Normal sleep depends on the human body? Yin Pingyang secret? The viscera are harmonious, the qi and blood are sufficient, the mind is stable, and Wei Yangcan enters the yin. If you think too much, your heart will be sad; Or physical weakness and yin injury, yin deficiency and fire flourishing; Or frightened, heart and gallbladder qi deficiency; Or food accumulation turns into phlegm heat, which disturbs the stomach; Or emotional distress, qi stagnation leading to fire, liver fire disturbing the spirit, can make the mind uneasy and cause this disease.
Location of disease: mainly in the heart, closely related to liver, spleen and kidney.
Pathological nature: there is a difference between deficiency and excess.
Liver depression turns into fire, or phlegm-heat is disturbed internally, and those who are uneasy are mainly empirical.
Deficiency of both heart and spleen, deficiency of qi and blood, or deficiency of both heart and gallbladder, or disharmony between heart and kidney, disharmony between fire and water, loss of mind and restlessness, mostly due to deficiency syndrome. However, chronic diseases can be manifested as deficiency and excess, or caused by blood stasis.
Pathogenesis transformation: liver depression turns into fire syndrome, and fire hurts yin and consumes qi, then it turns from excess to deficiency; People with deficiency of both heart and spleen, improper diet, hurt the spleen and stomach, make qi and blood more deficient, stop food accumulation, see the mixture of deficiency and excess; If the temperature is too dry, it is easy to cause yin deficiency and fire; Those who belong to heart-kidney disharmony can further develop into syndrome of hyperactivity of heart fire and deficiency of kidney water.
Diagnostic basis
1. Insomnia, it is difficult to fall asleep, or it is difficult to fall asleep, sometimes I wake up, or I can't sleep after waking up, or I can't sleep all night.
2. It may be accompanied by dizziness, headache, palpitation, forgetfulness, upset, mental fatigue, etc.
3. Often have a history of emotional disorders, improper diet, overwork, illness and physical weakness.
How is insomnia treated by syndrome differentiation and classification in internal medicine of traditional Chinese medicine?
Key points of syndrome differentiation
Insomnia must first distinguish between excess and deficiency.
Deficiency syndrome: mostly due to insufficient yin and blood, the heart loses support. If you can fall asleep, but it is easy to wake up when you sleep, it is not easy to sleep after waking up. At the same time, we can see that your physique is thin, your face is dull, you are tired and lazy, and you have palpitations and forgetfulness. Most of them belong to deficiency of both heart and spleen. If you are upset and insomnia, it is not easy to fall asleep, and you can also see palpitation, five upset fever and hot flashes, mostly due to yin deficiency and fire; If it is easy to wake up after falling asleep, it is usually good at shock, mostly for the syndrome of guilty conscience and timidity or the syndrome of blood deficiency and liver hyperactivity.
Demonstration: disturbing the mind and mind for evil heat. Such as upset and irritable, insomnia and dreaminess, bitter mouth and dry throat, constipation and redness, which are the symptoms of liver fire disturbing the heart; For example, insomnia with heavy head and excessive phlegm is the syndrome that phlegm heat disturbs the heart.
Principles of treatment
Treatment should be based on the principle of tonifying deficiency and purging excess, and regulating yin and yang of viscera.
Evidence: purging excess, such as soothing the liver and purging fire, resolving phlegm and clearing heat, eliminating pathogenic factors and harmonizing middle energizer;
Deficiency syndrome: tonify its deficiency, such as nourishing the heart and spleen, nourishing yin and reducing fire, benefiting qi and calming the nerves. On this basis, select and add sedative products.
Dialectical analysis
First, liver fire disturbs the heart.
Symptoms: sleepless nights, even restless, irritable, accompanied by dizziness, red eyes and tinnitus, bitter mouth and dry mouth, red constipation, red tongue with yellow fur and rapid pulse.
Summary of syndrome mechanism: liver depression turns into fire and disturbs the mind.
Treatment: soothing the liver and purging fire, calming the heart and calming the nerves.
Representative: Longdan Xiegan Decoction.
This prescription has the effect of clearing liver and gallbladder fire, and is suitable for insomnia caused by liver depression and excessive internal heat.
Commonly used drugs: Radix Gentianae, Scutellariae Radix, and Fructus Gardeniae for clearing liver and purging fire; Alisma orientalis and Plantago asiatica can clear away dampness and heat; Angelica sinensis and Radix Rehmanniae nourish yin and blood; Bupleurum is smooth with the qi of liver and gallbladder; Licorice. Raw keel, oysters and magnetic magnets can calm the brain and soothe nerves.
Add and subtract with syndrome:
For those with chest tightness and flatulence, and those who are good at breathing more, add incense, turmeric and bergamot to soothe the liver and relieve depression.
Those with severe liver and gallbladder fire, insomnia all night, dizziness, splitting headache and constipation can take Danggui Longhui Pill instead.
Second, phlegm heat disturbs the heart.
Symptoms: restlessness, chest tightness, fullness, nausea, belching, bitter taste, heavy head, dizziness, red tongue, yellow greasy fur and slippery pulse.
Summary of syndrome mechanism: wet food produces phlegm, phlegm and blood stasis produce heat, which disturbs the mind.
Treatment: clearing away heat and resolving phlegm, calming the nerves.
Representative: Huanglian Wendan Decoction.
This prescription is suitable for insomnia caused by phlegm-heat disturbing the heart, which can clear the heart and reduce fire, eliminate phlegm and calm the middle energizer.
Commonly used drugs: Pinellia ternata, Pericarpium Citri Tangerinae, Poria cocos for invigorating spleen and resolving phlegm; Fructus Aurantii Immaturus, Rhizoma Coptidis, and various whey have phlegm; Dragon teeth, mother-of-pearl and magnets can soothe nerves.
Add and subtract with syndrome:
Insomnia with chest tightness, belching, abdominal distension, uncomfortable stool, greasy fur and slippery pulse, add Banxia glutinous rice soup to strengthen the spleen and nourish the stomach and communicate yin and yang;
Diet stagnation, disharmony in the stomach, sour taste, abdominal distension and pain, add medicated leaven, burnt hawthorn, radish seed, or Baohe pill to eliminate middle warmer.
For those with excessive phlegm heat, phlegm fire disturbing the mind, insomnia all night and constipation, Jieshi Guntan Pill can be used to purge fire and eliminate phlegm.
Third, deficiency of both heart and spleen.
Symptoms: insomnia and dreaminess, palpitation and forgetfulness, listlessness, dizziness, weakness of limbs, abdominal distension and loose stool, pale face, pale tongue with thin coating and weak pulse.
Summary of syndrome mechanism: spleen deficiency and blood deficiency, mental dystrophy and restlessness.
Treatment: tonify the heart and spleen, nourish blood and soothe the nerves.
Representative: Guipi Decoction.
This prescription is suitable for insomnia, forgetfulness, palpitation, yellow complexion and anorexia.
Commonly used drugs: Ginseng, fried atractylodes, Radix Glycyrrhizae Preparata, Radix Astragali and Radix Angelicae Sinensis; Polygala tenuifolia, Ziziphus Spinosae Semen, Poria and Arillus Longan nourish the heart, strengthen the spleen and soothe the nerves; Radix aucklandiae promotes qi and strengthens the spleen.
Add and subtract with syndrome:
For patients with severe insomnia, add Fructus Schisandrae, Caulis Polygoni Multiflori and Semen Platycladi to nourish the heart and soothe the nerves, or add Os Draconis, Concha Ostreae and amber powder to calm the nerves;
If the blood is insufficient, add Radix Rehmanniae Preparata, Radix Paeoniae and Colla Corii Asini to nourish the blood;
If you feel dull at the same time, you should reuse Atractylodes Macrocephala, and add Atractylodes Macrocephala, Pinellia ternata, Pericarpium Citri Tangerinae and Poria to invigorate the spleen, eliminate dampness, regulate qi and resolve phlegm.
Fourth, the heart and kidney do not pay the card.
Symptoms: restlessness, difficulty sleeping, palpitation and dreaminess, dizziness and tinnitus, soreness of waist and knees, hot flashes and night sweats, upset and fever, dry throat and scanty body fluid, nocturnal emission in men, irregular menstruation in women, red tongue with little fur and rapid pulse.
Summary of syndrome mechanism: kidney water is insufficient, which can not support the heart, and heart fire is blazing, which can not be passed down to the kidney.
Treatment: nourishing yin and reducing fire, communicating heart and kidney.
Representative: Liuwei Dihuang Pill and Jiaotai Pill.
Nourishing yin and tonifying kidney is mainly used for kidney yin deficiency syndrome such as dizziness, tinnitus, soreness of waist and knees, hot flashes and night sweats; Clearing the heart and lowering the fire can be used for hyperactivity of the heart, such as irritability and dreaminess.
Commonly used drugs: Radix Rehmanniae Preparata, Fructus Corni and Rhizoma Dioscoreae nourish kidney yin; Alisma orientalis, Poria cocos, and Cortex Moutan clear fire; Coptis chinensis clearing heart and reducing fire; Cinnamon brings fire back to the original.
Add and subtract with syndrome:
If the heart yin is insufficient, Tianwang Buxin Dan can be used to nourish yin and blood, replenish the heart and soothe the nerves.
If yin and blood are insufficient and heart fire is excessive, Zhusha Anshen Pill can be used.
For those who are upset and stay up all night, add cinnabar, magnet, raw keel and dragon teeth to soothe the nerves.
Five, heart gallbladder qi deficiency syndrome
Symptoms: insomnia, nightmare, easy to wake up, easy to panic, restless all day, palpitation, spontaneous sweating, shortness of breath, fatigue, pale tongue and thready pulse.
Summary of syndrome mechanism: heart and gallbladder are weak and timid, mind is out of support, and mind is uneasy.
Treatment: Yiqi Zhen Jing, soothe the nerves.
Representatives: Anshen Zhi Ding Pill and Suanzaoren Decoction.
Supplementing qi and relieving spasm, calming the heart before, is suitable for insomnia, palpitation and shortness of breath caused by qi deficiency of heart and gallbladder and phlegm disturbing the heart; Nourishing blood in the rear, clearing away heat and removing annoyance, suitable for insomnia with yin deficiency and blood deficiency.
Commonly used drugs: Ginseng, Poria, and Radix Glycyrrhizae Preparata are beneficial to heart and gallbladder; Poria cocos, polygala tenuifolia, Draconis Draconis and Acorus gramineus are used for resolving phlegm, calming the heart and calming the nerves. Chuanxiong and Ziziphus jujuba seed regulate blood and nourish heart; Anemarrhena asphodeloides clearing away heat and vexation.
Add and subtract with syndrome:
For patients with heart and blood deficiency, palpitation and sweating, ginseng should be reused, and Radix Paeoniae Alba, Radix Angelicae Sinensis and Radix Astragali should be added to replenish qi and nourish blood.
If the wood does not dredge the soil, chest tightness, shortness of breath and abdominal distension are full, Radix Bupleuri, Rhizoma Cyperi, Pericarpium Citri Tangerinae, Rhizoma Dioscoreae and Atractylodis Macrocephalae are added to soothe the liver and strengthen the spleen;
If the palpitation is serious and disturbed, add raw keel, raw oyster and cinnabar to soothe the nerves.