Prof. Kong Lingxu’s Experience in TCM Treatment of Insomnia

　　By Peng Jin, (Institute of TCM Basic Theories, China Academy of Traditional Chinese Medicine, Beijing 100700)
　

In over 30 years of clinical practice, Prof. Kong Lingxu has adopted a great multitude of formulae for treatment of insomnia, and cured many severe and lingering cases with his unique experience in the use of specific drugs on the basis of syndrome-and disease-differentiations. The following are some examples.

Promoting Coordination between the Heart and Kidney and Nourishing Yin to
Tranquilize the Mind

Mr. Li, 37 years Old, paid his first visit on Sept. 2, l997. The patient complained of insomnia with dream-disturbed sleep, which occurred one year before when he was attending a training course and often stayed late studying. The accompanying symptoms were irritability and forgetfulness, inability to concentrate his mind, nocturnal emission, tinnitus, soreness and pain in the waist, dry mouth, and feverish sensation in the chest, palms and soles. The tongue was red with then-white coating, and the pulse thready and rapid with a deep and thready chi pulse. It was differentiated as hyperactivity of fire due to Yin-deficiency, and incoordination between the heat and kidney. Treatment was given for nourishing Yin to reduce pathogenic fire, and restoring coordination between the heart and the kidney. Prescription: “Huanglian (Rhizoma Coptidis) l0g, Rougui (Cortex Cinnamomi)5g, (Zhi) Biejia (Carapax Trionycis Praeparata) 15g, Sangjisheng (Herba Taxilli) 20g, Niuxi (Radix Achyranthes Bidentatae) 10g, Shengdihuang (Radix Rehmanniae) l5g, Shanyurou (Fructus Corni) 10g, Fuling (Poria) l5g, and Longchi (Dens Draconis) 15g. The above drugs were decocted in water for a one-day dose and orally taken for seven days. After that, irritability and dream-disturbed sleep were improved. Another 20 doses were given, which brought about sound sleep, and disappearance of nocturnal emission, soreness and pain in the waist, and all the other symptoms.

Comment: In this case, the heart and kidney are affected. Its pathogenesis is consumption and deficiency of the kidney Yin, which fails in ascending to nourish the heart, leading to hyperactivity of the heart-Yang, which disturbs the mind and causes insomnia, and dysphoria with feverish sensation in the chest, palms and soles. Tinnitus and forgetfulness are attributed to deficiency and consumption of the essence and hollowed sea of marrow, soreness and weakness to malnutrition of the kidney, waist, and nocturnal emission to incoordination between the heart and kidney. Prof. Kong holds that the fundamental cause of this case is the Yin-deficiency of the heart and kidney. Here, the fire pertains to deficient fire, which is entirely different from the excessive pathogenic fire due to flaring up of the heart-fire. So, the treatment should be given for enriching the deficient aspect, and fire-purging drugs bitter in taste and cold in property should not be given. In the above prescription, Huanglian is the only drug used for clearing away the heart-fire and checking the hyperactive heart-yang. Small dose of Rougui (Cortex Cinnamomi) is used for conducting the heart-fire downward to the kidney, i.e. conducting the fire back to its origin. Shengdihuang (Radix Rehmanniae), Shanyurou (Fructus Corni), (Zhi)Biejia (Carapax Trionycis Preparata), Sangjisheng (Herba Taxilli), and Niuxi (Radix Achyranthis Bidentatae) are used for nourishing Yin. Fuling (Poria) is used for nourishing without stagnating, and Longchi (Dens Draconis) for strengthening the effect of tranquilizing the mind.

Clearing Away the Heart-Fire to Tranquilize the Mind

Mr. An, 35 years old, paid his first visit on Oct. 27, l996. The patient had a history of intermittent insomnia for 4 years, which got worse in recent half a year due to frequent night shifts. There appeared even the whole-night sleeplessness. The other symptoms were irritability, changeable moodiness which affected his work, dry mouth and throat, yellow and scanty urine, red tongue with thin-yellow coating, and rapid pulse. It was differentiated as exuberant fire in the Heart Meridian disturbing the mind. The treatment was given for clearing away the heart-fire, soothing the heart and calming the mind.

Prescription: Huanglian (Rhizoma Coptidis)10g, Zhizi (Fructus Gardeniae) 10g, Danzhuye (Herba Lophatheri) 10g, Shengdihuang (Radix Rehmanniae) 25g, Maidong (Radix Ophiopogonis) 10g, Baishao (Radix Paeoniae Alba) l5g, Yujin (Radix Curcumae) 10g, Fuling (Poria) 15g, and (Sheng) Gancao (Radix Glycyrrhizae) 5g. After taking 14 doses of the above prescrition, the symptoms of dry mouth, irritability and yellow-scanty urine were eliminated, and the patient could sleep for 4--6 hours each night. Then, he was treated with “Tianwang Buxin Dan (The Supreme Heart-nourishing Pill), and was cured 2 months later..

Comment: A normal sleep is closely related to the Heart Meridian. Prof. Kong holds that the heart belongs to fire of the five elements, and it is easily stirred-up by pathogenic heat; and that excessive emotional activities may also turn into fire to disturb the heart and make the latter unable to govern the mental activities, hence the appearance of insomnia. Since the heart is exteriorly-interiorly related to the small intestine, the transfer of heat from the heart to the small intestine can give rise to the yellow and scanty urine. In the above prescription, Huanglian (Rhizoma Coptidis), Zhizi (Fructus Gardeniae), and Danzhuye (Herba Loghatheri) can clear away the heart-fire and eliminate irritability. Shengdi (Radix Rehmanniae), Maidong (Radix Ophiopogonis), and Baishao (Radix Paeoniae Alba) can nourish the heart-Yin. Fuling (Poria) is used for diuresis. Therefore, the mind is tranquilized when the heat is eliminated.

Soothing the Liver, Regulating the circulation of Qi, and Relieving Mental Depression to Tranquilize the Mind

Ms. Yan, 68 years old, paid her first visit on March 1l, l997. The patient had insomnia for over 3 months because of the sudden death of her husband. She could only sleep for l hour or 2 hours each night, sometimes even kept sleepless for several days. She was deeply grieved and mourn fully sighed, with fullness in the chest and hypochondrium, dry stool, red tongue with thin-yellow coating, and wiry pulse. The differential diagnosis was stagnation of the liver Qi upward disturbing the mind. Treatment was given for relieving the depressed liver, and regulating the circulation of Qi to tranquilize the mind.

Prescription: Baishao (Radix Paeoniae Alba) l5g, Chaihu (Radix Bupleuri) 10g, Danggui (Radix Angelicae Sinensis) l0g, Fuling (Poria) l5g, Bohe (Herba Menthae) 5g, (Chao) Zaoren (parched Semen Ziziphi Spinosae) 20g, Yujin (Radix Curcumae) l0g, Hehuanpi (Cortex Albiziae) l5g, Longgu (Os Draconis) l5g, (Sheng) Muli (raw Concha Ostreae) 30g, Huangqin (Radix Scutellariae) 10g, Caojueming (Semen Cassiae) 25g, and Gancao (Radix Glycyrrhizae) 5g. After the administration of 7 doses of the above prescription, the above symptoms were improved. Zhenzhufen (powder of Margarita) 1.2g, and Hupofen (powder of Succnum) 2g were then added to the original prescription. After administration of more than 40 doses, all the symptoms and signs disappeared with a basically normal sleep.

Comment: This patient is mentally injured, resulting in insomnia due to the failure of the liver in promoting free flow of Qi, which upward disturbs the mind. Prof Kong holds that the liver dominates free flow of Qi, and that soothing the liver is to improve the function of the liver. Therefore, modified “Xiao Yao San (Ease Powder)"should be used for regulating the liver Qi. Dry stool and red tongue are the signs of the depressed liver-Qi turning into heat, which should be cleared away by adding Huangqin (Radix Scutellariae) and Caojueming (Semen Cassiae). Longgu (Os Draconis) and Muli (Concha Ostreae) are used for tranquilizing the mind. The prescription given on the basis of differentiation of both symptoms and diseases can surely enhance the therapeutic effect. On the second visit when all the symptoms were alleviated, Zhenzhufen (powder of Margarita) and Hupofen (powder of Succinumn) were added for strengthening the effect of relieving depression of the liver and tranquilizing the mind.

Purging Pathogenic Fire from the Liver to Relieve Irritability and Tranquilize the Mind

Mr. Wu, 40 years old, paid his first visit on Sep. l9, l996. The patient had a hot temper. One year before, he got insomnia after a dispute with his colleague. The accompanying symptoms were dizziness with distention in the eyes, irritability and peevishness, bitter taste in the mouth, dark urine, constipation, red tongue with yellow coating, and wiry-rapid pulse (more obvious at the left Guan pulse). It was differentiated as a case of disturbed mind by liver-heat. The patient was treated by purging the liver of pathogenic fire to eliminate irritability and tranquilize the mind.
Prescription: (Sheng) Shijueming (raw Concha Haliotidis) 30g, Chaihu (Radix Bupleuri) l0g, Huangqin (Radix Scutellariae) l0g, Zhizi (Fructus Gardeniae) l0g, Longdancao (Radix Gentianae) 6g, Shengdihuang (Radix Rehmanniae) 15g, Baishao (Radix Paeoviae Alba) 20g, Danggui (Radix Angelicae Sinensis) l0g, Fuling (Poria) 15g, Zhishi (Frutus Aurantii Immaturus) l0g, Lingyangfen (Powder of Cornu Saigae Tataricae, taken separately after infusion in hot water) 0.6g. The above prescription was given one dose daily for 7 consecutive days. On the second visit, the patient reported that he could sleep for 4-5 hours each night, and the dizziness and distention sensation in the eyes were also alleviated, yet bitter taste in the mouth, and yellow urine still remained. Another l4 doses of the prescription were given, which brought about a complete recovery.

Comment: Prof. Kong holds that the liver plays a very important role in regulating the mental activity; if it is injured by anger, the liver-fire will go upward to cause a hyperactive mental activity, thus resulting in insomnia, irritability, dizziness and vertigo, dry mouth with bitter taste, yellow urine, and constipation. That is why the modified “Longdan Xie Gan Tang (Decochon of Gentian for Purging the Liver-fire)"was used for the patient. The drug Shijueming (Concha Haliotidis) has the effect of calming down the hyperactive liver-Yang. For excessive liver-heat or hyperactivity of the liver-Yang, add Lingyangfen (Powder of Cornu Saigae Tataricae) to enhance clinical therapeutic effect.

Nourishing the Liver-Yin and Calming the Endogenous Wind to Tranquilize the Mind

Ms. Lin, 64 years old, paid her first visit on April l8, l997. The patient suffered from insomnia for about 10 years. She usually had a dream-disturbed sleep, easy to be waken up, which went worse in recent half a year. She could only sleep for 2 hours each night, accompanied by dry mouth with desire for drink, unconscious shaking of the head, dryness of the eyes with a foreign body sensation, tinnitus, red tongue with thin and white coating, and wiry-thready-rapid pulse. It was differentiated as deficiency of the liver-Yin, with stirring-up of endogenous wind of the deficiency type. Treatment was given for nourishing the liver-Yin and calming the endogenous wind to tranquilize the mind.

Prescription: Nüzhenzi (Fructus Ligustri Lucidi) l0g, Hanliancao (Herba Ecliptae) l5g, Shanyurou (Fructus Corni) l0g. Gouqizi (Fructus Lycii) 15g, Baishao (Radix Paeoniae Alba) l0g, Shengdihuang (Radix Rehmanniae) l5g, (Chuan) Shihu (Herba Dendrobii) l5g, Shanyao (Rhizoma Dioscoreae) 20g, Fuling (Poria) l5g, and (Chao) Zaoren (parched Semen Ziziphi Spinosae) l5g, which were decocted to be taken one dose daily for 7 consecutive days. On the second Visit, the patient's sleep was improved and dry mouth and foreign body sensation in the eyes were alleviated. Then, (Zhi) Biejia (Carapax Trionycis Preparata) 15g and (Sheng) Muli (raw Concha Ostreae) 30g were added for another one-month treatment. The patient could then sleep for 4--6 hours each night.

Comment: Prof. Kong holds that the liver responds to moistness and is averse to dryness. Moistness marks the liver soft which ensures a normal activity. The aged people with prolonged illness are susceptible to deficiency with consumption of the Yin-essence. Deficiency of the liver-Yin may result in restlessness of the mind due to stirring-up of the endogenous wind, hence the appearance of unconscious shaking of the head, foreign body sensation in the eyes, tinnitus, sleeplessness and irritability. In the above prescription, “Er Zhi Wan (Two Solstices Pill) added with Shanyurou (Fructus Corni), Gouqi (Fructus Lycii), Shengdihuang (Radix Rehmanniae), Shanyao (Rhizoma Dioscoreae), and Shihu (Herba Dendrobii) are all used for nourishing the liver-Yin; Fushen (Poria cum Ligno Hospite), Suanzaoren (Semen Ziziphi Spinosae) for tranquilization; and (Zhi) Biejia (Carapax Trionycis Preparata) and (Sheng) Muli (raw Concha Ostreae) for nourishing Yin and suppressing the hyperactive Yang, so as to make the Yin-blood ample and the endogenous liver-wind controlled.

Clearing Away Phlegm-Heat and Regulating the Middle-jiao to Tranquilize the Mind

Ms. Sun, 42 years old, paid her first visit on Dec. l8 1997. The patient had a history of intermittent insomnia for 6 years, usually with less sleep but lots of dreams. In the recent one month, the condition went worse. She had difficulty in falling asleep and often woke up at 2 o'clock in the morning. After that, it was difficult for her to fall asleep again. The accompanying symptoms were chest distress, poor appetite, stomach distention, heavy sensation in the head, red tongue with yellow and sticky coating, and rolling pulse. It was differentiated as disturbance of the heart by phlegm-heat. The treatment was given for clearing away phlegm-heat and regulating the Middle-jiao to tranquilize the mind. Prescription: “Huanglian (Rhizoma Coptidis) 10g, Zhishi (Fructus Aurantii Immaturus) l5g, Zhuru (Caulis Bambusae in Taeniam 20g, (Qing) Banxia (Rhizoma Pinelliae) 15g, Fuling (Poria) l5g, Chenpi (Pericarpium Citri Reticulatae) l0g, Chuanbeimu (Bulbus Fritillariae Cirrhosae) 10g, Yuanzhi (Radix Polygalae) l0g, Longgu (Os Drasonis) l5g, and (Chao) Maiya (parched Fructus Hordei Germinatus) l5g, which were decocted to be orally taken one dose daily for 7 consecutive days. On the second visit, the patient reported postponement of the waking-up time from 2 a.m. to 4 a.m., and turning of the tongue coating from yellow-sticky to thin-yellow. Another 20 doses of the decoction were given, and the patient was cured.

Comment: Prof. Kong holds that in the clinical differentiation of insomnia, although attention should be paid mainly to the regulating of the heart, spleen, liver, and kidney, yet disturbance of the mind by phlegm-heat can not be ignored. For those insomnia patients accompanied by chest distress and distention, heaviness of the head, red tongue with yellow-sticky coating, and rolling pulse, the principle of treatment should be clearing away the phlegm-heat and regulating the Midddle-jiao to tranquilize the mind. Prof. Kong is good at using the modified “Huanglian Wen Dan Tang"for this kind of condition. In the above prescription, Banxia (Rhizoma Pinelliae), Chenpi (Pericarpium Citri Reticulatae), Zhuru (Caulis Bambusae in Taeniam), and Zhishi (Fructus Aurantii Immaturus) are used for regulating circulation of Qi and resolving phlegm. Yuanzhi (Radix Po1ygalae), Chuanbeimu (Bulbus Fritillariae Cirrhosae) are often added according to the actual condition. The formation of phlegm indicates the dysfunction of the Middle-jiao. Therefore, (Chao) Maiya (parched Fructus Hordei Germinatus) is added for stopping the source of phlegm formation, and Longgu (Os Draconis) added for enhancing the effect of tranquilization.

Promoting Blood Circulation and Removing Obstruction in the Meridian to Tranquilize the Mind

Ms. Zhang, 60 years old, paid her first visit on Dec 30, l997. The patient had a history of rheumatic heart disease. In recent five years, she often had insomnia and had been treated by herbal medicine for nourishing the heart and tranqui1izing the mind, acupuncture and moxibustion, and magnet therapy, with no obvious therapeutic effects. She complained of difficulty in dropping a sleep, often being dream-disturbed and waken up. The accompanying symptoms were headache, palpitation, poor memory, pricking pain in the anterior chest region and the back, dull tongue proper with ecchymoses at the edge and tip and white-rolling coat, and deep pulse. It was differentiated as obstruction of the meridians by blood stasis, with unsmooth flow of Yang-Qi. Treatment was given for promoting blood circulation to remove obstruction from the meridians and tranquilize the mind.

Prescription: Guizhi (Ramuls Cinnamomi) l0g, Taoren (Semen Persicae) 10g, Chishao (Radix Paeoniae Rubra) l0g, Danshen (Radix Salviae Miltiorrhizae) l5g, Chaihu (Radix Bupleuri) l0g, Yujin (Radix Curcumae) l0g, Zhiqiao (Fructus Aurantii) l5g, Gualou (Fructus Trichosanthis) l5g, Dilong (Pheretima) 15g, Biejia (Parapax Trionycis) l5g, Yejiaoteng (Caulis Polygoni Mu1tiflori) 30g, and Suanzaoren (Semen Ziziphi Spinosae) l5g, which were decocted to be orally taken one dose daily for 7 consecutive days. On the second visit, the sleep turned more peaceful, and the pricking pain in the chest and back was alleviated. Hehuanpi (Cortex Albiziae) l5g, (Qing) Banxia (Rhizoma Pinelliae) l5g were then added, and another 45 doses were given. After that, the patient could sleep for 4-6 hours each night, and was more cheerful and energetic in the daytime.

Comment: Considering the case history and the present condition of the patient that she had had the intractable insomnia for more than five years and had been treated with various therapies without effect, Prof. Kong gives the following differentiation i.e. protracted illness affecting the meridians which causes obstruction of blood stasis in the interior and unsmooth flow of Yang-Qi, leading to derangement of mental activity, hence the occurrence of insomnia. It is stated in the classic medical book “Corrections on the Errors of Medical Works"that if no obvious effect has been shown in the treatment of insomnia with drugs for nourishing the blood and tranquilizing the mind, the prescription of Xuefu Zhuyu Tang (Decoction for Removing Blood Stasis in the Chest) will work wonders. In clinical treatment for patients with protracted insomnia on the basis of a comprehensive differentiation, Prof. Kong often adds such drugs as Taoren (Semen Persicae), Chishao (Radix Paeoniae Rubra), Dilong (Pheretima) and Biejia (Trionycis Praeparata) for promoting blood circulation to remove blood-stasis from the meridians and tranquilize the mind, which usually produce miraculous therapeutic effects.