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Expert Advice-Treatment of Insomnia in Traditional Chinese Medicine(TCM):

Traditional Chinese Medicine for Insomnia

Nothing is worse than not sleeping well. That is what I hear every day from people who suffer from insomnia. When we canít sleep well, nothing is right. We are tired, moody, irritable, our muscles are stiff, our head hurts, we can hardly think or function. Furthermore, lack of adequate sleep can cause serious health problems. Most doctors now believe that chronic insomnia brings on the symptoms of fibromyalgia and contributes to cardiovascular stress, not to mention the countless car accidents caused by people falling asleep at the wheel.

Western medicine and traditional Chinese medicine (TCM) have different approaches to insomnia. To Western doctors, insomnia is the inability to sleep soundly. If there is no obvious physical reason, such as pain, for the sleeplessness, it will usually be seen as an emotional problem such as stress, anxiety, or depression. A patient with a mild case of insomnia is told to "relax more, cut back on caffeine, try a hot bath or warm milk before bedtime." For chronic insomnia, the usual response is sleeping pills or anti-depressants.

In TCM, a primary concept is the idea of "root and branch." Symptoms like insomnia are considered to be the branches of a disease. The root of a disease is a dysfunction or imbalance of the fundamental substances (Chi, blood, Yin, Yang, Jing, Shen), or of the major organ systems (Lungs, Heart, Spleen, Liver, Kidneys). When a person suffers from insomnia, the two organs most often out of balance are the Heart and the Liver. Each of these two organs houses a specific aspect of the spirit. If these organs are out of balance, they will not be able to house the spirit properly, and the spirit will wander. (TCM, although a very complex medical system, had its origins in Taoism, and before that in shamanism. Therefore, there is a spiritual consciousness built into TCM theory.) A wandering spirit, or Shen disturbance, can manifest in a number of ways, including mood disorders and heart palpitations, but insomnia is one of the commonest symptoms.

There is a lot of space devoted to insomnia in classical Chinese medicine textbooks. Several different types of insomnia are noted, and the differences point to different origins of the problem. The commonest types of insomnia are as follows:

Dream-disturbed sleep: Nightmares normally indicate a disorder of the Gall Bladder meridian. Dreams in which we go over and over the same ground, walking in a maze, reliving aspects of our jobs or our relationships generally are due to a Spleen/Heart imbalance. People with this problem say, "I canít shut my mind off."

Difficulty falling asleep: This is usually related to an excess condition of the Liver or Liver and Gall Bladder. People will lie awake, tossing and turning for hours.

Waking up easily: Many people can fall asleep easily, but then they wake up later and find it difficult to go back to sleep again. They may be awake for an hour or so, or may not go back to sleep at all. These people have a deficiency pattern, often a Heart/Spleen deficiency.

Waking up at a specific time every night: For example, some people regularly wake up at three oíclock in the morning. In Chinese medicine theory, the bodyís energy (Chi) circulates through the twelve principal meridians over a 24-hour period. Each meridian relates to an internal organ. If a person wakes or has some unusual symptoms at the same time every day, it is probable that there is an imbalance in the organ system that is "highlighted" at that time of day. Energy peaks in the Liver meridian at 3:00 a.m., which is why people often wake up then. Liver problems can result from unexpressed anger, stress triggering Liver Chi stagnation, and Liver Fire.

Other symptoms: When a Chinese medicine practitioner is analyzing a patientís sleeping problems, he narrows down the possibilities by looking for other symptoms that are characteristic of a particular disorder. For example, people with the Liver Fire pattern get angry easily, and have Heat signs such as a red face, dark yellow urine, and dry bowel movements. People with Spleen/Heart deficiency tend to be forgetful, have poor concentration, feel very fatigued, and are always worrying about something. People with a Kidney/Heart disharmony can have tinitus, palpitations, weakness in the low back, feel light-headed, and get flushed easily. Chinese medicine practitioners also examine their patientsí tongues and feel the pulse for further indications of which particular pattern is predominant.

Everyone wants to sleep well and have sweet dreams every night. Nobody wants insomnia, but some people have been suffering with it for a long time. In my practice, patients come in with these complaints every day: "Iíve only slept a couple of hours a night for seven years." "I have not slept well for 15 years since my divorce." "I have been taking sleeping pills for years. It all started when our company went down." "I was diagnosed with fibromyalgia, and my doctor said my aches and pains are related to my sleeping disorder. Can you do anything?

In the first part of this section, I mentioned that Chinese medicine sees insomnia as a symptom of an imbalance in either the fundamental substances of the body (Chi, Blood, Yin, Yang, Shen), or of the major organ systems (Lungs, Heart, Spleen, Liver, Kidneys). Insomnia most often results from imbalances of the Heart or Liver. I also outlined the principal types of insomnia, as described in Chinese medicine textbooks: dream-disturbed sleep; difficulty falling asleep; waking early; and waking at a specific time every night. This article will discuss the Chinese medicine approach to treating insomnia.

In this country, people say "acupuncture" as a shorthand term for traditional Chinese medicine (TCM). Most TCM practitioners also include Chinese herbal formulas and dietary modifications in their treatments. When treating insomnia, acupuncture and Chinese herbal formulas are combined for the quickest and most effective results. Not every insomnia patient will be treated with the same herbs or acupuncture points, however. A particular combination of signs and symptoms is called a pattern, and different patterns are treated differently. For example, students who are burned out on studying and canít shut their minds off usually fall into a Spleen/Heart imbalance pattern; whereas elderly people who have trouble sleeping are generally manifesting a Heart/Kidney imbalance.

One of the most popular herbs in China for treating insomnia is Suan Zao Ren. This is the kernel of a small red date that grows wild in the mountainous areas of northern China. The branches of this shrubby plant are so thorny that farmers use it as fencing to keep their animals contained. I remember the scratches I got as a little girl when I visited the mountains and picked the dates for their sweet/sour flavor. Suan Zao Ren has the effect of nourishing Heart Shen and Liver Blood, as well as regulating Liver Chi. This makes it very effective at "calming the spirit" and dealing with stress. I often prescribe a formula which has Suan Zao Ren as a principal component when my patients have insomnia due to a Liver/Heart imbalance. For people with a Spleen/Heart disorder, such as the overworked students mentioned above, Gui Pi Wan is a useful herbal formula.

The Kidney/Heart disharmony pattern is also very common in this country, especially in peri-menopausal women and the elderly. Tian Wang Bu Xin Dan is an old and well-studied Chinese herbal formula that is often used for Kidney/Heart imbalances. Several studies have proven that it can help people to sleep deeply and stay asleep longer. People who take this formula tend to feel more refreshed and energetic in the morning. It can also be used to treat the nervous exhaustion that comes with depression.

Acupuncture is also effective treatment for insomnia. Many of my patients who come for other problems such as migraine, back pain, or depression notice that their sleeping has improved, too, even though they may not have considered insomnia to be a problem. Patients will comment that theyíve been sleeping really well since they started acupuncture.

One of my patients had multiple health problems including chronic insomnia. She had only slept one or two hours a night for many years, and suffered from fibromyalgia, which is generally considered to be related to chronic insomnia. After acupuncture treatments twice a week for three or four weeks, plus herbs, her sleep improved dramatically. She could sleep five or six hours a night without waking up, and the intensity of her other symptoms began to diminish. She also began to cut down on the number of prescription medications she had been taking. Because her case was so severe, I am still seeing her once every week or two, but she is practically a new woman. Now she has a normal sleeping pattern, and her aches and pains have pretty much disappeared. She said, "You donít know how wonderful you feel when you can sleep well. The world is very different. My mood is good; I have energy; Iím not in pain; and I donít need to take all those pills.

Maggie is a patient who comes in specifically for insomnia. She is a young woman with a stressful job and a small child to raise. She said, "I donít know what happened with my nervous system Ė I just canít sleep. Either I canít fall asleep, or I sleep one or two hours, then Iím wide awake for several hours. Since my son was born, everything is worse." After treatment with herbs and acupuncture, she is doing well. One day she told me that she had just called her parents and told them about her wonderful experience. She was encouraging them to try acupuncture because they were in their mid-70s and had been taking sleeping pills for years.

Acupuncture has many positive benefits. It is safe (sterile disposable needles are always used), it is effective for a wide variety of health problems, and it is virtually free of side effects. It has been scientifically demonstrated that acupuncture can have an effect on the body's central nervous system, and can increase levels of several neurotransmitters, including serotonin. Acupuncture promotes natural sleeping patterns, and doesnít have the hangover effect that most sleeping pills do. If you have been having problems with your sleep, it may be worthwhile to give acupuncture a try before taking heavy-duty medications. If you are currently taking sleeping pills and are bothered by the side effects, consider talking to your doctor or a Chinese medicine practitioner about alternatives.