Insomnia refers to a disorder in which patient can not have normal or enough sleep. Clinically, it has different manifestations. In mild cases, it is manifested  as difficulty in getting to sleep, easy to wake up and unable to sleep again after waking. In severe cases, it is manifested as sleeplessness during the whole night. 

There are different factors which leads to insomnia. They are as the following: over anxiety and overwork impairing the heart and spleen, a breakdown of the nor mal physiological coordination between the heart and kidney, hyperactivity of liver yang due to yin deficiency, qi deficiency of t he heart and gallbladder and disorder of stomach qi, etc.. 

Insomnia resulting from emotional upset, or from a noisy environment or an uncomfortable sleeping position is not a disease.     

I. Keys of Diagnosis 
1. In mild cases, it is manifested as difficulty in getting to sleep, easy to wake up and unable to sleep again after waking for over three weeks. In severe cases, it is manifested as sleeplessness during the whole night. 

2. Often accompanied with headache, dizziness, palpitation, amnesia, tiredness, restlessness, dreaminess, etc.. 

3. No organic disorders which may disturber sleeping.   

II.  Differentiation in TCM  
1.  Deficiency of the Heart and Spleen  
Difficulty in going to sleep, easy to wake up with excessive dreams during sleep. Palpitations, amnesia, spontaneous sweating, lusterless complexion, fatigue, weakness, abdominal distension, and loose stool. Pale tongue with a thin whitish coating, a thready and weak pulse. 

2. Hyperactivity of Fire due to yin Deficiency 
Insomnia, restlessness, or easy to wake up after a short sleep. Hot sensation in the palms and soles, severe palpitations, night sweating, a dry mouth and throat, dizziness, tinnitus, amnesia, seminal emission, soreness and weakness of the  waist and knees. Red tongue, a thready rapid pulse. 

3.  Disorder of Stomach qi 
Restlessness and insomnia. Vexation with a full sensation in the heart, gastric distension, belching, dizziness, even vomiting with phlegm. A yellow and greasy  tongue coating, a slippery or wiry pulse. 

4. Flaring up of Excessive Liver Fire  
Sleeplessness with dizziness and headache. Irritability and easy to be scared, redness of the eyes, tinnitus, a bitter taste in the mouth, hypochondriac pain. Red tongue with a thin yellowish coating, a wiry and rapid pulse.   

III.  Treatment of Acupuncture and Moxibustion  
1. Traditional Acupuncture Method  
(1) Deficiency of heart and spleen 
Treatment principle: Strengthening qi and nourishing blood. 
Main points: Pishu (BL 20), Xinshu (BL 15), Shenmen (HT 7), Sanyinjiao (SP 6). 
Manipulation: Puncture Pishu and Xinshu obliquely inward 0.5-1.0 cun,  Shenmen perpendicularly 0.5-0.8 cun, Sanyinjiao perpendicularly 1.0  cun. Use the reinforcing method. Moxibustion may also be used. 

(2) Hyperactivity of fire due to yin Deficiency 
Treatment principle: Nourishing yin to reduce pathogenic fire. 
Main points: Shenshu (BL 23), Xinshu (BL 15), Taixi (KI 3), Daling (PC 7), Taichong (LR 3), Shenmen (HT 7). 
Manipulation: Puncture Xinshu and Shenshu obliquely inward 0.5-0.8 cun, and the other points perpendicularly 0.5-1.0 cun. It is advisable to apply the reinforcing and reducing methods simultaneously.

(3) Disorder of stomach qi 
Treatment principle: Removing phlegm and dampness to restore the normal function of the stomach.
Main points: Zhongwan (CV 12), Fenglong (ST 40), Tianshu (ST 25), Neiguan (PC 6) .   Manipulation: Puncture all the points perpendicularly 1-1.5 cun with the reducing method. 

(4) Flaring up of excessive liver fire 
Treatment principle: Calming liver yang and lowering hyperactive liver fire. 
Main Points: Ganshu (BL 18), Danshu (BL 19), Xingjian (LR 2), Zuqiaoyin (GB 44).  
Manipulation: Puncture Ganshu and Danshu obliquely inward 0.5-0.8 cun,  Xingjian perpendicularly 0.5 cun. Prick Zuqiaoyin to cause bleeding.  Use the reducing method. 

2. Other Therapies 
(1) Auricular acupuncture therapy  
Ear points: Subcortex, Sympathesis, Heart, Kidney, Endocrine, Ear Shenmen, etc. Method: Needle-embedding therapy is applicable; or applies seedplastering method. Keep the needles and seeds for 3-4 days in summer or 4-5 days in winter.  

(2) Cutaneous needle therapy
Mild tapping the zones along the sides of spinal column, sacral region and temples till the skin becoming reddish slightly. Give the treatment once a day or very second day.   

IV.  Notes  
1. Acupuncture and moxibustion are effective in treating this disease. It can also cure insomnia patients who have taken sedative-hypnotics for a long time without any effect. 

2. Insomnia is generally not fatal, but chronic cases can produce mental stress and affect the patients' health and work. 

3. Treating insomnia which is caused by fever, pain, cough and asthma, etc. should aim at treating the primary disease. 

4. The stress in treating insomnia should lay on the regulation of the internal  Zang organs, e.g. strengthening the heart and spleen, nourishing yin  to reduce pathogenic fire, removing phlegm and regulating stomach qi, calming the liver to subdue fire, etc.. 

5. In treating insomnia, patients are advisable to take part in sports and physical work, so as to have an easy mind and get rid of worries and nervousness.  

By Xu Li, Meng Hong,etc.