Insomnia: a special prescription and medicine, based on the six meridians, has a good effect.
To sum up, insomnia is mainly divided into three aspects: difficulty in falling asleep, early awakening and shallow sleep.
The difficulty in falling asleep is mainly fire, which can be divided into two types: virtual fire and real fire, and can also be mixed with reality. Excess fire is mostly manifested in shaoyang and Yangming, while deficiency fire is mostly manifested in deficiency of kidney essence, and Lei Long fire cannot be hidden. Therefore, the treatment should be based on shaoyin.
Shallow sleep is mainly manifested in Jue yin, which is more common with cold and heat inclusions.
Looking at the treatment of insomnia in modern Chinese medicine, most of them take regulating the liver as the first priority.
Those who are biased towards reality, those who are depressed by liver-qi often choose Sinisan and Xiaoyao San;
Chai Qinwen and Tang Dan are often used for patients with gallbladder deficiency and heat depression;
For patients with stomach disharmony, Baohe Pill, Banxia Xiexin Decoction and Banxia Zaomi Decoction are often used, in which the usual dosage of Banxia is 30g, some are 60g, and common glutinous rice is 30g;
Pure deficiency, Ganmai jujube soup plus polygala tenuifolia and lily;
For patients with deficiency of both liver and blood, Ziziphus jujuba seed decoction is often used.
Clinically, some of these prescriptions are effective and some are ineffective, especially for patients with severe insomnia such as cold and heat, phlegm and blood stasis, which are difficult to achieve by using the above treatment methods alone.
First of all, we should understand the etiology and pathogenesis of insomnia, so as to handle more complicated clinical problems with ease.
People should be in sync with the sun and the moon, which is the natural way of yin and yang.
Walk in the dark night and sleep in the victory.
During the day, the defensive qi is normal and the yang is sufficient, so it is prosperous.
In other words, during the day, the yang is relatively strong and the spirit is relatively strong. This is the norm.
Sleep is like the relationship between egg yolk and egg white. At night, the yolk must go to protein, which is called balance and harmony.
Egg yolks must hatch during the day, so we get up in the morning, full of yang and full of energy.
In other words, Yang must come from Yin during the day and enter Yin at night.
If the pathogenic factors are in the five internal organs, then the way of yin and yang entering and leaving is blocked, and the egg yolk can't belong to the egg white at night, and the yang is alone, and the yin is lost. I can't sleep when I am excited.
In addition, pathological products such as phlegm and blood stasis will also block the intersection of yin and yang, making yin unable to embrace yang.
Judging from the lesion site, insomnia is mainly related to heart, kidney, liver and spleen.
The relationship between five internal organs, heart and kidney under physiological conditions: heart fire, yang also, yang rooted in exercise;
Kidney water, yin is also, yin is also rooted in silence.
Heart yang wants to rise, yin attacks from below, gloomy yang leads, yin essence can't help, water rises and fire falls, becoming a good divination.
In this way, the heart fire helps the economy, the kidney water rises, the middle earth is blessed, and the liver pulse is unobstructed, showing a good image of holding yang in the yin.
If the heart and kidney are out of harmony, the heart yang rises and the kidney water drops, and Yang Can cannot be hidden, then there will be abnormal sleep.
I usually treat insomnia based on six meridians syndrome differentiation, and the effect is quite good.
Syndrome differentiation and classification
(A) Shaoyang Yangming disease
Shao Yangyang's clinical manifestations are insomnia, mainly difficulty in falling asleep, accompanied by dry mouth, bitter or thirsty mouth, sticky stool, yellow and greasy tongue coating and slippery pulse. The treatment was Xiaochaihu decoction plus Wendan decoction combined with Ziziphus jujuba seed decoction.
In addition, there are four special prescriptions that should be grasped accurately.
1. Chaihu plus Gulong Oyster Decoction Syndrome
The syndrome of Chaihu plus Gulong oyster soup can be understood as follows: shaoyang is the foundation. Under normal physiological conditions, opening yang and lowering Yangming can restore the physiological function of opening and closing axis.
This prescription mainly treats shaoyang with Bupleurum, Scutellaria baicalensis and Pinellia ternata, Guizhi mainly promotes yang, and rhubarb mainly reduces Yangming.
This kind of patients have many symptoms, generally manifested as alternating excitement and inhibition, sometimes talking a lot, sometimes not talking, easy to get angry, and often have mental symptoms such as headache, dizziness, insomnia and irritability.
It is often accompanied by cardiovascular symptoms, such as chest tightness and palpitation;
At the same time, it is often accompanied by stomach symptoms, stomach pain or bloating, tenderness under the hypochondriac is more obvious, and digestive system symptoms are more obvious.
Judging from the quality of the tongue, the tip of the tongue is red and the coating is thick and greasy.
The pulse condition is mostly string-shaped, or left astringent and right slippery, or left slippery and right weak.
Clinically, it is not very effective to treat insomnia with Chaihu plus Gulong Muli Decoction alone, but it is faster to use Banxia Xiexin Decoction in combination.
In addition, Radix Aconiti Lateralis Preparata and Cortex Cinnamomi can be added for those with yang deficiency, lumbago and fear of cold.
People with blood deficiency and excessive water, manifested as lower limb pain or abdominal pain, can take Danggui Shaoyao powder.
2. Syndrome of Longdan Xiegan Decoction
Everyone is familiar with Longdan Xiegan Decoction, especially dermatology. Acute eczema or scrotal eczema is very useful.
I often use this prescription to treat insomnia, but I need to grasp several diagnostic points:
① Dry mouth and bitter taste;
2 scrotum is wet, and the body or lower limbs often sweat;
③ The tongue coating is yellow and greasy, and the pulse is slippery.
3. In Treatise on Febrile Diseases, Zhang Zhongjing repeatedly described Taohe Chengqi Decoction combined with Zhu Fei Decoction and Xuefu Zhuyu Decoction as clinical symptoms such as madness, madness, etc., and three methods can be used for those who are frightened by excess syndrome.
Wang Qingren also mentioned in "Correcting Mistakes in Lin Yi" that if you don't sleep at night, the method of calming the nerves and nourishing blood is ineffective, which is a miracle.
The brain and intestine are inseparable. Sometimes the stool is dry and the tongue is black. We will basically consider blood stasis, first have loose bowels and have a little bowel movement, so that our minds will be refreshed and we will soon fall asleep.
If the pulse condition is firm, you can have a diarrhea first, take a few doses to see the situation, and then adjust according to the pulse condition later.
Therefore, for blood stasis syndrome, I often use Xuefu Zhuyu decoction, Zhu Fei decoction and Taohe Chengqi decoction together. According to the situation of stool, I can increase the dosage with proper amount of rhubarb and mirabilite, depending on how many times the patient has diarrhea.
4. Ji Fang Dihuang Decoction Syndrome
Ji Fang Dihuang Decoction comes from Stroke Syndrome and Pulse Syndrome: "Treating diseases like madness, acting rashly, talking alone, without cold and heat, and floating pulse."
The prescription consists of five herbs: Radix Stephaniae Tetrandrae, Ramulus Cinnamomi, Radix Saposhnikoviae, Radix Glycyrrhizae and Radix Rehmanniae.
Judging from the ingredients of the prescription, they are all vegetarian drugs, and the products that soothe the nerves are useless, but I realize that this prescription really has the miraculous effect of calming the nerves in clinic.
Judging from the symptoms, the patient's madness is not madness, but his madness and monologue are mental symptoms;
There is no cold and heat, and the pulse is floating without exogenous factors, which belongs to internal wind. My understanding is that the next yuan loses money and the wind floats.
Therefore, rehmannia glutinosa is reused to replenish the next yuan, replenish the exhaustion of the three yin, and strong water dominates the sun;
Compatibility with Ramulus Cinnamomi, dredging blood vessels and preventing spontaneous descent; The windbreak forest is accessible, with up-and-down traffic and shallow veins floating.
For this prescription, I mainly use it to treat patients who can't sleep during the day and night, that is, they can't sleep all night. I often use it with Banxia Xiexin Decoction or Wendan Decoction.
In addition, this prescription has special effects in treating depression, especially if the syndrome differentiation is accurate.
Clinically, I also use it to treat hormone-dependent dermatitis, mainly manifested as burning skin, mania and irritability, insomnia, especially suitable for people who can't sleep at night. Basically, this prescription is mainly used, and 60 ~ 90g of Radix Rehmanniae is used, and the effect is quick.
(II) Deficiency of Yin and Yang
Early awakening is the main feature of this type, accompanied by backache and fatigue, cold limbs, pale tongue and often fat. The pulse is two inches visible and two feet heavy and thin.
Yinhuo decoction combined with fengsui qianyangdan for treatment.
In my experience, the reuse of Radix Rehmanniae Preparata 60 ~ 120 g, together with Amomum villosum, Carapax et Plastrum Testudinis and Cortex Phellodendri, can hide floating fire, and has a particularly good effect on insomnia caused by heart-kidney disharmony and deficiency.
According to the situation of tongue coating, Banxia Xiexin Decoction can be used if there is phlegm-dampness, and Gui Ling Zhugan Decoction can be used if there are teeth marks on the tongue, all of which have very obvious effects.
(III) Syncope cold-heat syndrome
The clinical manifestations of this type are shallow sleep, lethargy, waking up with a little movement, or waking up regularly at 1 ~ 2 in the morning, and it is difficult to fall asleep after waking up, and it is easy to panic, accompanied by backache, cold lower limbs, constipation, fat tongue, tooth marks and weak left pulse.
Jueyin disease is treated with Wu Mei Pills, Os Draconis and Oysters.
The dosage of Cortex Phellodendri is generally 3-5g according to the gastrointestinal condition.
If the stomach is good or the dry mouth is obvious, you can also reuse Phellodendron amurense and gypsum for treatment.
Grasping the left tip of the tongue with red tongue, thick and greasy tongue coating and weak pulse condition, we can boldly use Wu Mei Pill, and the curative effect is very remarkable.
Case Collection Case 1 Shen, female, 49 years old.
Current medical history: poor sleep for more than 2 years, MUBI, woke up at 2 ~ 3 o'clock at night, with fatigue, dry mouth, fat tongue with teeth marks, weak left pulse and weak right pulse.
Syndrome differentiation: Jueyin disease.
Treatment: Warming and nourishing liver yang, clearing up the upper part and warming the lower part.
Prescription: Jiawei Wu Mei Pill. Mume 10g, Asarum 3g, Cinnamomum cassia 3g, Coptidis Rhizoma 6g, Cortex Phellodendri 6g, Angelica sinensis 10g, Ginseng Rubra 10g, Zingiberis Rhizoma 3g, Radix Aconiti lateralis Preparata 5g, Glycyrrhiza uralensis 10g, Semen Ziziphi Spinosae 20g, Rhizoma Corydalis 10g and Os Draconis 30g. 15 dose.
Press: Add and subtract Wu Mei Pill, add Semen Ziziphi Spinosae, Rhizoma Corydalis, Os Draconis and Concha Ostreae, and the patient will recover in more than one month.
Case 2: Jiang, female, 48 years old.
Current medical history: difficulty in falling asleep 1 year or more, taking 3 sleeping pills every night, only sleeping for 3 hours, accompanied by dizziness, dry mouth and bitter taste, pale tongue with white fur, weak pulse in left inch and weak pulse in right inch.
Syndrome differentiation: blood deficiency and wind dryness.
Treatment: nourishing blood and expelling wind.
Prescription: Ji Fang Dihuang Decoction.
5 grams of Radix Stephaniae Tetrandrae, 0/0g of Ramulus Cinnamomi/kloc-,0/0g of Radix Saposhnikoviae/kloc-,50g of Radix Rehmanniae, 24g of Radix Ginseng Rubra/kloc-,24g of Semen Ziziphi Spinosae, 0/0g of Rhizoma Corydalis/kloc-,20g of Caulis Spatholobi, 30g of Caulis Polygoni Multiflori, 6g of Radix Glycyrrhizae, 6g of Rhizoma Coptidis and 3 of Cortex Cinnamomi. 15 dose.
Press: When adding or subtracting Dihuang Decoction, Spatholobus suberectus, Rhizoma Corydalis, Caulis Polygoni Multiflori, Rhizoma Coptidis, Cortex Cinnamomi, Radix Gentianae, Os Draconis and Concha Ostreae are added, and the curative effect is better.
Case 3: Current medical history: poor sleep 1 year or more, shallow sleep, waking up at 4 o'clock every morning, accompanied by dizziness, alopecia, dry mouth, dry stool, pale and fat tongue, white fur and weak pulse in both feet.
Syndrome Differentiation: Yin deficiency and essence deficiency.
Treatment: tonify kidney and deficiency.
Prescription: Yinhuo decoction combined with Fontainebleau.
Radix Rehmanniae Preparata 90g, Cortex Cinnamomi 3g, Radix Asparagi 10g, Radix Ophiopogonis 10g, Fructus Lycii 10g, Semen Cuscutae 10g, Poria 10g, Fructus Amomi 10g, and Plastrum Testudinis/kloc-0.
After taking 75 doses of this prescription, sleep returned to normal.
Press: Deficiency of kidney essence can easily lead to deficiency fire, which is manifested as early awakening.
It is the key to use Yin Huo Tang to tonify kidney essence and reuse Radix Rehmanniae Preparata.
clinical experience
1. Ziziphus jujuba seed
For Ziziphus jujuba seeds, many doctors have suggested using 60g, and if not, using 120g can really achieve a certain sedative effect.
But if we don't remove the cause, we can't solve the fundamental problem. Semen Ziziphi Spinosae is generally mixed with Rhizoma Corydalis, with the ratio of Semen Ziziphi Spinosae 20g Rhizoma Corydalis 10g, which is the usual dosage.
On this basis, Radix Polygoni Multiflori and Caulis Spatholobi are added, generally 30-60g of Radix Polygoni Multiflori and 20g of Caulis Spatholobi. These four herbs are combined to treat deficiency syndrome and insomnia.
Ziziphus jujuba seed is not particularly used for demonstration, and Gardenia can be used.
I think the dosage of Ziziphus jujuba seed should be small. I usually start with 10g, and the first consultation is 10g. If not, the second consultation can be increased to 24g, which is my maximum dosage.
Generally, it does not exceed 24g, and the curative effect is very good.
2. Pinellia and Prunella vulgaris
Pinellia ternata 15~20g, Prunella vulgaris 15 ~ 20g.
This pair of medicine belongs to the treatment of phlegm-dampness. Thick and greasy tongue coating and phlegm dampness can be used. If there is no phlegm, don't use it.
3. Lilium perillae
Lily flowers bloom at night and perilla leaves droop at dusk, both of which can attract yang into yin by feeling the opening and closing of heaven and earth.
Clinically, I usually use lily 20 ~ 30g and perilla leaf 10g to clean the tongue coating.
4. Acacia flower cicada clothing
Albizia Albizia flower with cicada clothing is generally used for menopausal insomnia. Generally, 10 ~ 15g is used for Albizia Albizia, and 20 ~ 30g can be used for cicada slough, which has a good calming effect. .