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Concept of sleeping disorder in Traditional Chinese Medicine
Sleep is a normal physiological activity of a human being as well as other spicies in purpose of helping the body to rest and recover after working hours. In average, a normal adult sleeps from 7-8 hours per day. A good leep need to satisfy sufficient time, good quality and the person should feel good after sleeping.
Insomnia or poor sleep quality is a common sleep disorder. It may include difficulty to get to sleep, intermittent sleep, shallow sleep and frequent dreaming, easy to wake up, early wake up in the morning, and tiredness after sleep.
This condition had been mentioned in some Classics of Traditional Chinese Medicine with some different names, but the most popular one is Thất Miên (or Shi Mian in Chinese), which means Lack of sleeping.
Physiology of sleep according to Traditional Chinese Medicine
In chapter Wei Qi Xing (Which means The circulation of Protective Qi) of The Classic Ling Shu, it’d been stated that: “The time from 5 AM to 5 PM belongs to Yang, the time from 5 PM to 5 PM belongs to Yin. In the time of a day and night, Protective Qi circulates 50 cycles around the body. In day time, it circulates in the Yang part of the body, in night time, it circulates in the Yin part and the internal organs. At early morning, Protective Qi finishes its circulation in the Yin part and emerges from the eyes, the eyes thus open. At night, Protective Qi circulates in the Yin part and the internal organs in the following order: Kidney --> Heart --> Lung --> Liver --> Spleen --> Kidney. The amount of cycles that Wei Qi completes in the Yang part is the same with the amount of cycles that it does in the Yin part and is 25 cycles.”
In chapter Ying Wei Sheng Hui (Which means The generation and meeting of Nutritive Qi and Protective Qi) of The Classic Ling Shu, it’d been stated that: “At night, Protective Qi circulates 25 rounds in the internal organs, at day time, it circulates 25 rounds in the Yang meridians, thus we have night and day. When Wei Qi is in the Yang part, we are awake for activities; when Protective Qi is in the Yin part, we sleep. At midnight, Yin energy reaches its peak; after that, it decreases and is in its terminal at dawn; this is when Yang energy arises and grows up. At noon, Yang energy reaches its peak and decreases when it turns to sunset. At midnight, Nutritive Qi and Protective Qi meet each other, the person is sleeping for the restoring and nourishment of the body. At dawn, Protective Qi leaves the Yin part to the Yang part to supply ernegy for more active activities. This autonomic process of human body mimics the basic movement of the Nature or Universe.”
So the awake-sleeping statuses of human as well as every spicies on Earth is a presentation of Yin-Yang rule. They represent active and static situations, external and internal activities, consumption and preservation,… This is harmonious to the rhythm of the Universe and thus we can maintain our lives and healthy body and mind.
The pathogenic mechanism of sleeping disorder in traditional Chinese medicine
According to TCM, there are two main situations that cause sleeping disorder, which are the insuffient situation and the excessive situation.
Chapter Ying Wei Sheng Hui (Which means The generation and meeting of Nutritive Qi and Protective Qi) of The Classic Ling Shu stated that: “Young people have abundant of Qi and Blood, strong muscles, clear and smooth Qi pathways, effective Qi and Blood transportation. Thus, during day time, they have rich resource of energy for body activities, at night they sleep well. Old people are opposite; their Qi and Blood are poor, their muscles are dry and week, their Qi pathways are blogged and difficult to transport Qi, the internal organs are not harmonious, Nutritive Qi is insufficient, Protective Qi is mutinous, hence they can not sleep well.”.
Chapter Da Huo Lun (Which means The big confusions) of The Classic Ling Shu stated that: “in day time Protective Qi circulates in the Yang part, thus we are perky; at night, Protective Qi circulates in the Yin part, thus we are sleepy. If Protective Qi can not get into the Yin part but stuck in the Yang part, the Yang part will be stagnated with over arised Yang Qi. Protective Qi can not move to the Yin part will lead to Yin Qi deficiency, then the Yin part can not shelter Yang Qi, so we can not sleep.”
The phrase “old people” that was mentioned in the first excerpt does not only mean elderly, but also refer to people with weak constitution. These people is not nescessarily old, they could be young but their body is just like middle-age people. This situation is not rare, especially nowadays, when people tend to have abnormal working schedule and unhealthy lifestyles, such as overconsuming of junk foods, alcoholic drinks, lack of physical activities… These are the common reasons that cause our body to be degenerate quickly.
The second excerpt mentioned the phenomenon that Protective Qi can not enter the Yin part at night and that makes us irritated and sleepless. This could because of Nutritive Yin is deficient and can not shelter Protective Qi, but it might also because of Protective Qi is mutinous and is not governed by Nutritive Yin. In the modern life, this is a common thing to happen when we tend to over consume stimulant and addictive substances, sleep late at night, work in front of the screen for a long time, suffer a lot of pressure from our families and society, that make us frustrated.
In traditional Chinese medicine, there are concepts of “Five exhausting and seven harming factors”. Five exhausting factors are five activities that if we do them for a long time, they will make the body exhausted. They are: Long time seeing exhausts Blood, long time lying exhausts Qi, long time sitting exhausts flesh, long time standing exhausts bones, long time walking exhausts tendons. Seven harming factors are seven activities that if we violate, they will harm our body. They are: Over eating harms Spleen; over anger harms Liver; Over working and staying in the humid environment for a long time harm Kidney; acquiring cold or drink cold harm Lung; tired body and over thinking harm Spirit; wind, rain, cold, heat harm Figure; Over scare harms Volition. It’s easy to say that we all violate some of the above Five exhausting and seven harming factors. They lead to many consequences which sleeping disorders included.
Sleep disorder classification in traditional Chinese medicine
Two main types of sleeping disorder in traditional Chinese medicine are insufficient type and excessive type. From those, we classify them into some more sub-types:
(Note: The names of internal organs below are just used to describe a group of function but not the physical organs in Western medicine)
1. Sleeping disorder caused by Heart Yin deficiency syndrome
Heart Yin deficiency leads to up-raising Heart Yang, hence causes difficulty of getting to sleep, dreaming, frequent waking up at night, poor memory, including the signs of Yin insufficiency such as warm feet and palms, mild fever in the late afternoon, night sweating, red dry tongue.
In this case, the treatment stratery is nourishing the Heart, calming the Spirit.
2. Sleeping disorder caused by Heart and Kidney connection loss
In the normal condition, the fire Qi of Heart goes down and the water Qi of Kidney goes up; they meet each other and restrain each other to keep the Qi circulation harmonious and smooth, thus the internal organs can work effectively. When Kidney water is weak and can not go up, it can not restrain Heart fire, then the Heart fire is uncontrolled and causes sleeping disorder. This condition represents with more serious signs of Yin deficiency such as all right restlessness along with signs of Kidney Yin deficiency as dizziness, tinnitus, tired low back and knees, premature ejaculation, semen leakage…
This condition’s treament plan is tonifying Kidney water, restrain Heart fire, reconnect Heart and Kidney transportation.
3. Sleeping disorder caused by Speen deficiency
This condition is caused by speen deficiency which leads to the insufficient production of Qi and Blood. The blood is not enough to nourish the Heart, so that the Heart Spirit is annoyed and causes sleeping disorder. The key point of this condition is hardness of sleep accompanies with the signs of Blood insufficiency such as palpitation, forgetfulness, tired hands and feet, fatigue, pale skin, loss of appetite…
In this condition, the treatment plan is tonifying the Spleen, nourishing the Blood, calming the Spirit.
4. Sleeing disorder caused by Gallbladder Qi subduction
This condition is caused by Gallbladder Qi subduction, which is usually original from great scare or panic. Gallbladder is the organ that governs the assertiveness of a person; when it’s injured, the person loses the ability to be resolute and being sleepless. The key point here is the patient is frightened and does not dare to sleep alone. when he/she sleeps, it’s easy for he/she to be startled and wake up. The accompanying symptoms could be dizziness and vertigo.
In this condition, the treatment plan would aim to warming the Gallbladder, tonifying the Qi and calming the Spirit.
5. Sleeping disorder caused by Liver Qi stagnation
This condition is caused by Liver Qi stagnation which transforms to fire. The fire stucks in the Liver meridian and interupts the function of Liver to harmonise internal environment. This could happen because of various reasons, such as over consumption of alcohol, or stressfull working condition. The fire raises up and disturbs Heart Spirit, thus causes poor sleeping quality, easy waking up at night. Liver Qi stagnation also causes anger, tightness around the rib cage, often sighing, bitterness in the mouth, red eyes, yellow urine.
To treat this condition, we aim to clearing internal heat, restraining fire, calming the Spirit.
6. Sleeping disorder caused by Damp-heat accumulation
This condition is caused by the accumulation of Damp-heat that blocks and prevents the Heart spirit to function. The reasons could be over consumption of fatty food and alcohol. The characteristics of this type are constant restlessness, blurred consciousness, dream talking, heaviness in chest, thick phlegm, nauseous and vomitting, bitterness in mouth, sticky tongue…
This condition’s treatment strategy is clearing the heat, transforming the dampness and camling the spirit.
7. Sleeping disorder caused by Heart Fire upraising
This condition is caused by the Heart fire raises high for many reasons and causes restless Heart spirit. The symptoms of this type are palpitation, anxiety, uneasy going, red face, mouth ulcer. The Heart fire goes down to Small Intestine and causes low urine output and pain in urination.
The treatment strategy for this case is easing the Heart and calming the Spirit.
8. Sleeping disorder caused by Fire disturbing the chest
This condition is caused by excessive heat represents in the chest and leads to restlessness, anxiety, difficulty in sleeping.
To treat this condition, we aim to clearing the excessive heat in the chest.
Is it safe to take sleeping pills for long term?
Taking sleeping pills (Western medicine) is an effective solution for people with sleeping disorder who can not help themselves, especially when long-term insomnia affects their lives badly.
According to pharmacology, all sleeping pills work through a neurochemical called GABA (which is the short for gamma – aminobutyric acid). GABA’s function is to reduce neuronal excitability by inhibiting nerve transmission. Although there are many kinds of sleeping pills, but the final target is this neurochemical.
In short, sleeping pills work by reducing brain function. In traditional Chinese medicine, there are some herbs with kind of similar effect. (in TCM, herbs are not only plants but also any substance which can cause the effect on human body). They belong to the group of intense sedative herbs. Most of them is mineral, which has heavy constitution and toxin.
According to TCM, those herbs function by subdue the Yang Qi of the body. They seem to be effective in short term, but if we take them for long time, we will destroy body’s Yang Qi, and the consequences are Yang deficiency syndrome with the symptoms like indigestion, mental sickness, poor memory and consciousness…
So, in the perspective of TCM, we don’t recommend long-term using of sleeping pills. We should dive deeply to the root problems and solve them. If sleeping pill is a must, it should be managed by a qualified doctor to balance restraint and promoting, reduction and tonifying.
How to avoid sleeping disorder?
In the modern life, sleeping disorder is a common problem, not only for old people, but also for young people with bad lifestyle and diet. As mentioned above, these are risk factors that weaken our bodies and cause mental illness and finally lead to sleeping disorder.
To avoid sleeping disorder, we should practice a healthy diet and lifestyle. Beside working hours, we should spend time for sports and recreation.
Some traditional Chinese medicine techniques also show effect on preventing sleeping disorder, such as acupressure, massage, hot foot bathe, warm compress on back and belly.
If you get long lasting sleeping disorder, it’s nescessary to meet a doctor to have professional treatment.
Author: Dr. Tan Pham – Dr.Tan Clinic