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Insomnia (bude mian) is a common manifestation of yin-yang imbalance. In the context of cold damage diseases, Yangming disease is the primary cause of insomnia. If it were Shaoyin disease, the patient should present with drowsiness (yumi); the current presentation of insomnia occurs because yang qi has entered the Shaoyin meridian, which is not the typical pathology of Shaoyin disease.

Causes for insomnia include those resulting from prior sweating or purging, those arising without such interventions, and those caused by iatrogenic fire therapy errors; treatments are detailed in their respective sections. Generally, insomnia is associated with heat syndromes. However, in cases where Taiyang disease patients experience daytime restlessness and inability to sleep after sweating and purging, Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction) is used not to treat the contracted cold pathogen, but to restore yang qi lost through excessive sweating and purging.

Although insomnia is a frequent symptom, if a Shaoyin disease patient presents with deep and fine pulse, spontaneous diarrhea, irritability, and inability to sleep, it indicates a critical condition (death). Similarly, in cold damage, fever accompanied by diarrhea, cold limbs, irritability, and inability to lie flat also signifies a critical condition due to the failure of healthy qi and yang qi to recover.

The *Huoren Shu* states: Sweat is the fluid of fire; excessive sweating leads to mental confusion and insomnia. Extreme heat causes unclear spirit and insomnia. Severe purging damages blood; since the Heart governs blood, this leads to insomnia. After recovery, if residual heat remains and yin qi has not recovered, insomnia occurs.

[Taiyang Disease]
In Taiyang disease, if within two to three days the patient cannot lie down but wishes to sit up, there must be palpable obstruction in the epigastrium. With a faint pulse, this indicates cold-fluid retention. Treat with Guizhi Jia Houpo Zizi Tang (Cinnamon Twig Decoction plus Magnolia Bark and Apricot Seed).
In cold damage with floating pulse, if forced sweating via fire therapy causes panic, mania, tossing and turning, treat with Guizhi Qu Shaoyao Jia Shujie Longgu Muli Jiuni Tang (Cinnamon Twig Decoction minus Peony plus Pinellia Prepared, Dragon Bone, and Oyster Shell to Rescue from Reversal).
After purging followed by sweating, if the patient is irritable and unable to sleep during the day but quiet at night, without vomiting, thirst, or exterior syndrome, with a deep and faint pulse and no significant heat, treat with Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction).
Patients prone to epistaxis should not undergo sweating; if sweated, they may develop sunken temples, tight pulse, fixed gaze, and insomnia (treat with Huangqin Shaoyao Tang).
After cold damage purging, if the patient experiences vexation, abdominal fullness, and restlessness, treat with Zhizi Houpo Tang (Gardenia and Magnolia Bark Decoction).
After sweating, vomiting, or purging, if deficiency vexation leads to insomnia, tossing and turning, and inner regret, treat with Zhizi Chidui Tang (Gardenia and Fermented Soybean Decoction).
After Taiyang disease sweating, if stomach dryness causes insomnia and thirst, give small amounts of water to resolve it.

[Yangming Disease]
Body heat, eye pain, nasal dryness, and inability to lie down, with long pulses at all three positions, indicate Yangming disease involvement. If the patient has difficult urination, alternating difficulty and ease of defecation, slight fever, panting, and vertigo preventing lying down, this indicates dried feces accumulation; use Dachengqi Tang (Major Order the Qi Decoction).
In Yangming disease, with floating-tight pulse, dry throat, bitter taste, abdominal fullness, panting, fever, sweating, aversion to heat rather than cold, and heavy body, if moxibustion is added, the patient will likely feel terrified, irritable, and unable to sleep; use Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction).

[Shaoyin Disease]
In Shaoyin disease, if drowsiness persists for two to three days followed by vexation and inability to sleep, treat primarily with Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction).

Huanglian Ejiao Tang Formula
Huanglian (Coptidis Rhizoma) (4 liang), Huangqin (Scutellariae Radix) (2 liang), Shaoyao (Paeoniae Radix Alba) (2 liang), Ejiao (Colla Corii Asini) (3 liang), Jizihuang (Ovi Gallus Albumen) (2 units).
Boil the first three herbs in five sheng of water to obtain two sheng, strain, dissolve Ejiao, let cool slightly, add Jizihuang, mix well, and take seven he of warm decoction three times daily. (Cheng Wuji notes: Excess yang is cleared with bitter flavors; Coptis and Scutellaria clear heat. Insufficient yin is tonified with sweet flavors; Ovi Gallus Albumen and Colla Corii Asini nourish blood. Sour flavors astringe; Paeoniae Radix Alba astringes yin and drains pathogenic heat. However, if illness persists after taking Ovi Gallus Albumen, it is proposed to add Danggui (Angelicae Sinensis Radix), Renshen (Ginseng Radix), Fuling (Poria), and Baizhu (Atractylodis Macrocephalae Rhizoma) in equal parts to the previous four herbs for immediate effect.)

If Shaoyin disease involves diarrhea and drowsiness, and after six to seven days presents with cough, vomiting, thirst, vexation, and insomnia, use Zhuling Tang (Polyporus Decoction) (see Diarrhea section).
If Shaoyin disease presents with drowsiness, deep-fine pulse, no vexation, desire to vomit, and progresses to spontaneous diarrhea with irritability and insomnia on the fifth or sixth day, it is fatal.
Fever, diarrhea, cold limbs, irritability, and inability to lie flat are fatal signs.

Wu's Commentary:
In Taiyang disease, with floating-numerous pulse, body ache, anhidrosis, irritability, and insomnia, induce sweating for cure.
For Yangming superficial heat with headache, eye pain, body heat, nasal dryness, inability to lie down, and long pulse, use Gegen Jiemi Tang (Kudzu Root Muscle-Releasing Decoction) to induce sweating.
If spontaneous sweating,洪-numerous pulse, interior-exterior heat, vexation, thirst, and dry tongue occur, use Baitu Jia Renshen Tang (White Tiger Plus Ginseng Decoction).
If steaming heat and hard constipation occur, use Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction) to purge.
If external cold damage has resolved but worsens due to dietary indiscretion, causing stifling sensation, dry retching, dry mouth, groaning, delirium, and insomnia, use Huanglian Jiedu Tang (Coptis Detoxification Decoction).
If interior-exterior severe heat with dry tongue and thirst occurs, use Renshen Baitu Tang combined with Jiedu Tang.
For Shaoyang fever, bitter taste, vexation, insomnia, and wiry-numerous pulse, use Xiaochaihu Tang (Minor Bupleurum Decoction) plus Huanglian and Zhizi. For deficient individuals with insufficient fluids, add Maidong and Suanzaoren.
After Taiyang sweating, if insomnia occurs with floating-numerous pulse, slight heat, vexation, thirst, and dysuria, use Wuling San (Five-Ingredient Powder with Poria). If the pulse is large-numerous, use Renshen Baitu Tang or Zhuye Shigao Tang; do not use Wuling San.
For deficiency vexation and insomnia after sweating/purging, select from Jiawei Wendan Tang, Suanzaoren Tang, Zhizi Wumei Tang, or Zhusha Anshen Wan.

Appendix:
Suanzaoren Tang: Treats deficiency vexation, rushing qi in the chest, and insomnia.
Suanzaoren (Stir-fried), Renshen, Fuling (each 1.5 qian), Guixin (0.5 qian), Shigao (2.5 qian), Zhimu, Gancao (each 1 qian), Shengjiang (3 slices).
Decoct one dose in two zhong of water to one zhong, strain, and take before bed.

Qianjin Liushui Tang: Treats deficiency vexation and insomnia.
Maidong (de-heart), Banxia, Gancao, Huanglian, Yuanzhi, Renshen, Bibi (each 1 qian), Fushen, Suanzaoren (each 1.5 qian), Guixin (0.5 qian), Shengjiang (3 slices), Mi (1 he).
Boil running water in two and a half zhong until crab-eye bubbles appear, ladle ten thousand times to obtain two zhong of water, then decoct herbs to one zhong, strain, and take warm.

Jiawei Wendan Tang: Treats deficiency vexation and insomnia after Taiyang disease, attributed to gallbladder cold.
Banxia (washed), Suanzaoren (stir-fried, each 1.5 qian), Lvzhishi, Chenpi, Gancao (each 1 qian), Renshen (2.5 qian), Fushen (2 qian), Zhuru (one ball), Shengjiang (3 slices).
Decoct in two zhong of water to one zhong, strain, and take warm. If internal heat/vexation, double Huanglian and Maidong. If dry mouth/tongue, remove Banxia, add Maidong, Wuweizi, Tianhuafen. If exterior heat remains, add Ruanmiao Chaihu. If interior deficiency with loose stools, remove Zhishi, add Baizhu and Fuling. If interior excess with severe vexation, add Zhiren.

Suanzaoren Tang (Variant): Treats insomnia day and night after vomiting/purging.
Suanzaoren (stir-fried, 2.5 qian), Maidong, Fushen, Dangguishen (each 2 qian), Gancao, Zhimu, Chuanxiong (each 1.5 qian), Ganjiang (0.3 qian), Shengjiang (3 slices).
Decoction method as above.

Zhizi Wumei Tang
Zhizi, Huangqin, Gancao, Renshen, Maidong (each 1 qian), Chaihu (2 qian), Wumei (2 units), Shengjiang (3 slices), Zhuye (14 leaves).
Decoction method as above.

Huanglian Jiedu Tang: Treats severe heat, dry retching, delirium, groaning, and insomnia.
Huanglian (2.5 qian), Huangqin, Huangbai (each 0.5 liang), Zhizi (4 units).
Decoct in two and a half zhan of water to one and a half zhan, strain, and divide into two doses.