Insomnia, the name of TCM disease. This is a disease characterized by frequent lack of normal sleep. Most of them are caused by emotional injury, improper diet, disorder of work and rest, chronic illness and physical weakness. , leading to visceral dysfunction, qi and blood disharmony, yin and yang imbalance, yang qi does not enter yin. The location of the disease is mainly in the heart, involving the liver, gallbladder, spleen, stomach and kidney, with deficiency and excess. The treatment is based on the principle of tonifying deficiency and purging excess, and regulating viscera and yin and yang.

The relationship between insomnia and the names of diseases in western medicine

When insomnia is the main clinical manifestation of neurosis, climacteric syndrome, chronic dyspepsia, anemia and atherosclerosis in western medicine, we can refer to this article for syndrome differentiation and treatment.

Mainly manifested in the lack of sleep time and depth, which often affects people's normal work, life, study and health.

The development of history

1. Neijing called insomnia "not lying" and "not satisfied".

2. "Su Wen's Theory of Inverse Tone" records that "stomach disharmony leads to anxiety"

3. Treatise on Febrile Diseases and Synopsis of the Golden Chamber think that the causes can be divided into two categories: exogenous and internal injuries, and put forward the argument that "fatigue can't sleep".

4. The pathogenesis of insomnia can be summarized into two types: evil and innocence.

5. Li Mingzhongzi proposed: "There are probably five reasons for insomnia: one is qi deficiency, the other is yin deficiency, the third is phlegm and blood stasis, the fourth is water cessation, and the fifth is stomach disharmony."

6. Dai Yuanli's "Essentials of Syndrome Treatment" also put forward the theory that "the elderly are senile and sleepless".

The cause of disease

1. Emotional disorders, emotions, joys and sorrows, etc. Will lead to visceral dysfunction, leading to insomnia. Or because of emotional frustration, liver qi stagnation, liver qi stagnation into fire, evil fire disturbing the mind, restless and sleepless. Or from the five ambitions to the extreme, the heart is blazing, and the heart can't sleep. Or from laughter, excitement, ecstasy, insomnia; Or by sudden panic, leading to guilty conscience, fear, insomnia at night.

2. Overeating, food stagnation, damage to the spleen and stomach, phlegm-heat brewing, depression in the middle, phlegm-heat disturbing people, and disharmony between stomach and qi can all cause insomnia. In addition, strong tea, coffee, wine and other drinks are also factors leading to insomnia.

3. Excessive fatigue due to imbalance of work and rest will damage the spleen, and too much leisure and insufficient exercise will also lead to spleen deficiency and weak qi, poor transport, passive blood and biochemistry, which can not be presented in the heart, resulting in mental malnutrition and insomnia. Or because of excessive thinking, sad spleen, heart injury and yin consumption, distracted; Spleen injury leads to loss of appetite, lack of biochemical sources, insufficient blood, loss of heart support and anxiety.

4. Long-term physical weakness after illness, blood deficiency in the elderly, resulting in lack of qi and blood, loss of support, anxiety and insomnia. As "The Complete Book of Pure Moon Insomnia" said: "Those who are innocent and sleepless will have qi deficiency, while those who are guilty will be upset." It can also be caused by old age, weakness of both yin and yang, and insomnia. The pathogenesis of insomnia is mainly in the heart, which is related to the liver, spleen and kidney. The basic pathogenesis is yang excess and yin deficiency, and yin and yang are blocked. One is that yin deficiency cannot absorb yang, and the other is that yang excess cannot enter yin. Pathology has two sides: liver depression turns into fire, phlegm-heat interferes internally, and mental anxiety is the truth; Deficiency of both heart and spleen, qi deficiency of heart and gallbladder, disharmony between heart and kidney, and lack of mind, but chronic illness can be manifested as deficiency or excess, or caused by blood stasis. Diagnostic points and diagnostic basis

1. Lighter people have difficulty falling asleep or wake up easily after falling asleep. I can't sleep for more than 3 weeks after waking up, and in severe cases I can't sleep all night.

2. It is often accompanied by symptoms such as headache, dizziness, palpitation, forgetfulness, mental fatigue, fidgeting and dreaminess.

3. This disease often has a history of improper diet, emotional disorder, fatigue, overthinking and physical weakness after illness. Insomnia should be differentiated from insomnia caused by transient insomnia, physiological insomnia and other diseases. Insomnia is characterized by simple insomnia and persistence. Severe sleep difficulties. Temporary insomnia caused by temporary changes in temperament or living environment is not pathological. As for the elderly, sleeping less and waking up early are mostly physiological. If insomnia is caused by other diseases, it should be based on excluding related diseases.

Related examination can be clinical polysomnography: 1. The average sleep latency is prolonged; 2. Measurement of actual sleep time reduction;

3. Measure the increase of awakening time. Key points of syndrome differentiation and treatment This disease can be divided into deficiency and excess.

Deficiency syndrome is mostly caused by deficiency of yin and blood, which is characterized by weak constitution, dull complexion, listlessness, palpitation and forgetfulness.

The syndrome is pathogenic heat disturbing the heart, and its clinical characteristics are upset and irritable, bitter mouth and dry throat, constipation and redness.

Disease differentiation and localization

The main site of the disease is the heart. Insomnia caused by mental malnutrition or anxiety is related to liver, gallbladder, spleen, stomach and kidney. If you are restless and insomnia, it is mostly disturbed by anger; Stomach stuffy greasy fur, insomnia, mostly due to food in the stomach, phlegm and heat inside; Upset, palpitation, dizziness, forgetfulness, insomnia, mostly due to yin deficiency and excessive fire, heart and kidney do not pay; Hua Shao complexion, fatigue and weakness of limbs, mostly spleen deficiency and malnutrition; Upset, insomnia, easy to be shocked, mostly due to qi deficiency of heart and gallbladder.

Principles of treatment

Treatment should be based on the principle of tonifying deficiency and purging excess, and regulating yin and yang of viscera. Excess syndrome can eliminate excess syndrome, such as soothing the liver and purging fire, resolving phlegm and clearing heat, eliminating pathogenic factors and harmonizing middle energizer; Deficiency syndrome can make up for its deficiency, such as invigorating qi and nourishing blood, invigorating spleen and nourishing liver and kidney. On the basis of purging excess and tonifying deficiency, soothe the nerves, such as nourishing blood to soothe the nerves, calming the heart and calming the nerves, clearing the heart and calming the nerves.

Syndrome classification and treatment

1. Symptoms of liver fire disturbing the heart: insomnia, dreaminess, even staying up all night, impatience and irritability, accompanied by dizziness, bloating, red eyes and tinnitus, dry mouth and bitter taste, loss of appetite, constipation and redness, yellow tongue coating and rapid pulse. Treatment: soothing the liver and purging fire, calming the heart and calming the nerves. Prescription: Longdan Xiegan Decoction. Commonly used drugs: Radix Gentianae, Scutellariae Radix, Fructus Gardeniae, Alismatis Rhizoma, Semen Plantaginis, Radix Angelicae Sinensis, Radix Rehmanniae, Bupleuri Radix, Glycyrrhrizae Radix, Os Draconis, Concha Ostreae and Magnetite.

2. Symptoms of phlegm-heat disturbing the heart: upset and insomnia, chest tightness and fullness, nausea and belching, bitter taste, heavy head, dizziness, red tongue, yellow and greasy fur and slippery pulse. Treatment: clearing away heat and resolving phlegm, calming the nerves. Prescription: Huanglian Wendan Decoction. Commonly used drugs: Pinellia ternata, Pericarpium Citri Tangerinae, Poria, Fructus Aurantii Immaturus, Coptidis Rhizoma, Zhuru, Dragon's Tooth, Mother of Pearl and Magnetite.

3. Symptoms of deficiency of both heart and spleen: difficulty in falling asleep, dreaminess, palpitation and forgetfulness, mental fatigue, lack of food and dizziness, weakness of limbs, abdominal distension and loose stool, pale face, thin tongue coating and thready pulse. Treatment: tonify the heart and spleen, nourish blood and soothe the nerves. Prescription: Guipi Decoction. Commonly used drugs: ginseng, Atractylodes macrocephala, licorice, angelica, astragalus, polygala tenuifolia, Ziziphus jujuba seed, Poria, longan pulp and radix aucklandiae.

4. Symptoms of heart-kidney disharmony: restless sleep, difficulty in falling asleep, palpitation and dreaminess, dizziness and tinnitus, soreness of waist and knees, hot flashes and night sweats, vexation and fever, dry throat and scanty body fluid, nocturnal emission in men, irregular menstruation in women, red tongue with little coating, and rapid pulse. Treatment: nourishing yin and reducing fire, communicating heart and kidney. Prescription: Liuwei Dihuang Pill plus Jiaotai Pill. Commonly used drugs: Radix Rehmanniae Preparata, Fructus Corni, Rhizoma Dioscoreae, Rhizoma Alismatis, Poria, Cortex Moutan, Rhizoma Coptidis and Cortex Cinnamomi.

5. Symptoms of qi deficiency of heart and gallbladder: insomnia, anxiety, palpitation, shortness of breath, spontaneous sweating, fatigue, pale tongue and thready pulse. Treatment: Yiqi Zhen Jing, soothe the nerves. Prescription: Anshen Zhi Ding Pill and Suanzaoren Decoction. Commonly used drugs: Ginseng, Poria, Glycyrrhrizae Radix, Poria, Polygalae Radix, Sanguis Draxonis, Rhizoma Acori Graminei, Rhizoma Chuanxiong, Semen Ziziphi Spinosae and Rhizoma Anemarrhenae.

For other therapies, 9 grams of Evodia rutaecarpa was applied to acupoints, and appropriate amount of rice vinegar was used. After mashing the medicine, make it into a paste with vinegar. Apply it to Yongquan point in the center of your feet and take it off after 24 hours.

needle therapy

(1) Body acupuncture: acupuncture at Shenmen and Sanyinjiao points. Xin Shu, Jue Yin Shu and Pi Shu can be added for patients with deficiency of both heart and spleen; Shenshu, Shenshu and Taixi points are selected for patients with kidney deficiency; For those who are restless with liver fire, choose Jiaganshu, Intermittent Period and Taichong; If the spleen and stomach are not in harmony, choose Jiawei Shu and Zusanli. Acupuncture is used to tonify deficiency and stop diarrhea, or both acupuncture and moxibustion are used.

(2) Ear acupuncture: The acupoints are subcortical, sympathetic, heart, spleen, kidney, endocrine and Shenmen. Choose 2-3 acupoints at a time, moderately stimulate strongly, and leave the needle for 20 minutes.

prognosis

The prognosis of this disease is generally good. However, due to different conditions, the prognosis is also different. The course of disease is short, the condition is simple, the treatment effect is quick, the course of disease is long, and the condition is complex, so it is difficult to get quick results. Moreover, if the cause is not removed or not handled properly, the condition will be more complicated and the treatment difficulty will increase.

Preventive nursing

This disease belongs to mental disorder, so paying attention to psychological adjustment and sleep hygiene has practical preventive significance for insomnia patients. Actively carry out psychological and emotional adjustment, overcome excessive tension, excitement, anxiety, depression, panic, anger and other negative emotions, achieve moderate emotions, maintain spiritual comfort, try to treat it with a relaxed and natural attitude, and make sleep better. Help patients to establish a regular work and rest system and engage in appropriate physical activities or physical fitness activities. Develop good sleep habits, light dinner, don't be too full, avoid strong tea, coffee and smoking, avoid engaging in exciting activities before going to bed, and form the habit of going to bed regularly. In addition, we should pay attention to the quiet sleeping environment, comfortable beds, soft lighting in the bedroom, reduce noise and eliminate all kinds of external factors that may affect sleep.