Library

Zi Hezi treated a wealthy woman who, due to excessive worry and overthinking, had suffered from insomnia for two years, with no medicine effective. Her husband sought Zi's treatment. Zi said, "The pulses in both hands are slow (Huan), indicating the Spleen is affected, as the Spleen governs thought." He then made an agreement with the woman's husband to provoke her with anger, collected a large fee, drank wine for several days, and left without prescribing any treatment. The woman became extremely angry and sweated; that night she fell into a deep sleep. This pattern repeated for eight or nine days, after which she no longer suffered from insomnia, her appetite improved, and her pulse normalized. (Xu Lingtai's note: This method is accessible to anyone, but one must verify if it is indeed the correct way to cure the patient.)

Wang Sizhong treated Zhou, who suffered from fever and cough. The condition worsened due to Yin deficiency and internal injury, leading to a month of insomnia. Wang diagnosed, "This is called Xuan Yin (Suspended Fluid), caused by stagnant heat. When Qi fails to ascend and descend properly, fluids accumulate, gradually forming a fluid cyst. The treatment should focus on resolving stagnation and promoting Qi movement. Each dose used seven lotus leaf stems. After one dose, he slept with snoring, and recovered fully within a few days." (From *Wujiang County Gazetteer*. Regarding the syndrome of fluid cyst, Yu Jia Yan and Xu Lingtai discussed it extensively but provided no formulas. Xu only stated that light, clear, and penetrating single herbs should be used. Using lotus leaf stems here aligns with this principle.)

Zhan Lianshui, named Kang Zhong, once treated Grand Secretary Dong, who suffered from Yang hyperactivity and insomnia. He prescribed one tael of Stemona Root (Bubai) and one tael of Pinellia Tuber (Banxia). Dong subsequently enjoyed good sleep and rewarded him with one hundred taels of gold. After sleeping, Dong dreamed he was a laborer pulling a boat under the scorching sun, feeling exhausted, until he suddenly saw cool trees and pleasant shade, bringing great joy before waking. People remarked that Dr. Zhang earned a hundred taels with two herbs, while Lord Dong spent a hundred taels for just a moment of rest akin to a laborer's respite. (From *Shixiao Lu* by Xu Shupi. Xu Lingtai's note: This is also a case of Fluid retention.)

Sun Wen Yuan treated the wife of Pan Jing Yu, who could not sleep in the latter half of the night (Liver Fire floating into the Pericardium). She experienced pain in both temples and the supraorbital ridge (Liver Fire counterflowing to collateral branches), yellowish complexion, emaciation, loose stools, body heat upon slight exertion, and weakness in the four limbs (all indicating Liver Yang excess and Spleen Yin deficiency). Her pulse was surging and slippery at the Left Cun position (Liver pulse overflowing). This persisted from spring to autumn. The cause was identified as Spleen deficiency with excess Fire in the Liver and Heart meridians. (It should be described as Liver excess and Spleen deficiency.) Initially, he used Si Jun Zi Tang (Four Gentlemen Decoction) modified with Wine-processed Coptis Rhizome (Jiu Lian), Bupleurum Root (Chai Hu), Dolichos Seed (Bian Dou), Alisma Rhizome (Ze Xie), and Talcum (Hua Shi) for regulation. At night, he administered Qian Zhong Yang's An Shen Wan (Calming the Spirit Pill) with Juncus Effusus Decoction (Deng Xin Tang). After eight doses, she slept, and the temple pain ceased. (Coptis contributed most to the effect.) Subsequently, Liu Jun Zi Tang (Six Gentlemen Decoction) modified with Scutellaria Root (Huang Qin), Gentian Macrophylla Root (Qin Jiao), Bupleurum Root, Alisma Rhizome, Angelica Sinensis Root (Dang Gui), White Peony Root (Bai Shao), and Phellodendron Bark (Huang Bo) led to complete recovery.

Lu Bu Yuan treated the mother of Wen Zijiang, who, in winter, felt her heart suddenly dispersing and sinking, causing insomnia for nearly three months. Pulse diagnosis revealed only the Left Guan pulse was weak and imperceptible. It was diagnosed as Liver deficiency, requiring tonification of its mother organ (Kidney), expected to resolve after the Start of Spring. He used Rehmannia Root (Shu Di Huang) as the sovereign herb, with Poria (Fu Ling), Sour Jujube Seed (Suan Zao Ren), Angelica Sinensis Root, Ginseng Root (Ren Shen), Saposhnikovia Root (Fang Feng), and Polygala Root (Yuan Zhi) as supporting herbs (dosages of Fang Feng and Yuan Zhi to be adjusted). After twenty doses, she recovered at the appointed time. Wen Zijiang asked, "Heart dispersion and insomnia seem related to the Heart meridian; why did Liver and Kidney herbs work, and why did it take until Start of Spring?" Lu replied, "This conclusion comes from the pulse. The Classics state: 'When Liver is deficient, there is fear; fear causes Qi to sink.' Although there was no emotional fear, the pulse qi resembled this state. Based on pulse and symptoms, Liver deficiency is certain. Due to Liver insufficiency, phlegm arose during the Winter season (Water generates Wood). Waiting for the seasonal change allowed Yuan Qi to recover. How can heart dispersion be attributed solely to the Heart meridian? This is not heart dispersion, but the Heart reflecting the image of Qi dispersion in the body. If the Heart itself were diseased, how could it perceive its own dispersion?"

Li Tu Cai treated Zhang Tong Chu, who was prone to anger and depression, compounded by heavy social engagements, causing severe chest pain and nightly insomnia. Previous doctors used Acorus Rhizome (Shi Chang Pu), Immature Bitter Orange (Zhi Shi), Magnolia Bark (Hou Po), Aucklandia Root (Mu Xiang), and Cardamom (Dou Kou). Li knew this was a deficiency syndrome where deficiency leads to failure of turbid Yin to descend and loss of Shen spirit control, causing pain and wakefulness. He prescribed Gui Pi Tang (Restore the Spleen Decoction) with doubled Ginseng Root and Angelica Sinensis Root. Within ten doses, his chest felt comfortable, and he slept peacefully. (From *Yi Tong*.)

Zhang Lu Yu treated a young man who, due to fear and anxiety, had been unable to lie down for two months, having taken countless calming and blood-nourishing medicines. He prescribed Wen Dan Tang (Warm the Gallbladder Decoction) with doubled Pinellia Tuber and Bupleurum Root. One dose resulted in immediate sleep lasting two days and nights, leading to full recovery.

A patient suffering from seminal emission, irritability, and inability to lie down was given Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) modified with Sour Jujube Seed. After a few doses, he stabilized and slept normally.

Another patient with a chronic ulcer that failed to heal and could not lie down was untreatable by surgeons. He was ordered to take a large dose of Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) and recovered.

Lu Yang Yu treated Shen Han Zhuan Hong Tai, nearly fifty years old, obese, fond of alcohol and rich foods, often sleeping outdoors. In late autumn/early winter, he suddenly became irritable and insomniac after drinking. Calming and blood-nourishing herbs were ineffective; only phlegm-clearing and fire-purging herbs offered slight relief. Changing prescriptions brought temporary relief followed by relapse. Only after heavy drinking and vomiting could he sleep for one or two hours. During the day, he was too fatigued to rise and had no appetite. By mid-summer, he developed irritability and body itching. A hot bath allowed him to sleep until dawn. Thereafter, bathing before bed ensured sleep for one or two watches, even if not prolonged. Skipping baths caused insomnia. By Start of Autumn, bathing was ineffective, and by August, he slept completely none. Pulse was deep and choppy in all positions, especially at the Cun positions. He reported that previously, warm weather caused heat intolerance and sweating. Now, he felt only irritability and stuffiness without heat intolerance, and had no sweat even in summer. Recalling the *Nei Jing*, which discusses insomnia with formulas unlike other sections, he wondered why modern practitioners ignored them or found them ineffective. The Classics state the cause of insomnia: "Wei Qi travels in the Yang, failing to enter Yin. Traveling in Yang makes Yang abundant; failing to enter Yin makes Yin deficient, hence the eyes cannot close." Also: "Yang Ming Qi rebels, failing to follow its path, thus preventing sleep." And: "If the Stomach is disharmonious, sleep is uneasy." Treatment involves regulating deficiency/excess, unblocking pathways, and eliminating pathogens. Also: "Clear obstructions, open collaterals, harmonize Yin and Yang." The formula uses water from a thousand miles, stirred ten thousand times, cooked with reed fire, decocted with Foxtail Millet Grain (Shu Mi) and Pinellia Tuber. For recent-onset sweating disorders, sleep follows immediately, and sweating resolves it. Bathing promotes sleep by opening external collaterals. Thus, adopting Zi Hezi's method, he used Du Sheng San (Single Miracle Powder) for three days to expel about a basin of saliva and fluid. That night, though tired, he slept. He prohibited rich foods and alcohol, allowing only thin porridge. Five days later, he instructed placing boiling water pots in a sealed room for steam inhalation, with a bucket for bathing in hot water, then drying and sleeping. He used Ephedra Herb (Ma Huang), Perilla Leaf (Su Ye), Kudzu Root (Gan Gen), Saposhnikovia Root, Notopterygium Rhizome (Wei Ling Xian), and Pinellia Tuber, each one tael, decocted per *Nei Jing* methods, taken hot and covered. Mild sweating ensued, and that night he slept deeply. After two days of recuperation, he repeated the method to induce heavy sweating. From then on, sleep normalized, body felt light, spirit refreshed, pulses became rising and smooth, and the disease was cured.

A patient suffered from irritability, fever, emaciation (skin and bones only), and inability to close eyes for three years. Doctors prescribed thousands of doses of heat-clearing, Yin-nourishing, phlegm-resolving, and spirit-calming medicines without effect, resulting in total nightly insomnia. Pulse showed the Liver pulse alone was deep and rapid. This indicated long-standing suppressed Fire anger and Liver Wood stagnation requiring dissemination. He used Bupleurum Root four qian, White Peony Root two qian, Moutan Cortex (Dan Pi), Gardenia Fruit (Zhi Zi) each two qian five fen, Licorice Root (Gan Cao) five fen, and Cinnamon Twig (Gui Zhi) four fen. After administration, he slept soundly for a day and night. Later, Xiao Yao San (Free and Easy Wanderer Powder) added with Ginseng Pill cured him. (For Liver Wood stagnation affecting Earth, only Bupleurum can disseminate; this usage is highly appropriate. Had it been used indiscriminately like by Xue Li Zhai, hidden harm would have occurred.)

Li Ji Dou's concubine, due to her son's smallpox complications and accumulated fatigue, suffered from empty irritability and insomnia, with Heart and Gallbladder deficiency/cowardice, startling easily at trivial matters. Hundreds of medicines failed. His brother Li Chang Wen heard from a friend that Chen Dan Ya from Xinghua treated a woman with similar symptoms using Wen Dan Tang. Trying a few doses proved effective. The prescription was Pinellia Tuber seven qian, Bamboo Shavings (Zhu Ru), Immature Bitter Orange each three qian, Tangerine Peel (Chen Pi) four qian half, Poria and Licorice Root each two qian two fen half, divided into two doses, decocted with Ginger and Jujube, plus Sour Jujube Seed five qian. Later, Ginseng Root two qian was added due to extreme deficiency. Zhang Jie Bin (Zhong Chun) commented, "This patient must have phlegm and be fond of drinking." Indeed. (From *Guang Biji*.)

Gu Tai Xue Shu Xia's wife suffered from Yin deficiency with Fire, experiencing total insomnia for two months, refusing food and drink, with daily physical wasting. Everyone believed she was incurable. Li Shi Cai examined her, determined she faced no major danger but required time. He used large doses of Ginseng Root, Sour Jujube Seed, Poria Spirit (Fu Shen), Polygala Root, Rehmannia Root (Sheng Di), Angelica Sinensis Root, Schisandra Berry (Wu Wei Zi), and Ophiopogon Tuber (Mai Dong). Due to extreme deficiency and timid Qi, he supplemented with Amber (Hu Po), Cinnabar (Chen Sha), and silver/gold vessels. After about a hundred doses, she recovered. When asked later, Li explained, "Though this disease is deficiency-based, fortunately the Zang-Fu organs were undamaged. Although there was Fire in the Heart meridian, it fortunately did not scorch the Lung. Taking more Yin-tonifying and astringent agents allows Water and Fire to ascend and descend naturally. This is what is meant by 'Strengthening Water to Control Solar Flare.' With long-term illness, regulated pulse, and no fever, what else could be feared?"

Qian Guo Bin treated Yu Shao Chuan from Shaanxi, who ran a felt shop in Hangzhou. He was robust, favored roasted/fried foods, had an irritable temperament affecting Liver Qi, and was over fifty. He had suffered from total insomnia for six years, using many medicines for phlegm-fire and Qi/blood issues. Morning pulse: Cun and Guan positions were surging, floating, and forceful, resembling firmness, while Chi positions were large. Upon deep reflection: Pulse-wise, obese people usually have deep pulses, yet now all six pulses were surging, floating, and forceful. Symptom-wise, upper body feared heat, lower body feared cold. Medicinally, clearing and tonifying agents had all been tried. The *Nan Jing* states: "In peaceful sleep, Shen returns to Heart, Po to Liver, Yi to Spleen, Zhi to Kidney; the five Zang reside in their proper places." Night belongs to Yin, governing stillness; Day belongs to Yang, governing activity. Harmony of Yin and Yang ensures peaceful sleep. This six-year insomnia is a Yang Hyperactivity syndrome. It requires drastic draining of Yang to allow Yin to gradually recover, enabling sleep. He used Da Cheng Qi Tang (Major Order the Qi Decoction) with two taels of Rhubarb (Da Huang). After more than ten evacuations, the patient became drowsy and slept for several days before waking. Recovery was achieved with porridge diet.