（附梦寐）
卧者。身着席。头就枕之谓也。寐者。神返舍。息归根之谓也。不得卧寐之证。杂病犹少。失血家往往有之。
不得卧有二证。一是胃病。一是肺病。
胃病不得卧者。阴虚则邪并于阳。烦躁不卧。此与伤寒论阳明篇。微热喘冒。不得卧者。为胃有燥屎之义
同。三一承气汤治之。若无燥结。但系烦热者。竹叶石膏汤。白虎汤治之。兼理血分。则宜用玉烛散。玉女煎。
又有胃中宿食。胀闷不得卧者。越鞠丸加山楂麦芽莱菔子。盖阳明主阖。和其胃气。使得还其主阖之令。
斯能卧矣。
肺病不得卧者。肺为华盖。立则叶垂。卧则叶张。水饮冲肺。面目浮肿。咳逆倚息。卧则肺叶举而气益上。故
咳而不得卧。葶苈大枣泻肺汤。攻去其水。则得卧矣。或二陈汤加干姜细辛五味子。温利水饮亦可。若是
火逆之气。挟痰上冲者。则又宜水火兼泻。痰甚者。消化丸主之。火甚者。滚痰丸主之。平剂则宜二陈汤。加
柴胡栝蒌黄芩旋复花杏仁姜汁竹沥。保和汤亦治之。若无痰饮。但是火气上冲者。其人昼日不咳。卧则
咳逆。气不得息。乃肺痿叶焦。卧则肺叶翘举。气随上冲。咳呛不已。宜清燥救肺汤。加生地黄栝蒌根百合
五味子以敛之。再加钟乳石以镇降之。且肺之津生于肾中。如肾水不能上济上焦。冲气逆上。咳不得卧
者。当从肾治之。六味丸。加参麦散。再加牛膝。以引气下行。加磁石。以吸金气。使归于根。
不寐之证有二。一是心病。一是肝病。
心病不寐者。心藏神。血虚火妄动。则神不安。烦而不寐。仲景黄连阿胶汤主之。阴虚痰扰。神不安者。猪苓
汤治之。一清火。一利水。盖以心神不安。非痰即火。余每用朱砂安神丸。加茯苓琥珀。或用天王补心丹。
肝病不寐者。肝藏魂。人寤则魂游于目。寐则魂返于肝。若阳浮于外。魂不入肝。则不寐。其证并不烦躁。清
睡而不得寐。宜敛其阳魂。使入于肝。二加龙骨汤。加五味子枣仁阿胶治之。又或肝经有痰。扰其魂而不
得寐者。温胆汤。加枣仁治之。肝经有火。多梦难寐者。酸枣仁汤治之。或滑氏补肝散。去独活。加巴戟。四物
汤。加法夏枣仁冬虫夏草龙骨夜合皮。亦佳。
又按魂虽藏于肝。于昼游于目。目在面部。乃肺胃之所司。肺胃之气。扰而不静。亦能格魂于外。使不得返
也。宜生地黄百合麦冬知母枳壳五味子白芍甘草枣仁天花粉茯苓治之。人参清肺汤。亦治之。又有虚
悸恐怖不寐之证。仁熟散治之。思虑终夜不寐者。归脾汤加五味治之。须参看怔忡烦悸门。
又有昏沉多睡之证。在杂病为邪入阴分。在失血虚痨。乃血脱之后。元气不支。是以昏睡。如汗出气喘。危
急之候也。参附汤救之。寤属阳。故不寤为阳虚。人参养荣汤。亦治之。若身体沉重。倦怠嗜卧者。乃脾经有
湿。平胃散。加猪苓泽泻治之。六君子汤。加防己薏苡仁。补中益气汤亦治之。此论多睡。多是阳虚。然亦有
胆经火甚。而多昏睡者。龙胆泻肝汤治之。
梦乃魂魄役物。恍有所见之故也。魂为病。则梦女子花草神仙欢喜之事。酸枣仁汤治之。魄为病。则梦惊
怪鬼物争斗之事。人参清肺汤加琥珀治之。梦中所见。即是魂魄。魂善魄恶。故魂梦多善。魄梦多恶。然魂
魄之所主者。神也。故安神为治梦要诀。益气安神汤治之。又有痨虫生梦。照痨虫法治之。又有梦而遗精。详遗精门。
再按。睡而恶明喜暗者。火邪也。侧卧不得转身者。少阳之枢机不利也。侧卧一边者。详咳嗽门。
(Attached: Discussion on Dreams and Sleep)
"Wo" (lying down) refers to the state where the body rests on a mat and the head leans on a pillow. "Mei" (sleeping) refers to the state where the spirit returns to its residence and the breath roots itself. Disorders of inability to lie down or sleep are relatively rare in general miscellaneous diseases, but they often occur in patients who have suffered blood loss.
Inability to lie down presents with two syndromes: one is Stomach disease, and the other is Lung disease.
For inability to lie down due to Stomach disease, Yin deficiency causes pathogenic factors to merge with Yang, resulting in restlessness and an inability to lie down. This shares the same principle as the "slight fever, panting, dizziness, and inability to lie down" mentioned in the Yangming Chapter of *Shanghan Lun* (Treatise on Cold Damage), which indicates dry stool in the Stomach. It should be treated with Sanyi Chengqi Tang (Three-One Purging Decoction). If there is no dry accumulation, but only irritant heat, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) or Baihu Tang (White Tiger Decoction) should be used. To simultaneously regulate the Blood level, Yuzhu San (Jade Candle Powder) or Yuni Jian (Jade Maiden Decoction) is appropriate.
Furthermore, for cases where retained food in the Stomach causes distension and fullness leading to an inability to lie down, Yueju Wan (Yueju Pill) added with Hawthorn Fruit, Malt, and Radish Seed should be used. Since the Yangming channel governs closure, harmonizing the Stomach Qi allows it to resume its function of closure, thereby enabling sleep.
For inability to lie down due to Lung disease, the Lung is the canopy (the highest organ covering the others). When standing, the lung lobes hang down; when lying flat, they expand. If fluid retention rushes to the Lung, causing edema of the face and eyes, coughing, and panting requiring leaning support, lying flat causes the lung lobes to rise and the Qi to ascend further, resulting in coughing and an inability to lie down. Tingli Dazao Xiefei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung) should be used to attack and remove the fluid retention, after which sleep can be achieved. Alternatively, Erchen Tang (Two-Cured Decoction) added with Dried Ginger, Asarum, and Schisandra Berry can warm and promote the discharge of fluid retention. If rebellious Qi from fire carries phlegm upward, both Water and Fire should be drained simultaneously. For severe phlegm, Xiaohua Wan (Digestion Pill) is indicated. For severe fire, Tuntan Wan (Rolling Phlegm Pill) is indicated. For a milder formula, Erchen Tang added with Bupleurum Root, Trichosanthes Root, Scutellaria Root, Inula Flower, Apricot Kernel, Ginger Juice, and Bamboo Sap is suitable. Baohe Tang (Preserve Harmony Decoction) also treats this condition. If there is no fluid retention or phlegm, but only rebellious Qi from fire, the patient does not cough during the day but experiences coughing and panting upon lying down, indicating that the Qi cannot breathe smoothly. This is due to Lung萎 (Lung Withering) and scorched lung lobes; lying flat causes the lung lobes to lift, and Qi rushes upward, causing incessant coughing. Qingzao Jiufei Tang (Clear Dryness and Rescue the Lung Decoction) added with Rehmannia Root, Trichosanthes Root, Lily Bulb, and Schisandra Berry should be used to astringe, followed by Zeolite to anchor and descend the Qi. Furthermore, Lung fluids are generated from the Kidney. If Kidney Water fails to nourish the Upper Jiao, causing rebellious Qi to rush upward and resulting in coughing and inability to lie down, treatment should focus on the Kidney. Liuwei Wan (Six-Ingredient Pill) added with Shenmai San (Ginseng and Ophiopogon Powder), along with Achyranthes Root to guide Qi downward and Magnetite to attract Metal Qi so that it returns to its root, is appropriate.
Insomnia (Bu Mei) presents with two syndromes: one is Heart disease, and the other is Liver disease.
For insomnia due to Heart disease, the Heart houses the Spirit. Blood deficiency leads to reckless movement of Fire, causing the Spirit to be unsettled, resulting in restlessness and insomnia. Zhang Zhongjing prescribed Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) as the primary treatment. For insomnia due to Yin deficiency and phlegm disturbance unsettling the Spirit, Zhuling Tang (Polyporus Decoction) is used. One clears Fire, and the other promotes urination. Generally, if the Heart Spirit is unsettled, it is either due to phlegm or Fire. I frequently use Zhusha Anshen Wan (Cinnabar Calming the Spirit Pill) added with Poria and Succinum, or Tianwang Buxin Dan (Emperor of Heaven's Tonifying the Heart Pill).
For insomnia due to Liver disease, the Liver houses the Hun (Ethereal Soul). When awake, the Hun travels to the eyes; when sleeping, it returns to the Liver. If Yang floats outward and the Hun does not enter the Liver, insomnia occurs. The symptoms do not include restlessness, but rather being alert yet unable to sleep. It is appropriate to astringe the floating Yang and Hun to allow them to enter the Liver. Erjia Longgu Tang (Two-Added Dragon Bone Decoction) added with Schisandra Berry, Sour Jujube Seed, and Donkey-Hide Gelatin should be used. Alternatively, if Phlegm in the Liver Channel disturbs the Hun causing insomnia, Wendan Tang (Warm the Gallbladder Decoction) added with Sour Jujube Seed is used. If Fire in the Liver Channel causes many dreams and difficulty sleeping, Suanzaoren Tang (Sour Jujube Seed Decoction) is used. Or, Huashi Bu Gan San (Master Hu's Liver-Tonifying Powder) with Du Huo removed, added with Morinda Root, Siwu Tang (Four-Substance Decoction), Pinellia Tuber, Sour Jujube Seed, Cordyceps Sinensis, Dragon Bone, and Albizia Bark, is also excellent.
Additionally, although the Hun resides in the Liver and travels to the eyes during the day, the eyes are located on the face, governed by the Lung and Stomach. If the Qi of the Lung and Stomach is disturbed and restless, it can also repel the Hun outside, preventing its return. Treatment should involve Rehmannia Root, Lily Bulb, Ophiopogon Root, Anemarrhena Rhizome, Aurantium, Schisandra Berry, White Peony Root, Licorice Root, Sour Jujube Seed, Trichosanthes Root, and Poria. Renshen Qingfei Tang (Ginseng Lung-Clearing Decoction) also treats this. There is also insomnia due to deficiency palpitations and fear, treated with Ren Shu San (Ren Shu Powder). Insomnia due to excessive worry all night is treated with Guipi Tang (Restore the Spleen Decoction) added with Schisandra Berry. Refer to the chapter on Palpitations and Restless Heart for details.
There is also a condition of lethargy and excessive sleep. In miscellaneous diseases, this is pathogenic factors entering the Yin level. In blood-loss deficiency consumption, it is due to Yuan Qi (Primal Qi) failing to support the body after blood loss, leading to drowsiness. If accompanied by sweating and panting, it is a critical emergency, treated urgently with Shen Fu Tang (Ginseng and Aconite Decoction). Awakening belongs to Yang, so inability to awaken indicates Yang deficiency, treated with Renshen Yangrong Tang (Ginseng Nourishing Glory Decoction). If the body feels heavy, with fatigue and a desire to lie down, it is Dampness in the Spleen Channel, treated with Pingwei San (Level the Stomach Powder) added with Polyporus and Alisma. Liujunzi Tang (Six-Gentleman Decoction) added with Stephania Root and Coix Seed, or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) can also be used. This discussion on excessive sleep mostly attributes it to Yang deficiency. However, there are cases of lethargy and excessive sleep due to severe Fire in the Gallbladder Channel, treated with Longdan Xiegan Tang (Gardenia and Gentian Decoction to Drain the Liver).
Dreams occur because the Hun and Po interact with external objects, creating illusory visions. When the Hun is diseased, one dreams of women, flowers, plants, immortals, and joyful events, treated with Suanzaoren Tang. When the Po is diseased, one dreams of startling phenomena, ghosts, monsters, and fights, treated with Renshen Qingfei Tang added with Succinum. The visions seen in dreams are essentially the Hun and Po themselves. The Hun is benevolent, and the Po is malevolent; thus, Hun-dreams are mostly good, and Po-dreams are mostly bad. However, what governs the Hun and Po is the Shen (Spirit). Therefore, calming the Spirit is the key to treating dreams, using Yiqi Anshen Tang (Qi-Nourishing Spirit-Calming Decoction). There are also dreams caused by "labor worms" (parasites associated with tuberculosis), treated according to the methods for labor worms. Dreams accompanied by nocturnal emission are detailed in the Nocturnal Emission chapter.
Further notes: Sleeping while disliking light and preferring darkness indicates Fire Pathogen. Side-sleeping with an inability to turn over indicates dysfunction of the Shaoyang pivot. Side-sleeping on one side is detailed in the Cough chapter.