Insomnia & Clinically Useful Patent Chinese Herbal Medicines
by H. Alyse Hyder. Emperor's College, Los Angeles, California.
Most people in our society have experienced insomnia at some time in
their life. Insomnia is defined from the perspective
of Biomedicine as ``difficulty falling asleep or
staying asleep or a disturbance in sleep that makes sleep seem
inadequate or unrefreshing'' (Beers & Berkow p. 1409). Current
statistics state ``about 10% of the population have chronic insomnia,
and about 50% have significant insomnia at some time'' (Beers & Berkow
p. 1410). Insomnia is not a considered disease, but a symptom. It is also not
defined by the number of hours you sleep every night as the amount of
sleep each person needs varies. The basic guidelines for establishing
if a person has insomnia is one or more of the following: ``difficulty
falling asleep, waking up often during the night and having trouble
going back to sleep, waking up too early in the morning, and/or
unrefreshing sleep (Beers & Berkow p. 1410). Modern Biomedicine classifies
insomnia as either primary, which is sleep problems that are not
directly associated with any other health condition or problem, or
secondary, which the insomnia is due to other physical disorders, pain,
or emotional problems. How often insomnia occurs and how long it lasts
can vary. Insomnia can be short-term (acute insomnia) or last a long
time (chronic insomnia). Left untreated, insomnia can cause problems
during the day such as fatigue, irritability, sleepiness, and difficulty
concentrating.
Treatment depends on the cause most associated with the
sleeplessness. Many patients overcome their insomnia by discussing
and treating their anxiety or depression. Others benefit by establishing a
schedule and developing relaxation methods. Some patients use medication such
as sedatives, hypnotics, minor tranquilizers, and anti-anxiety drugs to
help induce sleep. The problem with these drugs is that most pose some
risk of overdose, tolerance, addiction and withdrawal. Side effects can
include, but are not limited to, drowsiness, lethargy, and decreased
mental clarity. This is the main reason Chinese Herbal Medicine is beneficial
for numerous people who have tried other avenues with no success. Many
people find they fix their insomnia by taking sleeping pills, only to
find the addiction to the pills much worse than the original problem. A
Chinese Medicine practitioner takes into account the patient's insomnia
and figures out where it stems from, what organs are being affected, and
determines a plan to heal the body in a healthy way from the inside out.
The plan is based on a differential diagnosis of the patient's clinical
pattern, or "zheng" and takes into account a number of variables, many of
which are described in this paper. Then based on this plan, can recommend an herbal formula most closely
linked to the patient's certain type of insomnia. Most, if not all,
herbal formulas have few side effects and no addictive qualities as
encountered in Western Medicine. Several herbal patent formulas for various
type of insomnia, as based on Chinese Medical differential diagnosis will therefore
be introduced here.
In Traditional Chinese Medicine, the term insomnia covers a wide
range of sleeping problems. ``The amount and quality of sleep depend of
course on the state of the mind and spirit, or "shen". The mind is rooted in
the Heart and specifically in Heart-Blood and Heart-Yin. If the Heart is healthy
and the Blood abundant, the mind is properly rooted and sleep will be sound.
If the Heart is deficient or if it is agitated by pathogenic factors, such as Fire, the
Mind is not properly rooted and sleep will be affected'' (Maciocia,
p.281). There a number of differential diagnoses for insomnia. The
sleeplessness a person experiences can be due to Blood deficiency, Yang
deficiency, Yin deficiency, Blood stagnation, deficient Fire,
excess in the Liver, or damp Heat in the Liver and Gallbladder.
Insomnia due to Blood deficiency is one of the most common types.
``Since Blood is deficient, the person cannot fall asleep easily but
once asleep, because Yin is sufficient, he or she stays asleep''
(Maciocia p. 291). The clinical manifestations for a patient with Blood
deficient insomnia always revolve around issues of the Heart. Any of the
following symptoms may be present: difficulty in falling asleep, poor
concentration, palpitations, dizziness, fatigue, blurred vision,
anxiety, poor memory, and pale face. The tongue is this case is pale due to the
lack of blood nourishing the Heart, and the pulse is choppy. A
patient who has insomnia with the above symptoms and also poor appetite,
poor digestion, excessive dreaming, tiredness and chronic leukorrhea,
has Heart Blood deficiency due to Spleen Qi deficiency. The classic
patent formula in this case is Gui Pi Wan. This formula tonifies the
Spleen and Heart qi, nourishes Heart blood, and calms the shen. Another
formula that is similar to Gui Pi Wan but also helps reduce Yang deficiency
symptoms such as cold limbs, and spontaneous sweating, is Yang Ying Wan.
This formula tonifies Spleen and Heart qi, tonifies Blood, warms the
Yang, and calms the shen. Another version that is more powerful in
supporting heart blood and strongly addresses insomnia, poor
concentration and palpitations is Ren Shen Yang Ying Wan (Fratkin p.
960-969).
Insomnia due to Yang deficiency involves the Kidneys. The clinical
manifestations for a patient with insomnia due to Kidney Yang deficiency
could be any of the following: lethargy, tiredness, lack of initiative
or will power, depression, low back or knee pain, weakness, urinary
incontinence, lowered sex drive, and mental restlessness. The tongue
is pale and the pulse is deep and weak due to the lack of
Yang energy in the body. Huan Shao Dan and Du Zhong Bu Tian Su are
especially helpful for symptoms of insomnia along with fatigue,
palpitation and shortness of breath. Ge Jie Da Bu Wan is also a good
choice, as this patent formula helps strengthen the Kidney, Spleen,
Heart and Lung. Insomnia with mental restlessness, palpitations, poor
memory, and sexual depletion can be treated with Ren Shen Lu Rong Wan,
or Shen Gui Lu Rong Wan. Both formulas tonify Spleen and Heart qi, warm
the Kidney yang, and tonify blood. Ren Shen Lu Rong Wan is more useful
in strengthen the tendons for weakness in the body, while Shen Gui Lu
Rong Wan includes herbs to help calm the shen (Fratkin p. 993-1027).
Insomnia due to Yin deficiency involves either the Heart or the Liver. A
patient with Heart Yin deficiency insomnia presents with waking
frequently during the night, mental restlessness, dry throat, palpitations,
5-palm heat, and night sweating. The tongue will be red, without coating,
with the tip being redder compared to the body, and possibly a crack in the tip. The
pulse is floating-empty. A great patent formula that has a
pronounced effect on nourishing the Heart Yin and calming the shen is An
Shen Bu Nao Pian. However, if the patient presents the same symptoms as above
and also with a pale and thin body tongue, a better formula would be
Ding Xin Wan. This formula not only nourishes Heart Yin, but Heart Blood
as well. One of the most widely used formulas for insomnia falls into
this category. Tian Wang Bu Xin Dan nourishes Heart Blood and Yin,
settles the Heart, calms the shen and clears Blood Heat. This famous
classic formula treats restlessness, palpitation, anxiety, and vivid
excessive dreaming. It is useful for treating mental fatigue and poor
concentration or memory as well. Lastly, a formula with an equal effect
as Tian Wang Bu Xin Dan is Bai Zi Yang Xin Wan. This formula can be
taken for long periods of time.
A patient with Liver Yin deficiency insomnia also has dry throat,
irritability, blurred vision, sore and dry eyes, dry skin and hair and
dizziness. The tongue is red without coating and the pulse is
floating-empty, especially in the Liver position. ``The deficiency of
Liver-Yin causes the Ethereal Soul, the Hun, to be deprived of its root and to
wander at night during sleep. This causes insomnia and excessive
dreaming'' (Maciocia p. 296). It may also lead to sleep walking.
A good formula for basic Liver Yin
deficiency insomnia is Suan Zao Ren Tang Pian. For Liver and Kidney Yin
deficiency insomnia, a better formula would be Liu Wei Di Huang Wan.
Both formulas are suitable for long periods of use. (Maciocia p.
292-297).
Insomnia due to blood stagnation is gives rise to more of a restless sleep
accompanied by chest pain, dizziness, headache and irritability. The
tongue will is dark and purple, has purple dots, or
distended veins because of the stagnation. The pulse
may be choppy, wiry or irregular. This condition most often
follows stroke or myocardial infarction. All of the following formulas
are very similar and treat the above conditions after the incident, or
can be taken as a preventative against myocardial infarction. All are
prohibited during pregnancy. Dan Shen Yin, She Xiang Bao Xin Wan,
Mao Dong Qing Jiao Nang, and Xue Fu Zhu Yu Tang are the main herbal
patent formulas. They invigorate the blood, break blood stasis, open the Orifices,
warm the channels and collaterals, resolve chest oppression and calm the
shen. (Fratkin 691-697).
Insomnia due to Liver Yang rising is caused by excessive Liver qi stagnation
that stirs up Liver Yang that rises accompanied by violent physical symptoms.
Liver Yang causes the energy of the body to float and disturb the
to the Heart and mind. The tongue is red with possible purple spots
especially on the sides, and the pulse is choppy or wiry. The
patent formula for this condition is Chai Hu Long Gu Mu Li Wan. It
treats insomnia with palpitations, delirious speech, irritability, anxiety,
or fright. It can also be used with neurotic disorders such as hysteria,
epilepsy, and schizophrenia. This formula smooths Liver qi, cools Liver
Heat, and subdues Yang. It is not to be used during pregnancy and trace mineral
substances may cause digestive upset (Fratkin p. 614).
Insomnia due to damp heat in the Liver and Gallbladder can be due to
endogenous or exogenous factors. A patient can develop this condition
by stagnation of Liver qi leading to heat, or by being exposed to
chemical toxins or parasites. Symptoms are diverse and tongue and pulse
can vary accordingly. Patents should be chosen based on the patient's
pattern of disharmony. Usually you will see a red tongue with a possible
yellow coat and a wiry or slippery pulse. The patient may wake up very
early in the morning and be unable to fall asleep again, dream a lot,
lack timidity or be easily startled. A great formula for patients with
these insomnia symptoms who also suffer from early stage cirrhosis or
chronic hepatitis is Fu Fang Wu Ren Chun Jiao Nang. This formula
invigorates blood, tonifies blood, softens the Liver and relieves pain.
``It is effective in lowering elevated liver enzymes'' (Fratkin p. 677).
A useful formula for insomnia due to chronic gallbladder inflammation is
Wen Dan Tang Wan. This formula normalizes qi, transforms phlegm, and
harmonizes the Gallbladder and Stomach. (Fratkin p. 660-677).
All of these patent formulas treat the various incidents of insomnia in
different ways. Each herbal formula works with the patient and certain
underlying symptoms in order to find the root and treat it as directly
as possible. Chinese medicine differs from modern Biomedicine medicine
in terms of drug formulation.
The herbal formulas presented here are not nearly as
harmful to the body compared to pharmaceuticals for a number of reasons.
First, the herbs have undergone fewer refining steps and are therefore less
severe in action. For example, Valerian is a western herb which produces a
mild high and can help one fall asleep if taken before bedtime. The pharmaceutical
derivative, Valium knocks you up, but prevents you from achieving a sleep cycle
critical to the body's ability to repair itself. Second, Chinese patent formulas
are used in combination which complementary herbs which, work synergystically to
enhance, balance, and harmonize each other. ``These formulas are not sedatives in the western
allopathic sense. They do not cause drowsiness or impair motor function
or physical function and can be taken throughout the day. In cases of
insomnia, however, it is often beneficial to take one of the doses
before bed and if necessary, another dose in the middle of the night''
(Fratkin p. 716). It is also important to note that the many patent formulas
are derived from historically used Chinese Medical raw herb formulas.
Raw herb formulas are even more powerful compared to patent formulas and can be
further customized. For simple insomnia cases, depending on the degree of
severity, patents are expected to work very well.
Hopefully as more people are educated about the benefits of herbal remedies,
they will choose their medicine wisely and more often.
References
1. Beers, Mark and Berkow, Robert. The Merck Manual of Diagnosis
and Therapy. Merck Research Laboratories. Whitehouse Station, New
Jersey, 1999.
2. Fratkin, Jake. Chinese Herbal Patent Medicines-Clinical Desk Reference.
Shya Publications. Boulder, Colorado, 2001.
3. Maciocia, Giovanni. The Practice of Chinese Medicine. Churchill Livingstone
r. 1994.
contact the author H. Alyse Hyder