考前哲方书，别有虚烦一门，然大抵不外于不眠，而愚既拈之于伤寒余证中，故不复赘。
病由卫独行阳 大病之后，脏腑尚虚，荣卫未和，故生于冷热。阴气虚，卫气独行于阳，不入于阴，
故不得眠。若心烦不得眠者，心热也。若但虚烦而不得眠者，胆冷也。（《病源论》）（按∶此本于经义，故首
拈之。）
今人久坐夜宴，及劳神过度，反不得眠，是卫气久留于阳，阳主动，理可见矣。（《六要》）
饮浓茶则不寐，心有事亦不寐者，以心气之被伐也。盖心藏神，为阳气之宅也。卫主气，司阳气之化也。
凡卫气入阴则静，静则寐，正以阳有所归，故神安而寐也。而浓茶以阴寒之性，大制元阳，阳为阴抑，则神索
不安，是以不寐也。又心为事扰则神动，神动则不静，是以不寐也。故欲求寐者，当养阴中之阳，及夫静中之动，
则得之矣。（《景岳》）
所因有等 不寐有二种∶有病后虚弱，及年高人阳衰不寐；有痰在胆经，神不归舍，亦令不寐。（《要
诀》）
春甫谓痰火扰乱，心神不宁，思虑过伤，火炽痰郁，而致不眠者多矣。有因肾水不足，真阴不升而心阳独亢，
亦不得眠。有脾倦火郁，夜卧遂不疏散，每至五更，随气上升而发躁，便不成寐，此宜快脾发郁、清痰抑火之法
也。（《医统》）
病辨邪正 不寐证，虽病有不一，然惟知邪正二字则尽之矣。盖寐本乎阴，神其主也，神安则寐，神
不安则不寐。其所以不安者，一由邪气之扰，一由营气之不足耳。有邪则
多实证，无邪者皆虚证。凡如伤寒、伤风、疟疾之不寐者，此皆外邪深入之扰也。如痰如火，如寒气水气，如
饮食忿怒之不寐者，此皆内邪滞逆之扰也。舍此之外，则凡思虑劳倦，惊恐忧疑，及别无所累，而常多不寐者，
总属真阴精血之不足，阴阳不交，而神有不安其室耳。知此二者，则知所以治此矣。（《景岳》）
脉候 不眠，脉微涩为血虚，寸口浮大有火，兼滑为痰，两尺弦大为肾虚相火炎上。（《医统》）
梦 春甫曰∶心为栖神之所。凡思虑过多，则心血亏耗而神游于外，故多梦。所谓昼之所思，夜之所梦。
神魂根据形而至，形体未到之处，梦亦罕能到也。（《医统》）
凡梦因阴阳之虚实而感之。如肝气盛则常梦怒，治宜平肝之药。如肺气盛则常梦哭，治宜清肺金。如上焦热
则梦飞，治宜降火。如下部虚则梦坠，治宜滋阴之属是也。余可类推。（同上）
《内经》梦事虽分脏腑阴阳，大要总系心肝两脏为主。何也？未有神魂静而梦寐颠倒者也。（《吴医汇讲·日
讲杂纪》）
治分虚实 体气素盛，偶不眠，为痰火所致，宜先用滚痰丸，次用安神丸、清心、凉膈之类。体气素
弱，或因过劳，或因病后，此为不足，宜养血、安神、补心之类。（《医统》）
病后及汗下后与溃疡不得眠，属胆虚，人参、茯神、炒酸枣仁、陈皮、麦冬、龙眼肉为主。脉数实滑有力而
不眠者，中有宿滞痰火，所谓胃不和则卧不安也。心下硬闷，属宿滞不化。硬闷兼恶心口干者，属痰火。宜分别
治。（《六要》）
治宜理痰 大抵惊悸、健忘、怔忡、失志、不寐、心风，皆是胆涎沃心，以致心气不足。若用凉心之剂太
过，则心火愈微，痰涎愈盛，病愈不减，惟当以理痰气为第一义。（《要诀》）
治须养血 凡人劳心思虑太过，必至血液耗亡，而痰火随炽，所以神不守舍，烦数而不寐也。导痰清火
以治其标，稍得效验，仍须养血收神，兼之静定以治其本，则不再复以竭其真也。此心气之主，神思之病，不可
不慎。每见轻浅视之，渐至元神俱竭而不可救者有矣。（《医统》）
无邪而不寐者，必营气之不足也。营主血，血虚则无以养心，心虚则神不守舍，故或为惊惕，或为恐畏，
或若有所系恋，或无因而偏多妄思，以致终夜不寐，及忽寐忽醒而为神魂不安等证，皆宜以养营养气为主治。凡
人以劳倦思虑太过者，必致血液耗亡，神魂无主。所以不寐，即有微痰微火者不必顾，只宜培养气血，血气复则
诸证自退。若兼顾而杂治之，则十暴一寒，病必难愈，渐至元神俱竭而不可救者有矣。（《景岳》）（按∶不寐
有其证属发狂之渐，而不得不伐肝镇心者，今专以补养为主，殆非适中之论，学人宜审虚实而治之可也。）
不得眠，属心血虚有热，忌升、辛燥、热，宜敛、养阴血、清热。（《本草经疏》）
病后不眠治例 凡病后及妇人产后不得眠者，此皆血气虚而心脾二脏不足，虽有痰火，亦不宜过于攻
治，仍当以补养为君，而略佐以清痰火之药。其不因病后而不寐者，须以痰火处治，亦必少佐以养血补虚之药，
方为当也。（《医统》）
服药得寐 凡治病者服药即得寐，此得效之征也。正以
邪居神室，卧必不宁。若药已对证，则一匕入咽，群邪顿退，盗贼甫去，民即得安。此其治乱之机，判于顷刻，
药之效否，即此可知。其有误治妄投者，反以从乱，反以助虐，必致烦恼懊 ，更增不快。知者见几，当以此预知
之矣。（《景岳》）
消饮方 《短剧》流水汤，主虚烦不得眠方。
半夏（二两洗十遍） 粳米（一升） 茯苓（四两）
上三味切，以东流水二斗，扬之三千遍，令劳（按∶《医心》引《玉箱方》作千里流水一石，扬之万遍，取二
斗），煮药取五升，分服一升，日三夜再，忌羊肉、饧、醋物。有半夏，必须着生姜四两，不尔戟人咽。不审古
方何以如此，今改正之。（《外台》）（按∶此方系《灵枢》半夏汤加茯苓。又《千金》举类方数首，今取其一，
录于《嗜眠》中。）
镇心清心诸方 治胆虚不睡，酸枣仁煎方。
酸枣仁（五两微炒捣罗为末取二两半其滓不用） 乳香（三两） 蜜（四两） 牛黄（四分） 糯米（二合）
朱砂（半两）
上件药，用酒一中盏，和蜜等一处，慢火煎如稀饧，不计时候，以温酒调下一茶匙。（《圣惠》）
治胆虚睡卧不安，心多惊悸方。
人参（一两） 白茯苓（一两） 朱砂（半两）
上件捣细罗为散，入朱砂同研令匀，每服不计时候，清粥饮调下一钱。（同上）
治虚劳烦热，不得睡卧，宜服黄芩散方。
黄芩（三分） 甘草（半两） 羚羊角屑 知母 酸枣仁 白茯苓（各一两）
上件药捣，粗罗为散，每服四钱，以水一中盏，入枣三枚，煎至六分去滓，不计时候温服。（《圣惠》）
烦不得眠，六一散加牛黄服之。（即益丸散）（《纲目》引丹溪）
养心安神丸，治心虚多梦，除乱梦、恶梦。
当归身 白茯神 酸枣仁 五味子 犀角 琥珀 玄明粉 黄连 朱砂（为衣） 甘草（熬膏各等分）
为细末，甘草和炼蜜，丸黍米大，每服二十丸，夜卧时津下，久服梦自少，（《医统》）
加味温胆汤，治病后虚烦不寐，或触物惊悸。（《医汇》）（按∶此系于《三因》温胆汤，加人参、酸枣仁、
远志。）
高枕无忧散（云林制），治心胆虚怯，昼夜不睡。百方无效，服此一剂如神。
人参（五钱） 软石膏（三钱） 陈皮 半夏（姜汁浸炒） 白茯苓 枳实 竹茹 麦门冬 龙眼肉 甘
草（各钱半） 酸枣仁（炒一钱）
上锉，水煎服。（《医鉴》）（按∶酸枣诸方既出《伤寒》中，仍不复赘。）
补心诸方 治胆虚不得睡，神思不安，宜服茯神散方。
茯神（一两） 柏子仁（半两） 酸枣仁（一两） 黄 （一两） 人参（一两） 熟干地黄（半两）
远志（半两） 五味子（半两）
上件药筛为散，每服不计时候，以温酒调下一钱。（《圣惠》）《三因》大补心丹，安心神，调血脉，镇惊
补虚，即本方蜜丸如梧子大，用辰砂为衣，每服三十丸，米汤、温酒任下。《是斋》十四友丸，补诸虚不足，益
血，收敛心气，治怔忡不宁，精神昏倦，睡卧不安，于本方去五味子，加紫石英、川当归、白茯苓、阿胶、
肉桂、龙齿、辰砂、炼蜜丸，此韩魏公方。
治虚劳，起动汗出，恒热多惊恚，不得睡卧，宜服茯神散方。
茯神 人参 熟干地黄 牡蛎（烧为粉） 麦门冬 酸枣仁 黄 龙骨（各一两） 五味子 苍术 甘草（各半
两）
上件药捣，粗罗为散，每服四钱，以水一中盏，入生姜半分，枣三枚，煎至六分去滓，不计时候温服。
（《圣惠》）（按∶此方苍术可疑，宜去而不用。又此方即《千金》枣仁汤变方，宜与《虚劳》相参。）
治劳心胆冷，夜卧不睡，定志丸，加炒酸枣仁，炒柏子仁，共为末，蜜丸如梧子大，朱砂、乳香为衣，每
服五十丸，枣汤送下。（《医鉴》）
破气方 苏合香丸，若用心过度，夜睡不安，临卧以酒调服，其功不在妙香散、宁志膏之下。（《易简》）
附睡法 睡不厌 ，觉不厌舒。 者，曲膝卷腹，以左右肋（《慈航》肋作勿）侧卧，修养家所谓狮子
眠是也。西山蔡季通，引《千金方》睡诀云∶睡则必侧（《慈航》睡则而屈），觉正而伸，早晚以时，先睡心，后睡眼。
晦庵以为此古今未发之妙。（《寿世》）
查阅前代医家方书，另有“虚烦”这一门类，但大抵都不外乎不眠证。我既然将其归纳在伤寒病的余证中，所以不再赘述。
病机在于卫气独自行于阳分。大病之后，脏腑仍然虚弱，营卫之气尚未调和，因此产生寒热错杂之象。阴气虚弱，卫气独自运行于阳分，不能入于阴分，所以导致无法入睡。如果心中烦乱且无法入睡，这是心热的表现。如果只是单纯的心烦意乱而无法入睡，这是胆冷的表现。（出自《诸病源候论》）（按：此理论本于经典经义，所以首先提出。）
现代人久坐参加夜间宴会，以及过度劳神，反而导致无法入睡，这是因为卫气长时间停留在阳分。阳主运动，其道理由此可见。（出自《医学六要》）
饮用浓茶会导致失眠，心中有事也会导致失眠，这是因为心气受到损伤。大概心是藏神的器官，是阳气居住的宅邸。卫气主管气化，负责阳气的生化。凡是卫气进入阴分则人安静，安静就能入睡，正是因为阳气有所归属，所以心神安宁而能入睡。然而浓茶具有阴寒的性质，极大地抑制了元阳，阳气被阴寒所压抑，那么心神就会索然不安，因此导致失眠。另外，心事干扰心脏则心神躁动，心神躁动就不能安静，因此导致失眠。所以想要获得睡眠，应当滋养阴中之阳，以及静中之动，这样就能得到安睡了。（出自《景岳全书》）
病因分类 不寐有两种情况：一是病后身体虚弱，以及老年人阳气衰退导致的不寐；二是痰浊阻滞在胆经，神魂不能回归本舍，也导致不寐。（出自《医宗金鉴·要诀》）
薛立斋认为，痰火扰乱，心神不宁，思虑过度受伤，火热炽盛、痰浊郁结，而导致不眠的情况很多。有因为肾水不足，真阴不能上升而心阳独自亢盛，也不能入睡的。有脾脏疲倦、火邪郁结，夜晚卧床时气机不能疏散，每到五更时分，随着气机上升而发躁，便无法成眠，这种情况适宜用疏畅脾气、发散郁结、清化痰浊、抑制火邪的方法治疗。（出自《医统》）
辨别病邪与正气 不寐的病证，虽然病情不一，但只要懂得“邪”和“正”这两个字就概括尽了。大概睡眠根本在于阴，神是主宰，神安宁就能入睡，神不安宁就不能入睡。之所以神不安宁，一方面是由邪气干扰，另一方面是由营气不足所致。有邪气的多为实证，没有邪气的都是虚证。例如像伤寒、伤风、疟疾等引起不寐的，这都是外邪深入体内的干扰。像痰浊、火热、寒气、水气，以及饮食停滞、愤怒情绪等引起不寐的，这都是内邪滞逆的干扰。除此之外，凡是因思虑劳累、惊恐忧虑怀疑，以及没有其他牵累，却经常多梦失眠的，总属于真阴精血不足，阴阳不能相交，而神没有安定的居所罢了。知道了这两点，就知道如何治疗这些病症了。（出自《景岳全书》）
脉象候诊 不眠，脉象微涩为血虚，寸口脉浮大表示有火，兼见滑脉为有痰，两尺脉弦大为肾虚相火上炎。（出自《医统》）
梦境 薛立斋说：心是神灵栖息的处所。凡是思虑过多，就会耗损心血而让神游荡于体外，所以多梦。所谓白天思考什么，晚上就梦见什么。神魂依附形体而至，形体未到达的地方，梦境也很少能到达。（出自《医统》）
凡是梦境都是因阴阳的虚实感应而产生的。如肝气旺盛则常梦见发怒，治疗宜用平肝的药物。如肺气旺盛则常梦见哭泣，治疗宜清肃肺金。如上焦有热则梦见飞翔，治疗宜降火。如下部虚损则梦见坠落，治疗宜滋阴类药物。其余可类推。（同上）
《黄帝内经》关于梦境的事虽区分脏腑阴阳，但大体总以心、肝两脏为主。为什么呢？没有神魂安静而梦境颠倒混乱的情况。（出自《吴医汇讲·日讲杂纪》）
治疗分为虚证与实证 体质素来强壮，偶尔不眠，是由痰火引起的，适宜先用滚痰丸，再用安神丸、清心丸、凉膈散之类。体质素来虚弱，或因过度劳累，或因病后，这属于不足，适宜养血、安神、补心之类。（出自《医统》）
大病之后及汗法、下法治疗后，以及溃疡病患者出现不得眠，属于胆虚，以人参、茯神、炒酸枣仁、陈皮、麦冬、龙眼肉为主药。脉象数实滑有力而不眠的，中有宿食停滞、痰火，这就是所说的“胃不和则卧不安”。心下硬闷，属于宿食停滞不化。硬闷兼恶心口干者，属于痰火。应当分别治疗。（出自《医学六要》）
治疗宜调理痰气 大概惊悸、健忘、怔忡、失志、不寐、心风，都是由于胆中涎沫浸渍心脏，以致心气不足。如果使用清心凉的药剂太过，则心火更加微弱，痰涎更加旺盛，病情不会减轻，只应当以调理痰气为第一要义。（出自《医宗金鉴·要诀》）
治疗须养血 凡人劳心思虑太过，必定导致血液耗亡，而痰火随之炽盛，所以神不守舍，烦躁多次而无法入睡。用导痰、清火的方法来治标，稍微见效后，仍须养血收神，配合静心定志来治本，这样才能不再竭尽真气。这是心气之主、神思之病，不可不慎。常见有人轻视看待，逐渐导致元神俱竭而无法挽救的情况。（出自《医统》）
没有邪气干扰而不寐的，必然是营气不足。营主血，血虚则无法养心，心虚则神不守舍，所以有时惊恐惕励，有时恐惧畏缩，有时好像有所牵挂留恋，有时无缘无故偏多妄思，以致整夜不寐，或者忽睡忽醒而出现神魂不安等证，都适宜以养营养气为主要治疗方法。凡是因为劳倦思虑太过的人，必定导致血液耗亡，神魂无主。所以不寐，即使有微量的痰火也不必顾虑，只宜培养气血，气血恢复则各种症状自然消退。如果兼顾而杂乱治疗，则十次暴治一次寒凉，病必难愈，逐渐导致元神俱竭而无法挽救的情况。（出自《景岳全书》）（按：不寐有其证候属于发狂的先兆，而不得不伐肝镇心的，现在专门以补养为主，恐怕不是适中的论述，学习者应当审察虚实而治疗即可。）
不得眠，属于心血虚且有热，忌用升提、辛燥、热性药物，宜用收敛、滋养阴血、清热之法。（出自《本草经疏》）
病后不眠的治疗案例 凡是病后及妇女产后不得眠的，这都是气血虚弱而心脾两脏不足，虽然有痰火，也不宜过于攻伐治疗，仍当以补养为主，略微佐以清化痰火的药物。那些不因病后而不寐的，必须以痰火来处理治疗，也必须少佐以养血补虚的药物，这才是恰当的。（出自《医统》）
服药后得眠 凡是治病的人服药后即能入睡，这是见效的征兆。正因为邪气占据神室，睡觉必然不宁静。如果药物对症，那么一匕药入口咽下，群邪顿时退去，盗贼刚去，百姓即得安宁。这是治乱的关键，判断于顷刻之间，药物的效果与否，由此可知。如果有误治妄投的，反而助长乱象，反而帮助虐邪，必定导致烦恼懊恼，更加增加不适。明智的人见到征兆，应当以此预先知晓。（出自《景岳全书》）
消饮方 《短剧方》流水汤，主治虚烦不得眠方。
半夏（二两，洗十遍） 粳米（一升） 茯苓（四两）
以上三味切碎，用东流水二斗，扬之三千遍，令其劳（按：《医心方》引《玉箱方》作千里流水一石，扬之万遍，取二斗），煮药取五升，分服一升，日三次夜两次，忌羊肉、饴糖、醋物。因为有半夏，必须加生姜四两，否则刺人咽喉。不知古方为何如此，现在改正它。（出自《外台秘要》）（按：此方系《灵枢》半夏汤加茯苓。又《千金方》列举数首方剂，现取其一，录于《嗜眠》篇中。）
镇心清心诸方 治疗胆虚不睡，酸枣仁煎方。
酸枣仁（五两，微炒捣罗为末，取二两半，其渣不用） 乳香（三两） 蜜（四两） 牛黄（四分） 糯米（二合） 朱砂（半两）
以上药物，用酒一中盏，和蜜等一处，慢火煎如稀饧，不计时候，以温酒调下一茶匙。（出自《太平圣惠方》）
治疗胆虚睡卧不安，心多惊悸方。
人参（一两） 白茯苓（一两） 朱砂（半两）
以上捣细罗为散，入朱砂同研令匀，每服不计时候，清粥饮调下一钱。（同上）
治疗虚劳烦热，不得睡卧，宜服黄芩散方。
黄芩（三分） 甘草（半两） 羚羊角屑 知母 酸枣仁 白茯苓（各一两）
以上药物捣碎，粗罗为散，每服四钱，以水一中盏，入枣三枚，煎至六分去滓，不计时候温服。（出自《太平圣惠方》）
心烦不得眠，六一散加牛黄服之。（即益元散）（出自《本草纲目》引丹溪）
养心安神丸，治疗心虚多梦，除乱梦、恶梦。
当归身 白茯神 酸枣仁 五味子 犀角 琥珀 玄明粉 黄连 朱砂（为衣） 甘草（熬膏各等分）
为细末，甘草和炼蜜，丸黍米大，每服二十丸，夜卧时津下，久服梦自少，（出自《医统》）
加味温胆汤，治疗病后虚烦不寐，或触物惊悸。（出自《医汇》）（按：此系于《三因极一病证方论》温胆汤，加人参、酸枣仁、远志。）
高枕无忧散（云林制），治疗心胆虚怯，昼夜不睡。百方无效，服此一剂如神。
人参（五钱） 软石膏（三钱） 陈皮 半夏（姜汁浸炒） 白茯苓 枳实 竹茹 麦门冬 龙眼肉 甘草（各钱半） 酸枣仁（炒一钱）
以上锉碎，水煎服。（出自《医鉴》）（按：酸枣仁诸方既出《伤寒论》中，仍不再赘述。）
补心诸方 治疗胆虚不得睡，神思不安，宜服茯神散方。
茯神（一两） 柏子仁（半两） 酸枣仁（一两） 黄芪（一两） 人参（一两） 熟干地黄（半两） 远志（半两） 五味子（半两）
以上药物筛为散，每服不计时候，以温酒调下一钱。（出自《太平圣惠方》）《三因方》大补心丹，安心神，调血脉，镇惊补虚，即本方蜜丸如梧子大，用辰砂为衣，每服三十丸，米汤、温酒任下。《是斋百一选方》十四友丸，补诸虚不足，益血，收敛心气，治疗怔忡不宁，精神昏倦，睡卧不安，于本方去五味子，加紫石英、川当归、白茯苓、阿胶、肉桂、龙齿、辰砂、炼蜜丸，此为韩魏公方。
治疗虚劳，起动汗出，恒热多惊恚，不得睡卧，宜服茯神散方。
茯神 人参 熟干地黄 牡蛎（烧为粉） 麦门冬 酸枣仁 黄芪 龙骨（各一两） 五味子 苍术 甘草（各半两）
以上药物捣碎，粗罗为散，每服四钱，以水一中盏，入生姜半分，枣三枚，煎至六分去滓，不计时候温服。（出自《太平圣惠方》）（按：此方苍术可疑，宜去而不用。又此方即《千金方》枣仁汤变方，宜与《虚劳》篇相参。）
治疗劳心胆冷，夜卧不睡，定志丸，加炒酸枣仁，炒柏子仁，共为末，蜜丸如梧子大，朱砂、乳香为衣，每服五十丸，枣汤送下。（出自《医鉴》）
破气方 苏合香丸，若用心过度，夜睡不安，临卧以酒调服，其功不在妙香散、宁志膏之下。（出自《易简方》）
附睡法 睡觉不厌蜷曲，醒来不厌舒展。蜷曲者，曲膝卷腹，以左右肋侧卧，修养家所谓狮子眠是也。西山蔡季通，引《千金方》睡诀云：“睡则必侧，觉正而伸”，早晚按时，先睡心，后睡眼。晦庵朱熹认为这是古今未发的奥妙。（出自《寿世保元》）
Consulting the prescription books of former sages, there is a separate category called "Empty Vexation" (Xu Fan), but it essentially does not go beyond insomnia. Since I have already categorized it among the residual syndromes of Cold Damage (Shanghan), I will not elaborate further.
The pathology lies in the Wei Qi (Defensive Qi) moving alone in the Yang aspect. After a severe illness, the Zang-Fu organs remain deficient, and Ying Qi (Nutritive Qi) and Wei Qi are not harmonized, thus generating sensations of cold and heat. When Yin Qi is deficient, Wei Qi moves alone in the Yang and does not enter the Yin, resulting in the inability to sleep. If one experiences mental vexation and cannot sleep, this indicates Heart Heat. If there is only empty vexation and an inability to sleep, this indicates Gallbladder Cold. (From *Zhu Bing Yuan Hou Lun*) [Note: This theory originates from classical scriptures, hence it is presented first.]
Modern people who sit for long periods attending night banquets, or those who overwork their minds, often suffer from insomnia because Wei Qi remains in the Yang aspect for too long. Yang governs movement; the principle is evident here. (From *Yi Xue Liu Yao*)
Drinking strong tea leads to insomnia; having worldly concerns also leads to insomnia, because the Heart Qi is damaged. The Heart stores the Shen (Spirit) and is the residence of Yang Qi. Wei Qi governs Qi transformation and is responsible for the metabolism of Yang Qi. Whenever Wei Qi enters the Yin, the body becomes quiet, and quietness allows for sleep. Precisely because Yang has a place to return to, the Shen is peaceful, and sleep occurs. However, strong tea possesses a Yin-Cold nature that severely suppresses Yuan Yang (Original Yang). When Yang is suppressed by Yin, the Shen becomes restless and uneasy, leading to insomnia. Furthermore, when worldly matters disturb the Heart, the Shen becomes agitated; agitation prevents stillness, leading to insomnia. Therefore, to seek sleep, one should nourish the Yang within Yin, and the movement within stillness, thereby achieving rest. (From *Jing Yue Quan Shu*)
Etiological Classification There are two types of insomnia: one is due to post-illness weakness and the decline of Yang in the elderly; the other is caused by Phlegm obstructing the Gallbladder Meridian, preventing the Hun and Po (Soul and Corporeal Soul) from returning to their dwelling, also causing insomnia. (From *Yao Jue*)
Xue Fuzheng stated that Phlegm-Fire disturbing and unsettling the Shen, excessive worry injuring the mind, blazing Fire with stagnant Phlegm, often leads to insomnia. Some cases arise from insufficient Kidney Water, where True Yin fails to ascend while Heart Yang flares independently, also preventing sleep. In cases of Spleen fatigue with Fire stagnation, Qi fails to disperse during night rest; at dawn (Wu Geng time), Qi rises upward causing irritability, making sleep impossible. Such cases require methods to invigorate the Spleen, resolve stagnation, clear Phlegm, and suppress Fire. (From *Yi Tong*)
Differentiating Pathogenic Factors and Healthy Qi Although insomnia presents with various symptoms, understanding the concepts of "Pathogen" (Xie) and "Healthy Qi" (Zheng) suffices to explain them all. Sleep fundamentally relies on Yin, with Shen as its master. When Shen is peaceful, one sleeps; when Shen is unsettled, one does not sleep. The reasons for Shen's unrest are either disturbance by pathogenic factors or insufficiency of Ying Qi. Cases with pathogens are mostly Excess syndromes; those without pathogens are Deficiency syndromes. For instance, insomnia caused by Cold Damage, Wind Strike, or Malaria results from deep invasion of external pathogens. Insomnia caused by Phlegm, Fire, Cold Qi, Fluid Retention, dietary stagnation, or anger results from internal pathogenic stagnation and reversal. Outside of these, insomnia caused by excessive worry, fatigue, fright, anxiety, or doubt, without other specific causes, generally belongs to insufficiency of True Yin, Essence, and Blood. It involves the failure of Yin and Yang to interact, leaving the Shen without a stable abode. Understanding these two aspects reveals the treatment principles. (From *Jing Yue Quan Shu*)
Pulse Diagnosis In insomnia, a faint and choppy pulse indicates Blood deficiency. A floating and large pulse at the Cun position indicates Fire; if accompanied by a slippery pulse, it indicates Phlegm. A wiry and large pulse at both Chi positions indicates Kidney deficiency with ministerial Fire flaming upward. (From *Yi Tong*)
Dreams Xue Fuzheng said: The Heart is the dwelling place of the Shen. Excessive thinking consumes Heart Blood, causing the Shen to wander outside, resulting in frequent dreaming. As the saying goes, "What is thought by day is dreamed by night." The Hun and Po arrive according to the physical form; where the form does not reach, dreams rarely occur. (From *Yi Tong*)
All dreams are induced by the excess or deficiency of Yin and Yang. For example, excessive Liver Qi leads to dreams of anger; treatment should use herbs to soothe the Liver. Excessive Lung Qi leads to dreams of crying; treatment should clear Lung Metal. Heat in the Upper Jiao leads to dreams of flying; treatment should descend Fire. Deficiency in the Lower Jiao leads to dreams of falling; treatment should use Yin-nourishing agents. Other cases can be inferred similarly. (Ibid.)
Although *Nei Jing* classifies dreams by Zang-Fu and Yin-Yang, the general principle centers on the Heart and Liver. Why? There is no case where the Shen is calm yet dreams are chaotic and inverted. (From *Wu Yi Hui Jiang*)
Treatment Differentiated by Excess and Deficiency For those with robust constitution who occasionally suffer from insomnia due to Phlegm-Fire, initially use Gun Tan Wan (Rolling Phlegm Pill), followed by An Shen Wan (Calming Spirit Pill), Qing Xin San (Clear Heart Powder), or Liang Ge San (Cool Diaphragm Powder). For those with weak constitution, or due to overwork, or post-illness, this is a Deficiency pattern. Treatment should focus on nourishing Blood, calming the Spirit, and tonifying the Heart. (From *Yi Tong*)
Insomnia after severe illness, or following sweating and purging therapies, or in patients with ulcers, belongs to Gallbladder Deficiency. Main herbs include Ren Shen (Ginseng), Fu Shen (Poria with Hostwood), Chao Suan Zao Ren (Fried Sour Jujube Seed), Chen Pi (Tangerine Peel), Mai Dong (Ophiopogon Tuber), and Long Yan Rou (Longan Aril). If the pulse is rapid, solid, slippery, and forceful with insomnia, it indicates retained food stagnation and Phlegm-Fire internally—this is what is meant by "When the Stomach is discordant, sleep is disturbed." Hardness and fullness below the heart indicate undigested food retention. Hardness/fullness accompanied by nausea and dry mouth indicates Phlegm-Fire. These must be treated separately. (From *Yi Xue Liu Yao*)
Treatment Should Regulate Phlegm Generally, palpitations, amnesia, panic, loss of will, insomnia, and Heart Wind are all caused by Gallbladder fluid overflowing into the Heart, leading to Heart Qi deficiency. If cooling Heart agents are used excessively, Heart Fire becomes weaker, Phlegm-fluid increases, and the disease persists. The primary principle must be regulating Phlegm-Qi. (From *Yao Jue*)
Treatment Requires Nourishing Blood Excessive mental labor inevitably depletes Blood, allowing Phlegm-Fire to flourish. Consequently, the Shen does not reside in its house, causing烦躁 (vexation) and insomnia. Using Phlegm-resolving and Fire-clearing methods treats the branch; once slight improvement is seen, one must nourish Blood and gather the Shen, combined with mental stillness to treat the root, so as not to exhaust True Qi again. This is a disease of the Heart Qi master and Shen thoughts; caution is essential. It is common to see such cases dismissed lightly, gradually leading to exhaustion of Yuan Shen (Original Spirit) and incurable states. (From *Yi Tong*)
In cases of insomnia without pathogenic factors, it is necessarily due to Ying Qi deficiency. Ying governs Blood; Blood deficiency fails to nourish the Heart, Heart deficiency causes the Shen to lose its residence. Thus, one may experience fright, fear, attachment, or baseless obsessive thoughts, leading to all-night insomnia or waking frequently with unsettled Shen. All such patterns should be primarily treated by nourishing Ying and Qi. Anyone suffering from excessive fatigue and worry inevitably depletes Blood, leaving the Shen without a master. Regarding insomnia, even if there is slight Phlegm or Fire, do not focus on them; instead, cultivate Qi and Blood. Once Qi and Blood recover, other symptoms recede naturally. If one tries to treat everything simultaneously and杂乱ly, using ten parts aggressive treatment and one part cooling, the disease will be hard to cure, potentially leading to irreversible exhaustion of Yuan Shen. (From *Jing Yue Quan Shu*) [Note: Some insomnia cases are precursors to mania, requiring Liver-subduing and Heart-calming interventions. Focusing solely on tonification here may not be appropriate; students should examine Excess and Deficiency before treating.]
Insomnia due to Heart Blood deficiency with Heat contraindicates ascending, acrid-dry, and hot herbs. Instead, use astringent, Yin-nourishing Blood, and Heat-clearing methods. (From *Ben Cao Jing Shu*)
Post-Illness Insomnia Treatment Examples Insomnia after illness or postpartum in women is due to Qi and Blood deficiency and insufficiency of the Heart and Spleen. Even if Phlegm-Fire exists, harsh attacking treatments are inappropriate. Tonification should be the main approach, slightly assisted by herbs that clear Phlegm and Fire. For insomnia not caused by post-illness weakness, treat based on Phlegm-Fire, but always slightly assist with Blood-nourishing and Deficiency-tonifying herbs. This is the correct approach. (From *Yi Tong*)
Sleep Upon Medication Administration If a patient falls asleep immediately after taking medicine, it is a sign of efficacy. This is because pathogens occupy the chamber of the Shen, causing restless sleep. If the medicine matches the syndrome, upon swallowing, pathogens retreat instantly; like thieves fleeing, the people find peace. The shift from chaos to order happens in an instant; the efficacy of the drug is known here. If misdiagnosed and wrongly prescribed, it exacerbates chaos and aids evil, causing greater vexation and discomfort. Wise practitioners recognize signs early and predict outcomes accordingly. (From *Jing Yue Quan Shu*)
Formula for Eliminating Fluids *Duan Ju* Formula: Liu Shui Tang, governing empty vexation and insomnia.
Ban Xia (Pinellia Rhizome, 2 liang, washed 10 times) Jing Mi (Rice, 1 sheng) Fu Ling (Poria, 4 liang)
Cut the three ingredients. Use 2 dou of East-flowing water, stir 3,000 times to aerate (Note: *Yi Xin Fang* cites *Yu Xiang Fang* using 1 stone of Thousand-Li Flowing Water, stirred 10,000 times, to obtain 2 dou). Decoct the herbs to yield 5 sheng. Divide into doses of 1 sheng, taken three times daily and twice nightly. Avoid mutton, maltose, and vinegar products. Because Ban Xia is used, add 4 liang of Sheng Jiang (Fresh Ginger); otherwise, it will irritate the throat. The reason for the ancient prescription's format is unclear; it is corrected here. (From *Wai Tai Mi Yao*) [Note: This formula is Ban Xia Tang from *Ling Shu* plus Fu Ling. *Qian Jin Fang* lists several similar formulas; one is recorded here under "Hypersomnia".]
Formulas for Calming and Clearing the Heart: Suan Zao Ren Decoction for Gallbladder Deficiency Insomnia.
Suan Zao Ren (Sour Jujube Seed, 5 liang, lightly fried, pounded, sifted; take 2.5 liang, discard dregs) Ru Xiang (Frankincense, 3 liang) Mi (Honey, 4 liang) Niu Huang (Calculus Bovis, 4 fen) Nuomi (Glutinous Rice, 2 he) Zhu Sha (Cinnabar, 0.5 liang)
Mix the herbs with one zhong of wine and honey. Slowly decoct until resembling thin syrup. Take one tea spoon mixed with warm wine at any time. (From *Tai Ping Sheng Hui Fang*)
Formula for Gallbladder Deficiency Restlessness and Palpitations.
Ren Shen (Ginseng, 1 liang) Bai Fu Ling (White Poria, 1 liang) Zhu Sha (Cinnabar, 0.5 liang)
Pound and sieve into powder. Mix thoroughly with Cinnabar. Take one qian mixed with clear rice broth at any time. (Ibid.)
Huang Qin San for Deficiency Consumption with Vexation and Heat, Inducing Sleep.
Huang Qin (Scutellaria Root, 3 fen) Gan Cao (Licorice Root, 0.5 liang) Ling Yang Jiao (Antelope Horn) Zhi Mu (Anemarrhena Rhizome) Suan Zao Ren (Sour Jujube Seed) Bai Fu Ling (White Poria, 1 liang each)
Pound and sieve coarsely. Take 4 qian per dose. Add three dates to one zhong of water. Decoct to 60%. Strain and take warm at any time. (From *Tai Ping Sheng Hui Fang*)
For vexation and insomnia, take Liu Yi San (Six-One Powder) added with Niu Huang (Calculus Bovis). (Also known as Yi Yuan San) (From *Ben Cao Gang Mu* citing Dan Xi)
Yang Xin An Shen Wan for Heart Deficiency with Frequent Dreams, Removing Chaotic and Nightmares.
Dang Gui Shen (Angelica Sinensis Root Body) Bai Fu Shen (White Poria with Hostwood) Suan Zao Ren (Sour Jujube Seed) Wu Wei Zi (Schisandra Berry) Xi Jiao (Rhinoceros Horn - *Note: Substitute with Buffalo Horn in modern practice*) Hu Po (Amber) Xuan Ming Fen (Mirabilite) Huang Lian (Coptis Rhizome) Zhu Sha (Cinnabar, coating) Gan Cao (Licorice Root, paste, equal parts)
Make fine powder. Mix with Licorice paste and refined honey. Form pills the size of millet seeds. Take 20 pills swallowed with saliva before bed. Long-term use reduces dreaming. (From *Yi Tong*)
Jia Wei Wen Dan Tang for Post-Illness Empty Vexation and Insomnia, or Startle/Palpitations upon Contact. (From *Yi Hui*) [Note: Based on Wen Dan Tang from *San Yin Fang*, adding Ren Shen, Suan Zao Ren, and Yuan Zhi.]
Gao Zhen Wu You San (Prepared by Yunlin) for Heart-Gallbladder Deficiency Fear, Day and Night Insomnia. Effective when hundred prescriptions fail. One dose works miraculously.
Ren Shen (Ginseng, 5 qian) Ruan Shi Gao (Soft Gypsum, 3 qian) Chen Pi (Tangerine Peel) Ban Xia (Pinellia, soaked in Ginger Juice and fried) Bai Fu Ling (White Poria) Zhi Shi (Immature Bitter Orange) Zhu Ru (Bamboo Shavings) Mai Men Dong (Ophiopogon Tuber) Long Yan Rou (Longan Aril) Gan Cao (Licorice Root, 1.5 qian each) Suan Zao Ren (Sour Jujube Seed, fried, 1 qian)
Chop and decoct in water. (From *Yi Jian*) [Note: Formulas containing Suan Zao Ren originate from *Shang Han Lun*; they are not repeated here.]
Formulas for Tonifying the Heart: Fu Shen San for Gallbladder Deficiency Insomnia and Mental Unease.
Fu Shen (Poria with Hostwood, 1 liang) Bai Zi Ren (Biota Seed, 0.5 liang) Suan Zao Ren (Sour Jujube Seed, 1 liang) Huang Qi (Astragalus Root, 1 liang) Ren Shen (Ginseng, 1 liang) Shu Di Huang (Prepared Rehmannia Root, 0.5 liang) Yuan Zhi (Polygala Root, 0.5 liang) Wu Wei Zi (Schisandra Berry, 0.5 liang)
Sieve into powder. Take one qian mixed with warm wine at any time. (From *Tai Ping Sheng Hui Fang*) *San Yin Fang* Da Bu Xin Dan (Great Heart-Tonifying Pill) calms the Spirit, regulates blood vessels, settles fright, and tonifies deficiency. It uses the above formula made into honey pills the size of wu zi seeds, coated with Chen Sha (Vermilion). Take 30 pills with rice soup or warm wine. *Shi Zhai Fang* Shi Si You Wan (Fourteen Friends Pill) tonifies various deficiencies, benefits Blood, gathers Heart Qi, treats panic and restlessness, mental fatigue, and sleep disturbance. It modifies the above formula by removing Wu Wei Zi, adding Zi Shi Ying (Fluorite), Chuan Dang Gui (Angelica Sinensis), Bai Fu Ling (White Poria), E Jiao (Donkey-Hide Gelatin), Rou Gui (Cinnamon Bark), Long Chi (Dragon Teeth), Chen Sha (Vermilion), and refined honey. This is the formula of Duke Han Wei.
Fu Shen San for Deficiency Consumption with Sweating on Movement, Constant Heat, Fright/Irritability, and Insomnia.
Fu Shen (Poria with Hostwood) Ren Shen (Ginseng) Shu Di Huang (Prepared Rehmannia) Mu Li (Oyster Shell, calcined to powder) Mai Men Dong (Ophiopogon Tuber) Suan Zao Ren (Sour Jujube Seed) Huang Qi (Astragalus) Long Gu (Dragon Bone, 1 liang each) Wu Wei Zi (Schisandra) Cang Zhu (Atractylodes Rhizome) Gan Cao (Licorice Root, 0.5 liang each)
Pound and sieve coarsely. Take 4 qian per dose. Add half a piece of Sheng Jiang (Fresh Ginger) and three dates to one zhong of water. Decoct to 60%. Strain and take warm at any time. (From *Tai Ping Sheng Hui Fang*) [Note: Cang Zhu is questionable in this formula and should be omitted. This is a variation of Zao Ren Tang from *Qian Jin Fang*; refer to the "Deficiency Consumption" chapter.]
Ding Zhi Wan for Heart Labor and Gallbladder Cold causing Night Insomnia. Add fried Suan Zao Ren and fried Bai Zi Ren. Pound into powder, make honey pills the size of wu zi seeds, coated with Zhu Sha (Cinnabar) and Ru Xiang (Frankincense). Take 50 pills sent down with Jujube Soup. (From *Yi Jian*)
Qi-Breaking Formula: Su He Xiang Wan (Styrax Pill). For excessive mental exertion causing restless sleep, take with wine before bed. Its efficacy rivals Miao Xiang San and Ning Zhi Gao. (From *Yi Jian Fang*)
Appendix: Sleeping Methods Do not dislike curling up when sleeping; do not dislike stretching when waking. Curling up means bending knees and drawing in the abdomen, lying on the left or right side (Note: *Ci Hang* says "Do Not"). Cultivators call this "Lion's Sleep." Cai Jitong of Xishan cited the *Qian Jin Fang* sleeping maxim: "Sleep on the side, wake straight and stretch." Observe morning and evening timing. First put the Heart to sleep, then the eyes. Zhu Xi (Hui'an) considered this an unexplored profound secret. (From *Shou Shi Bao Yuan*)