Insomnia is often caused by emotional or psychic disturbances. Anxiety and anger make the Liver depressed, and the depressed Liver qi may be transformed into fire, which interferes with the normal functions of the Heart. Excessive anxiety may also impair the Heart (mind) and the Spleen, and insomnia occurs due to inadequate supply of nutrients and blood to the Heart.

In the aged and the patients suffering from chronic diseases, qi and blood are insufficient to nourish the Heart, thus leading to palpitations and insomnia. Qi deficiency may also involve the Heart and the Gallbladder, impairing one's  sleep and making one vulnerable to fright. Consumption of Kidney essence may break down the normal balance between the Heart and the Kidneys, and incoordination between the Heart and the Kidneys may also be manifested as insomnia.

Syndrome Differentiation

According t the pathogenesis, insomnia can be classified into the following syndrome patterns:

1. Depressed Liver with exuberant fire: Insomnia accompanied by irritability, irascibility, thirst, yellow coating, and stringy, rapid pulse.

2. Incoordination of the Heart and the Kidneys: Insomnia accompanied by dizziness, tinnitus, dryness in the mouth, heat sensation in the palms and soles, palpitations, forgetfulness, lumbar aching, reddened tongue, and thready, rapid pulse.

3. Deficiency f both the Heart and the spleen: Dreamful sleep with early waking, palpitations, forgetfulness, dizziness, lassitude, lack of strength, anorexia, pallid complexion, and thready, weak pulse.

4. Deficiency of the Heart ad the Gallbladder: Dreamful sleep with wakefulness, susceptibility to fright, and stringy, thready pulse.

Herbal Medication

1. Depressed Liver with exuberant fire

Principle of treatment: To purge the Liver of fire.

Formula of choice: Longdan Xiegan Tang (Decoction of Gentian to Purge the Liver).

2. Incoordination of the Heart and the Kidneys

Principle of treatment: To coordinate the Heart and the Kidneys.

Formula of choice: Liuwei Dihuang Wan (Pill of Six Ingredients with Rehmannia) plus Rhizoma Coptidis (goldthread rhizome) and Cortex Cinnamomi (cinnamon bark).

3. Deficiency of both the Heart and the Spleen

Principle of treatment: to nourish the Heart and the Spleen.

Formula of choice: Guipi Tang (Spleen-Invigorating Decoction).

4. Deficiency of the Heart and the Gallbladder

Principle of treatment: To replenish qi and induce tranquilization

Formula of choice: Anshen Wan (Tranquilizing Pill).

Patent Medicines

1. Depresed Liver with exuberant fire: Longdan Xiegan Wan (Gentian Pill to Purge the Liver).

2. Incoordination of the Heart and the Kidneys: Tianwang Buxin Dan (Heavenly King's heart Tonic).

3. Deficiency of both the Heart and the Spleen: Renshen Guipi Wan (Spleeninvigorating Pill with Ginseng).

4. Deficiency of the Heart and the Gallbladder: Anshen Wan (Tranquilizing Pill).