The Chinese medical approach to insomnia

It is important to know one concept within its metaphorical system to understand Chinese medicine and insomnia. The word “shen” translates to spirit, but in this context refers to one’s consciousness/alertness. There is an important saying that goes: the shen is rooted in the blood. For purposes here, it denotes that if one wants to settle consciousness, ie fall sleep, the shen must retreat into the blood.

Not every insomnia is the same

As discussed previously, classical Chinese diagnosis works by determining someone’s symptom pattern. There are many different ways that sleep can be improper. Treating with Eastern medicine, paying attention to these differences is the key. This is because each type of insomnia has its own cause and its own treatment. One can broadly categorize these patterns into two groups: insomnia from an excess condition or from a deficiency.

Insomnia from excess

The most common excess condition that leads to insomnia symptoms is “heat”. If there is heat in the system, then “the blood is too hot” and the shen cannot stay within it. This leads to an insomnia pattern that include restless or light sleeping, irritability, and fitful dreams or nightmares. These patients may not have a hard time falling asleep, but a problem staying asleep. It is almost literally that they’re too fired up to stay asleep. An obvious example is caffeine in the blood won’t let you fall asleep. In these cases, one must calm the shen and clear heat.

Insomnia from deficiency

When someone is deficient in qi or blood, depending on the specifics, there can also be insomnia. The Chinese theory here is rather than the blood being too hot for the shen to rest within it, the blood is too thin or weak and it cannot hold the shen within. These patients tend to have a problem going to sleep rather than staying asleep, characterized by anxious thoughts preventing sleep. This can be distressing because, being deficient, the patient feels tired throughout the day yet still can’t fall asleep. Instead of calming and clearing as with excess conditions, the shen must be nourished and the qi or blood tonified.

Neurochemicals of sleep

Though sleep and cognition are still being mapped by Western neuroscience, it is currently known that the sleep-wake cycle depends on the homeostatic balance of particular neurochemical substances. One of the more central substances is melatonin. Light/dark information received by the eyes is filtered through the hypothalamus. This signal in turn triggers the pineal gland to release more melatonin, initiating sleep.

Neurochemicals of wakefulness

Cortisol has been shown to increase in the morning, and in conjunction with an increase in light information received by the eye, induces wakefulness. It has been demonstrated that through the hypothalamic-pituitary axis, melatonin and cortisol are in opposite balance. This means that if cortisol is high, melatonin is low, and vice versa.

Integrative understanding of sleep

When said in a more general sense, this aspect of sleep neuroscience near-perfectly mirrors the Chinese medical thought that too much of one or too little of another biochemical substance in the blood directly affects sleep. This balance of substances can be affected by proper neuroimmunological stimulation with an acupuncture needle or neurochemical alteration by herbal substances, and meditative techniques to calm the mind. These techniques can easily be used alongside the current standard of Western insomnia treatments. These consist of proper sleep hygiene, cognitive behavioral therapy, and chemical sleep aids ranging from melatonin itself to potent sedatives.

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Mayo Clinic, Insomnia

Healthline, How Does Cortisol Affect Your Sleep?

Nature, Characterizing the Temporal Dynamics of Melatonin and Cortisol Changes in Response to Nocturnal Light Exposure