A good night’s sleep solves many problems, but lack of sleep not only causes tiredness and distress but over the long term contributes to many chronic illnesses. It has been estimated that 1 in 3 persons has difficulty with sleeping at some stage of life. For the elderly, it is one of the most prevalent conditions that affect health and the enjoyment of life.
There are multiple causes of insomnia. The most common causes are stress and anxiety, but insomnia can also arise from underlying illnesses like asthma, metabolic disorder, hyperthyroidism and depression.
From the point of view of traditional Chinese medicine (TCM), certain states of imbalance in the body are associated with difficulty in falling asleep, maintaining sleep throughout the night, and poor quality of sleep. These symptoms are captured in the term Bumei. The imbalances, or syndromes, that cause insomnia are many and varied.
Most of them fall under two categories:
1. “Fire”, characterized by restlessness and vexatiousness, and
2. Weaknesses in blood and qi depriving the heart (related to the brain in modern physiology) of the nourishment necessary for good sleep.
Four imbalances causing insomnia commonly seen in Singapore are described here. The first two are known in TCM as excess syndromes, comprising excess heat or “fire” in the heart or liver. These are treated with medications that mainly purge or dissipate the fire. The other two syndromes are deficiency (weakness) syndromes in the liver, heart and spleen. These may be relieved with tonics.
In the excess syndrome called “exuberance of heart fire”arising from prolonged stress, the heat in the heart is stirred up. As the heart in TCM terms controls the mind, sleep is disturbed. Symptoms include irritability, dry mouth, coloured urine, a bright red tongue tip, thin yellowish fur on the tongue surface, and an elevated pulse rate. Treatment is with herbs that clear heart fire such as huanglian, pearl powder, with shengdi and danggui added to nourish the yin and blood of the heart. The mind can also be disturbed by fire that is transformed from qi stagnation in the liver.
Liver qi stagnation is commonly triggered by anger or frustration. It is has been observed that some women are more vulnerable to getting upset over irritations, small or large, that crop up in daily life. They are therefore susceptible to liver qi stagnation that ignites liver fire, affecting the heart and consequently disturbing the mind. Symptoms may include irritability, hot temper, dizziness, headache, redden eyes, tinnitus, dryness and bitterness in the mouth, poor appetite, constipation and a red tongue with yellow fur. The therapeutic principle is to purge liver fire and promote the flow of liver qi. Herbs such as longdancao and huangqin can help to purge the liver fire, and chaihu and Xiangfu can be used to soothe liver qi.
Insomnia can also be caused by deficiency syndromes in the kidney, yin or in the spleen and heart (comm). The former commonly afflicts menopausal women as well as the elderly. In menopausal women, this may produce symptoms of hot flushes and night sweats. In general, the level of yin in the body tends to decline with age, resulting in yang gaining ascendancy and producing sleep disturbing heat. Symptoms include soreness and weakness in the lower back and knee, tinnitus, and irregular menstruation for women. The prescription liu weidi huang wan may provide relief by nourishing kidney yin and purging heat. The other kind of deficiency, that in the heart and the spleen, is common among both young and middle-aged who do not maintain work-life balance. Too much anxiety at work damages the spleen (which in TCM theory controls digestion), While idleness and the pursuit of hedonistic pleasures injures the heart, leading eventually to qi and blood deficiency. Symptoms may include heart palpitation, forgetfulness, poor appetite, dizziness, lassitude, abdominal bloatedness, loose stools, a pale complexion and a tongue with thin fur.