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IMeG HealthTM, Clinical Report, 2009, No.

- a Platinum Link Health Management Inc. TCM Clinic


Suite 300 – 1177 West Broadway, Vancouver, BC V6H 1G3 • 604-736-8928 • info@imeghealth.com

Traditional Chinese Medicine and Acupuncture


Treatment of Insomnia
Keywords: Insomnia, Traditional Chinese Medicine, TCM, Acupuncture, Chinese Herbal
Medicine, Deficiency, Excess, Qi, Vital Energy

Introduction only lasts for a few days and no more than three
weeks, it’s called transient insomnia.
Sleep is essential to us as food, air and Conventional treatment methods involve the use
water are. Occasionally, many people do have of sleeping pill, anti-depression medications,
difficulty sleeping. They either have difficulty behavioural or psychological therapies. In
falling asleep quickly or they are easily general, sleep medication are effective as a
awakened or they are unable to sleep at all. temporary aid, not a long term solution. Some
Although some people may not consider it as a medications commonly prescribed to treat
serious health issue, insomnia actually causes insomnia are Ambien, Lunesta, Rozerem,
the dysfunction of internal organs. Usually, Sonata, Benzodiazepines, and Desyrel
patients experience anxiety, fatigue, pain, poor (Antidepressant). If the medicines are sold in
appetite, poor memory, constipation and pharmacies or stores without a doctor’s
depression. Insomnia can be caused by drugs, prescription, they are called over-the-counter
diseases, pain, changes in habits and (OTC) drugs. There are some OTC drugs on the
schedules, stress, depression, or brain damage. market for Insomnia such as Diphenhydramine
For some, no clear cause of insomnia can be (found in brand names like Nytol, Sominex,
found. Sleepinal, and Compoz) and Doxylamine (found
in brand names like Unisom, Nighttime sleep
The definition of insomnia, according to the Aid). Although sleeping pills can resolve the
American Sleep Disorders Association (ASDA), sleep problems quickly, they do not cure
is “difficulty falling asleep or staying asleep”. If it insomnia, and they can often make the problem
occurs every night or most nights for an worse over time. In March 2007, the FDA issued
extended time, it is called chronic insomnia. If it “warnings for prescription sleep drugs”, alerting
patients that these drugs can cause rare allergic
Clinical practice at the IMeG Health™ TCM reactions and complex sleep-related behaviours,
Clinic is supported by research at some of the finest including “sleep driving”. The FDA’s warnings
universities in the world. This platform enables include most of the drugs listed above.
practitioners to achieve the mission of “patient-focus” Concerns about the use of both over-the-counter
health care delivery. IMeG Health™ Clinical Report (OTC) and prescription sleep medication are
is a community service provided by IMeG Health™. summarized in Table 1.
For all enquiries on this report, please contact the
editor: Professor Steve C. F. Au-Yeung, email:
Traditional Chinese Medicine
s.auyeung@imeghealth.com. Other Clinical resource
materials are available on the Clinic’s website at treatment of Insomnia
www.imeghealth.com.

© Platinum Link Health Management Inc. 2009 All Rights Reserved.


IMeG HealthTM, Clinical Report, 2009, No.2

In Traditional Chinese Medicine, insomnia Qi, the clinical manifestations are irritability, red
is characterized in terms of deficiency or excess. eyes, bitter taste, headache with distension, a
Examples of excess would include eating too red tongue with yellowish coating and a wiry,
late in the evening, consuming too much sugar rapid pulse. In patients with disharmony
or alcohol, acute pain, or lack of exercise. All of between heart and kidney, the clinical
these factors cause the Qi, or energy, to manifestations are dizziness, dreamful sleeping,
stagnate and build up. Examples of deficiency soreness and weakness of the knees, cold
would include poor digestion, long term stress, limbs, pale tongue, and a thready, deep and
and chronic disease state; and would lead to weak pulse.
poor production of blood and inability to create
new cells.

In order to treat insomnia properly, it is Clinical Experience


important to determine whether the symptoms
originate from a deficiency of Qi or from an In my experience, I have found people with
1
excess of Qi. The deficiency of Qi is generally insomnia to respond very favourably to Chinese
from the heart, spleen, and kidney. The excess herbal medicine treatment. The important fact is
of Qi is usually caused by stagnant liver Qi that they are non-addictive. The most commonly
transformed into fire, or by the retention of food used herbal medicines for the treatment of the
and turbid phlegm. According to the symptoms, different syndromes is summarized in Table 2. A
medical history and palpation and tongue’s patient takes on average about 21-90 days of
picture of the patient, insomnia is categorized in herbal medicine to achieve improvement and
Traditional Chinese Medical theory as different recovery. Besides herbal medicine, acupuncture
syndromes. In patients with Qi and blood is another “natural solution” for solving sleep
deficiency of spleen and heart, the main clinical problems. There are the basic acupuncture
manifestations are excessive dreaming, points for treating insomnia, e.g. Heart
palpitation, tiredness in limbs, lustreless hair, meridian(H7), Spleen Meridian(Sp6) and some
little inclination to talk, pale tongue, and a thin, additional points as well, e.g. Bladder
weak pulse. In patients with stagnation of liver Meridian(B14, B15, B20) for heart and spleen

Table 1
Medical Impacts of the Use of Sleeping Drug

Issues of concern Impact on Patient Medical Consequences

Increase dose to achieve


Drug tolerance Experience increasing side effects
effectiveness

Absolute reliance on the use of


Drug dependence Unable to sleep or ability to sleep deteriorate
drug

Abrupt medication interruption nausea, sweating and shaking Develop withdraw symptoms

drowsiness the next day, confusion,


Side effects Increasing severity of side effects
forgetfulness and dry mouth

Consumption of prescribed
Side effects increases to a dangerous level Drug interactions
pain killer and sedatives

Rebound insomnia Deterioration of the insomnia condition need to stop medication

mental or even a sleep disorder, when treated underlying problem undetected or


Disease Masking
would provide relief from insomnia unresolved

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IMeG HealthTM, Clinical Report, 2009, No.2

deficiency; Bladder Meridian (B15, B23), Kidney (usually 3-4 months). Depending on the patient’s
Meridian (K3) for kidney deficiency, Bladder condition and reaction, they may be
Meridian (B18), Pericardium Meridian (P5), Liver recommended to use Chinese herbal medicine
Meridian (Liv3) for Liver Qi stagnation. For the or Acupuncture or both together. Besides herbal
treatment plan (Table 3), it is recommended that medicine and acupuncture treatment, lifestyle
treatment starts at 2-3 times per week initially. If management is essential, such as cutting back
the patient responds well, it will be reduced to 1 on caffeine, strong tea, cigarette, and alcohol,
to 2 treatments per week for several weeks, then spicy and oily food. Moderate exercise is also
1 per week, then every 2 weeks until recovery helpful.

Table 2
Commonly Used Herbal Medicine for the Treatment of the Different Syndromes

Syndromes Commonly Use Herbs for Treatment

Phlegm fire disturbing the mind Huang Lian, Mu Dan Pi, Zhi Zi, Shang Di Huang,

Qi & Blood deficiency of heart & spleen Dang Dui, Dang Shen, E Jiao, Suan Zao Ren

Liver Qi stagnation Chai Hu, Yu Jin, Chen Pi, Xiang Fu, Zhen Zhu Mu

Yin deficiency with fire Mai Dong, Tian Dong, Zhi Zi

Liver fire hyperactivity Mu Li, Zhi Mu, Xuan Shen, Long Dan Cao

Disharmony between heart & kidney Shan Zhu Yu, Niu Xi, Wu Wei Zi

Table 3
General Treatment Protocol for Insomnia Using Acupuncture

Phase Duration/weeks Times/weeks Response Total Number of treatments

1 2-4 2-3 Good 4-12 times

Reassessment

2 4-6 1-2 Good 4-12 times

Reassessment

3 6-8 1 Good 6-8 times

Reassessment

4 8-16 1 per 2 weeks Good 4-8 times

Reassessment

Case 1: Insomnia (61-year-old male) of breath, cold limbs and tired eyes were his
treated with Herbal Medicine major complaints. He is a Hepatitis B virus
carrier and had a liver biopsy 7 years ago. His
This patient suffered from insomnia for over father died of liver cancer, and he really does
6 years and for several months his condition not want to take sleeping pills since his liver is
deteriorated. Fatigue, chest distress, shortness susceptible to chemical risks. He was diagnosed
as suffering from “combined deficiency of heart,

© Platinum Link Health Management Inc. 2009 All Rights Reserved . 3


IMeG HealthTM, Clinical Report, 2009, No.2

spleen and liver qi stagnation”. According to his Case 2: Insomnia (47-year-old female)
palpation (wiry, thready and weak pulse) and treated with Acupuncture
tongue picture (pale tongue with light yellow
coating) and his symptoms, he agreed to take This patient suffered from insomnia for 3
Chinese herbal medicine to treat his problems. years. She often could not fall asleep or had
The treatment (Table 4) was aimed at tonifying dream-disturbed sleep because of the heavy
the heart, reinforcing the spleen, nourishing the mental stress she experienced. The
blood and soothing the liver. The patient accompanying symptoms included headache,
responded very well upon finishing 5 days of bitter taste in the mouth, fidgeting and nausea.
prescription and continued with the same herbal The tongue was red with a yellow, greasy
medicine treatment for an additional 7 days. coating and the pulse slippery and rapid. It was
diagnosed as “Heart disturbance due to phlegm
A modification to the prescription was made
fire”. She had been taking herbal medicine for
to enhance relief of irritated eyes and to
the past 3 months in another clinic and failed to
strengthen energy flow. As his quality of sleep
achieve the expected improvement. I decided to
had improved, and his eyes and overall energy
treat her with Acupuncture. The objective of the
felt better, his herbal treatment was
treatment was to clear the heat, resolve the
discontinued. However, upon stopping the
phlegm, harmonize the heart and tranquilize the
herbal formula, he reported a tendency to wake
2 mind.
up easily during the night.
The acupuncture points included Heart
He returned for herbal medicine treatment
Meridian (H7, H8), Spleen Meridian (Sp6), Liver
for another 36 days and has since developed
Meridian (Liv 3), Bladder Meridian (B15, B21).
the discipline to relax and maintained the quality
The treatment and the response of the patient to
of sleep for more than 6 hours.
treatments are summarized in Table 5. In total,
the patient had received 32 treatments within 5
Table 4
Herbal Medicine Treatment for Case 1 Table 5

Prescribed Acupuncture Treatment for Case 2


Days Effects
Herbal medicine
huang jing 10g Treatment Treatment
Patient Response
bai zhu 10g (month) Frequency
he huan pi 10g
sha ren 10g Achieved intermittent
bai zi ren 10g Quality of sleep st sleep; headache, and
1-5 1 12 times
bai he 10g achieved bitter taste in the mouth
wu wei zi 6g were relieved
mai dong 10g
zhen zhu mu 10g Sleep quietly for 4
jue ming zi 10g nd hours or more; fidgeting
2 8 times
6 - 12 Same as above and nausea reduced
Adding Continue improvement significantly
yu jin in quality of sleep,
13 - 30 rd Uninterrupted sleep for
mu li comfortable eyes and 3 4 times
about 6 hours
xiang fu good energy
31 - 45 Stop medication Easily awoken th Uninterrupted sleep for
4 4 times
Continually maintained 7 hours nightly
46 - 82 Same as above
6 hrs quality sleep
th Uninterrupted sleep for
5 4 times
7 hours nightly

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IMeG HealthTM, Clinical Report, 2009, No.2

months. She is now able to maintain 7 hours of disorders of liver and kidney function, they are
sleep every night and has had no recurrence of strongly recommended to seek complementary
symptoms. solutions. The use of acupuncture and herbal
medicine treatment to treat insomnia tends to
produce little to no side effects and known
interaction with other medications is rare.
Summary
Contributed by Jenny Huang, Dr. TCM
By definition, insomnia is “difficulty initiating
or maintaining sleep or both” and it may be due
1
to inadequate quality or quantity of sleep. It is Si Fuchun “Analysis on Syndromes of Insomnia and
typically followed by functional impairment while TCM Prescriptions” World Journal of Integrated
awake. The new studies show that high blood Traditional and Western Medicine 2007 Vol. 2 (9),
pressure is associated with insomnia. Insomnia 520.
is related to poor health and leads to weight
2
problem and raises risk of hypertension. Zhou Xiaobo “Clinical Observation on Effect of
Modified Huanglian Ejiao Decoction for Insomnia in
In general, sleep medications are most
Syndromes of Yin Deficiency with Fire” World
effective when used sparingly for short term
Journal of Integrated Traditional and Western
situations. Examples include taking the
Medicine 2007, Vol.2 No.9, 524.
medication when traveling across many different
time zones or recovering from a medical
procedure. If the patient has chronic insomnia
(more than 3 weeks), herbal medicine and/or
acupuncture are more effective than taking
sleeping pills on a daily basis to avoid
dependency and high tolerance. The patient
statistics on the outcome of 120 cases is
summarized in Table 6.

Table 6

Treatment outcome for 120 patient cases

Cases Success Treatment Status of


treated (%) Outcome Disorder

Complete
Able to sleep
resolution
84 70 for more than 6
of
hours
symptoms

Able to sleep
30 25 Improved
for 5-6 hours

Able to sleep
6 5 Ineffective
for 3-4 hours

If the patients have other chronic medical


conditions and are taking medications for the
treatment of hypertension, diabetes, cancer, and

© Platinum Link Health Management Inc. 2009 All Rights Reserved . 5