Insomnia is defined as having difficulty falling asleep or staying asleep for long periods of time. This often results in poor sleep quality and a lack of sufficient rest. Most people will experience some form of insomnia at some point in their life. According to the National Institute of Health, approximately 30 percent of the general population experiences insomnia.

For most people, insomnia comes in cycles. Initially, those suffering from insomnia may simply have trouble falling asleep. For others, even after falling asleep, they might not be able to stay asleep for an adequate amount of time and may find themselves waking up throughout the night.

The most comprehensive description of insomnia can be summarised  in “Jing Yue Quan Shu: Bu Mei( The Complete Works of Zhang Jing Yue: Insomnia)” which said: “Inability to sleep can be differentiated into many patterns, in reality it is a case of pathogen versus zheng qi.  This is because sleep is associated with yin and is governed by the shen. If the shen is calm then sleep ensues; conversely a restless shen will result in sleeplessness. The cause of the restlessness is attributed to harassment by pathogenic qi or insufficiency of ying qi.” The root cause stems from the body’s qi and blood as well as the status of the zang fu organs.

Discussion on Insomnia:

Zhang Zhong Jing said that insomnia can be differentiated into the presence or absence of pathogen.  Insomnia associated with absence of pathogen is due to insufficiency of ying qi. Ying governs blood, blood deficiency will result in the inability to nourish the heart; heart deficiency will lead to shen’s inability to be anchored to its abode characterised by anxiety and fright or due to excessive thought causing sleeplessness or disrupted sleep and restlessness etc. Treatment is to nourish ying qi. Excessive thought with damage to the heart and spleen resulting in exhaustion of qi and sinking of essence manifests as heart palpitations and insomnia, the indicated formula is Gui Pi Tang.

If there is damage to both the ying and wei with devastated qi and blood characterised by sleepless nights, the indicated formula is Da Bu Yuan Jian modified. The other formula which is effective in dealing with insufficiency of the middle qi with the sinking of the clear yang is Bu Zhong Yi Qi Tang.

If the insomnia is due to pathogenic influence, then the strategy is to eliminate the pathogen to restore the calming of the shen. Formulas such as Chai Hu Yin, Ma Huang, Gui Zhi, Zi Su, Ge Gen etc are indicated. If there is phlegm harassment, Wen Dan Tang and Liu An Jian and Dao Tan Tang can be used.

Road-test Formulas for treatment of Insomnia:

Professor Zhang Bing Hou of Beijing University of Chinese Medicine created a core formula known as An Shen Tang (Calm the Spirit Decoction)and it has had very good results in dealing with  many different types of insomnia.

An Shen Tang: Chao Suan Zao Ren, Chuang Xiong, Dang Shen, Sheng Long Chi (or Zi Bei Chi 紫贝齿)

Formula Analysis: Suan Zao Ren nourishes blood and calms the shen; clears heat and alleviates vexation; Chuan Xiong tonifies and invigorates blood, designed to negate the cloying properties of the other herbs. Modern research suggests Chuan Xiong can increase the cerebral blood flow. This is a strategy of Zhang Zhong Jing by incorporating calming herbs with blood invigorating herbs. Long Chi sedates and calm the mind; while Dang Shen augments qi and when combined with Suan Zao Ren has the objective of calming the mind and augmenting qi. The rationale of using Dang Shen is because it is thought that insomnia is mainly attributed to the non- interaction of the heart and kidney, thus Dang Shen acts as an intermediary to connect the heart and the kidney.

The clinical effect of An Shen Tang is to nourish blood and augment qi to achieve the ultimate effect of calming the shen.

The following are the five supplementary formulas to be combined with An Shen Tang.

1. Shu Gan Xie Re An Shen Tang (Dispersing and purging the liver decoction + An Shen Tang).

Long Dan Cao, Chai Hu, Huang Qin, Sheng Di Huang, Gan Cao + An Shen Tang.

Indications: Liver constrained transformed to heat characterised by insomnia with dreams, irritability, thirst, bitter taste in the mouth, scant and dark urination,red  tongue tip, yellow tongue coat and wiry and rapid pulse.

2. Hua Tan Qing Re An Shen Tang (Transforming phlegm and clearing heat + An Shen Tang)

Huang Lian, Ban Xia, Chen Pi, Fu Ling, Zhi Shi, Zhu Ru + An Shen Tang.

Indications:  Phlegm heat harassment characterised by heaviness in the head, dizziness, chest oppression, nausea, acid regurgitation, bitter taste in the mouth, heart vexation, yellow, greasy tongue and slippery and rapid pulse.

This type of insomnia is due to spleen and stomach excess heat with phlegm harassing the pericardium and network vessels. The knotted fire and phlegm in turn attacks the shen causing insomnia. Wen Dan Tang clears heat, transforms phlegm, regulates qi; while Huang Lian clears heart heat and drains fire.

3. Zhi Yin Bu Xue An Shen Tang (Nourishing Yin and Tonifying Blood Calming the Shen Decoction:

Shu Di Huang, Bai Shao, E Jiao + An Shen Tang

Indications: Insufficiency of yin blood with mal-nourishing of shen  characterised by heart palpitations, vexation, wilting complexion, irregular menstruation, abdominal and umbilical pain, thin white or yellow tongue coat and thready or thready and rapid pulse. This type of insomnia is characterised by early waking.

Shu Di and E Jiao tonify blood; Bai Shao harmonizes ying and regulate blood + the basic core formula to nourish yin and blood; augment qi and calm the heart; sedate the shen.

4. Bu Yi Xin Pi An Shen Tang (Tonify the heart and spleen and calming the shen Decoction):

Huang Qi, Dang Shen, Fu Ling, Gan Cao, Dang Gui + An Shen Tang

Indications: Excessive thinking and over-taxation resulting in insomnia with early waking.

Explanation: Heart stores the shen; spleen governs thought with the function to manage blood. Excessive thinking and taxation damage the heart and spleen causing spleen and blood deficiency with inability to nourish the heart hence this type of insomnia is characterised by early waking, dreams and forgetfulness. Si Jun Zi Tang tonifies the spleen qi which is the source of qi and blood formation; Huang Qi and Dang Gui is Dang Gui Bu Xue Tang and will  generate blood and augment the heart and spleen. Dang Gui when paired with Chuang Xiong will tonify blood and invigorate qi.

5. Zhi Yin Qin Xin An Shen Tang (Nourish Yin and clear heart fire and calming the shen decoction):

Huang Lian, Huang Qin, E Jiao, JI Zi Huang, Shi Di Huang, Mai Dong, Zhi Mu, Gan Cao + An Shen Tang.

Indications: Yin deficiency with hyperactive fire characterised by heart vexation, restlessness, forgetfulness, dizziness, tinnitus, lumbar ache and weak knees, five hearts heat, parched mouth, red tongue with scant tongue coat and thready and rapid pulse.

The focus of this formula is to target kidney yin deficiency with non-interaction of heart and kidney compounded by hyperactive and upflaming liver fire. Huang Lian drains heart fire; E Jiao and Shu Di augment the kidney water; Zhi Mu, Mai Dong nourish yin and clear heat; Huang Qin enhances Huang Lian’s heat clearing effect while Shao Yao enhances E Jiao’s yin nourishing effect. Ji  Zi Huang (egg yolk) a product of flesh and blood calms the mind, moistens the heart yin and augments the kidney.

(Ref: Case Study Collections of Professor  Zhang Bing Hou, Beijing)