mind, so the basic treatment of this disease is to calm the mind and the heart, mainly to nourish the blood and calm the mind, to clear the heart and calm the mind, to nurture the yin and calm the mind, to benefit the qi and calm the mind, to calm the liver and calm the mind, to nourish the brain and calm the mind, etc.
Third, strengthen the spiritual therapy
Emotional and mental discomfort or mental tension, excessive anxiety and other mental symptoms are common factors leading to sleeplessness, thus eliminating concerns and tensions and keeping the mind relaxed is one of the important methods of treating sleeplessness, and every time it can be desirable to the curative effect that is difficult to be achieved by drugs.
Ten evidence types of sleeplessness
According to the clinical experience, insomnia is classified into 10 types of evidence and the treatment is as follows.
(1) Heat disturbing the mind
[Symptoms] Red face and red eyes, difficulty in sleeping at night, disturbed mind, body heat and thirst, chest stuffiness and fullness, dizziness and headache, dry mouth and lips, constipation, short and red urine, red tongue, yellow dry coating, sunken pulse.
[Treatment] Clearing heat from the internal organs, clearing the brain and calming the mind.
[Formula] Cool Diaphragmatic San (He Diao Bureau Formula): 10g each of Chuan Da Huang and Pu Nian, 6g of licorice, 10g of gardenia, 6g of peppermint, 9g of scutellaria, l5g of forsythia, 10g of bamboo leaves, and a little honey.
(2) Liver stagnation and fire
[Symptoms] Sleeplessness, impatient and irritable temperament, not thinking about food and drink, thirsty, red eyes and bitter mouth, yellow urine and constipation, red tongue, yellow fur, string and number of pulse.
[Treatment] Drain fire from the liver and clear the brain to calm the mind.
(3) Gentian diarrhea of the liver soup (The Secret Collection of the Orchid Room): 6g of gentian herb, 9g of scutellaria and gardenia, l2g of zedoary, 9g of mouton, 9g of psyllium, 3g of angelica, 9g of raw groundnut, 6g of chai hu and raw licorice. at the same time, can add porcupine, dragon bone, oyster to calm the mind and sleep; if the chest is stuffy and swollen, good at breathing, add yujin, fragrant herb to clear the liver and relieve depression.
(3) Phlegm-heat internal disturbance
[Symptoms] Sleeplessness with head heavy, phlegm with tightness in the chest, malodorous belching, acid swallowing and nausea, distress in the heart and mouth, dizziness in the eyes, greasy and yellow coating, slippery pulse.
[Treatment] Clearing phlegm and clearing heat to calm the mind.
[Formula] Clearing fire and cleansing phlegm soup (“Medical Alcohol”): 15 g of Salvia miltiorrhiza, 10 g each of orange red, bile star and ginger silkworm, 15 g of chrysanthemum, 10 g each of almonds and maidenhair, 12 g of Fu Shen, 10 g each of cypress seeds and mother of pearl, half a cup of bamboo drip and 1 drop of ginger juice. If phlegm and food are obstructed and the stomach is not in harmony, add half asia, Shen Qu, hawthorn, lycopodium to eliminate and harmonize the middle; if palpitations and anxiety, add mother-of-pearl and vermilion to calm the mind; if phlegm and heat are heavy and the stool is obstructed, add Pores and Rolling Phlegm Pills to lower the fire and remove heat, expel phlegm and calm the mind.
(4) Stomach Qi disorder
[Symptoms] Chest tightness and belching, abdominal discomfort and sleeplessness, nausea and vomiting, unpleasant stools, abdominal pain, yellowish or dry tongue coating, slippery or smooth pulse.
[Treatment] Harmonizing the stomach and strengthening the spleen, resolving stagnation and calming the mind.
[Formula] Panicum Panicum Soup (Ling Shu? If the stagnation of bitter food is more severe, and see belching and swallowing of acid, and distension and pain in the abdomen, one can add Baohe Pill, in order to eliminate and guide and calm the mind.
(5) Internal obstruction of blood stasis
[Symptoms] Restlessness, headache like stabbing, panic and heartbeat, sleeplessness at night; or dreams with eyes closed, easily waking up, or even sleeplessness for several days, nervousness and pain, with dark purple tongue and thin and astringent pulse.
[Treatment] To regulate Qi, resolve blood stasis, clear orifices and calm the mind.
[Formula] Blood Mansions and Stasis Removal Soup (《医林改错》): Angelica Sinensis and Radix et Rhizoma each 9g, Peach kernel l2g, Safflower 9g, Citrus Aurantium and Radix Paeoniae each 6g, Radix Bupleurum 3g, Glycyrrhiza Glabra 6g, Radix Platycodon grandiflorum and Rhizoma Chuanxiong each 5g, Radix Ziziphiopogonis 15g, Mother-of-pearl l2g, Radix et Rhizoma l5g.
(6) Heart and spleen deficiency
[Symptoms] The patient has difficulty falling asleep, or dreaming a lot during sleep, waking up easily and having difficulty falling asleep again, with palpitations and forgetfulness, dizziness, tiredness and fatigue, tasteless eating and drinking, with a light complexion, pale tongue, thin white fur, and weak pulse.
[Treatment] Tonifying the heart and spleen, nourishing blood and calming the mind.
[Formula] Gui Shen Tang (Ji Sheng Fang): 10 g of Radix et Rhizoma Ginseng, l8 g of Radix Astragali, 10 g of Atractylodes Macrocephala, 10 g of Fu Shen, l8 g of fried sour date, 10 g of longan, 6 g of Mu Xiang, 6 g of licorice, l2 g of Angelica Sinensis, 10 g of Yuan Zhi, 3 g of ginger, 10 jujubes. If insomnia is more serious, add Schisandra chinensis, Acanthopanax, nightshade, Phellodendron to help nourish the heart and calm the mind, or add keel and oyster to calm the mind; if blood deficiency is more serious, add Radix Rehmanniae, Paeonia lactiflora, Agaricus to replenish blood and energize the brain; if the epigastric stuffiness and dullness, thick and greasy tongue coating, add Radix Panax, Chen Pi, Poria, Hou Pu to strengthen the spleen and resolve phlegm.
(7) Yin deficiency and fire
[Symptoms] Restlessness, palpitation, dizziness, tinnitus, forgetfulness, lumbago, fever in the hands and feet, night sweating, thirst, dry throat, or crusty mouth and tongue, red tongue with little moss and fine pulse.
[Treatment] Nourishing Yin and clearing the heart, nourishing the brain and tranquilizing the mind.
[Formula] Huang Lian A Gou Tang (Treatise on Typhoid): Huang Lian 9g, A Gou 12g, Scutellaria 10g, Bai Shao l8g, Chicken Root Yellow 2 pieces. If Yang rises with heat and slight redness, dizziness and tinnitus, add oyster, tortoise plate and magnetic stone to calm Yang, so that Yang rises can be pacified and Yang can enter Yin and sleep; if sleeplessness is more serious, add cypress kernel and jujube seed to nourish the heart and calm the mind.
(8) Heart and gallbladder Qi deficiency
[Symptoms] Sleeplessness and dreaminess, easy to wake up, timidity and palpitations, panic in case of events, shortness of breath and tiredness, clear and long urine, light tongue, thin pulse.
[Treatment] Benefiting Qi, calming panic, tranquilizing the mind.
[If the blood deficiency Yang floating, false sleeplessness, it is appropriate to use sour date soup, the main formula to jujube seeds to calm the mind and nourish the liver; Chuanxiong and blood to help jujube seeds to nourish the heart; Poring phlegm nourish the heart, help jujube seeds to calm the mind; Zhi Mu clear bile and calm the mind. If the condition is more serious, the two sides can be used together; if the palpitations are more severe, raw oyster and vermilion are added on the basis of the front to strengthen the sedative and tranquilizing power.
(9) Heart and kidney disconnection
[Symptoms] Heart trouble, dizziness, tinnitus, fever, night sweating, dry throat, mental depression, forgetfulness, soreness and weakness of the waist and knees; impotence in men, irregular menstruation in women, red tongue with little coating and fine pulse.
[Treatment] To improve the heart and kidney, tonify the brain and calm the mind.
[If heart yin deficiency is the main cause, use Tianwang Xin Tonic Dan; if kidney yin deficiency is the main cause, use Liuwei Dihuang Wan with nightshade vine, sour date palm, hehuanpi, Fu Shen, etc. to calm the mind and nourish the kidney.
(10) Liver depression and blood deficiency
[Symptoms] Difficulty in sleeping, or even if sleeping, waking up easily from dreams, or fullness in the chest, good sighing, irritability, red tongue with yellow fur and string veins.
[Treatment] Diversify the liver and nourish the heart, tranquilize the mind and calm the panic.
[Formula] Sour Jujube Soup (Jin Kui Yao): 18g of sour jujube, 6g of licorice, 12g of Zhi Mu, 10g of Fu Shen, 6g of Chuan Xiong. If liver depression is more severe, and if the fire is more severe, it can be treated by referring to the evidence of liver depression and fire.