By Peng Jin

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- differentiation. The following are some examples.

Case one
Mr. Lee, 37 years old, paid his first visit on Sept. 2, 1997. 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 thin-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 in-coordination between the heart and kidney.

Treatment was given for nourishing yin to reduce pathogenic fire, and restoring coordina-
tion between the heart and the kidney.
Prescription: Huang Lian (Rhizoma Coptidis) 10g, Rou Gui (Cortex Cinnamomi) 5g, Zhi Bie Jia (Carapax Trionycis Preparata) 15g, Sang Ji Sheng (Herba Taxilli) 20g, Niu Xi (Radix Achyranthis Bidentatae) 10g, Sheng Di (Radix Rehmanniae) 15g, Shan Yu Rou (Fructus Corni) 10g, Fu Ling (Poria) 15g, and Long Chi (Dens Draconis) 15g. The above herbs 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 taken, 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 kidney essence and hollowed sea of marrow, soreness and weakness to malnutrition of the kidney, waist, and nocturnal emission to in-coordination 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 herbs bitter in taste and cold in property should not be given. In the above prescription, Huang Lian(Rhizoma Coptidis) is the only drug used for clearing away the heart-fire and checking the hyperactive heart-yang. Small dose of Rou Gui (Cortex Cinnamomi) is added for conducting the heart-fire downward to the kidney, i.e. conducting the fire back to its origin. Sheng Di (Radix Rehmaninae), Shan Yu Rou (Frnctus Corni), Zhi Bie lia (Carapax Trionycis Preparata), Sang Ji Sheng (Herba Taxilli), and Niu Xi (Radix Achyranthis Bidentatae) are used for nourishing yin. Fu Ling (Poria) is used for nourishing without stagnating, and Long Chi (Dens Draconis) for strengthening the effect of tranquilizing the mind.

Case two
Mr. An, 35 years old, paid his first visit on Oct. 27, 1996. 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 Channel disturbing the mind.

The treatment was given for clearing away the heart-fire, soothing the heart and calming the mind.
Prescription: Huang Lian (Rhizoma Coptidis) 10g, Zhi Zi (Fructus Gardeniae) 10g, Dan Zhu Ye (Herba Lophatheri) 10g, Sheng Di (Radix Rehmanniae) 25g, Mai Dong (Radix Ophiopogonis) 10g, Bai Shao (Radix Paeoniae Alba) 15g, Yu Jin (Radix Curcumae) 10g, Fu Ling (Poria) 15g, and Sheng Gan Cao (raw Radix Glycyrrhizae) 5g. After taking 14 doses of the above prescription, 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, and was cured 2 months later.

Comment: A normal sleep is closely related to the Heart Channel. Prof. Kong holds that the heart belongs to fire of the five elements, and it is easily disturbed 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 and interior 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, Huang Lian (Rhizoma Coptidis), Zhi Zi (Fructus Gardeinae), and Dan Zhu Ye (Herba Lophatheri) can clear away the heart-fire and eliminate irritability. Sheng Di (Radix Rehmanniae), Mai Dong (Radix Ophiopogonis), and Bai Shao (Radix Paeoniae Alba) can nourish the heart-yin. Fu Ling (Poria) is used for diuresis. Therefore, the mind is tranquilized when the heat is eliminated. (to be continued)