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Shen Yaozi, on the Autumn Equinox in the Year of Jichou (己丑)

Difficulty falling asleep, easily waking up, having many dreams, or feeling unrested after waking up are all considered insomnia. Insomnia is merely a manifestation or symptom, and it is necessary to identify the underlying causes to treat it, rather than merely suppressing brain nerves temporarily with medication. However, the causes of insomnia are complex, ranging from external environmental factors, sleeping posture, muscle and bone soreness, to dysfunction of the internal zang-fu organs, all of which need to be considered.

Some people cannot sleep due to changing beds or pillows, some due to a noisy environment, some due to work stress, nervous tension, or overwork leading to insomnia, some due to long-term staying up late or alternating night shifts causing insomnia, and some due to poor sleeping posture, compressing limbs, or twisting the neck leading to insomnia. These external factors must be eliminated first, otherwise, no amount of medication will be effective.

There are also those who suffer from insomnia due to car accidents or external injuries, where the spine may be misaligned and compressing nerves, blood vessels, or organs, causing internal zang-fu organ dysfunction and leading to insomnia. Such patients require physical manipulation to correct the misalignment, otherwise, no amount of medication will be effective.

There are also those with stiff muscles and joint pain leading to insomnia, especially in large joints like the neck, shoulders, hips, and knees. Such patients wake up in pain when they turn over and press on the affected area, so they dare not turn over all night, affecting sleep quality. Naturally, the muscle and joint pain must be treated first; once the pain stops, sleep will improve.

Some suffer from insomnia due to frequent urination, getting up to urinate 3 to 5 times a night. Naturally, the frequent urination must be treated first.

Some patients have no obvious external factors causing insomnia, so internal zang-fu organ dysfunction must be considered.

Traditional Chinese Medicine (TCM) believes that dysfunction of the five zang and six fu organs can lead to insomnia, especially the heart, kidney, liver, gallbladder, stomach, and other zang-fu organs. Additionally, "disharmony of the nutritive and defensive qi," "yin deficiency with effulgent fire," "qi deficiency," "blood deficiency," "excessive heat," "phlegm-fire," etc., can all cause insomnia. Treatment should differentiate between yin-yang deficiency and excess, adjust the function of the zang-fu organs, treat deficiency with tonification, and drain excess.

Modern people often suffer from overwork, staying up late, and irregular sleep times, causing the body to frequently enter "combat mode" (what modern medicine calls the stress response), with excessive deficiency fire, and brain nerves often in a state of virtual excitement, finally unable to "shut down." TCM calls this "yang not entering yin," "insufficiency of heart yin," or "non-interaction between heart and kidney," "insufficient kidney water." This can be seen as the brain nerves being overactive (yang), consuming all the brain's nutrients (yin), and temporarily lacking enough nutrients to perform the "shutdown" process, leading to an unwillingness to sleep. Treatment mainly focuses on calming the excessive yang qi and replenishing the depleted yin qi, and patients must also improve their lifestyle habits.

Blood deficiency leading to insomnia is more common in overworked young women. These patients often have gastrointestinal dysfunction, poor nutrient absorption, and blood loss from menstruation, forming what TCM calls "blood deficiency" syndrome (blood tests may not show anemia). Their brains do not receive sufficient blood circulation to supply nutrients, so although the body is tired, they find it hard to sleep, with random thoughts or chaotic dreams.

Those with insufficient yang qi leading to insomnia often feel cold hands and feet, with cold air emanating from the body during sleep, feeling cold no matter how many blankets they use, leading to difficulty sleeping. Treatment naturally focuses on warming and tonifying yang qi.

There are also those with poor gastrointestinal function causing insomnia. TCM has long had the saying "stomach disharmony leads to restless sleep" ⁽¹⁾, and clinically, there are cases where gastrointestinal medicine alone cured insomnia. From the modern perspective of the "gut-brain axis," the gastrointestinal tract contains about 100 billion neurons, forming the so-called "second brain," which has unimaginable interactions and connections with the brain. When gastrointestinal function is poor, the feedback to the brain can often cause negative emotions such as fear and depression, and even lead to insomnia.

In summary, the causes of insomnia are complex and varied, and the above only outlines the main points.

Generally, short-term insomnia caused by external factors is easy to treat and quick to heal; long-standing insomnia caused by internal zang-fu organ dysfunction and yin-yang imbalance is difficult to treat and slow to recover. In terms of treatment, acupuncture, ear acupoints combined with Chinese medicinals have a faster and more reliable effect, and there are many cases where patients sleep well on the same night of treatment. For those who have been taking sleeping pills and sedatives for many years, the brain nerves of such patients have been paralyzed by modern medicine for a long time, and the brain has accumulated too much metabolic waste, so it can only be improved slowly and cannot be cured in a short time.

Insomnia patients should avoid grilled, fried, biscuits, nuts and other foods that are easy to cause internal heat in their daily diet, do not eat late-night snacks, avoid coffee beans, tea, cigarettes, alcohol, and avoid vigorous exercise before bedtime⁽²⁾, develop regular eating and sleeping habits, and wear earplugs and eye masks when necessary.

Meditation is a good way to relax the nerves and help fall asleep. When you are tossing and turning in bed and have difficulty falling asleep, you can try sitting cross-legged, letting go of all thoughts, or counting your breaths, or silently reciting the name of the deity you believe in. When you feel sleepy, you can lie down and fall asleep smoothly.

bubble_chart Note

1. See Huangdi Neijing-Nitiao Lun chapter.
2. Vigorous exercise will excite the sympathetic nerves, making the spirit too good and difficult to fall asleep.