Sleep including dreams

Sleep (including dreams)

Sleep refers to lying down on a mat and resting one’s head on a pillow. Dreaming, on the other hand, refers to the spirit returning to its home (1) and breathing returning to its roots (2). Conditions that prevent sleep are relatively rare in general diseases, but are common in blood-related conditions.

There are two main reasons for difficulty sleeping: gastrointestinal issues and lung problems.

For those with gastrointestinal issues, Yin deficiency allows pathogenic factors to invade Yang, leading to restlessness and inability to sleep. This aligns with the principle stated in the “Yang Ming Chapter” of the “Shang Han Lun”: “If there is slight fever and dizziness, one cannot sleep due to dry stool in the stomach.” In such cases, San Yi Cheng Qi Tang is recommended. If there is no dry stool but rather irritability and heat, use Zhu Ye Shi Gao Tang or Bai Hu Tang. If blood stasis is also involved, Yu Zhu San or Yu Nu Jian are recommended. Additionally, if there is retained food in the stomach causing bloating and discomfort, Yue Ju Wan supplemented with Shan Zha, Mai Ya, and Lai Fu Zi is advised. After all, the Yang Ming meridian is responsible for coordinating (4), balancing the stomach’s Qi, and restoring its normal function, which is essential for achieving good sleep.

For those with lung problems, the lungs act like a canopy, with leaves hanging down when standing and spreading out when lying down. When water enters the lungs, the face swells, coughing becomes severe, and breathing is labored. When lying down, the lung leaves lift up, allowing more Qi to rise, which makes coughing worse and prevents sleep. In such cases, Ting Li Da Zao Xie Fei Tang can be used to remove excess water, enabling better sleep. Alternatively, Er Chen Tang supplemented with Gan Jiang, Xi Xin, and Wu Wei Zi can also be used to regulate water intake and improve breathing. If the Qi is reversed and phlegm builds up, it is necessary to address both water and fire simultaneously. For cases with heavy phlegm, use Xiaohua Wan; for cases with excessive fire, use Gun Tan Wan; for moderate cases, use Er Chen Tang supplemented with Chai Hu, Gua Lou, Huang Qin, Xuan Fu Hua, Xing Ren, Ginger Juice, and Bamboo Sap to maintain balance. If there is no phlegm but the Qi is still rushing upward, the person may not cough during the day but will cough violently when lying down, with Qi unable to settle, leading to lung atrophy and leaf curling (5). The Qi continues to surge upward, causing constant coughing and choking. In such cases, use Qing Zao Jiu Fei Tang supplemented with Sheng Di Huang, Gua Lou Gen, Bai He, and Wu Wei Zi to calm the lungs, and add Zhong Lu Shi to stabilize the Qi. Moreover, since lung fluids originate in the kidneys, if kidney water cannot reach the upper burner, Qi will reverse and rush upward, making it impossible to sleep. In such cases, treatment should start from the kidneys: Liu Wei Wan supplemented with Shen Mai San, plus Niu Xi to guide Qi downward, and Ci Shi to attract metal Qi, bringing it back to its roots.

There are two main reasons for insomnia: heart disease and liver disease.

For those with heart disease, the heart houses the spirit, and when blood is deficient and fire acts erratically, the spirit becomes unsettled, leading to restlessness and insomnia. Zhong Jing’s Huang Lian A Jiao Tang is the primary remedy. For cases where Yin deficiency and phlegm disturb the spirit, use Zhu Ling Tang. One focuses on clearing fire, the other on regulating water. Since the spirit is disturbed by either phlegm or fire, I often use Zhu Sha An Shen Wan supplemented with Fu Ling and Amber, or Tian Wang Bu Xin Dan.

For those with liver disease, the liver houses the soul, and when people are awake (6), the soul wanders around the eyes, while when asleep, the soul returns to the liver. If Yang floats outward and the soul cannot enter the liver, one cannot sleep. The symptoms are not necessarily irritating; rather, it is a case of peaceful sleep (7) but inability to fall asleep. In such cases, it is necessary to restrain the Yang soul and guide it back to the liver. Two additions—Long Gu Tang supplemented with Wu Wei Zi, Zao Ren, and A Jiao—are recommended. Alternatively, if the liver meridian is filled with phlegm that disturbs the soul and prevents sleep, use Wen Dan Tang supplemented with Zao Ren. If the liver meridian is on fire, leading to frequent dreaming and difficulty sleeping, use Suan Zao Ren Tang, or use Hua Shi Bu Gan San to replace Du Huo with Ba Ji, and Si Wu Tang supplemented with Fa Xia, Zao Ren, Dong Chong Xia Cao, Long Gu, and Ye He Pi is also effective.

It should also be noted that although the soul is housed in the liver, during the day it wanders around the eyes, which are under the jurisdiction of the lungs and stomach. If the Qi of the lungs and stomach is disturbed and unstable, it can also push the soul outward, preventing it from returning. In such cases, use Sheng Di Huang, Bai He, Mai Dong, Zhi Mu, Zhi Ke, Wu Wei Zi, Bai Shao, Gan Cao, Zao Ren, Tian Hua Fen, Fu Ling, and Ren Shen Qing Fei Tang to address the issue. Additionally, there are cases of palpitations and fear that prevent sleep, which can be treated with Ren Shu San. For those who think about things all night and cannot sleep, Gui Pi Tang supplemented with Wu Wei Zi is recommended. For more details, refer to the sections on palpitations and anxiety.

There are also cases of deep sleep and excessive drowsiness. In general diseases, this is often caused by pathogenic factors invading the Yin level; in blood-related conditions, however, it is often due to exhaustion after blood loss, leaving the body with insufficient Qi. In such cases, symptoms like sweating and shortness of breath indicate a critical condition, requiring immediate intervention with Shen Fu Tang. Since wakefulness belongs to Yang, lack of wakefulness indicates Yang deficiency, and Ren Shen Yang Rong Tang is also recommended. If the body feels heavy and sleepy, it is likely due to dampness in the spleen meridian. In such cases, Ping Wei San supplemented with Zhu Ling and Ze Xie is recommended, as well as Liu Jun Zi Tang supplemented with Fang Ji and Yi Yi Ren, and Bu Zhong Yi Qi Tang is also effective. This discussion on excessive sleep mainly focuses on Yang deficiency, but there are also cases where the gallbladder meridian is on fire, leading to excessive drowsiness. In such cases, Long Dan Xie Gan Tang is recommended.

Dreams are the manifestation of the soul and spirit (8), reflecting what the soul perceives. If the soul is ill, dreams may involve women, flowers, deities, or joyful events, which can be treated with Suan Zao Ren Tang. If the spirit is ill, dreams may involve strange creatures, ghosts, or conflicts, which can be treated with Ren Shen Qing Fei Tang supplemented with Amber. What is seen in dreams is determined by the nature of the soul and spirit: good souls tend to dream good things, while bad souls tend to dream bad things. However, since the soul and spirit govern the mind and emotions, calming the spirit is key to treating dreams. Yi Qi An Shen Tang is recommended for this purpose. Additionally, if worms cause dreams, treat them according to the rules for dealing with worms. If dreams involve nocturnal emissions, refer to the section on nocturnal emissions.

Furthermore, if one prefers darkness to light when sleeping, it indicates the presence of fire-related pathogenic factors. If one cannot turn over while lying on their side, it suggests that the Shaoyang meridian is not functioning properly. For those who lie on one side, refer to the section on coughing.

[Note] (1) Spirit returning to its home: Under normal physiological conditions, after deep sleep, the heart’s Qi stabilizes and the spirit rests. According to the “Ling Shu · Xie Ke Pian,” “The heart is… the place where the spirit resides.” (2) Breathing returning to its roots: The kidneys can absorb Qi, allowing for calm and steady breathing. “Xi” is another term for breathing. According to the “Nan Jing,” the “Ming Men” is “the gateway of breathing” and “the root of the twelve meridians.” (3) Shortness of breath: “Chuan” refers to wheezing, while “Mao” refers to dizziness. (4) Yang Ming governing: According to the “Su Wen · Yin Yang Li He Lun,” “Yang Ming is the governing meridian.” Zhang Zhongjing said, “Yang Ming is the governing meridian, meaning that Yang Qi is stored internally and serves as the inner core of the three Yang meridians.” (5) Leaf curling: Refers to the lung leaves losing their natural droop. (6) Wakefulness: Being awake. (7) Peaceful sleep: Not being restless and having a calm mind. (8) Soul and spirit: According to the “Su Wen · Xuan Ming Wu Qi Pian,” “The lungs house the spirit,” and “The liver houses the soul.” Soul and spirit refer to functions related to emotions, mental states, sensations, and movement.

[Commentary] This section discusses the pathogenesis and treatment of conditions that prevent sleep and cause insomnia. Drawing on the “Shang Han Lun” passage, “When there is slight fever and dizziness, one cannot sleep due to dry stool in the stomach,” the author argues that gastrointestinal issues are often the root cause of sleeplessness. Similarly, citing the “Jin Gui Yao Lue” passage, “When there is fluid retention and difficulty breathing, Ting Li Da Zao Xie Fei Tang is the primary remedy,” the author contends that lung problems are also a major factor. For gastrointestinal issues, only cases with mild heat are suitable for Bai Hu Tang or Zhu Ye Shi Gao Tang; for those with retained food in the stomach, Yue Ju Wan is recommended. For lung problems, cases involving both fire and phlegm are best treated with Xiaohua Wan or Gun Tan Wan; for those with severe nighttime coughing and choking, Qing Zao Jiu Fei Tang is recommended; for cases where kidney water cannot reach the upper burner and Qi rushes upward, Liu Wei Wan with modifications is advised.

Regarding insomnia, the author bases the classification on the concepts of “the heart housing the spirit” and “the liver housing the soul,” dividing it into heart-related insomnia and liver-related insomnia. Heart-related insomnia includes cases where blood deficiency and fire activity disrupt the spirit, requiring Huang Lian A Jiao Tang; there are also cases where Yin deficiency and phlegm disturb the spirit, calling for Zhu Ling Tang; and for cases combining phlegm and heat, Zhu Sha An Shen Wan or Tian Wang Bu Xin Dan can be used with adjustments. Liver-related insomnia includes cases where liver Yang floats outward and the person sleeps peacefully without being bothered by anything, which can be treated with Er Jia Long Gu Tang; there are also cases where phlegm disturbs the liver’s soul, requiring Wen Dan Tang; and for cases where the liver meridian is on fire, Suan Zao Ren Tang or Hua Shi Bu Gan San are recommended. Furthermore, since the soul “wanders around the eyes during the day,” and the eyes are under the jurisdiction of the lungs and stomach, insomnia can also be treated with Ren Shen Qing Fei Tang or Gui Pi Tang supplemented with Sheng Di, Bai He, Mai Dong, Zhi Mu, Wu Wei Zi, and other herbs. This discussion on sleep and insomnia is quite detailed, with many of the prescribed formulas proving clinically effective. However, the discussion on dreams still cannot completely escape metaphysical constraints. For example, statements like “If the soul is ill, dreams may involve women, flowers, deities, or joyful events,” and “If the spirit is ill, dreams may involve strange creatures, ghosts, or conflicts” carry a certain idealistic tint.