Insomnia refers to a frequent reduction in sleep, difficulty falling asleep, easily waking up after falling asleep, inability to fall back asleep after waking up, or even staying awake all night, all of which are considered insomnia.

This condition is referred to as "mu bu ming" (eyes not closing), "bu de mian" (unable to sleep), and "bu de wo" (unable to lie down) in the Neijing; the Nan Jing first called it "insomnia"; the Zhongcang Jing referred to it as "wu mian" (no sleep); the Waitai Miyao called it "bu mian" (not sleeping); the Shengji Zonglu named it "shao shui" (little sleep); the Taiping Huimin Heji Jufang called it "insomnia"; the Zabing Guangyao referred to it as "bu shui" (not sleeping), and it is commonly known as "insomnia".

Occasional inability to sleep due to uneven weather conditions, excessive warmth or coldness of bedding, drinking strong tea, coffee beans, or other stimulating beverages before bed, or occasional mental stimulation or excessive thinking does not constitute a pathological condition. Inability to sleep due to pain, coughing, cutaneous pruritus, etc., is not within the scope of this condition and can be referred to in related entries.

bubble_chart Pattern Analysis

1. Insufficiency of Heart Yin︰Difficulty falling asleep, palpitation and restlessness, dreamfulness and forgetfulness, tidal fever and night sweat, feverish feeling in palms and soles, dry mouth and throat, red tongue with scanty fluid, thin and rapid pulse. Heart yin deficiency insomnia is caused by insufficiency of heart yin, hyperactivity of heart yang, failure of yin to restrain yang, and restlessness of the heart spirit. Heart yin deficiency and hyperactivity of heart yang prevent yang from entering yin, leading to difficulty falling asleep. The key diagnostic points include dreamful sleep with easy awakening, palpitation and forgetfulness, dry mouth and throat, vexing heat in the chest, palms and soles, tidal fever and night sweat, red tongue with scanty fluid, and thin, rapid pulse. The treatment should focus on nourishing heart yin and calming the heart spirit, using the modified Celestial Emperor Heart-Tonifying Pill.
2. Non-interaction between Heart and Kidney︰Difficulty falling asleep, or even staying awake all night, dizziness, tinnitus, tidal fever, night sweats, vexing heat in the chest, palms, and soles, forgetfulness, dreamfulness, soreness and weakness in the lower back and knees, seminal emission, a red tongue with scant coating, and a thin, rapid pulse. Non-interaction between the heart and kidney insomnia is caused by overstrain and internal damage, kidney yin deficiency below failing to nourish the heart above, heart fire flaring alone above without descending to the kidney, resulting in the failure of mutual nourishment between the heart and kidney's water and fire. As stated in *Ancient and Modern Medical Unity*: "There are cases where kidney water is insufficient, true yin fails to ascend, and heart fire flares alone, leading to insomnia." The symptoms of insomnia are often severe, with tossing and turning all night, accompanied by dizziness, tinnitus, soreness and weakness in the lower back and knees, seminal emission, and other signs of kidney yin deficiency. Treatment should focus on nourishing kidney water, descending heart fire, and restoring coordination between the heart and kidney. The recommended formula is Coptis and Ass Hide Glue Decoction combined with Harmonic Interacting Pill with modifications. *Leng Lu Medical Talks* advocates the use of Pinellia and Prunella to restore coordination between the heart and kidney, which can also be incorporated.
3. Deficiency of Both Heart and Spleen︰insomnia, dreamfulness, easily awakened, dull complexion, physical fatigue, shortness of breath and reluctance to speak, palpitation, forgetfulness, poor appetite, loose stool, pale tongue with thin coating, thready and weak pulse. Deficiency of both heart and spleen insomnia is caused by overthinking and overstrain, which injures the heart and spleen. Spleen qi deficiency weakens the source of qi and blood generation and transformation, leading to insufficient blood to nourish the heart, resulting in restlessness of the mind and insomnia. Leizheng Zhicai states: "Overthinking damages the spleen, leading to deficiency of spleen blood and chronic insomnia." The key diagnostic points, besides insomnia, include palpitation, forgetfulness, limb fatigue, mental fatigue, dull complexion, and poor appetite, which are symptoms of blood deficiency pattern. The treatment should focus on tonifying the spleen and replenishing qi, nourishing blood and tranquilizing the spirit. Recommended formulas include Returning to Spleen Decoction, Eight Precious Ingredients Decoction with additions such as fried Zizyphi Spinosae Semen, Milkwort Root, and Tuber Fleeceflower Stem.
4. Gallbladder Qi Deficiency︰Fear prevents one from sleeping alone, easily startled during sleep as if being pursued, with a restless and uneasy heart, dizziness and blurred vision, frequent sighing, or vomiting of bitter fluid. The tongue appears swollen and pale, with a thin, weak, and slow pulse. Gallbladder qi deficiency timidity and insomnia often result from sudden fright, qi sinking, and gallbladder injury, leading to impaired decision-making and thus fear that prevents sleep. Treatment should focus on warming the gallbladder, tonifying qi, and calming the spirit. Recommended formulas include Liver and Gallbladder Dual-Benefit Decoction or Worry-Free Decoction.
5. Liver-Gallbladder Stagnant Heat︰Restless sleep, dreamfulness and easy awakening, dysphoria and irritability, fullness and distension in the chest and hypochondrium, frequent sighing, bitter taste in the mouth, red eyes, scanty and dark urine, red tongue with yellow coating, wiry and rapid pulse. Liver-gallbladder depressive heat insomnia is caused by anger damaging the liver, leading to the liver qi losing its free coursing and dispersing function, with prolonged stagnation transforming into fire; or due to improper diet and alcohol consumption, allowing damp-heat to accumulate in the liver and gallbladder, which congeals and transforms into fire. The flaming of fire-heat disturbs mental activity, unsettling the spirit, hence restless sleep, dreamfulness, and easy awakening. Stagnation of liver-gallbladder qi results in dysphoria, irritability, and distension in the chest and hypochondrium, which is relieved by sighing; qi depression transforming into fire leads to bitter taste in the mouth, red eyes, dark urine, red tongue, and rapid pulse. Treatment should focus on clearing heat and purging fire to calm the spirit. Prescriptions such as Gentian Liver-Draining Decoction, Clear Gallbladder Bamboo Shavings Decoction with dragon's teeth, Nacre, and Magnetite may be selected.
6. Phlegm-Heat Disturbing the Heart︰Restless sleep, dreamfulness, easily awakened, dysphoria and uneasiness, chest tightness with excessive phlegm, nausea and vomiting, bitter taste in mouth with stickiness, red tongue with yellow greasy coating, slippery and rapid pulse. Phlegm-heat disturbing the heart insomnia is caused by impaired spleen transportation, or indulgence in rich and greasy food, leading to dampness accumulation and phlegm formation, which transforms into heat; or pathogenic heat invading the interior, scorching body fluids and condensing into phlegm, with phlegm-heat disturbing the heart-mind. The characteristics of this insomnia also include restless sleep, easily awakened by external dreams, dysphoria and uneasiness, but must be accompanied by phlegm-heat symptoms (chest tightness with excessive phlegm, nausea and vomiting, slippery and rapid pulse). Treatment should focus on clearing heat and resolving phlegm to calm the mind. The recommended formulas are Coptis Rhizome Gallbladder-Warming Decoction and Phlegm-Guiding Decoction with modifications.
7. Exuberance of Heart Fire︰Insomnia dreamfulness, chest vexation and heat, palpitation severe palpitation, facial flushing, bitter taste in the mouth, mouth and tongue sores, short voidings of reddish urine with pain, red tongue tip, and a rapid forceful pulse. Exuberance of heart fire insomnia is due to taxation damaging the heart, leading to solitary exuberance of heart fire and unsettled spirit. Hence, there is insomnia dreamfulness with chest vexation and heat; palpitation severe palpitation; flaming upward of fire-heat resulting in facial flushing, bitter taste in the mouth, and mouth and tongue sores; heart heat transferring to the small intestine causing short voidings of reddish urine with pain and stagnation. Treatment should aim at clearing the heart and tranquilizing the spirit. The formula used is Redness-Removing Powder taken with Cinnabar Spirit-Tranquilizing Pill.
8. Residual Heat Disturbing the Diaphragm︰Restless and unable to sleep, troubled by unease, stifling sensation in the chest and diaphragm, epigastric upset resembling hunger, red tongue texture with thin yellow coating, and fine rapid pulse. Insomnia due to residual heat disturbing the diaphragm is Rebing late stage [third stage], caused by lingering heat disturbing the mind, leading to restlessness, insomnia with vexation, chest oppression, and epigastric upset resembling hunger. Treatment requires resolving depression and discharging heat, often using Bamboo Leaf and Gypsum Decoction or Gardenia and Fermented Soybean Decoction.

1. Jingyue Quanshu．Miscellaneous Diseases．Insomnia: "Although insomnia manifests in various forms, it can be fully understood by grasping the concepts of evil and righteousness. Sleep is fundamentally rooted in yin, with the spirit as its master. When the spirit is at peace, one sleeps; when the spirit is restless, insomnia occurs. The reasons for this restlessness are twofold: one is the disturbance by evil, and the other is the insufficiency of Yingqi. Those with evil often exhibit excess pattern, while those without evil exhibit deficiency pattern."
2. Wenbing Tiaobian．Lower Energizer ChapterWang's Note: "The causes of insomnia are numerous. Some are due to yin deficiency not receiving yang, some are due to yang hyperactivity not entering yin, some are due to gallbladder heat, some are due to insufficient liver function, some are due to heart qi deficiency, some are due to heart fluid deficiency, some are due to disharmony of the qiao vessels, and some are due to phlegm-fluid retention disturbing the heart."