灵枢云。卫气不得入于阴。当留于阳。留于阳。则阳气满。阳气满。则阳跷盛。不得入于阴。
则阴气虚。故目不瞑。（卫气行阳则寤。行阴则寐。此其常也。失其常则不得静而藏魂。所以目不
得瞑也。）壮者之气血盛。其肌肉滑。气道通。营卫之行不失其常。故昼精而夜瞑。老者之气血衰。
其肌肉枯。气道涩。五脏之气相搏。其营气衰少。而卫气内伐。故昼不精。夜不瞑。素问云。阴
虚故目不暝。补其不足。泻其有余。调其虚实。以通其道。而去其邪。饮以半夏汤一剂。阴阳已
通。其卧立至。病新发者。覆杯则卧。汗出则已矣。久者三饮而已也。胃不和。则卧不安也。卧
则喘者。是水气之客也。
不寐有二。有病后虚弱。有年高人血衰不寐。有痰在胆经。神不归舍。亦令人不寐。虚者。
六君子加枣仁。痰者。灵枢半夏汤。虚劳烦热不得眠。酸枣汤。或酸枣仁一两炒研。水煎绞取汁。
下米二合煮糜。以生地五钱捣汁入。更煮过。时时服之。大病后虚烦不得眠。竹叶石膏汤。水停
心下不得眠。茯苓甘草汤。妇人肥盛多郁不得眠者吐之。从郁结痰火治。大抵胆气宜静。浊气痰
火扰之则不眠。温胆汤。用猪胆汁炒半夏曲加柴胡三钱。炒枣仁一钱五分。立效。盖惊悸健忘失
志心风不寐。皆是痰涎沃心。以致心气不足。若凉心太过。则心火愈微。痰涎愈盛。惟以理痰顺气
为第一义。导痰汤加石菖蒲。有寐中觉魂魄飞荡惊悸。通夕不得安眠。是肝虚受邪也。其人易怒。
魂不归肝。是以飞扬。独活汤、珍珠母丸。次第服之。喘不得卧。以喘法治之。苏子、橘红、甘
草、桔梗、竹茹。厥不得卧。以香港脚法治之。牛膝、丹皮、木通、沉香、观桂。虚劳咳嗽。形脱
不得卧。不可治。烦不得卧。诸药不效者。栀子豉汤下朱砂安神丸。不应。用益元散加牛黄。更
不应。虚火用事也。补中益气汤下朱砂安神丸。间进六味丸。恒服方效。有病久余热不止。久不
得卧者。六味丸滋其真阴。自然热止安卧矣。脉数滑有力不眠者。中有宿滞痰火。此为胃不和。
则卧不安也。心下硬闷。属宿滞。半夏、白术、茯苓、川连、枳实。病后。及汗下后。与溃疡不
得眠。属胆虚。人参、茯苓、炒枣仁、陈皮、麦冬、圆眼肉为主。有火。脉数口干。加知母、川
连、竹茹。心烦。用炒黑山栀。
石顽曰。平人不得卧。多起于劳心思虑。喜怒惊恐。是以举世用补心安神药。鲜克有效。曷
知五志不伸。往往生痰聚饮。饮聚于胆。则胆寒肝热。故魂不归肝而不得卧。是以内经用半夏汤
涤其痰饮。则阴阳自通。其卧立至。一少年因恐虑两月不卧。服安神补心药无算。余与温胆汤倍
半夏、柴胡。一剂顿卧两昼夜。竟尔霍然。复有一人遗精烦扰不得卧。与六味丸料加枣仁。数服
而安寝如常。更有一人。溃疡久不收敛而不得卧。疡医不能疗。令用大剂十全大补而安。大抵因
病不得卧。当详所因。亦不专主胆病也。
多卧 经云。卒然多卧者。邪气客于上焦。上焦闭而不通。已食若饮汤。卫气久留于阴而不
行。故卒然多卧焉。胆虚不眠。寒也。酸枣仁一两炒为末。醇酒调服。胆实多卧。热也。酸枣仁
一两生为末。茶清调服。
嗜卧 东垣云。脉缓怠惰。四肢不收。或大便泄泻。此湿胜。从胃苓汤。食入则困倦。精神
昏冒而欲睡者。脾虚也。
六君子加曲、 、山楂。时值秋燥。怠惰嗜卧。兼见肺病。洒淅恶寒。不嗜食者。此阳气不伸也。升阳益胃汤。
According to the *Ling Shu* (Spiritual Pivot): When Wei Qi (Defensive Qi) cannot enter the Yin aspect, it remains in the Yang aspect. Remaining in the Yang aspect causes Yang Qi to become full; when Yang Qi is full, the Yang Qiao vessel becomes vigorous. Because Wei Qi cannot enter the Yin aspect, Yin Qi becomes deficient, resulting in an inability to close the eyes (When Wei Qi travels through the Yang aspect, one is awake; when it travels through the Yin aspect, one sleeps. This is the normal state. Deviating from this norm prevents the Hun [Ethereal Soul] from resting quietly, hence the inability to close the eyes). In robust individuals, Qi and Blood are abundant, muscles are smooth, and the Qi pathways are unobstructed. The movement of Ying Qi (Nutritive Qi) and Wei Qi follows its normal course, so they are energetic during the day and sleep soundly at night. In elderly individuals, Qi and Blood decline, muscles wither, and Qi pathways become obstructed. The Qi of the Five Zang organs clashes with each other, Ying Qi becomes scarce, and Wei Qi invades inwardly. Consequently, they lack energy during the day and cannot sleep at night. The *Su Wen* (Basic Questions) states: Yin deficiency leads to an inability to close the eyes. Tonify the deficiency, drain the excess, regulate the deficiency and excess, unblock the pathways, and eliminate the pathogenic factors. Administer one dose of Banxia Tang (Pinellia Decoction); once Yin and Yang are unblocked, sleep will resume immediately. For newly onset cases, sleep comes as soon as the decoction is consumed and covered; sweating indicates recovery. For chronic cases, three doses suffice. "If the Stomach is disharmonious, restlessness ensues." Dyspnea upon lying down is caused by Water Qi invading.
Insomnia (Bu Mei) arises from two main categories: weakness after illness, blood deficiency in the elderly, or Phlegm in the Gallbladder Meridian preventing the Shen [Spirit] from returning to its residence. For deficiency patterns, use Liujunzi Tang (Six Gentlemen Decoction) with Suanzaoren (Semen Ziziphi Spinosae). For Phlegm patterns, use Banxia Tang from the *Ling Shu*. For insomnia due to deficiency-heat and vexation, use Suanzao Ren Tang (Ziziphus Decoction). Alternatively, take one liang of roasted and ground Suanzaoren, decoct in water, extract the juice, add two he of rice to cook into a porridge, then add five qian of fresh juice from Shengdi Huang (Radix Rehmanniae Preparata), simmer slightly, and consume frequently. For insomnia due to deficiency-vexation after severe illness, use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). For insomnia due to Water retention under the Heart, use Fuling Gancao Tang (Poria and Licorice Decoction). For obese women with insomnia due to stagnation, employ emesis therapy, treating from the perspective of stagnation, Phlegm, and Fire. Generally, Dan Qi (Gallbladder Qi) should be tranquil; if disturbed by turbid Qi, Phlegm, or Fire, insomnia occurs. Use Wendan Tang (Warm the Gallbladder Decoction): prepared with Pinellia Qu (Fermented Pinellia) fried in pig bile, plus Chaihu (Radix Bupleuri) 3 qian and roasted Suanzaoren 1.5 qian, which yields immediate results. Insomnia due to palpitations, forgetfulness, loss of will, or Heart Wind is generally caused by Phlegm-Saliva coating the Heart, leading to Heart Qi deficiency. Over-cooling the Heart diminishes Heart Fire further and increases Phlegm-Saliva; thus, regulating Phlegm and smoothing Qi is paramount. Use Daotan Tang (Expel Phlegm Decoction) with Shichangpu (Rhizoma Acori Tatarinowii). If one feels their Hun flying about during sleep, causing palpitations and all-night wakefulness, this is Liver deficiency with pathogenic invasion. The person is irritable, and the Hun does not return to the Liver, causing it to fly about. Take Duhuo Tang (Angelica Pubescens Decoction) and Zhenzhumu Wan (Mother-of-Pearl Pill) in succession. For dyspnea preventing lying down, treat the dyspnea using Su Zi (Fructus Perillae), Juhong (Exocarpium Citri Reticulatae Rubrum), Gancao (Radix Glycyrrhizae), Jiegeng (Radix Platycodonis), and Zhuru (Spiraxis Caulis). For Jue (Reversal Cold/Heat) preventing lying down, treat Hongjiaojiao (Beriberi/Leg Swelling) using Niuxi (Radix Achyranthis Bidentatae), Danpi (Cortex Moutan), Mutong (Caulis Akebiae), Chenxiang (Lignum Aquilariae Resinatum), and Guixin (Cortex Cinnamomi). Insomnia due to deficiency-cough and physical collapse is incurable. For vexation preventing sleep where all medicines fail, use Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) to administer Zhusha Anshen Wan (Cinnabar Calming the Spirit Pill); if ineffective, use Yiyuan San (Benefit Origin Powder) with Niuhuang (Calculus Bovis); if still ineffective, it is due to Deficient Fire. Use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to administer Zhusha Anshen Wan, occasionally taking Liuwei Wan (Six-Ingredient Pill with Rehmannia), long-term administration yields results. For lingering residual heat after prolonged illness causing chronic insomnia, use Liuwei Wan to nourish True Yin, naturally stopping heat and restoring sleep. A rapid, slippery, and forceful pulse with insomnia indicates retained food stagnation and Phlegm-Fire; this is "Stomach disharmony leading to restless sleep." Hardness and oppression below the Heart belong to food stagnation, treated with Banxia (Rhizoma Pinelliae), Baizhu (Rhizoma Atractylodis Macrocephalae), Fuling (Poria), Chuanlian (Rhizoma Coptidis), and Zhishi (Fructus Aurantii Immaturus). Post-illness, post-sweating/purging, or ulcer-related insomnia belongs to Gallbladder deficiency, primarily using Renshen (Radix Ginseng), Fuling, roasted Suanzaoren, Chenpi (Pericarpium Citri Reticulatae), Maidong (Radix Ophiopogonis), and Yuanranyrou (Arillus Longan). If there is Heat, with a rapid pulse and dry mouth, add Zhimu (Rhizoma Anemarrhenae), Chuanlian, and Zhuru. For mental distress, use charred Zhizi (Fructus Gardeniae).
Shiwan stated: Normal people suffering from insomnia often arise from mental labor, overthinking, anger, joy, fear, or fright. Thus, the world uses Heart-tonifying and Spirit-calming medicines, rarely achieving success. One must understand that blocked emotions often generate Phlegm and fluid retention. Fluid retention in the Gallbladder causes Gallbladder Cold and Liver Heat, so the Hun does not return to the Liver, causing insomnia. Therefore, the *Neijing* uses Banxia Tang to wash away Phlegm and fluids, allowing Yin and Yang to naturally unblock, and sleep resumes immediately. A young man suffered from fear and worry for two months without sleep, consuming countless Spirit-calming and Heart-tonifying medicines. I prescribed Wendan Tang with doubled Banxia and Chaihu; one dose resulted in continuous sleep for two days and nights, and he recovered completely. Another patient suffered from seminal emission, vexation, and insomnia. I prescribed Liuwei Wan formula with added Suanzaoren; after several doses, he slept normally like everyone else. Another patient had non-healing ulcers and insomnia; the surgeon could not treat it, but large doses of Shiquan Dabu Tang (Ten Ingredients Great Tonifying Decoction) brought relief. Generally, insomnia caused by illness requires detailed investigation of the cause and is not solely attributed to Gallbladder disease.
Excessive Sleep (Duo Wo): The Classics state: Sudden excessive sleep is caused by pathogenic factors lodging in the Upper Jiao (Triple Burner), blocking it. After eating or drinking soup, Wei Qi stays long in the Yin aspect without moving, causing sudden excessive sleep. Gallbladder deficiency causing insomnia is Cold: one liang of roasted Suanzaoren ground into powder, taken with strong wine. Gallbladder excess causing excessive sleep is Heat: one liang of raw Suanzaoren ground into powder, taken with clear tea.
Listlessness (Shi Wo): Dongyuan stated: Slow pulse, lethargy, flaccidity of the four limbs, or loose stools indicate Excess Dampness, treated with Weiling Tang (Atractylodes and Poria Decoction). Feeling sleepy and mentally foggy after eating indicates Spleen deficiency. Treat with Liujunzi Tang adding Shenqu (Massa Medicata Fermentata), Maiya (Fructus Hordei Germinatus), and Shanzha (Fructus Crataegi). During autumn dryness, lethargy and listlessness accompanied by Lung symptoms, chills, and anorexia indicate unexpressed Yang Qi, treated with Shengyang Yizhe Tang (Raise Yang and Benefit the Stomach Decoction).