Chinese Herbal Formulas for Insomnia

Dr. Hong-yen Hsu

Introduction

    In modern medical theory, normal patterns of sleeping and waking are controlled by the brain’s sleeping and waking centers. Insomnia is the result of a breakdown of this regulatory function and is often associated with psychic, social, physical or health stimulation influencing the physiological pathways that moderate the normal sleeping cycle.

    Chinese medical theory postulates that insomnia is a result of mental overload, fright, and organ deficiencies, irregular diet, fatigue, prolonged illness. It treats insomnia according to the specific cause of the insomnia according to Chinese medical diagnosis and theory and the patient’s unique confirmation of excess and deficiencies.

Patterns

Deficiency of the Heart and Spleen:

This pattern is marked by insomnia or dreaminess, restless and fitful sleep, poor memory, palpitations, fatigue, weakness, anorexia, poor facial complexion, pale tongue, and a thready, weak pulse.

It is commonly treated with Ginseng and Longan Combination (gui pi tang) to nourish the heart and invigorate the spleen.  Studies have found this formula to regulate the mental excitability and promote smooth digestion.

For frequent insomnia one can modify Gui Pi Tang by adding the following:

·         Schizandra (wu wei zi)

·         Polygonum stem (ye jiao teng)

·         Biota (bai zi ren)

·         Dragon bone (long gu)

Hyperactive Fire due to Yin Deficiency

This pattern is marked by anxiety, insomnia, dizziness, tinnitus, feverish sensation in the palms and soles, dry mouth with little saliva, nocturnal emissions, spermatorrhea, premature ejaculation, palpitations, amnesia, soreness of the waist, red tongue body and thready, rapid pulse.

Commonly used formulas are Coptis and Gelatin Combination (huang lian e jiao tang) and/or Ginseng and Zizyphus Formula (tian wang bu xin dan). Both formulas are indicated for this pattern. However, Tian Wang Bu Xin Dan is more effective to regulate mental disturbance which affect sleep and can tranquilize without causing restlessness.

Fright caused by the deficiency of Heart Qi

This pattern is marked by insomnia, anxiety, palpitation, dreaminess, fitful sleep, easily frightened, neurosis, and a taught, thready pulse.

Zizyphus Combination (suan zao ren tang) and/or Ginseng and Acorus Combination (an shen ding zhi wan) are commonly used formulas to treat this pattern of insomnia. Another formula that may be considered is Astragalus and Zizyphus Combination (yang xin tang). Research shows Suan Zao Ren Tang effective to induce sleep and decrease fever.

Stagnation of Liver Qi

This pattern is marked by mental depression with a tendency to lose one’s temper, anxiety, vertigo, blurred vision, fullness of the abdomen, eructation, anorexia, felling chest oppression, hypochondriac pain, irregular menstruation, and a wiry pulse. Bupleurum and Cyperus Combination (chai hu shu gan tang) is commonly recommended for use.

If this pattern is complicated with rebellious qi and rising heat marked by bitter taste in the mouth, restlessness, headache, conjuctival congestion, yellow tongue coating and wiry, rapid pulse one may modify by adding:

·         Moutan (mu dan pi)

·         Gardenia (zhi zi)

·         Chrysanthemum (ju hua)

·         Gambir (gou teng)

Disorder of the Stomach Qi

This pattern is marked by indigestion, stuffiness and fullness of the epigastrium, distention of the abdomen with period pain, regurgitation of stomach acid, eructation with fetid odor, loss of appetite, nausea and/or vomiting, greasy, yellow tongue coat and a slippery pulse.

Citrus and Crataegus Formula (bao he wan) is commonly used to harmonize the Stomach Qi and clear food stagnation.

Rising Phlegm Heat

Marked by insomnia, anxiety, vertigo, palpitation, oppressive sensation in the chest, vomiting, copious phlegm, gastric discomfort with acid regurgitation, bitter taste in the mouth, greasy and yellow tongue coat, and a slippery, rapid pulse.

Commonly used formulas are Hoelen and Bamboo Combination (wen dan tang) and/or Bamboo and Ginseng Combination (zhu ru wen dan tang). Both of these formulas have the effect to tranquilize the mind and harmonize the vegetative nerve.

Other Important Formulas Used to Treat Insomnia

Bupleurum and Dragon Bone Combination (chai hu jia long gu mu li tang)

·         Palpitation

·         Chest and sub cardiac distention

·         Dreaminess

·         Feeling of insecurity

·         Agitation

·         Irritability

·         Melancholy

·         Worry

Tang-kuei and Cyperus Formula (nu shen san)

·         Insomnia

·         Menopausal symptoms with tidal fever with flushed face

·         Paroxysmal feverishness with sweating

·         Tension

·         Depression

·         Irritability

·         Tendency to anger

·         May add the following ingredients to Nu Shen San:

o   Dragon Bone (long gu)

o   Gambir (gou teng)

Licorice and Jujube Combination (gan mai da zao tang)

·         Persistent depression that results in impairment of mental functions

·         Insomnia

·         Withdrawal

·         Dysphoria

·         Sadness and melancholy

·          Tendency to cry

·         Unfounded fear

·         May add the following ingredients to Gan Mai Da Zao Tang:

o   Zizyphus (suan zao ren)

o   Biota (bai zi ren)

o   Dragon bone (long gu)

o   Albizzia (he huan pi)

o   Tumeric (yu jin)

Pinellia and Licorice Combination (gan cao xie xin tang)

·         Insomnia

·         Distention beneath the heart

·         Dysfunction of the GI system

·         Mental instability

·         Excess constitution of average constitution

·         Effective for relieving inflammation

·         Tranquilizing the mind

·         Regulating the GI system

Bupleurum Formula (yi gan san) and Bupleurum, Citrus, and Pinellia Formula (yi gan san jia chen pi ban xia)

·         Excitability caused by liver qi disturbance

·         Nervousness

·         Irritability

·         Insomnia

Cinnamon and Coptis Combination (jiao tai wan)

·         Insomnia due to an imbalance of the heart yang and kidney yin

·         Worry

·         Palpitation

·         Tidal fever

·         Night sweats

·         Tinnitus

·         Dizziness

·         Lumbago

·         Spermatorrhea

·         Empty, quick pulse

·         Red tongue tip

The Most Commonly Used Herbs for Treating Insomnia

Polygala (yuan zhi)

·         Relieve mental distress

·         Tranquilize the mind

·         Remove phlegm

Biota (bai zi ren)

·         Nourish the heart

·         Tranquilize the mind

Polygonum stem (ye jiao teng)

·         Tranquilize the mind

·         Nourish the blood

Zizyphus (suan zao ren)

·         Nourish the heart

·         Tranquilize the mind

·         Tonify yin

Albizzia (he huan pi)

·         Promote blood circulation

·         Tranquilize the mind

Dragon bone (long gu)

·         Calm the liver

·         Suppress rising liver yang

·         Sedate and tranquilize the mind

Oyster shell (mu li)

·         Calm the liver

·         Suppress rising liver yang

·         Sedate and tranquilize the mind

Notes:

Ginseng and Acorus Combination (an shen ding zhi wan)

Hoelen 10.0        Fu-shen 10.0      Ginseng 10.0      Polygala 10.0      Acorus 5.0           Dragon Bone 10.0

Cinnamon and Coptis Combination (jia tai wan)

Cinnamon bark 3.0          Coptis 18.0