The discussion on the causes of insomnia in ancient literature can be roughly divided into six aspects: exogenous six evils, internal emotional injury, improper diet, prolonged illness and insomnia. Shi Weiqun, an external expert in the Department of Hepatology, Hainan Provincial Hospital of Traditional Chinese Medicine, believes that although there are many causes of insomnia, with the development of society, people's material living standards have been greatly improved. In ancient times, the common cases of exogenous factors and physical weakness have been rare, and the insomnia caused by spiritual and emotional factors has become more and more. There are not a few people who have irregular work and rest and have a bad diet. The basic pathogenesis of insomnia is disharmony between ying and Wei, imbalance between yin and yang, visceral injury and deficiency of qi and blood.
Insomnia is closely related to the liver. As one of the five internal organs, the liver has the physiological functions of regulating the discharge and storing blood.
The stagnation of liver-qi can promote the operation of heart-blood, and the stagnation of liver-qi and heart-blood stasis may lead to symptoms such as anxiety, insomnia, and Huang Chi in urine. Shi Weiqun pays more attention to purging liver fire for patients with intractable insomnia in clinic.
Clinical symptoms: less sleep, easy to wake up, various nightmares, irritability, dizziness and bloating, red eyes and tinnitus, short and red urine, and sometimes sores on the tongue, clearing away the liver and purging fire, nourishing the heart and calming the nerves. Longdan Xiegan Decoction is selected. For patients with chest pain and hypochondriac pain, Rhizoma Aconiti Fragrantis, Fructus Citri Sarcodactylis, Plum Blossom, Radix Notoginseng and Flos Albiziae can be added to soothe the liver and relieve depression, and Fructus Cannabis and Fructus Trichosanthis can be added for patients with constipation. If the mouth is dry and the throat is heavy, Radix Ophiopogonis, Radix Rehmanniae, Radix Scrophulariae, etc. are added to nourish yin and promote fluid production.
Shi Weiqun believes that most patients with insomnia have symptoms of emotional depression, and the liver governs the discharge, which means that the liver has the physiological function of dredging and regulating the whole body qi. Stagnation of liver-qi tends to turn into fire for a long time, and phlegm-fire disturbs the gods, which leads to insomnia. Shi Weiqun commonly used Chaihu Shugan Powder combined with Huanglian Wendan Decoction in clinical practice. Change Coptidis Rhizoma to Scutellariae Radix for those with excessive heat; For patients with severe hypochondriac pain, Radix Curcumae, Radix Linderae, etc. should be added to enhance the power of promoting qi circulation and blood circulation. Diet stagnation, stomach disharmony plus medicated leaven, hawthorn digestion guide stagnation.
The liver stores blood, and the blood gives up the soul. If the liver is excessively drained, it will lead to liver blood deficiency and sleepless nights. It is advisable to nourish the heart and liver, and Guipi decoction or Ziziphus jujuba seed decoction can be used. If dizziness, tinnitus, soreness of waist and knees, hot flashes, night sweats and other kidney-yin deficiency are seen at the same time, Liuwei Dihuang Pill can be used together. For patients with heart yin damage such as insomnia, palpitation and dreaminess, Jiaotai Pill can be combined with floating wheat and Juncus Juncus to clear the heart and relieve annoyance; For those who feel dull and dull, and have greasy fur, Rhizoma Atractylodis, Rhizoma Pinelliae, Pericarpium Citri Tangerinae and Poria can be added to strengthen the spleen and dry the dampness.
(Contributed by Hainan Provincial Hospital of Traditional Chinese Medicine)