III
Acupuncture for Acupuncture Insomnia Sleep and Dreams in Chinese Medicine
Hamid Montakab, MD Academy of Chinese Healing Arts Winterthur Private Practice Savièse Switzerland
With the collaboration of Solange Montakab-Pont
40 illustrations illustrations
Thieme Stuttgart · New York
IV
Library Library of Congress Congress Cataloging Cataloging-in-Pub -in-Publication lication Data is available available from the publisher publisher..
Some Some of the produc productt names, names, patent patents, s, and regist registered ered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain.
© 2012 Georg Thieme Verlag, Rüdigerstrasse 14, 70469 70469 Stuttgart, Germany http://www.thieme.de Thieme New York, 333 Seventh Avenue, New York, NY 10001, USA http://www.thieme.com
Cover design: Thieme Publishing Group Typesetting by Sommer media GmbH & Co KG, Feuchtwangen, Germany Printed in China by Asia Pacific Offset, Hong Kong
ISBN 978–3–13–164401–5
Important Important note: Medicine is an ever-changing science undergoing continual development. Research and clinical experience experience are continually continually expanding expanding our knowledge, in particular our knowledge of proper treatment and drug therapy. Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of knowledge at the time of production of the book. Nevertheless, this does not involve, imply, or express any guarantee or responsibility on the part of the publishers in respect to any dosage instructions and forms of applications stated in the book. Every user is requested to examine examine carefully carefully the the manufacturers’ leaflets accompanying each drug and to check, if necessary in consultation with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Every Every dosag dosage e schedu schedule le or every every form form of app applic licati ation on used is entirely entirely at the user’s own risk and responsibility. The authors and publishers request every user to report to the publish publishers ers any any discrep discrepanci ancies es or inaccu inaccurac racies ies noticed. If errors in this work are found after publication, errata will be posted at www.thieme.com at www.thieme.com on on the product description page.
123456
This This book, book, includi including ng all parts parts thereof thereof,, is legall legally y proprotected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation, legislation, without the publisher publisher’s consen consent, t, is illegal illegal and liable to prosecution. This applies in particular to photostat photostat reproduction, reproduction, copying, copying, mimeographing mimeographing,, preparation of microfilms, and electronic data processing and storage.
V
Dedicate Dedicated d to the memory of my parents. parents.
Dreaming when Dawn s Left Hand was in the sky I heard a Voice within the Tavern cry, Awake, my Little ones, ones , and fill the Cup Before Life's Liquor in its Cup be dry. ʼ
“
”
The Rubaiyat of Omar Khayyam (11 th century Persian Sufi mystic)
VI
Hamid 2009
VII
Acknowledgements
In the the real realiz izat atio ion n of this this book book I am grea greatl tly y indebted to Master Jeffrey Yuen for having shared with us his profound understanding and knowledge of Chinese Medicine and Daoist philosophy over over the the past past 11 year yearss and and for for allo allowin wing g me to share these gems with the readers. His knowledge has given substance to many of the Chinese theories, helping us to understand and integrate them into modern acupuncture practice. I am grat gratef eful ul to Dr. Dr. Mich Michel el Frey Frey and and Rolan Roland d Solere for their personal contributions, and especially to Dr. Kamran Ghaffari for his invaluable support in reading and commenting my text.
I woul would d like like to than thank k Dr. Dr. Gera Gerald ld Lange Langel, l, coauthor of the Insomnia study project, and Professor K. von Berlepsch for his support and counsel. I woul would d like like to than thank k Ange Angelik likaa Find Findgo gott tt of Thieme Publishers for supporting this book project and her and Deborah Cecere for their painstaking and expert editing editing of the manuscript. manuscript. Finally I would like to express my deep gratitude to my wife Solange —for her input on dream work and, above all, for her unwavering and patient support port of my variou variouss proje project cts. s.
VIII
Foreword
Everyone, at some point in their life, suffers from a sleepless night. Unfortunately, some are haunted by what what appe appears ars to be endl endles esss nigh nights ts with withou outt sleep.While some may say that the nocturnal life depe depend ndss heav heavily ily on how how calm calm we are are and and how how calm the day was, it does not necessarily provide the solutions for those afflicted. The good news is that Dr. Hamid Montakab has created a clinically proven and extremely eclectic synthesis of medical medical traditions that has brought hope and sound sleep to his patients. In add additio ition, n, the shado shadowle wless ss image imagess and the nameless voices expressed in dreams tell us that at the heart of our sleep lies an enduring sense of revelation. Drawing upon dream analysis can provide us with a deeper understanding of life where shen-spirit is confronted with the our psyche or shen-spirit choices, conscious or unconscious, that can further unravel the meaning of our life. From sweet dreams to nightm nightmare ares, s, sign signpos posts ts are fashio fashioned ned for for our undertaking. We may find ourselves awake, only to close our eyes again and let our deep inhalation bring bring us back back to the the huma humann nnes esss of our our plig plight ht.. Some may choose not to return to sleep and lie awake, tossing and turning with the uncertainties of the glimpses they have broken away from. Dr. Montakab explores this process with his insightful methodology to bring tangible results to those suffering from dream disturbances. Insomnia can also be viewed as a continuous challenge of emptying the heart and mind of its sediment, so a new life as expressed by a new day can makes its way into these domains. For some, the new day never comes and life continues in its standstill standstill defiance. defiance. Surrender is the blossoming blossoming of the heart and the welcoming of a new tomorrow. The words on these pages will show the reader how how the heart and mind can dance ecstatical ecstatically ly together in steps toward personal transformation. Hamid Montakab, MD, the inspired author of this book, has taken on the vision and task beyond the current literature available on sleep, insomnia, and dreams. Sharing his vision not only from his understanding of the research from Western medicine cine,, but but also also weav weavin ing g the the wisd wisdom om of Chin Chines ese e
medicine and the influence of French acupuncture, Dr. Dr. Montak Montakab ab has create created d a compre comprehen hensiv sive e approac proach h for for delv delvin ing g into into the the myst mystery ery of slee sleep. p. Beyo Beyond nd the the alph alphaa wa wave ves, s, hormo hormone nes, s, circ circad adian ian rhythms, and wandering hun, hun , Dr. Montakab investigates the significance of sleep to the essence of our spirit. With the integration of these various traditions, the content of this book will provoke the clinician, comfort the patient, and implore the reader to utilize these protocols. Often physicians and clinicians tend to be conservativ servative, e, fearfu fearfull of sayin saying g thing thingss in print print that that might be challenged by their peers as seemingly o r “lacking references.” “unscientific, ” “anecdotal,” or Dr. Montakab, trained in the scientific inquiry, has yet yet also also trekk trekked ed into into the vast abyss abyss of Chines Chinese e medica medicall wisdom wisdom—garn garner ered ed from from cent centur urie iess of empirical practice. I believe he has decided to be brave and to begin sharing his logic with those in both the scientific and clinical community with his synthesis of East and West, so as to open and perhaps stimulate their minds to these other viable and sensible options in the treatment of insomnia. Every now and then a book is written that is not inert matter, mere paper upon which ink has been spread in a specific font, format, and print. Rather, it serves to not only change the way we think but also the way we feel. Not only does it open our minds, it opens our hearts. This book is a product of such endeavors, written and expressed through the intelligence of a clinician who genuinel inely y cares cares abou aboutt our our ordea ordeall in the the strug struggl gle e to achieve restful and restorative sleep. It points the way to a new perspective in its contribution to the profession of Oriental medicine. Metaph Metaphoric orically ally,, sleep sleep is the prepar preparatio ation n for for death—the the pass passag age e that that inst instill illss lettin letting g go and and being at peace. Instead of the curiosity enticed by the light, we move into the darkness. Here lays transformation, for the unknown forces us to surrender. Upon awakening, we are resurrected into a new day. We are refreshed and the opportunity to embrace a new day or mindset is here. Paving the way to new possibilities is bestowed upon us each mornin morning. g. The treatme treatments nts instruc instructed ted in this this text text
Foreword
will serve as an important companion toward that renewal. It is reas reassu surin ring g that that Dr. Dr. Hami Hamid d Monta Montaka kab b is leading the way toward a new healing system that is more more clinica clinically lly effec effectiv tive, e, more more humane humane,, and more cost effective. He continues to demonstrate his brilliance, determination, and altruism in his servitude to humanity in this text.
May this book honor that which has guided the reader reader throu through gh life in that that dance dance we call being asleep. Jeffrey C. Yuen Director of Classical Studies Daoist Traditions Traditions (College of Chinese Medical Arts) Asheville, North Carolina USA
IX
X
Preface
In my almost 40 years of clinical practice it seems to me that that more more and and more more patie patient ntss hav have been been compla complaini ining ng of sleepi sleeping ng problem problems. s. In the early early 1990s I designed a study project which was supported ported by project project No. 4034-3 4034-3587 5871 1 of the Swiss Swiss Nation National al Science Science Founda Foundation tion (Compl (Compleme ementa ntary ry Medicine). At that time I did a lot of research into sleep and acupuncture and was surprised to find so little literature in Chinese medical texts on sleep and sleep pathologies. Although there are clinical textbooks in Chinese Medicine covering all types of pathologies, not a single one is dedicated specifically to sleep, despite sleep being as indispensible to life as air, water, and food. In an average lifetime of 75 years, we spend over 20 years sleeping and about 6 of those dreaming! In my opinion, such an important aspect of human life deserves at least some recognition. In the 1990s, 1990s, variou variouss statist statistical ical data data showe showed d that, that, on avera average ge,, over over 25% of the populatio population n in industrialized industrialized countries suffered suffered from insomnia. insomnia. Today oday this this figure figure is even even highe higherr —clos closer er to 40%. 40%.
Insomnia Insomnia affects affects all age groups including, including, disturbdisturbingly, an increasing number of children. In the the past past deca decade des, s, many many anci ancien entt Chin Chines ese e medical medical princip principles les have have found found explan explanati ation on and justification in modern nuclear physics and advances in medical neuroendocrinology and genetic science. Throughout this book, I have attempted to draw parallels between the ancient oriental theories and modern day discoveries or theories pertaining to sleeping and dreaming. My main concern has been to keep this text as practical as possible for the acupuncture clinician. At every every step, I have have suggested suggested the classical classical and traditional Chinese medical approaches as well as various other other possible possible methodolo methodologie gies, s, giving giving ample ample clinical examples, covering not only insomnia but also a variety variety of other sleep pathologie pathologies. s. I hope that this work will spark interest in the subject and open the door to further studies and invest investiga igatio tions ns into into the fascin fascinati ating ng dimens dimension ion of sleep and dreams. Hamid Montakab Savièse, Switzerland Swit zerland
Foreword
Abbreviations
AASM AASM CPAP CPAP CNS DILD DILD DMT EEG EEG GABA GABA MEF MEF MOS MOS MS non-REM OSA
Ameri American can Acad Academ emy y of Slee Sleep p Medi Medicin cine e cont contin inuo uous us posi positiv tive e airwa airway y pres pressu sure re central nervo rvous system drea dreamm-in init itia iatted luci lucid d drea dream m dimet imeth hyltry ltrypt ptam amin ine e elect lectro roen ence ceph phal alog ogra raph ph Gamm Gammaa-am amin inob obut utyr yric ic acid acid (MOS (MOS)) Ener Energy gy and and Fatig atigue ue Modu Module le Medi Medica call Outc Outcom omes es Stud tudy (MOS) Sleep Module non rapid eye movement movement obst obstru ruct ctiv ive e sleep leep apn apnea
OSHAS OSHAS PET PET PSQI PSQI REM REM RLS RLS SAD SAD SCN SCN SIDS SIDS SWS TCM TCM WILD WILD
obst obstru ructi ctive ve slee sleep p apne apneaa–hypopnea syndrome pos positro itron n emis emissi sion on tomo tomogr grap aph hy Pitt Pittsb sbur urgh gh Slee Sleep p Qual Qualit ity y Inde Index x rapid eye movement restless legs syndrom rome seas season onal al aff affecti ectiv ve diso disord rder erss supr suprac achi hias asm matic atic nucl nucleu euss sudd sudden en infa infant nt deat death h synd syndro rome me slow-wave sleep Tradi raditi tion onal al Chin Chines ese e Medi Medici cine ne wake wa ke-in -initi itiat ated ed luci lucid d drea dream m
XI
XII
Table of Contents
1
Physio Phy siolog logy y of Sl Sleep eep
Western Physiology Physiology of Normal Sleep ............. ................. .... 1 The Functions of Sleep ........................... ..................................... ............. ... 1 Why Do We Sleep? ................... ............................. .................... ................... ......... 1 Physiological Processes Related Related to Sleep ............... ............... 1 Restoration/Rejuvenation Restoration/Rejuvenation .................... .............................. ............. ... 1 Anabolism and Somatic Growth ................... ....................... .... 2 Development of the Brain/Ontogenesis ............ ............ 2 Memory and Sleep ................... ............................. .................... ............... ..... 2 Normal Sleep ................... ............................. .................... .................... ................ ...... 2 Sleep Stages ................... ............................. .................... .................... ................... ......... 2 Circadian Rhythm ................... ............................. ......................... ..................... ...... 4 Ultradian Rhythm ................... ............................. ......................... ..................... ...... 5 Amount of Sleep ................... ............................. .................... .................... ............ .. 5 Consequences of Inadequate Inadequate Sleep Sleep .................... ...................... .. 6 Dreams ..................... ............................... .................... .................... .................... .............. .... 6 Dream Theories ................... ............................. .................... .................... .............. .... 7 Sleep Disorders .................. Disorders ............................... ....................... .................... ............ 9 Dyssomnia ................... ............................. .................... .................... .................... ............ 9 Parasomnia ................... ............................. .................... .................... .................. ........ 10 Secondary to Medical or Psychiatric Conditions ................... ............................. .................... .......................... .................... .... 10 Insomnia ................... ............................. .................... .................... .................... ............ 11 Causes of Insomnia ................... ............................. .................... ................ ...... 12 Treatment Treatment of Insomnia ................... ............................. .................... ............ 12
2
Sleep in Chin Chinese ese Medi Medicine cine
Yin/Yang ................... ............................. ......................... ......................... ................. ....... 13 Sleep and the Substances: Wei Substances: Wei Qi – Xue– Xue– Shen Shen ... 14 Movements of Wei Wei Qi : Physical Relaxation Relaxation ........... ........... 14 Shen: Shen: Mental Relaxation Relaxation .................... ............................. .................. ......... 16 Shen 神 ................... ............................. .................... .................... ................... ......... 16 Yi 意 ................... ............................. .................... .................... .................... ............... ..... 17 Gui 鬼 .................... .............................. ........................ ........................ ................. ....... 18 Hun 魂, Po 魄 ................... ............................. .................... .................... .......... 18 Xue, Xue, Shen, Shen, and Hun and Hun .................. ............................ .................... .................. ........ 19
Sleep and the Zang the Zang Fu ..................... ............................... .................. ........ 21 Heart, Sleep, and the Emotions ................... ........................... ........ 21 Hun, Hun, the Liver, and Dreaming Dreaming ............................ .............................. .. 21 Sleep and the Fu the Fu ................... ................................ ....................... .................. ........ 22 Sleep and the Extraordinary Vessels ................ ................ 22 Organization of Yang ................ Yang .......................... .................... ................. ....... 23 Organization of Yin ............... Yin ......................... .................... ..................... ........... 23 Organization of Sleep ............................ ...................................... .............. .... 24 Time ...................... ................................ .................... .................... .................... ............ 25 Space .................... .............................. .................... .................... .................... ............ .. 26
3
Inso In somn mnia ia
Diagnosing Insomnia .................... .............................. .................... .......... 30 Etiology and Treatment of Insomnia ............... ................. 32 Movements of Wei Wei Qi ................... Qi ............................ ................... .............. .... 32 Movements of Blood .................... .............................. .................... ............. ... 35 Zang Fu Pa Fu Pathologies thologies .................... .............................. .................... .............. .... 35 Fire Phase .................... .............................. .................... .................... ............... ..... 35 Wood Phase .................... ............................. ................... .................... ............. ... 37 Earth Phase .................... .............................. .................... .................... ............. ... 38 Metal Phase .................... ............................. ................... .................... ............. ... 38 Water Phase .................... ............................. ................... .................... ............. ... 38 Emotions .................... .............................. ........................ ........................ ................. ....... 39 The Five Movements and the Five Wills .......... 39 Management of Emotional Patterns That Disturb Sleep .................... .................................. ....................... ................ ....... 40 Extraordinary Vessels Vessels .................... .............................. .................... ............ .. 42 Insomnia Due to Seasonal Desynchronization .................... .............................. .................... ................ ...... 43 Acupuncture Points Affecting Sleep Sleep .................... .................... 44 Heart-Shou Heart-Shou Shao Yin and Yin and Kidney- Zu Zu Shao Yin Channels .................... .............................. .................... .................... ................. ....... 44 Pericardium-Shou Pericardium-Shou Jue Yin and Yin and Liver- Zu Zu Jue Yin Channels .................... .............................. .................... .................... ................. ....... 44 Lung-Shou Lung-Shou Tai Yin and Yin and Spleen- Zu Zu Tai Yin Channels ................... ............................. .................... .................... .................. ........ 45 Large Intestine-Shou Intestine-Shou Yang Ming and Ming and Stomach- Zu Zu Yang Min Channels .................... ...................... .. 46 Small Intestine-Shou Intestine-Shou Tai Yang and Yang and Bladder- Zu Zu Tai Yang Yang Channels .................... ......................... ..... 46
Table of Contents
Triple Burner-Shou Burner-Shou Shao Yang and Yang and Gallbladder- Zu Zu Shao Yang Channels ................ ................ 47 Du Mai -Governing -Governing and Ren and Ren Mai -Conception -Conception Vessels .................... .............................. .................... .................... .................... .......... 48 Extra Points for Insomnia .................... .............................. ................ ...... 48 Ear Acupuncture .................... .............................. .................... ................... ......... 50 Some Classical Acupuncture Point Combinations .................... .............................. .................... .................... ............. ... 51 Qi Gong for Gong for Insomnia .................... .............................. .................... ............. ... 51 Overview of Treatment Treatment Strategies ...................... ........................ 52 Case Studies .................... .............................. .................... .................... ............... ..... 53
4
Other Sleep Path Patholog ologies ies
Somnolence— Somnolence— Shi Shui 嗜睡 ......................... ............................... ...... 65 Explanation and Discussion ................. ........................... ............ .. 65 Patterns and Treatment Treatment .................... .............................. .............. .... 66 Somnambulism/Sleep-walking — Meng Meng You 梦游 67 Explanation ................... ............................. .................... .................... .............. .... 67 Patterns and Treatments Treatments ................... ............................. ............. ... 68 Sleep-talking— Sleep-talking— Meng Meng Yi 梦呓 ................... ............................. .......... 69 Explanation .................... .............................. .................... .................... ............. ... 69 Patterns and Treatments Treatments .................... .............................. ............ .. 69 Sleep Apnea— Apnea— Shui Mian Hu Xi Zhan Ting Zong He Zheng 睡眠呼吸暂停综合征 ........................ .......................... Explanation ................... ............................. .................... .................... .............. .... Patterns and Treatments Treatments ................... ............................. ............. ... Treatment Treatment Strategies ................... ............................. ................... .........
70 70 71 72
Enuresis and Nocturia— Nocturia — Yi Yi Niao 遗尿 ................. ................. 72 Explanation .................... .............................. .................... .................... ............. ... 72 Patterns and Treatments Treatments .................... .............................. ............ .. 73 Treatment Treatment Strategies .................... .............................. .................. ........ 74 Excessive Dreaming — Dreaming — Duo Duo Meng 多梦 .............. 74 Explanation .................... .............................. .................... .................... ............. ... 74 Patterns and Treatments Treatments .................... .............................. ............ .. 75 Nightmares — Nightmares — Meng Meng Yan 梦魘 ...................... ............................. ....... 77 Explanation .................... .............................. .................... .................... ............. ... 77 Patterns and Treatments Treatments .................... .............................. ............ .. 78 Night Fright/Night Terror— Terror — Ye Ye Jing 夜惊 ............ ............ 79 Explanation ................... ............................. .................... .................... .............. .... 79 Patterns and Treatments Treatments ................... ............................. ............. ... 80
Dreams of Flying— Flying — Meng ...................... .. 80 Meng Fei 梦飞 .................... Explanation .................... .............................. .................... .................... ............. ... 80 Patterns and Treatments Treatments .................... .............................. ............ .. 81 Dreams of Falling Falling— — Meng Meng Zhui 梦坠 .................. .................. 81 Explanation .................... .............................. ................... ................... .............. .... 81 Patterns and Treatments Treatments .................... ............................. ............ ... 82 Sexual Dreams— Dreams— Meng Meng Jiao 梦交 ....................... ....................... 83 Explanation ................... ............................. .................... .................... .............. .... 83 Patterns and Treatments Treatments ................... ............................. ............. ... 83 Circadian Rhythm Desynchronization Desynchronization .............. .............. 84 Jet Lag .................... .............................. .................... .................... .................... ............... ..... 84 Explanation ................... ............................. .................... .................... .............. .... 84 Therapeutic Protocols .............................. ..................................... ....... 85 Shiftwork ................... ............................. .................... .................... .................... ............ 88
5
Dreams and Dreams and Their Sign Significan ificance ce in Chin Chinese ese Medicine
Modern Western Western and Ancient Eastern Theories about Dreams .................... .............................. .................... .................... ............ .. 89 Greek Mythology Mythology ................... ............................. ......................... ................... .... 89 Middle Eastern Traditions ........................... .................................... ......... 89 Hindu Traditions ................... ................................. ........................ ................. ....... 89 Buddhist Tradition ................... ............................. .................... .................. ........ 90 Chinese Tradition Tradition ................... ............................. ......................... ................... .... 90 Modern Dream Theories in Relation to Chinese Traditional Concepts ........................ ........................... ... Developmental Developmental Dreams ................... ............................. ................... ......... Interacting Dreams ................... ............................. .................... ................ ...... Transformational Transformational Dreams ................... ............................. ................. .......
94 95 95 96
Dreams as Reality, or Life as a Dream .............. .............. 98 The Significance of Dreams in the Chinese Tradition ................... ............................. ......................... ......................... ................. ....... 99 Common Dream Interpretations and Therapeutic Strategies Based on the Discussions and Commentaries on Sleep and Dreams by Master Yuen ................... ........................... ........ 100 Dreams of Fear/Danger/Threat = Kidneys ......... 101 General Concepts Concepts ................... ............................. .................... ............ .. 101 Other General Points Indicated in Fear Dreams ................... ............................. .................... .................... ................. ....... 101 Common Traditional Traditional Chinese Medicine Kidney Kidney Patterns Causing Fear Fear Dreams ...................... ...................... 101
XIII
XIV
Table of Contents
Dreams of Home/Property/Territory/ Boundaries/Valuables Boundaries/Valuables = Spleen Spleen ................... ......................... ...... 102 General Concepts Concepts ................... ............................. .................... ............ .. 102 General Points for Spleen Patterns Patterns ................ ................ 102 Common Traditional Traditional Chinese Medicine Spleen Patterns Causing Loss of Property Dreams ................... ............................. .................... .......................... .................. .. 103 Dreams of Control/Direction/Movement/ Navigation = Liver ................... ............................. .................... ................ ...... 103 General Concepts Concepts ................... ............................. .................... ............ .. 103 General Points for Liver Patterns ................... ................... 104 Common Traditional Traditional Chinese Medicine Liver Patterns Causing Control Control Dreams ................. ................. 104 Dreams of Vulnerability/Exposure = Lungs ........ 104 General Concepts Concepts ................... ............................. .................... ............ .. 104 General Points for Lung Patterns .................. .................. 105 Common Traditional Traditional Chinese Medicine Lung Patterns Causing Vulnerability Vulnerability Dreams ......... 105 Dreams of Night Terrors/Ghosts = Accumulation of Phlegm ................................... 105 General Concepts Concepts ................... ............................. .................... ............ .. 105 General Points for Phlegm Phlegm Patterns .............. .............. 105 Common Traditional Traditional Chinese Medicine Dream-Shock Dream-Shock Patterns Causing Night Terrors 105 The Importance of Reintegrating Dream Interpretation Interpretation into Chinese Medicine ............ ............ 107
6
Clinical Clin ical Ev Evalu aluatio ation n
Clinical Study on Acupuncture and Insomnia 109 Patients ..................... ............................... .................... .................... .................... .......... 109 Methodology ................... ............................. .................... .................... ............. ... 110 Protocols for the Subjective Evaluation of Sleep ...................... ............................... ................... .................... .................... .......... 111 Protocols for the Objective Evaluation of Sleep ...................... ............................... ................... .................... .................... .......... 111 Results ................... ............................. .................... .................... .................... ............. ... 111 Objective Evaluation Evaluation by by Polysomnography Polysomnography ... 111 Subjective Assessment of Sleep .................... .................... 112 Discussion and Analysis of Results .................... .................... 112 Other Clinical Studies on Insomnia and Other Sleep Disorders .................. Disorders ............................... ....................... ................. ....... 119
Appendices Appendix 1 ................... ............................. .................... .................... ................ ...... Index of Sleep-related Symptoms and Acupuncture Points ........................... ..................................... ................ ...... Acupuncture Points Containing the Characters Shen, Shen, Ling, Ling, and Gui and Gui ................... ............................. .................... ............... ..... Acupuncture Points Containing the Character Shen Character Shen— 神 ................... ............................. .................... .......... Acupuncture Points Containing the Character Ling Character Ling (Soul) (Soul)— 靈 .......................... .............................. .... Acupuncture Points Containing the Character Gui Character Gui (Ghost) (Ghost) 鬼 ............................ .............................. .. Point Combinations for the Treatment of “Possessions” ................... ............................. .................... .................... ............. ... Sun Si Miao’s 13 Ghost Points— Treatment Treatment for Possessions .................... .............................. ......................... ................. Worsley ’s Seven Dragons— for for Internal and External Demons Demons .................... .............................. .................... ............ ..
124 124 127 127 127 128 128 128 129
Appendix 2 .................... .............................. .................... .................... ............... ..... 129 Working with Dreams, by Solange Montakab-Pont .................... .............................. .................... ................... ......... 129 Energetic and Physiological Effects of Dreams .................... .............................. .................... .......................... .................. 129 The Place of Dreams in Modern Psychotherapy .................... .............................. ......................... ................. 130 How to Use Dreams in Psychotherapy .......... 130 Lucid Dreaming .................... .............................. .................... .............. .... 131 Dream Analysis .................... .............................. .................... ............... ..... 131 Integrating Dream Work into an Acupuncture Session .................... .............................. ................ ...... 132
Glossary of Chinese Terms Used in the Book . 134
Bibliography Chinese Classical Texts .............. Texts ........................ .................... ............ .. 137 Contemporary Texts .................... .............................. ................... ......... 137 Personal Communications Communications ....................... .............................. ....... 143
Index .................... .............................. .................... .................... .................... .............. .... 144
1
1 Ph Phys ysio iolo logy gy of Sl Slee eep p
Western Physiology of Normal Sleep Sleep is defined as a natural, regularly recurring condition of rest for the body and mind that has been observed in humans and some animals. Sleep is disti disting ngui uish shed ed from from quie quiett wake wakeful fulne ness ss by a decreased ability to react to stimuli, and it is more easily reversible than hibernation or coma. Sleep is common to all mammals and birds, and is also seen in many reptiles, amphibians, and fish. In humans, other mammals, and a substantial majority of other animals that have been studied (such as some species of fish, birds, ants, and fruit flies), regular sleep is essential for survival. The purposes and mechanisms of sleep are only partially understood, stood, and and are theref therefore ore the subject subject of intens intensee research.
The Functions of Sleep
Sleep deprivatio deprivationn causes causes mental, mental, emotiona emotional,l, and physical fatigue and is a risk factor for depression (Riemann and Voderholzer Voderholzer 2003). It is unclear why a lack of sleep causes irritability; some relate this to the reduced production of cortisol during deep sleep, which can have a negative effect on the alertness and emotions of a person during the day (Leproult et al. 1997, Balbo et al. 2010). Sleep debt results in diminished abilities to perform high-level cognitive functions. This has led many Japanese companies to provide facilities for their employees so that they can have short sleep breaks of 15–20minutes, which seems to improve their vigilance and performance. After suffering sleep deprivation, a person will recuperate by increasing the proportion of deep sleep (also known as Stage 4, or N3) and rapid eye movement (REM), or dreaming, sleep. This indicates cates that both of these stages stages of sleep are essential for the health of the organism. Deep sleep assists in the physical repair of the body, while REM sleep is responsible for the recovery of the CNS (Friedmann et al. 1977, Gaillard 1990).
Why Do We Sleep?
Science Science has not yet been able to provide a definidefinitive answer to the question of why we need to sleep. Is it to recover from fatigue or to prevent us getting tired? In humans, each sleep cycle lasts 90 to 110minutes (Swierzewski 2000), and each stage has a distinct physiological function. Sleeping pills, alcohol, or other drugs can suppress certain stages of sleep, resulting in sleep that does not fulfill its physiological functions. In other words, the person wakes up still feeling tired after apparently getting sufficient sleep. Studies on total or selective sleep deprivation, both both on huma humans ns and and on most most anim animal als, s, have have demonstrated no somatic changes in the body, only disturbances of the central nervous system (CNS) manifesting as nervous fatigue and reduced intellectual capacity (Horne 1988). This could be due to an accumulation of certain metabolites such as gamma-aminobutyric acid.
Physiological Processes Related to Sleep Restoration/Rejuvenation
A study conducted in 2004 analyzed the effects of sleep deprivation on wound healing in male rats. Results showed that wound healing may indeed be delayed in rats deprived of sleep (Gumustekin et al. 2004). Zager et al. (2007) proposes that loss of sleep impairs immune function, and that immune challenge lenge alters alters sleep. sleep. Most Most specie speciess increa increase se their their sleeping hours when recovering from trauma or disease. It has also been suggested that species with longer sleep times have higher white blood cell counts (Marks et al. 1995).
2
1 Ph Physiology of Sleep
Anabolism and Somatic Growth
Anabolic hormones such as growth hormones are primar primarily ily secret secreted ed during during sleep. sleep. Altho Althoug ughh one stud studyy on chil childr dren en did did not not show show any any effe effect ct on growth (Jenni et al. 2007), another study on adults found that men with a high percentage of slowwave sleep (SWS; N3, Stages 3 and 4, or deep sleep) had a higher level of growth hormone secretion than participants with a lower percentage of SWS (Van Cauter et al. 2000). Sleep, therefore, can be described as an anabolic state that enhances various physiological processes relating to the immune, nervous, muscular, and skeletal systems, for instance. Wakefulness, on the other hand, may be considered to be a catabolic state during which the organism acquires nourishment and reproduces.
fluence of sleep on memory to be related to the functioning of the nerve cell dendrites. These dendrites send information to the cell body, to be organ organize izedd into into new new neuron neuronal al connec connectio tions ns proprovided that no external information is presented to these dendrites. It could be that we solidify memories and organize knowledge during sleep .
Normal Sleep In mammals and birds, sleep is divided into two broad types: REM and non-REM. Each type has a distinct set of associated physiological, neurological, and psychological psychological features. Sleep Stages
Development of the Brain/Ontogenesis
According to Marks et al. (1995) brain development ment occurs occurs during during neona neonatal tal REM sleep. sleep. REM sleep occupies the majority of infants ’ sleep time, and and is thus thus importa important nt for for brain brain devel developm opment. ent. Babies born prematurely spend more time in REM sleep. The muscle inhibition in the presence of brain activation during REM sleep allows for brain development by activating the synapses without any any moto motorr cons conseq eque uenc nces es.. REM REM slee sleepp (dre (dream am)) deprivat deprivation ion in infants infants results results in develo development pmental al abnormalities later in life, such as behavioral behavioral problems, sleep disruption, and decreased brain mass (Mirmiran et al. 1983). Memory and Sleep
Sleep deprivation deprivation affects affects the working working memory, memory, which is responsible for high-level cognitive functions such as decision-making, reasoning, and episodic memory. Memory can be affected differently by certain stages of sleep. REM sleep can benefit procedural memory (long-term memory of learned skills), whereas non-REM slow-wave slow-wave sleep (SWS) can enhance declarative memory (memory of facts as for word-pair retention [Born et al. 2006, Walker 2009]). A Harvard sleep research study (Stickgold et al. 2001, Stickgold 2005) considers the essential in-
The stages of sleep were first described in 1937 by Loomis et al., who separated the different electroencephalograph (EEG) features of sleep into five levels (A to E) representing the stages between wakefulness and deep sleep. In 1957, Dement and Kleitman identified REM sleep as being separate from from non-RE non-REM M sleep. sleep. They They further further reclas reclassifi sified ed sleep into four non-REM stages and REM. In 1968, Rechtschaffen and Kales standardized this classification in their R & K sleep scoring manual, dividing dividing non-REM sleep into four stages, with SWS comprising Stages 3 and 4. In Stage 3, delta waves made up less than 50% of the total wave patterns, whereas they made up more than 50% in Stage 4. REM sleep was sometimes referred to as Stage 5 sleep. In 2004, the American Academy of Sleep Medicine (AASM) reviewed the sleep stages and made some changes, dividing non-REM sleep into three stages: N1, N2, and N3, the latter comprising the previous Stages 3 and 4, also called SWS, or delta sleep (Table 1.1). Sleep stages and other biophysiological variables of sleep can be evaluated in a sleep laboratory by means of polysomnography, which includes an EEG of brain waves, electrooculography of eye movements, and electromy electromyograp ography hy of skele skeletal tal muscle muscle activity, as well well as other parameters such as an electrocar trocardio diogra gram, m, nasal nasal airflow airflow,, pulse pulse oxime oximetry, try, a sound probe for snoring, and in some cases a gauge to measure nocturnal penile tumescence.
Normal Sleep
Table 1.1 Normal sleep stages, EEG and clinical correlation Sleep stage (AASM) N1 (R & K Stage 0–1)
EEG
Alpha activity
Beta activity
Wave type
Clinical correlation
Progressive attenuation of alpha waves of 8–13Hz (common in the awake state) to theta waves 4–7 Hz
●
Drowsiness or somnolence (transition of wakefulness to sleep)
●
Slow rolling eye movements
●
Some loss of muscle tone
●
Loss of most conscious awareness of the external environment
●
Occasional twitches and jerks
●
Occasional hypnagogic hallucinations
Enhanced beta activity (12–30Hz)
Theta waves
N2 (R & K Stage 2)
N2 is characterized by the appearance of: ●
Spindle
K-complex
N3 Slow wave sleep (SWS) (R & K Stage 3–4)
●
Sleep spindles: shortlived 15-Hz activity (fronto-central regions)
●
●
Absence of conscious awareness of the external environment
●
Corresponds to superficial sleep with the possible presence of short fragmented mundane thoughts
●
Predominant sleep Stage 45%–55% of total sleep in adults
●
Deep sleep
●
Body immobility
●
Manifestations of parasomnia (sleepwalking, sleep-talking, night terrors, and bed-wetting)
●
REM
●
Muscle atonia
●
REM sleep accounts for 20%–25% of total sleep time in human adults
K-complexes: highamplitude, long-duration biphasic activity
Delta waves ranging from 0.5–4Hz: Stage 3: delta activity 20%–50% of the time
Decrease of muscular activity
Stage 4: delta delta > 50% Sleep efficacy evaluated by delta activity, combining Stages 3 and 4
Delta waves
Rapid eye movement (REM) or paradoxical sleep
EEG desynchronization: ●
Brief, fragmented rapid alpha rhythm
●
Low-voltage EEG theta and beta acivity as in wakefulness
●
Saw tooth waves (central regions)
3
4
1 Ph Physiology of Sleep
Polysomnography has been used to distinguish the following stages of sleep: Stage N1 (previously classified as Stage 0 and Stag Stagee 1): drowsi drowsine ness ss or somnol somnolenc ence, e, which which is define definedd by the transit transition ion from from wake wakeful fulnes nesss to sleep. The brain waves evolve evolve from alpha waves in the frequency range of 8–13Hz (common in the awake state) into theta waves in the frequency range of 4–7Hz. During Stage N1, the person loses some muscle tone and most conscious awareness of the external environment. Sometimes sudden twitches and jerks can be observed at this stage. Some people also experience hypnagogic hallucinations. Stage N2 (Stage 2 of the R & K standard) is characterized by sleep spindles (i.e., an EEG waveform consisting of short-lived 15-Hz activity, mostly in the fronto-central regions) in the frequency range 12–16Hz and K-complexes (i.e, an EEG waveform consisting of high-amplitude, long-duration biphasic activity). During this stage, muscular activity decreases, and conscious awareness of the external environment disappears. This stage occupies 45% – 55% of total sleep in adults, and corresponds to superfic superficia iall sleep, sleep, with with the possi possible ble presen presence ce of short, fragmented, mundane thoughts. Stage N3 (deep sleep or SWS, previously known as Stages 3 and 4 of the R & K standard), is characterized by delta waves in the frequency range 0.5 – 4 Hz (also known as delta rhythms). Today, Today, the efficacy of sleep is evaluated evaluated based on this delta activact ivity. Manifest Manifestatio ations ns termed parasomn parasomnia, ia, such as sleep-wa sleep-walkin lking, g, sleep-talki sleep-talking, ng, night night terrors, terrors, and bed-wetting, occur in Stage N3. REM (paradoxical) sleep is so called because the EEG shows that the brain is very active while the body is virtually immobile. This is also known as the stage in which dreaming occurs. Muscle atonia at this stage could be a natural necessity to protect the person from self-harm through physically acting out scenes from the vivid dreams that are occurri occurring. ng. REM sleep sleep accoun accounts ts for for 20%–25% of total sleep time in human adults. The criteria for REM sleep include rapid eye movements as well as a rapid low-voltage EEG.
Circadian Rhythm
Our biological functions follow a circadian cycle, referred to as chronobiology. chronobiology. This circadian cycle c ycle is subject to two synchronizers: internal (the inner clock) and external (the day –night cycle). It would seem logical that the internal clock would follow the external day –night cycle. Surprisingly, however, in studies in which participants were isolated from the outside world and allowed to find their own internal rhythm, there was a discrepancy between the exogenous 24-hour rhythm and the endogenous rhythm. The internal (endogenous) rhythm turned out to be closer to 25 hours, actually a 24.65-hour cycle, which corresponds to the natural solar day –night cycle on the planet Mars rather than to the normal 24-hour (23.56-hour) cycle of the earth’s rotation (Wever 1979, Scheer et al. 2007). The primary primary circad circadian ian clock clock in mammal mammalss is located in the suprachiasmatic nucleus (SCN), in the the hypo hypoth thal alam amus us,, ref referred erred to as the the “master clock.” The retina, containing special photosensitive cells, transmits information about light, specifically the length of day and night, light intensity and wavelength (or color) and light direction, to the hypo hypotha thalam lamus. us. The hypo hypotha thalam lamus us in turn transmits the information to the pineal gland. The pineal gland secretes melatonin; its peak at night enhances sleep. This “master clock” governs the many aspects of physiology and behavior by controlling the fluctuation of the hormones, neurotransmitters, and chemicals. In the 1990s, Dr. Takahashi ’s team identified the first first mamma mammalilian an gene gene relat related ed to circad circadian ian rhythms, and discovered that this protein, named the “clock protein,” was not only found in the brain, but actually in every cell (in King et al. 1997). In a more recent study (Takahashi 2010), it was demonstrated that the SCN transforms that information into neural signals that set the body ’s temperature. Even small changes in body temperature can send a powerful signal to the clocks in our bodies. The core body temperature, which also presents a rhythmic alternation of about 25 hours and is therefore similar to the sleep and wake cycle cycless is indepe independe ndent nt of outsid outsidee temper temperatu ature re changes. It may therefore be suggested that there are two main internal oscillators: the day –night cycle and and core body temperature. temperature.
Normal Sleep
10:00: Highest alertness 9:00: Highest testosterone secretion 8:00: Likeliest time for bowel movement 7:30: Melatonin secretion stops 6:45: Sharpest rise in blood pressure
Midday 12:00 14:30: Best coordinati coordination on 15:30: Fastest reaction time Human biological clock
4:30: Lowest body temperat temperature ure
17:00: Greatest cardiovascular efficiency and muscular strength 18:30: Highest blood pressure 19:00: Highest body temperatur temperature e 21:00: Melatonin secretion starts
2:00: Deepest sleep
24:00 Midnight
Fig.1.1 The human clock by Yassine Yassine Mrabet: the circadian patterns of someone who rises early in the morning, eats lunch around noon, and goes to sleep around 10p.m. The circadian rhythms tend to be synchronized with the cycles
The inner inner synch synchron ronize izer, r, the circad circadia iann clock clock,, besides being closely related to the fluctuations of temperature, seems to work in tandem with adenosine, a neurotransmitter that inhibits many of the bodily processes associated with wakefulness. Adenosine, produced over the course of the day, reaches high levels at night, leading to drowsiness. drowsiness. Norm Normal ally ly slee sleepi pine ness ss occu occurs rs as the the circa circadi dian an rhythm causes the release of melatonin and gradual decrease in core body temperature (Fig.1.1). The circadian cycle depends, on the one hand, on the individual ’s chronotype (reflecting at what time of the day their physical functions, i.e., hormone levels, body temperature, cognitive faculties, eating, and sleeping) are active, and on the other hand partly on the person ’s sociocultural conditionin tioningg and and will. will. The chrono chronotype type is commo commonl nlyy reduced to sleeping habits only and determines the ideal timing for a restorative sleep episode. Any individual variation in excess of 2 hours earlier or later than average average may cause a person social difficulties. These are classified under “circadian rhythm sleep disorders.” No objective biological differences have been noted between the morning types or evening types outside the high and low hormonal secretion periods. Beside Besidess this this circad circadian ian monop monopha hasic sic rhyth rhythm, m, there appears to be a second rhythm with a 12hour periodicity. This could explain the drowsiness or reduced alertness experienced by many people in the early afternoon.
of light and dark. Other factors, such as ambient temperature, meal times, napping, stress, and exercise, can also influence the timings.
Ultradian Rhythm
The ultradian cycle is defined as a rhythmic repetition tion of certain certain phenom phenomena ena in living living organi organisms sms throughout a 24-hour circadian day. In relation to sleep, the ultradian cycle is defined by the occurrence of (REM) sleep, appearing after a phase of normal non-REM sleep. Usually REM sleep occurs about 90minutes after sleep onset and is followed by a short waking stage, which allows us to register our dreams dreams.. In gener general, al, the sleepe sleeperr forge forgets ts most dreams, except for the ones experienced during the last cycle of sleep. REM sleep occupies 15–20 minutes of the last part of each cycle, cycle, and is the primer primer of this ultradian ultradian rhythm. In the 1980s, Horne (1988) established that sleep comprises two obligatory parts: deep sleep (Stages 3 and 4, or N3) and REM sleep, the other sleep stages being optional. The duration of the various stages changes during the night. SWS (Stages 3 and 4, or N3) is the dominant sleep stage during the early night, representing about 23% of sleep. During latelate-ni night ght sleep, sleep, REM become becomess the most most active active sleep stage, representing about 24% of sleep. Amount of Sleep
It is not how much we sleep, but how well we sleep that matters. Indeed, it has been claimed that Leonardo da Vinci only slept for 20 minutes every 4 hours!
5
6
1 Ph Physiology of Sleep
However, the optimal amount of sleep is only meaningful if it is taken at the right point in the person’s circ circad adia iann rhyt rhythm hm.. If a pers person on’s majo majorr sleep episode occurs at the wrong time of the day, it will will be relat relativ ivel elyy ineffic inefficien ientt and inade inadequ quate ate.. According to Dijk and Lockley (2002), the best time to be asleep is at least 6 hours before the lowlowest body temperature period. Wyatt et al. (1999) propose that the ideal time to sleep is when the two circadian markers—maximum melatonin concentration and minimum core body temperature — occur after the middle of the sleep episode and before awakening. The need for sleep varies with age and physical condition. A newborn baby sleeps up to 18 hours per day, half of which is in REM sleep. This proportion progressively declines, so that by the age of 5 the child sleeps about 12 hours, with only about 2 hours of REM ( Table 1.2). Consequences of Inadequate Sleep
The National Sleep Foundation in the United States defines as optimal 7 –9 hours of sleep for an adult, maintaining that sufficient sleep benefits alertness, memory, problem-solving, and overall health, and reduces the risk r isk of accidents (National Sleep Foundation 2002). A study performed at the University of Pennsylvania School of Medicine demonstrated that that cognit cognitiv ivee perform performanc ancee decli declines nes with with 6 or fewer hours of sleep (Van Dongen et al. 2003).
Table 1.2 Sleep time and age Age and condition
Average amount of sleep per day (h)
Newborn
Up to 18
1–12 months
14 –18
1–3 years
12–15
3–5 years
11–13
5–12 years
9–11
Adolescents
9–10
Adul Adults ts,, incl includ udin ing g the the elde elderl rlyy
7 –8
Pregnant women
8
A study of more than one million adults conducted by the University of San Diego found that people who live the longest sleep for 6 –7 hours each night (Rowland 2002). Another study shows that sleeping more than 7 –8 hours per day has been consistently associated with increased mortality (Patel et al. 2006), although the study suggest gestss that that othe otherr fact factor orss are are inv involv olved, ed, such such as depression and socioeconomic status. It also suggests that the correlation between shorter sleep and reduce reducedd morbi morbidity dity only only occurs occurs with with those those who wake wake natur naturall allyy rather rather than than use an alarm alarm clock. British researchers have found that lack of sleep can can more more than than doub double le the the risk risk of deat deathh from from cardiovascular disease, but that too much sleep may also double the risk of death (Ferrie et al. 2007). This research also indicates that short sleep is a risk factor for weight gain, hypertension, and type 2 diabetes, sometimes leading leading to mortality. In contrast, no potential mechanisms by which long sleep could be associated with increased mortality have yet been determined. Stud Studie iess in Germa Germany ny have have expl explor ored ed the the inincreased incidence of cardiovascular accidents in patients patients with sleep difficulties, difficulties, especial especially ly those those with obstructive sleep apnea (Fietze et al. 2010, Oldenburg 2010). Some cardiologists advise cardiac patients to have their sleep evaluated in a sleep laboratory in an attempt to identify and reduce inadequate sleep. The quality of sleep and its relation to chronic pain has been explored in a study by Horlemann (2009). Further, sleep difficulties are closely associated with psychiatric disorders such as depression, alcoholism, and bipolar disorder: up to 90% of patients with depression have been found to have sleep sleep difficu difficulti lties es (Maran (Maranoo 2003). 2003). Insomn Insomnia ia has long been thought of as a symptom of depression, but new research shows it may actually trigger the mental disorder (Perlis et al. 2006). Dreams
We dream for about 2 hours each night, which represents a total of about 6 years of dreaming time during a normal life span. Dreams are probably the most fascinating yet the least understood part of sleep. Mostly occurring during REM sleep they appear to be related to
Normal Sleep
the pons, the part of the brainstem relaying sensory information between the cerebellum and cerebrum, which also controls arousal and regulates breathing (Hobson and McCarley1977). However, some believe that several parts of the brain are involved in the dreaming process (Solms 2000). During REM sleep, the release of certain neurotransmitters is completely suppressed. As a result, motor motor neuron neuronss are not stimul stimulat ated, ed, a condit conditio ionn known as REM atonia. This prevents dreams from resulting in dangerous movements of the body. Most Most drea dreams ms last last from from 5–20 minute minutes; s; REM sleep episodes lengthen progressively throughout the night, with the first episode being shortest and the following episodes increasing to 15 –20 minutes at the end of the night. We remember dreams when we wake before the end of the REM period. The ability to recall dreams appears to be related to the vividness of the dream imagery, colors, and emotions. Studie Studiess have have shown shown that that vario various us specie speciess of mammals and birds also experience REM during sleep, and follow the same series of sleeping states as humans (Payne and Nadel 2004).
●
●
●
Dream Theories ●
There are many current scientific theories that attempt to explain the mechanism and the functions of dreaming. Some of the neurohumoral theories referenced below seem to explain only one or another aspect of dreams. Other hypotheses have been proposed about the function of dreaming; the most interesting ones are from the psychoanalytic schools. Sigmund Freud in his 1900 seminal paper The Inter pretation pretation of Dreams (Freud 1994) considers dreams to be symbolic expressions of frustrated desires that have been relegated to the unconscious mind. Dream interpretation plays an important part in Freudian Freudian and Jungian Jungian psychoa psychoanal nalysis ysis.. Howeve However, r, since the 1940s, dream studies in social sciences dropped dropped out of the scientific literature literature in favor favor of more self-consciously self-consciously objective methods: methods: Activation synthesis theory. According to Hobson and McCarley (1977), the sensory images and sounds we “see” and “hear” during sleep are the result of the random firing of neurons in the cerebral cortex during REM sleep. These are then reorganized by the forebrain into a ●
●
●
●
●
coherent story in which the person is most often often a partic participa ipant nt rathe ratherr than than an observe observerr. Hobso Hobsonn and McCarl McCarley ey clearl clearlyy dismis dismissed sed the idea that there are deep, nonphysiological, or hidde hiddenn meani meanings ngs in dreams dreams.. Solms Solms (2000) (2000),, however, challenges this theory by suggesting that dreams are generated in the forebrain, and that REM sleep and dreaming are not directly related, but are a function of many complex brain structures. This validates Freudian dream theory. Jie Zhan Zhangg (200 (2004, 4, Continual-ac Continual-activati tivation on theory. Jie 2005) proposes that the function of sleep is to proce process, ss, encode encode,, and transf transfer er data data from from the temporary memory to the long-term memory. Dreams as excitations of long-term memory. Tarnow (2003) suggests that dreams are ever-present excitations of long-term memory, occurring even during waking life. Linking and consolidation of semantic memories . Duri During ng REM REM slee sleep, p, the the flow flow of info inform rmat atio ionn between between the hippoc hippocamp ampus us and and neocort neocortex ex is reduced due to the increase in cortisol levels (Stikcgold et al. 2001). One stage of memory consolidation consolidation involves the linking of distant but related memories, which are then consolidated into a smooth narrative (Payne and Nadel 2004). Eliminating unnecessary memories and connections from the day. This theory was revised by
Crick and Mitchison’s (1983) “reverse learning” theory. Testing and selecting selecting mental mental schemata schemata. Coutts (2008) calls this “ emotional selection.” Adler (in Stein 2006) suggested that dreams are often emotional preparations for solving problems. Darwinia Darwinian n random random though thoughtt mutatio mutations ns, termed “oneiric oneiric Darwinism Darwinism” by Blechner (2001). This theory suggests that dreams create new ideas by genera generatin tingg random random thoug thought ht mutati mutations ons.. Some Some may be rejected by the mind as useless, while others may be seen as valuable and retained. The result of DMT (dimethyltryptamine) in the brain. This theory was proposed by Callaway in
1988, and suggests a connection between DMT and visual dream phenomena (Wallach (Wallach 2009). Psychosomatic theory. Dreams are a product of “dissociat dissociated ed imagina imagination tion,,” drawing drawing material material from sensory memory for simulation. By simulating the sensory signals to drive the autonomous mous nerves, nerves, dreams dreams can affect affect mind mind–body interaction. In the brain and spine, the autono-
7
8
1 Ph Physiology of Sleep
mous “repair nerves,” which can expand the blood vessels, connect with pain and compression sion nerves. nerves. These These nerves nerves are groupe groupedd into into many chains, called channels in Chinese medicine (Tsai 1995). ●
Other hypotheses:
Antrobus proposes a mental interpretation of external stimuli, integrating them as part of a dream (Cartwright 1993). – Dreams Dreams allo allow w the repressed repressed parts parts of the mind to be satisfied through fantasy (Vedfelt 2002). – Freud suggested that bad dreams let the brain learn to gain control over emotions resulting from distressing experiences (Cartwright 1993). – Jung suggested that dreams dreams might compensate for one-sided attitudes held in waking consciousness consciousness (Jung 1934, 1974, 2002). – Ferenczi (1927) proposes that dreams express that which is not being said outright. – According to Kramer (1993), dreams regulate moods. – Hartm Hartman annn (199 (1995) 5) prop propos oses es that that drea dreams ms function function like like psychot psychotherap herapy, y, allowing allowing the dreamer to integrate thoughts that may be dissociated during waking life. – In their fulfillment theory of dreaming, dreaming, Griffin and and Tyrel yrelll (200 (2003, 3, 2007 2007)) sugg sugges estt that that dream dreaming ing metap metaphor horica ically lly comple completes tes patpatterns of emotional expectation in the autonomic nomic nervous nervous system system and and lowe lowers rs stress stress levels in mammals. –
Sensory cort rte ex
Right inferior parietal cortex Visual cortex
Positron emission tomography (PET) studies have shown two areas of the brain to be highly activated during REM sleep: the limbic and the paralimbic system. The limbic system is a set of brain structures that include hippocampus, amygdala, anterior thalamic nuclei, septum, limbic cortex, and fornix. It supports a variety of functions including emotional behavior. The paralimbic system consists of the following structures: the pyriform, the entor entorhin hinal al and and parahi parahippo ppocam campal pal cortex cortex on the medial surface of the temporal lobe, and the cingulated cortex. These structures are involved involved in emotion processing, goal seeking, and motivation. The right hypothalamus, hypothalamus, which integrates the sensory – perceptual, emotional, and cognitive functions of the mind with the biology of the body, is also active during REM sleep. Meanwhile, there is a loss of functional funct ional connection between the frontal frontal cortex and the posterior posterior perceptual areas, resulting in a lack of reality testing, hence different types of brain communications. In other words, dream images are experienced, biologically and emotionally as reality. In his book Dream Language (2005), R.J. Hoss updates the earlier activation synthesis model of the dreaming brain by Hobson (Fig.1.2). Table 1.3 presents a compilation of various sources of recent research on the state of the brain in dreaming sleep.
Motor co cortex
Cingulate cortex Limbic system Thalamus
Cerebellum basal ganglia
Brainstem
Amygdala
Parts of the brain active during dreaming
Fig.1.2 Brai Brain n acti activi vity ty duri during ng dreaming: dreaming: limbic and paralimbic paralimbic systems (Hobson and McCarley in Hoss, Dream Hoss, Dream Language, Language, 2005); see Table see Table 1.3 for 1.3 for details.
Sleep Disorders
Table 1.3 Brain activity during dreaming (Hobson 2002, Hoss 2005, Pannier 2006) Brain structure
Functions
Effect during dreaming
Motor cortex (inactive)
Motor functions
Muscular atonia: body paralysis
Dorsolateral, prefrontal, parietal cortex (inactive)
Rational thought, planning, choice, decision, working memory, will, control of inappropriate behavior
Irrational action, loss of will and control, strange imagery accepted as normal, believing one is awake, forgetfulness upon awaking
Sensor y cortex (inactive)
Sensor y input
None or very little sensor y input
Precunius, lateral and inferior prefrontal cortex (inactive)
Processing Processing of visual memory, memory, recall recall
Situations Situations producing producing a dream are different from waking situations
Post Poster erio iorr cing cingul ulat ate e (ina (inact ctiv ive) e)
Work Workin ing g and and epis episod odic ic memo memory ry
Sudd Sudden en scen scene e chan change gess seem seem norm normal al,, no reflective awareness
Left frontal and temporal areas (inactive)
Language association, speech, naming of things
Dream language becomes metaphoric
Left Left inferi inferior or pariet parietal al cortex cortex (inacti (inactive) ve)
Distin Distincti ction on between between self self and others others
Percep Perceptio tion n of self self as the other other
Pont Pontin ine e stem stem and and thal thalam amus us
Init Initia iati tion on of REM REM slee sleep, p, mot motor patpattern generator, arousal and attention
Consciousness, eye movement, movement in dreams, believing one is awake
Right hypoth hypothalamus alamus and and basal forebra forebrain in
Autonomic Autonomic and and instinctual instinctual functions, flight or fight, reward
Themes of fear, escape, emotion, reward and motivation
Limbic and paralimbic: amygdala, hippocampus
Emotion and image association, memory processing, emotion processing, goal-directed behavior, social processing
Emotional memories stimulate the dream, themes with emotional features, goal orientation; focus on anomalies of self-image and others
Basal ganglia
Initiation of programmed motor activity
Perception of movement in the dream
Cerebellum
Fine-tuning of movement, motion perception (vestibular sensations)
Sense of movement and body sense
Visual Visual cortex cortex (tempo (tempororo-occ occipi ipital tal))
Integr Integrati ation on of visual visual percep perceptio tions, ns, image recognition (face, color, shape…)
Visual dream construction from personal associations and emotions
Righ Rightt infe inferi rior or pari pariet etal al cort cortex ex
Spat Spatia iall and and self self-p -per erce cept ptio ion, n, orie orient ntaation, movement, spatial imagery, metaphoric language, pictographs
Dream space as referenced to self, symbolic imagery, metaphoric language
Anterior cingulate
Emotional awareness, error detection, decision-making, appropriate action
Coherent dream scenarios in relation to the dreamer ’s concerns, suggestion of future action
Sleep Disorders Sleep disorders are broadly classified as follows.
Dyssomnia
Dyssomnias are a broad classification of sleeping disorders, including including primary disorders of initiating or maintaining sleep, or of excessive sleepiness. They are characterized by a disturbance in the amount, quality, or timing of sleep. There are over
9
10
1 Physiology of Sleep
30 kinds of dyssomnia, which are subdivided into intrinsic, extrinsic, and disturbances of the circadian rhythm. They include: Primary insomnia insomnia: a chronic difficulty falling asleep and/or maintaining sleep with no apparent causative factor (see “ Insomnia” below) Narcolepsy: excessive daytime sleepiness, often culminating in the person falling asleep spontaneously but unwillingly at inappropriate times Sleep apnea: a sleep disorder that is characterized by pauses in breathing during sleep Obstructive sleep apnea: obstruction of the airway during sleep, causing a lack of sufficient deep sleep, and often accompanied by snoring. Central sleep apnea is less common. Hypopnea syndrome: abnormally abnormally shallow breathing or a slow respiratory respiratory rate while sleeping sleeping Restless legs syndrome: which manifests as an irresistible urge to move the legs. Restless legs syndro syndrome me suffe sufferers rers often often also also have have period periodic ic limb movement disorder. Periodic limb movement disorder , also known as nocturnal myoclonus: sudden involuntary involuntary movements of the arms and/or legs during sleep Chronobiol Chronobiologic ogical al disorders disorders, main mainly ly circa circadi dian an rhythm sleep disorders: the inability to awaken and and fall fall asleep asleep at social socially ly accept acceptabl ablee times, times, although the person has no difficulty maintaining sleep Situational circadian rhythm sleep disorders: shiftwork sleep sleep disorder and jet lag Sleep paralysis: charac character terize izedd by tempor temporary ary paralysis of the body shortly before or after sleep. It may be accompanied by visual, auditory, or tactile hallucinations. Sleep paralysis is often regarded as part of narcolepsy and is not considered a disorder unless it is severe. Parasomnia: events that disrupt sleep, such as sleepsleep-wa walki lking, ng, sleepsleep-tal talkin king, g, night night terror terrors, s, bruxism, bed-wetting, or sleep sex (see “Parasomnia ” below)
●
●
●
●
●
●
●
●
●
transit transition ion between between wake wakeful fulnes nesss and non-REM non-REM sleep, or between bet ween wakefulness wakefulness and REM sleep. Parasomnias include the following: REM sleep behavior disorder . The normal paralysis occurring during REM sleep is absent or incom incomple plete, te, allo allowin wingg the person person to act out dreams that are vivid, intense, or violent. Night terror, or pavor nocturnus. This involves an abrupt awakening from sleep with behavior consistent with terror. Sleep-walking, or somnambulism. Pers Person on enengages, without conscious knowledge, in activities that are normally associated with wakefulwakefulness, such as walking, eating, or dressing. Sleep sex, or sexsomnia. Non-REM arousal parasomnia (sexual behavior in sleep) is considered to be a distinct variant of sleep-walking and causes the person to engage in sexual acts. Sleep-talking, or somniloquy. Person talks aloud in their their sleep. sleep. SleepSleep-tal talkin kingg can range range from from simple sounds to long speeches. Bruxism. This is the involuntary grinding or clenching of the teeth while sleeping. Nocturia . This comprises a frequent need to get up and go to the bathroom to urinate at night. Nocturia differs from enuresis, or bed-wetting, in which the person does not awaken, but the bladder empties anyway. Exploding head syndrome. Sufferers awaken during the night hearing loud noises. ●
●
●
●
●
●
●
●
●
●
Parasomnia
Parasomnia refers to a category of sleep disorders that involve abnormal and unnatural movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, while sleeping, between sleep stages, or during arousal from sleep. Most parasomnias constitute partial arousal during the
Secondary to Medical or Psychiatric Conditions
This category includes: Psychoses, such as schizophrenia and bipolar disorders Mood disorders, such as depression or anxiety Panic attacks Alcoholism ●
● ● ●
Examples of other conditions that disturb sleep are physica physicall pains pains (lumbar (lumbar or neck), neck), environme environmental ntal noises, incontinence, or endocrine causes such as those observed during hormonal changes in the premenstruum or menopausal transitions. The most common sleep disorders include primary insomnia, sleep apneas, narcolepsy, periodic limb movement disorder, restless legs syndrome, and the circadian rhythm sleep disorders. The sec-
Insomnia
ond ond editio editionn of the Intern Internati ationa onall Clas Classifi sifica cation tion of Sleep Disorders (ICSD) (American Academy of Sleep
Medicine 2005) documents 81 official sleep disorders.
International Classification of Sleep Disorders (American Academy of Sleep Medicine 2005) Adjustment sleep disorder
Insufficient sleep syndrome
Sleep bruxism
Advanced sleep-phase syndrome
Intrinsic sleep disorder
Sleep choking syndrome
Alcohol-dependent sleep disorder
Irregular sleep –wake pattern
Sleep enuresis
Alcoholism
Limit-setting sleep disorder
Sleep hyperhidrosis
Anxiety disorders
Long sleeper
Sleeping sickness
Benign neonatal sleep myoclonus
Menstruation-associated sleep disorder
Sleep-onset association disorder
Central alveolar hypoventilation syndrome
Mood disorders
Central sleep apnea syndrome
Narcolepsy
Sleep-related abnormal swallowing syndrome
Cerebral degenerative disorders
Nightmares
Sleep-related asthma
Chronic obstructive pulmonary disease
Nocturnal cardiac ischemia
Sleep-related epilepsy
Circadian rhythm sleep disorder
Nocturnal eating (drinking) syndrome
Sleep-related gastroesophageal reflux
Confusional arousals
Nocturnal leg cramps
Sleep-related headaches
Congenital central hypoventilation syndrome
Nocturnal paroxysmal dystonia
Sleep-related laryngospasm
Non-24-hour sleep –wake syndrome
Sleep-related painful erections
Delayed sleep-phase syndrome
Obstructive sleep apnea syndrome
Sleep starts
Dementia Parkinsonism
Other parasomnia
Sleep-state misperception
Electrical status epilepticus of sleep
Panic disorder
Sleep-talking
Environmental sleep disorder
Peptic ulcer disease
Sleep/night terrors
Extrinsic sleep disorder
Periodic limb movement disorder
Sleep-walking
Fatal familial insomnia
Posttraumatic hypersomnia
Stimulant-dependent sleep disorder
Food allergy insomnia
Primary snoring
Sudden infant death syndrome
Fragmentary myoclonus
Psychophysiologic insomnia
Hypnotic-dependent sleep disorder
Recurrent hypersomnia
Sudden unexplained nocturnal death syndrome
Idiopathic hypersomnia
REM sleep behavior disorder
Terrifying hypnagogic hallucinations
Idiopathic insomnia
REM sleep-related sinus arrest
Impaired sleep-related penile erections
Restless legs syndrome
Time zone change (jet lag) syndrome
Inadequate sleep hygiene Infant sleep apnea
Rhythmic movement disorder
Sleep paralysis
Toxin-induced sleep disorder
Shift-work sleep disorder Short sleeper
Insomnia Insomnia is the most common of the sleep complaints, plaints, affecting affecting 30%–40% of the general adult population and about 15% –25% of children. Primary insomnia is not caused by any physical, psychiatric, chiatric, or environm environmental ental conditio condition. n. Secondary Secondary
insomnia is caused by other intrinsic or extrinsic conditions, medications, or substance intake. Insomnia may be acute, short-term (lasting up to a few weeks), or chronic (when a person suffers from insomnia for at least three nights a week for over a month, including periodic insomnia).
11
12
1 Physiology of Sleep
Causes of Insomnia
Causes of acute insomnia include: Significant life stress (job loss or change, the death of a loved one, divorce, moving house) Illness Emotional or physical discomfort Environmental factors such as noise, light, or extreme temperatures (hot or cold) that interfere with sleep Some Some medica medicatio tions ns (e.g., those those used used to treat treat colds, allergies, depression, high blood pressure, and asthma) Interference with the normal sleep schedule (e.g., jet lag or switching from a day to a night shift) ●
● ● ●
●
●
Causes of chronic insomnia include: Depression and/or anxiety Chronic stress Pain or discomfort at night
● ● ●
An important factor in insomnia is wrong sleep hygie hygiene, ne, such such as irregul irregular ar sleepi sleeping ng habit habits, s, the effect of stimulating food, drink, and drugs, stimulating activities before sleep, and an uncomfortable sleeping environment. Stimulants and depressants include: Caffeine, which acts as an antagonist antagonist at the adenosine receptors and slows the action of the hormones in the brain that cause somnolence. Caffeine sensitivity varies from person to person, but its stimulating effects may last for up to 12 hours. It may cause a rapid reduction in alertness as it wears off. Energy Energy drinks, drinks, which which functio functionn in much much the same way as caffeine. Some individuals experience ence sleep sleep disrup disruptio tionn with with certain certain vitami vitamins, ns, such as vitamin C, or even with mint tea. Drugs containing amphetamines Cocaine Alcohol, which initially causes sleepiness and is theref therefore ore common commonly ly used used to enhanc enhancee sleep. sleep. However, as it has a rebound effect later in the night, it will seriously disrupt sleep. Other depressants such as barbiturates, which act in a similar way to alcohol. ●
●
● ● ●
●
Treatment of Insomnia
Treatment strategies for sleep disorders fall into four categories: Behavioral/psycho Behavioral/psychotherapeutic therapeutic treatments Rehabilitation/management Medication Other somatic treatments ● ● ● ●
Hypnotic benzodiazepines are widely used as they represent the least toxicity. The use of barbiturates has greatly diminished. Other classes of drug, such as anxiolytics or neuroleptics, are also used to treat insomnia. Unfortunately Unfortunately,, many of the medical drug therapies have inconvenient side-effects, such as habituation and the patient becoming dependent on the artificially artif icially induced sleep. Several articles have documented the therapeutic difficulties and side-effects of the drugs that are currently being prescribed for insomnia (Goldenberg berg 1984 1984,, Roy-By y-Byrn rnee and Homm Hommer er 1988 1988,, Copinschi et al. 1990, Gaillard 1990, Mignot 1991, Buclin et al. 1992). It is important to stress that sleep induced by hypnotics is not physiological: Barbiturat Barbiturates es and antidepres antidepressant sant drugs drugs cause reduced REM sleep. Benzodiaz Benzodiazepin epines es and opiates opiates reduce reduce Stage Stage 4 (N3) (N3) slee sleep, p, the the incr increa ease se in tota totall slee sleepp time time being due to an increase in Stage 2 (N2) sleep. ●
●
Moreo Moreover ver,, some some indivi individua duals ls have have experi experienc enced ed what are known as rebound phenomena when they have tried to stop their hypnotic medication. The The foll follow owin ingg symp sympto toms ms have have been been repo reporte rtedd (Buclin et al. 1992, Copinschi et al. 1990, Genton 1990, Hanin and Marks 1988, Mignot 1991, Taj 2002): Nightmares Increase in heart rate and apnea with hypnotic drugs Amnesia and attention deficit with some benzodiazepines Dependence and tolerance with most products Toxicity with certain cer tain barbiturates ● ●
●
● ●
13
2 Sl Slee eep p in Ch Chine inese se Med Medic icin ine e
To understand the pathologies of sleep, we must first explore the significance of sleep in the context of Chinese physiology. Historical Historically ly,, the earliest earliest Chinese Chinese discussio discussions ns about sleep related the sleeping process to the movements of wei qi (defensive energy), orchestrated by the extraordinary vessels, the yin and yang qiao mai (motility vessels). During the Tang dynasty (7th–8th century CE), Chinese physiology became became primarily primarily humoral, humoral, that is, pathologi pathologies es were seen through the concept of the five humors, or substances. Thus, sleep was associated primarily with shen (spirit) and its relation to xue (blood). It was not until the Song dynasty (10th –13th century CE) that the zang (organ) system system was zang fu (organ) adopted as the basis of Chinese medical physiolzang fu and their disharmonies today ogy. The zang constitute the foundation of modern Traditional Chinese Medicine (TCM). Besides the humoral and organic theories, the movements of energy, which are responsible for sleeping process, involve the channel system, in particular the extraordinary vessels. vessels. It is thus obvious that, in order to be able to understand sleep phenomena, we must consider sleep in the context of yin and yang , qi, xue, and shen theories, the zang fu organ models, and the jing luo channel systems. In TCM, the notion of normal sleep is reflected in the terminology used, that is, an mien = peaceful sleep: an 安 quiet, quiet, peacef peaceful, ul, calm calm (as in calming calming the shen) shen) mien 眠 sleep (made up of the character for the eye and the character for community) community)
An mien signifies quiet communion with the self,
probably through dreams (inner vision). Sleep, being a regularly recurring condition of rest for the body and the mind, could be redefined as somatic stillness ( zang fu and jin-sinews) and mental quietness (shen).
Yin/Yang According to basic Chinese premises, daytime and activity are considered to be yang , whereas nighttime and sleep are considered to be yin. Yang grows during the morning, reaching its apex at noon, and declines in the afternoon. Yin grows in the afternoon, reaches its maximum at midnight, and declines in the early morning ( Fig.2.1). In humans, the rhythmic balance between sleep and activity depends primarily on the “internal structure,” the microc microcosm osm,, and second secondari arily ly on external influences, the macrocosm. In a state of health, there is a harmonious balance between
Maximum of yang of yang
Yang Growth Growth
Phase 1
Decline
Phase 2
Decline
Yin Phase 3
Phase 4
Maximum of yin of yin
Maximum of yang of yang Birth of yin of yin Phase 1
Phase 2
Yang Growth of yin of yin Decline of yang of yang
Growth of yang of yang Decline of yin of yin
Yin Phase 4
Phase 3
Maximum of yin of yin Birth of yang of yang
Fig.2.1 The The four four phas phases es of of yang and yin; yin; growth growth and and decline of yang and yang and of yin. yin.
14
2 Sleep in Chinese Medicine
yang qi , which expands during the day, and yin qi,
which abounds at night. Sleep time, which represents the major part of an infant’s 24-hour cycle, progressively progressively diminishes to about 6–7 hours in an adult. Internal factors balance the length and depth of sleep with the length and intensity of daytime activity. This balance can be viewed as being dependent on two parameters: time and space ( Fig.2.2). In relation to sleep, space may be defined as the depth or intensity of sleep. Internal “synchronizers,” primarily the extraordinary vessels, control these parameters, which in turn define our basic and inherent rhythms. Four of these vessels are not only intimately connected to the internal systems ( zang fu), but are also permanently tuned into external variations, such as day and night and the climate ( Fig.2.3). In the absence of a lack of harmony between these syn-
Wake = activity
Yang
Sleep = rest
Normal sleep
Fig.2.2 Balance Balance between sleeping and waking. Under normal conditions, the length (time) and the depth (space) of sleep are adapted to the length and intensity of daytime activity.
Yang intensity “space” Yang wei mai
Yang “time” Yang “time” Yang qiao mai
Sleep and the Substances: – Shen Wei Qi – Xue Xue– Movements of Wei Wei Qi : Physical Relaxation
Yin
Yang
chronizers and other zang fu pathology, the body adapts adapts perfectl perfectlyy to externa externall varia variatio tions ns and demands, while keeping its individual characteristics. This capacity to adapt to change defines the individual’s state of health. Insomnia is a yang condition, condition, which in the great majority of cases is due to a disturbance of yin. This yin disturbance is either due to the inability of yin to achieve a proper depth of sleep, which is the case in superficial or dream-disturbed sleep, or due to a shortened sleep time, as witnessed in problems of falling asleep, and early or frequent waking. The type of insomnia is, therefore, defined by whether it concerns the length or the depth of sleep, or both.
Yin “time” Yin “time” Yin qiao mai
Yin Yin depth “space” Yin wei mai
Fig.2.3 Balan Balance ce between between time time and space. space. The intern internal al organizers of yin and yang, yang, the wei mai and the qiao mai extraordinary vessels.
The Chinese classical text Ling Shu (Spiritual Pivot) describes the circulation of wei qi during the day and the night: “Wei qi circulates on the surface of the body, predominantly along the sinew channels, 25 times during the day, penetrates the deeper layers of the body at the area of the ankle in the evening, circulates circulates in the zang fu through 25 cycles during the night, following following the ke (control) cycle of the five movements, and emerges at the corner of the eye, most probably at jing ming , BL-1, enabling the eyes to open” (Ling Ling Shu, French translation 1995) (Fig.2.4). The text cited here obviously relates to the cycle of sleeping and waking and to the move wei qi, and is strongly reminiscent of the ments of wei role of the yin qiao mai and its synchronization with the yang qiao mai in managing the nycthemeral sleep cycle. The French school, in particular, Nguy Nguyen en Van Nghi Nghi,, prop propos oses es that that the the poin pointt at which the wei qi leaves the surface to penetrate the deeper parts of the body is zhao hai , KI-6. Wei qi, which is mostly concentrated in the jing (sinew channel channels) s) during during the day, day, maintain maintainss jin (sinew muscle tone and mobility; the process of wei qi moving from the surface to circulate internally allows the muscles to relax. This process is considered the first stage of sleep.
Sleep and the Substances: Wei Substances: Wei Qi Blood Blood–Shen
Fig.2.4 The internal circulation of wei of wei qi during during sleep: kidney heart lung liver spleen kidney, and so on. →
→
→
→
→
The passage of wei qi to the interior is a consequence of the relaxation of the external jin, the muscles and the tendons. This movement movement of wei qi mobilizes blood toward the interior, helping it to return to the liver. This would explain the action of points such as qu quan LR-8, yang ling quan GB-34, and yang jiao GB-35 to relax the sinews and help to guide blood to the interior, as indicated for sleep pathologies involvi involving ng restlessn restlessness, ess, for example example restless restless legs syndrome (RLS). Wei qi circulates in the interior during sleep, while ying (nourishing) (nourishing) qi circulates on the exterior. Closing the eyes, which is controlled by jing ming BL-1, BL-1, corresponds to the deactivation of wei qi. Hence, the extra point yin tang is is indicated for insomnia, since it helps to relax the eyes and the nose, and also supports breathing. Jing ming BL-1 is connected to the stomach and large intestine channels (ying xiang LI-20 LI-20 BL-1), and also to the cheng qi ST-1 jing ming BL-1), small intestine channel (via quan liao SI-18, which continues to ting gong SI-19). Relaxing the eyes helps to relax the nose, as manifested in the deeper breathing occurring when falling asleep, and a blockage in the nose can affect sleeping. Jing ming BL-1 is helpful in sleep apnea and also helps to qi at the ear can cause close the ears. A blockage of qi a high-pitched ringing in the ears or cause the person to hear their own heartbeat. Jing ming BL-1, BL-1, as a confluent point of yang qiao mai, can be regushen mai BL-62. Supplementing BL-62 lated by shen helps the patient to wake up; reducing it helps the patient to sleep. The closing of the eyes is the first manifestation manifestation of the wei qi moving inward. The second area the wei qi has to pass through is the chest. The chest needs to relax and to loosen up in order to permit the wei qi to further descend to the zang fu. In the absence of this relaxation, a person may wake up during the night feeling hot and sweating. This shows the importance of relaxing the xiong (chest) and ge (diaphragm), which affects the zong [gathering] qi), with points such as ge shu qi (chest [gathering] BL-17 and zong hui TB-7: BL-17 is used for night sweating, tidal fevers, steaming bone syndrome, and menopausal syndrome (as it cools the blood). Hui zong zong TB-7 helps move wei qi downward toward the abdomen (and is used when the patient wakes in the night to eat). →
→
Wei qi is also responsible for surface body tem-
perature. It is interesting to note that modern research has shown that body temperature also presents a 25-hour cycle, and there appears to be some interaction between sleep and body temperature rhythms (Takahashi, 2010). Falling asleep and deep sleep occur during the lowest body temperature dip, whereas waking occurs during the ascending phase of the curve. Master Jeffrey C. Yuen (lecture 2009, personal wei qi and communication) communication) defines wei and this process more precisely. According to Master Yuen, wei qi, yang qi, is rooted in the yuan qi (source being being part part of yang qi) and needs to return to the source, the kidneys. If the wei qi cannot fully complete its return to the source—the kidneys kidneys—the patien patientt will will experi experienc encee fear in the form of nightmares, and in the case of infants, even convulsions, called jing feng , or fright wind. Master Yuen further says that wei qi also penetrates deeper during the sleep state to protect us against gui (ghost) influences. This kind of gui commonly manifests as gui zha (ghost oppression). Bai Zheng Fu (Ode of One Hundred Patterns) gives indications for: PC-5 jian shi for gui xie (ghost evil) SP-1 yin bai for gui zha ST-45 li dui and SP-1 yin bai for sleeping or dreaming with a heavy sensation on the chest LU-3 tian fu for gui yan (ghost talk) ● ● ●
●
15
●
●
16
2 Sleep in Chinese Medicine
●
●
●
●
Jian shi PC-5 can also be used for sleeping dis-
orders associated with eating late, causing stomach yin xu vacuity, with empty heat disturbing sleep leep.. It can can also lso be used used for eati eatinng disorders (food compensation). Yin bai SP-1 is used for excessive dreaming, restlessness, restlessness, and fright wind (nightmares). Yin bai SP-1 + li dui ST-45 is supplemented for excessive sleeping, reduced for insomnia. From the chest, wei qi moves to the abdomen and down to ming men GV-4 with the liver as the zhu (chief governor or emissary), given its position position between between the heart shen and kidney jing.
In the Daoist tradition, sleep is a preparation for deat death, h, and and rest restle less ss slee sleepp fore forebo bode dess a rest restle less ss death:
Wei qi Ying qi Yuan qi
Jing jin (sinew jin (sinew channels) = process of relaxation Luo mai (connecting mai (connecting channels) = PC luo / KI luo luo / SP great luo luo / / GV luo luo / / CV luo Jing bie (divergent bie (divergent channels)
Fig.2.5 The inward movement of wei of wei qi and and the collateral channels.
solutions or resolutions. In the absence of any emotional issues to process, wei qi moves back to the primary channels. Sleep is then restful and one wakes up rested and rejuvenated. Shen:: Mental Relaxation Shen
“We
die in the same manner that we sleep.”
Master Yuen further elaborates on the movement wei qi inward: under the control of the lung, the of wei liver releases the ying outward, outward, causing the hun (ethereal soul) to move out and wander (rapid eye movement [REM] sleep). The wandering of the hun can be seen as the liver releasing its internal wind, that is, the emotions. Hun includes aspects of memory, the record-keeper, but also insights into the future, as the liver is associated with time (that is, qi men LR-14). Wei Wei qi, being the result of the conversion of ying qi (nourishing qi), should also move back to the ying level. level. This process involves the secondary or collateral channels, particularly the luo (connecting channels) ( Fig.2.5). As described by Master Yuen, the return of wei wei qi to to the ying the ying level level involves the luo the luo mai , in particular the pericardium luo pericardium luo,, which moves to the chest, and the kidney luo, luo, which returns to the lower abdomen. Three other luo help bring back the wei qi to the yuan, yuan, the spleen great luo great luo and and the luo the luo of of the ren the ren mai (conception vessel) and du and du mai (governing (governing vessel).
As the luo are heavily involved with the blood and shen, they act as a buffer system and manage our emotional responses to the world. The involvement of the luo during the night gives us the oppo opportu rtuni nity ty to revi review ew the the psyc psycho ho-e -emo moti tion onal al impacts of our daily life in the form of dreams manifesting as challenges, prompting us to find
Sleep is defined as a regularly recurring condition of rest for the body and mind. Body rest results from the relaxation of the jin (sinews) and the movements of wei qi. Mental relaxation is in the domain of the shen. Shen 神
In the Chinese classics, shen has been defined as spirit or spirits, gods, creative instance, organizing spirit or principle, subtle influx inf lux received from heaven, mysterious cause (unfathomable metaphys physica icall princi principle ple), ), pure pure action, action, trans transfo formi rming ng force, and creative force that enhances growth, elaborates, and completes the transformation of an individual and his or her consciousness of the world. Shen is a collective term for the emotional, mental, and spiritual aspects of human existence; hence hence,, it is invo involv lved ed in learni learning ng,, intel intelli lige gence nce,, memory, memory, the ability ability to differenti differentiate ate emotions emotions,, and coherence of thoughts, association, and alertness ( jing shen s hen ). On the one hand, shen is responsible for our perception of reality. In Confucianism, the cultivation of the mind (that is, the thoughts) changes our perception of reality. On the other hand, shen represents our spiritual evolution. Shen is responsible for how our life mandate ( ming ),), stored in the kidneys, will be manifested and carried out. In the Daoist tradition, t radition, the heart channel points represent the nine steps or stages in life. Master
Sleep and the Substances: Wei Substances: Wei Qi Blood Blood–Shen
Yuen calls these points the nine steps towards redemption, recovery, and sovereignty: sovereignty: HT-1: ji HT-1: ji quan High quan Highest est Spring Spring Endless Endless possibilit possibilities ies HT-2: qing HT-2: qing ling Green-Blue ling Green-Blue Spirit
A young soul
HT-3: shao HT-3: shao hai Le hai Less sser er Sea Sea
Oce Ocean of life life
HT-4: ling HT-4: ling dao Spir Spirit it Path Path
Path Path for for the the soul soul
HT-5: tong HT-5: tong li Connecting Li Connecting Li
Life challenges
HT-6: ying HT-6: ying xi Yin Clef Cleftt
Them Theme e of life life (m (mid id-l -lif ife e cris crisis is))
HT-7: shen HT-7: shen men Spirit Spirit Gate
Enteri Entering ng the heart heart
HT-8: shao HT-8: shao fu Lesser fu Lesser Mansion
Less residence (attachment)
HT-9: shao HT-9: shao chong Lesser chong Lesser Surge
Less blueprint (less curriculum, less karma)
Consciousness and wakefulness are defined by the activity of the shen. Awareness is the result of the harmonious activity of the zang fu as expressed by (clarity of the spirit). shen ming (clarity Mental activity may be summarized as: Shen receiving the sensory input (consciousness, alertness) Processing Processing (digestion) of the information by the (intellect, thought/mindfulness) thought/mindfulness) yi (intellect, Stori Storing ng of the inform informati ation on by the zhi (will) (Fig.2.6) ●
●
●
All information is understood, properly analyzed, and stored accordingly in this manner. manner. Yi 意 Yi represents the thinking process, concentration
Hence shen, being being respon responsib sible le for for our spiritu spiritual al evolution, will manifest through the offices of the hun in the form of dreams, enacting the challenges of our chosen life curriculum (predetermined life mandate). One can process these challenges by practicing lucid or conscious dreaming (see Chap(see Chapter 5). 5). When difficulties are encountered in this processing, the dream is experienced as a nightmare. On the other hand, shen also represents the sum total of our emotions and is responsible for their manifestation. Therefore, all emotions will affect the shen and disrupt the heart, causing sleep problems: Anger will cause heart fire. Joy or excitement excitement and sadness sadness affect heart qi. Pensiveness Pensiveness affects heart hear t blood. Fear and fright (shock) in adults affects heart – kidney communication. communication. ●
in thinking thinking and focusin focusing, g, providi providing ng boundaries boundaries,, and giving meaning to experiences. Yi functions through through memory, memory, analysi analysis, s, synthesis synthesis,, thinking, thinking, classification, concentration, focusing, symbolism, abstract thinking, conceptualization, ideas, learning, integration of sensory, mental and emotional input, and physical awareness. All sensory sensory inform informati ation on proces processed sed by yi will, therefore, be broken down, as in the digestive process, into separate components, to be understood
Sensory input
● ● ●
Mental activity is the combined interaction of consciousness, qi (energy/ (energy/fun functio ction), n), and the nao (brain). It can, therefore, be summarized as the manifestation of the “ Three Treasures Treasures”:
Shen
Yi Analysis
Shen — Shen — spir s pirit it
Resid esides es in the the hear heartt
→
Coordination, coherence
Qi — ener e nergy gy
Prod Produc uced ed by the the sple spleen en
→
Function
Jing — Jing — essenc essence e
Store Stored d in the kidney kidneyss
→
Brain matter
Zhi
Storage
Fig.2.6 Mental activity and the role of shen of shen,, yi , and zhi and zhi .
17
18
2 Sleep in Chinese Medicine
and integrated, and to be stored in appropriate compartments according to color, sound, sensation, emotion, and so on. The recollection of an event, when experienced consciously and hence analyzed by yi, will contain all the associated events, even the memory of the experience, without actually reactivating the emotion experienced at the time. Hun and po (corporeal spirits) ensure the “free flow” and the “entry and exit” of movement movements. s. When shen is disconnected, as is the case in sleep, hypnosis, or coma, hun and po take over and store the memories. Yi then no longer analyzes the sensory input. Instead, hun stores the impressions and emotio emotions, ns, and and po stores stores physi physical cal sensat sensatio ions ns (Fig.2.7). As hun and po do not analyze the experience, the memory is stored in its entirety, and when this is recalled or reactivated, the person will experience the whole event as though it were occurring right there and then. These unexplained and apparently illogical responses are referred to as gui in Chinese medicine. Gui 鬼
The The Chines Chinesee notio notionn of gui, an unnamed spirit, entity, or energy mass, refers to apparently unexplained or inappropriate reactions to outer stimuli. This is the case in unconscious conditioning, hyp-
Sensory input
Shen
Hun
Yi
Po
Fig.2.7 In the absence of shen of shen and yi , hun stores hun stores impressions and emotions emotions (behavioral (behavioral gui gui ), ), while po while po stores physical sensations and pain (somatic gui (somatic gui ). ).
nosis, phobias, behavioral neurosis, many psychosomatic diseases, and of course most psychotic manifestations. Both hun and po contain the radical gui in their ideograms. Hun 魂, Po 魄 Hun is responsible for behavioral behavioral gui, and po is the origin of somatic gui. According to the correspondence system, wu xing (five moving forces or phases and five ele-
ments), at all times the three planes of man ’s constitution—spiritual, spiritual, emotional emotional,, and physical physical—are always interrelated. Hence the physical (somatic) or emotional levels may affect the higher mental aspect aspectss or, vice vice versa versa,, psycho psycho-em -emoti otiona onall state statess may have an effect on the somatic body. It is necessary here to point out that there are two representations of the five elements, which have most often been confounded: the “cosmogenic order” describes the creation order of the elements and represents the universal structure, that is, our internal structure. In this model, the earth element is represented in the center, identified by the character di 地. This model is usually used to represent the wu xiang (five directions, with the earth as the center), or the wu ji (four seasons, plus the earth in the center, representing the seasonal interphase). In this text, I will refer to this model as five elements, as it represents five inva invaria riabl blee posi positio tions ns.. As far far as I am awar aware, e, no Chinese term has been used to differentiate this model. On the other hand, the term wu xing refers refers to the well-known “correspondence system” of the five moving forces, also called the five phases, and describes the homeostatic interrelationship of the organs and the correspondence with external and internal factors. In this model, the earth is considered one of the changing phases, and is represented by the character tu 土 (Fig.2.8). Hence, the five moving forces wu xing reflect reflect the substance disharmonies and the consequences of the external climatic, internal emotional, and other dietary and lifestyle causes of disease and their consequences on various organs. The five f ive elements, on the other hand, explain the inner structure ture of the the psyc psyche he and and the the inte interre rrela lati tion onsh ship ip between shen (mind), hun (ethereal soul), po (corporeal soul), yi (intellect), and zhi (will) (Fig.2.9).
Sleep and the Substances: Wei Substances: Wei Qi Blood Blood–Shen
Maximum of yang of yang Birth of yin of yin South
Growth of yang of yang East Decline of yin of yin
Fire
Growth of yin of yin West Decline of yang of yang
Wood
North Maximum of yin of yin Birth of yang of yang
Ear th
Metal
Water
The cosmogenic order of the universe: 4 + 1 (the four directions and the center)
Fire
Wood
Earth Wu xing
Water
Metal
The correspondence system: the five movements 3 + 2 (3 yang + 2 yin) yin)
Fig.2.8 The five phases and the five moving forces.
During sleep, shen retires to the xue, which explains a person’s reduced reduced response response to outer stimuli. Modern analysis of the brain using an electroenc troenceph ephal alogr ogram am (EEG) (EEG) shows shows an import important ant slowing down in the electrical activity of the brain waves that is different from that seen in a state of simple relaxation or quiet wakefulness (see Chap(see Chapter 1). 1). The sleep stages as evidenced on an EEG can be equated with the five aspects of the psyche (Hervé de Coux 1991) (Table 2.1). In the absence of shen shen, hun and po are responsible for protecting the individual. This explains the wei qi at night in need for the deep penetration of wei order to protect against gui. When shen has difficulty in quieting due to emotions or blood vacuity, a person will have difficulty falling asleep due to excessive mental activity, called zao (agitation).
At night, blood moves back inside to be stored in the liver, and the hun soul also returns inward, although it is occasionally liberated to wander, which explains the phenomenon of dreaming (see Chapter 5). 5). Xue,, Shen Xue Shen,, and Hun and Hun
The function of the blood is to nourish and to moisten. The absence of this moistening process results in dryness of the organs and a condition called zang zao (visceral agitation). When zang zao affects the mind, mental conditions such as panic attacks, paranoia, and phobias occur. Blood is also called the “mother of qi,” and is believed to be the medium of our intentions. It is said that blood contains consciousness. According
19
20
2 Sleep in Chinese Medicine
●
H E A V E N
Shen
Po Mental– spiritual level
Yi
Zhi
Hun
Cogitation
Joy, excitement M A N
The heart, the seat of shen shen, which defines our connections or interpersonal encounters
Anger
Emotional level
Sadness
Finally, how we feel about a person or situation relates to the lung and po, and disconne disconnection, ction, whereas feeling disconnected or rejected relates to the pericardium According to Chinese texts, blood stores both shen and hun, hence the importance of blood in the physiology of sleep. Blood vacuity therefore affects the shen and the hun and may cause sleep disturbanc disturbances es involvi involving ng difficulty difficulty falling falling asleep. asleep. These are classified as: Calm insomnia: zao (agitation) involving heart blood, with mental activity (mental agitation) Restlessness: fan (vexatio (vexation), n), involv involving ing liver liver blood, with muscular restlessness ●
Fear
●
SP-ST
HT-SI E A R T H
Physical (somatic) level
LR-GB LU-LI KI-BL
Fig.2.9 Man’s three planes of existence: the physical, or somatic level, the emotional level, and the mental –spiritual level.
Table 2.1 Mental states and activity of the psyche by Hervé de Coux (La ( La Peur et le Rêve 1991) Rêve 1991) Menta entall stat state e
Consciousness
EEG EEG acti activi vity ty Eleme Element nt
Beta
Earth
Psyc Psychi hicc activity Yi
Alert watchfulness Alpha
Fire
Relaxed watchfulness, drowsiness
Theta
Metal
Po
Deep sleep
Delta
Water
Zhi
Wood
Hun
Paradoxical sleep, Beta REM sleep
Shen
to Master Yuen, the three organs involved in consciousness are: The spleen, which houses yi, and represents our boundary and contact with the world The liver, which houses the hun, and is responsible for our interaction with the world ●
●
In cases of blood vacuity where the blood cannot contain shen and hun, there will in addition be easy and frequent waking, and dream-disturbed sleep. The person will also manifest emotional vulnerability, will be easily startled and overly sensitive, have the urge to fidget, and or have memory loss, usually for the most recent events. Other conditions that disturb the blood also disrupt sleep: Blood heat causes agitated sleep with a tendency to depression, irrationality, and impulsiveness. If the heat is internal, there is more likely to be fan with heat in the chest, whereas external heat generates zao, with heat in the limbs resulting in the need to fidget. f idget. Blood stagnation will also cause agitated sleep through the consumption of blood, and over time leads to lao (taxation). This pattern is most common among those with severe psychological condit conditio ions ns invo involvi lving ng worry worry,, anxiet anxiety, y, or depressio depressionn coupled coupled with eating eating disorders disorders or addicti addictive ve beha behavio viors rs such such as those those invo involvi lving ng alcohol, drugs, or sex. Blood stasis often leads to forgetfulness, dementia, and even to kuang (mania). ●
●
Sleep and the Zang the Zang Fu
Sleep and the Zang the Zang Fu Heart, Sleep, and the Emotions
The heart ( xin) is the primary primary zang responsible responsible for regulating sleep on account of its main function being to house the shen. The role of shen shen in the sleeping process has already been discussed. However, the heart is also responsible for the states of xue, which also have a central role in the initiation and maintenance of sleep. As all emotions affect the heart, causing heat, they can all have an effect on sleep (please see p.17). Practic Practicall allyy all heart heart patho patholog logies ies,, espec especial ially ly those producing heat, will disrupt the sleeping process, namely: Heart fire or phlegm–fire Heart blood vacuity ( xin xue xu) or heart yin vacuity ( xin yin xu ) Lack of communication between the heart and the kidney ( xin shen bu jiao) Heart qi vacuity (xin (xin qi xu) or heart yang vacuity ( xin yang xu ) ● ●
●
●
Other heat patterns involving the pericardium, xin bao (exter jiao (external nal heat), heat), or triple triple burner burner,, san jiao (damp–heat), will also affect the heart, with the same consequences for sleep.
The liver plays a primordial role in the sleeping process. During the waking stage, the liver manages the circulation of wei qi on the surface and, through the jing jin , muscular activity. The liver is also responsible for the eyes and vision. The liver plays an important role in the initiation of sleep by mobilizing wei qi inward, which results in a lowering of muscle tone. We have seen that this movewei qi to the interi ment of wei interior or causes causes sensory sensory relaxation as well, starting with the eyes, the nose, and then the ears. The movement of hun inward helps move qi away from the head and helps relax the shen. Where the process of movement of hun to the interior is disturbed, this will manifest as difficulty diff iculty falling asleep through zao. According to Master Yuen, the liver acts as the zhu (emissary), given its position between kidney jing , the water phase, and heart shen, the fire phase (noting that the deep pathway of the kidney channel passes through the liver to ascend to the lung and the heart): The first stage of sleep is enabled by the liver and lungs, which allow the body to relax (any disturbance in this stage would cause difficulty falling asleep). The second stage involves the liver interacting with the spleen to maintain sleep (any disturbance in this stage would cause difficulty staying asleep). The third stage, in which the liver interacts with the kidneys, inducing deep sleep, as in concentration without distraction (any disturbance in this stage would would cause restless restless sleep). Finally, the liver interacts with the heart or pericardium, inducing rejuvenation and regeneration through liberation or redemption from one’s predetermined course or ming , via the processing that takes place through dreams. ●
●
●
Hun,, the Liver, and Dreaming Hun
Dreams are indispensable to health, although the reason remains unclear. In Western medicine, this phase of sleep is termed rapid eye movement (REM) or paradoxical paradoxical sleep. Two phenomena occur during dreaming, and both are strong indicators that the liver is involved in the process: rapid eye movement, movement, which may be associated with internal wind; and the flow of blood towards the outer genitalia, the territory of the liver channel, connecting back to the jing level. level. Rapid eye movement denot denotes es intens intensee visua visuall activity activity,, a kind kind of inner inner vision, through which the liver releases its internal wind. The The impo importa rtanc ncee of drea dreami ming ng,, the the diff differ eren entt kinds of dreams, and their interpretatio interpretations ns will be further explored in Chapter 5. In pathological disturbances, hun may wander excessively to cause dream-disturbed sleep or nightmares.
●
This interaction between the liver and pericardium per icardium allows for lucid dreaming or vivid awareness during the dream state in order to: Bear witness to, or at least to prepare oneself to observe, the events of the past and future (the role of the hun) and to observe our reactions to these events (the role of the pericardium) Eventually, achieve the goal of the practice of lucid dreaming, which is to consciously place oneself in a challenging situation and to develop solutions or resolutions
●
●
21
22
2 Sleep in Chinese Medicine
Master Yuen further compares the sleep stages to processes involved in meditation: N1: Drowsiness, falling asleep
Relaxation (physical and mental)
N2: Superficial sleep, maintaining sleep
Concentration (no external distraction)
N3: Deep sle sleep
Medi Medittati ation (comple plete inner stillness)
REM REM sleep sleep:: Drea Dreami ming ng
Levi Levita tati tion on (deta (detach chme ment nt of spirit)
Sleep and the Fu the Fu
As it moves inward and passes through que pen (ST-12), the chest, and the diaphragm, wei qi will descend to the fu (bowels). According to Master Yuen, wei qi descends in orde orderr to ensu ensure re that that the the proc proces esss of “rest rest and digest” takes place, with yang qi moving inward via que pen (ST-12) (except for the bladder channel). Any stagnation in the transport of wei qi in f u will affect sleep, causing insomnia with visthe fu ceral symptoms such as bloating, colic, or hunger. Additionally, Additionally, there will be specific signs and symp qi via da zhui (GVtoms due to the counterflow of qi 14) toward bai hui (GV-20): Large intestine (LI): teeth-grinding, neck and shoulder tension (and often also difficulty in moving bowels in the morning) Stomach (ST): difficulty falling asleep, fan, and nighttime food cravings Bladder (BL): difficulty falling asleep with zao (e.g., (e. g., RLS, calf cramps, and so on) and nighttime sweating Smal Smalll inte intest stin inee (SI) (SI):: dry mout mouth, h, nigh nightti ttime me thirst, and enuresis Gallbladder (GB): bitter bitter taste, itching (mostly (mostly of the head), and neck tension Triple burner (TB): drooling and a lot of crusting around the eyes ●
●
Sleep and the Extraordinary Vessels All yin and yang phenomena correspond to the eight extraordinary channels or vessels ( qi jing ba These chann channel els, s, which which act as reserv reservoir oirs, s, mai). These maintain internal balance and harmony, and adapt the inner milieu, the microcosm, to outer variations, the macrocosm. The extraordinary vessels are considered to be the link between the pre-heaven and the post-heaven qi. chongg mai mai The The four four fundam fundament ental al channe channels ls—chon mai (penetrati (penetrating ng or thorough thoroughfare fare channel) channel),, du mai (governing channel), ren mai (conception channel), and dai mai (belt or girdling channel) channel)—are directly connected with the source, source, dong qi qi (the moving qi between the kidneys) (Fig.2.10 ). The ). The four fundamental channels participate in the first cellular divisions. Chong mai, du mai, and ren mai, often with the addition of dai dai mai, are referred to as the “first first ances ancestry try” and and are are cons consid ider ered ed to be the the “source of creation.” These four extraordinary vessels all derive qi from the kidneys and circulate the jing qi through the body: Ren mai distributes yuan qi/jing qi mainly to yang ming ( ( yang brightness). brightness). Chong mai distributes to the three yin levels (tai, jue, shao). Du mai distributes mainly to tai yang (supreme (supreme ). yang ). Dai mai distributes mainly to shao yang (lesser (lesser yang ) and tai yang . ●
●
●
●
●
Navel
●
Dong qi
●
●
Ming men —the Fig.2.10 Dong qi — t he moving qi moving qi between between the kidneys. Origin of three of the four fundamental vessels.
Sleep and the Extraordinary Vessels
The other four extraordinary vessels, which originate nate in the the kidn kidney ey and and blad bladde derr chan channe nels ls,, are are mainly involved in modulating (regulating) yuan qi: Yin and yang wei mai (binding or linking vessels) regulate variations in the yin and yang spaces. Yin and yang qiao mai regulate variations in the rhythms (times). yin and yang rhythms ●
●
The kidneys, through the chong mai and ren mai, program and regulate the cycles of life (puberty, menopause, and so on), and through the yin and yang wei mai and yin and yang qiao mai regulate not only rhythmic changes (sleep –wake, menstrual cycle, cycle of pregnancy), but also psycho-spiritual transformations. transformations. The eight extraordinary vessels distribute jing qi to the six extraordinary fu organs, and integrate them into the zang fu system (Table 2.2). They act to consolidate and regulate the “quantity” of qi in the main channels by: Absorbing any excess yang (external heat, or liver yang rising rising)) or any any exces excesss yin (damp, phlegm) Transferring qi to a deficient channel Redistributing qi between different areas in the body: – Front/back: ren mai and du mai (also chong mai) – Exterior/interior: yin and yang wei mai – Upper/lower body: dai mai – Right/left: yin and yang qiao mai – Day/night: yin and yang qiao mai – Regulating Regulating the circulation circulation of wei wei qi: yin and ●
● ●
yang qiao mai
The role of the eight extraordinary vessels in the regulation of sleep cycles and the impact their disturbance may have on sleep patterns is clear. It also seems quite probable that there is a direct connection between these vessels and central nervous system activity, as evidenced by some of the sympto symptoms, ms, and espec especia ially lly the pathw pathway ays, s, of the extraordinary vessels: all except dai mai reach the head; du mai, yin and yang qiao mai penetrate the brain directly, and chong mai and ren mai penetrate the brain via ST-1 and BL-1. At all times yang activity activity must be balanced by yin rest. Organization of Yang Yang
Four of the extraordinary vessels are responsible for for all all yang activities activities,, spaces, spaces, and phenomen phenomenaa (Fig.2.11): Du mai, the Sea of Yang Yang , recapitulates all yang activities. Yang wei mai , the Preserver or Binder of Y ang ang , maintains the balance between inside and outside, and controls wei qi on the surface. Yang qiao mai accelerates yang. Dai mai maintains the distribution of yang and and regulates the upper and the lower parts of the body. ●
●
● ●
Organization of Yin Yin
In a similar manner, four of the extraordinary vessels are responsible for all yin activities, spaces, and phenomena (Fig.2.12):
Table 2.2 The six extraordinary fu organs fu organs and the eight extraordinary vessels Extraordinary fu Extraordinary fu organs
Extraordinary mai ve mai vesssels
Western anatomical or physiological equivalent
Nao (brain) Nao (brain)
Du mai / yin qiao and qiao and yang yang qiao mai
Nervous system
Sui (marrow) (marrow)
Chong mai /du mai
Hematopoietic system
Gu (bones) Gu (bones)
Chong mai /du mai /ren mai
Electrolytic system
Mai (vessels) (vessels)
Chong mai
Vascular system
Dan (gallbladder) Dan (gallbladder)
Dai mai
Hepatic portal system
Nu zi bao (uterus) bao (uterus)
Chong mai /ren mai
Genital system
23
24
2 Sleep in Chinese Medicine
Dai mai Yang organizer
Yang
Yang wei mai Yang preserver (Yang space)
Du mai Sea of yang of yang ●
Yang qiao mai Yang accelerator (Yang time)
Fig.2.11 The regulation of of yang by the four yang extraordinary vessels.
Yin qiao mai Yin accelerator (Yin time)
Yin wei mai Yin preserver (Yin space)
Yin
Ren mai Sea of Yin
Chong mai Yin organizer
Fig.2.12 The regulation of yin by yin by the four yin extraordinary yin extraordinary vessels.
●
●
●
●
Ren mai, the Sea of Yin Yin , nourishes yin and recapitulates all yin activities. Chong mai, Sea of Blood, Sea of the five Zang and the six Fu, Sea of the 12 Channels, is the organizer of yin. yin. Yin Yin wei wei mai mai, the Preserver or Binder of Yin,
maintains the balance between the inside and outside and controls the blood; hence, it influences the heart and the shen. Yang qiao qiao mai regulates the intensity of yin, mainly at nighttime, and accelerat accelerates es yin.
The yin and yang wei mai are involved in regulating wei qi and in its movements between the surface and the deeper areas; hence, they play an important role in the muscular and mental relaxation necessary for sleep to occur: Yang wei mai symptoms: – Repletion: alternating alternating fever fever and chills; sensitivity to changes in the weather; insomnia with easy waking; chest oppression; changing moods; pains and spasms, lumbar pain; skin hyperesthesia, arthralgia (of the hands or heels) heels),, parot parotidi iditis tis,, diarrhe diarrhea, a, headac headache he with with heat heat or thunde thunderst rstorm orms; s; red eyes eyes or excess excessiv ivee lacrimati lacrimation on (with wind); wind); otitis, otitis, deafne deafness ss,, tinni tinnitus; tus; acute acute sinusi sinusitis tis;; facia faciall neuralgia; eczema of the neck or ears – Vacu Vacuity ity:: cold coldne ness ss,, loss loss of stren strengt gthh with with changes in the weather (snow, rain); weakness or stiffness of the limbs Yin wei mai symptoms: – Repletion: tightness tightness or pain in the chest chest (tai yin [supreme or greater yin]: stinging pain; jue yin [terminal yin]: sharp pain; shao yin [lesser yin]: stabbing pain); pain along the low lower bord border er of the the rib rib cage cage;; pain pain and and spasms in the legs, very cold limbs, energy shooting upward in the body, intense headaches aches (verte (vertexx or occipu occiput), t), hypert hyperten ensio sion; n; intestinal gas; lumbar aches (after emotional shock); palpitations; fear, panic attacks, phobia, agitation, nervous tics, nervous eating ●
●
Organization of Sleep
The yin and yang qiao mai have traditionally been indicated for sleep pathologies, more specifically for symptoms related to day and night: Yin qiao mai symptoms: – Replet Repletion ion:: hyper hypersom somnia nia,, heada headache ches, s, epiepilepsy (worse during the day); medial leg pain painss or gene genera rall spas spasms ms,, lumb lumbar ar pain pain (radiating to the genitals or to the chest and ●
neck); difficulty swallowing; redness of the inner corner of the eye, chronic eye diseases – Vacuity: insomnia, headaches, pains (worse at night); convulsions; weakness or paralysis of the legs; blurred vision, difficulty opening the eyes, anuria, spermatorrhea, impotence, sterility, menstrual cycle problems, and so on Yang qiao mai symptoms: – Repletio Repletion: n: insomnia insomnia;; headache headachess (worse (worse at night night); ); lumbar lumbar pains, pains, one-si one-sided ded pains pains or weakn weakness ess;; pains pains and tightn tightness ess (not (not localocalized, worse at night), lateral leg and hip pains pains and spasti spasticity city;; intern internal al or extern external al wind; wind; convulsi convulsions, ons, tinnitus, tinnitus, epilepsy epilepsy,, ParParkinson disease; nose bleeds; red and painful eyes, exophthalmia – Vacuity: lassitude during the daytime, lack of strength, unilateral paralysis of the leg, hemiplegia, apathy; excessive lacrimation
Sleep and the Extraordinary Vessels
–
Vacuity: Vacuity: vacuity of the heart and lung, hypohypotension, ptosis; depression, tears; oversensitivity; insomnia resulting from fear
A number of recent studies have demonstrated that, under normal conditions, the internal organization of sleep allows for a reduction in the length of sleep due to an increase in its depth with no somatic consequences consequences (Horne and Wilkinson 1985). constantl tlyy mainta maintaine inedd in a Yin and yang are constan dynamic state of balance by the regulating function of the yin and yang wei (linking) and the yin and yang qiao qiao vessels (Fig.2.13). A disturbance of yin yin, for example yin vacuity, suggests either a weakness of the yin wei vessel or the yin qiao vessel, or an excess of the opposite yang wei or yang qiao vessels. Thus, when assessing sleep disorders, it is also important to consider the complementary yang vessels. vessels. It may be presumed that “ time” is organized by the yin qiao and the yang qiao vessels, and that “space ” is managed by the yin wei and yang wei vessels. Therefore, it can be assumed that sleep, being a yin phenomenon, is synchronized in its temporal structure by the yin qiao vessel and in its depth and intensity by yin wei vessel. These two regulators are naturally in equilibrium with the other two synchronizers, the yang qiao and yang wei vessels, which relate to a state of wakefulness and activity, thus balancing sleep with activity. As a result, the more intense or prolonged the activity, the deeper the sleep. The most pertinent fact about the four extraordinary vessels which appear to regulate “time” and “space” (in other words, our basic rhythms Yang intensity “space” Yang wei mai Wake = activit y
Yang Yang “time” Yang qiao mai
Sleep = rest
and cycles) is that traditionally xi (cleft) points have been indicated for them. Now, the function of a xi point is to de-obstruct or to unblock, indicating that these channels can in fact be obstructed in a similar way to the primary channels. Furthermore, the sensitivity of these xi points, when palpated, is an excellent indicator that these channel systems are disturbed. Time
In its temporal movements, yin is first shao yin, then tai yin, and then jue yin. This sequence can be seen in life as well as in all phenomena: all things begin shao (small), then they grow tai (big), and then grow old, tired, worn down, and become terminal ( jue). Sleep, in its temporal structure, is regulated by the yin qiao vessel, as indicated by the classical statement on wei qi that “it penetrates inside at the medial ankle at night, and emerges at jing ming , BL-1 in the morning, allowing the eyes to open” (Ling Shu). Therefore, in a temporal sequence, the initial stage of sleep —that is, falling asleep and the first hours of sleep—corresponds to the shao yin segment. The middle stage of sleep corresponds to the tai yin segment. The last, or third stage of sleep is related to the jue yin segment (Fig.2.14). The yin qiao mai sequence starts with shao yin points: ran gu KI-2, zhao hai KI-6, and jiao xin KI-8. The channel then runs through the territories of tai yin, abdomen, and jue yin, chest, without specific confluent points ( Fig.2.15). This means that if sleep is disturbed in its temporal structure, the yin qiao or its complementary yang qiao mai will manifest a disturbance, as evidenced in the sensitivity of their respective xi points.
Yin “time” Yin qiao mai
Yin
Yin qiao mai
Normal sleep Yin depth “space” Yin wei mai mai
Fig.2.13 In normal sleep, the length (time) and the depth (space) of sleep are adapted to the length and intensity of daytime activity. The qiao and the wei mai maintain maintain this state of dynamic balance.
Shao yin Tai yin
Jue yin
Yin Sequence in “time” Yin Sequence = Yin Yin rhythms rhythms
Fig.2.14 Yin qiao mai and and the three yin sequences yin sequences in time: shao yin tai yin jue yin. yin . →
→
25
26
2 Sleep in Chinese Medicine
Space BL-1 ST-9 ST-12
KI-6
KI-8 KI-6 KI-2
In its intensity, yin is first tai yin, then jue yin, and then shao yin. This spatial organization relates to the order of the primary channels in the body, from the outside to the inside, where the shao yin is the deepest level (Fig.2.16). The term “depth” is defined as the position of the channel in relation to wei/nei (outer/inner), where yang is exterior, and yin interior ( interior (Fig.2.17). Tai yang is is the outermost channel, which is in contact with the world; then comes shao yang , and then the deepest yang , yang ming . Tai yang is is more than yang ming , and therefore closer to the yang than outside (wei). The yin channels are energetically clos closer er to the the insi inside de (nei). This This organi organizat zation ion in space is clearly demonstrated in the disposition of the 12 primary channels in the body, where the most yang zones zones will be tai yang , followed by shao yang , then yang ming , then tai yin (the yin closest to the outside), followed by jue yin, and then shao yin, the deepest yin in the body. The yin wei mai point sequence on the trunk clearly demonstrates the three levels of yin as it runs through the three sections ( sections (Fig.2.18 ):
Fig.2.15 Yin qiao mai and and its constituent points.
The six zones
Fig.2.16 The “spatial” distribution of yin and yang, yang, from back to front: front: tai yang yang,, shao shao yang yang, yang ming, ming, tai yin, yin, jue yin, yin, and shao yin. yin.
Sleep and the Extraordinary Vessels
● ●
Tai yang ●
Shao yang Yang ming Tai yin Jue yin Shao yin
Fig.2.17 The “spatial” distribution of yin and yang yang,, from outside to inside: tai inside: tai yang, shao yang, yang ming, tai yin, jue yin, yin, and shao and shao yin. yin.
SP-15, fu ai SP-16 Tai yin: fu she SP-13, da heng SP-15, Jue yin: qi men LR-14, coming back to the conception vessel Shao yin: lian quan CV-23, knot of shao shao yin
This This spatia spatiall organi organizat zatio ionn of sleep sleep signi signifies fies the quality or the depth of sleep. The depth of the initial phase of sleep corresponds to the tai yin segment, and the middle phase of sleep corresponds to the jue yin segment. The quality of the last phase of sleep corresponds to the shao yin segment (Fig.2.19 ). If sleep is disturbed in its spatial structure, that is, in its quality, the yin wei mai , the yin linking yang wei mai, will vessel, or its complementary yang manifest a disturbance, as evidenced in the sensitivity of their respective xi points.
Yin variations in “space” = Yin variations intensity or quality of sleep
Yin wei mai
CV-22, CV-23
LR-14
PC-6
SP-16 SP-15 SP-13
Tai yin: yin: SP-13, SP-15, SP-16 Jue yin: yin: LR-14 Shao yin: yin: KI-9, CV-23
KI-9
Fig.2.18 Yin wei wei mai and and its constituent points.
Tai Tai yi yin n
Juee yi Ju yin n
Sha hao o yi yin n
Fig.2.19 Yin wei mai and and the three yin sequences in space — initial initial phase: tai yin mid-phase: jue yin end phase: shao yin. yin. →
→
In summary, and as an aid to the Western reader, the author has provided a comparison of the physiology of sleep according to Western medicine and classical Chinese medicine ( Table 2.3).
27
28
2 Sleep in Chinese Medicine
Table 2.3 Comparison of Western and Eastern physiology of sleep Western medicine
Chinese classical medicine
Sleep
Rest for body and mind
Body stillness and mental quietness
Physiology
Lowered body temperature
Wei qi (responsible (responsible for surface heat and protection) moving inward
Reduced immunity Circ Circad adia ian n sync synchr hron oniz izer erss
Mental states:
Supr Suprac achi hias asma mati ticc nucl nuclei ei— pineal pineal gland (melatonin)
The eight extraordinary vessels Yin tang and tang and bai bai hui GV-20 GV-20
EEG activity:
Shen activity Shen activity of the pysche:
●
Consciousness
●
Beta
●
Yi
●
Alert watchfulness
●
Alpha
●
Shen
●
Relaxed watchfulness
●
Theta
●
Po
●
Deep sleep
●
Delta
●
●
REM sleep
●
Beta
●
Dreaming
Purpose of sleep
Purpose of dre dreamin ming
Earth element
↔
↔
Zhi
↔
Metal element
↔
Hun
Fire element
Water element
↔
Wood element
REM sleep: rapid eye movements
Wandering of the hun the hun
Loss of muscle tone
Wei qi and and blood leaving the sinews
Erection and female lubrication
Blood returning to the liver (liver luo chan luo channel)
Restoration, anabolism
Building up yin up yin,, ying qi
Immune functions, healing
Wei qi returning returning to the kidney
Memory
Hun (retrieval Hun (retrieval of memory)
Memory consol solidation
Hun and Hun and zhi zhi
Psychosomatic theory
Shen leading Shen leading the qi the qi
Premonitory dreams
Hun and Hun and memory of the future
Releasing of repressed emotions
Hun releasing Hun releasing retained heat (external pathogens or internal emotions)
29
3 Insomnia
In Chapter 2, sleep was defined as a regularly recurring condition of rest for the body and the mind. Based on this definition, insomnia is difficulty in achieving either physical or mental relaxation, or both. Insomnia is the most common of the sleep disorders, affecting more than one third of the general adult population and about one quarter of children. Thus, what is important is not how long we sleep but how well we sleep. Therefore, an alternative definition of insomnia would be insufficient or unsatisfactory sleep. In both cases, insufficient yin is generated to respond to the day’s physical and mental activities. When analyzing sleep, the main factor is not, therefore, the length of sleep but the person’s state upon waking. Has sleep been restful for the body and revitalizing for the mind? If the patient complains of tiredness upon waking, this this is cons consid ider ered ed in Chin Chines esee medi medici cine ne to be insomnia, even if the person has slept for 12 hours. Insomnia is a yang condition, condition, which in the great majority of cases is due to a disturbance of yin. This yin disturbance is either due to the inability of yin to achieve proper depth—which is the case in superficial or dream-disturbed sleep—or to a shortened sleep time—as witnessed in problems falling asleep and early or frequent waking. The type of insomnia, therefore, is defined in accordance with whether it affects the length or the depth of sleep, or both. Reduced sleep time may be the consequence of: Dfficulty falling asleep Frequent waking for various reasons Early waking ( Fig.3.1) ● ● ●
Unsatisfactory Unsatisfactory sleep may be due to: Superficial sleep due to mental restlessness or physical agitation with visceral manifestations such as restless legs syndrome (RLS) and pruritis Dream Dream-di -distu sturbe rbedd sleep, sleep, night nightmar mares, es, sleepsleepwalking, sleep-talking, and so on Other pathologies that disturb the quality of sleep, such as snoring, sleep apnea, respiratory difficulties, or pain (secondary insomnia) ●
●
●
Wake
A
Sleep
B
Missing time
A>B Reduced time = “quantity”
Fig.3.1 Insomnia through reduced sleeping time = quantity.
Wake AA A
Sleep
B A>B Reduced depth = “quality”
B
Missing depth
Fig.3.2 Insomnia through reduced depth of sleep = quality.
In all these cases, sleep is not revitalizing enough, and it can be said that the yin is not reaching the appropriate depth during the night ( Fig.3.2). In most chronic cases of insomnia, both variables, that is the length and the quality of sleep, are affected, making the treatment that much more complex. It must be emphasized that, in Chinese medicine, insomnia is not a disease but a symptom. Any pattern of disharmony that produces yang reple repletion or yin vacuity can result in disturbed sleep. All those emotions that affect the shen may equally disrupt sleep or dreams. The complexity in diagnosing the causes of insomnia lies in the fact that the following all need to be considered so that finally the involved involved zang fu (organ) pattern can be identified: The state of the substances, that is, xue (blood) and the yin, and possibly the jin ye (fluids) The overall state of the mind and the emotions The movements of wei wei qi (defensive qi) ●
● ●
30
3 Insomnia
I propose a simpler and more systematic way of approaching the problem. As we have seen in the previous chapter, all disharmonies of yin or yang will ultimately influence the eight extraordinary vessels. vessels. These vessels attempt to harmonize and in some ways keep the body in equilibrium. When the capaci capacities ties of the extrao extraordi rdinary nary vess vessel elss are exhausted, the symptom—in this case insomnia — will manifest itself. Thus, if we analyze the state of the extraordinary vessels, vessels, namely the four vessels dealing with variation in time and space, we can establish establish which of the primary channel channelss are dysfu dysfuncti nction onal, al, and hence hence which which zzan angg fu are involved.
Diagnosing Insomnia As defined above, insomnia is the inability to reach sufficient physical or mental relaxation, or both. In Traditiona raditionall Chinese Chinese Medicine Medicine (TCM), (TCM), it involv involves es the state of wei wei qi, of xue xue, and of the shen. Also Also,, the the peri period od of wak wakeful efulne ness ss is of grea greatt importance as it indicates which channels are disturbed. The main task of the TCM practitioner is to define whether sleep is disturbed in its temporal sequence (duration of sleep), its spatial quality (depth of sleep), or both. As each parameter is subdivided into three phases, we can divide the night into roughly three phases of 1.5 –3 hours each, which correspond respectively to an initial, middle, and end phase of the night, or sleep. If a person’s normal sleep is roughly 6 –7 hours, for example, each phase will be equal to about 2 –2.5 hours. The first step is thus to establish in which phase of the night sleep is disturbed: Initi Initial al stag stagee inso insomn mnia ia (initi initial al phas phasee of the the night/sleep) night/sleep) = difficulty falling asleep Middle stage insomnia (middle phase of the night/sleep) = waking up in the middle of the night End-of-the-night/terminal stage insomnia (end/ terminal phase of the night/sleep) = waking early Insomnia may also affect the entire sleep time due to frequent waking. ●
●
●
●
The second step is to establish the person’s physical state when awake:
●
●
Physical tension or restlessness, which usually indicates liver blood vacuity, whereas mental agitation denotes an unsettled shen, signifying heart blood vacuity Soma Somati ticc symp sympto toms ms,, such such as teet teethh grind grindin ingg (bruxism), restless legs, bloating, hunger, itching and so on are due to an inability of the wei qi to move in or to remain inside.
The third step is to explore the patient ’s mental and emotional state during the wake phase: Is the mind calm and quiet? Is there coherent and clear mental activity, during which the person is wide awake, thinking about projects, resolving problems or analyzing options, putting the light on to read, or even going to watch television, and so on? Conversely, is the mind confused, irritated, and tired? Is the person unable to concentrate and too tired to read? read? Are thoug thoughts hts fragme fragment nted ed with no coherence? What emotions are present when the patient is awake: worry, fear, anxiety, sadness?
● ●
●
●
Finally, what is the person ’s state upon waking? Are they obviously tired due to the insomnia? Do they find it difficult to get out of bed? Are they in a bad mood and irritable, or are they depressed? When the length of time (quantity) of sleep is affected, the person is wide awake at night and the mind is either totally calm or may be active but clear; it is as though the sleep cycles have been completed. The person may engage in mental activity for an hour or more until sleep returns. If the insomnia occurs at the end of the night, the person usually gets out of bed and goes about their daily activities. If the quality of sleep is disturbed, the person is tired but cannot find sleep, the mind is unclear, or there is physical physical or mental restlessness. restlessness. As we have seen in Chapter 2, in its temporal movements, yin is first shao yin (lesser yin), then tai yin (supreme or greater yin ), and finally jue yin (terminal yin). Sleep, in its temporal structure, is regulated by the yin qiao mai ( yin motility or yin springing springing vessel vessel),), and its complem complementary entary yang qiao mai ( yang motility motility or yang springing springing vessel). If there is difficulty falling asleep with a clear or calm mind, as is the case when the patient reads for a while before falling asleep, the yin qiao is disturbed in its initial segment. This first segment is represented by the shao yin, which corresponds to
Diagnosing Insomnia
a heart heart and/o and/orr kidney kidney dishar disharmon monyy patter pattern, n, for for example heart yin vacuity, heart blood vacuity, or kidney yin vacuity. If the patient wakes in the middle of the night with a clear or calm mind, the cause of the insomnia is to be found in the second segment of yin qiao, the tai yin. Hence, the lung or spleen channels channels and organs organs are invo involv lved, ed, for for examp example, le, lung lung or spleen qi vacuity, lung heat, or stomach heat. Finally, if the person wakes too early and is wide awake, it is the last segment of yin qiao, the jue yin channel that is involved, indicating pathologies of the liver or pericardium, as are commonly seen in liver blood vacuity or liver yin vacuity, pericardium qi vacuity, pericardium fire, or liver fire. On the other hand, if the quality of sleep is affected, either sleep is very superficial or the person feels tired but cannot sleep. The mind is not clear but is tired, confused, even chaotic and irritated. tated. Altern Alternati ative vely ly,, sleep sleep will will be distur disturbed bed by somatic manifestations, such as restless legs, neck tension, grinding of the teeth, abdominal bloating, unrestrained eating at night, sweating, pruritis, or respiratory difficulties such as snoring or sleep apnea. The quality of sleep may also be affected due to excessive dreaming or disturbing dreams, such as nightmares, or by sleep-walking, or sleeptalking. In any event, sleep is not restful for the body or for the mind. The quality or depth of yin is regulated by the yin wei ( yin binding) vessel and its complementary binding) vessel. The three phases of yang wei ( yang binding) the night also correspond spatially to the three channel channels, s, which constitute constitute the three segments of yin or yang : The first phase of the night corresponds to tai yin. The person will present with restlessness and maybe snoring or other visceral manifestations. tions. The dishar disharmon monyy respon responsib sible le for for these these symptoms can be found in the tai yin (lung and spleen) systems, such as spleen qi vacuity, lung heat, stomach heat, and so on. The middle phase of the night corresponds to the jue yin (liver and pericardium) channels. Pathologies such as liver blood vacuity or liver yin vacuity, pericardium qi vacuity, pericardium fire, or liver fire will cause restlessness, nightmares, muscle cramps, or other disturbances that reduce sleep efficiency. The last phase of the night corresponds, in its ●
●
●
spatial disposition, to shao yin, heart and kidney, channels. Sleep will be disturbed by symptoms such as hot flashes, sweating, disturbing dreams, or various emotions, as well as pain, most typically lumbar pain. The The natu nature re of the the slee sleepp dist distur urba banc ncee can can be assessed quite quickly based on this diagnostic approach. Once it has been established that sleep is disturbed in its temporal or spatial structure, that is, in its length or quality, quality, the diagnosis can be confirmed by palpating the xi (cleft) points of the four extraordinary vessels: vessels: Jiao xin KI-8 on the yin qiao vessel Fu yang BL-59 BL-59 on the yang qiao vessel Zhu bin KI-9 on the yin wei vessel Yang jiao GB-35 on the yang wei vessel ● ● ● ●
After establishing that the extraordinary vessels are invo involv lved, ed, the segmen segmentt of the night night during during which the sleep is disturbed will indicate which vessels are involved and hence their associated zang fu f u: Difficulty falling asleep and the person has a clear mind (reads for an hour before falling qiao vessel asle asleep ep). ). In this this case case,, the the yin qiao vessel is involved, which is confirmed by the tenderness jiao xin KI-8. The channels to be considered of jiao are the shao yin (heart and kidney) channels. The treatment will involve five or six points: zhao hai KI-6 on the side where jiao xin KI-8 is sensitive, lie que LU-7 on the opposite side, and shen men HT-7, tai xi KI-3, lian quan CV-23, or some other appropriate shao yin point such as KI-23, ling xu KI-24, you men KI-21, shen feng KI-23, shen cang KI-25, KI-25, and so on. Difficulty falling asleep, the person is too tired to read, or they cannot fall asleep from worry. Zhu bin KI-9 is sensitive, which confirms a yin wei vessel disturbance and therefore involves the tai yin (lung and spleen) channels. Nei guan PC-6 gong sun SP-4 on the should be treated with gong opposite side, possibly zhu bin KI-9, da heng SP SP15 as a tai yin point of yin yin wei mai, and appropriate tai yin points: yin bai SP-1 (together with li dui ST-45for ST-45 for worry) and san yin jiao SP-6. Waking between 1 a.m. and 3 a.m. with a clear mind indicates that the yin qiao vessel is probably disturbed and jiao xin KI-8 is sensitive to palpation. The tai yin (lung and spleen) channels are involved. The treatment combines zhao ●
●
●
31
32
3 Insomnia
hai KI-6 with lie que LU-7 and other tai yin points according to symptoms: zhong fu LU-1, zhong wan CV-12, and san yin jiao SP-6. ●
●
●
Waking between 1 a.m. and 3 a.m., or restless sleep with nightmares, asthma attacks, or other visceral manifestations, is an indication of suswei vessel pected yin wei vessel involv involvement, ement, which is confirmed by palpating zhu bin KI-9. The jue yin channels (liver and pericardium) are disturbed. The treatment consists of nei nei guan PC-6 with gong sun SP-4 on the opposite side, qi men LR-14 as a jue yin point of yin wei mai and other jue yin points such as da ling PC-7, PC-7, jian shi PC-5, tai chong LR-3, LR-3, or qu quan LR-8. Early waking. The person is wide awake, and jiao xin KI-8 is tender. The involved jue jue yin yin (liv (liver er and perica pericardi rdium) um) channe channels ls should should be treated, together with regulating the yin and yang qiao mai: zhao hai KI-6 or shen mai BL-62 with da ling PC-7, PC-7, jian shi PC-5, tai chong LR-3, LR-3, or qu quan LR-8. Early Early wakin waking: g: becaus becausee of night night sweat sweatin ingg or nightmares, the person is tired but cannot find sleep. Zhu bin KI-9 is tender. The yin wei and the shao yin channels (kidney and heart) should be treated, for example nei guan PC-6 with gong sun SP-4 and fu liu KI-7, and yin xi HT-6 with shen shen men HT-7 and another of the shao shao yin points suggested above.
Where there is no underlying zang fu pathology and the sleep disorder is caused by a recent disturbance of the synchronizing extraordinary vessel alone, as witnessed in jet lag or in shiftworkers, we usually find that only one of the four extraordinary vessels vessels will show a disturbance, most often the yin qiao vessel. In such cases, the treatment is simple and the response is quite fast, that is, jiao xin KI-8 is supplemented on the dominant side (left for men, right for women), or according to xi-cleft sensitivity; shen mai BL-62 is reduced on the opposite side and yin tang is is used. Another possibility is to harmonize the yin and yang wei channels, especially if sleep is of poor quality, by reducing wei guan TB-5 and reinforreinforcing nei guan PC-6. For example, a standard combination of points for jet lag is wei guan TB-5 with he gu LI-4 (which helps improve improve the quality quality of sleep). When an underlying pathology is causing the insomnia, more than one of the organizing extraordinary vessels may be affected. For example:
●
●
●
Blood vacuity first affects the heart, which may disturb the yin qiao vessel, affecting the initial phase of sleep ( shao yin). If the yin wei vessel is invo involv lved, ed, this this will will affect affect the third third phase phase of sleep. If both vessels are affected, the patient will have difficulty falling asleep (initial stage insomnia), and will have superficial or dreamdisturbed sleep during the third phase. If blood vacuity also affects the liver, the patient will have difficulty falling asleep and will wake early when the yin qiao vessel is disturbed. In cases where the yin wei vessel is also affected, bad quality of sleep with restlessness is present in the second and third stages of sleep. When the problem is chronic, both yin wei and yin qiao vessels are involved and the whole sleep cycle will be disturbed. Here the treatment has to include supplementing the deficient substance—blood or qi—as well as synchronizing the appropriate extraordinary vessels (Figs.3.3 –3.5).
Etiology and Treatment of Insomnia Movements of Wei Wei Qi Wei qi has to move into and circulate in the interior during sleep. This inward movement of wei qi,
which is a consequence of the relaxation of the external muscles and tendons, helps to mobilize blood to the interior so that it can return to the liver. The first stage of this movement is represented by closing of the eyes, and is controlled by jing ming BL-1. The relaxation of the eyes helps to relax the nose and supports breathing. Symptoms
Difficulty in the movement of wei qi at the eyes can cause: A blockage in the nose, with snoring or obstructive sleep apnea (OSA) A blockage at the ear, with high-pitched ringing or the ability to hear one ’s own heartbeat
●
●
Treatment Jing ming BL-1 BL-1, which may be replaced by yin tang, together with the regulation of yang qiao mai, by
Etiology and Treatment of Insomnia
Shao yin - HT fire (PC heat) - HT blood vacuity = HT-SP blood vacuity = HT-LR blood vacuity - HT yin HT yin vacuity vacuity = HT-KI yin HT-KI yin vacuity vacuity - HT qi qi vacuity vacuity = HT-GB qi qi vacuity vacuity - HT yang HT yang vacuity vacuity = HT-KI yang HT-KI yang vacuity vacuity
Yin Qiao Mai (if KI-8 is sensitive)
Fig.3.3 Sha Shao o yin yin heart–kidney patholo pathologie giess will will distur disturb b either either the initial initial phase phase of sleep, sleep, with with difficu difficulty lty fallin falling g asleep asleep,, or the terminal terminal phase, phase, with poor-qualpoor-quality sleep.
Shao yin Tai yin Jue yin
Shao yin pathologies yin pathologies will shorten sleep, with difficulty falling asleep with a clear mind
Tai yin Jue yin Shao yin
Yin Wei Mai
Shao yin pathologies yin pathologies will disrupt the sleep quality at the end of the night
(if KI-9 is reactive)
Yin qiao mai (if KI-8 is sensitive)
Jue yin - LR fire - LR blood vacuity (HT-LR blood vacuity) - LR yin LR yin vacuity vacuity - GB qi vacuity (HT-GB qi qi vacuity) vacuity)
Shao yin Tai yin Jue yin
Jue yin pathologies yin pathologies will shorten sleep, with early waking with a clear mind
Tai yin Jue yin Shao yin
Yin wei mai
Jue yin pathologies yin pathologies will disrupt sleep quality in the middle of the night
(if KI-9 is reactive)
Fig.3.4 Jue yin pericardium– pericardium– live liverr patho patholo logi gies es will will distu disturb rb eith either er the the term termin inal al phase phase of sleep, with early waking, or the middle phase, with poor-quality sleep.
33
34
3 Insomnia
Yin qiao mai (if KI-8 is sensitive)
Tai yin - LU heat - LU qi qi vacuity vacuity - SP qi qi vacuity vacuity - ST heat - ST heat heat-phlegm -phlegm
Fig.3.5 Tai yin lung–spleen pathologies will disturb either the middle phase of sleep, through waking up with a clear mind, or the initial phase, with poor-quality sleep.
Shao yin Tai yin Jue yin
Tai yin pathologies yin pathologies will shorten sleep, with waking in the middle of the night with a clear mind
Tai yin Jue yin Shao yin
Yin wei mai
Tai yin pathologies yin pathologies will disrupt sleep quality in the first part of the night
(if KI-9 is reactive)
yin qiao mai, by reducing shen mai BL-62, and of yin supplementing zhao hai KI-6. Add ying xiang LI-20 LI-20 or bi tong for for nasal blockage and ting gong SI-19for SI-19for ear manifestations. manifestations.
In the second stage, the wei qi has to pass through the throat area. Symptoms
A blockage at this level causes: Snoring and OSA A choking sensation
● ●
Treatment
Relax the throat. Tian ding LI-17, LI-17, fu tu LI-18, or lian chuan CV-23, que pen ST-12 (inward passage of qi qi), with yun men LU-2 (controls the movements of wei qi) and zhong fu LU-1 (helps with the inward qi and blood, and opens the chest). movement of qi In the third stage, the chest needs to relax to permit the wei qi to descend further to the zang fu. Symptoms
In the absence of this relaxation, the person: Wakes up at night with a feeling of heat and sweating ●
●
Experiences chest oppression, with the sensation of something sitting on the chest: gui zha (ghost oppression)
Treatment Ge shu BL-17
(night sweating, tidal fevers, steaming bone syndrome, menopausal syndrome), zong hui TB-7 (helps move wei qi downward toward the abdomen: when the person wakes up to eat); jian shi PC-5 (for gui xie [ghost evil]), yin bai SP-1 (for gui zha); additionally, shan zhong CV-17 CV-17 and gao huang shu BL-43. In addition to the above points, nei guan PC-6 is indicated to help open the chest, to regulate yin wei mai, and to improve improve the quality of sleep. In the fourth stage, wei qi moves to the abdomen and down to ming men and the kidneys. If the wei qi cannot fully complete its return to the source (the kidneys), the person will experience “fright wind,” which manifests as nightmares in adults or, in the case of children, both nightmares and infantile convulsions. convulsions. The stagnation of transport in the fu (bowels) will affect sleep. Here, the insomnia is due to the fact that the wei qi is released outward by a coun-
Etiology and Treatment of Insomnia
terflow movement of qi qi via da zhui GV-14 toward bai hui GV-20. Symptoms
Additionally, there are specific signs and symptoms that indicate which fu is involved: Large intestine: with grinding of the teeth, and neck and shoulder tension (also often difficult bowels in the morning) Stomach: difficulty falling asleep, fan (irritability), nighttime food cravings Bladder: difficulty falling asleep, with zao (restlessness) (e.g., restless legs syndroms [RLS], calf cramps, etc.) with nighttime sweating Small intestine: dry mouth, nighttime thirst, enuresis Gallbladder: bitter taste, itching (mostly of the head), neck tension Triple burner: drooling, a lot of crusting around the eyes ●
●
●
cle tension, cramping, or the typical RLS. Points such as qu quan LR-8, yang ling quan GB-34, and yang jiao GB-35, xi –cleft of yang yang wei mai are indicated to relax the sinews and help with the inward movement of blood. Xue can also move out during sleep, causing the hun (ethereal soul) to become unsettled and to wander wander.. This manifest manifestss as excessi excessive ve dreaming, dreaming, nightmares, or even sleep-walking. The propensity of blood to move out is related to: xue: blood heat, blood vacuity, The condition of xue or more rarely blood stasis The state of the liver: liver qi stasis, especially liver heat or liver fire ●
●
●
●
●
Treatment
To help bring the wei qi back down, bai hui GV-20 shen cong cong (EX-HN-1) pen ST-12 or si shen (EX-HN-1) and que pen should be combined with the lower he (sea) point and jing (well) (well) point of the corresponding channel: For the large intestine channel: shang ju xu ST37 and shang yang LI-1 LI-1 For the small intestine channel: xia ju xu ST-39 with shao ze SI-1 For the stomach channel: zu san li ST-36 and li dui ST-45 For the bladder channel: wei zhong BL-40 BL-40 and zhi yin BL-67 yang ling ling quan quan For the gallbladder channel: yang GB-34 with zu qiao yin GB-44 For the triple burner channel: wei yang BL-39 BL-39 and guan chong TB-1 TB-1 ●
The treatment has three objectives: To harmonize xue by supplementing ( pi shu BL BL 20, gan shu BL-18, xin shu BL-15, san yin jiao SP-6), moving ( ge shu BL-17, gao huang shu BL-43, tai chong chong LR-3), or cooling ( wei zhong zhong BL-40, xue hai SP-10) To harmonize the liver by moving liver qi (tai LR-3), supplementing liver yin (que quan chong LR-3), LR-8, gan shu BL-18), or extinguishing liver fire ( xing jian LR-2, lao gong PC-8) PC-8) To calm the shen and settle the hun. There are three strategies for dealing with shen, depending on the state of blood (see the section “To Calm the Shen” p.41) p. 41).. ●
●
●
●
Zang Fu Pathologies Fu Pathologies
●
●
●
●
Fire Phase Heart Fire Symptoms ● ● ● ●
Movements of Blood
● ●
The inward movement of wei wei qi, which is a consequence of relaxation of the external muscles and tendons, helps mobilize xue to the interior so that it can return retur n to the liver. If this inward movement of wei wei qi and of xue xue is disturbed, it can result in an accumulation of wei qi and blood in the muscles. This causes initialstage insomnia with zao, which manifests as mus-
● ● ●
Difficulty falling asleep due to anxiety Nightmares, dreams of flying Mental and emotional restlessness Bright eyes, loud voice, reckless character Always feeling hot, thirsty Tachycardia, Tachycardia, hypertension, heart diseases Tongue ulceration, bitter taste Tongue: red, red tip, yellow coating Pulse: rapid, overflowing
Treatment Shen men HT-7, shao fu HT-8, jue yin shu BL-14, xin shu BL-15, ju que CV-14, shen feng KI-23, KI-23, hou GV-19, jiu wei CV-15, and jian shi PC-5. ding GV-19,
35
36
3 Insomnia
Phlegm Fire Harassing the Mind Symptoms ● ● ● ● ● ●
Difficulty falling asleep due to anxiety Nightmares Snoring, chest oppression Nausea, lack of appetite appetite Tongue: red, red tip, yellow coating Pulse: rapid and slippery
Heart Yin Vacuity Heart Yin Vacuity (Often Associated with Kidney Yin Vacuity: Yin Vacuity: Heart and Kidney Out of Harmony) Symptoms ●
●
● ●
Treatment PC-8, shao fu HT-8, jue yin Jian shi PC-5, lao gong PC-8, shu BL-14, zhong wan CV-12, shui fen CV-9, feng long ST-40. ST-40. Heart Blood Vacuity Symptoms ● ● ● ● ●
● ●
Difficulty falling asleep Anxiety, restless sleep, frequent waking Dreams, nightmares, nightmares, dreams dreams of flying Palpitations Dizziness, blurred vision, poor memory, problems concentrating, feeling spaced out Tongue: pale pa le Pulse: choppy or weak
●
Treatment Shen men HT-7, jue yin shu BL-14, xin shu BL-15, ju que CV-14, shen feng KI-23, KI-23, hou ding GV-19, GV-19, jiu wei CV-15, jian shi PC-5, san yin jiao SP-6, guan yuan
CV-4. vacuity ty, add: yong For heart and kidney yin vacui quan KI-1, tai xi KI-3, zhao hai KI-6, xin shu BL-15, shen shu BL-23, shen tang BL-44, BL-44, zhi shi BL-52. Heart Qi Vacuity Heart Qi Vacuity (Often Associated with Gallbladder Qi Gallbladder Qi Vacuity) Vacuity) Symptoms ● ●
Treatment Shen men HT-7, jue yin shu BL-14, xin shu BL-15, ju que CV-14, shen feng KI-23, KI-23, ling xu KI-24, hou ding GV-19, jiu wei CV-15 and jian shi PC-5, san yin jiao SP-6, pi shu BL-20, ge shu BL-17, zu san li ST-36, EX-HN-3. yin tang EX-HN-3. Heart Blood Stasis Symptoms ● ● ● ● ● ●
Anxiety when lying down, restless sleep Dream-disturbed sleep Palpitations Chest pains, angina Tongue: purple, or spots Pulse: choppy
Treatment Nei guan PC-6, shen men HT-7, tong li HT-5, shen KI-23, jue yin shu BL-14, xin shu BL-15, ge shu feng KI-23, BL-17, xin shu BL-15, gao huang shu BL-43.
Difficulty falling asleep, restless sleep, frequent waking Dry throa throat, t, palpi palpitat tation ions, s, night night sweat sweats, s, “five palm” heat Tinnitus, lumbar pains Tongue: peeled, red tip, cracks, heart crack Pulse: floating and empty
● ● ●
●
Superficial sleep, insomnia from anxiety Easily startled, timid, indecisive Palpitations (arrhythmia) Shortness of breath, fatigue, depression Tongue ongue:: pale, pale, swol swollen len at the front, front, possib possibly ly heart crack Pulse: empty
Treatment Shen men HT-7, jue yin shu BL-14, xin shu BL-15, ju que CV-14, ling xu KI-24, shen cang KI-25, KI-25, nei guan PC-6, qiu xu GB-40, shan zhong CV-17, CV-17, qi hai CV-6, zu san li ST-36. Heart Yang Heart Yang Vacuity Vacuity Symptoms ●
● ● ●
As above; often accompanies kidney yang defi deficiency Dislikes cold, gets cold with emotions Tongue: pale, bluish Pulse: slow, deep
Treatment
As above, but add ming men GV-4, da zhui GV-14, bai hui GV-20.
Etiology and Treatment of Insomnia
Pericardium Qi Pericardium Qi Repletion Repletion Symptoms ●
● ●
Same as heart fire in relation to external heat (fevers) Congestion, Congestion, heart pain Overexcitement, Overexcitement, sexual perversions
Treatment
Treatment Treatment as above, but add jian shi PC-5, nei guan PC-6, da ling PC-7. PC-7.
Treatment LR-3, zu qiao yin GB-44, Xing jian LR-2, tai chong LR-3, wan gu GB-12, or an mien (EX-HN-54), feng chi bai hui GB-20, gan shu BL-18, hun men BL-47, bai GV-20, ben shen GB-13, or tou lin qi GB-15, shen GV-24; also treat the kidney. ting GV-24; Liver Blood Vacuity Symptoms ● Fan, waking early, vivid dreams ●
Pericardium Qi Pericardium Qi Vacuity Vacuity
● ●
Internal wind symptoms, eye symptoms Tongue: pale sides Pulse: choppy
Symptoms ● ● ●
Same as heart blood vacuity or heart qi vacuity Needs a lot of rest, easily tired Sexually stimulated but not satisfied
Treatment Jue yin shu BL-14, gao huan huangg shu shu BL-43, shan CV-17. zhong CV-17.
Treatment Gan shu BL-18, pi shu BL-20, ge shu BL-17, shen shu BL-23, qu quan LR-8, san yin jiao SP-6; or an mien (EX-HN-54). Liver Yin Liver Yin Vacuity Vacuity Symptoms
Damp Heat in Tri Triple ple Burner Symptoms ● ● ●
● ● ●
Extreme nervous ner vous tension, overexcitement overexcitement Repressed emotions; willful, cannot stand people Gallbladder symptoms: tics, spasms, trembling, convulsions Sensitive to changes in the weather Sudden deafness Hypertension with nervousness
Treatment TB-1, tian jing TB-10, TB-10, wei guan TB-5, ge Guan chong TB-1, shu BL-17, shi men CV-5, yin jiao CV-7, zhong wan CV-12, shan zhong CV-17. CV-17.
Wood Phase Liver Fire Symptoms ● ● ● ● ●
● ●
Restless sleep, nightmares, waking early Anger, irritability, envy, jealousy Headaches Liver symptoms, internal wind Bitter taste in the mouth, red face, dark urine, dry stools Tongue: red sides, dry yellow coating Pulse: rapid and wiry
●
● ● ● ● ● ●
Restless sleep, waking early, sleep-walking or sleep-talking Nightmares, excessive excessive dreaming, irritability ir ritability Dryness of the throat, eyes, skin, and hair Feeling of heat Dizziness Tongue: dry, peeled sides, maybe red Pulse: floating and empty, or thin and rapid
Treatment Gan shu BL-18, hun men BL-47, qu quan LR-8, san yin jiao SP-6, ting hui GB-2, ben shen GB-13, shen ting GV-24; GV-24; also treat kidney yin. Gallbladder Qi Vacuity (Often Gallbladder Qi (Often Associated with Heart Qi Heart Qi Vacuity) Vacuity) Symptoms ●
● ● ● ● ●
Insomnia from insecurity, light sleep, excessive dreaming Waking Waking early, difficulty getting up Easily startled, timid, lack lack of will and initiative initiative Palpitations, Palpitations, shortness of breath, fatigue Tongue: pale, swollen Pulse: empty
Treatment Add qiu xu GB-40
(EX-HN-54).
and wan gu GB-12 or an mien
37
38
3 Insomnia
Earth Phase
Metal Phase
Spleen Qi Spleen Qi Vacuity Vacuity
Lung Heat
Symptoms
Symptoms
● ● ● ● ●
Waking Waking at 3 a.m., sleep-walking General fatigue with daytime sleepiness Bloating after meals, soft soft stools Tongue: pale, swollen with tooth marks Pulse: empty
Treatment Pi shu BL-20, zhang men LR-13, shang qu KI-17, da du SP-2, tai bai SP-3; also yin bai SP-1 and nei ting
● ● ● ●
Insomnia with agitation, waking waking at 3 a.m. Asthma, cough, yellow sputum Tongue: red at the front Pulse: flooding and fast
Treatment Fei shu BL-13, zhong fu LU-1, chi ze LU-5, kong zui LU-6, yu ji LU-10, bu lang KI-22, KI-22, he gu LI-4, qu chi LI-11, feng long ST-40, ST-40, jian shi PC-5.
ST-44. Lung Qi Lung Qi Vacuity Vacuity Stomach Heat Symptoms ● ● ● ●
● ● ● ● ●
Restless sleep; frequent dreams, nightmares Needing to eat or drink in order to fall asleep Mental fan, discontent, accusing Agitation (if extreme, the compulsion to climb to high places to sing, or to undress and run around madly, for example) Moving and talking too fast Gastritis, thirst, halitosis (bad breath), hunger Acne, red eyes Tongue: stomach crack, red, yellow dry coating Pulse: flooding
Treatment Wei shu BL-21, yin jiao CV-7, zhong wan CV-12, lie que LU-7, jie xi ST-41, zu san li ST-36, liang men ST21, yin bai SP-1, nei ting ST-44. ST-44.
Symptoms ● ● ● ● ●
Treatment Fei shu BL-13, zhong zhong fu LU-1, tai yuan LU-9, bu KI-22, he gu LI-4. lang KI-22,
Water Phase Kidney Yin Vacuity, Kidney Yin Vacuity, Accompanied by Heart Yin Heart Yin Vacuity (Also Referred to as Heart and Kidney Not in Harmony) Symptoms ●
Damp–Heat Harassing the Mind Symptoms ● ● ●
●
As above, above, plus snoring Heaviness, obesity, chest oppression Tongue: swollen with tooth marks, sticky coating Pulse: slippery and fast
Waking at 3 a.m. Weak breathing, cough, asthma, frequent colds Dry skin, loss of hair Tongue: swollen at the front, pale Pulse: empty, floating
● ● ● ● ● ●
Difficulty falling asleep, restless sleep, frequent waking Lumbar pain Tinnitus Palpitations, night sweats, “ five heart” heat Dry throat; dark urine Tongue: peeled, cracks, red Pulse: floating and empty or thin
Treatment Treatment
Same as stomach heat, also add tou wei ST-8, jian ST-40, li dui ST-45, yin ling quan shi PC-5, feng long ST-40, SP-9, shui fen CV-9.
As for heart yin vacuity. Add yong quan KI-1 if the shen is very unsettled, you men KI-21 if the patient is tired but cannot sleep, shen feng KI-23for KI-23 for a restrestshen cang cang KI-25 less less mind, mind, shen KI-25 for for insom insomnia nia from from worry, yu zhong KI-26 KI-26 for waking in a bad mood, and shu fu KI-27 for persistent insomnia.
Etiology and Treatment of Insomnia
Kidney Yang Vacuity, Kidney Yang Vacuity, Accompanied by Heart Yang Heart Yang Vacuity Symptoms ● ●
● ● ● ● ● ●
Superficial sleep, insomnia from anxiety Easily Easily startled, startled, timidity, timidity, indecisiv indecisivenes eness, s, cold with emotions Dislike of cold Lumbar pain, frequent urination Palpitations Palpitations (arrhythmia) Shortness of breath, br eath, fatigue, depression Tongue: pale, bluish Pulse: slow, deep
Treatment Shen men HT-7, tai xi KI-3, xin shu BL-15, shen shu BL-23, zhi shi BL-52, ju que CV-14, ling xu KI-24, shen cang KI-25, KI-25, ming men GV-4, da zhui GV-14, bai hui GV-20.
In Chinese physiology, physical health is dependent on the free flow of qi and xue, which is in turn dependent on freedom of the mind. On the other hand, the free flow of the mind depends on the free circulation of qi and xue. Thus, physical and psychological healths are interdependent. The mind, which is orchestrated by shen, perceives the worl worldd and and resp respon onds ds acco accord rdin ingl glyy thro throug ughh the the offices of the five zang . The specific movement of qi is the qi in each zang is expression of its zhi (will). When this strength is expressed harmoniously, there is no emotion. But if there is an excessive use of this will, the organ will produce its corresponding emotion. Therefore, the fact that an emotion is being expressed, as well as its intensity, will indicate how the mind perceives the world. This explains the central importance that is given to the cultivation of the mind in Daoism, Confucianism, and Buddhism. The cultivation of thoughts changes the perception of reality.
Emotions
In Chinese medicine, emotions are considered to be the body’s driving force. The classical concept of the “Five Emotions and Seven Passions ” refers to the emotio emotions ns in their their normal normal and pathol pathologi ogical cal aspects. The body’s basic program is to perpetuate life, the will to live. This desire for life is represent sented ed in the the symb symbol olis ism m of the the hear heartt as the the emperor, where shen resides. The natural order of life is tranquility of the heart; hence, any behavior that does not follow this rule is considered abnormal or pathological. The five basic emotions are necess necessary ary for for surviv survival al and for for inner inner freedo freedom, m, choice, and inner peace. The five emotions are the natur natural al reacti reaction onss of the the shen to environme environmental ntal changes, in relation to the wu xing , the five moving forces. Emotions are called the t he seven passions when they are not rooted in the basic desire for life. The number number seven seven here symbol symbolize izess the destruct destructiv ivee forces, and refers to when an emotion is excessive, repressed, or unadapted to the situation. An empty heart perceives all and makes choices, whereas a heart occupied by desires distracts the consciousness and causes inappropriate responses. –Master Yuen
Confucian saying
The Five Movements and the Five Wills ●
●
●
●
●
Hun is the will of the liver, giving it the ability
to move forward; when in excess, it produces anger. Shen is the will of the heart, giving it the ability to expand; when in excess, it produces excitement. The will of the spleen is the ability to transform; when in excess, it produces worry. The will of the lung is to gather and separate; when in excess, it produces sadness and grief. The will of the kidney is to consolidate; when in excess, it produces fear.
Although a person’s overall mental and emotional equilibrium is referred to as their shen, shen itself is the sum of the five shen (spirits), also called the five zhi (Fig.3.6). Excessive or inappropriate emotions will disrupt the corresponding organ, either by producing heat, through suppression, or by depleting the qi, xue, or yin of the organ. Ultimately, all emotions affect the shen and the heart, producing heart heat or heart fire:
39
40
3 Insomnia
Shen
Shen Yi Hun Po Zhi
Releasing the Emotion Using the Five Zhi Five Zhi Points Points on the Outer Bladder Line ● Shen tang BL-44: for clarity and intelligence; calms the shen. Combine with shen shu BL-23 and zhi shi BL-52for depression and insomnia. ● Hun men BL-47: for lack of direction and aim in
●
Fig.3.6 Shen, Shen, in a sense, is composed composed of the manifestation manifestation of the five spirits. ● ● ● ● ●
Anger will cause heart fire. Joy/excitement Joy/excitement and sadness sadness affect heart qi. Pensiveness Pensiveness affects heart hear t blood. Fear and fright (shock) in adults affects heart – kidney communication. communication.
As the xin (heart) is the primary zang responsible responsible for for regula regulatin tingg sleep, sleep, all emotio emotions ns affecti affecting ng the heart can disrupt sleep. One of the functions of hun during sleep, especially during the dreaming, or rapid eye movement (REM), phase, is to help release this emotional accumulation. This aspect of dreaming is explored in more detail in Chapter 5. Management of Emotional Patterns That Disturb Sleep
Please note that the treatment of psychiatric conditio ditions, ns, which which very very often often also also produc producee serious serious sleep disturbances, is beyond the scope of this book. Less severe emotional disturbances in a normal human being resulting from reactions to environmental changes respond readily to acupuncture. The The emot emotio ionn may may be easi easily ly iden identif tifie iedd by the the patient, who cannot fall asleep or who wakes up with that particular emotion, such as worry, sadness, grief, anger, fear. Alternatively, the dream pattern is suggestive of an emotion, as explored in Chapter 5. The treatment strategy has two aims: To release the emotion To calm the shen ● ●
●
life; depression, irritability, anger, frustration, anxiety, a vague feeling of fear at night. Combine with shen shu BL-23 and zhi shi BL-52for difficulty relating to others. Yi she BL-49: strengthens memory, improves concentration, releases obsessions and worry. Combine with shen shu BL-23 and zhi shi BL-52 for thinking in circles. Po hu BL-42: enhances introspection, supports the instinct of self-preservation self-preservation and being comfortable with oneself. Treats sadness, grief, loss, and and worry worry abou aboutt the the futur future. e. With With shen shen shu shu BL-23 and zhi shi BL-52, it helps to release emotions from the chest, and with fei shu BL-13 and shen shen zhu zhu GV-12, it treats thoughts or fear of death. Zhi shi BL-52: strengthens willpower and stimulates memory (in older patients); treats fear of change (fear of life), difficulty moving into action, and being blocked by emotions. Combine with shen shu BL-23 and hun men BL-47 for severe depression. Combine with da zhu zhu xuan zhong GB-39, and du mai (SI-3/ BL-11, xuan BL-62) to strengthen character.
In general when treating emotions, if there is an underlying vacuity of yin or blood, I recommend supplementing the back transport ( shu) point and releasing the zhi point (inner and outer bladder channel lines): In case casess of irrit irritab abil ility ity and and ange angerr with with live liverr blood vacuity: supplement gan shu BL-18 and drain hun men BL-47. In cases of worry or obsessive thinking with spleen qi vacuity: supplement pi shu BL-20 and drain yi she BL-49. In cases of fear from kidney qi vacuity: supplement shen shu BL-23 and drain zhi shi BL-52. ●
●
●
In case of emotional manifestations manifestations from repletion of qi, the ying (spring) and shu (stream) points should be used: In case of intense anger or rage from liver fire: drain xing jiang LR-2 LR-2 and tai chong LR-3. LR-3. ●
Etiology and Treatment of Insomnia
●
In case of overexcitement and manic behavior from heart fire: drain shao fu HT-8 and shen men HT-7.
I have noticed that the five zhi points are excellent excellent indica indicato tors rs of emotio emotional nal patter patterns, ns, as the points points become tight and tender on palpation. Quite often, even if the patient is not able to accurately identify the emotio emotional nal patter pattern, n, the sensit sensitivi ivity ty of these these points can reveal the true t rue underlying emotion. Other Points Affecting Shen Affecting Shen ● Shen men HT-7for depression, ●
●
●
●
●
anxiety, insomnia, hysteria, loss of memory, retardation Shen dao GV-11 GV-11fo forr sadnes sadness, s, fear, fear, amnesi amnesia, a, regrets GV-24 for severe anxiety, mania, hys Shen ting GV-24 teria, nightmares Shen feng KI-23 KI-23 for mental restlessness, anxiety when lying down Shen cang KI-25 KI-25 for insomnia, mental restlessness, negativity, waking up in a bad mood GV-24 with ben shen GB-13for GB-13 for anger, anger, Shen ting GV-24 anxiety, or depression.
Another Strategy for Dealing with Emotions The luo (connecting channels), with their network
of blood capillaries, act as a buffer against the outer world. Both emotions and external pathogenic genic factor factorss are mainta maintaine inedd in the luo in an attempt to prevent them from penetrating deeper zang fu. Bleeding the luo of the yanginto the zang coupled channel helps to release the emotional pattern: For habitual irritability, frustration, anger, or hate, bleed guan ming GB-37. GB-37. For For overex erexci cite teme ment nt or exce excess ssiive cra craving ving (desire), bleed zhi zheng SI-7. SI-7. In obsessive patterns and worry, bleed feng long ST-40. For sadness, grief, and melancholia, as well as anxiety about the future, bleed pian li LI-6. For fearfulness and chronic anxiety, bleed fei yang BL-58. BL-58. ●
●
●
●
Wang Qing-Ren in Yi Lin Gai Cuo (Correcting the Errors Errors in the the Fore Forest st of Medi Medici cine ne), 1830, 1830, recomrecommends the use of ji ji quan HT-1, da bao SP-21, and LR-13 to treat treat inso insomn mnia ia (all (all thre threee zhang men LR-13 points points should should be needle needledd obliq oblique uely ly towa toward rd the front). To Calm the Shen the Shen
Insomnia is by definition a condition in which the shen is unsettled or overactive. In all treatment principles, be it using acupuncture or herbs, the shen needs to be calmed. Acco Accord rdin ingg to Mast Master er Yuen, uen, ther theree are are thre threee terms that correspond to three strategies for dealing with shen disturbances. Acupuncture points are classified according to their actions on the shen: An (calm). Calming involves qi , especially heart qi. The strategy is to help move wei qi inward. All the points along the shou shao yin (heart) channel, especially shen men HT-7 or tong li HT5, can be used, as well as shou tai yin (lung) channel points, including tian fu LU-3, tai yuan LU-9, or yu ji LU-10, may be indicated. Zhao hai KI-6 (when bled) and feng long ST-40 ST-40 also calm the shen. (quiet). Quieting Quieting involv involves es blood, blood, mainly mainly Qing (quiet). liver blood, which helps soothe or quiet the shen. Points that quiet the shen cannot really function if blood is deficient: the shou jue yin (pericardium) channel points jian shi PC-5, da ling PC-7, PC-7, and xi men PC-4 need sufficient blood and require the addition of qu quan LR-8 or other blood supplementing points such as ge shu BL-17 or qi chong ST-30. Shen men HT-7 also calms the shen. Ding (settle). (settle). Settling or stabilizing involves kidney yin or lung yin. The kidneys help to grasp, or anchor, the heart qi to settle the shen and calm the mind. Some common settling points include yong quan quan KI-1, yin bai SP-1, and chi ze LU-5.
●
●
●
●
All the luo involve the blood mansion, the heart and pericardium. The strategy also calls for helping to circulate the heart qi with nei guan PC-6, to open the chest, as well as opening the Great Luo of the Spleen (da bao SP-21).
Besides these direct actions on the shen when the shen disturbance is caused by heat, a qing (clear (clearing) ing) strategy can be used, that is, li dui ST-45. Generally speaking, when emotions affect the shen, the treatment treatment strate strategy gy should should be chosen chosen according according to the emotion: Calm the shen: for issues involving anxiety, joy, or nonfulfillment affecting heart qi ●
41
42
3 Insomnia
●
●
Quiet the shen: for patterns involving worry (spleen) or anger (liver) Settle the shen: in cases of grief (lung) or fear (kidney)
As mentioned above, each emotion will affect the heart in a different way: Anger will cause heart fire: use lao gong PC-8 PC-8 and shao fu HT-8. Joy and sadness affect heart qi: use shen men HT-7. Pensiv Pensivenes enesss affects affects heart blood: blood: use da ling ling PC-7 and tong li HT-5. Fear and fright or shock in adults affects heart – kidney communication: use xi men PC-4 with xin shu BL-15, gan shu BL-18, and pi shu BL-20. ●
●
●
●
●
Extraordinary Vesse Vessels ls
Chapter 2 explored in detail the central role of the eight extraordinary vessels, in particular the yin qiao mai (motility or stepping vessel) and wei mai (linking vessel). Insomnia caused by the first four extraordinary vessels, which are referred to as the “first ancestry,” is, however, more rare than insomnia caused by the second four extraordinary vessels: Du mai (governing vessel): – Yang repletio repletion: n: excit excitabi ability lity,, irritab irritabilility ity,, insomnia, a painful and tight spine with heat in the middle middle,, high high feve fever, r, overre overreacti activi vity ty (allergy) – Yang stasis: stasis: insomnia; headaches, stiff neck; red eyes, eye pains – Treat Treat both by reducing hou xi SI-3, shen mai BL-62, zhi yang yang GV-9, and bai hui GV-20 (and use other du mai points too, such as ling tai GV-10, tao dao GV-13, nao hu GV-17, qiang qiang jian GV-18, hou ding GV-19, GV-19, and xin hui GV-22). Ren mai (conception vessel): – Yin vacuity: insomnia, mouth dryness, thirst at night; menopausal syndrome; patterns of blood vacuity or jing vacuity vacuity – Treat by supplementing lie que LU-7, zhao hai KI-6, guan yuan CV-4, qi hai CV-6, yin jiao CV-7, and jiu wei CV-15 Chong mai (penetrating vessel): – A counterflow qi causing the sensation of qi rush rushin ingg up, up, “runnin runningg pigle piglett” syndrome ●
●
●
(panic attacks), insomnia with a hot head and cold feet, dizziness, nausea, vomiting, dyspnea, and chest oppression – Treat with gong sun SP-4 and nei guan PC-6; add tai chong LR-3, LR-3, da ling PC-7, PC-7, and the kidney channel points on the chest, especially shen feng KI-23, ling xu KI-24, shen cang KI-25, or yu zhong KI-26 KI-26 Dai mai (belt or girdling vessel): – Yang stasis in the upper body with deficiency in the lower body: insomnia, pruritis of the head, headaches, a sensation of sitting in water and weakness of the legs, belt-like lumbar pain – Treat with zu lin qi GB-41, dai mai GB-26, wei guan TB-5; also xuan zhong GB-39 GB-39 (helps to balance excess in the upper body)
The second- and third-ancestry extraordinary vessels are more involved involved with regulating the internal rhythms and synchronizing the zang fu physiology with external changes. The disturbances of the yin and yang wei and qiao vessels can cause sleep difficul ficultie tiess in spec specifi ificc segm segmen ents ts of the the nigh night, t, as expl explor ored ed in the the secti section on abo above on “Diagnosing Insomnia,” which can be confirmed by palpating their xi points: Jiao xin KI-8 on the yin qiao vessel BL-59 on the yang qiao vessel Fu yang BL-59 Zhu bin KI-9 on the yin wei vessel Yang jiao GB-35 on the yang wei vessel Yin qiao mai (motility or stepping vessel): vessel): – Vacuity: insomnia, headaches, pain (worse at night); convulsions; weakness or paralysis of the legs; blurred vision, difficulty opening the eyes; anuria, spermatorrhea, impotence, sterility, menstrual cycle problems – Treat with zhao hai KI-6, jiao xin KI-8, lie que LU-7, jing ming BL-1 BL-1 (or yin tang ) Yang qiao mai (motility or stepping vessel): – Replet Repletion ion:: insomn insomnia, ia, headac headaches hes (worse (worse at night); lumbar pain, one-sided pain or weakness; pain and tightness (not localized; worst at night), lateral leg and hip pain and spasticity; internal or external wind: convulsions, tinnitus, tinnitus, epilepsy epilepsy,, Parkinso Parkinsonn disease; disease; nose bleeds; red and a nd painful eyes, exophthalmia – Treat with shen mai BL-62, fu yang BL-59, BL-59, BL-1 (or yin tang ),), and hou xi SI-3, jing ming BL-1 possibly feng chi GB-20 ● ● ● ● ●
●
Etiology and Treatment of Insomnia
●
linking vessel): Yang wei mai ( yang linking Repletion: alternating alternating fever fever and chills, sensitivity to changes in the weather; insomnia with easy waking; chest oppression; changing moods; pain, and spasms, lumbar pain; skin hyperesthesia, arthralgia (hand, heel); parotiditis; diarrhea; headache with heat or stor storm; m; red or tear tearin ingg of the the eyes eyes (wit (withh wind); otitis, deafness, tinnitus; acute sinusitis; facial neuralgia; eczema of the neck or ears – Treat with wei guan TB-5, zu lin qi GB-41, yang jiao GB-35, ben shen GB-13 Yin wei mai ( yin linking vessel): – Vacuity: insomnia from fear, vacuity of the heart heart and lung, lung, palpit palpitati ations ons,, heart heart pains, pains, hypotension; ptosis; depression, tears, oversensitivity – Treat with nei guan PC-6, gong sun SP-4, zhu bin KI-9.
jue yin yin (the liver and pericarcontrolle controlledd by jue dium), and corresponds to the time between 2 a.m. and 4 a.m. Since jue yin is the intermediary between tai and shao yin and helps move yin in and out, sleep alternates between deep sleep and REM sleep. Palpitations, anxiety, or possibly heat with a need for cool drinks (liver heat) often accompany waking up at this time. This type of insomnia is most often observed duri during ng the the spri spring ng or autu autumn mn equi equino nox. x. The The treatment consists of draining tai chong LR-3, nei guan PC-6, and yu tang CV-18. CV-18.
–
●
Insomnia Due to Seasonal Desynchronization
Dr. Michel Frey (personal communication) has a slightl slightlyy different different approach to insomnia insomnia.. He exexplains the sleeping process in relation to three phases: Falling asleep. This phase corresponds to progressive relaxation and letting go of consciousness. In energy terms, this corresponds to shao yin, as manifested in the slowing down of the cardiac rhythm and mental quieting (heart) and articular relaxation (kidney). As shao yin governs “letting go,” all types of fears, especially the fear of death, will more easily manifest at this stage. A vacuity of kidney qi or kidney yin causes the heart yang to become overactive, with the consequence that a state of mental agitation alternates with initial drowsiness. This type of insomnia is frequently witnessed at the summer or winter solstices. The treatment protocol calls for unbinding the shao yin using the xi points shui quan KI-5 and yin xi HT-6, with the addition of ju ju que CV-14 to release the accumulation of qi qi in the chest. Deep sleep. During this phase, there is a loss of muscle tone and, according to Chinese medicine, the eyes turn inward to engage in the dream vision. In energy terms, this phase is ●
●
●
Inte Interme rmedi diary ary slee sleep, p, or the the termi termina nall phase phase of sleep. This phase corresponds in energy terms to the exit of yin toward the yang , that is, the passage of tai yin toward yang ming (bright-
ness). It is the first regaining of consciousness during which the mind may occupy itself with the the forthc orthcom omin ingg activ activit itie iess of the the day day. This This worry, concern, or anticipation of the coming day can be responsible for this type of terminalphase insomnia. It may also be observed during the period between the seasons, representing the passage between one situation and another. The treatment aims to help the opening or exit of yin toward yang : use zhong fu LU-1, chong men SP-12, with the addition of yi she BL-49 to help reduce the cogitation and pensiveness. Although this classification of the three phases of sleep seems different to the one I proposed previously in the chapter, it is another way of looking at sleep which definitely has its place in this book as it has proved its efficacy over the years.
43
44
3 Insomnia
Acupuncture Points Affecting Sleep
Ling xu KI-2 KI-24 4
Cons Consti titu tuen entt poin pointt of chong chong mai , ling point: psychological stress, anxiety; doubting, suspicion, sensation of having two opposing wills; reduced memory; needing to swear, obsessions. As a ling point, ling point, helps to let go of the past and to forgive
Shen cang KI-2 KI-25 5
Cons Consti titu tuen entt poin pointt of chong chong mai , corresponds to the middle Cinnabar Chamber: insomnia from worry, restless mind; depression, disliking life, seeing the negative aspect of things
Yu zhong KI-2 KI-26 6
Cons Consti titu tuen entt poin pointt of chong chong mai , inward movement point of shao shao yin: yin: insomnia, waking in a bad mood, easily easily angry; feeling of not being loved; fearful spirit, touchy; concentration and memory problems
Jing (well) Jing (well) and wood point; draining (sedation) point; strong sinking action, stabilizes the shen the shen:: hysteria, anxiety with palpitations, insomnia, fright wind, very visual dreams; shyness, refusal to speak, fearfulness; forgetfulness; forgetfulness; overemotionality; emotionality; mental confusion; excessive willpower; loss of desire for food
Shu fu KI-2 KI-27 7
Cons onstit tituent uent poi point of chong chong mai , connection with CV-23 and PC-1: persistent insomnia, agitation; apprehension, expecting a misfortune; jumpy, irritable; headaches from mental effort
Tai xi KI-3 KI-3
Yuan (source) and (source) and earth point: stabilizes the emotions, regulates the will; insomnia; fear
Pericardium- Shou Shou Jue Yin and Yin and Liver- Zu Liver- Zu Jue Yin Channels
Zhao hai KI-6 KI-6
Key (ope (openi ning ng)) poin pointt of yin yin qiao mai insomnia with agitation (bleed), irregular menstrual cycles; sadness, hysteria, sense of unease but cannot localize the pain
Jiao xin KI-8 xin KI-8
Xi (accumulation) (accumulation) point of yin yin qiao mai , mobilization point of yin in yin in the legs: no sense of identity; schizophrenia; lack of trust in oneself
Zhu bin KI-9
Starting and xi point point of yin yin wei mai, unstable, capricious, or discontented character; fear, anxiety, restlessness, paranoia; schizophrenia, depression; hysteria, tongue sticking out, drooling
Heart- Shou Shou Shao Yin and Yin and Kidney- Zu Kidney- Zu Shao Sha o Yin Y in Channels Shen men HT-7 men HT-7
Shao fu HT-8 fu HT-8
Yong quan KI-1 quan KI-1
You men KI-2 KI-21 1
Shen feng KI-2 KI-23 3
Yuan (source), Yuan (source), shu shu (stream), (stream), and earth point; draining (sedation) point: quiets and calms the shen the shen,, all insomnia, frequent waking, excessive dreaming, agitation, sleep-talking; hysteria, psychosis, running around; hallucinations; lack of memory, mental retardation in children; mental anorexia, mental dullness
Ying (spring), Ying (spring), fire, and pen and pen (element) (element) point: mental restlessness, mania, hysteria, schizophrenia; emotionality, fear of people; sighing; insomnia, mental restlessness
Cons Consti titu tuen entt poin pointt of chong chong mai , specific organ point of the liver (stores and circulates blood): anxiety, depression, amnesia, anger, moodiness, better with movement; tiredness but cannot sleep; infants need to be carried all the time Cons Consti titu tuen entt poin pointt of chong chong mai, specific mai, specific organ point of the heart (blood circulation and production co-coordinator): restless mind, anxiety when lying down
Tian chi PC chi PC-1 -1
Wind Window ow of the the Sky poin point, t, mobil mobiliz izat atio ion n point of blood in the head, meeting point of jue jue yin: yin: liver and pericardium channels; regulates blood: restlessness
Xi men PC-4 men PC-4
Xi point; point; barrier point of descending yin descending yin of the elbow: quiets the shen, shen, rectifies qi , deals with guilt and shame, loss of memory, fear of people, claustrophobia, melancholia, hysteria
Jian shi PC-5
Metal, jing (river) jing (river) point; use group-luo group- luo meeting points of the upper yin: yin : brings yin to yin to the upper body: insomnia, night terrors; use with PC-7 in menopause; insecurity, shyness in children; needing to move all the time; hysteria, psychosis; hallucinations (seeing ghosts); infantile crying
Nei guan PC-6 guan PC-6
Luo point; Luo point; key point of yin yin wei mai , command point of the upper burner and chest: rectifies qi rectifies qi , deals with guilt and shame, fright wind, convulsions; forgetting words, indecision; laziness; stress, anxiety with palpitations, insomnia, hysteria
Etiology and Treatment of Insomnia
Da ling PC-7 ling PC-7
Lao gong PC-8 gong PC-8
Yuan, Yuan, shu (stream), shu (stream), and earth point; draining (sedation) point; quiets the shen, shen, opens the chest: insomnia, anxiety, fear, panic, grief; use with PC-5 in menopause; weeping, sadness with hysterical laughter; insomnia; anxiety; indignation, discontent, depressions; helps to detach when dying or in mourning
Ying (spring), Ying (spring), and fire and pen and pen point: point: shyness, anxiety and depression, discontent; mental restlessness, mania, hysterical laughter, anxiety, cannot sleep at all
Zhong chong PC-9 chong PC-9 Jing (well) Jing (well) and wood point, supplementing point: night crying in children, fear of the dark, anxiety, amnesia Xin jian LR-2 jian LR-2
Ying (spring), Ying (spring), fire point, draining (sedation) point: depression, sighing, desire to die, easily moved to tears; seeing ghosts, fear; nervous palpitations, anger; insomnia, manic behavior
Tai chong LR-3 chong LR-3
Shu (stream), Shu (stream), yuan yuan point; point; guan guan (barrier) (barrier) point (mobilization and distribution of qi ), ), earth point, constituen constituentt point of chong mai , blood purification point: repressed repressed emotions, insomnia, insomnia, nervousness, irritability; irritability; fright wind in children children
Qu quan LR-8 quan LR-8
He (sea), He (sea), water point, supplementing point: restless legs syndrome (RLS)
Zu wu li LRli LR-10 10
Tai yuan LU-9 yuan LU-9
Yu ji LU-10 LU-10
Yuan (source) Yuan (source) and shu and shu (stream) (stream) point, hui (meeting) (meeting) point of vessels, earth point, supplementing point of lung; command point of qi qi emotional emotional outbursts, insomnia from overexcitement, nervous pains; vulnerability from guilt or embarrassment
Ying (spring) Ying (spring) and fire point; clears lung heat: insomnia, grief; anxiety, nervous trembling; madness
Shao shang LU-11 shang LU-11 Jing (well) Jing (well) and wood point: insomnia in children, sleeping with half-open eyes Yin bai SP-1 SP-1
Jing (well), Jing (well), wood point; stabilizes shen stabilizes shen:: restless sleep, excessive dreaming, mental agitation, nightmares; infantile shyness or fear; meningitis, convulsions, coma, grief, melancholia, ghost oppression
Da du SP-2 du SP-2
Ying (spring), Ying (spring), fire point, supplementing point: lack of morality, of discipline, or of emotional control, mental tiredness, lack of concentration or of synthesis; friendly but egotistical, tactless, people who accumulate, superficial, cannot think ahead; worry, obsessive thinking, insomnia, anxiety, depression; dreams of narrow rocky passes or of ruins in the rain
Tai bai SP-3 SP-3
Yuan (source), Yuan (source), earth point, pen point: pen point: agitation, heavy head, confusion; laziness upon waking
Local Local mobiliz mobilizati ation on point: point: insomn insomnia ia Gong sun SP-4 sun SP-4
Luo point, Luo point, key key point point of chong chong mai Sea Sea of Blood, the Mother of the 12 Channels, rectifies qi rectifies qi insomnia, insomnia, restlessness, judgment issues related to moral and sociocultural values, manic depression
Lung- Shou Shou Tai Yin and Yin and Spleen- Zu Spleen- Zu Tai Yin Channels Shang qiu SP-5 qiu SP-5 Zhong fu LU-1 fu LU-1
Mu (collecting; Mu (collecting; alarm) point, connecting with spleen and liver channels, inward movement of yin: yin : insomnia, waking at 3 a.m., puffy face in the morning
Yun men LU-2 U-2
Dist Distri ribu buti tio on of ying ying qi from from the chest, complementary, yin complementary, yin exteriorization exteriorization from the chest: insomnia, waking at 3 a.m.
Tian fu LU-3 U-3
Wind Window ow of the the Sky poin point, t, cont contro rols ls the the balance of qi qi and and blood of the head: depression, anxiety, loss of memory, confusion, talking to oneself, claustrophobia, restless sleep, ghost talk (sleeptalking), feeling of an external presence, excessive crying from sadness, waking with puffy eyes
Jing (river), Jing (river), metal point, draining (sedation) point: pessimism, worry about the future, agitation, depression with sighing, obsessions; altruism, masochism; nightmares; hysteria, convulsions (from excess insulin), epilepsy, children who need to be carried
San yin jiao SP-6
Gro Group-luo point luo point of the spleen, liver, and kidney channels, crossing of yin of yin wei mai , regulates qi regulates qi , blood, and jing: insomnia from fatigue, nocturia; shyness in children; neurasthenia
Di ji SP-8 SP-8
Xi point: point: feeling of dropping when falling asleep, dreams of falling or sinking
45
46
3 Insomnia
Large Intestine- Shou Shou Yang Ming and Ming and Stomach Zu Yang Min Channels Min Channels
Small Intestine- Shou Shou Tai Ta i Yang and Yang and Bladder- Zu Zu Tai Ta i Yang Channels Yang Channels
Er jian LI-2 jian LI-2
Hou xi SI-3 SI-3
Shu (stream) Shu (stream) point; wood point; supplementing point; key point of du du mai hysteria, mania, insomnia, dream-disturbed sleep; dream of narrow passages; chronic mental weakness and depression
Jing ming BL-1 BL-1
Cons Consti titu tuen entt poin pointt of yang and yang and yin yin qiao mai; connection mai; connection with small intestine (SI-18), stomach (ST-1), and liver channels (LI-20), bladder–sinew channel, and heart, small intestine, spleen, and stomach jing stomach jing bie (divergent) bie (divergent) channels; jie (termination jie (termination or knot) point of tai of tai yang (channel): yang (channel): insomnia or sleepiness, intellectual fatigue
Zan zhu BLBL-2
Barr Barrie ierr of asce ascend ndin ing g yang: yang: nightmares, overexcitement, hallucinations
Tian zhu BL-1 L-10
Meeting of yang and yang and yin yin qiao mai , Window of the Sky point: brings yang brings yang down down from the head; barrier of descending yang: yang: frozen by emotions; fear of heights; insomnia (from overwork); nightmares; sexual dreams, lack of coordination, lack of memory and concentration; neurasthenia, schizophrenia, sexual overstimulation
Xin shu BL-15
Back shu (transporting) point of the heart; control point of qi of qi and and blood circulation in the upper parts: nocturnal enuresis in children; depression, loss of memory; fear, stage fright; irritability, anxiety, dream-disturbed sleep, dreaming of the dead, sexual dreams, spermatorrhea; hallucinations, hysteria, mania
Pi shu BL-20
Back shu (transporting) shu (transporting) point of the spleen pancreas: light sleep; anxiety, depression, sadness
Gao huang shu BL-43
Regulates thoracic blood and qi and qi , huang point, relative to autonomous nourish “ hundred ment; Sun Si Miao’s point of “ diseases”: depression, neurasthenia; loss of memory, insomnia, anxiety; hysteria, overexcitement; doubts; nutritional problems
Shen tang BL-44 L-44
Pala Palacce of shen: shen: depression, disorientation, insomnia, anxiety; mania
Yi xi BL xi BL-4 -45 5
Sigh Sighin ing g poin point; t; inso insomn mnia ia from from fati fatigu gue, e, sweating from shock
Ying (spring), Ying (spring), water point, sedation point: tendency to fall asleep
San jian LI-3 jian LI-3 He gu LI-4 gu LI-4
Shu (stream), Shu (stream), wood point: extremely emotional, likes to lie down
Yuan (source) Yuan (source) point, guan point, guan point, point, mobilization and distribution of qi qi anxiety, anxiety, restlessness, influences the quality of sleep, insomnia from weakness; dreams of flowers or landscapes
Qu chi LI-11 LI-11
He (sea) He (sea) point, earth point, supplementing point: depression, fear, forgetfulness, dreams of untilled fields
Shou wu li LIli LI-13 13
Helps Helps the inward inward movem movement ent of yang: yang: worry, fear, likes to lie down
Que pen ST-1 ST-12 2
Gath Gather erin ing g poin pointt wher where e qi descends, descends, crossing of liver, small intestine, triple burner, and gallbladder channels: anxiety, dislike of tightness around the neck, insomnia from nervousness
Liang men S men ST-2 T-21 1
Specia Speciall organ organ point point of the the stomac stomach: h: insomnia after midnight, needs to eat to fall asleep
Da ju ST-27
Brings thoracic yang down, yang down, moves pelvic qi vic qi : fright, anxiety, nervousness, infertility from stress, insomnia from worry
Zu san li san li ST-36
He (sea) He (sea) point, earth point, pen point, pen point; point; Sea of Nourishment point, distribution of ying ying qi (nourishing qi (nourishing qi ) and xue and xue:: all psychiatric diseases, insomnia, weakness from emotion
Feng long ST-40 long ST-40
Luo point; Luo point; command point of the mucous membranes, clears hot phlegm: tightness in the solar plexus, anxiety, dizziness; phobia, schizophrenia; the compulsion to climb to high places to sing, or to undress and run around madly, for example; hallucinations
Nei ting ST-44 ting ST-44
Li dui ST-45 ST-45
Ying (spring) Ying (spring) and water point: nightmares, restless extremities at night; desire for silence Jing (well) Jing (well) and metal point, draining (sedation) point: jumpiness, hypersensitivity; dream-disturbed sleep, nightmares, sleepiness
Etiology and Treatment of Insomnia
Han yan GB-4 GB-4
Conn Connec ecti tion on with with the the trip triple le burn burner er,, stomach, and liver channels; yang channels; yang mobilization point: calms fear and pain, infantile fears, night terrors
Shuai gu GB-8 GB-8
Conn Connec ecti tion on with with bladd bladder er chan channe nel, l, mobilization of yang from yang from inside to outside and downward: calms fear, all dependencies (with GB-9), withdrawal syndrome, alcohol detox; lack of willpower; oral complex
Wan gu GB-12 GB-12
Connec Connectio tion n with with bladder bladder channe channel: l: insomnia, aphasia, mania
Ben shen GB-1 GB-13 3
Cons Consti titu tuen entt poin pointt of yang yang wei mai , command point of the extraordinary fu, fu , controls contact to the world: insomnia, excessive dreaming, nightmares, anxiety, fixed ideas, paranoia, jealousy; schizophrenia; fever from emotions, depression
Tou lin qi GBqi GB-15 15
Triple Burner- Shou Shou Shao Sh ao Yang and Yang and Gallbladder- Zu Zu Shao Sha o Yang Channels Yang Channels
Cons Consti titu tuen entt poin pointt of yang yang wei mai . Connection with the bladder and triple burner channels: unstable emotions, easily frightened, trembling or stiffness from shock, depression, insomnia, anxiety, nightmares
Zheng ying GB-17
Guan chong TB-1 chong TB-1 Jing (well) Jing (well) and metal point: agitation, insomnia, tightness in the throat
Constituen Constituentt point of yang yang wei mai , helps diffuse lung qi lung qi insomnia, insomnia, agitation
Feng chi GB chi GB-2 -20 0
Cons Consti titu tuen entt poin pointt of yang yang wei and yang and yang qiao, qiao, mobilizing point of qi qi and and blood of the head and the neck, major wind point: insomnia, irritability, mania
Zhe jin GB-23 jin GB-23
Mu (collecting, Mu (collecting, alarm) point of the gallbladder channel (along with GB-24); yang exteriorization yang exteriorization point: insomnia from overwork, infantile night fright; amnesia, indecision
Ri yue GB-24 yue GB-24
Mu point Mu point of the gallbladder channel (along with GB-23); yang GB-23); yang exteriorization exteriorization point: alternating joy and sadness; sighing; hysteria with excessive talking; indecision; somnolence
Hun men BL-47 men BL-47
Kun lun BL-60 lun BL-60
Hun gate: Hun gate: depression, irritability, anger, resentment, frustration; anxiety, vague feeling of fear at night, paranoia; lack of direction or ideas, lack of roots; unable to let go of the past
Shen mai BL-6 mai BL-62 2
Xin shu BL-15, shu BL-15, Gan shu BL-18, shu BL-18, Pi shu BL-20 shu BL-20
Jing (river) Jing (river) and fire point: insomnia from emotions, infantile insomnia teething pain in infants; pain, discontent, or irritation; uterine blood stasis, from fear or sexual abuse; helps to surrender in the dying person Key Key (openi (opening) ng) and startin starting g point point of yang qiao mai m ai , command point of the “Gate of the Ankles ”: introversion; insomnia (drain); somnolence and dull spirit (supplement); depression, amnesia, disorientation, mania, obsessions; delirium Insomnia from xue from xue vacuity, vacuity, superficial sleep
Wei guan TB-5
Luo (connecting) Luo (connecting) point, key point of yang wei mai sleep sleep cycle disturbance, jet lag (with he (with he gu LI-4)
Tian jing TB-10 jing TB-10
He (sea) He (sea) and earth point, draining (sedation) point: difficulty falling asleep, insomnia from sadness; melancholia (with GV-11, BL-15); palpitations; emotional skin rashes; repressed worry; depression, anxiety; pushing oneself too hard; hypertension; insanity
Tian yu TB-1 TB-16 6
Wind Window ow of the the Sky, Sky, mobi mobili lize zess yin: yin: restless dreams, dreams of falling or standing on one ’s head
Lu xi TB xi TB-1 -19 9
Regul egulat ates es the the sens sensor oryy func functi tion ons: s: insomnia, fear, restless legs syndrome (with TB-2)
Si zhu kong TB-2 TB-23 3
Help Helpss yang flow yang flow forward: tightness tightness in the throat and solar plexus, fear, restless sleep, nervous jerking at night; mania
Ting hui G hui GB-2
Mobilizes yang from yang from back to front: insomnia after 3 a.m.; eating quickly, lack of joy, false ideas
Xia xi GB-43 GB-43
Zu qiao yin GB-44 yin GB-44
Ying (spring) Ying (spring) and water point, supplementing point: insomnia from fear and insecurity, humiliating dreams; worry, lack of courage, putting things off Jing ( well) well) and metal point: agitation, insomnia with excessive dreaming, nightmares
47
48
3 Insomnia
Du Mai -Governing -Governing and Ren and Ren Mai -Conception -Conception Vessels Xuan shu GV-5 Ling tai GV-10 GV-10
Moves yang up yang up and down: always in a hurry, impulsive, dreaming of snakes
Ling (soul) Ling (soul) point, perception of danger: problematical introspection, insomnia
Extra Points for Insomnia Yin Ta Tang ng (EX-HN-3) (EX-HN-3) Location
On the glabella, between the eyebrows eyebrows (Fig.3.7). Actions
Benefits the nose; dispels wind; alleviates pain; calms the shen.
Tao dao GV-13 GV-13
Connec Connectio tion n with with BL-10, BL-10, BL-11, BL-11, BL-12: BL-12: insomnia from fatigue, shyness, seeking solitude, lack of joy
Nao hu GV-17 GV-17
Connec Connectio tion n with with the bladder bladder channe channel, l, Sea of Marrow point and connection to the brain; mobilizes blood on the surface: mania, hysteria, insomnia before midnight
Insomnia, to calm the mind; nose and eye diseases, dizzin dizziness ess,, hypert hypertens ension ion;; infan infantil tilee convul convulsio sions ns (fright wind)
Qiang jian GV-18
Connection Connection to the brain: hysteria, hysteria, insomnia
Yi Ming/ Ming/ An Mien (EX-HN-54) Mien (EX-HN-54)
Hou ding GV-19 GV-19
Connec Connectio tion n to the brain: brain: insomn insomnia, ia, severe anxiety
Location
Indications
In spite of the different nomenclature, I believe them to be at the same point as they are described with the same location: on the lower border of the mastoid, on the sternocleidomastoid muscle, midway between yi feng TB-17 and feng feng chi GB-20 (slightly posterior and superior to wan gu GB-12) (Fig.3.8).
Bai hui GV hui GV-2 -20 0
Conn Connec ecti tion on with with all all the the yang channels, yang channels, end of the liver channel, meeting of all jing bie (divergent) bie (divergent) channels; Sea of Marrow point (with GV-16 and GV-17), connection to BL-1 and GB-8; brings qi , yang, yang, yin, yin, and blood to the head: depression; anxiety; mania hysteria; insomnia; lack of will to live, loss of reality, false ideas
Xin hui GV-22
Mobilizes yin and yin and blood in the head: mental confusion, dyslexia, fright, insomnia, lack of imagination
Calms the shen; regulates the liver.
Shen ting GV-24 GV-24
Meetin Meeting g with with bladder bladder and stomac stomach h channels: schizophrenia, severe anxiety (with GB-13), mania, hysteria
Insomnia, sensitivity to external factors, agitation and restlessness; eye diseases; tinnitus
Guan yuan C yuan CV-4 V-4
Meetin Meeting g of spleen, spleen, liver liver,, and and kidney kidney channels, mu channels, mu point point of small intestine; birth and mobilization of yin of yin:: anxiety, insomnia, night fears, shock
Qi hai CV hai CV-6 -6
Cen Center ter of human uman phys physic ical al qi qi , Sea of All the huang the huang (vital) (vital) points: depression, lack of willpower, alcoholism; no desire to live, insomnia
Jiu wei CV-15 CV-15
Luo point Luo point of ren ren mai , command point of the sexual organs, source of the five zang: zang: depression, difficulty finding words, boredom, feeling of doom; absentmindedness; anxiety; mania; hysteria, insomnia
Actions
Indications
Yin tang
Fig.3.7 Yin tang for tang for insomnia and to calm the mind.
Etiology and Treatment of Insomnia
1/2 1/2
GB-20 Yi ming (An mien)
GB-12 GB-20
GB-12 TB-17
TB–17 An mien I mien I Yi ming ( ming ( An mien) mien) An mien II mien II
Fig.3.8 Yi ming or an or an mien (EX-HN-54) mien (EX-HN-54) for insomnia from sensitivity to outer stimuli.
An Mien I Mien I (EX-HN-52) and An and An Mien II Mien II (EX-HN-53) Location An mien I:
on the lower edge of the mastoid, on the sternocleidomastoid muscle midway between yi feng TB-17 TB-17 and yi ming EX-HN-54. EX-HN-54. An mien II: between yi ming and and feng chi GB-20 (Fig.3.9).
Fig.3.9 An mien I mien I and II for insomnia and sleep-walking.
Actions
Calms the shen; benefits ears and eyes. Indications
Insomnia, sleep-walking; nervousness, psychosis; headaches, convulsions; palpitations. (EX-HN-1) Si Shen Cong Cong (EX-HN-1) Location
On the vertex, 1 Cun away from bai hui GV-20 anterior, posterior, left and right ( Fig.3.10).
GV-20
1 Cun
Actions
Calms the shen; dispels wind; benefits the eyes.
1 Cun
EX-HN-1 Si shen cong
Indications
Insomnia; stroke (apoplexy); epilepsy; headaches; dizziness; eye diseases; pruritis.
Fig.3.10 Si shen cong (EX-HN-1) cong (EX-HN-1) for insomnia and pruritis.
49
50
3 Insomnia
Ear Acupuncture Shen Men
Endocrine Hormones/Internal Secretion/ Hypophysis/Pituitary Point
Location
Location
At the tip of the triangular fossa.
At the lower extremity of the intertragic intertr agic incisure.
Actions
Actions
Alleviates Alleviates pain, calms the shen, reduces inflammation.
Controls hormonal secretions, maintains homeostasis.
Indications
Indications
Pain, tension, anxiety, depression; hypertension; insomn insomnia ia;; pruriti pruritis; s; verti vertigo; go; hypert hypertens ensio ion; n; epiepilepsy; all addictions ( Fig.3.11)
Antirheuma Antirheumatic, tic, anti-inflamma anti-inflammatory tory,, antiallerg antiallergic; ic; resolves dampness: edema, obesity, and eczema; urogenita urogenitall and digesti digestive ve problems problems (malabso (malabsorprption).
Sympathetic/Autonomic Point Location
Under the helix, on the extremity of the lower branch of the antihelix.
Master Cerebral Point/Master Omega Point/ Psychosomatic Point Location
On the ear lobe, in the mid-anterior section. Actions
Regulat Regulates es the sympathe sympathetic tic and parasymp parasympathe athetic tic nervous systems, regulates vasodilatation, inhibits secretions.
Actions
Analgesic, calming; psychosomatic symptoms. Indications
Indications
Allevia Alleviates tes pain; pain; intestina intestinall spasms, spasms, stomach stomach hyperacidity; peracidity; tachycar tachycardia; dia; hyperthy hyperthyroidi roidism, sm, stress; stress; asthma; Raynaud disease, vascular diseases; dermatitis; matitis; amenorrhea amenorrhea,, dysmenorrh dysmenorrhea; ea; eye problems; drug addiction.
Fear, worry, nervousnes ner vousness, s, negative thinking, obsessive–compulsive compulsive disorder; chronic pain, emotional stress; sleeping disorder: dream-filled sleep, light sleep, sleep, easily easily awak awakene enedd with with difficu difficulty lty falli falling ng asleep again. Tranquilizer/Relaxation Tranquilizer/Relaxatio n Point Location
Lower third and anterior part of the tragus. Insomnia 1
Shen Men Sympathetic
Actions
Relaxes, Relaxes, calms the mind, reduces tension. Indications
Insomnia 2 Temple Endocrine
Relaxation (Tranquilizer)
Muscle Muscle tensio tension, n, restle restlessn ssnes ess, s, nervous nervous tensio tension, n, insomnia, hypertension.
Omega (Master Cerebral)
Insomnia 1 and Insomnia 2 Points Fig.3.11 Auri Auricu cula larr poin points ts for for inso insomn mnia ia (Chi (Chine nese se and and French schools).
Locations Insomnia 1. In the upper part of the scaphoid fossa
(between the helix and the antihelix), below the darwinian tubercle.
Etiology and Treatment of Insomnia
Insomnia 2. In the lower part of the scaphoid
fossa, level with the antitragal groove (junction of antihelix and antitragus). Actions
Benefits sleep; calms the shen. Indications
Insomnia. Some Classical Acupuncture Point Combinations
The following point indications are compiled from source texts such as the Huang Di Nei Jing (Inner Classic of the Yellow Emperor) (ca. 100BCE), Zhen Jiu Jia Yi Jing (Systematized (Systematized Classic of Acupuncture and Moxibustion) (ca. 282CE), Bei Ji Qian Jin Yao (Essential ial Formu Formulas las Worth a Thousa Thousand nd in Fang (Essent Gold) (ca. 625), Bei Ji Qian Jin Yi Fang (Supplement (Supplement to the Essential Formulas Worth a Thousand in Gold) (ca. 682), Bai Zheng Fu (Ode of One Hundred Patterns) (1529), and Zhen Jiu Da Cheng (The (The great Compendi Compendium um of Acupuncture Acupuncture and Moxibusti Moxibustion) on) (1601). The point indications were mainly cited by authors such as G. Soulié de Morant, E. Rochat de la Vallée, J.-M. Kespi, and Daoist Master J. Yuen.
Waking to eat
Hui zong TB-7 zong TB-7
Disturbing dreams
Tian you TB-16 you TB-16
Sexual dreams
Shen shu BL-23 shu BL-23
Sleep-talking
Shen men HT-7 men HT-7
Ghost talking
Tian fu LU-3 fu LU-3
Ghost oppression
Yin bai SP-1 SP-1
Excessive dreaming
Yin bai SP-1 SP-1
A lot of dreams
Xin shu BL-15, shu BL-15, pi pi shu BL-20, shu BL-20, gan gan shu BL-18 shu BL-18
Nightmares
Shen ting GV-24 ting GV-24 with ben with ben shen GB-13
Dreams of death
Zu qiao yin GB-44 yin GB-44 with shang with shang qiu SP-5 qiu SP-5
Dreamy state
Da zhui GV-14, quqi GV-14, quqi LI-11, yang LI-11, yang ling quan GB-34, quan GB-34, guan guan yuan CV-4, and shen and shen que CV-8 que CV-8
Wandering hun
Hou ding GV-19, jiu GV-19, jiu wei CV-15 CV-15
With chest oppression
Yin bai SP-1, li SP-1, li dui ST-45 ST-45
Anxiety
Shen ting GV-24 ting GV-24 (or bai (or bai hui GV-20) with jiu with jiu wei CV-15 CV-15
Mind obstructed
Qiang jian GV-18, jian GV-18, zheng zheng ying GB-17, cheng GB-17, cheng ling GB-18 ling GB-18
Tossing and turning
Xing jian LR-2, jian LR-2, tai tai chong LR-3 chong LR-3
Light sleep
Gan shu BL-18, shu BL-18, qu qu quan LR-8 quan LR-8
Cannot sleep at all
Lao gong PC-8, gong PC-8, da da ling PC-7 ling PC-7
Insomnia in children
Shao shang LU-11 shang LU-11
Insomnia in menopause
Da ling PC-7, ling PC-7, jian jian shi PC-5 PC-5
Difficulty falling asleep
An mien (EX-HN-54) mien (EX-HN-54)
Modern point combination Shen men HT-7, men HT-7, san san yin jiao for all types of insomnia SP-6, with si with si shen cong (EX-HN-1) or an or an mien (EX-HN-54), or yin or yin tang (EX-HN-3)
Qi Gong for Gong for Insomnia
The Daoist physician Ge Hong (3rd century) proposed a set of exercises to treat insomnia: 1. Lie in a supine position with the knees bent. Use the hands to pull the knees toward the chest, breathing normally. Hold the position for 1 minute, then straighten the legs, relax the arms and hands and bring them to the sides. 2. Sti Still ll in a supi supine ne posi positi tion on.. Both Both arms arms are are stretched up and above the head while inhaling. While exhaling, bring the hands down to the chest and massage from the chest to the abdomen. Then relax the arms and hands and bring them back to the sides. Repeat several times. 3. Still Still in the same position, position, make the hands hands into fists and place them under the back, one fist on either side of the spine, as high as possible toward the shoulder blades. Take three deep breaths, and then move the fists downward a few inches and repeat the deep breathing, moving down until the fists are at waist level. Five deep breaths are taken here. The fists are then mov moved to eith either er side side of the the tail tailbo bone ne and and another five breaths are taken. 4. Lying face down, place the hands under the belly. Inhale and exhale slowly, pausing after each exhalation, relax all the muscles, and let go of all mental and emotional tension. Repeat several times. 5. The sleep position: the Daoist Deer Sleeping Posture, which is very similar to the Lion Posture in Buddhism. Lying on the right side, bend
51
52
3 Insomnia
the right arm at the elbow, elbow, with the palm facing up in front of the face. The left arm rests on the side, and the elbow on the left hip, with the hand hanging in front of the abdomen. The right leg is straight, and the left knee is bent, resting on the bed in front of the right thigh. Overview of Treatment Strategies
The initial assessment should aim to: Establish the type of insomnia: mental agitation or physical (visceral) restlessness, or both Establ Establish ish which phase of the night night sleep sleep is affected: initial, middle, or end Identify and diagnose whether one of the four extraordinary vessels responsible for synchronizing sleep and waking time is affected. This helps to identify the zang fu patterns involved and helps select the channels to be treated Identify any substance disharmony, in particular blood vacuity or yin vacuity Establish the presence and type of emotion Identify the zang fu patterns Explore the dreams. This may help identify the zang fu pattern, but mainly mental and emotional issues.
●
●
●
●
● ● ●
In most cases of insomnia due to time adjustment, as in jet lag or shift work, work, or any recent insomnia insomnia with no apparent substance or zang zang fu dishar jiao xin KI-8 or fu yang BL-58 mony, especially if jiao BL-58 is reactive to palpation, I often begin treatment with the following combination of points: Zhao hai KI-6 (supplement on the dominant side: right for women, left for men) Shen mai BL-62 (reduce on the opposite side) EX-HN-3 Yin tang EX-HN-3 This point combination combination is very often sufficient sufficient to regulate sleep with one or two sessions, 3 –4 days apart. ●
● ● ●
In more complex insomnia patterns, there may be a substance disharmony, most often xue vacuity or yin vacuity, as well as an emotional disturbance. The treatment principle is then to pacify the shen, supplement the vacuity, and release the emotion. Identifying an extraordinary vessel helps to select the involved involved yin channels (tai yin, shao yin, or jue yin), and to choose the best points for dealing with the shen disturbance.
Where possible, I try to treat a patient twice a week, but I do not treat the extraordinary vessels more than once a week. In long-standing cases of insomnia, several months of treatment are necessary. In these conditions, some dietary advice, like avoiding stimulants (see Chapter 1) or avoiding yang -producing -producing foods and drinking at night, as well as good sleep hygiene is important. Appropriate Chinese herbal treatments certainly help to improve the chances of success. Patients who are used to taking pharmacological substances to induce sleep should try to progressively reduce the dose and frequency in order to avoid the rebound effect. Simple Western Western herbal teas should be tried out when replacing medication. There are many on the market, the most common being: Chamomile tea: a teaspoon of dried chamomile flowers, or two chamomile teabags per cup of water with honey (calming) Chamomile and valerian root (for anxiety) Valerian root and lavender Chamomile (1 teaspoon), vervain leaves (1 teaspoon), and spearmint (half a teaspoon) Chamomile, valerian root, and linden flowers (Tilia) Hypericum, or St. John’s Wort, which has wellknown antidepressant and anxiolytic effects Digestion-promoting teas such as peppermint (some patients may be stimulated by peppermint), fennel, lemon balm, and chamomile Passionflower Passionflower (Passiflora incarnata) for anxiety, when stopping antianxiety medication Green tea should be substituted for coffee as it contai contains ns the amino amino acid acid L -theanine -theanine (which (which increases the activity of the neurotransmitter GABA GABA), promot promoting ing relaxa relaxatio tionn and reduci reducing ng anxiety. However, green tea should be avoided in the afternoon after noon and evening. ●
● ● ●
●
●
●
●
●
According to the Mayo Clinic, the use of light therapy, for instance using artificial light to simulate natural sunlight, helps to correct the body ’s circadian rhythms and may be proposed for conditions such as jet lag, sleep disorders, and seasonal affective disorders (SAD) (Mayo Clinic Clinic 2010). Other studies show that phototherapy devices produce melatonin suppression and significant phase delays (Paul et al. 2007). Some useful lifestyle advice can also be given: Take a hot bath 1 hour before going to bed. This ●
Case Studies
●
●
●
●
●
●
●
increases core body temperature, which then starts to drop, simulating the normal temperature drop observed prior to sleep. Limit access to the bedroom and to bed to a very specific time-frame, that is from 1 a.m. to 7 a.m., or from 2 a.m. to 8 a.m. It is very important that the patient avoids falling falling asleep before this time, for example in front of the television. It is equally important to wake up at the same time every day, even on Sundays, and even when one feels tired and could have slept more. This is an effective method for resetting the inner synchronizers, and most importantly for breaking the mental associations between the bed and the nightly struggle. A siesta, if needed, should not exceed 30 minute utes and and shou should ld occu occurr only only in a time time slot slot between 2 p.m. and 5 p.m. Avoid sleeping at other times. Light. Sleeping in very dark rooms is advisable, drawing the curtains to prevent early daylight entering. Also the use of artificial light to simulate natural sunlight or phototherapy devices helps to correct the body ’s circadian rhythms. Dietary advice. Avoid coffee (10 hours prior to sleep time) and alcohol (at least 4 hours before sleep) sleep).. In gener general, al, light light meals meals are advisa advisable ble;; give preference to starchy foods over proteins. Carbohydrates stimulate the release of insulin, which leads to a relative relative increase in Tryptophan Tryptophan level levelss and helps helps to increa increase se brain brain seroto serotonin nin levels. Snoring and nocturia are two conditions that contribute greatly to insomnia and should be actively treated. Relaxation from tension. Exercise as in yoga is advisable prior to falling asleep. Each part of the body is tensed, the tension is maintained for a few minutes, holding the breath, and then relaxed while breathing out. This helps mobilize the wei qi to move in. Jet lag. For patients who travel regularly, especially when crossing time zones, the internal synchronizers should be reset. Drink but avoid food during the flight, eat only at the appropriate meal time at your place of destination (see also the sections on the prevention and treatment of jet lag in Chapter 4).
Case Studies Insomnia Case 1: Worry and Spleen Qi Spleen Qi Vacuity Vacuity
A 19-year-old student who had been preparing for his final exams presented with insomnia that had lasted for a few weeks. He was waking up after a few hours of sleep, worrying and thinking about the exam. He also presented with daytime fatigue and somnolence, as well as reduced concentration and memory, lack of appetite, soft stools, an empty pulse, and a swollen and pale tongue with tooth marks. The sleep analysis suggested a yin qiao disturbance (waking with a clear mind), which was confirmed by the sensitivity of jiao xin KI-8. As the middle phase of sleep was affected, the tai yin chan channe nell was was invo involv lved ed.. The The othe otherr symp sympto toms ms pointed to a spleen qi vacuity pattern. For the initial session, I chose zhao hai KI-6 on the side where joia xin KI-8 was most reactive, with lie que LU-7 on the opposite side, as well as bai hui GV-20 and two zu tai yin spleen points: da du SP-2 on the left side to supplement the spleen and calm the shen and the worry, and san yin jiao SP-6 on the right side to regulate qi and blood and help quiet the shen. I saw the patient 3 days later and concentrated on the emotional pattern, namely the worry. As this was a deficient pattern, I used the back shu points: Pi shu BL-20 was used to supplement spleen qi and ge shu BL-17 to support the blood. Yi she BL-49 was reduced for the worry and obsession. Si shen cong (EX-HN-1) (EX-HN-1) was used to calm the mind. ●
●
●
I saw the patient 1 week later. His sleep, concentration, and appetite were back to normal. However, ever, he was was still still worrie worriedd about about his his upcomi upcoming ng examination. I supplemented da du SP-2 and shen men HT-7 on the left side, tong li HT-5 on the right, and yin xi HT-6 bilaterally to calm and quiet the shen and overcome his anxiety before having to perform. He passed his exam the following week and got excellent grades.
53
54
3 Insomnia
Insomnia Case 2: Time Change, Disturbed Synchronizers
A 37-year-old man presented with insomnia that had lasted for 2 months, beginning after he had changed job and had to adapt to different working hours. He used to sleep well and for 8 hours. Now he was falling asleep, slept for 4 hours, but then had agitated sleep with physical restlessness, very frequent waking, and mental cogitation. His mind was not clear, and he was tired when he had to get up. He also had two nocturia episodes per night. The man was generally healthy and athletic. He had eczema on his left palm, which had recently become aggravated, and said he had also recently noticed noticed stronger stronger-sme -smellin llingg sweat sweat that was was quite quite rancid. His tongue was slightly pale on the sides, his pulses were slow, the left cun (heart) was tight and the left chi (kidney) was empty. Joia xin KI-8 was reactive on the right side. Analysis. The The pati patien entt’s slee sleepp was was distu disturb rbed ed mainly in the terminal phase, but also partially in the middle phase, as he only slept for 4 out of 8 hours. The mental cogitation and worry are more suggesti suggestive ve of qiao qiao mai (the temporal aspect of sleep) disturbances, the physical restlessness restlessness more on the wei mai (the quality of sleep). As the xi point of yin yin qiao mai was reactive on the right and the the cond condit itio ionn had had clea clearl rlyy start started ed with with a shif shiftt change (time), I decided to start by regulating the yin qiao synchronizer first and concentrate on the middle phase (tai yin channel) and the terminal phase ( jue yin channel): r ight) and lie que LU-7 (on Zhao hai KI-6 (on the right) the left); LU-7 was added to support tai yin and secondarily as a luo point to release the distal heat (eczema). San yin jiao SP-6 was used to support tai yin and supplement liver blood and kidney qi. (EX-HN-3) were Shen men HT-7 and yin tang (EX-HN-3) used to calm the mind. Shen feng KI-23 KI-23 on the left was used for mental agitation and excessive thinking. ●
●
●
●
Although, based on the analysis, the jue yin channel should also have been treated, I decided to keep that for the second session. I saw the patient 1 week later. He was sleeping perf perfect ectly ly well well,, as befo before re the the shif shiftt chan change ge,, his his energy was back to normal, his body body odor was nornormal again, his eczema had almost disappeared,
and he had only one nocturia episode per night. In the second session, I used: Zhao hai KI-6 (on the right) Tai chong LR-3 LR-3 (on the right) with da ling PC-7 PC-7 (on the left) Qu quan LR-8 on the right to further support liver blood (bilaterally) San yin jiao SP-6 (bilaterally) Yin tang (EX-HN-3) (EX-HN-3) ● ●
●
● ●
I advised the patient to call me back if the insomnia recurred. To date he has not called back, but has instead sent two colleagues with sleep problems to see me. If only all insomnia cases were as simple! Insomnia Case 3: Retained Fear, Shao Fear, Shao Yin Pattern Yin Pattern
A 50-year-old woman had suffered from insomnia for 9 months. She was waking up at around 2 a.m. to 3 a.m., was wide awake and stayed awake for up to 2 hours. When she went back to sleep, her sleep was superficial with dreams that were often fearful. She was tired upon waking. In general, she was a fearful and anxious person. She presented a history of allergies, asthma, and chronic bronchitis. She was still having her periods, which lasted 7 days and were abundant with some clots. A uterine myoma had been diagnosed, she was also overweight and had a tendency to retain water, and she presented some nigh nightt swea sweati ting ng and and one one noctu nocturi riaa epis episod odee per per night. She was constitutionally a water type, with a shao yin personality. Her tongue was slightly swollen and pale with tooth marks. There was a greasy coating on the base with raised red spots; there were also red spots at the tip. Her pulses were generally deep, tight in the left cun (heart) position, slippery on the right guan (spleen), and very deficient in both right and left chi positions (kidney). Analysis. The sleep in the middle and terminal phases was disturbed: Her waking in the middle of the night, when she felt wide awake, suggested a “temporal ” desynchronization, hence the qiao mai, as the middle phase of her sleep was affected. This is suggestive of a tai yin phase (history of rhinitis, asthm asthma, a, chroni chronicc bronch bronchiti itis, s, dampne dampness ss and phlegm, spleen qi vacuity) disturbance. The pal●
Case Studies
●
pation of jiao xin KI-8 revealed sensitivity on both sides. Her superficial and dream-disturbed sleep in the terminal phase suggested a “quality” problem, hence a wei mai disturbance. This was confirmed by the reactivity of zhu bin KI-9. The terminal phase of the night corresponded to shao shao yin (constituti (constitution, on, water water retention, retention, nocturia, fear, pulses).
In the first two sessions, which were 5 days apart, I concentrated on the mid-phase of sleep and the yin qiao mai and the tai yin channel: Zhao hai KI-6 and jiao jiao xin KI-8 (on the left) were used as the latter was more sensitive on this side. Lie que LU-7 on the right. LU-7, to open ren mai, was added as the complementary point for yin qiao, and also as a tai yin point. Zhong fu LU-1 (bilaterally) was used for waking around 3 a.m. San yin jiao SP-6 (bilaterally) was used to regulate qi and blood, to support yin and harmonize ●
●
●
●
tai yin. (EX-HN-1) was added in the second Si shen cong (EX-HN-1)
session (KI-8 was omitted, and SP-6 needled on the right side only). After After the initia initiall sessio sessions, ns, she was was still still wakin wakingg because of her nocturia, although going back to sleep much faster; she still had superficial sleep in the terminal phase. The treatment was directed at the wei mai (quality of the sleep) and shao yin (terminal phase of sleep) channels: channels: Nei guan PC-6 and zhu bin KI-9 (on the right) were used as the latter was more sensitive on this side. Gong sun SP-4 was added on the left side to open chong mai (uterine myoma) and further support tai yin. Fu liu KI-7 (on the right) was used to supplement shao yin and for astringing yin (nocturia), alternating with tai xi KI-3 (to help stabilize the emotions and fearfulness). Shen men HT-7 (on the left) was used to calm the shen (pulse) and harmonize shao yin. Later, this was replaced by yin xi HT-6 (for empty heat, night sweating and a red tip of the tongue). Yu zhong KI-26 KI-26 was used to help stabilize shao yin and calm the mind, and alternated with shu (for persistent insomnia and apprehen fu KI-27 (for sion). ●
●
●
●
After three more weekly sessions, the patient was sleeping much better, still waking once to urinate but quickly going back to sleep; her sleep was deeper in the last phase, although still with occasional dreams with fear patterns. She felt much more rested and had more energy during the day. She had no more night sweating and her pulses were better better,, altho althoug ughh the defici deficienc encyy on the kidney kidney positi position on still still remain remained. ed. The foll follow owing ing sessio sessions ns addressed the root of her emotional problems, the fear stemming from childhood abuse, insecurity, and grief: Shen shu BL-23 (supplemented), zhi shi BL-52 (reduced) Po hu BL-42 BL -42 (retained (retained grief) and gao huang shu BL-43 (self-esteem) were sensitive and were reduced, xin shu BL-15 BL -15 was supplemented. ●
●
Some follow-up sessions were used to release the consequences consequences of the childhood trauma: Shen mai BL-62 (reduc fang ST-14 (reduced ed), ), ku fan (reduced), shao hai HT-3 (supplemented); this combin combinati ation on helps helps releas releasee the “undigested ” emotions and shocks. The above points were alternated with shao hai KI-6 (on the right), lie que (on the left), tai xi KI-3 (on the left), shen men HT-7 (on the right), lian quan CV-23 (knot of shao shao yin), and zhong KI-26, to stabilize the zhu KI-15 and yu zhong KI-26, shao shao yin axis and harmonize the kidney and heart. ●
●
The patient was treated for a total of 3 months. Her sleep improved and stayed deep. She had no more dreams of fear, felt much stronger and selfassertive, and could speak about her childhood trauma more easily. I advised her to continue with some form of psychotherapy as well as qi gong to to help heal the wounds of the past. Insomnia Case 4: Circadian Desynchronization, Shao Desynchronization, Shao Yin Pattern Yin Pattern
A 60-year-old man, a retired pilot, had had a long history of insomnia going back 15 years. He presented with difficulty falling asleep, needing up to 1–1.5 hours to do so. His mind was active and calm at the beginning of his sleep, he read, but after a while he became agitated. He also had superficial sleep and was waking often, with no memory of his dreams. He felt tired in the morn-
55
56
3 Insomnia
ing. He had a history of stomach ulcers and prostatic hypertrophy, but was otherwise healthy. healthy. The tongue was red at the tip, his pulses were strong and slightly tight, and there was deficiency of the left chi (kidney yin ). He was constitutionally a fire type, with a tai yang personality, personality, consequently his appearance was hyperactive and restless, with a slightly congested face. Analysis. The initia initiall-sta stage ge insom insomnia nia with with an active active mind mind sugge suggest sted ed a qiao qiao mai mai disturbance involving the shao yin channel. Both jiao xin KI-8 and fu yang BL-59 BL-59 were reactive. In view of his professional past, the initial treatments aimed at regulating the internal synchronizers: Zhao hai KI-6 (on the left) was supplemented, shen mai BL-62 (on the right) reduced, yin tang stimulated, and shen men HT-7 reduced bilaterally. The above points were alternated with shao yin harmonization: fu liu KI-7 or tai xi KI-3, shen men HT-7 with shao fu HT-8 (for mental restlessness), zhong zhu KI-15, and yu zhong KI-26. KI-26. ●
●
After three sessions, he was able to fall asleep more easily, although there was still some mental agitation and his sleep was still not deep enough: An mien mien (EX-HN-54) and si shen cong (EX-HN-1) (EX-HN-1) were added alternately, as was shen feng KI-23 KI-23 to help calm the mind. Xin shu BL-15 and shen shu BL-23 (supplemented), shen tang BL-44, and zhi shi BL-52 (reduced) were also used.
●
●
It took several months of treatment to completely normalize the patient ’s sleep and calm his mind, as he would periodically lapse back into his habitual mental agitation when stressed. Insomnia Case 5: Blood Xu Blood Xu,, Jue Yin Pattern Yin Pattern
A 45-year 45-year-old -old woman woman presented presented with insomnia insomnia that had lasted for the past 4 years following the birth of her last child. She had superficial sleep, was waking frequently and easily, was sensitive to noise and had difficulty falling asleep again. She had great difficulty getting going in the morning, and felt tired in general. Apart Apart from from this this,, she she had had abou aboutt two two stres stresssrelated migraine headaches per month, above the eyebrow (alternating sides) and rather dull in nat-
ure. She had difficulty digesting fats and alcohol, was tired after meals, and had soft stools. She also bruised bruised easily easily.. She had had occasi occasiona onall pain pain in her chest, which was pinching in nature, around the sixth intercostal space on the left side. Her cycles were regular, her period lasting only 1 day, with 2 days of spotting before and 4 days after. after. In her history, she had had eczema, which had now cleared, and a viral meningitis 6 years previously. Her tongue was peeled, with many cracks in the center and on the sides, and it was also swollen with tooth tooth marks. marks. Althoug Althoughh the color color of the tongue tongue appeared normal, the inner eyelid was pale. The pulse was empty on the right guan (spleen) position, and thin and deficient on all left positions. Point palpation revealed sensitivity of zhu bin KI-9 and jiao xin KI-8, both on the left. Analysis. The sleep was disturbed in its totality and both synchronizers, yin qiao and yin wei mai, were involved. The pattern points primarily to a substa substance nce disha disharmo rmony ny,, in this this case case xue blood vacuity of the liver and heart, probably with an underlying liver qi xu (weak liver pulse), a stomach and spleen yin vacuity and spleen qi vacuity. The first three sessions were aimed at supplementing blood by aiding the stomach and spleen, and at calming the shen: Zhong wan CV-12, zu san li ST-36, and san yin jiao SP-6 were used. These points were alternated with ge shu BL17, gan shu BL-18, pi shu BL-20, shen shu BL-23, xin shu BL-15, and gao huang shu BL-43 (the most reactive points were needled) to support blood blood produc productio tionn and supple supplemen mentt live liverr and heart blood. Shen men HT-7 was used. An mien (EX-HN (EX-HN-54 -54)) (for (for the sensit sensitiv ivity ity to noise) was used. ●
●
● ●
The quality of the patient ’s sleep improved, she had fewer waking episodes, and would go back to sleep more quickly, but she was still very sensitive to noise. The following sessions aimed at regulating the yin wei mai and calming the shen: Nei guan PC-6 (on the left), zhu bin KI-9 (on the gong sun SP-4 (on the right) were left), and gong used. In this case, gong sun SP-4 was added to support yin wei and to help uphold the spleen qi (spotting, easy bruising, soft stools). Fu she SP-13, da heng SP-15, SP-15, and fu ai SP-16 were palpated and the reactive points needled. ●
●
Case Studies
●
This is the tai yin segment of yin yin wei mai (stinging pain in the chest). These points of both groups above were alternated with tai chong LR-3 LR-3 and qu quan LR-8 (to supplement liver blood) together with da ling PC-7 (to quiet the shen) and jian shi PC-5 (to calm the shen and help move yin up to the head).
ing spleen qi to produce blood and help settle and calm the shen. The points were mainly chosen from the tai yin and yang ming channels: channels: Nei guan PC-6 (on the left) and gong sun SP-4 (on the right) were used. San yin jiao SP-6 (bilaterally) and zu san li ST36 (bilaterally) were used to support spleen qi and blood production. Shen men HT-7 was used bilaterally. Yin tang (to (to calm the mind) was alternated alternated with an mien I (EX-HN-52) or an mien II (EX-HN-53) (sleep-walking). All the points above were alternated with yin bai SP-1 and li dui ST-45, both for restless sleep and nightmares, and da ju ST-27 (for insomnia from worry). ●
●
●
The stomach yin had to be supported regularly with: Zhong wan CV-12, zu san li ST-36, chong yang ST-42, yang chi TB-4, and san yin jiao SP-6 ●
The treatment took almost 6 months, with sessions sions first first weekl weeklyy and then every every other other week week,, before sleep normalized and before the tongue coating returned and the patient’s overall energy levels improved.
●
●
An important part of the treatment was to settle the shen and the hun and stop the worrying: Xin shu BL-15, gan shu BL-18, and pi shu BL-20 were supplemented. Shen tang BL-44, hun men BL-47, and yi she BL-49 were reduced. ●
Insomnia Case 6: Somnambulism, Tai Somnambulism, Tai Yin Pattern Yin Pattern
A 40-year-old man presented with insomnia that had lasted for over 10 years. His sleep was superficial, with easy waking, and occasional difficulty falling asleep through worry. There were also occasional episodes of nightmares, sleep-walking, or sleep-talking, which were aggravated aggravated by overwork or stress. He felt tired in the morning and during the day. He had a pale and dull complexion, was healthy overall, and only had some bloating and tiredness after meals and a tendency to soft stools. His tongue was swollen with tooth marks and a greasy coating. The pulses were of a weak and deficient quality overall. He had an earth –metaltype constitution and a tai yin metal temperaZhu bin bin KI-9 ment. Zhu KI-9 appe appear ared ed more more reac reacti tive ve,, although not very clearly. Analysis. The patient ’s sleep was disturbed in its quality (superficial), indicating a yin wei pattern; occasional initial phase difficulty suggested the tai yin level was affected, which is consistent with the spleen qi vacuity symptoms and the worry. In my experi experienc ence, e, sleepsleep-wa walki lking ng and nightm nightmare aress are usually seen in repletion patterns, especially in men. In this case, however, there was no evidence of an exce excessss-typ typee patte pattern. rn. The dampne dampness ss and and phlegm were not affecting the upper functions (the patient had an excellent intellect and memory). The strategy therefore aimed at supplement-
●
After six weekly sessions, the patient ’s sleep was much deeper, there had been no episodes of sleepwalking or nightmares, and his overall energy was much improved. I saw him occasionally during periods of stress over the coming years. One or two sessions were usually enough to re-establish equilibrium. Insomnia Case 7: Nightmares, Jue Nightmares, Jue Yin Pattern Yin Pattern
A 31-year-old woman had suffered from insomnia for 6 years following the birth of her child. Her sleep was agitated, with frequent waking, occasiona sionall nightm nightmare aress (wors (worsee in the premen premenstru strual al phase) phase),, restle restless ss legs legs and parest paresthes hesia ia (pins (pins and needles) in the extremities, and occasionally difficulty falling asleep. She was very tired in the mornings and had difficulty starting the day. Her cycl cyclee was was regu regula larr with with stron strongg prem premen enst strua ruall cramps and breast tension. She was also intolerant to fats, suffered from neck tension, and had constipation with goat pellets. In her history, there was cystitis in her teens, anxiety attacks at 15 (later diagnosed as spasmophilia), and ovarian cysts that had been operated on at 16. Her tongue was red on the sides, with red spots at the tip and a thick
57
58
3 Insomnia
and greasy coating at the root with red and raised spots. The pulse was strong and wiry on the left guan superficial (gallbladder) and hollow in the deep (liver) positions, slippery on the right guan (spleen), and quite weak in the left chi (kidney yin) positions. Both zhu bin KI-9 and jiao xin KI-8 were reactiv reactive. e. She appear appeared ed to be consti constituti tutiona onally lly a wood type with a jue yin personality. Analysis. The sleep was disturbed in its quality (restlessness and nightmares), as well as in its length, with initial stage insomnia. The patient ’s constitution and history suggested a jue yin pattern, with strong liver qi stasis, aggravated aggravated by liver blood vacuity and kidney yin vacuity following following childbirth. The liver yang rising rising accounted for the nightmares. As she was in the last part of her cycle, the first treatment t reatment focused on moving liver liver qi: LR-3 (on the right) and da ling PC-7 PC-7 Tai chong LR-3 (on the left) were used to harmonize the liver. Xing jian LR-2 (on the left) and qu quan LR-8 (on the right) were used to reduce liver heat and supplement liver blood. Ben shen shen GB-13 with shen shen ting GV-24 were used to settle the mind (nightmares). Zhao hai KI-6 (on the right; where KI-8 was most reactive) was added to help harmonize the cycle and the premenstrual breast distension. ●
●
●
●
I saw the patient a week later. She had slept very well and had had very few premenstrual complaint plaints. s. In the follow following ing session session,, as it was was the yin , I concentrated on the shao ascending phase of yin yin, to stabilize the yin and the liver yin and blood: Zhao hai KI-6 and jiao xin KI-8 (on the right), and shao fu HT-8 (on the left), were used, as were tai xi KI-3 (on the left) and shen men HT-7 (on the right). KI-26 were used Zhong zhu KI-15 and yu zhong KI-26 to close the shao yin inward. This is an excellent jue yin yin strate strategy gy for for stabil stabilizi izing ng an unstab unstable le jue (spasmophilia). ●
●
In a follow-up follow-up session, session, the back shu points and the shen and hun were treated with xin shu BL-15, shen tang BL-44, BL-44, gan shu BL-18 and hun men BL-47. The patient was seen a few more times over the coming months. Her sleep continued to be good, with no night nightma mare res. s. The The restl restles esss legs legs syndro syndrome me (RLS) (RLS) recurred once, and was treated with qu quan LR-8, yang ling quan GB-34, and yang jiao GB-35.
Insomnia Case 8: Liver Qi Liver Qi and and Blood Vacuity, Heart Blood Vacuity
A 32-year-old man had suffered from insomnia for 6 months, and it had been getting progressively worse. He was waking up between 2 a.m. and 4 a.m., and then either had restless and superficial sleep, often waking with palpitations, or simply could not go back to sleep, with mental agitation. His sleep was much better on the weekend. He was starting to feel exhausted, but otherwise was in good health. He had difficulty diff iculty digesting fats and alcohol, and had constipation, with goat pellet stools. His tongue was peeled in patches and red. His pulses were slightly rapid and deficient in the left deep positions. Zhu bin KI-9 and jiao xin KI-8 were reactive on the left, as was fu yang BL59 BL59 on the right. Analysis. Waking early with a clear mind suggests a temporal disturbance, namely of the qiao mai, and the terminal phase of the night is suggestive of a disturbance of the jue yin channel. The restlessness or superficial sleep of the middle and termin terminal al phases phases sugge suggests sts a disturb disturbanc ancee of the quality (depth) of sleep, concerns the wei mai and is suggestive of a disturbance of the jue yin or shao yin segments. As the sleep seems more disturbed in its quality rather than in quantity, with obvious liver qi and blood patterns, the initial treatments aim at synchronizing the wei mai. The following points were used: Nei guan PC-6 (on the left) and gong sun SP-4 (on the right) LR-3 (on the right) (for restlessness), Tai chong LR-3 qu quan LR-8 (on the right) (for restlessness), and da ling PC-7 PC-7 (on the left) Yu tang CV-18 jue yin, for anxiety and CV-18 (knot of jue palpitations) Ting hui GB-2 (insomnia after 3 a.m.), alternating with wan gu GB-12 ●
●
●
●
After two sessions, 1 week apart, the patient ’s sleep had improved, he was waking up less frequently and had fewer palpitations, but he was still waking early with a clear mind, although no agitation. The following points were used: Zhao hai KI-6 (on the left), shen men HT-7 (on the right), and shen mai BL-62 (reduced on the right) KI-25 (for a restless mind) and shu fu Shen cang KI-25 KI-27 ●
●
Case Studies
● ●
●
San yin jiao SP-6 (EX-HNYin tang , alternating with si shen cong (EX-HN-
1) All the previous points were alternated with back shu points: xin shu BL-15, gan shu BL-18, shen shu BL-23, shen tang BL-44, BL-44, and hun men BL-47 (the most reactive points being needled). needled).
In the follow-up sessions, the stomach yin was supplemented as well with: Zhong wan CV-12, zu san li ST-36, chong yang ST-42, and yang chi TB-4, with the addition of shan ju shu ST-37 and xia ju shu ST-39 to help with the production of fluids and the lubrication of the intestines (the points ST-36, ST-37, and ST-39 were palpated and needled on the more reactive side). ●
The patient was followed for a total of 10 sessions over 5 months. His sleep was satisfactory, with no more more palpi palpitat tation ions, s, and his bowe bowell move movemen ments ts became regular providing he did not indulge in greasy and fried foods or alcohol. He was still prone to stress, which disrupted his sleep, but only for a night or two. Insomnia Case 9: Spleen Qi Spleen Qi Vacuity Vacuity with Dampness
A 44-year-old man had suffered from insomnia for over 6 months. He claimed that he had not slept at all for the past 2 months. His sleep was analyzed for two nights in a sleep laboratory, which showed showed that he actually did sleep for 4 –5 hours, but quite superficially, waking frequently. He was slightly overweight, complained of bloating and tiredness after after eatin eating, g, and had soft soft stools stools,, spont spontan aneou eouss sweating, and two nocturia episodes per night. His tongue was swollen with a greasy coating. His pulses were weak and empty on both guan (spleen and liver) positions, as well as the left chi (kidney) position. The xi points were not reactive. Analysis. This is obviously a disturbance of the quality (depth) of sleep, even though the wei mai does not seem to be affected. The spleen qi vacuity is the main pattern. The treatment aims at supplementing: spleen qi, and heart qi and blood, and liver blood and kidney qi. The treatment involved: San yin jiao SP-6 Shen men HT-7 (EX-HN-1) Yin tang , alternated with si shen cong (EX-HN-1) ● ● ●
●
All of the above points were alternated with the following points: – Pi shu BL-20, xin shu BL-15, and gan shu BL BL 18 (for superficial sleep) – Shen shu BL-23 and fu liu KI-7
After four sessions, the patient seemed to be sleeping better, although the tiredness and the spleen patterns were still present: Zhong wan CV-12, san yin jiao SP-6, da du SP-2, gong sun SP-4, and zu san li ST-36 were alternated with the following; Fu liu KI-7, zhu bin KI-9, and shu fu KI-27.
●
The treatment continued for a total of 10 sessions. The patient’s sleep and other symptoms improved only partially. Insomnia Case 10: Liver Blood Vacuity
A 47-year-old woman had suffered from insomnia for 1 year, with frequent waking, restless sleep, jerking during the night, periods of staying awake awake with mental agitation, worry, and obsessive obsessive thinking; she was very tired upon waking. She also complained of premenstrual migraine headaches, episodes of dizziness, blurred vision, and reduced night vision, a tendency to palpitations, muscle cramps, and some paresthesia of the extremities. Recently, she had also had night sweating and loss of hair. Her tongue was pale and dry with a peeled coating and cracks in the center, and some red spots on the sides. The pulses were weak and thin in all of the deep positions, especially on the left side. Zhu bin KI-9 was most reactive on both sides. Analysis. A typical liver blood vacuity pattern affecting the sinews, but also a heart blood vacuity pattern with mental agitation. The patient ’s age and the recent night sweating were suggestive of a declining kidney yin. I mostly selected jue yin and points for this patient: shao yang points Nei guan PC-6 (on the right) and gong sun SP-4 (on the left) LR-3 (on the right), qu quan LR-8 (on Tai chong LR-3 the right) (to supplement liver blood), together ling PC-7 (on the left) (to quiet the with da ling shen) San yin jiao SP-6 to support blood and yin point to help relax Wan gu GB-12 (shao yang point the mind and body), or yi ming (EX-HN-54). (EX-HN-54). ●
●
● ●
59
60
3 Insomnia
● ●
●
TB-23 (for the jerking at night) Si zhu kong TB-23 All of the above points were alternated with ge shu BL-17, gan shu BL-18, pi shu BL-20, shen shu BL-23, xin shu BL-15, and gao huang shu BL-43 (the most reactive points being needled) to support blood production and supplement liver and heart blood; yi she BL-49 was used for worry. Additionally: da du SP-2 or shang qiu SP-5 was used for obsessive obsessive thinking.
The patient was treated for a total of seven sessions over 2 months. Her sleep improved greatly and became deeper; she had no more palpitations or headaches. However, However, her pulses remained weak and the tongue still pale. She was given dietary advice and herbal supplements for the blood. Insomnia Case 11: Nightmares, Liver Fire
A 30-year-old woman consulted me for intense premenstrua premenstruall syndrome syndrome with lower lower abdominal abdominal pain pain and and cram cramps ps,, breas breastt dist disten ensi sion on and and pain pain,, strong migraine headaches in the temporoparietal region region,, mostl mostlyy on the left left side, side, irritab irritabilility ity and moodiness for a week before her periods. Her period lasted for 5 days with abundant and scarletcolored blood. Her sleep was generally bad, with many nightmares, with themes of aggression, and she woke up frequently, often with palpitations. However, However, her sleep got even worse during the premenstrual phase. She showed a tendency to constipation with dry stools or goat pellets and frequent genital herpes. She had a propensity to be impatient, accompanied by bursts of anger. Her tongue was red with redder sides, and her pulses were wiry and rapid in general. She was a wood type with a jue yin personality. Palpation revealed tai chong LR-3 strong strong reactivity reactivity of tai LR-3 and qi men LR-14. Analysis. All the elements point to an exuberant liver yang from liver qi stasis. In regard to the amount of liver heat, I inquired about lifestyle and diet. She liked to stay up late, had dinner quite late when her husband came home, and mostly ate red meat and drank wine at night. Tai chong LR-3 LR-3 (on the right), da ling PC-7 PC-7 (on the left), and qi men LR-14 (on the right) were used to harmonize the liver. PC-8 Xing jian LR-2 (on the left) and lao gong PC-8 (on the right) were used to reduce liver heat. ●
●
● ●
●
CV-18, knot of jue Yu tang CV-18, jue yin (for palpitations) Ben shen shen GB-13 with shen shen ting GV-24 were used to settle the mind (nightmares). The patient was advised not to eat red meat.
I saw her a week later: she had had no nightmares, and her sleep was less agitated. After this, she was treated twice per month in mid-cycle and in the premenstrual phase. After 3 months, she was having deep and peaceful sleep, with no more premenstrual headaches, and was much less tense. She was also advised to exercise regularly. Insomnia Case 12: Sleep-walking, Stomach Fire
An 8-year-old boy had been diagnosed with attention deficit disorder and hyperactivity. He had a strong constitution, was quite restless, and had a clammy body. He had a tendency to catch colds easil easilyy and had had many many course coursess of antibi antibioti otics, cs, especially in his earlier years. He had restless sleep with episodes of sleep-walking and sleep-talking. He was quite tired in the mornings, with halitosis, had little appetite, was constipated with frequent belly aches, and sweated easily. His tongue had a yellow yellow coating, with reddish spots along along the surface. Analysis. There was an obvious stomach heat pattern (restless sleep, halitosis, no appetite in the morning, constipation), with an underlying qi deficiency ciency (spont (spontane aneou ouss sweat sweating ing,, a propen propensity sity to catch colds). There was most probably residual heat (tongue spots) in the yang ming . The following ing poin points ts were were stimu stimula late tedd with with an infr infrar ared ed (670nm) 40mW laser for 10 seconds each: In the first two sessions tian shu ST-25, zu san li ST-36, shang ju xu ST-37, xia ju shu ST-39, and zhi gou TB-6 to clear heat from the yang ming In the third session yin bai SP-1, li dui ST-45, shen shen men HT-7 and an mien mien (EX-HN-54 (EX-HN-54)) to calm the mind and settle the shen The following sessions aimed at harmonizing the center using zhong wan CV-12, jian li CV11, and xia wan CV-10, with zu san li ST-36, da du SP-2, and tai bai SP-3. All of the above points were alternated with zhong wan CV-12 with zu san li ST-36, followed by shang wan CV-13 with nei guan PC-6, followed by xia wan CV-10 and tian shu ST-25, followed by qi hai CV-6 to strengthen the center and the production of post-heaven post-heaven qi. ●
●
●
●
Case Studies
●
The boy’s mother was instructed to moxa zu san li ST-36 for 7 days around the new moon every month to build up the ying qi and wei qi.
The patient’s sleeping problem resolved rapidly, and and the the stom stomac achh heat heat subs subsid ided ed afte afterr the the first first month. I saw the child a few months later; he had not been sick and seemed more calm and attentive, he had regular bowel movements, and his appetite was good. Insomnia Case 13: Waking Early, Insomnia
A 50-y 50-yea earr-old -old woma woman, n, prem premen enop opau ausa sal,l, comcomplained plained of recent recent terminalterminal-stag stagee insomnia insomnia:: she was waking up too early, often in a bad mood, feeling tired but unable to go back to sleep. She occasionally also had hot flashes and sweating when she woke in the morning. Her tongue had a reddish tip. Her pulses were rapid, slightly thin, and weak in the left guan and chi (liver and kidney) positions. All the xi points of the four extraordinary vessels were reactive, as were most of the points around her ankles. Analysis. The quality of the sleep ( wei mai) was disturbed; the terminal phase corresponds to the shao yin channel. The following points were used: Zhu bin KI-9 (bilaterally; starting point of yin wei and shao shao yin point), fu liu liu KI-7 (on the right), yin xi HT-6 (on the left; for night sweating), shen men HT-7 (on the right; to calm shen), and yu zhong KI-26 KI-26 (for waking in a bad mood) ●
Two sessio sessions ns were were suffici sufficient ent to normal normalize ize the patient’s sleep. She was seen 6 months later to further treat her recurring menopausal symptoms, but her sleep remained satisfactory. Insomnia Case 14: Enuresis, Night Frights, and Insomnia
A 10-year-old boy had been bed-wetting due to very deep sleep. His parents had tried everything; the mother had to resort to a “ bed-wetting alarm,” which often woke her up at least twice a night but not the child. In his history, he and his twin sister had had been been born born prem premat atur urel elyy. His His pare parent ntss had had recently separated. He had allergic asthma triggered by animal hair, but was otherwise healthy and not prone to colds, and he had no digestive
problems. The boy showed difficulty falling asleep, taking between 30 and 60 minutes to do so. His mind was quiet and clear, but then his sleep was very deep and often his mother had difficulty waking him up in the middle or at the end of the night. He also presented with night terrors, or fearful dream dreams, s, alway alwayss before before midni midnight ght and often often not remembering the topic of the dream. He was often tired in the mornings. His tongue was normal and his pulses tight on the left middle guan (liver) and knotted on the left chi (kidney) positions. He had quite dark circles under his eyes, appeared quite sharp and present, and seemed not to be fearful. His mother even said that he had a daring and risk-taking character. The diffi difficu cult lt and and prem premat atur uree birth birth Analysis. The could suggest a kidney jing weakness, although there was no evidence of growth or mental retardation. A kidney qi or yang or or jing vacuity might explain the enuresis. The yang vacuity was also consistent with the very deep sleep, and a kidney jing weakness (knotted pulse) may have derived from liver blood vacuity causing the nightmares and the night terrors. In the absence of other clinical symptoms, I selected this last hypothesis. The boy’s daring nature defied the kidney deficient pattern, but could have been a contraphobic attitude. The initial stage insomnia would also fit the shao yin pattern ( yin qiao mai). In the first session, I used shen shu BL-23, zhi shi BL-52 (reduced to release fear and excessive willpower), fu liu KI-7 (on the left; for astringing the urine), shen men HT-7 (on the right), and bai hui GV-20. During the following week, there were fewer nightmares and no enuresis but still one episode of nocturia: gong sun SP-4 (on the left; chong chong mai was treated to address the birth trauma trauma and help uphol upholdd the spleen spleen qi), tai LR-3 (on the right), qu quan LR-8 (on the chong LR-3 right; for liver blood), bai hui GV-20, and jian shi PC-5 (on the left; for night terrors). His sleep became less heavy, although he still had an occasional single episode of nocturia, and he was still taking 30 minutes to get to sleep. The following points were used: fu liu KI-7 (on the left), zhao hai KI-6 (on the right), shen men HT-7, guan yuan CV-4 (to support the kidney and for night terrors), si shen cong (EX (EXHN-1), KI-1 (with the laser, to settle the shen and help with night frights). ●
●
●
61
62
3 Insomnia
The boy was later seen twice in 2-week intervals. The enuresis and night frights had stopped, his sleep was lighter, and he was waking up rested.
●
Insomnia Case 15: Nightmares, Sleep-walking, Sleep-talking
An 11-year-old 11-year-old girl had had episodes of nightmares, somnambulism, and night-talking. She was falling asleep very rapidly, had agitated sleep with night sweating, especially of her hands, and was waking up in a bad mood. She was very anxious and insecure, and did not like to be touched. She showed thoracic, throat, and epigastric tightness. The girl had a tendency to muscle cramps, and was in general quite stiff. She had been born prematurely with neonatal jaundice, but there were otherwise no other health issues in her history. Her tongue was peeled peeled at the front with many red spots, spots, and a thin coating coating at the base. Her pulses were weak and thin in the left cun and chi (heart and kidney) positions and tight in the guan (liver) position. Heart hea heat (fire fire)) from from hea heart yin Analysis. Hea vacuity could have been causing the restlessness, agitation, and nightmares with sleep-walking and sleep-talking. This was consistent with the findings in the tongue and pulses, although the girl was falling asleep rapidly. rapidly. The root r oot of this could be the kidney yin vacuity (pulse and tongue). However, liver blood vacuity with qi stasis could also have been causing the nightmares and agitation, and was consistent with her history and the other symptoms. In the first session, I used tai chong LR-3 LR-3 (on the right), qu quan LR-8 (on the right), san yin jiao SP-6 (liver blood), qi men LR-14 (on the right; to move liver qi); an mien (EX-HN-54) (for sleepwalking), ben shen GB-13, and shen ting GV-24 GV-24 (for nightmares). In the second session, I used gan shu BL-18, pi shu BL-20, ge shu BL-17, shen shu BL-23, and hun men BL-47, as well as an mien (EX-HN-54). ●
●
The girl had no more nightmares and did not sleep-walk, but she still talked in her sleep. The following points were used: Zhu bin KI-9 (on the right), tai xi KI-3 (on the right), shen men HT-7, and yu zhong KI-26 KI-26 (for waking in a bad mood) After this, there was no more sleep-talking. A final treatment addressed her birth trauma: ●
Gong sun SP-4 (on the right); nei guan PC-6 (on the left): here chong mai is used to harmonize blood and qi and to release perinatal issues; yin wei to move liver and chest qi, and to improve the quality of sleep, tai chong LR-3 LR-3 (on the left); CV-18 (knot of jue yu tang CV-18 jue yin, for chest oppresfang ST-1 sion), sion), and ku fang ST-144 (not (not liki liking ng to be
touched). Insomnia Case 16: Snoring, Sleep Apnea
A 70-year-old patient had been diagnosed with obstructive sleep apnea (OSA) and instructed to use a continuous positive airway pressure (CPAP) device during the night. He had a history of snoring with frequent waking, needing 8–9 hours of sleep, and felt tired in the morning. His sleep and daytime tiredness had greatly improved since he had been using the CPAP device. He had a tendency to catch colds easily, which sometimes evolved into bronchitis, and he had smoked up until 10 years previously. Otherwise, he was healthy, with a tendency to some some bloa bloati ting ng and and tired tiredne ness ss afte afterr meal meals. s. His His bowels were regular. His tongue was large with a slightly sticky coating. His pulses were strong and slippery in the right guan (spleen) position. Constitutionally, he was metal and earth, with a yang ming temperament. temperament. Analysis. The OSA suggested that the wei qi was having difficulty returning inward. The obstruction at the nose or the throat would also have been causing the snoring, and obstruction at the chest could have been causing the apnea. Phlegm, the most common cause of sleep apnea, was not really present; the patient was not overweight overweight and did not have other phlegm symptoms. Therefore, I chos chosee to work work on the the obst obstruc ructio tionn at diff differe erent nt levels: shen mai mai BL-62 For the nasal nasal obstruc obstructio tion: n: shen (reduced), yin tang (EX-HN-3), (EX-HN-3), ying xiang LI-20, LI-20, and pian li LI-6 (luo connecting point affecting the nose, throat, and chest) For the throat obstruction: tian ding LI-17, LI-17, lian chuan CV-23, que pen ST-12, and zhong fu LU-1. These points were alternated with: fu tu LI-18 and yun men LU-2 (both to regulate the move wei qi and ying qi). ments of wei For the chest obstruction: ge shu BL-17 and gao huang shu BL-43, zong hui TB-7; jian shi PC-5 ●
●
●
Case Studies
●
●
●
(also to clear phlegm from the throat), yin bai SP-1 (for chest oppression), and shan zhong CV CV17. In all cases, nei guan PC-6 was regularly treated to open yin wei mai to help the quality of sleep and as a luo to open the chest. Occasionally, Occasionally, this was combined with gong sun SP-4 and other local chest points such as bu lang KI-22 KI-22 (chong mai confluent point to support the lung), yu KI-26 with zhong zhu KI-15 to help the zhong KI-26 inward movement of the yin, and to help qi return to the kidney. These points were alternated with qi xue KI-13 and qu gu CV-2 (to fortify the kidney and help reception of lung qi). tai yin yin points Other tai points were regularly regularly treated, treated, including yin bai SP-1, da du SP-2, shang qiu SP-5 (for dampness); zhong fu LU-1, yun men LU-2, lie que LU-7 (to rectify lung qi), and feng long ST-40 ST-40 (to resolve dampness in the chest). Once in a while the back shu points were used: fei shu BL-13, pi shu BL-20, shen shu BL-23, ge shu BL-17, gao huang shu BL-43, and shen zhu GV-12 (to support lung qi).
bluish, with a greasy coating at the base. His pulses were rather slow and deep, being very weak in both chi (kidney) positions. He had a water type constitution with a shao yin temperament. Analysis. The local obstruction of the patient ’s throat and chest appear to have been aggravated by the accumulation of damp phlegm in the chest. I considered the root cause to be kidney vacuity, especially of kidney yang , with deficiency of the digestive fire and accumulation of phlegm. The kidneys were also not able to receive and hold lung qi. The panic attacks and anxiety indicated chong mai and yin wei, with the emphathe use of chong sis on the shao yin. In the first session, I used nei guan PC-6 (on the left) coupled with gong sun SP-4 (on the right), zhu bin KI-9; lian chuan CV-23 (knot of shao yin), fu liu KI-7 (on the left), and shen men HT-7 (on the right). In the second session, I used gong sun SP-4 (on the left), nei guan PC-6 (on the right); tai chong LR-3 (on the right), jian shi PC-5 (on the left), shan zhong CV-17, CV-17, and shen cang KI-23. KI-23. In the following session, I employed fei shu BL BL 13, pi shu BL-20, shen shu BL-23, ge shu BL-17, gao huang shu BL-43, zhi shi BL-52, and ming men GV-4 GV-4 (the (the most most reac reacti tive ve poin points ts bein beingg needled). The treatme treatments nts altern alternat ated ed between between openin openingg the chest, supporting the kidney yang and qi and the spleen. The patient was also instructed in better sleep hygiene. His diet was modified to reduce reduce food overl overloa oadd at night night,, to reduce reduce dampdamp- and phlegm phlegm-pr -produ oducin cingg foods foods,, and and to avoid alcohol, especially in the evening. ●
●
●
Over Overal all,l, I saw saw the the pati patien entt over a peri period od of 6 months, first on a weekly basis and later twice a month. He was able to sleep most nights without using his CPAP device, although he still used the device when he had had a heavier meal or when he was traveling and staying in hotels. Insomnia Case 17: Sleep Apnea, Snoring
A 60-year-old patient had had a long history of very heavy snoring after an episode of laryngitis some 30 years ago. He had been frequently and suddenly waking in a state of panic during the night. His wife had noticed a strange breathing patter pattern, n, which which after after analy analysis sis was was diagno diagnosed sed as OSA. He was given a CPAP device to use. After a few months of trying the device, he found it very awkward and handicapping. In his history, there were many episodes of upper respiratory and lung infections. In general, he was in delicate health, slightly overweight, with a history of recurring lumbar pains and two episodes of nocturia per night. He often had a puffy face upon waking. The patient looked much older than his age, and complained of frequent anxiety and fear, with frequent panic attacks. The tongue was swollen and slightly
●
After 3 months of treatment, the patient ’s overall health had greatly improved. He had no more panic attacks, was less anxious in general, and only had one nocturia episode per night. He was able to do without the CPAP device most of the time. However, his snoring remained unchanged. Insomnia Case 18: Night Terrors
A 4-year-old child had been having night terrors for 6 months, involving up to 15 episodes of waking up crying during the night. It turned out that the terrors started shortly shortly after he had witnessed witnessed an intense argument between his mother and her
63
64
3 Insomnia
parents. He was otherwise healthy, and had an average appetite and regular bowel movements. He sweated during the night, and had recently been rather listless. Analysis. The usual patterns that cause night terrors or nightmares appeared to be absent. The emotional impact of seeing his mother and grandparents fighting had been a strong enough shock to cause this deep insecurity. The treatment was aimed at releasing this emotional shock. During the first session, I used ku fang ST-14, ST-14, shao hai HT-3 (on the left), shen men HT-7 (on the right), shen mai BL-62 (on the left), and jian shi PC-5. The seven points were stimulated with a 40mW infrared laser for 10 seconds each. The boy was seen a week later. He had had only two episodes of night terror during the whole ku fang ST-14, week. Treatment of ku ST-14, shao hai HT-3, shen men HT-7, and jian shi PC-5 was repeated one more time. The mother was instructed to call back a week later to report on his sleep. He had no more night terrors or nightmares after that. Insomnia Case 19: Insomnia from Fear, Shao Fear, Shao Yin
A 10-year-old girl had been having difficulty falling asleep since her infancy. infancy. She would be wide awake and take up to 1 –1.5 hours to fall asleep. There was no physical restlessness, she often read to fall asleep, and she disliked the dark, and had to have a small light on in her room. She had one nocturia episode per night, hot extremities, and was generally nervous, quite anxious, and fearful. She tended to be tired, but otherwise had no other revealing symptoms. Her tongue was reddish at the tip. In her history, her birth had been difficult during which she almost died. Most pertinent of all, when she was 10 months old, her mother ’s sister had lost her child to sudden infant death syndrome (SIDS), which had, of course, totally shocked the whole family. The girl ’s mother started dropping
in on her child regularly and all through the night, at which time the girl’s insomnia began. Analysis. The girl’s sleep was very obviously disturbed in its temporal aspect ( yin qiao mai) and in the initial phase; which is suggestive of a disturbance of the shao channel. Although Although there shao yin channel. were not many symptoms to go by, there were, however, a few indications of a kidney qi or particularly yin vacuity, with some heart heat. The difficult birth affected the chong mai and the kidneys. The emotional shock, although she was only an infant, had obviously had a great impact on her. The initial treatment aimed at regulating the yin qiao by supplementing zhao hai KI-6 (on the right), and reducing shen mai BL-62 (on the left); yin tang was was stimulated, shen men HT-7 (on the left) reduced, and fu liu KI-7 (on the right) supplemented. At this point, the girl began to fall asleep more easily and had no more episodes of nocturia. The follow-up sessions aimed at releasing the shock and supporting chong mai and the kidneys using: – Shen mai BL-62, xiao hai HT-3, and ku fang ST-14 (to release the shock pattern) – Gong sun SP-4 (on the right), nei guan PC-6, shen shen feng feng KI-23, cang KI-25 (for KI-23, and shen cang insomnia and anxiety), with bai hui GV-20 – Xin shu BL-15 and shen shu BL-23 were both supplemented, zhi shi BL-52 was reduced, BL-44 stimulated. shen tang BL-44 ●
●
The patient was seen five times, on a weekly basis, and her sleep became normal. Over the next 2 years, she was seen several times when this pattern recurred whenever she experienced stress or a change in her life. Usually, one or two sessions were sufficient to regulate her sleep, although she still easily became anxious. More consistent treatment of the shao yin axis and the kidneys was felt to be advisable.
65
4 Oth Other er Sl Slee eep p Pa Path tholo ologi gies es
Somnolence— Shi Shui 嗜睡 Explanation and Discussion
Somnolence, defined as a predilection for sleep, varies from mild drowsiness drowsiness or a desire to sleep, to a condition known as narcolepsy, in which the individual constantly falls asleep. This condition may or may not be associated with difficulty sleeping at nighttime or with conditions in which sleep is not deep enough. In general, somnolence is due to an accumulation of yin yin in the upper body and in the head. The yin repletion is most often the result of an accumulation of dampness in the upper body parts, which prevents the rising of the clear yang of the stomach. This pattern involves the organs that process fluids and may produce dampness: the lung, spleen, and kidney (specific points such as chi ze LU-5, shang qiu SP-5, and da chong KI-4), KI-4), and the triple burner (san jiao) system in general. Specifically, as arm yang channels channels distribute fluids to the orifices and help open them, points such as san yang luo TB-8 (Meeting of the Three Yang ) or tian jing TB-10 TB-10 are indicated. Er jian LI-2 and san jian
LI-3 are also traditionally indicated for somnolence. The yin repletion could either be due to a repletion in the yin qiao mai ( yin motility vessel) with its symptom described as “the eyes cannot open, somnolence,” or due to vacuity in the yang qiao mai, with the symptom of “daytime lassitude and sleepiness” (Ling Shu, Chapter 21). As was explored in Chapter 3, palpation of the respective xi (cleft) points ( jiao xin KI-8 and fu yang BL-59) BL-59) helps to differentiate which channel is involved. Yin accumulation may also result from blood stasis, mainly involving the liver. This blood stasis could be a consequence of the sequelae of internal wind, causing a cerebrovascular accident, but can also be post-traumatic, occurring after concussion or very frequentl frequentlyy follow following ing whiplash whiplash injuries. injuries. Some severe feverish diseases, such as meningitis or Lyme disease, can also produce similar conditions in which local stasis of phlegm or blood prevents the clear yang from from ascending to the head.
The inability of yang to to ascend is not only due to an accumu accumula latio tionn of yin in the the uppe upperr body body,, phlegm obstruction, or blood stasis, but can also be the consequence of yang deficiency, deficiency, as in kidney yang vacuity vacuity patterns. In practice, I have very often noticed a combination of factors, for example a kidney and spleen vacuity, in which the ascent of yang to the yang vacuity, head is further hampered by phlegm blocking the orifices. With reference to the combination of factors mentioned above, it is also interesting to consider the jing bie (divergent channels) and the Window of the Sky points, in particular: Jing bie of the stomach and spleen ( qi chong chong ST-30 and chong men SP-12), whose function is to carry clear yang and and fluids f luids to the head (especially the eyes). The points are used together with ren ying ST-9, ST-9, as a Window of the Sky point, which brings yang to to the head with the help of bai BL-1. bai hui GV-20 via jing ming BL-1. Jing bie of the lung and large intestine ( jian yu LI-15 and zhong fu LU-1) with tian ding LI-17, LI-17, which brings yang to to the head, and fu tu LI-18, which helps bring wei qi (defensive qi) to the surface There are also two Window of the Sky (or Window of Heaven) points that regulate the movements of blood and qi to and from the head: – Tian fu LU-3, for forgetfulness and cerebral congestion – Tian chi PC-1, for headaches, blurred vision, and psychotic episodes Some classical point indications for sleepiness are: – Er jian LI-2: tendency to fall asleep – Li dui ST-45: excessive dreaming or sleepiness – Jing ming BL-1: BL-1: insomnia or sleepiness (regulates the qiao mai) – Shen Shen mai mai BL-62: somno somnolen lence ce (shoul (shouldd be supplemented) – Ri yue GB-24: somnolence – San jian LI-3: likes to lie down – Shou wu li LI-13: likes to lie down ●
●
●
●
66
4 Other Sleep Pathologies
Patterns and Treatment Phlegm Misting the Mind Symptoms ● ● ● ● ● ●
● ●
Sleepiness after meals, the head feels muzzy Dizziness Feeling of heaviness; chest oppression Blurred vision Copious sputum; nausea Snoring (sleep apnea is quite common in these cases) Tongue: swollen with a sticky coating Pulse: slippery
Spleen Qi Spleen Qi Vacuity Symptoms ● ● ● ● ● ● ●
●
Sleepiness; mental and physical asthenia Often following a stroke episode Heaviness Heaviness of the limbs Lack of appetite, appetite, bloating, soft stools Spontaneous sweating Dull or pale complexion Tongue: swollen with tooth marks, white sticky coating Pulse: Pulse: weak weak or empty
Treatment Treatment
Resol Resolve ve phlegm phlegm,, supple supplemen mentt the stoma stomach ch and spleen, and open the orifices: zhong wan CV-12, pi shu BL-20, san jiao shu BL-22, zu san li ST-36, feng ST-40, tou wei ST-8, san yin jiao SP-6, shui fen long ST-40, CV-9; san yang luo TB-8 (helps open the orifices), tian jing TB-10, chi ze LU-5, shang qiu SP-5 (for those who need to sleep all the time), da chong KI-4 (for those who can sleep anytime), zhao hai KI-6 ( yin qiao mai).
Supplement the spleen and stomach, and supplement qi: zhong wan CV-12, pi shu BL-20, san jiao shu BL-22, zu san li ST-36, tou wei ST-8, bai hui GV-20, tai bai SP-3, shang qiu SP-5, san yang luo TB-8, er jian LI-2, san jian LI-3; also li dui ST-4 with yin bai SP-1 or da du SP-2. Heart and Spleen Qi Spleen Qi Vacuity Vacuity Symptoms ●
Blood Stasis in the Upper Body, with Possible Underlying Blood Vacuity Symptoms ●
●
●
● ● ● ●
Sleepiness, lack of concentration, loss of memory Often following a stroke episode or a trauma (whiplash) May May be associ associate atedd with with agita agitated ted night nighttim timee sleep Abdominal masses, painful periods Headaches, chest pain (angina) Tongue: purple, or purple spots Pulse: wiry or choppy
Treatment
Regulate blood and move liver qi: ge shu BL-17, yin LR-3, he lian LR-11, da dun LR-1 (moxa), tai chong LR-3, gu LI-4, gan shu BL-18, gao huang shu BL-43, xue hai SP-10, bai hui GV-20, tian chi PC-1, tian fu LU-3.
● ● ● ● ●
●
Sleepiness, fatigue, weakness Palpitations, Palpitations, shortness of breath Lack of appetite, appetite, bloating, soft stools Forgetfulness Dull or pale complexion Tongue: swollen, pale with tooth marks, thin white coating Pulse: Pulse: weak weak or fine
Treatment
Supplement the spleen and heart qi: zhong wan CV-12, pi shu BL-20, san jiao shu BL-22, xin shu BL-15, zu san li ST-36, san yin jiao SP-6, bai hui GV-20, xin hui GV-22, shen mai BL-62, er jian LI-2, san jian LI-3; also li dui ST-45 with da du SP-2. Kidney Yang Kidney Yang Vacuity Vacuity Symptoms ● ●
● ● ● ● ●
Sleepiness, Sleepiness , apathy, mental fatigue Maybe episodes of sleep-walking; exhaustion upon waking Forgetfulness Lack of willpower, willpower, depression depression Dislike of cold Lumbar pains, worse with cold Tinnitus
Somnambulism/Sleep-walking— Meng Meng You 梦游
● ● ●
Frequent urination, edema Tongue: swollen, pale or bluish Pulse: weak and slow
Treatment Warm yang , supplement qi, supplement kidney yang , and support the ascent of yang : shen shu BL-23, zhi shi BL-52, pi shu BL-20, ming men GV-4, tai xi KI-3, feng fu GV-16, bai hui GV-20, xin hui GV-22, shen mai BL-62, ju gu LI-16, er jian LI-2, san jian LI-3.
Somnambulism/Sleep-walking— Meng You 梦游 Explanation
Somnambulism, or sleep-walking, is a parasomnia (sleep disorder) during which the sufferer engages in activities normally associated with wakefulness while asleep or in a sleeplike state. Individuals are not completely unconscious while sleep-walking, but they have no memory of the sleep-walking episode. Sleep-walking is more commonly experienced in people with high levels of stress, anxiety, or psychological factors. A common misconception is that sleep-walking sleep-walking occurs as part of a dream. However, sleep-walking in fact takes place earlier in the sleep cycle, during slow-wave sleep (SWS; Stage 3 or 4, N2 sleep) (Horne 1988). The proper term applied to those who “act out” their dream is “REM (rapid eye movement) behavior disorder.” As children and young adults have a higher proportion of SWS (up to 80% of the night), they are more likely to have episodes of somnambulism than older individuals. Most cases of somnambulism occur when the person is “awakened” or disturbed during their SWS. They may get up and engage in some activity, with their eyes open, and they they may may even even respon respondd to quest question ions, s, but they they usually go back to sleep if not awakened. A more recent study by Arnulf (Oudiette et al. 2009) reported that, in 71% of participants, short, unpleasant, dreamlike mental activity occurs during sleep-walking and sleep terror episodes, suggesting that people with these sleep disorders may be acting out the last part of a previous longer dream. Individuals who sleep-walk and have sleep
terrors reported more severe daytime sleepiness and had woken from SWS four times as frequently. From From a Chine Chinese se medicin medicinee perspe perspectiv ctive, e, sleepsleepwalking can be explained as a partial disconnection of the shen during which hun (ethereal soul) and po (corporeal soul) take over (see Chapter 2). 2). In this case, the hun directs muscular m uscular activity. The wandering of the hun can be regarded as the liver releasing its internal wind or the emotions, which normally manifests as anxiety dreams or even nightmares. This may explain why, in adults, somnambulism is more common in stressed individuals. This shows the import importanc ancee of explori exploring ng and treatin treatingg points points such as hun men BL-47 or shen tang BL-44, BL-44, and in all cases treating shen men HT-7 to calm the shen. All the usual factors that contribute to unsettling the hun and the shen, such as blood vacuity, or blood heat, especially from liver qi stasis and liver fire, contribute to sleep-walking. Points that help the blood and wei qi to return to the liver are therefore indicated: qu quan LR-8 and yang ling quan GB-34. From a synchronizer point of view, the treatment pattern can be refined by palpating the xicleft points of the four extraordinary vessels: Jiao xin KI-8 on the yin qiao mai ( yin motility vessel) BL-59 on the yang qiao mai ( yang moti motiFu yang BL-59 lity vessel) Zhu bin KI-9 on the yin wei mai ( yin linking vessel) Yang jiao GB-35 on the yang wei mai ( yang link linking vessel) ●
●
●
●
In this case, yang jiao GB-35 is the point of choice, as it helps to relax the sinews. However, sleep-walking may also be a reaction to dreams of confinement and fear that are experienced as nightmares. Hence the kidneys are involved, as in kidney yang vacuity, vacuity, with the person waking up extremely tired. Two classical points have been described for sleep-walking: an mien I EX-HN-52 and an mien II EX-HN-53 (see Chapter 3). See also Chapter 3, Cases 6, 12, and 15.
67
68
4 Other Sleep Pathologies
Patterns and Treatments Heart Blood Vacuity
● ● ●
Symptoms ● ● ● ● ● ●
● ●
Difficulty falling asleep Anxiety, restless sleep, frequent waking Dreams, nightmares, nightmares, dreams dreams of flying Occasional sleep-walking, aggravated by fatigue Palpitations, Palpitations, dizziness, blurred vision Poor memory, problems concentrating, feeling spaced out Tongue and face: pale Pulse: choppy or weak
Treatment
Invigorate blood, supplement heart blood, quiet and settle the shen: shen men HT-7, xin shu BL-15, gan shu BL-18, shen tang BL-44, BL-44, hun men BL-47, KI gao huang shu BL-43, ju que CV-14, shen feng KI23, ling xu KI-24, hou ding GV-19, GV-19, san yin jiao SP-6, pi shu BL-20, ge shu BL-17, zu san li ST-36, yin tang EX-HN-3.
● ●
Treatment
Extinguish liver fire, clear heat, subdue wind, setxing jian LR-2, xia xia xi tle the shen and the hun: xing GB-43, nei ting ST-44, ST-44, wan gu GB-12 or an mien EX-HN-54, feng chi GB-20, gan shu BL-18, hun men BL-47, bai hui GV-20, either ben shen GB-13 or tou GV-24; also treat the lin qi GB-15, and shen ting GV-24; kidney. Phlegm Fire Harassing the Mind Symptoms ● ● ● ●
Liver Blood Vacuity with Liver Qi Liver Qi Stasis Stasis Symptoms ●
● ● ●
● ● ●
Restless sleep, fan (restlessness), waking early, vivid dreams Night-walking aggravated by emotions Internal wind symptoms, eye symptoms Chest oppression, hypochondrial tension, depression Irregular cycles, premenstrual breast distension Tongue: pale sides (possibly with pale red spots) Pulse: choppy or wiry
Headaches Liver symptoms, internal wind Bitter taste, nausea, red face, dark urine, dry stools Tongue: red sides, dry yellow coating Pulse: rapid and wiry
● ● ● ●
Difficulty falling asleep through anxiety Nightmares, dreams of flying, f lying, sleep-walking sleep-walking Mental and emotional agitation Bright eyes, loud voice, daring character Always feeling hot, bitter taste, nausea Tachycardia; Tachycardia; hypertension, heart diseases Tongue: red, red tip, yellow greasy coating Pulse: rapid, overflowing, or slippery
Treatment
Clear fire, transform phlegm and open the orifices, calm and settle the shen: jian shi PC-5, lao gong jue yin yin shu shu BL-14, xin xin shu shu PC-8, shao fu HT-8, jue BL-15, zhong wan CV-12, shui fen CV-9, feng long ST-40, shen men HT-7, shao fu HT-8, ju que CV-14, shen feng KI-23, hou ding GV-19, jiu wei CV-15, jian shi PC-5.
Treatment
Invigorate and supplement liver blood, mobilize liver qui, quiet and settle the shen: gan shu BL-18, pi shu BL-20, ge shu BL-17, shen shu BL-23, qu LR-3, qi quan LR-8, and san yin jiao SP-6; tai chong LR-3, men LR-14, gong sun SP-4; an mien I EX-HN-52 or an mien II EX-HN-53.
Blood Stasis/Heart Blood Stasis Symptoms ● ● ● ●
Liver Fire
● ●
Anxiety when lying down, restless sleep Dream-disturbed sleep, sleep-walking Palpitations Chest pain, angina Tongue: purple, or purple spots Pulse: choppy
Symptoms ●
● ●
Restles Restlesss sleep, sleep, frequent frequent nightma nightmares, res, waking waking early Night-walking, worse during emotional periods Anger, irritability, envy, and jealousy
Treatment
Invigorate Invigorate blood, expel heart hear t blood stasis, move qi, calm the shen: nei guan PC-6, shen men HT-7, tong KI-23, jue yin shu BL-14, xin shu li HT-5, shen feng KI-23,
Sleep-talking— Meng Meng Yi 梦呓
BL-15, ge shu BL-17, xin shu BL-15, gao huang shu BL-43, he gu LI-4, tai chong LR-3. LR-3. Kidney Yang Vacuity, Kidney Yang Vacuity, Accompanied by Heart Yang Heart Yang Vacuity Symptoms ● ● ●
● ● ● ● ● ●
Superficial sleep, insomnia from anxiety Night-walking, waking up exhausted Easily Easily startled, startled, timidity, timidity, indecisiv indecisivenes eness, s, cold with emotions Dislike of cold Lumbar pains, frequent urination Palpitations Palpitations (arrhythmia) Shortness of breath, br eath, fatigue, depression Tongue: pale, bluish Pulse: slow, deep
In Chinese medicine, sleep-talking involves a partial activation of the shen, hence the speaking. Again, any factor contributing to unsettling the shen, especially blood heat, can promote sleeptalking. Points that calm the shen and affect speech, such as shen men HT-7 and tong li HT-5, are indicated for all sleep-talki sleep-talking. ng. Sleep-talki Sleep-talking ng is also sometimes sometimes referred to as gui (ghost) talk. In the Bai Zheng Fu (Ode (Ode of On Onee Hund Hundre redd Patt Pattern erns) s) (Gao (Gao Wu Ming Ming 1529), tian fu LU-3 is indicated for this condition. See also Chapter 3, Case 15. Patterns and Treatments Heart Fire Symptoms
Treatment
Supplement yang of of heart and kidney, calm shen fortify zhi: shen men HT-7, tai xi KI-3, xin shu BL-15, shen shu BL-23, zhi shi BL-52, ju que CV-14, ling xu KI-24, shen cang KI-25, ming men GV-4, da zhui GV-14, bai hui GV-20.
● ● ● ● ● ● ● ●
Sleep-talking— Meng Meng Yi 梦呓 Explanation
Somniloquy, or sleep-talking, is a parasomnia that refers to talking aloud in one ’s sleep. It can range from simple sounds to long speeches, although these are not always comprehensible. Sleep-talking, like sleep-walking, usually occurs during during transi transitory tory arousa arousall from from non-ra non-rapid pid eye eye movement (non-REM) sleep. It may also occur during REM sleep, when there is a breakdown of the normal motor atonia. Sleep-talking can occur on its own or as a feature of another sleep disorder such as: REM behavior disorder Sleep-walking Night terrors (intense fear, screaming, shouting) Sleep-related eating disorder
●
Difficulty falling asleep through anxiety Nightmares, dreams of flying, f lying, sleep-talking Mental and emotional agitation Bright eyes, loud voice, daring character Always feeling hot and thirsty Tachycardia; Tachycardia; hypertension, heart diseases Tongue ulceration; bitter taste Tongue: red, red tip, yellow coating Pulse: rapid, overflowing
Treatment
Clear heart fire, supplement heart yin, quiet and settle shen: shen men HT-7, shao fu HT-8, tong li HT-5, lian quan CV-23, jue yin shu BL-14, xin shu BL-15, shen tang BL-44, BL-44, ju que CV-14, shen feng KI KI23, hou ding GV-19, GV-19, jiu wei CV-15, jian shi PC-5. Blood Stasis / Heart Blood Stasis Symptoms ● ●
●
●
●
●
●
●
Anxiety when lying down, restless sleep Dream-dis Dream-disturbed turbed sleep, sleep, sleep-talki sleep-talking, ng, sleepsleepwalking Palpitations, chest pain, angina Tongue: purple, or purple spots Pulse: choppy
●
Treatment
Sleep-talking is very common in young children (50%), it may persist into adulthood (4% of adults), and it is more frequent during fevers. Polysomnography shows that episodes of sleep-talking may occur during any stage of sleep.
Invigorate Invigorate blood, expel heart blood stasis, move qi , calm the shen: nei guan PC-6, shen men HT-7, tong li HT-5, shen feng KI-23, KI-23, jue yin shu BL-14, xin shu BL-15, ge shu BL-17, xin shu BL-15, gao huang shu BL-43, he gu LI-4, tai chong LR-3. LR-3.
69
70
4 Other Sleep Pathologies
Food Stagnation Symptoms ●
●
● ● ● ●
Restles Restlesss sleep; sleep; frequent frequent dreams, dreams, nightmar nightmares, es, sleep-talking Abdominal distension, burping, nausea, halitosis (bad breath) Greasy skin, acne, red eyes Smelly stools Tongue: yellow greasy coating Pulse: flooding or slippery and rapid
Treatment
Invigorate the stomach, transform phlegm, move food stasis, settle and clear the shen: wei shu BL 21, yin jiao CV-7, zhong wan CV-12, lie que LU-7, jie xi ST-41, zu san li ST-36, tian shu ST-25, liang men ST-21, yin bai SP-1, nei ting ST-44. ST-44.
Sleep Apnea— Shui Mian Hu Xi Zhan Ting Zong He Zheng 睡眠呼吸暂停综合征 Explanation
Sleep apnea is a sleep disorder that is characterized by pauses of at least 10 seconds between breaths during sleep. The episodes occur repeatedly edly throu througho ghout ut sleep sleep and and cause cause one or more more breath breathss to be missed missed.. The condit condition ion result resultss in either either neurologi neurological cal arousal, arousal, blood blood oxygen oxygen desadesaturation (more than 3%–4%), or both arousal and desaturation. Sleep apnea is diagnosed by polysomnography somnography (see Chapter 1). 1). The condition is more frequent in elderly men, and it affects about 6.5% of the population (Young (Young et al. 2002). There are three types of sleep apnea: central, obstructive, and a combination of the two. The most most frequ frequent ent type is obstruc obstructiv tivee sleep sleep apnea apnea (OSA; 84% of cases), during which breathing is interrupted by a physical block to the airflow. The mech mechan anis ism m of cent centra rall apne apneaa (4% (4% of case cases) s) is unkno unknown. wn. The The aggra aggrava vatin tingg factor factorss for for all three three forms of apnea seem to be age, obesity, diabetes, smokin smoking, g, alcoho alcohol,l, muscle muscle relaxa relaxants nts,, and drugs drugs with central respiratory-depressant effects, such as opiat opiates, es, barbitu barbiturat rates, es, benzod benzodia iazep zepin ines, es, and many tranquiliz t ranquilizers. ers. Generally speaking, those with sleep apnea are
rarely aware aware that they are having difficulty breathing. Sleep apnea is usually either witnessed by another person or suspected because of its effects, such as morning fatigue and daytime sleepiness. Other symptoms include loud snoring, restless sleep, sleep, morning morning headaches headaches,, moodines moodiness, s, reduced reduced memory, and sexual dysfunction. There is a 30% increased risk of heart attack (Shah et al. 2007) in patients with OSA, as well as a risk of high blood pressure and stroke. There is even evidence of tissue loss in certain brain regions, particularly the mammillary bodies (Kumar et al. 2008), which could explain the memory loss in patients with OSA. There are only a few studies (Freire et al. 2007, Wang et al. 2009, Xu et al. 2009) that have proved the efficacy of acupuncture in the treatment of OSA (Chapter 6). As always, always, it is important to insist on a personalized treatment. From a Chinese medicine perspective, OSA can be regarded as phlegm obstructing the orifices. This is coherent with the other factors that are present, such as obesity and snoring. From a synchron chronize izerr perspe perspectiv ctive, e, it is mainl mainlyy the qual quality ity rather than the length of sleep that is disturbed in sleep apnea. This would be more suggestive of the yin and yang wei mai ( yin and yang linking linking vessels). If the palpation of zhu bin KI-9 or yang qiao GB-35 reveals sensitivity, this will help in choosing the right treatment strategy: Yin wei mai: nei guan PC-6 with gong sun SP-4; additionally, confluent points such as da heng SP-15 or fu ai SP-16, which help to resolve dampness, or qi men LR-14 to relax the chest, or especially tian tu CV-22 and lian quan CV-23 to relax the throat Yang wei mai: wei guan guan TB-5, possibly with some neck confluent points such as feng fu GV16, ya men GV-15, and feng chi GB-20 ●
●
A blockage in the nasal passages can affect sleep and cause sleep apnea as well as snoring. We have seen in Chapter 2 that the closing of the eyes is the first manifestation of the wei qi moving inward. Relaxing the eyes helps to relax the nose, as manifested in the deeper breathing that occurs when we fall asleep. Jing ming BL-1 BL-1 controls this movement through its connections with the stomach and large intestine channels: ying xiang LI-20 cheng qi ST-1 jing ming BL-1. BL-1. Jing ming BL-1, BL-1, as a major confluent point of yang and yin qiao mai ,
→
→
Sleep Apnea— Shui Shui Mian Hu Xi Zhan Ting Zong Zong He Zheng 睡眠呼吸暂停综合征
can be regulated by shen mai BL-62 or zhao hai KI-6. Reducing BL-62 or supplementing KI-6 helps the patient to sleep and is helpful in sleep apnea. The second area the wei qi has to pass through is the chest. The chest needs to relax and to loosen up to permit the wei qi to further descend to the zang fu (orga (organs) ns).. Relax Relaxing ing the chest chest and diadiaphragm with points such as ge shu BL-17 (relaxes the diaphragm), zong hui TB-7 (helps move wei qi toward the abdomen), jian shi PC-5 (opens the orifices blocked by phlegm and also used for eating disorders), gao huang shu BL-43 (moves blood and helps to relax the chest), shan zhong CV-17 CV-17 (supports zhong, ancestral qi and breathing), as well as classical points such as yin bai SP-1 and li dui ST45. Local points points to help remove the obstruction obstruction to xiang LI-20, bi tong tong the air passages are ying xiang (EX-HN-14), lian quan CV-23, tian tu CV-22, as well as xuan ji CV-21 (helps to relax the chest). In central sleep apnea, points that affect the brain (mostly Window of the Sky points) can be added: feng fu GV-16, ya men GV-15, bai hui GV20, tian zhu BL-10, ren ying ST-9, ST-9, and feng chi GB20. The combination of all the above points can be adde addedd wh when en treat treatin ingg the the patte pattern rnss desc describ ribed ed below. In general, the treatment should aim to reduce phlegm by supporting the spleen, lung, and kidney. Lifestyle and diet (weight reduction) play a very important role in sleep apnea. There is even some evidence for the positive effects of exercising the air passages passages through singing or playing certain wind instruments (Puhan et al. 2006).
Spleen Qi Spleen Qi Vacuity Vacuity Symptoms ● ● ● ● ● ● ●
●
Sleep apnea, frequent snoring Sleepiness after meals, muzziness of the head Chest oppression, heaviness heaviness of the limbs Lack of appetite, appetite, bloating, soft stools Spontaneous sweating Dull or pale complexion Tongue: swollen with tooth marks, white sticky coating Pulse: Pulse: weak weak or empty
Treatment
Supplement the spleen and stomach, supplement qi, and dispel dampness: zhong wan CV-12, pi shu BL-20, san jiao shu BL-22, zu san li ST-36, tou wei ST-8, bai hui GV-20, tai bai SP-3, shang qiu SP-5, san yang luo TB-8, li dui ST-45 with either yin bai SP-1 or da du SP-2. Phlegm Misting the Mind Symptoms ● ●
● ● ● ● ● ● ●
Sleep apnea and snoring Daytime sleepiness; mental and physical asthenia Dizziness, Dizziness, morning headaches Feeling of heaviness; chest oppression Blurred vision Copious sputum; nausea Obesity Tongue: swollen with a sticky coating Pulse: slippery
Treatment
Patterns and Treatments
In practice, as sleep apnea is most frequent in the elderly and often in overweight individuals, it is quite common for several of the following patterns to be found in the same patient, such as spleen and kidney yang vacuity, associated with heart yang vacuity, and complicated by phlegm misting the mind mind and and bloc blocki king ng the the orific orifices es.. Kidn Kidney ey yang vacuity can also lead to vacuity of the Sea of Marrow. In this case, the sleep apnea manifests as or aggra aggrava vate tess a neuroneuro-men mental tal condit condition ion,, such such as amnesia or dementia.
Resol Resolve ve phlegm phlegm,, supple supplemen mentt the stoma stomach ch and spleen, and open the orifices: zhong wan CV-12, pi shu BL-20, san jiao shu BL-22, zu san li ST-36, feng long ST-40, ST-40, tou wei ST-8, jian shi PC-5, san yin jiao SP-6, shui fen CV-9; san yang luo TB-8 (helps open the orifices), tian jing TB-10, TB-10, chi ze LU-5, shang qiu SP-5, da chong KI-4. KI-4. Kidney Yang Kidney Yang and and Spleen Yang Spleen Yang Vacuity Vacuity Symptoms ●
● ●
Sleep apnea, sleepines sleepiness, s, possibly possibly episodes episodes of sleep-walking Exhaustion upon waking, apathy Forgetfulness, Forgetfulness, mental fatigue
71
72
4 Other Sleep Pathologies
● ● ● ●
● ●
Lack of willpower, willpower, depression depression Dislike of cold Lumbar pains, worse with cold Frequent urination, edema, “cock-crow” diarrhea Tongue: swollen, pale or bluish Pulse: weak and slow
Treatment Warm yang , supplement qi, supplement kidney and spleen yang , and support the ascent of yang : shen shu BL-23, zhi shi BL-52, pi shu BL-20, ming men GV-4, tai xi KI-3, gong sun SP-4, feng fu GV-16, bai hui GV-20, xin hui GV-22, shen mai BL-62, ju gu
LI-16.
●
●
●
●
Use local treatment with three to four points to remove obstruction. Only On ly six six to eigh eightt poin points ts shou should ld be need needle ledd when treating every other day. Eight to 12 points may be used when treating once a week. I usually needle unilaterally except for the local points.
The general strategy for transforming dampness and and phlegm phlegm requir requires es attent attentio ionn to diet, diet, herbal herbal remedies, and definitely a change of lifestyle and habits. Although the latter is often difficult to initiate, the improved quality of life observed by the patient becomes an incentive to maintain this new lifestyle.
Blood Stasis Symptoms ● ●
● ● ● ● ●
Consequence Consequence of trauma, stroke, shock, or phlegm Slee Sleepp apne apnea, a, slee sleepi pine ness ss,, ment mental al lass lassit itud ude, e, amnesia May be associated with agitated sleep Headaches, dizziness Chest pain (angina), tumors, painful periods per iods Tongue: purple, or purple spots Pulse: wiry or choppy
Treatment
Regulate blood, and move liver qi: ge shu BL-17, yin lian LR-11, da dun LR-1 (moxa), tai chong LR-3, LR-3, he gu LI-4, gan shu BL-18, gao huang shu BL-43, xue hai SP-10, bai hui GV-20, feng fu GV-16, tian chi PC-1, tian fu LU-3. See also Chapter 3, Cases 16 and 17. Treatment Treatment Strategies
The two main objectives are: To transform dampness and phlegm To remove the local obstructions
● ●
In practic practice, e, frequ frequent ent treatme treatments nts are neces necessary sary,, preferably every other day to begin with, or at least twice a week: If the extraordinary vessels are involved, they can be treated once every 10 days with the key point and possibly the appropriate confluent points. Treat Treat the pattern using one or two points. ●
●
Enuresis and Nocturia— Yi Yi Niao 遗尿 Explanation
Enures Enuresis, is, or bed-w bed-wetti etting ng,, is a paraso parasomni mniaa that that causes sleep disturbance in children. Enuresis can be divided into primary enuresis and secondary enuresis, the latter occurring after a 6-month period of continence. In primary primary enuresis, enuresis, psychol psychologic ogical al problems problems are almost always the result and only rarely the cause of the condition. By contrast, psychological problems—very often the birth of a sibling, family tension, divorce, and so on —are a possible cause of secondary enuresis. I have also observed many cases of secondary enuresis following vaccinations. The emotional impact of enuresis on a child and family can be considerable. Numerous studies report feelings of embarrassment and anxiety in children with enuresis; loss of self-esteem; and effects on self-perception, interpersonal relationships, quality of life, and school performance (Moffatt 1989). Enuresis is more common in boys, and there even appears to be a genetic predisposition (Von Gontard et al. 1999). The incidence of the condition diminishes with age: 25% by age 4, 5%–10% by age 7, and less than 5% by age 10. In adults, the prevalence is 0.5%–2%. Nocturia, or nocturnal polyuria, is the need to get up during the night to urinate. When the frequency of getting up is high, or if the person has
Enuresis and Nocturia— Yi Yi Niao 遗尿
difficulty falling asleep again, nocturia is considered to be a parasomnia, as it interrupts sleep and also disturbs the quality of sleep. Nocturia occurs mainly in the elderly, but may also be observed in some some young younger er adults adults.. Nocturn Nocturnal al polyur polyuria ia can result simply from too much fluid intake before going to bed (usually the case in the young), or it can be a symptom of a bigger problem, such as sleep apnea, hyperparathyroidism, chronic renal failure, failure, urinary urinary incontine incontinence, nce, bladder bladder infection infection,, interstitial cystitis, diabetes, heart failure, benign prostatic hyperplasia, ureteropelvic junction obstruction, or prostate cancer. From the perspective of Chinese medicine, both enuresis and nocturia have the same zang fu patterns: Kidney qi vacuity Kidney yang vacuity vacuity (congeni (congenital tal in children, children, acquired in the elderly) Kidney yang and and spleen yang vacuity vacuity Spleen qi and lung qi vacuity Damp–heat in the lower jiao and bladder
Lumbar pains; fearfulness, weak weak libido – Sweaty and smelly feet In children: – Enuresis with with large amounts of urine – Weak constitution, possibly possibly nervous or even hyperactive In both children and adults: – Tongue: pale – Pulse: weak and deep –
●
●
Treatment
Strengthen kidney qi and the lower orifices: shen shu BL-23, zhi shi BL-52, pang guang shu BL-28, fu f u liu KI-7, tai xi KI-3, da zhong KI-4, KI-4, zhong ji CV-3, qi hai CV-6, bai hui GV-20, san yin jiao SP-6, gong sun SP-4.
● ●
Kidney Yang Kidney Yang Vacuity Vacuity
●
Symptoms
●
●
●
According to Julian Scott (1999), enuresis in children is always a manifestation of a weakness in the Lower Gate ( xia guan ), which is suggestive of a kidney qi vacuity. Often, kidney qi vacuity is the result of a neonatal problem, such as the mother ’s condition prior to birth, a difficult birth, or postnatal infantile pathologies affecting the normal development of the kidney qi. In this case, I often add the chong mai (penetrating vessel) to the treatment, especially the points gong sun SP-4 and bai hui GV-20. In many many instan instances ces,, bed-w bed-wetti etting ng in childr children en accompanies a disorder of sleep arousal in which the child sleeps too deeply and does not feel the need to urinate. Points such as bai hui GV-20 or san yang luo TB-8 help raise the yang to to the head. If the cause is possibly emotional, especially related to fear or insecurity, zhi shi BL-52 is highly indicated. See also Chapter 3, Case 14.
●
●
In adults and the elderly: – Frequent and and clear urination, urination, incontinence – Lumbar pains; weak libido, libido, spermatorrhea spermatorrhea – Dislike of cold, cold feet, edema edema – Tinnitus, deafness, deafness, forgetfulness, forgetfulness, lack of of will, apathy In children: – Enuresis with with large amounts of urine – Weak constitution, possible retardation In both children and adults: – Tongue: swollen, pale or bluish – Pulse: weak and slow
Treatment
Warm the yang (moxa), supplement qi, supplement kidney kidney yang (moxa) (moxa),, and strengt strengthen hen the lower orifices: shen shu BL-23, zhi shi BL-52, ming men GV-4, fu liu KI-7, tai xi KI-3, da zhong KI-4, KI-4, zhong ji CV-3, guan yuan CV-4, bai hui GV-20, zu san li ST-36, san yin jiao SP-6, gong sun SP-4, and (in the elderly) gao huang shu BL-43. Kidney Yang Kidney Yang and and Spleen Yang Spleen Yang Vacuity Vacuity Symptoms
Patterns and Treatments Kidney Qi Kidney Qi Vacuity Vacuity Symptoms ●
In adults and the elderly: – Frequent urination, urination, especially at night
● ● ● ● ●
As above Exhaustion upon waking, apathy Forgetfulness Forgetfulness and mental fatigue Dislike of cold Frequen Frequentt urination urination,, edema, edema, “cock-crow” diarrhea
73
74
4 Other Sleep Pathologies
● ●
Tongue: swollen, pale or bluish Pulse: weak and slow
●
●
Treatment
Warm the yang , supplement qi, supplement kidney and spleen yang , and support the ascent of vacuity yang . Use the same points as kidney yang vacuity shen que que CV-8 (moxa) tai bai bai SP-3 and and add add shen (moxa),, tai (moxa), and shen mai BL-62. Spleen Qi Spleen Qi and and Lung Qi Lung Qi Vacuity Vacuity Symptoms ●
●
●
In adults and the elderly: – Frequent urination, urgency, urgency, incontinence incontinence – The need to urinate small amounts when lying down – Waking at 3 a.m. – Weak Weak breathing breathing,, cough, cough, asthma, asthma, frequent frequent colds – Bloating after meals, somnolence, somnolence, soft stools stools – Fatigue, apathy, depression In children: – Following an external pathogenic episode; listlessness – Enuresis with with small amounts of urine – Wea Weakk cons consti titut tutio ion, n, pron pronee to cold coldss and and coughs – Poor appetite, appetite, loose loose stools In both children and adults: – Tongue: swollen in the front, pale – Pulse: empty, floating
Treatment
Strengthen the lung, spleen, and lower orifices: fei shu BL-13, pi shu BL-20, zhong fu LU-1, tai yuan LU-9, lie que LU-7, yin ling quan SP-9, lou gu SP-7, zhong ji CV-3, zhong wan CV-12, shan zhong CV17, zu san li ST-36, shen zhu GV-12 (in children), and (in the elderly) gao huang shu BL-43. Damp–Heat in the Lower Jiao Lower Jiao (Lower (Lower Burner) and Bladder
● ● ●
In children: – Enuresis with with strong-smelling strong-smelling urine Restless sleep, tooth grinding, possible nightmares Irritability Tongue: red, sticky yellow coating Pulse: slippery and full and rapid, or wiry
Treatment
Clear heat, transform damp, and clear the lower jiao: pang guang shu BL-28, san jiao shu BL-22, zhong ji CV-3, shui dao ST-28, yin ling quan SP-9, san yin jiao SP-6, tai chong LR-3, LR-3, qu quan LR-8, yin lian LR-1. Treatment Strategies
Quite good results can be expected when treating enuresis in children. In general, I follow follow a few basic rules: Use only a few points per session, usually not more than four to six, especially if using needles. I personally use a mid-laser (30 –40mW), infrared, for children under 10 years of age. Do not use the extraordinary vessels, except for chong mai, under the age of 7. ●
●
One treatment session per week often produces very good results, and in most cases three to four sessio sessions ns are suffici sufficient ent.. The excep exceptio tionn is when when there are intricate patterns, such as a residual pathogenic factor, with long-standing long-standing qi deficiency complicated by emotional factors. Here, the treatment can take up to several months. In my experience, all the resistant cases I encountered involved involved family issues that were usually quite difficult to unravel.
Excessive Dreaming — Duo Duo Meng 多梦 Explanation
Symptoms ●
In adults and the elderly: – Frequent urination, urgency, urgency, pain and difficulty urinating – Dark urine, postmicturition postmicturition drip – Dry mouth, thirst, constipation, lower abdominal pain
Althou Although gh dreami dreaming ng is indis indispen pensab sable le to health health,, excessive dreaming is a type of sleep disturbance in which the individual wakes up feeling tired and even stressed. Dream time, which represents up to 80% of an infant ’s sleeping time, drops to about 20%–25% 25% in an adul adult. t. Drea Dream m time time also also vari varies es
Excessive Dreaming — Duo Duo Meng 多梦
depending on life events and transitions such as puberty or pregnancy. People tend to dream more when they are learning new skills or during emotional episodes in their lives or certain diseases. Depressed people have up to three times as much REM sleep as those who are not depressed. Dreams affect us on three levels: levels: Physiological. This is evidenced by hormonal chang changes es,, with with the relea release se of adrena adrenaliline ne and and other stress hormones; or the increase in heart rate and breathing; or an increased blood flow to the outer genitalia with erection in men and lubrication in women. Emotional. Accor Accordin dingg to dream dream theori theories es disdiscussed in Chapter 1, and especially the psychoanalytic theories further developed in Chapter 5, dreaming has an important role in the process cessin ingg of distu disturbi rbing ng emot emotio ions ns.. Stud Studie iess of dreams have found that about three quarters of dream content or emotions are negative in nature (NPR 2007). Mental. The brain EEG shows an intense mental activit activityy during during REM sleep. sleep. Furthe Furthermo rmore, re, the importance of dreaming in the processing of memory was underlined in Chapter 1.
patterns, ying (spring) (spring) and shu (stream) points are indicated, such as xing jian LR-2 and tai chong LR LR3, or da ling PC-7 PC-7 and lao gong PC-8, PC-8, and so on. The following points have been traditionally indicated for excessive dreaming: ●
●
●
●
●
●
●
●
●
frequent waking, waking, excess excessiv ivee Shen men HT-7: frequent dreaming, agitation, sleep-talking Yin bai SP-1: restless sleep, excessive dreaming, agitation, nightmares Li dui dui ST-45: ST-45: dream-distu dream-disturbed rbed sleep, sleep, nightnightmares Hou xi SI-3: dream-disturbed sleep; dreaming of narrow passages Xin shu BL-15: BL -15: dream-disturbed dream-disturbed sleep; dreaming of the dead excessiv ivee dreaming; dreaming; nightnightBen Ben shen shen GB-13: excess mares Zu qiao yin GB-44: excessive dreaming; nightmares
●
Patterns and Treatments Heart Blood Vacuity Symptoms
Hence, it can be said that dreaming is hard work and and that that too too mu much ch is not not good good for for the the body body.. Dreaming tends to increase toward toward the middle and end of the night, night, but fortun fortunat atel elyy early early wakin wakingg often acts to protect the dreamer from excessive dreaming and its potential harm. In Chinese medicine, patterns that tend to disrupt the shen and especially the hun cause excessive dreaming. Blood vacuity, which affects both the shen and the hun, is the primary cause. Hun can be unsettled in repletion patterns, as seen in heat or in hot phlegm conditions. Other patterns involving heart and kidney not being in harmony combine both vacuity and repletion, and cause viscer visceral al agita agitatio tionn and exces excessi sive ve dreami dreaming. ng. The content and significance of dreams are explored in Chapter 5. Excess Excessiv ivee dreaming dreaming often accompan accompanies ies light light sleep, disrupting the quality of sleep. From a synchronizer perspective, this is suggestive of yin wei mai (that is, zhu bin KI-9 is reactive). In general, in the case of vacuity patterns, the treatment treatment strategy strategy involv involves es bladder bladder shu (transport) points, especially xin shu BL-15, pi shu BL-17, and gan shu BL-18 for blood vacuity. In repletion
●
● ● ●
● ●
Difficulty falling asleep, restless sleep; frequent waking Frequent dreams, nightmares, dreams of flying f lying Palpitations, Palpitations, dizziness, blurred blur red vision Poor memory, concentration problems, feeling spaced out Tongue: pale pa le Pulse: choppy or weak
Treatment
Nourish heart blood, and calm the shen: shen men HT-7, jue yin shu BL-14, xin shu BL-15, ju que CV14, shen feng KI-23, KI-23, ling xu KI-24, hou ding GV-19, GV-19, jiu wei CV-15, jian shi PC-5, san yin jiao SP-6, pi shu BL-20, ge shu BL-17, zu san li ST-36, yin tang EX-HN-3. Liver Blood Vacuity Symptoms ●
● ● ●
Restless sleep, waking early, frequent and vivid dreams Dizziness, Dizziness, diminished night vision Tongue: pale sides Pulse: choppy
75
76
4 Other Sleep Pathologies
Treatment
Invigorate and supplement liver blood, mobilize liver qi, quiet and settle the shen: gan shu BL-18, pi shu BL-20, ge shu BL-17, shen shu BL-23, qu quan LR-8, san yin jiao SP-6; an mien EX-HN-54. Liver Yin Liver Yin Vacuity Vacuity Symptoms ●
● ● ● ● ●
Restless sleep, waking early, sleep-walking or sleep-talking Nightmares, excessive excessive dreaming, irritability Dryness of the throat, eyes, skin, and hair Feeling of heat, dizziness Tongue: dry, peeled sides, may be red Pulse: floating and and empty, or thin and rapid rapid
Treatment
Support the liver and kidney yin, and settle the hun: gan shu BL-18, hun men BL-47, qu quan LR-8, san yin jiao SP-6, ting hui GB-2; ben shen GB-13, shen ting GV-24; GV-24; also treat kidney yin. Heart Qi Heart Qi and and Gallbladder Qi Gallbladder Qi Vacuity Vacuity Symptoms ●
● ● ● ● ●
Insomnia from insecurity, light sleep, excessive dreaming Nightmares, waking early, early, difficulty diff iculty getting up Easily startled, timid, lack lack of will and initiative initiative Palpitation, Palpitation, shortness of breath, fatigue Tongue: pale, swollen Pulse: empty
● ● ●
Tinnitus, lumbar pains Tongue: peeled, red tip, cracks, heart crack Pulse: floating and empty
Treatment
Supple Supplemen mentt heart heart and kidney kidney yin, clear empty heat, and re-establish heart–kidney communication (mainly pericardium [ xin bao] points): shen PC-7, jian men HT-7, yin xi HT-6, fu liu KI-7, da ling PC-7, shi PC-5, jue yin shu BL-14, xin shu BL-15, ju que CV-14, shen feng KI-23, hou ding GV-19, jiu wei CV-15, jian shi PC-5, san yin jiao SP-6, guan yuan CV-4; also yong quan KI-1, zhao hai KI-6, shen shu BL-23, shen tang BL-44, BL-44, and zhi shi BL-52. Liver Fire Symptoms ● ● ● ●
● ● ●
Restless sleep, intense nightmares, waking early Anger, irritability, envy, and jealousy Headaches, dizziness Tightness in the chest, sides, and hypochondrium Bitter taste, red face, dark urine, dry stools Tongue: red sides, dry yellow coating Pulse: rapid and wiry
Treatment
Clear liver and gallbladder heat, move the qi, and settle the shen and hun: xing jian LR-2, tai chong LR LR3, zu qiao yin GB-44, wan gu GB-12 or an mien, feng chi GB-20, gan shu BL-18, hun men BL-47, jian shi PC-5, bai hui GV-20, ben shen GB-13, or tou lin qi GB-15 and shen ting GV-24; GV-24; also treat the kidney. kidney.
Treatment
Supplement heart and gallbladder qi, and calm the shen: shen men HT-7, qiu xu GB-40, xin shu BL-15, dan shu BL-19, zu qiao yi GB-44, wan gu GB-12 or an mien, zhe jin GB-23, tou lin qi GB-15, ben shen GB-13, shuai gu GB-8, han yan GB-4.
Phlegm Fire Harassing the Mind Symptoms ● ● ●
Heart Yin and Heart Yin and Kidney Yin Kidney Yin Vacuity Vacuity with Empty Heat (Heart and Kidney out of Harmony)
●
●
Difficulty falling asleep through anxiety Nightmares, night night terrors, dreams of flying Mental and emotional restlessness, irritability Snoring, chest oppression, nausea, lack of appetite Tongue: red, red tip, yellow coating Pulse: rapid and slippery
This pattern is very ver y common in menopause.
●
Symptoms
Treatment
●
● ●
Difficulty falling asleep, restless sleep, frequent waking Dream-disturbed sleep; thirsty at night Dry throat throat,, palpit palpitati ations ons,, night night sweat sweats, s, “five palm” heat
Clear heat, dissolve phlegm, and calm and settle the shen: jian shi PC-5, lao gong PC-8, PC-8, da ling PC-7, PC-7, nei guan PC-6, shao fu HT-8, shen men HT-7, jue yin shu BL-14, zhong zhong wan CV-12, shui fen CV-9, feng long ST-40, ST-40, li dui ST-45.
Nightmares — Meng Meng Yan 梦魘
Nightmares — Meng Meng Yan 梦魘 Explanation
A nightmare is an unpleasant dream that causes the perso personn to wak wake up and and have have stro strong ng emot emotio iona nall responses, typically of fear or horror. The dream may contain situations of danger, discomfort, or psychological or physical distress. Such dreams can be related to physical causes such as high fever, stress, or post-traumatic disorder. The person may wake up in a state of distress and may be unable to get back to sleep for some time. Eating before before sleeping may also stimulate nightmares nightmares (Stephens 2006). Occasional nightmares are commonplace, but recurrent nightmares can interfere with sleep. The occurrence of nightmares seems to be age-related: rare in children under 5, more common in young children (25% experience one nightmare at least once per week), most common in adolescents, and less common in adults (dropping in frequency to about one-third from age 25 to 55) (NPR 2007). Nightmares occur during REM sleep and should be differentiated from night terrors, which occur in non-REM sleep. As the length of REM sleep increases increases throughout throughout the night, night, nightmar nightmares es are more likely likely to occur in the latter part of sleep. From a Chinese medicine perspective, nightmares are associated with fear. Fear is the primary survival emotion, and first and foremost involves the kidney and consequently the liver. As the hun travels at night and is confronted by various life challenges, some of which are perceived as lifethreatening, the dream is experienced as fearful, hence the nightmare. Conditions that unsettle the rising, contrihun, such as liver heat or liver yang rising, bute to the manifestation and frequency of nightmares. Nightmares are much more common in children as they tend to have a weak kidney and an exuberant liver (that is, internal wind). In general, the presence of strong emotions, especially fear in daily life, increases the incidence of nightmares. According to Master J. Yuen, wei qi, as part of yang qi, is rooted in the yuan (source) qi and needs to return to the source, the kidneys. If the wei qi cannot fully complete its return to the source, the indi indivi vidu dual al will will expe experi rien ence ce fear fear in the the form form of nightmares, as well as fright wind in the form of seizures. Master Yuen further states that wei qi also moves inward to protect us during the sleep
state against gui influences. This kind of gui commonly manifests as gui zha (ghost oppression), the sensation of someone or something “sitting” or “pressing” on the chest. Bai Zheng Fu (Ode of One Hundred Patterns) (Gao Wu Ming 1529) gives indications for the following, which all manifest as restless sleep: Jian shi PC-5for gui xie (ghost evil) Yin bai SP-1for gui zha Li dui ST-45 and yin bai SP-1 for sleeping or dreaming with a heavy sensation on the chest Tian fu LU-3for ghost talk ● ● ●
●
From a synchronizer perspective, nightmares mainly disrupt the quality of sleep; hence, the yin wei mai is most often found to be disturbed (that is, zhu bin KI-9 is reactive). As nightmares occur more frequently in the latter part of sleep, the most common zang fu patterns involve involve the liver and kidney. This may be of great help in orienting the diagnostic investigation and choosing the therapeutic protocol: The middle phase of the night, from a yin wei perspective, e, correspond correspondss to the jue mai perspectiv jue yin yin channels (liver and pericardium; see Chapter 3). 3). Use nei guan PC-6 with other jue yin points, such as jian shi PC-5, da ling PC-7, PC-7, zhong chong PC-9 (in children), and xin jian LR-2, as well as the complementary shao yang points, points, many of which are indicated for these conditions, that is, zu qiao yin GB-44, zhe jin GB-23, tou lin qi GB-15, ben shen GB-13, shuai gu GB-8, han yan GB-4 (in children), and lu xi TB-19. The end phase of the night involves the shao yin channels (kidney and heart). Use nei guan PC-6 with zhu bin KI-9, shen men HT-7, shao fu HT-8, yong quan KI-1, and ling xu KI-24, as well as the complementary tai yang points points appropriate for nightmares: zan zhu BL-2, tian zhu BL 10, xin shu BL-15, and hun men BL-47. ●
●
However, if the disturbed organizer is the yin qiao mai, the person wakes up, is wide awake, and cannot go back to sleep, and the jiao xin KI-8 is reactive: reactive: The middle phase of sleep corresponds to the tai yin channels (lung and spleen) (in the yin qiao qiao mai point sequence). Use zhao zhao hai KI-6 with other tai yin points: tian fu LU-3, yin bai SP-1, shang qiu SP-5. The end phase of sleep corresponds to the jue yin channels (liver and pericardium). Use zhao ●
●
77
78
4 Other Sleep Pathologies
mentioned hai KI-6 with the jue jue yin yin points mentioned above. Some classical point indications for nightmares are as follows:
qiao yin GB-44, wan gu GB-12 or an mien EX-HN54, feng chi GB-20, gan shu BL-18, hun men BL-47, jian shi PC-5, bai hui GV-20, either ben shen GB-13 or tou lin qi GB-15, and shen ting GV-24; GV-24; also treat
the kidney.
Yin bai SP bai SP-1 -1
Rest Restle less ss slee sleep, p, exce excess ssiv ive e drea dreami ming ng,, agitation, nightmares
Heart Fire
Shang qiu SP-5
Nig Nightmare ares
Symptoms
Nei ting ST-4 ST-44 4
Night Nightmar mares es,, rest restle less ss extr extrem emit itie iess
Li dui ST dui ST-4 -45 5
Drea Dreamm-di dist stur urbe bed d slee sleep, p, nigh nightm tmar ares es
Zan zhu BL-2
Nightmares
Tian zhu BL-10 BL-10
Insomn Insomnia ia from from overwo overwork, rk, nightm nightmares ares
Ben shen GB-13 GB-13
Excess Excessive ive dreamin dreaming, g, nightm nightmare aress
Tou lin qi GBqi GB-15 15
Insomn Insomnia, ia, anxiety anxiety,, nightm nightmare aress
Zu qiao yin GB-44
Excessive Excessive dreaming, dreaming, nightmares nightmares
Additionally, Master Yuen recommends the following points: Yong quan KI-1 KI-1
For For frig fright ht wind wind or panic panic attac attacks ks
Tai xi KI xi KI-3 -3
Lack Lack of reso resou urces rces in the the drea dream, m, shor shorttness of breath
Both yong Both yong quan To promote defecation (as constipation KI-1 and tai and tai xi KI-3 KI-3 could be causing the nightmares) Zhao hai KI-6 KI-6
Blee Bleed d for for nigh nightm tmar ares es in the the preme premennstrual phase or prior to labor due to blood stasis
● ● ●
●
● ● ●
Treatment
Clear heat, calm and settle the shen: shen men HT7, shao fu HT-8, jue yin shu BL-14, xin shu BL-15, ju KI-23, yong quan KI-1, hou que CV-14, shen feng KI-23, ding GV-19, GV-19, jiu wei CV-15, jian shi PC-5. Phlegm Fire Harassing the Mind Symptoms ● ● ●
See also Chapter 3, Cases 3, 7, and 11.
● ●
Patterns and Treatments Liver Fire Symptoms ● ● ● ●
● ● ●
Restless sleep, intense nightmares, waking early Anger, irritability, envy, jealousy Headaches, dizziness Tightness in the chest, sides, and hypochondrium Bitter taste, red face, dark urine, dr y stools Tongue: red sides, dry yellow coating Pulse: rapid and wiry
Clear liver and gallbladder heat, move qi, and settle the shen and hun: xing jian LR-2, tai chong LR-3, LR-3, zu
As above Nightmares, irritability, dysphoria, mania Snoring, chest oppression, nausea, lack of appetite Tongue: red, red tip, yellow coating Pulse: rapid and slippery
Treatment
Clear heat, and resolve phlegm: jian shi PC-5, lao gong PC-8, PC-8, shao fu HT-8, jue yin shu BL-14, zhong wan CV-12, shui fen CV-9, feng long ST-40. ST-40. Liver and Heart Blood Vacuity Symptoms ●
●
●
Treatment
Difficulty falling asleep through anxiety Nightmares, dreams of flying Mental and emotional restlessness, daring character Bright Bright eyes, eyes, loud loud voice voice,, alway alwayss feelin feelingg hot, hot, thirsty Palpitations, Palpitations, tongue ulceration, bitter taste Tongue: red, red tip, yellow coating Pulse: rapid, overflowing
● ● ●
Restl Restless ess sleep, sleep, wakin wakingg early early,, vivid vivid dreams dreams,, nightmares occurring early in the night Palpitations, dizziness, tinnitus, reduced memory Numbness Numbness of the extremities Pale face face and lips Tongue: pale p ale Pulse: weak, fine
Night Fright/Night Terror— Ye Ye Jing 梦魘
Treatment
Nourish the blood, and calm the shen and hun: xin shu BL-15, gan shu BL-18, pi shu BL-20, ge shu BL-17, shen shu BL-23, hun men BL-47, shen men HT-7, qu quan LR-8, san yin jiao SP-6; an mien EXHN-54.
● ● ●
high high plac places es to sing sing,, or to undr undres esss and and run run around madly, for example) Gastritis, thirst, halitosis, hunger, acne, red eyes Tongue: stomach crack, red, yellow dry coating Pulse: flooding
Treatment Liver Yin Liver Yin Vacuity Vacuity with Liver Yang Liver Yang Rising Rising Symptoms ●
● ● ● ● ●
Restless sleep, waking early, sleep-walking or sleep-talking Nightmares, excessive excessive dreaming, irritability Dryness of throat, eyes, skin, and hair Feeling of heat, headaches, dizziness Tongue: dry, red and peeled sides Pulse: floating and empty, or thin and rapid or wiry
Clear heat, support stomach fluids, and calm and settle the shen: wei shu BL-21, yin jiao CV-7, zhong wan CV-12, lie que LU-7, jie xi ST-41, zu san li ST-36, liang men ST-21, yin bai SP-1, li dui ST-45, nei ting ST-44. ST-44. Blood Stasis/ Stasis/ Heart Blood Stasis Stasis Symptoms ●
●
Treatment
Subdue liver yang , supplement liver yin, and calm the shen and hun : gan shu BL-18, hun men BL-47, qu quan LR-8, tai chong LR-3, LR-3, san yin jiao SP-6, feng chi GB-20, ting hui GB-2, ben shen GB-13, shen ting GV-24; also treat kidney yin. Heart and Gallbladder Qi Gallbladder Qi Vacuity Vacuity Symptoms ●
● ● ● ● ●
Insomnia from insecurity, light sleep, excessive dreaming Nightmares, waking early, early, difficulty difficult y getting up Easily startled, timid, lack lack of will and initiative initiative Palpitation, Palpitation, shortness of breath, fatigue Tongue: pale, swollen Pulse: empty
● ● ●
Anxiety when lying down, down, restless sleep, nightnightmares Dream-dis Dream-disturbed turbed sleep, sleep, sleep-talki sleep-talking, ng, sleepsleepwalking Palpitations, chest pain, angina Tongue: purple, or purple spots Pulse: choppy
Treatment
Move the blood, and calm the shen: nei guan PC-6, KI-23, jue shen men HT-7, tong li HT-5, shen feng KI-23, yin shu BL-14, xin shu BL-15, ge shu BL-17, xin shu BL-15, gao huang shu BL-43, he gu LI-4, tai chong LR-3, bai hui GV-20, shen ting GV-24. GV-24.
Night Fright/Night Terror — Ye Jing 夜惊 Explanation
Treatment
Supplement heart and gallbladder qi, and calm the shen: shen men HT-7, qiu xu GB-40, xin shu BL-15, dan shu BL-19, zu qiao yi GB-44, wan gu GB-12 or an mien EX-HN-54, zhe jin GB-23, tou lin qi GB-15, ben shen GB-13, shuai gu GB-8, han yan GB-4. Stomach Heat Symptoms ● ● ● ●
Restless sleep, frequent dreams, nightmares Needing to eat or drink in order to fall asleep Mental restlessness, moving and talking too fast Agitation (if extreme: compulsion to climb to
Night terror, also known as sleep terror or pavor nocturnus, is a parasomnia disorder that is characterized by extreme terror and a temporary inability to fully regain consciousness. The individual wakes abruptly from non-REM sleep (SWS), usually with manifestations such as gasping, moaning, or screaming. It is often impossible to fully wake the person, and after the episode he or she normally settles back to sleep without waking, the episode being rarely recalled by the person themselves. Night terror may be experienced at any age, although it is more common in children (15%), especially between the ages of 2 and 6 years. Many
79
80
4 Other Sleep Pathologies
factors can trigger the episodes, such as emotional stress, high fever, irregular sleep or diet, and even constipation. constipation. In adults, night terrors are frequently trauma-related. Unlike nightmares, night terrors usually occur in the early stages of sleep, approximately 90 minutes after sleep onset. Other symptoms may accompany the terror, such as tachycardia, tachypnea, and sweating. From a synchronizer perspective, night terrors mainly disrupt the quality of sleep; hence, the yin wei mai is most often involved (that is, zhu bin KI-9 is reactive). As they occur in the first phase of the night, the tai yin (lung and spleen) channels are involved. The treatment strategy involves using nei guan PC-6 with gong sun SP-4, and the tai yin points tian fu LU-3, yin bai SP-1, and shang qiu SP-5. Night fright, also referred to as gui fright, is tan (phlegm), often related to the accumulation of tan although many of the patterns seen in the section on night nightma mares res can also also produc producee night night terror terrors, s, especially in children. Some classical point indications for night terrors are: Jian shi PCPC-5
Inso Insomn mnia ia,, nigh nightt terr terro ors
Han yan GBGB-4
Nig Night terrors
Shuai gu GB-8 GB-8
Fear Fear,, nigh nightt terr terror orss
Zhe jin GB-2 GB-23 3
Night Night terr terror orss in infa infant nts, s, inso insomn mnia ia from from overwork
Guan yuan CV-4
Insomn Insomnia, ia, night night terrors terrors
Treatment
Clear heat, dissolve phlegm, and calm and settle the shen: jian shi PC-5, lao gong PC-8, PC-8, da ling PC-7, PC-7, nei guan PC-6, shao fu HT-8, shen men HT-7, jue yin shu BL-14, zhong zhong wan CV-12, shui fen CV-9, feng long ST-40. ST-40. Other points for fright wind include chi ze LU-5, yin bai SP-1, shang qiu SP-5, yong quan KI-1, and shen dao GV-11. Phlegm Misting the Mind Symptoms ● ●
● ● ● ● ● ● ●
Night terrors, possibly sleep apnea and snoring Daytime sleepiness, mental and physical asthenia Dizziness, morning headaches Feeling of heaviness, chest oppression Blurred vision Copious sputum, nausea Obesity Tongue: swollen with a sticky coating Pulse: slippery
Treatment
Resol Resolve ve phlegm phlegm,, supple supplemen mentt the stoma stomach ch and and spleen, and open the orifices: zhong wan CV-12, pi shu BL-20, san jiao shu BL-22, zu san li ST-36, feng long ST-40, ST-40, tou wei ST-8, jian shi PC-5, san yin jiao SP-6, shui fen CV-9, san yang luo TB-8 (helps to jing TB-10, chi ze LU-5, open the orifices), tian jing shang qiu SP-5, da chong KI-4. KI-4.
See also the previous section on “ Nightmares” and Chapter 3, Cases 14 and 17.
Dreams of Flying— Meng Meng Fei 梦飞 Patterns and Treatments Phlegm Fire Harassing the Mind Symptoms ● ● ● ●
● ●
Difficulty falling asleep through anxiety Nightmares, night night terrors, dreams of flying Mental and emotional restlessness, irritability Snoring, chest oppression, nausea, lack of appetite Tongue: red, red tip, yellow coating Pulse: rapid and slippery
Explanation
Dreams of flying are usually reported as pleasant and do not really fall under the causes of sleep disturbance, but they nevertheless signify an underlying disharmony pattern, often that of a yin vacuity yang rising, with yang rising, usually referred referred to as floating floating yang . Chapter 17 of the Huang Di Nei Jing Su Wen relates dreams of flying to an “excess above above with a deficiency below.” In Chapter 43 of that text, the signi significa ficance nce of dreams dreams of flying flying,, white white object objects, s, wars, and beheading and bleeding wounds are related to lung qi vacuity with an external xie qi (pathogenic factor) invading the lung.
Dreams of Falling— Meng Meng Zhui 梦坠
Patterns and Treatments Lung Qi Lung Qi Vacuity Vacuity Symptoms ● ● ● ● ● ●
Waking Waking at 3 a.m. (solar time), dreams of f lying Worry, anxiety, sadness Weak breathing, cough, asthma, frequent colds Dry skin, loss of hair Tongue: swollen in the front, pale Pulse: empty, floating
Treatment
Clear heat, and settle the shen: shen men HT-7, shao fu HT-8, jue yin shu BL-14, xin shu BL-15, ju KI-23, yong quan KI-1, hou que CV-14, shen feng KI-23, ding GV-19, GV-19, jiu wei CV-15, jian shi PC-5. Liver Yin Vacuity Liver Yin Vacuity with Liver Yang Liver Yang Rising Rising or Liver Wind Symptoms ●
Treatment
Supplement lung qi, and open the chest: fei shu BL-13, po hu BL-42, zhong fu LU-1, tai yuan LU-9, shan zhong CV-17, CV-17, nei guan PC-6, bu lang KI-22. KI-22. In the case of external pathogenic factors, add feng men BL-12, lie que LU-7, and he gu LI- 4.
●
● ● ● ●
Heart Blood Vacuity Symptoms ●
● ● ●
● ●
Difficulty falling asleep, restless sleep, waking frequently Frequent dreams, nightmares, dreams of flying f lying Palpitations, Palpitations, dizziness, blurred vision Poor memory, concentration problems, feeling spaced out Tongue: pale Pulse: choppy or weak
Treatment
Nourish the heart blood, and calm the shen: shen men HT-7, jue yin shu BL-14, xin shu BL-15, ju que CV-14, shen feng KI-23, KI-23, ling xu KI-24, hou ding GV GV19, jiu wei CV-15, jian shi PC-5, san yin jiao SP-6, pi shu BL-20, ge shu BL-17, zu san li ST-36, yin tang EX-HN-3. Heart Fire Symptoms ● ● ●
● ● ● ●
Difficulty falling asleep through anxiety Nightmares, dreams of flying Mental and emotional restlessness, daring character Bright eyes, loud voice, voice, always always feeling hot, thirsty Palpitations, Palpitations, tongue ulceration, bitter taste Tongue: red, red tip, yellow coating Pulse: rapid, overflowing
Restless sleep, waking early, sleep-walking or sleep-talking Nightmares, excessive dreaming, dreams of flying, irritability Dryness of throat, eyes, skin, and hair Feeling of heat, headaches, headaches, dizziness dizziness Tongue: dry, red and peeled sides Pulse: floating and empty, or thin and rapid or wiry
Treatment
Subdue liver yang , supplement liver yin, and calm the shen and hun : gan shu BL-18, hun men BL-47, qu quan LR-8, tai chong LR-3, LR-3, san yin jiao SP-6, feng chi GB-20, ting hui GB-2, ben shen GB-13, shen ting GV-24; also treat kidney yin.
Dreams of Falling— Meng Meng Zhui 梦坠 Explanation
This condition is not a sleep disturbance in itself, but it can cause a person to suddenly wake up frightened. Obviously, if this condition occurs regularly, it will affect the quality of sleep and cause emotional stress. Dreams of falling reveal an underlying disharmony, generally a vacuity pattern. Chapter 17 of the Su Wen relates dreams of falling to “repletion below.” This can be: An accumulation of cold below, which is consistent tent with with kidne kidneyy yang vacuity or kidney qi vacuity An accumulation of dampness, as seen in spleen and kidney yang vacuity vacuity Possibly even liver qi stagnation ●
●
●
Patte Patterns rns causin causingg light light sleep sleep and and fearfu fearfulne lness ss,, as seen in heart and gallbladder qi vacuity, can also provoke provoke dreams of falling and waking with a start.
81
82
4 Other Sleep Pathologies
The treatment strategy aims to identify and treat the causative pattern. Two points have traditionally been indicated for this condition: Di ji SP-8: dreams of dropping, of falling, or of sinking when falling asleep Tian yu TB-16: dreams of falling or standing on one’s head
●
●
Heart Qi Heart Qi Vacuity Vacuity Symptoms ● ● ● ● ●
Patterns and Treatments Kidney Yang Kidney Yang and and Spleen Yang Spleen Yang Vacuity Vacuity Symptoms ●
● ● ● ● ● ●
● ●
Dreams Dreams of fallin falling, g, maybe maybe episod episodes es of sleepsleepwalking Exhaustion upon waking, apathy, sleepiness Forgetfulness, Forgetfulness, mental fatigue Lack of willpower, willpower, depression depression Dislike of cold Lumbar pains, worse with cold Frequent urination, edema, “cock-crow” diarrhea Tongue: swollen, pale or bluish Pulse: weak and slow
●
Treatment
Strengthen heart qi, invigorate blood, calm and settle the shen: shen men HT-7, jue yin shu BL-14, xin shu BL-15, ju que CV-14, ling xu KI-24, shen cang KI-25, shen shen ting GV-24, yin tang EX-HN-3, CV-17, qi tian yu TB-16, nei guan PC-6, shan zhong CV-17, hai CV-6, zu san li ST-36. Heart and Gallbladder Qi Gallbladder Qi Vacuity Vacuity Symptoms ●
●
Treatment
Warm the yang , supplement qi, supplement kidney and spleen yang , and support the ascent of yang : shen shu BL-23, zhi shi BL-52, pi shu BL-20, ming men GV-4, tai xi KI-3, gong sun SP-4, di ji SP8, yin bai SP-1, bai hui GV-20, shen ting GV-24, GV-24, shen mai BL-62, ju gu LI-16. Kidney Qi Kidney Qi Vacuity Vacuity Symptoms ● ● ● ● ● ●
Dreams of falling Frequent urination, especially at night Lumbar pains; fearfulness, weak libido Sweaty and smelly feet Tongue: pale pa le Pulse: weak and deep
● ● ● ● ●
Strengthen kidney qi: shen shu BL-23, zhi shi BL 52, fu liu KI-7, tai xi KI-3, yong quan KI-1, qi hai CV-6, bai hui GV-20, san yin jiao SP-6, gong sun SP4, di ji SP-8.
Insomnia from insecurity, light sleep, excessive dreaming Dreams of falling, falling, nightmares Waking Waking too early, early, difficulty diff iculty getting up Easily startled, timid, lack lack of will and initiative initiative Palpitations, Palpitations, shortness of breath, fatigue Tongue: pale, swollen Pulse: empty
Treatment
Supplement heart and gallbladder qi, and calm the shen: shen men HT-7, qiu xu GB-40, xin shu BL-15, dan shu BL-19, zu qiao yi GB-44, either wan gu GB12 or an mien EX-HN-54, zhe jin GB-23, tou lin qi GB-15, ben shen GB-13, tian yu TB-16. Liver Qi Liver Qi Stasis, Stasis, Possibly with Liver Blood Vacuity Symptoms ● ●
Treatment
Superficial sleep, sexual dreams Easily startled, timidity, instability Palpitations (arrhythmia) Shortness of breath, fatigue, depression Tongue ongue:: pale, pale, swoll swollen en in the front, front, possib possibly ly heart crack Pulse: empty
● ● ●
● ●
●
Jerking when falling falling asleep, dreams of falling falling Restless sleep, vivid dreams Irritability, moodiness Dizziness, eye floaters Chest oppression, hypochondrial tension, depression Irregular cycles, premenstrual breast distension Tongue ongue:: pale pale sides sides (pos (possib sibly ly with with pale pale red spots) Pulse: choppy or wiry
Sexual Dreams— Meng Meng Jiao 梦交
Treatment
Move liver qi, and supplement liver blood: gan shu BL-18, pi shu BL-20, ge shu BL-17, shen shu BL-23, LR-3, qi qu quan LR-8, san yin jiao SP-6; tai chong LR-3, men LR-14, he gu LI-4, tian yu TB-16, gong sun SP4, an mien EX-HN-54.
Sexual Dreams— Meng Meng Jiao 梦交 Explanation
Tian zhu BL-10 BL-10
Insomn Insomnia ia from from overwo overwork, rk, nightm nightmares ares,, sexual dreams
Xin shu BL-1 BL-15 5
Drea Dreamm-dis distu turbe rbed d sleep sleep,, drea dreami ming ng of the dead, sexual dreams
Shen shu BL-2 BL-23 3
Sexu Sexual al drea dreams ms
Patterns and Treatments Heart Qi Heart Qi and and Spleen Qi Spleen Qi Vacuity Vacuity Symptoms ●
Difficulty falling asleep, sexual dreams Daytime sleepiness, fatigue, weakness Palpitations, Palpitations, shortness of breath Lack of appetite, appetite, bloating, soft stools Forgetfulness Dull or pale complexion Tongue: swollen, pale with tooth marks, white thin coating Pulse: Pulse: weak weak or fine
Sexu Sexual al drea dreams ms occu occurr in no more more than than 10% 10% of dreams and are more prevalent in the young to mid-teens (Hall and Van de Castle 1966). Partial sexual arousal seems to be consistent with REM slee sleep, p, as most most men men pres presen entt an erec erecti tion on and and women become more lubricated. In some cases, sexual dreams may result in orgasm or nocturnal emissi emission. on. These These are commo commonly nly known known as wet wet dreams. Sexual dreams are not considered pathological Treatment unless they disrupt the sleep and cause tiredness Supplement heart and spleen qi, calm the shen: in the morning. The treatment aims more at regu- zhong wan CV-12, pi shu BL-20, xin shu BL-15, zu lating the causative factor rather than eliminating san li ST-36, san yin jiao SP-6, shen men HT-7, bai the manifestation itself. Excessive sexual dreaming hui GV-20; also add zhi shi BL-52 and fu liu KI-7 in reflects an overactivity of yang qi, usually pericar- case of spermatorrhea. dium dium heat. heat. If accom accompan panied ied by sperma spermato torrhe rrhea, a, excessive sexual dreaming signifies an underlying Heart Qi Heart Qi Vacuity Vacuity qi vacuity. pattern of qi Nocturnal emission is a separate pathological Symptoms condition. There are two types of spermatorrhea Superficial sleep, sexual dreams ( yi jing ): ): Easily startled, timidity, instability With dreams: meng yi (dream spillage) spillage) Palpitations (arrhythmia) Without dreams: hua jing (slippery (slippery essence), a Shortness of breath, fatigue, depression depression more severe condition Tongue ongue:: pale, pale, swoll swollen en at the front, front, possib possibly ly heart crack In both cases, the nocturnal emission is either due Pulse: empty to qi vacuity, failing to contain or hold the jing (essence) (kidney qi vacuity, kidney yang vacuity, vacuity, Treatment heart and kidney yin vacuity, heart and spleen qi Strengthen heart qi, calm the shen: shen men HT-7, vacuity), or overactivity of yang qi pushing the jing jue yin shu BL-14, xin shu BL-15, ju que CV-14, ling out (liver fire, heart fire, damp–heat in the lower xu KI-24, shen shen cang cang KI-25, nei guan guan PC-6, shan jiao). The latter seems an excellent indication for zhong CV-17, CV-17, qi hai CV-6, zu san li ST-36 also add tian zhu BL-10, which is traditionally indicated for zhi shi BL-52 and fu liu KI-7 in case of spermatorsexual overstimulation. rhea. Classical points indicated for sexual dreams are: ● ● ● ● ● ●
●
● ●
●
●
●
● ●
●
83
84
4 Other Sleep Pathologies
Heart Yin and Heart Yin and Kidney Yin Kidney Yin Vacuity Vacuity with Empty Heat (Heart and Kidney Out of Harmony)
● ● ●
Symptoms ●
●
●
● ● ●
Difficulty falling asleep, restless sleep, waking frequently Dream-disturbed sleep, sexual dreams, sexual overstimulation Dry throat at night, night sweats, “five palm” heat Tinnitus, lumbar pains, palpitations Tongue: peeled, peeled, red tip, cracks, heart crack Pulse: floating and empty
Treatment
Supple Supplemen mentt heart heart and kidney kidney yin, clear empty heat, calm and settle shen, and re-establish heart– kidney communication communication (mainly (mainly pericardium points): shen men HT-7, yin xi HT-6, fu liu KI-7, da ling PC PC7, jian shi PC-5, jue yin shu BL-14, xin shu BL-15, ju que CV-14, shen feng KI-23, KI-23, hou ding GV-19, GV-19, tian zhu BL-10, jiu wei CV-15, jian shi PC-5, san yin jiao SP-6, guan yuan CV-4; also yong quan KI-1, zhao BL-44, zhi shi hai KI-6, shen shu BL-23, shen tang BL-44, BL-52. Pericardium Heat Symptoms ● ● ●
●
● ● ●
Difficulty falling asleep through anxiety Nightmares, dreams of flying, f lying, sexual dreams Mental Mental restlessn restlessness, ess, overex overexcitem citement, ent, sexual sexual perversions Always feeling hot, thirsty, tachycardia, hypertension Congestion, Congestion, heart pain Tongue: red, red tip, yellow coating Pulse: rapid, overflowing
Treatment
Clear heart and pericardium heat, calm and quiet the shen: jian shi PC-5, nei guan PC-6, da ling PC-7, PC-7, shen men HT-7, shao fu HT-8, jue yin shu BL-14, xin shu BL-15, ju que CV-14, shen feng KI-23, KI-23, hou ding GV-19, jiu wei CV-15. Liver Qi Liver Qi Stagnation Stagnation with Liver Fire Symptoms ●
Restless sleep, nightmares, sexual dreams, wakwaking early
● ● ●
Anger, irritability, envy, and jealousy Headaches, dizziness Tightness in the chest, sides, and hypochondrium Bitter taste, red face, dark urine, dry stools Tongue: red sides, dry yellow coating Pulse: rapid and wiry
Treatment
Clear liver and gallbladder heat, move the qi, and settle the shen and hun: xing jian LR-2, tai chong LR-3, zu qiao yin GB-44, wan gu GB-12 or an mien EX-HN-54, feng chi GB-20, gan shu BL-18, hun men BL-47, jian shi PC-5, bai hui GV-20, either ben shen GB-13, or tou lin qi GB-15, shen ting GV-24, GV-24, tian zhu BL-10; also treat the kidney.
Circadian Rhythm Desynchronization Jet Lag Explanation
Jet lag is not a pathological pathological condition per se, but the by-product of our modern-day forms of trave tr avelling. The crossing of time zones when traveling traveling east or west tends to disrupt the internal body clock. The symptoms may include: Fatigue Insomnia Disorientation or mental confusion Nausea or loss of appetite Headaches Edema ● ● ● ● ● ●
These symptoms can last up to 10 days. The duration of the symptoms are estimated to be 1 day for each time zone crossed. In general, traveling eastward (against the earth’s rotation) produces more severe symptoms than traveling westward. Children under the age of 5 seem to be less affected than adults. Circadian rhythms allow organisms to anticipate and prepare for precise and regular environmental changes; for instance, day and night, length of daylight, and seasons. The rhythmicity appears to be just as important in regulating and coordinating internal metabolic processes as in synchronizing with the environment (Sharma 2003).
Circadian Rhythm Desynchronization
The rhythm of the biological clock is linked to the cycle of light and dark. Scientists have identified a photosensitive protein that is believed to have originated in the earliest cells and has since been transmitted genetically (Nagoshi et al. 2004). This gene has been found to be defective in patients with advanced sleep phase syndrome (Jones et al. 1999). Different cells throughout the body communicate with each other, resulting in the synchronized output of electrical signals. These These coordinated coordinated electrical signals may interface with endocrine glands in the brain, resulting in the periodic release of hormones (see Chapter (see Chapter 1, 1, “Normal Sleep, Circadian Rhythm ”). In mammal mammals, s, the primary primary circad circadian ian clock clock is locat located ed in the suprac suprachi hiasm asmati aticc nucleu nucleuss (SCN), (SCN), which reacts to specific photosensitive ganglion cell receptors in the retina. The SCN passes the info informa rmati tion on on to the the pine pineal al glan gland, d, wh whic ichh in response secretes melatonin. Melatonin levels and core body temperature are the classic markers for measuring the circadian rhythm in mammals. It has been established that disruption of the circadian rhythm has significant adverse health consequen quence cess on the the peri periph phera erall orga organs ns,, such such as on cardiovascular diseases (Martino et al. 2008), and may also increase the risk of developing cancer (Straif et al. 2007). In classical Chinese medicine, this well-known body clock has been of fundamental importance both in lifestyle (living in accordance to the midday–midnight rhythm) and in diagnosis and therapy (Fig.4.1). In energy terms, the desynchronization of the circadian rhythm involves primarily the four extraordinary vessels responsible for synchronizing the inner with the outer factors.
Midday
9–11 Spleen 7–9 Stomach 5–7 Large intestine
11–13 Heart
13–15 Small intestine T a
g in m in g i y n a a Y T
3–5 Lung 1–3 Liver
i S y h a n a o g y i n
15–17 Bladder
17–19 Kidney n 19–21 i n u e y J u Pericardium y a n g S h a o 21–23 Triple burner 23–1 Gallbladder
Midnight
Fig.4.1 The midday –midnight clock: the Chinese chronobiological biological clock of qi circulation. qi circulation. The tide and web of qi of qi in in the channels and their respective organs.
● ● ● ●
Jiao xin KI-8 on the yin qiao mai Fu yang BL-59 BL-59 on the yang qiao mai Zhu bin KI-9 on the yin wei mai Yang jiao GB-35 on the yang wei mai
Most often, I have found the yin or yang qiao mai to be reactive. reactive. The treatment treatment protocol protocol is as follow follows: s: Zhao hai KI-6 (supplement on the dominant side: right for women, left for men) Shen mai BL-62 (reduce on the opposite side) Yin tang (not (not only calms the shen, but also has a strong effect on the pituitary and SCN) With the possible addition of si shen cong ●
● ●
●
Therapeutic Protocols Treatment of Jet Lag
The treatment of jet lag has three objectives: To reset the internal biological clock to the new time zone To synchronize the system to the different climate or season at the destination To help the organism ’s ability to adapt ●
●
●
First the four xi points of the extraordinary vessels are explored by palpation:
Otherwise, as it is the external synchronizer, the time zone that has changed yang wei mai should be considered, especially if yang yang jiao GB-35 is reactive: Wei guan TB-5 He gu LI-4 to regulate the quality of sleep in its capacity as regulating the surface and the wei qi. He gu LI-4 also regulates the distribution of ying qi (nourishing qi), wei qi, and blood from the center. For this purpose, tai chong LR-3 LR-3 can also also be adde added, d, as it addi additi tion onal ally ly help helpss to increase the organism ’s ability to adapt. ● ●
85
86
4 Other Sleep Pathologies
To synchronize the system to the new climate, I use the seasonal supplementation and reduction points based on the principle of “supplementing the mother and reducing the son.” The treatment is directed at the channels most likely to suffer. For example, when traveling from Europe to South East Asia in winter, we are going from winter into summer. The systems that will most likely suffer are the kidney and heart systems. The The seasonal supplementing pounts are the wood points, the reduction points are the earth points. Therefore, the points to use are shao chong HT-9, HT-9, shen men HT-7, yong quan KI-1, and tai xi KI-3 (Fig.4.2). Additionally, Additionally, to help the liver to adapt more easily, LR-3, and so on can be used. da dun LR-1, tai chong LR-3, When traveling in the opposite direction, from South East Asia to Europe, we are going from summer to winter. The points to choose here are the metal and wood points. The channels to treat are again the kidney and heart, as well as possibly the lung, which easily suffers from the cold: fu liu KI-7, yong quan KI-1, ling dao HT-4, and shao chong HT HT9, jing qu LU-8 and shao shang LU-11 LU-11 (Fig.4.3).
Summer Wood (mother)
Earth (son)
Insomnia 1
Zero point Pituitary gland Insomnia 2
Fig.4.4 Auricular points for the treatment of jet lag.
Additionally, if the patient has a known propensity to a certain weakness, the corresponding channels are also treated. For example, if the person has a tendency to present constipation when traveling, traveling, the mother–son points of the large intestine may be added, in this case shang yang LI-1 and san jian LI-3. The treatments are given daily, maybe even twice a day, using four to six points only per session. Auriculotherapy is also quite effective in alleviating the disturbed sleep patterns, disorientation, and other symptoms that accompany jet lag (Fig.4.4): ●
● ● ●
Wood (son)
Winter
Metal (mother)
Fig.4.3 Supplementing the mother, reducing the son to help the transition into winter.
Pineal gland Master omega (Master cerebral)
●
Fig.4.2 Supplementing the mother and reducing the son to help the transition into summer.
Shen men
Shen men
Zero point Insomnia 1 and 2 Pineal gland or pituitary gland Omega point
Master Yuen proposes an ancient Ming dynasty point combination for resetting the biorhythms and balancing the hormonal system (Yuen 2008). This This point point combin combinati ation on was was referre referredd to as the “Inner Four Gates.” Originally the Four Gates were the last points of the zu jue yin LR channel, qi men LR-14, combined with the first points of the shou tai yin LU channel, zhong fu LU-1 to re-establish the day –night balance and harmonize the post-heaven (postnatal) qi. Later for practical reasons, the chest points were replaced by distal points, tai chong LR-3 LR-3 and he gu LI-4, this becoming the “ Outer Four Gates” as we know them today. These four points are then complemented by bai hui GV-20 and zhong wan CV-12 to balance the pre-heaven (pre-natal) energies. By adding jing ming BL-1, this combination
Circadian Rhythm Desynchronization
Fig.4.5 Resetting the biorhythms.
(6) GV-20
(7 & 8) BL-1
(2) LU-1
(4) LU-1
(5) LR-14
(3) LR-14
(1) CV-12
becomes an interesting treatment option for all disturbances of the biological clock as experienced in jet lag or shift work. I recomm recommend end the follo followin wingg needli needling ng order: order: starting with CV-12, then LU-1 on the right side for women (left for men), followed by LR-14 on the opposite side, followed by LU-1 on the opposite side, followed by LR-14 on the same side (creating a figure 8), then GV-20, ending with BL-1 on both sides (Fig.4.5); yin tang EX-HN-3 EX-HN-3 may alternately replace BL-1.
Table 4.1 The time phases and points of the primary channels Channel
Time
Pen (horary) element point
Lung
3 a.m. –5 a.m.
Jing qu LU-8 qu LU-8
Large Large intest intestine ine
5 a.m. a.m. –7 a.m.
Shang yang LI-1 yang LI-1
Stomach
7 a.m.–9 a.m.
Zu san li ST-36 ST-36
Spleen
9 a.m.–11 a.m.
Tai bai SP-3 SP-3
Heart
11 a.m.–1 p.m.
Shao fu HT-8 fu HT-8
Preventing Jet Lag
Small Sm all inte intest stin ine e
1 p.m.–3 p.m.
Yang gu SI-5 gu SI-5
There are two protocols for avoiding jet lag. Both use the element points, also known as horary or pen points, in order to reset the biological clock to the new time zone (Table 4.1): 1. At the time of departure, departure, the watch is set to the the time at the destination. The current time at the destination is found in Table 4.1. 2. The acupuncture point corresponding to that time period is identified.
Bladder
3 p. m. m.–5 p.m.
Zu tong gu BL-66 gu BL-66
Kidney
5 p. m.–7 p.m.
Yin gu KI-10 gu KI-10
Per Pericardiu dium
7 p.m.–9 p.m.
Lao gong PC-8 gong PC-8
Tripl riple e burn burne er
9 p.m. p.m.–11 p.m.
Zhi gou TB-6 gou TB-6
Gallbladder
11 p.m.–1 a.m.
Zu lin qi GB-41 GB-41
Liver
1 a.m.–3 a.m.
Da dun LR-1 dun LR-1
87
88
4 Other Sleep Pathologies
3. The point is stimulated on both sides either with a needle for 5 minutes, or by acupressure 25–30 times. Personally, I use a hand-held infrared laser to stimulate these points. 4. The point corresponding to the next time period (Table 4.1) is stimulated every 2 hours. 5. I advise continui continuing ng the process for for a few hours after arriving. Amaro (2002) proposes working through the cycle until one reaches the point one started from. For example, when traveling from Paris to Los Angeles, a departure time of 11 a.m. in Paris corresponds to 2 a.m. in Los Angeles (liver time). Start by stimulating da dun LR-1; then, 2 hours later, stimulate the next point jing qu LU-8, 2 hours later shang yang LI-1, LI-1, and so on. If one sleeps through the next time period, the stimulation is resumed upon waking with the channel corresponding to the time upon waking. The stimulation is continued for several hours after arriving arr iving or until one full cycle has been completed. completed. The other and older protocol calls for stimulating the appropriate points of both channels active at the the time time of depa departu rture re and and dest destin inat atio ion. n. For For example, example, if the departure time from Paris Paris is 11 a.m., the pen point of the heart, shao fu HT-8, is selected together with da dun LR-1, the pen point of the live liver, r, as this this would would corres correspon pondd to the channe channell active at the time of destination, which would be 2 a.m. in Los Angeles. I find this protocol, however, to be less practical and somehow somehow less logical. I also also highl highlyy recomme recommend nd fastin fastingg during during the flight but drinking sufficient water. Eating should be resumed only at the appropriate meal time at the destination. This helps to set the inner synchronizers to the local time zone.
Shiftwork
Another cause of circadian rhythm disruption is shiftwork. Shiftwork sleep disorders (SWSD) are characterized by insomnia and excessive sleepiness at nonstandard times, causing the same type of symptoms as with insomnia, that is, impaired mental mental acuity, acuity, irritabili irritability, ty, reduced reduced performan performance, ce, and increased risk of accidents. There is even a possibil possibility ity of an increased increased risk of cancer cancer (Straif (Straif et al. 2007). Gene Genera rall llyy spea speaki king ng,, youn younge gerr peop people le adap adaptt much mu ch more more easi easily ly to chan change gess in work workin ingg and and sleeping times. In addition, the negative effects of shiftwork shiftwork appear to be allevia alleviated ted when the shifts are progressive, the person, for example, working from 7 a.m. to 3 p.m. for a few days, then from 3 p.m. to 11 p.m. for a few days, and then from 11 p.m. till 7 a.m., rather than working nights for a week and then days for the next week. I most often find the yin or yang qiao mai reactive in shift workers. The treatment protocol is as follows: Zhao hai KI-6 (supplement on the dominant side: right for women, left for men) Shen mai BL-62 (reduce on the opposite side) Yin tang EX-HN-3 EX-HN-3 ●
● ●
Resetting the Inner Four Gates with zhong zhong wan CV-12, zhong fu LU-1, qi men LR-14, bai hui GV-20 and jing ming BL-1; BL-1; the latter may be replaced by yin tang EX-HN-3. EX-HN-3. Another alternative would be to reset both the Inner and Outer Four Gates: LR-3, LI-4, followed by LR-14 and LU-1, CV-12 and GV-20, needled in a similar order as described previously. See also Chapter 3, Cases 2 and 4.
89
5 Drea Dreams ms and Thei Theirr Signi Significanc ficance e in in Chine Chinese se Medi Medicin cine e
Modern Western and Ancient Eastern Easte rn Theor Theories ies about Dreams Dreams are the least understood part of sleep and have been the subject of religious and philosophical fascination since the dawn of humanity. Greek Mythology
In ancient Greek mythology, Morpheus, the son of Nyx, goddess of the night, is considered to be the god of dreams, with the power to send dreams or visions and to give them any form or shape. With his brothe brothers rs Phobe Phobetor tor,, the maker maker of fears fearsome ome dreams, Phantasos, the bringer of unreal dreams, and the twins Hypnos, the god of sleep, and Thanatos, the god of death, he presides over sleep. Morpheus, the god of dreams, is considered superior to all of his brothers. The Greek Greek temple templess known known as “Asclepieions” were built for curing the sick by divine intervention through dreams. Dreams were also considered to be omens, as described in the Oneirocritica (The Interpretation of Dreams) (Artemidorus 2nd century CE). Middle Middl e Easte Eastern rn Traditi raditions ons
The Babylonian “Epic of Gilgamesh ” is one of the earliest written examples of dream interpretation (Thompson [1928], 2007). In ancient Egypt, priests interpreted people’s dreams. The Bible cites many dreams as divine revelation, and it is recorded that Daniel became known for his skill in dream interpret pretaation tion in the the Baby Babylo loni nian an court court (606 (606 BCE) BCE).. Joseph, as cited in the Book of Genesis, was made viceroy of Egypt after interpreting the Pharaoh’s dreams. The early early Muslim Muslim schola scholars rs recogn recognize izedd three three type typess of drea dream m (fals falsee, path pathog ogen enic ic,, and and true true dreams). An important treatise on dream interpretation was written by Ibn Sirin (654 –ca. 728), and
another on Sleep and Dreams by Al-Kindi (ca. 801 – ca. 873). The famous Persian physician Ibn Sina (980–1037), known as Avicena, included the study of dreams in his Canon of Medicine. Hindu Traditions
Many Many Easter Easternn traditi traditions ons have have empha emphasiz sized ed the importance of dreaming and have proposed working with dreams as a means of self-liberation. self-liberation. In the Hindu yoga traditions, Yoga Nidra refers to yogi yogicc slee sleep, p, and and yogi yogicc luci lucidd drea dreami ming ng (see (see below) has been practiced for millennia by Sadhu and Rishi adepts. The Hindu scripture Mandukya Upanishad (1st–2nd century CE) describes three common states of consciousness —waking, dreaming, and deep sleep —plus a fourth state, Turiya, or pure consciousness (Rama 1982). Yoga Yoga Nidra refers specifically to the conscious awareness of the deep sleep state, referred to as “Prajna.” Today, Today, Yoga Nidra is taught not only as a meditation, but also as a relaxation practice. Popularized in the West by Swami Satyananda since the 1980s, it has been shown to reduce tension and stress and to enhance sleep (Kumar 2005, 2006). In an attempt to understand the neurophysiological impact of Yoga Nidra, Swami Rama, a Hindu yogi, was extensively studied at the Menninger Foundation, where he demonstrated a variety of extreme abilities, including Yoga Nidra, which is a voluntary death-like state of physiological arrest (Anand (Anand et al. 1961). Dreams are a reservoir of knowledge and experience, yet they are often overlooked as a vehicle for exploring reality. Tarthang Tulku Yoga
90
5 Drea Dreams ms and and Thei Theirr Sign Signif ific ican ance ce in Chin Chines ese e Medi Medici cine ne
Buddhist Tradi Tradition tion
Dreams and dream practice occupy an important place in the Buddhist tradition too. Buddha Shakyamuni summarizes the source of human suffering in four fundamental truths. The first is that all phenomena have an illusory nature, as in dreams. In the Dzogch Dzogchen en school school of Tibeta Tibetann Buddhi Buddhism, sm, Dream Yoga, or Milam, comprises a set of advanced tantric processes and techniques described in the Six Yogas of Naropa. According to the contemporary temporary Dzogchen Dzogchen teachers teachers Namkhai Namkhai Norbu, Norbu, Lopön Tenzin Namdak, and Tenzin Wangyal, perceived reality and the phenomenal world are considere sideredd ultima ultimate tely ly to be an illusi illusion on (Maya (Maya), ), a dream, simply a thought-form. Quantum field theory in modern particle physics might ultimately confirm this ancient belief. What gives the apparent solidity to material reality is our beliefs and attachments (Samskara). In Dream Yoga, the living may become the dream, and the dream may become the living. According to this this teac teachi hing ng,, ther theree is also also a rela relatio tions nshi hipp between the states of sleeping and dreaming and our experiences when we die. After traversing the intermediate state between two life incarnations called the Bardo, a new karmic illusion is created and another existence begins. The primary aim of dream practice is to realize during a dream that one one is drea dreami ming ng;; this this is refe referre rredd to as “lucid dreaming” (see below). With this comes an understanding of the dreamlike nature of daily life, fundament damental al to reduci reducing ng attach attachmen ments, ts, which which are based on strong beliefs that life ’s perceptions and objects are real and, as a consequence, important. The realization that life is only a big dream can help us finally f inally liberate ourselves ourselves from the chains of emotions, attachments, and Ego, and ultimately leads leads to enlig enlighte htenme nment nt (Norbu (Norbu 1992, 1992, Wangya angyall 1998). The six stages of lucid dreaming practice pract ice are: First stage. The dreamer learns to become lucid in the dream. Second stage. The dreamer overcomes all fear of the contents of the dream. Third stage. The dreamer contemplates contemplates the illusory and changing nature of all phenomena, both in the dream and in waking life. Fourth stage. The dreamer realizes that we have control over our dreams. Fifth stage. The dreamer realizes that the dream ●
●
●
●
●
●
body is as insubstantial as the other objects in the dream. Sixth stage. The dreamer lucidly visualizes the images of deities serving as symbolic doorways to this mystical state of being (the Void or clear light). Chinese Tradition
In the Chinese tradition, ming 命, translated as “life” or “mandate ” or “life mandate,” represents the sum total of the requirements that the soul has to fulfill throughout a given life (or incarnation). Master J. Yuen refers to this life mandate as the “life curriculum.” The ming is is considered to carry the yun 运 , destiny or fortune, and is stored in the kidneys. In Western terms both ming and and yun are often understood as destiny. destiny. In the Chinese physiology of sleep, dreaming is the domain of the hun (ethereal spirit or soul), which resides in the liver. The liver is considered to be the “record-keeper.” Not only does it help to bring events from the subconscious into the conscious mind, but it is also believed to keep the “memory of the future,” that is, our life curriculum (Chen Shi Yuan in Meng Zhan Yi Zhi, 1562). In Chinese embryology, a fetus starts dreaming at the age of 5 lunar months, when the five senses are fully developed. It is believed that, at this time, the future baby communicates through dreams with the mother and even tells her its name. This curriculum will first manifest itself in the development of the embryo, as supervised and carried out by the chong mai (penetrating vessel) manifesting in the constitution and morphology. After birth and consolidation of the kidney qi, the qiao mai (motility vessels), and wei mai (binding or linking vessels) coordinate the unfolding of the curriculum through 7- and 8-year cycles ( Su Wen, Chapter 1). This coordination defines important physiological landmarks, such as childhood, adolescence, and maturity (maturescence), as well as psycho-spiritual developments. The French school defines these life passages as “ gates” and proposes the following correspondence with the yang wei and yang qiao extraordinary vessels: vessels:
Modern Western and Ancient Eastern Eastern Theories about Dreams
The three gates and the extraordinary vessels: Ankle Gate
Childhood
BL-61 pu can
Hip Gate
Puber ty
GB-29 ju liao
Shoulder Gate
Maturity
SI-10 nao shu
by the liver and lungs. ●
●
Here, BL-61 is the constituent point of yang qiao mai; and GB-29 and SI-10 are the constituent points of both yang qiao mai and yang wei mai. Master Yuen is more precise here, stating that the channels responsible for the life cycles (multiples of 7 and 8 years) are the yin and yang wei mai. At the end of our life curriculum, the yin and yang return to the constitutional level in preparation for rebirth, a new beginning. This is represented by the point sequence of yin and yang wei mai. The yin wei goes to qi men LR-14 (the yin aspect of wood) before returning to the yin, the ren mai (conception vessel) at lian quan CV-23. Yang wei ends at feng chi GB-20 (the yang aspect aspect of wood), and then returns to the yang , the du mai (governing vessel) at ya men GV-15 and feng fu GV-16. Wood represents renewal, and what we have not been able to process in our lives returns in the form of new challenges, hence the importance of the openin openingg points points of these these two channe channels ls—nei guan PC-6 and wei guan TB-5—for dealing with the challenges in our lives. The liver, which acts as an emissary between the the kidn kidney ey and and the the heart heart,, repr repres esen ents ts the the link link between between the deposited deposited destiny destiny,, ming , and the spiritual life transitions. The shen, being responsible ble for for our our spir spiritu itual al evol evolut utio ion, n, will will mani manife fest st through the offices of the hun in the form of dreams, enacting the challenges of our chosen life curriculum. The hun stored in the liver will explore these life challenges, helping to bring them into our consci consciou ousne sness ss and to prepar preparee us for for these these even events ts thro throug ughh drea dreams ms,, espe especi cial ally ly prop prophe heti ticc dreams. Through the practice of lucid or conscious dreaming, one can process these challenges. When there are difficulties in this processing, the dream is experienced as a nightmare. As we have previou viousl slyy seen seen in Chap Chapte terr 2 (see (see “ Shen: Mental Relaxation, ” p.21), the points on the heart channel symbolically represent the main stages of each person’s spiritual evolution. According According to Master Yuen, the liver plays a central role in all four stages of sleep: In the first stage of sleep, relaxation is enabled ●
●
In the second stage, the liver interacts with the spleen to maintain sleep. In the third stage, the liver interacts with the kidneys to allow for deep sleep. Ultimately, the interaction of the liver with the heart or pericardium allows for lucid dreaming or vivid awareness during the dream state.
The purpose of this lucid dreaming is: To bear witness or at least prepare oneself to obse observe rve the the even events ts of the the past past and and futur futuree (enabled by the hun) and to observe our reactions to these events (enabled by the pericardium). Eventually, to consciously place ourselves in a challenging situation and to develop the “solutions” or “resolutions”. ●
●
The Chinese medical literature, Huang Di Nei Jing Su Wen, commonly known as Nei Jing (Inner (Inner Classic or Inner Canon), and Ling Shu (Spiritual Pivot), extensively extensively analyze the pathological pathological significance of dreams as indicators of organ disharmony (see later in this chapter). Besides this use of dreams for medicinal diagnostic purposes, earlier cultures — mainly Daoism and Confucianism —placed important emphasis on dream interpretation: A dream is that which can be considered real when asleep. Mo Zi (4th Century BCE) A dream not interpreted is like a letter not read. The Talmud
In the Daoist tradition, the nature of reality and of all phenomena is attributed to the Void: Thirty spokes converge converge on a hub, but it is the emptiness that makes makes a wheel work pots are fashioned from clay but it is the hollow that makes a pot work windows and doors are carved for a house but it is the spaces that make a house work existence makes something useful but non-existence makes it work. Lao Zi (6th century BCE), Dao BCE), Dao De Jing, Jing, verse 11 (translated by Red Pine [aka Bill Porter], published by Mercury House, 1996)
91
92
5 Drea Dreams ms and and Thei Theirr Sign Signif ific ican ance ce in Chin Chines ese e Medi Medici cine ne
Of course, the question of the dreamlike nature of reality occupies an important place in Daoist literature: Once upon a time, I, Zhuang Zi, dreamt I was a butterfly, fluttering hither and thither, to all intents and purposes a butterfly. I was conscious only of my happiness happiness as a butterfly, unaware unaware that I was Zhuang Zi. Soon I awaked, and there I was, veritably myself again. Now I do not know whether I was then a man dreaming I was a butterfly, or whether I am now a butterfly, dreaming dreaming I am a man. Zhuang Zi (4th century BCE)
The paradox of the dreamlike nature of life and the similarity of death to sleep is again underlined in a statement by the Sophist Hui Zi: One can die and be born at the same moment. Hui Zi (4th century BCE)
During the Tang dynasty of the 7th century CE, three types of “ “ unusual” dream were described: Even Events ts occurring occurring simultan simultaneousl eouslyy in farawa farawayy places, notion of resonance Two persons dreaming the same dream Dreams of doubting, not knowing if an event was an illusion or reality ●
● ●
But the most interesting records from this time are dreams of death that are very similar to the modern-day near-death experiences. According to Master Yuen, these death dreams probably led to points being developed to bring a person out of this near-death (deep sleep) state. During During the Ming dynasty (16th century), century), Gao Wu recorded the nine points to return yang (resusci (resuscitate), which are useful for dying patients to help the process of dying, or to assess whether a patient is actually ready to die and help during the three stages of dying: First stage—when one starts to see one ’s loved ones: ya men GV-15, lao gong PC-8, PC-8, san yin jiao SP-6 Second Second stage stage—disorienta disorientation tion and losing losing consciousness: yong quan KI-1, tai xi KI-3, zhong wan CV-12 Third stage—the comatose stage, to resuscitate: huan tiao GB-30, zu san li ST-36, he gu LI-4 ●
The Daoist tradition distinguishes between three types, or categories, of dream: Dreams that allow the opposite belief to be, or expressing expressing what is suppressed Dreams that question reality and develop the imagination The The grea greatt awake wakeni ning ng (lif (lifee is like like a drea dream) m),, dreams representing a portal por tal to awakening awakening
●
●
●
Life is a preparation for death, life is like a dream, death is an awakening. Zhuang Zi (4th century BCE)
Zhuang Zi further states that a person in a state of self-realization or enlightenment does not need to dream. Therefore, the analysis of dreams in Chapter 17 of the Nei Jing falls falls into the first category, in a way expressing the hidden, that is, the organic vacuity, and the repletion of the xie qi (pathogenic qi). Confucianism considers the role of dreams to be: Teaching us to become a better person As prophecies, prophecies, measured measured by analyzing analyzing the Ghanzi stems and branches or Chinese astrology and considering considering seasonal or climatic influences in the interpretation interpretation of dreams ● ●
●
●
These points are used according to the manifestations, and only one stage is treated at a time. With the revival of Confucianism during the Song dynasty in the 11th century, dreams were considered to allow qi to follow li (principle). That is, dreams were believed to teach us. Dreams were considered to be directed by the zhi (will). It was therefore recommended to establish the theme of the recurring dream, and then then work on the zhi that produced that particular dream by working on the relativ relativee bladder bladder back shu points added to ying (spring) and shu (stream) points. Therefore, for a recurring dream with a wood theme, gan shu BL BL 18 or dan shu BL-19, xing jian LR-2, tai chong LR-3 LR-3 would be used. As dreams were considered to release memories via the hun, working with the liver and the kidneys was recommended. The most important textbook on dream interpretation was written during the Ming dynasty by Chen Shi Yuan (1516 –1595) and was called Meng Zhan Yi Zhi (Analysis (Analysis and Conclusion of Dreams). This was published in 1562, and was compiled
Modern Western and Ancient Eastern Eastern Theories about Dreams
from various sources, including the Nei Jing . Chen Shi greatly emphasized the importance of studying dreams, and he believed that dreams are the wandering of the hun. Chen Shi Yuan maintained that the qi of the tian (heaven) (heaven) produces hun (liver blood), and that the qi of the di (earth) produces po (corporeal soul; lung yin). When qi is pure, po follows hun. When qi is turbid (phlegm), hun follows po. In other words, strange dreams that we can relate to in some way come from liver blood. But if the dream topic is strange and unknown, it comes from lung phlegm. He also believed that the hun knows the future (aspirations). Po conceals the past (what we cannot let go of). This is called the gui (earth-bound spirit, ghost). The gui can affect the po and cause it to wander, sometimes resulting in seminal loss. In chapter 7 of the Meng Zhan Yi Zhi , there is a more elaborate classification of dreams: Normal dreams. These are often forgotten. They are the result of harmony between the five phases, especially the five emotions. There is often a varied range of emotional manifestations during the dream, but the person feels good upon waking. Through these dreams, the zang (organs) are capable of releasing some emotion, and the person wakes up feeling good and rested. The most regenerating of dreams are those which go through the full range r ange of the emotions. These are considered normal dreams. Nightmares are unsettling and often unusual dreams that wake the sleeper up in an uncomfortable state. They are associated with the kidney. Wakin akingg thou though ghts ts are are drea dreams ms inv involvi olvinng thoughts one had before falling asleep. They involve the spleen. Waking words are dreams that involve what was said before going to sleep. Speech concerns the tongue, hence corresponds to the heart. Happy, celebrating dreams are associated with the lung. Fearful dreams involve the gallbladder.
●
●
●
●
●
●
●
●
The assessment of the dream’s influencing factors enables us to choose the level that is affected ( wei, ying , yuen, or jing ) and the appropriate channel system to be used: For exogenous factors, wei qi level, use jing jin (sinew channels), the tai yang (supreme (supreme yang ),), and the jing (well) (well) points. In case of recurring themes of a certain climate, consider the jing bie (divergent channels). For internal, sociocultural themes, use the primary mary chann channel els, s, possib possibly ly the luo (connecting channels). ●
Chen Chen Shi Yuan analyz analyzes es the factor factorss that that affect affect dreams, as commented on by Master Yuen: Environmental Environmental factors: – Including settings, such as sleeping at at home or in a strange bed or even outdoors, as well as climatic factors, exposure to heat, wind, draft, and so on ●
The state of relaxation relaxation of the sinews sinews during sleep – The environmental environmental factors can be associated with the wei qi (defensive qi): the move wei qi were discussed in Chapter 2. ments of wei Social Social factors factors—the the influ influen ence ce of cult culture ure and and values: – Based on cultural definitions, some dream symbols represent concepts that have significance only for a particular culture. In other words, there is no concept of universality in dream symbolism. Social values also include notio notions ns of reward rewardss and punish punishmen ments, ts, or deat deathh and and dyin dying. g. They They are are rele releva vant nt in a society that emphasizes ancestral worship. Dreaming about a dead person often signifie nifiess unfin unfinis ishe hedd busi busine ness ss with with the the dedeceased. This is believed to be holding back a dead person, and it is good to resolve the issue. – Based on family myths or predispositions, especially dreaming of diseases that run in the family. These issues have to be explored and treated, as they may become reality. – Based on one ’s own personal experiences and and inte intera racti ction onss with with the the obje objects cts in the the dream, for example loss, theft, death, nature, heights, status, and so on – The social factors may be associated with the ying qi. Constitutional factors: as related to the yuan (source) qi: – Dreams Dreams could be reflections reflections of one’s primitive need to survive and basic drives, especially in the form of competition. – Dreams can be signposts or omens of our ming . They provide good clues to our ancestral sensitivities. –
●
93
94
5 Drea Dreams ms and and Thei Theirr Sign Signif ific ican ance ce in Chin Chines ese e Medi Medici cine ne
●
For For survi surviva val,l, com competi petitio tion, n, or prem premon onit itory ory dreams, use mainly the extraordinary vessels vessels as well as the jing bie.
Modern Dream Theories in Relation to Chinese Traditional Concepts As we saw in Chapter 1, dreaming is considered to be indispensable to mental health. Dreams mostly occur during rapid eye movement (REM) sleep, and we dream for about 2 hours each night. During a normal life span, that represents a total of about 6 years of dreaming time. Historically, Historically, dream significance was established in the the Chin Chines esee medi medica call trad tradit itio ionn as earl earlyy as 100BCE. In the West, although “dream interpretation” was taken up as part of psychoanalysis psychoanalysis at the end of the 19th century, it still remains on the fringes of the modern medical world. Sigmund Freud (1856–1939) considered dreams to be symbolic expressions of frustrated desires that had been relegated to the unconscious mind): Dreams are the royal road to the unconscious. unconscious. Sigmund Freud
In his work The Interpretation of Dreams (Freud, 1994), Freud revolutionized the study of dreams. He believed that, in order to be able to live in a society, we have have a tendency to hold back our urges and to repress our impulses. One way in which these impulses are released is through our dreams, often in symbolic language. Freud divided the mind into three parts: The The Id, Id, wh whic ichh is cen centere teredd arou around nd prim primal al impulses, pleasures, desires, unchecked urges, and wish fulfillment The Ego, which is the conscious, rational, moral, and self-aware self-aware aspect of the mind The Superego, the Id’s censor, which is also responsible for enforcing the Ego’s moral codes. ●
●
●
Thes Thesee thre threee aspe aspect ctss of the the mind mind can can be very loosely equated with three concepts in Chinese medicine: Hun roughly equates with the Id, the primal impulses. ●
●
●
Yi (thought) roughly equates with the Ego, the
social and moral order. Shen roughly equates with the Superego, which is in charge of maintaining internal and external balance.
Carl Gustav Jung (1875 –1961), although a follower follower of Freud, was equally influenced by the psychologist Alfred Adler as well as Greek philosophers such as Heraclitis. According to Jung’s theory of dreaming, the psyche regulates itself by means of a process of compensation. When there is an imbalance ance between between the consci conscious ous and and uncon unconsci sciou ouss minds, the result is a fragmentation of the personality as well as neurosis or psychosis. psychosis. Jung believed that the unconscious communicates cates with with the consci conscious ous mind mind throu through gh dream dream imagery. Unlike Freud, though, he did not agree with using “free association” as a means of interpreting dreams. For Jung, the psyche attempts to right itself by providing possible solutions to the problem through dreams of an opposite nature (proc (proces esss of compen compensat satio ion). n). He further further believ believed ed that the unconscious is a “rich vein” of creativity and the source of all genius. Jung divided the uncons unconscio cious us into into a more more superfic superficial ial “personal unconscious” and and a deep deeper er “collectiv collectivee unconunconscious.” The former includes personal experiences that have been forgotten or repressed, and the latter includes the primordial, racial, ethnic, cultural, and familial collective unconscious ( unconscious (Fig.5.1). The role of hun hun and po in the creation of behavioral and somatic gui (ghost, also called unnamed entity), were explored in Chapter 2. Many aspects of Jung’s collective unconscious are suggestive of the hun, in the the form form of imag images es,, symb symbol ols, s, and and myths, or of the po, as expressed by instincts, mainly of protection. From the classical Chinese perspective, one of the functions of the hun is to release retained emotions through dream imagery. Although dream interpretation constitutes an important important element element of psychoa psychoanal nalysis ysis,, it is only very recently that medical science has demonstrated the relation between moods and emotions and the body on one side, and the impact of visual imagery on the body’s chemistry on the other. Mapping of brain activity during dreaming (Hobson and McCarley 1977) has shown activity in the right hypothalamus, hypothalamus, which integrates the sensoryperceptual, emotional, and cognitive functions of the mind with the biology of the body. In other
Modern Dream Theories in Relation to Chinese Traditional Concepts
Consciousness The self Ego, persona Self-image Personal unconscious Subconscious memories/repressed emotions Collective unconscious Primordial/anima, Primordial/ani ma, animus Ethnic, racial/familial archetypes
Shen
Fig.5.1 Jung Jungian ian imag image e of the the stratified human psyche and its paralle parallell with with the Chines Chinese e conconcept of the shen. the shen.
Yi
Hun–po
Hun–po–zhi Hun–po–zhi
words, parts of the dreaming brain experience the dream images as real and respond to these images by secreting the appropriate neurotransmitters. In 1980, Candace Pert, Pert , a biophysics and physiology researcher, confirmed an intricate biochemical communication network between the body and the mind, specifically the neural, endocrine, and immune processes. She discovered neuropeptide rece recept ptor orss on the the sm smal alle lest st of cell cells, s, incl includ udin ingg immune cells. These neuropeptides, which act as molecular messengers, connect the mind and the body, which explains the action of emotions on the body (Pert 1999). There There are numero numerous us neuroh neurohumo umoral ral theori theories es about dreaming, briefly explored in Chapter 1, but personally, I do not believe that any single neurohumoral theory can explain all the different kinds of dreams that we may experience during our lifetime. By integrating the ancient Chinese concepts about dreams with modern neurohumoral theories and the great contribution of the psychoanalytic schools, I would instead like to attempt a different classification of dreams ( Table 5.1). Developmental Dreams
These dreams help the development of the brain, the body, and the psyche. This could explain the fact that babies spend over 50% of their sleep time in dreaming. During this type of dreaming, new ideas are experimented with by the mind, and probably new synaptic connections are established in the brain in preparation for learning new skills.
Babies Babies are known known to smile smile in their dreams dreams before before they smile in waking life. Several neurohumoral theories could support this group of dreams: The ontogenesis theory of Marks et al. (1995) concerns the development of the brain that would occur during neonatal REM sleep. Oneiri Oneiricc Darwin Darwinism ism,, instig instigat ated ed by Blechn Blechner er (2001) (2001),, sugge suggests sts that that dreams dreams create create new ideas ideas through the generation of random thought mutations. Some may be rejected by the mind as useless, while others may be seen as valuable and be retained. Emotio Emotional nal select selectio ionn theory theory,, as propos proposed ed by Coutts (2008), suggests that dreams function to test and select select mental mental schema. schema. Similar Similarly ly,, Adler Adler (see Stein 2006) suggested that dreams are often emotional preparations for solving problems. This category of dreaming could correspond to the Daoist Daoist “question questioning ing reality reality and develop developing ing imagination ” type of dreams. Interacting Dreams
This This woul wouldd cons consti titut tutee the the larg larges estt porti portion on of dreaming, involving the impact of the world on the dreamer. It includes three aspects: the impact the outer world has on the individual (random dreams); the storage of memories and the learning process; and how the individual attempts to deal with these external influences (releasing), and the body tries to correct the negative impacts (healing):
95
96
5 Drea Dreams ms and and Thei Theirr Sign Signif ific ican ance ce in Chin Chines ese e Medi Medici cine ne
●
●
●
random om thou though ghts ts and and Proces Processin singg the world world: rand dreams of recent events reorganized into a new scenario, as proposed by Hobson and McCarley (1977) in their activation synthesis theory. Memory and learning : storing information for later use, a function supported by many neurohumoral theories: – Memory consolidation theory (Stickgold et al. 2001, Payne and Nadel 2004) proposes that dreams are involved in the linking and consolidation consolidation of semantic memories. – Excitat Excitations ions of long-term long-term memory (Tarnow (Tarnow 2003) suggests that dreams are ever-present exci excita tatio tions ns of long long-t -term erm memo memory ry,, even even occu occurri rring ng duri during ng waki waking ng life life (as (as in daydaydreaming). – Continua Continual-acti l-activat vation ion theory (Zhang (Zhang 2004, 2005) proposes that the function of sleep is to proce process, ss, encode encode,, and and transf transfer er the data data from the temporary memory to the longterm memory. Self-preservation and self-healing dreams: to help process daily events, release unexpressed feel feeling ings, s, and correct correct the damag damagee caused caused by trauma traumatic tic experi experienc ences es.. In Chines Chinesee medici medicine, ne, this would also include the release of residual pathogenic factors.
Some neurohumoral theories support this type of dream: Reverse learning theory (Crick and Mitchison 1983): 1983): propos proposes es dreams dreams for for remov removing ing junk, junk, that is, the unnecessary memories and connections from the day. Releasing dreams, proposed by Ferenczi (1927) and and elabo elaborat rated ed by Vedfel edfeltt (2002) (2002):: consid considers ers that dreams allow the repressed parts of the mind to be satisfied through fantasy. Freud suggested that bad dreams let the brain learn to gain control over distressing emotions (Cartwrig wr ight ht 1993 1993). ). For For Jung Jung (193 (1934, 4, 1974 1974,, 2002 2002), ), dreams might compensate for one-sided attitudes held in waking consciousness. Integrating dreams theory (Hartmann 1995): dreams function as psychotherapy. Fulfill Fulfillmen mentt theory theory (Griffin (Griffin and Tyrell yrell 2003, 2003, 2007): demonstrates that dreaming metaphorically completes patterns of emotional expectation in the autonomic nervous system and lowers stress levels. levels. Mood regulating theory (Kramer 1993): pro●
●
●
●
●
●
poses dreams to have a corrective function with reference to mood. Psychos Psychosomat omatic ic theory theory (Tsai (Tsai 1995): proposes proposes that dreams could affect mind–body interaction by simulating the sensory signals to drive the auto autono nomo mous us nerve nervess refe referre rredd to as “repair nerves.” Maybe the discoveries of Pert (1999) (see p.95) support the psychosomatic theory.
In general, these types of dreaming correspond to the Daoist “releasing dreams.” In these “clearing” dreams, certain residual pathogens are released, either external pathogenic factors/ xie qi, as analysed in the Nei Jing and and the Ling Shu (see below), or especially internal pathogens, which are created cr eated by the unexpr unexpress essed ed emotio emotions. ns. The latte latterr belie belief f approaches that of the psychoanalytic schools discussed above. Transformational Transf ormational Dreams
These are dreams in relation to our life curriculum, through which we learn and evolve. Based on the Daoist belief that our ming is established at the moment of conception, this life curriculum will unfold itself through the shape that our lives take and the events that we encounter. In the West, no neurohumo neurohumoral ral theories theories have have been proposed proposed for this type of dream. The Daoist tradition classifies these dreams as the “great awakening. awakening.” This third category could include the following: whic ichh futur futuree even events ts Premonitory Premonitory dreams dreams, in wh reveal themselves in symbolic form Processing dreams, in which the dreamer works out certain life issues. In the Daoist tradition, the conscious processing of the life curriculum acts as a gateway to awakening. Lucid dreaming , which is the aim and purpose of spiri spiritua tuall seek seeker ers, s, be this this in the the anci ancien entt Hindu, Hindu, Buddhi Buddhist, st, or Daoi Daoist st traditi traditions ons,, or in more contemporary teachings, such as propagated gated by G.I. G.I. Gurdj Gurdjief iefff (Gurd (Gurdjie jieff ff 1950). 1950). By becomi becoming ng consci conscious ous during during our dreams dreams,, we first take control over the flow of our lives and ultimately ultimately awaken completely from the illusion of what we consider to be this reality. The dreamer thus becomes aware of the illusory nature of dreams and of life and can hence attain free will. ●
●
●
Modern Dream Theories in Relation to Chinese Traditional Concepts
Table 5.1 Proposed classification for dream categories Proposed classification
Western neurohumoral theories
Developmental dreams: dreams dreams: dreams that help the development of the brain, the body, and the psyche
●
Ontogenesis (Marks et al. 1995): concerns the development of the Dreams that question brain that would occur during neonatal REM sleep. This could explain reality, developing the fact that babies spend over 50% of their sleep time in dreaming imagination
●
Oneiric Darwinism (Blechner 2001) or random thought mutations: dreams create new ideas through the generation of random thought mutations. Some may be rejected by the mind as useless; others may be seen as valuable and be retained
●
Emotional selection theory (Coutts 2008): for testing and selecting mental schema. Adler (Stein 2006) similarly suggested that dreams are often emotional preparations for solving problems
● Interacting dreams: dreams that help to process daily events, consolidate memory, and release suppressed emotions or pathogenic factors (self-preservation and self-healing)
Activation synthesis theory (Hobson and McCarley 1977): the sensory images and sounds are the result of random firing of neurons in the cerebral cortex during REM sleep, reorganized by the forebrain into a coherent story in which the person is most often a participant. Solms (2000) challenges this theory by suggesting that dreams are generated in the forebrain, and that REM sleep and dreaming are not directly related, but a function of many complex brain structures, thus validating Freudian dream theory
●
Reverse learning theory (Crick and Mitchison 1983): proposes dreams act to remove junk, that is, the unnecessary memories and connections from the day
●
Releasing dreams (Ferenczi 1927, Vedfelt 2002): allow the repressed parts of the mind to be satisfied through fantasy. Freud suggested that bad dreams let the brain learn to gain control over distressing emotions (Cartwright 1993). For Jung, dreams might compensate compensate for one-sided attitudes held in waking consciousness (Jung 1934, 1974, 2002).
●
Mood-regulating theory (Kramer 1993): in which dreams correct, regulate, or influence mood
●
Integrating dreams (Hartmann 1995): 1995): dreams function as psychotherapy psychotherapy
●
Allowing the opposite belief to occur, or also to express what is suppressed
Psychosomatic theory (Tsai 1995): dreams can affect mind –body interaction by simulating the sensory signals to drive the descending pathway of autonomous nerves, referred to as “ repair nerves”
●
Memory consolidation theory (Stickgold et al. 2001, Payne and Nadel 2004): linking and consolidation of semantic memories
●
Excitations of long-term memory (Tarnow 2003): suggests that dreams are ever-present excitations of long-term memory, even during waking life (as in daydreaming)
●
Continual activation theory (Zhang 2004, 2005): proposes that the function of sleep is to process, encode, and transfer the data from the temporary memory to the long-term memory
●
Fulfillment theory (Griffin and Tyrell 2003, 2007): dreaming metaphorically completes patterns of emotional expectation in the autonomic nervous system and lowers stress levels
Transformational No Western theories have been proposed dreams: premonitory dreams: premonitory dreams, processing dreams, and lucid dreaming REM, rapid eye movement.
Daoist categories of dreams
Great awakening (life is like a dream), dreams carry a portal to awakening
97
98
5 Drea Dreams ms and and Thei Theirr Sign Signif ific ican ance ce in Chin Chines ese e Medi Medici cine ne
Dreamss as Reali Dream Reality, ty, or Life as a Dream Although science as yet has no clear theory regarding the mechanisms involved in and the purpose of drea dreami ming ng,, ther theree is one one popu popula larr cons consen ensu sus, s, namely that that dreams are not reality. reality. The Oxford Dictionary defines reality as “the state of things as they they actual actually ly exist. exist.” In its its wide widest st sens sense, e, this this includes everything that is, whether or not it is observable or comprehensible. On a much broader and more subjective level, private experiences and the personal interpretation of events shape reality as seen by one individual. This is called phenomenological reality. Historically, reality was based on facts. A fact is an observed phenomenon in the natural world that is perceived as an elemental principle. It is rarely one that can be subject to personal interpretation. And yet for centuries, “facts“ such as that the earth is flat or that the sun is at the center of the universe universe dominat dominated ed man’s perce percepti ptions ons and definitions of what is real. Today, the most pertinent of these facts could be said to be the “solid ” nature of matter. Even though science explains that more than 99% of matter comprises empty space, our age-old conditioning does not allow us to perceive it other than solid. To quote from a review of A. Zee’s book Quantum Field Theory in a Nutshell: It is often deeper to know why something is true rather than to have a proof that it is true. Zee 2010
In quan quantum tum physi physics, cs, Heisen Heisenber bergg’s Un Uncert certai ainty nty Principle led the nuclear physicist Amit Goswami to assume that no reality exists independently of our own consciousness as observer. Whether this is true or not, this line of thinking brings us back to the ancient philosophical systems such as Buddhism, which state that life, as we conceive it, is but an illusion. This illusion is created by the mind, which perceives the natural phenomena and interprets them according to our sociocultural conditioning. This social framework gives a semblance of coherence and maintains mental sanity. The dream world, on the other hand, offers windows of escape into other possible dimensions, in which other realities are experienced, allowing those possibilities to slowly seep into the current
objective” reality. Leonardo Da Vinci and Jules Verne are good examples of visionaries who imagined and described the future with uncanny accuracy. The question here is whether their dreams were visions of the future, or whether they were a means of offering new possibilities or beliefs that were waiting to be materialized. In a sense, what man imagines, man can create. The debate about the mind’s capacity to create or at least influence matter is the central topic of metaphysics. metaphysics. In medicine, previously controversial phenomena such as the placebo and nocebo effects are today considered to be facts. It is now clear that the human mind has the capacity to create a disease or to miraculously heal it, although we do not yet know how to duplicate these conditions. This could be considered to be the aspect which most spiritual teachers emphasize, that is, that we create our own reality. Most Most reli religi gion ons, s, alth althou ough gh they they beli believ evee in a supreme supreme creator, creator, make make humans humans responsi responsible ble for thei theirr actio actions ns and and the the cons conseq eque uenc nces es of thos thosee actions actions.. In the Western estern tradit tradition ion,, the relati relation on between the intellect and the intuitive, the human and and the the divi divine ne (cal (calle ledd “noeti noeticc theory theory”), was explored by ancient Greek philosophers such as Plato and Aristotle, and later by Christian and Muslim mystics. In China, the three main philosophical philosophical systems—Daoism, Confucianism, and Buddhism — support a similar vision of reality, in which life is considered to be a dream. Great emphasis is therefore put on understanding dreams in order to better realize the illusory nature of life. We are living in very exciting times. Science now has the possibility to verify ancient concepts and beliefs, in particular exploring the uncharted limits of the mind ’s potentials. This could even allow mankind to take over the reins of its own destiny. After all, is this not the message and the teaching of all past visionaries, teachers, and prophets?: “
I have to destroy the old structures and build a new kingdom, powerful and splendid. Bhagavad-Gita
The Significance of Dreams in the Chinese Tradition
The Significance of Dreams in the Chinese Tradition ●
Wen, Chapter 17, paragraph 7, Qi Bo In the Su Wen explains the localization of disease and the importanc tancee of taki taking ng the the puls pulses es and and obse observi rving ng the the appearance and the colors in Chinese medicine diagnosis (face, tongue, eyes, body, urine, stool, etc.), as well as the analysis of dreams. Qi Bo further associates certain dream topics to specific disharmony patterns:
●
●
●
●
and the wei qi, emerging with the hun and the po, and producing dream-disturbed sleep. When the yin is in repletion (pathogenic (pathogenic qi is in the ying level), the person dreams of wading fearfully in the Great Water (da shui). When the yang is is replete ( xie qi is in the wei level), the person dreams of Great Fire (da hua) and burning. When both yin and yang are are in repletion, one dreams of massacres. When the upper regions are in repletion, one dreams of flying. When the lower parts are replete, there are dreams of falling. Extreme hunger produces dreams of possession; in a state of satiety, the person dreams of donation.
Dreams of fire
Signify yang repletion yang repletion
Dreams of a large body of water
Signify yin repletion yin repletion
Dreams of mutual destruction
Signify yin and yin and yang yang repletion
Dreams of flying
Signify repletion above
Dreams of falling
Signify repletion below
Drea Dreams ms of crow crowde ded d plac places es
Rela Relate te to short short gu gu (worms) (worms)
Anger and irritability
Liver qi repletion repletion
Dreams Dreams of fights, fights, argumen arguments ts
Relate Relate to long long gu (worms) gu (worms)
Anxi Anxiet etyy, fear, ar, cryi cryin ng, flyi flyin ng
Lung ung qi repletion repletion
Dreams of anger
Relate to the liver
Laughter, fear, awe
Heart qi repletion repletion
Drea Dreams ms of cryin crying, g, sorr sorrow ow
Rela Relate te to the the lung lungss
Musi Music, c, sing singin ing, g, or a heavy heavy body body
Sple Spleen en qi qi repletion repletion
Pelvis, Pelvis, sexual dreams, loose spine
Kidney qi qi repletion repletion
In Chapter 80 of the Su Wen, the dream topics are associated with more specific zang zang fu dysfunctions, and more precisely the state of vacuity/deficiency of the zang yin organs:
●
The dreams listed below are specifically related to zang fu f u repletion (Table 5.2):
In the second paragraph of Chapter 43 of the Ling Shu, the significance of a dream is related to zang fu vacuity ( vacuity (Table 5.2) and xie qi:
Dreams of flowers, fragrance fragrance
Signify liver vacuity vacuity
Dreams of white objects, bloody battles
Signify lung vacuity
Mountains, impressive heights, mounds, fire, oppressive smoke
Qi vacuity vacuity with xie with xie qi in in the heart
Dreams of raging fires, explosions
Signify heart vacuity
Flying, losing one’s footing, strange metallic or golden objects
Qi vacuity vacuity with xie with xie qi in in the lung
Dreams of starvation, construction, buildings
Signify spleen vacuity
Trees, forest, plants, mountains
Qi vacuity vacuity with xie with xie qi in in the liver
Dreams of drowning, swimming
Signify kidney vacuity
Ruins, mounds, swamps, fog, wind, rain
Qi vacuity vacuity with xie with xie qi in in the spleen
Precipice, looking down into empty space, immersion or drowning in water
Qi vacuity vacuity with xie with xie qi in in the kidney
Wandering, traveling
Qi vacuity vacuity with xie with xie qi in in the bladder
Large meals of food and drink
Qi vacuity vacuity with xie with xie qi in in the stomach
Foreign lands and rice fields
Qi vacuity vacuity with xie with xie qi in in the large intestine
Chapter 43 of the Ling Shu ( Zan Xie Fa Meng , or “Repletion of Evil [Pathogenic] [Pathogenic] Qi and the Manifestation of Dreams”) is entirely dedicated to dreams. In this chapter, Qi Bo gives the following explanations: When the xie qi penetrates the body, it does not yet have a fixed location. It will replete the zang fu without residing in them, following the ying ●
99
100 100
5 Drea Dreams ms and and Thei Theirr Sign Signifi ifica canc nce e in Chin Chines ese e Medi Medicin cine e
Crowded places, meeting of many Qi vacuity vacuity with xie with xie qi in in people, busy roads, crowded cross- the small intestine roads Arguments, struggling with choices Qi vacuity vacuity with xie with xie qi in in and decisions; being emptied out, the gallbladder dried out; implication of self-destruction, suicide
Qi Bo further indicates a supplementing method for the above conditions. The follo followin wingg dream dreamss indica indicate te the physi physical cal location of the xie qi:
●
●
●
To take account of influences from shamanistic (oracle (oracle bones), bones), philosop philosophica hicall (Confucia (Confucianism nism),), and religious (Daoism and Buddhism) beliefs To evaluate not just the dream, but also the state upon awakening from the dream To correl correlat atee simila similariti rities es between between the dream dream themes and events and experiences involving stress, shock, and trauma
san fa) The The thre threee meth method odss of drea dream m anal analys ysis is (san include an analysis of: The dream itself The state of the person upon awakening awakening The awake state correlations: the factors that influence dreams ( san yin), that is: – Environmental factors – Cultural factors – Constitutional factors ● ●
Sexual dreams, relations
Xie qi in in the genital region
Beheading, sensation of being leaderless
Xie qi in in the neck area
Incapacity to walk, walking in circles; dwelling in a cave
Xie qi in in the lower limbs
Rites, prayer, prostration
Xie qi in in the upper and lower limbs
Loss of urine and stool
Xie qi in in the bladder and rectum
●
According According to Master Yuen, there are five f ive categories of dreams that should not be interpreted: Dreams after going to sleep in a stressed or emotional state Dreams after going to sleep with distressing thoughts Dreams with a great sense of danger (as interpretation may reinforce the sense of danger) Interrupted dreams (as there is no sense of conclusion) Partially forgotten dreams ●
●
●
Common Dream Interpretations and Therapeutic Strategies Based on the Discussions and Commentaries on Sleep and Dreams by Master Yuen
●
●
According According to Master Yuen, it is important in dream interpretation: Table 5.2 Dreams and their significance in relation to the zang fu Zang
Heart
Spleen
Lung
Kidney
Liver
Shi /excess/ /excess/ repletion
Laughter, fear, awe
Music, singing, a heavy body
Anxiety, fear, crying, flying
Loose spine, sexual dreams
Anger, irritability
Xu/deficiency/ Xu/deficiency/ vacuity
Raging fires, Starvation, White or metal oppressive smoke, building, ruins, objects, battles, explosions mounds, swamps, precipices fog
Drowning, swimming
Flowers, plants, trees, fragrance, mountains
Fu
Small intestine
Stomach
Large intestine
Bladder
Gallbladder
Xu/deficiency/ Xu/deficiency/ vacuity
Crowds, busy roads
Larg Large e meal mealss
Fore Foreig ign n land lands, s, rice fields
Wandering, Wandering, travel travel Arguments, Arguments, decisions, self-destruction
Common Dream Interpretations
Dreams of Fear/Danger/Threat = Kidneys
●
when bled. It is also indicated in nightmares in the premenstrual phase or prior to labor due to blood stasis.
General Concepts
Dreams of fear, danger, and threat represent life as a struggl strugglee for for surviv survival al.. This This idea idea is intima intimate tely ly related to the ren mai and du mai. The ren mai in particular, with its need for bonding or to be loved, manifests in dreams of danger in which there is no one to help or to support. It can also manifest in dreams of abandonment. In such cases, use lie que LU-7for ren mai, or hou xi SI-3for du mai. Dreams with feelings of being “frozen” or the inability to avert the threat can be associated with the jing bie. In such cases, use wei zhong BL-40, BL-40, yin gu KI-10, and tian zhu BL-10. Consider the size of objects, people, and animals and the color of the dreams. Black-and-white Black-and-white dreams denote a kidney pattern, whereas dreaming in color indicates a heart pattern, usually heart blood vacuity. vacuity. Take note of what or who is the predator. If it is a known person, this relates to blood, indicating the use of chong chong mai. If an unknown individual, a stranger, a ghost, or a villain is involved, volved, then phlegm is the cause, in which case ren mai or yin qiao mai (motility or stepping vessels) are indicated. Are there any threatening objects, such as a knife, teeth, or claws? If so, this indicates xie qi, hence the use of the jing -well -well points. Ask the dreamer about the sensation experienced upon awakening. awakening. Did the dreamer feel anxiety, dread, a feeling of being startled, hatred (often of someone they know), or a sense of eeriness around them? This indicates the use of gui points, such as yin bai SP-1 or jian shi PC-5. Other General Points Indicated in Fear Dreams ●
●
●
Yong quan KI-1 stabilizes the shen, and is used
for fright wind, very visual dreams, poor memory, that is, poor recall of events, loss of appetite, loss of desire for life or food, and “running piglet” syndrome (panic attacks). Tai xi KI-3 is used where there is a sense of lack of resources in the dream (lack of yin), for dreams related to the ears, for auditory dreams, for dreams of the voice box and asthma, and for dreams of shortness of breath. Both KI-1 and KI-3 promote urination and defecation (constipation could be causing the nightmares).
Zhao hai KI-6 clears heat and calms the shen
Common Traditional Traditional Chinese Medicine Kidney Patterns Causing Fear Dreams Liver Blood Not Nourishing Kidney Jing Kidney Jing
This is common among children. It can also manifest physically as bed-wetting. There are bluish tang area lines on yin tang area EX-HN-3, indicating liver blood vacuity. Use yong quan KI-1, tai xi KI-3, zhao hai KI-6, tai chong LR-3, LR-3, qu quan LR-8 (blood): This This patt pattern ern will will produ produce ce dream dreamss of being being attacked by a person, animal, monster, or object, with the intent to to harm or kill the dreamer. dreamer. There will be dreams of feeling threatened and not “knowing” what to do, with no sense of “direction” or control. The sense of loss of control involves the heart (liver (liver blood not nourishing the heart). In self-driven anger resulting in dreams with themes of danger or violence toward the self, use da dun LR-1, yong quan KI-1, tai xi KI-3, zhao hai KI-6. ●
●
●
●
Kidneys Not Grasping Lung Qi Lung Qi
Here the dreams do not involve an attacker, but instead injury, harm, threat, or death from an accident or illness. These dreams often occur during the onset of an illness illness in oneself or those those around around one, and are associated with one ’s inability to accept the disease, with fears of the illness. Lung qi remain remainss on the exteri exterior or to protec protect, t, defend, and guard with a sense of hypervigilance (as in autoimmune diseases). Consider the individual in the dream that is ill (child, elderly, middle-aged, the transitions of life as in cycles of 7 and 8 years), as they may represent the dreamer’s inability to accept a certain stage in their life. It is said that po holds on to the past (the person is unable to breathe in). These cycles concern the yin and yang wei mai . A particular trauma or difficulty that has occurred at a certain period of life will bring about a sense of lack of completion of that stage, which manifests itself in dreams. There might be asthmatic manifestations upon waking.
101
102 102
5 Drea Dreams ms and and Thei Theirr Sign Signifi ifica canc nce e in Chin Chines ese e Medi Medicin cine e
The yin wei mai deals with these life passages. The yin wei points represent these stages: zhu bin KI-9 represents a new beginning; the transitional stages are represented by fu she SP-13, da heng SP SP15, and fu ai SP-16; and the ending, with its sense of completion, is signified by qi men LR-14. Kidney Qi Kidney Qi or Yang or Yang Vacuity Vacuity
Dreams of death, often from neglect, withdrawal, suffo suffocat cation ion,, smolde smoldering ring fires, fires, or confin confineme ement nt occur. Often there is also some manifestation of sleep-walking (an attempt to break through the confinement). In such such case cases, s, use use dai (girdling vessel) vessel) dai mai mai (girdling together with shen shu BL-23, zhi shi BL-52 both with moxa. Such dreams can involve an inability to feel, reawakened, reawakened, renewed or restored (so the person is very tired t ired upon waking).
For example, for a nightmare involving involving fear and loss (kidney) and a natural calamity such as a blizzard (water), use yong quan KI-1 with bu lang KI KI22. Dreams are often influenced by severe environmental factors challenging the yuan qi, hence the fear. This may also involve the kidney and bladder jing bie, with their pathways looping around the abdomen and the chest. In this case, the dream pattern will be recurring, and wei BL-40, yin gu KI-10, and tian zhu BL-10 zhong BL-40, should be added. Nightmares are often associated with intense and overwhelming emotions, or pain and suffering. Consider what is at risk, and whether an escape route or protection is available. If there are possible solutions, help, or escape in the dream, this denotes that sufficient kidney qi is still available. ●
●
Dreams of Home/Property/Territory/ Boundaries/Valuables Boundaries/Val uables = Spleen
Heart and Kidneys Not Harmonized ( San ( San Jiao) Jiao )
Dreams of calamities, wars, battles, bombs, explosions, famine, nuclear explosions, disasters, annihilation, or chaos from natural causes occur. These dreams are interpreted in relation to the five types of pathogenic factor: Dreams of tornados, typhoons
Wind
Dreams of forest fires, volcanic volcanic eruptions eruptions
Fire
Dreams of flooding, flooding, tidal waves, waves, tsunami tsunami
Dampness Dampness
Dreams of drought
Dryness
Dreams of blizzards
Cold
General Concepts ●
●
These dreams involve the values that we attach to our possessions, treasures, or property. The destruction of these possessions is from either fire (which evokes stomach heat), water (evoking spleen dampness), or other natural causes (but not as severe as the disasters cited in the fear dreams, as in the case of the heart and kidney not in harmony). These dreams may involve the kidneys when the dreamer is attempting to save others or deal with fear involving escape or destruction. Consider what has been destroyed, stolen, or lost.
Here, the use of the kidney points on the chest as described in the Su Wen are indicated. These chest shu points are all situated on the chong mai:
●
KI-27
Shu fu
General Points for Spleen Patterns
KI-26
Yu zhong
Metal
For dr yness
KI-25
Shen cang
Fire
For heat and fire
KI-24
Ling shu
Wo Wood
For wind
KI-23
Shen feng
Ear th
For dampness
KI-22
Bu lang
Wa Water
For cold
General shu General shu point point
●
●
Yin Yin bai bai SP-1 SP-1 stabilize stabilizess the shen, is used for excessive dreaming (with li dui ST-45), retreat-
ing from the world, melancholia, melancholia, grief, frequent sighing, or a sensation of something sitting on one’s chest. associations (one Da du SP-2 is used for thought associations thought leading to another), a racing mind or heart, obsessive obsessive thinking, and excessive excessive dreaming, and it resuscitates yang .
Common Dream Interpretations
●
●
Gong sun SP-4 deals with judgment and values, and value given to property. It also rectifies qi
in relation to guilt or praise. San yin jiao SP-6 is the harmonization point (between the spleen, liver, and kidney), it regulates the middle burner, regulates the qi, blood, and jing , expels wind–dampness, and is used for anuria and nocturia.
Common Traditional Traditional Chinese Medicine Spleen Patterns Causing Loss of Property Dreams
Spleen Qi Spleen Qi Sinking Sinking ●
●
●
●
Spleen Qi Spleen Qi Vacuity Vacuity ●
●
●
●
●
●
Dreams involving the inability to maintain and secure one’s boundaries, property, or possessions, suggesting the concepts of value, worth, and ownership, indicate the involvement involvement of the postnatal qi, hence the use of zhong zhong wan CV-12. Consider what is destroying the property or who is stealing from you. A family member indicates the involvement of the kidney (water insulting earth); a stranger involves the liver (wood destroying the earth). If the destruction is caus caused ed by a cala calami mity ty,, then then fire fire indi indica cate tess stomach heat, water indicates spleen dampness, drought stomach yin vacuity, and a blizzard spleen yang vacuity. vacuity. Note the size or condition of the object. The size indicates the amount of phlegm; the age signifies chronic phlegm. Also, if a certain room in a house has been damaged or destroyed, there is a correlation between the room and the body. In these cases, supplement the yuan point of the related organ/room. Is the age of the object a reflection of the dreamer’s age (cycles of 7 or 8 years)? This will indicate the addition of yin yin wei mai points
Dreams Dreams of a destroy destroyed ed kitche kitchen n
Signif Signifies ies the stomach stomach
Dreams of a destroyed destroyed living room
Signifies Signifies the spleen
Dreams of a destroyed destroyed bathroom bathroom
Indicates Indicates the bladder
Dreams Dreams of a destroy destroyed ed bedroom bedroom
Indica Indicates tes the kidney kidney
Drea Dreams ms of a dest destro roye yed d libra library ry
Sign Signif ifie iess the the splee spleen n
Drea Dreams ms of a dest destro roye yed d garde garden n
Indi Indica cate tess the the live liverr
●
●
This often occurs when first starting to fall asleep, and produces an anxious rapid descent, or dreams of dropping. It can also follow a trauma from a major disappointment. Dreams of sinking and falling with no support or control, or after climbing to great heights, are quite common among the elderly. These dreams may originate from insecurities (kidney vacuity) or may indicate that a situation, such as health or finances, is changing for the worse. Cons Consid ider er wh whet ethe herr the the pati patien entt is afra afraid id of heights, being in front or on top, being too close to the edge (liver overacting on the spleen), or being knocked off a position of grace or of power, and whether there is anything to cushion or to support the fall. If there is no support, there is kidney vacuity, in which case use di ji SP-8 and add ran gu KI-2. You may need to ask what is seeking attention, what is letting the person down, or what the dreamer is falling from: a mountain signifies the lung, a boat represents the kidney, a car signifies the liver, and so on. These dreams indicate the organ causing spleen qi sinking.
Spleen Vacuity with Dampness ●
●
Dreams of drowning or being submerged, or of being buried in the ground due to being overwhelmed, denote excessive dampness. Dreams involving a sense of hopelessness and of being stuck, or of having a hard time staying up or afloat. also denote excessive dampness.
In such cases, use yin ling quan SP-9, moxa yin bai SP-1, da du SP-2, gong sun SP-4, san yin jiao SP-6, and yin ling quan SP-9. Dreams of Control/Direction/Movement/ Navigation = Liver General Concepts ●
These dreams involve the malfunction or breakdown of a necessity or instrument, a weapon (for (for surviv survival) al),, a machin machinee (for (for product productio ionn or
103
104 104
5 Drea Dreams ms and and Thei Theirr Sign Signifi ifica canc nce e in Chin Chines ese e Medi Medicin cine e
●
●
●
●
●
communication, such as a telephone), or a device or tool (to complete a task), or in general anything that prevents the person from reaching their completion or final f inal destination. Dreams may have themes resulting in an inability to provide a smooth flow f low or connection. Means of transport, for example bicycles, cars, carts, or horses, may be involved. There here is a furt furthe herr analo nalogy gy betw betwee eenn the the mechanical parts of the vehicle and the physical body. For example, the windows denote the eyes, the wheels signify the limbs, the engine is suggestive of the heart, the carburetor signifies the lung, and the cooling system signifies the triple burner. The notion of the ability to navigate, to steer, or to command (control of qi) and the ability to come to a halt, for example being able to brake, signifies liver controlling the spleen and stomach. Consider who is driving, and the size and condition of the vehicle. An old car signifies a longstanding blood stasis. Is the vehicle moving in the direction of choice or is it going the wrong way (counterflow qi)? What are the view and the landscape?
cate the stomach. In such cases, use the lower he (sea) points. Liver Blood Stasis ●
●
Liver Blood Vacuity ●
●
●
General Points for Liver Patterns ●
●
Xing jian LR-2 regulates regulates qi, clears heat, and
deals with movement, resentment from taking on responsibility, and true heat with false cold (cold extremities with heat in the middle). Tai chong LR-3 LR-3 is used for all liver patterns and areas (eyes, head, chest and flanks, genitals, medial legs).
●
Common Traditional Traditional Chinese Medicine Liver Patterns Causing Control Dreams Liver Qi Liver Qi Stagnation Stagnation
●
Dreams may involve the failure of an instrument ment or someth somethin ingg being being jammed jammed or stuck, stuck, causing a feeling of frustration. Consider the role and function of the tool, as it may correlate with a specific part of the body that is breaking down. For example, a toilet that does not flush represents the large intestine or bladder. A malfunctioning kitchen could indi-
There may be dreams of poor performance or preparation, of difficulty meeting a challenge, of missed opportunities, or of missed means of transport—such as a train, a plane, an elevator, a boat—that will allow one to reach a destination tion,, all all caus causin ingg reac reacti tive ve frustr frustrat atio ion. n. Such Such dreams are frequent in adolescence or in the premenstrual phase. Cons Consid ider er wh what at the the perf perfor orma manc ncee rela relate tess to (work or school?). What is the role of the person in the dream? And who is “ judging” the performance? Is time an issue? Consider what the opportunity, chance, connection, destination was, and the factors that prevented the patient from attaining the goal or getting somewhere. These dreams may stem from low self-confidence. For kidney yin vacuity resulting in liver blood vacuity, use qu quan LR-8.
Liver Yang Liver Yang Ascending Ascending ●
●
Dreams involve an inability to get around, with no sense of direction, a lack of control, an obstaobstacle along the way, or a vehicle about to crash or collapse. These dreams are common when individuals are physically or emotionally incapacitated. incapacitated. Use yin lian LR-11 and li gou LR-5.
Dreams involving excessive yang activity activity include those of running about, dancing, climbing, flying, and crowds. In such cases, use bai hui GV-20. Dreams of Vulnerability/Exposure = Lungs
General Concepts ●
●
Dream themes involving the skin and clothing, lack lack of prot protec ecti tion on,, or bein beingg nak naked or too too exposed relate to the lung. These dreams can also involve being caught or exposed from hiding.
Common Dream Interpretations
●
●
There may be feelings of being less “perfect” or “complete,” or perhaps overly protected or surrounded, or even feeling feeling suffocated; skin conditions (being self-conscious of one ’s looks) also appear in such dreams. Consider who is exposing the dreamer and who notices the “ embarrassment” or “ shame.” What are they they exposi exposing ng?? Consid Consider er the settin settingg or environment.
●
●
result of the deceased person’s po visiting the dreamer, to help process some unfinished matters. This kind of dream corresponds to the lungs. Difficulty with someone ’s death due to a violent death, non-acceptance, or guilt will often provoke these dreams. Gui can serve as “ spirit guides” or the return of the deceased to inspire or command (due to their perceived authority).
General Points for Lung Patterns General Points for Phlegm Patterns ●
●
Tian fu LU-3 for excess tearing from sadness,
dizziness, stress asthma, ghost talk (talking to oneself) Yu ji LU-10for heat in the lung, and blood heat with bleeding
●
●
Common Traditional Traditional Chinese Medicine Lung Patterns Causing Vulnerability Dreams Exogenous Pathogenic Factors ●
●
There may be vulnerability to nature or dreams of nature, and a personal aversion to or enjoyment of the scenery. Dreams of flowers and landscape often manifest change or metamorphosis toward “ beauty.” In such cases, add he gu LI-4 to the general points tian fu LU-3 and yu ji LU-10.
●
●
●
Lung Qi Lung Qi or or Lung Yin Lung Yin Vacuity Vacuity ●
For dreams of nakedness and being exposed with difficulty connecting with others, supplement chi ze LU-5 with moxa.
Shen men HT-7 quiets and calms the shen, and
is used for poor memory, Alzheimer disease, withdrawal, withdrawal, vexation, vexation, agitation, and sleep-talksleep-talking. Xi men PC-4 is used in an emergency. It quiets the shen, rectifies qi , and deals with guilt, fear, fright, sadness, melancholia, and claustrophobia. Nei guan PC-6 deals with guilt and shame. It rectifies qi, digestive issues with stasis, eating disorders, fright wind, convulsions, and poor memory. Da ling PC-7 PC-7 quiets the shen, opens the chest, and deals with fear, grief, and overanxiety or laughter. According to Liu Wansu (1120 –1200, founder of the “ school of cooling ”), to fully release an emotion there should be fluid discharge, such as crying.
Common Traditional Traditional Chinese Medicine Dream-Shock Patterns Causing Night Terrors Phlegm Harassing the Heart
Dreams of Night Terrors/Ghosts = Accumulation of Phlegm
●
General Concepts ●
●
Gui zha (ghost oppression) involves the sensa-
tion of a weight on the chest, which often feels like someone is sitting on top of the chest. This may block the production of qi (growth) and blood (space). The patient patient may dream of the deceased. deceased. In the Chinese tradition, this kind of dream is the
●
●
●
This is associated with harassment from the deceased, which is often due to guilt (e.g., did you do all you could have, are you responsible for their death, were you there at their passing?). Rarely do we feel that a ghost will harm us unles unlesss we feel feel some some respon responsib sibili ility ty for for their their death. At worst, the dream can provoke suicide ( “ join me”). Use feng long ST-40for ST-40for hot phlegm.
105
106 106
5 Drea Dreams ms and and Thei Theirr Sign Signifi ifica canc nce e in Chin Chines ese e Medi Medicin cine e
●
Phlegm Misting the Mind ●
●
This is associated more with a sense of unfinished business (perhaps due to the age of the dreamer), unfinished words, or warnings. It can be associated with a part of the dreamer ’s own life that they have not been able to let go of, for example a child ’s death, as well as abortion.
●
The pattern often evolves around the inability to acce accept pt some someon onee’s deat death, h, with with worki orking ng through grief. Use tian fu LU-3for those who often wake up with puffy eyes and for the “floating ghost ” (a sensation sensation of somethin somethingg hovering hovering around around)) (Table 5.3).
Table 5.3 Dream significance inspired by the Meng the Meng Zhan Yi Zhi (Analysis and Conclusion of Dreams), Dreams) , as commented on and complemented by Master J. Yuen Dream content
TCM patterns
Point selection
Nightmares: fear, danger, threat
Kidney qi Kidney qi or jing
KI-1, KI-3, KI-6
Being attacked, loss of control
Liver blood not nourishing the heart
Add: LR-8, HT-7
In children with enuresis
Liver blood not nourishing kidney jing kidney jing
Add: LR-3, LR-8
Self-directed violence
Liver blood not nourishing jing nourishing jing
Add: LR-1
Harm from accident or illness
Kidney not grasping lung qi lung qi
Add: LU-5, KI-22
Death dreams
Kidney qi qi or or kidney yang vacuity yang vacuity
Add: BL-23, BL-52, dai mai
Calamities, wars, explosions:
Heart and kidney not in harmony
Add: KI-27
— Tornado, Tornado, typhoon
— Wind Wind
Add: KI-24
— Fires, Fires, volcanic eruptions
— Fire Fire or heat (fire)
Add: KI-25
— Flooding, Flooding, tidal waves
— Dampness Dampness
Add: KI-23
— Drought Drought
— Dryness Dryness
— Blizzards, Blizzards,
cold
— Cold Cold
(wood) (earth)
(metal)
(water)
Add: KI-26 Add: KI-22
Recurring dreams of fear
Kidney and bladder jing bladder jing bie
Add: BL-40, KI-10, BL-10
Loss: property, boundaries, valuables
Spleen qi Spleen qi vacuity vacuity with dampness
SP-1, SP-2, SP-4, SP-6
Destruction, loss of possessions
Spleen qi Spleen qi vacuity vacuity
Add: CV-12
Falling or sinking
Spleen qi Spleen qi sinking sinking
Add: GV-20
Falling with no support
Spleen qi Spleen qi sinking sinking with kidney qi qi vacuity vacuity
Add: SP-8, KI-2
Drowning or being buried
Spleen qi Spleen qi vacuity vacuity with dampness
Add: SP-9
Control: direction, movement
Liver qi Liver qi stasis stasis or counterflow
LR-2, LR-3
Failure of a tool, blockage
Liver qi Liver qi stasis stasis
Add: LR-14
Obstacles, no sense of direction
Liver blood stasis
Add: LR-11, LR-5
Missed opportunity, bad performance
Liver blood vacuity
Add: LR-8
Excessive activity, crowds
Liver yang Liver yang rising rising
Add: GV-20
Vulnerability: exposure, shame
Lung qi Lung qi or or lung yin lung yin
LU-3, LU-10
Nature, vulnerable to the elements
Lung qi Lung qi vacuity vacuity with xie with xie qi invasion invasion
Add: LI-4
Nakedness, exposure
Lung qi Lung qi and and lung yin lung yin vacuity vacuity
Add: LU-5
Night terrors: ghost dreams
Accumulation of phlegm
HT-7, HT-7, PC-4, PC -6, PC-7
Harassed by the dead, guilt
Phlegm harassing the heart
Add: ST-40
Unfinished business, nonacceptance
Phlegm misting the mind
Add: LU-3
The Importance of Reintegrating Dream Interpretation into Chinese Medicine
The Importance of Reintegrating Dream Interpretation into Chinese Medicine Over the past century, Chinese medicine has been progressively progressively copying the Western Western scientific materialistic model, which has resulted in a brand of Chinese medicine misleadingly called “Traditional Chinese Chinese Medicine Medicine” or “TCM,” a term that was coined in the late 1940s (Taylor 2005). During the Cultural Revolution, all references to the psychospiritual dimensions of the human being were discarded as “old superstitions.” And yet the ancient texts describe the interaction of the emotions and the body. The Ling Shu confirms that shen and qi rule and shape matter: Heaven Heaven comes first, Earth is second. Ling Shu
The arrival of Buddhism in China further reinforced the concept that the source of all suffering was to be found in the mind, specifically in the manner in which we perceive reality: We are shaped by our thoughts, we become what we think. The Buddha
In the 12th century, Chen Yan clearly classified the causative factors of disease into three categories (san yin), introducing the two t wo opposites of climatic and physical causes, and internal or emotional factors tors (Frue (Frueha hauf uf 2004 2004). ). In an exce excell llen entt artic article le entitled “All Disease Comes From the Heart, ” Heiner Fruehauf elaborates on the “Pivotal role of the emotions in Classical Chinese Medicine ” (Fruehauf 2004). He further underlines the Nei Jing quote regarding the “ superior physician, physician,” who treats disease when it has not yet structurally manifested, whereas an “inferior physician” has to treat disorders that have already progressed to the physical body ( Su Wen, Chapters 2 and 26; Ling Shu, Chapter 55). 55). Chines Chinesee medici medicine ne has emphas emphasize izedd the notion of “the mind and the emotions affecting the the body body,,” somet somethin hingg Western estern medici medicine ne has has termed “psychosomatics.” Dreams have been used in Chinese medicine not only to analyze zang fu disharmony patterns, as in the Su Wen and Ling Shu, but also for explor-
ing psycho-emotional disturbances, as in the Meng Zhan Yi Zhi. In Chapter 2, we explored the Chinese notion of how the shen, through the auspices of the hun, releas releases es retain retained ed pathog pathogeni enicc energi energies es throu through gh dreams dreams.. Western estern psycho psycholog logy, y, mainl mainlyy owing to the pioneering work of Freud and Jung, offers us powerful tools for analyzing dreams and unders understan tandin dingg the underl underlyin yingg and suppre suppress ssed ed emotions. If the spirit is at peace, the heart is in harmony; when the heart is in harmony, the body is whole; if the spirit spirit becomes becomes aggrav aggravate ated, d, the heart heart wavers, wavers, and and when when the the heart heart wave wavers, rs, the spir spirit it becom becomes es injur injured; ed; if one seeks seeks to heal heal the the phys physic ical al body body,, therefore, therefore, one needs to regulate the spirit first. Liu Zhou, 6th century philosopher philosopher
In this manner, a therapist aspiring to become a superior physician has to treat the disease at its most subtle level, that is, the level of the shen, the mental and emotional dimensions. There are two possible approaches to treating the internal causes of diseases (the emotional patterns): shen and qi. Based on the principle that the shen leads qi, and qi affects the shen, one can better understand the first approach, the emphasis that Confuc Confucian ianism ism,, Daoism Daoism and and Buddhi Buddhism sm place place on mental discipline and the “cultivation of the self.” The second approach, that is, modulating qi to affect the shen, is the domain of acupuncture. In Chapter 3, we explored acupuncture points and some strategies for dealing with emotional issues. The Chinese medical tradition is full of shamanic practices, as reflected in the names of many acupuncture points containing shen, ling (soul), (soul), or gui (see Appendix 1). Sun Si Miao even described a protocol for releasing ghosts and treating possessions, called “The 13 Ghost Points” (see Appendix 1) It is worth mentioning a modern-day protocol attributed to Worsley called the “Seven Dragons,” which has two variants, for internal or external demons. The origin of these point combinations is unknown, but they have the benefit of some 40 years of clinical experimentation (see Appendix 1, p.129). In summary: Based on the rich Chinese medical tradition (explored above) and the contributions of mod●
107
108 108
5 Drea Dreams ms and and Thei Theirr Sign Signifi ifica canc nce e in Chin Chines ese e Medi Medicin cine e
●
●
ern psycho psychoana analy lytic tic schoo schools, ls, it could could be deducted that dreams offer an excellent doorway to the hidden dimensions of a disease process. Chinese medicine has given a central role to the emotions in the genesis of disease (see above). In Chapter 2, we have explored the impact of emotions on the shen, especially when they are not expressed. Also the role the hun plays in helping to liberate these emotional pathogenic factors through dreams. Therefore, the dream langua language ge can be an inva invalua luable ble help for for the patient in order to get to grips with this suppressed part of the psyche, as it has been suggeste gestedd by the psycho psychoana analy lytic tic school schoolss (Jung (Jung 1934, 1974, 2002; Garfield 1988; Faraday 1990; Freud 1994; Sullivan 1998; Barasch 2000). Many psycho-emotional patterns have deeper roots, and go back to early physical or psychological trauma.
It is very important for patients to be able to participate in their healing process by actively engaging in exploring the problem with their therapist. A Daoist saying expresses this idea: To treat a problem you have to first name it, then own it. The therapist can use dream symbolism, especially how the person felt during or after the dream, dream, to identi identify fy the main main messa message ge or issue issue.. Science has established that dreams produce certain biophysical changes in the body (see p.95) and and that that the the same same chan change gess coul couldd resu result lt from from appropriate visualization techniques (see Appendix 2). The The West offers offers modern modern psycho psychothe therap rapeut eutic ic approaches, including many that use dream work and guided visualizations. In combination with the ancient ancient treasures treasures of classical classical Chinese medicine medicine and acupuncture, they could provide a most formidable healing technique (see Appendix 2).
109
6 Cl Clin inica icall Eva valua luati tion on
The follo followin wingg study* study* was was desig designed ned almos almostt 20 years ago and was funded by the Swiss National Science Foundation. Today, if I had to redo the study, I would certainly not propose the same structure. At the time, a comparative statistical study of two groups —one treated with individualized acupuncture and the other receiving sham treatments—was considered scientifically relevant. relevant. But today, placebo effects are well acknowledged, and it is an established fact that the therapist ’s expectations have a quantifiable effect on the outcome of the therapy. As we cannot propose a double-blind study involving acupuncture, the methodolo ology used used in the the stu study is some somehhow now now obsolete. Further, proposing only three to five sessions of treatment was highly insufficient for the patients who were willing to undergo the therapy, as most had suffered from insomnia for between 15 and 20 years. With hindsight, I think it would have been more appropriate to conduct a study simply on the effects of acupuncture on insomnia on a much larger population, and to later make a compar compariso isonn with with result resultss obtain obtained ed using using other other methods. Most clinical trials and studies have been based on a subjective evaluation of sleep. Objective sleep analy analysis sis using using polys polysomn omnogr ograph aphyy has demon demon-strated an interesting point, namely that there is quite frequently a discrepancy between the objective and subjective evaluations of sleep. The validity of this finding was confirmed by many of the pati patien ents ts wh whoo were were anal analyz yzed ed in the the foll folloowing wing study. This discrepancy stresses the importance of evaluat evaluating ing sleep not only subjectivel subjectively, y, but also objectively.
Clinical Study on Acupuncture and Insomnia In order to assess the effectiveness of acupuncture using the diagnostic principles outlined above, a research project was set up involving 40 patients suffering from different types of primary insomnia. In this study, the treatment was limited to three to five sessions within 4 weeks. Obviously, much longer treatment is necessary in the case of chronic and resistant insomnia. After taking an in-depth patient history, the first session consisted of treating the affected “synchronizer.” In most cases, the yin qiao mai ( yin motility vessel) was involved, and therefore the following points were used: zhao hai KI-6, jiao xin KI-8, and jing ming BL-1 BL-1 or yin tang EX-HN-3. EX-HN-3. If both jiao xin KI-8 and fu yang BL-59 BL-59 were painful, zhao hai KI-6 was used with the reinforcing technique, and shen mai BL-62 with the reducing technique, together with jing ming BL-1 BL-1 or yin tang EX EXHN-3. In the subsequent sessions, other synchronizers were treated, as were the underlying zang fu (organ) disorders (see previous chapters). Particular emphasis was put on the palpation of the five outer bladder “spirit” points: po hu BL-42, BL-44, hun men BL-47, yi she BL-49, zhi shen tang BL-44, shi BL-52, as well as gao huang shu BL-43. As the cause of insomnia is frequently retained emotions, these points are likely to be sensitive to palpation, in which case needling with reduction technique is used. Patients
* Acknowledgements: Acknowledgements: The The study, The Effect of Acupuncture in the Treatme reatment nt of Insomn Insomnia, ia, 199 1994 4 , was was supp support orted ed by proj projec ectt no.4034–35871 of the Swiss National Science Science Foundation Foundation (Complementary Medicine). The author would like to thank Dr. Gerald Langel, the director of CENAS and co-author of the study project, Dr. K. v. Berlepsch, for his support and helpful comments throughout the course of this project, Dr. Helli Merica, for her valuable counsel, and Mr. Philippe Miserez at the CENAS laboratory, for his indispensable technical technical support.
The study included 40 patients aged 26 –60 years (22 women and 18 men) with an average age of 46. They had all suffered from difficulties maintaining sleep (waking early, more or longer periods awake during the night) for at least 3 months. In addition, several patients also had difficulties falling asleep. Secondary sleep disorders due to a severe severe physi physical cal or psychi psychiatr atric ic illnes illnesss were were not
110
6 Cli Clinical Evaluation
included, nor were cases of insomnia due to alcohol abuse, drugs, noise, and so on. Anyy medi An medica cati tion on with with seda sedati ting ng or hypn hypnot otic ic drugs had to be discontinued for at least 2 months prior to the start of the study. During the study no analge analgesic, sic, anti-inflamm anti-inflammatory atory,, or anti-hist anti-histamin aminic ic drugs were allowed; the birth control pill was, however, allowed. At the start of the study, the patients underwent a physical examination. A detailed patient history served to find out how the sleep disorder had developed since childhood and in which circumstances. In addition, a complete examination according to Traditional Traditional Chinese Medicine (TCM) was was carried out, out, includ includin ingg an intervi interview ew,, tongue tongue diagno diagnosis sis,, pulse diagnosis, and palpation of the acupuncture points. This allowed the insomnia to be classified according according to the patient ’s energy patterns. The characteristics of the two groups were as follows: Group A: average age 46.25 (standard deviation [SD] = 8.90) years; average insomnia 7.95 years Group B: average age 46.05 (SD = 10.21) years; average insomnia 6.20 years ●
●
Methodology
The The patie patients nts were were random randomize izedd to two groups groups.. Group A received personalized acupuncture treatment, while those in Group B were needled outside the channels and served as a control group. Only the treating acupuncturist knew which patient belonged to which group. The patients complete pletedd standa standardi rdized zed quest question ionna naire iress before before and after the study period, in the absence of the therapist. One polysomnographic session took place at the beginning of the study, and another 0 –3 days after the last acupuncture (or control needling) treatment. In clinical studies that investigate sleep disorders, at least two polysomnographic sessions are usually needed, after one night of acclimatization. In our study, which did not concentrate on the type of insomnia but rather aimed to compare a treated with an untreated group, one polysomnographic recording before the beginning of the treatment and one at the end of the study was considered to be sufficient.
Table 6.1 ranks
the most frequent complaints
according to group. The TCM patterns observed (several patterns being possible in the same patient) in the 20 cases treated in Group A were: Nine cases of blood vacuity Five cases of yin yin vacuity Two cases of damp –heat Elev Eleven en case casess of live liverr dish disharm armon onyy patte pattern rnss (blood or yin vacuity or qi stasis) Nine cases of heart disharmony patterns (blood or yin vacuity) Six cases of kidney disharmony patterns ( yin vacuity) ● ● ● ●
●
●
Table 6.1 Most frequent sleep complaints Complaint
Group A Group B
Frequent waking
55%
50%
Difficulty falling asleep
55%
45%
Waking up between 1 a.m. and 3 a.m.
40%
70%
Waking early (between 4 a.m. and 5 a.m.)
30%
30%
Superficial sleep
50%
40%
Frequent dreams
35%
30%
Bad dreams
30%
25%
Snoring
10%
10%
Agitation
20%
25%
Weariness on waking
50%
55%
10%
0
Somnambulism
5%
0
Paresthesia (pins and needles)
5%
0
Waking up startled
5%
0
Nocturnal sweating
5%
10%
Other complaints Impatience
Nocturnal hot flashes
10%
Hot feet
5%
Breathlessness
5%
Palpitations Hunger or thirst
10% 5%
Clinical Study on Acupuncture and Insomnia
●
Four cases of spleen/stomach disharmony patterns (stomach yin vacuity, spleen qi vacuity with dampness)
●
● ●
Protocols for the Subjective Evaluation of Sleep
● ● ●
Sleep was assessed subjectively subjectively using several several questionnaires: One questionnaire concerning the night spent in the sleep laboratory The Jenkins Sleep Questionnaire The Medical Outcomes Study (MOS): Energy and Fatigue module (MEF) The Medica Medicall Outco Outcomes mes Study Study (MOS): (MOS): Sleep Sleep module (MS) ●
●
● ●
Check-in time (which was kept as constant as possible) Total duration of sleep Duration and percentage of awakenings during the night Early morning awakening Duration of the sleep Stages 1, 2, 3, and 4 Delta activity Duration, latency, and percentage of rapid eye movement movement (REM, or paradoxical) sleep Number of sleep cycles and their duration Efficacy indices
● ●
Results
●
The last three questionnaires questionnaires were completed completed both before and after the study. Further, a sleep diary was kept for the duration of the study in order to monitor each patient ’s reactions and, if necessary, to modify the treatment. Protocols for the Objective Evaluation of Sleep
Objective Evaluation by Polysomnography
In order to evaluate objective changes in sleep quality, the variables recorded in the sleep laboratory before the acupuncture treatment (night 1) were compared with those recorded after completion of the treatment (night 2). The results are presented below in four different categories that illustrate: A1: Sleep–wake comparison A2: Orthodox sleep A3: Paradoxical sleep A4: Continuity of sleep ● ●
The patients had to check in at the CENAS sleep laboratory, near Geneva, Switzerland, at 8 p.m. A technici technician an fastened fastened 10–20 electrodes electrodes accordin accordingg to international standards. Conventional criteria accord accordin ingg to the Recht Rechtsc scha haffe ffenn and Kales Kales sleep sleep scoring manual (1968) were used with a derivation of C3-A2. Electrodes to measure eye movements were placed on the exterior canthus, while muscle tone was measured on the jaw (transverse muscle of the chin). All electrodes were noninvasive. They were fixed onto the scalp using a mixture of clay and glycerine, or were glued onto the bare skin. The signals they recorded were stored on a computer and amounted to approximately 100 megabytes of data for one night. A preanalysis was carried out online, but a final, f inal, fully automated data analysis took place in a second ond phas phasee and and enco encomp mpas asse sedd the the data data for for the the entire night. A visual control performed by the technician was was necessary in order to check for possible anomalies during the automated analysis. analysis. The following parameters were measured and stored for analysis: analysis:
● ●
Each of the following tables gives the average (X) and the standard deviation (SD) for each variable, as well as the probability ( P ) obtained from the -test. The difference between night 1 and night 2 t -test. was considere consideredd statistical statistically ly significa significant nt for all P values equal to or less than 0.05. However, since the variables do not always show a Gaussian distribution, bution, a nonpar nonparame ametric tric analy analysis sis was was also also perperforme formedd in orde orderr to valid alidat atee the the resu result ltss of the the paired t -test. -test. In the tables below, P values in parentheses indicate a significant difference only for the parametric test but not for the nonparametric test. In this case, we considered that the observed difference between the two nights was not statistically significant.
111
112
6 Cli Clinical Evaluation
Sleep–Wake Comparison (Table (Table 6.2) 6.2)
Group A. The total duration of sleep and the effi-
cacy cacy index index increa increased sed signi significa ficantl ntlyy between between the two two rec recordi ordinngs bef before ore and and afte afterr trea treatm tmen ent, t, whereas the values for latency of sleep, waking hours, and Stage 1 diminished. This is indicative of a net improvement in the quality of sleep. Theree was was no noti notice ceab able le diff differe erenc ncee Grou Group p B. Ther betw betwee eenn the the two two recor recordi ding ngs, s, poss possib ibly ly even even a shorter sleep with more hours awake. Orthodox Sleep (Table ( Table 6.3)
means no change, and a negative difference means a worsening of values. Jenkins Sleep Questionnair Questionnaire e (Tabl Table e 6.6) The Jenkins concentrates first on difficulties falling asleep then on maintaining sleep over the previous month. Each of these two questions allows six answers, which are graded from 1 to 6. The MOS Energy and Fatigue module questionnaire (MEF) also concentrates on the last month and asks, “How often during the last 4 weeks did you … ?” (Table 6.7). The MOS Sleep module questionnaire (MS) also concentrates on the previous month and asks, “How often during the last 4 weeks did you …?” (Table 6.8). ●
●
●
Group A. No comment. Group B. The amount of Stage 4 sleep was mark-
edly edly reduce reducedd in night night 2, indica indicatin tingg dimin diminish ished ed sleep quality. REM Sleep (Table ( Table 6.4) 6.4)
Group A. The significant increase in paradoxical sleep (P <0.001) <0.001) was an unexpected but very inter-
esting finding. Grou Group p B. Ther Theree was was no sign signifi ifica cant nt diff differ eren ence ce
between the results before and after treatment. Continuity of Sleep (Table ( Table 6.5) 6.5)
The differences between night 1 and night 2 are shown in Tables 6.9 and Table 6.10 for each patient and and each each ques questi tion on.. The The indi indivi vidu dual al valu values es are are totaled in the penultimate column in the table. This summation illustrates what happened to each patient in terms of the subjective assessment of his or her situation and is shown in Fig.6.1 and Fig.6.2. It goes without saying that a statistical evaluation of these values is not meaningful, but the two figures indicate a clear trend in the result. The diary kept over the entire study period and the quest question ionnai naire re concer concernin ningg the nigh nights ts spent in the sleep laboratory were used for informatio mationn purpos purposes es but were were not not system systemati atical cally ly evaluated.
Group A. The reduction in the number of changes
of sleep stage is indicative of more stable sleep and a tendency toward fewer periods awake. Group B. There were no significant changes in the
results before and after treatment. Subjective Assessment of Sleep
Three kinds of patient questionnaire questionnaire were used for the evaluation. The difference between night 1 and night 2 was taken as a qualitative indication of a change during the treatment period. The numerical values assigned to various answers were arbitrary but were chosen in such a way that value 1 was always the best and value 6 the worst. Therefore, a positive difference for night 1minus night 2 always always signifies an improveme improvement, nt, no differenc differencee
Discussion and Analysis of Results
The results of this study show that acupuncture treatment for insomnia is judged to be beneficial on both objective and subjective assessments. Following acupuncture treatment, the patients slept for longer and enjoyed better-quality sleep. The number number of wakin wakingg periods periods decrea decreased sed and their sleep was more stable, as judged by the reduced number of changes in sleep stages. The changes in sleep characteristics moved toward the norm, norm, that that is, is, the the dura duratio tionn of ortho orthodo doxx slee sleepp increa increased sed,, with with a tenden tendency cy towa toward rd prolon prolonged ged Stage 4 sleep. In summary, patients’ sleep became more restful. The increased REM sleep observed following acupuncture treatment is unexpected and interesting. Although we have no obvious explanation
Clinical Study on Acupuncture and Insomnia
Table 6.2 Sleep –wake comparison Variable
Night 1
Night 2
P
X
SD
X
SD
430.15
(46.77)
476.48
(36.70)
<0.001
Latency of sleep
20.73
(14.87)
14.83
(11.08)
0.059
Waking hours
81.68
(50.70)
43.83
(34.83)
0.001
Stage 1
28.55
(10.12)
20.73
(7.66)
<0.001
Efficacy index
84.17
(9.74)
91.60
(6.70)
0.001
6.78
(12.27)
4.68
(10.74)
0.603
15.83
(9.74)
8.40
(6.70)
0.001
460.23
(52.32)
432.60
(60.73)
(0.019)
Latency of sleep
15.20
(12.16)
14.03
(14.00)
0.634
Waking hours
52.32
(43.90)
78.80
(49.66)
0.020
Stage 1
22.65
(13.00)
22.23
(11.51)
0.883
Efficacy index
89.70
(8.82)
84.48
(9.90)
0.017
Early morning awakening
12.33
(17.54)
14.58
(20.98)
0.636
Waking hours (%)
10.30
(8.82)
15.53
(9.90)
0.017
Group A (treated) Total duration of sleep
Early morning awakening Waking hours (%) Group B (control) Total duration of sleep
Table 6.3 Orthodox sleep Variable
Night 1
Night 2
P
X
SD
X
SD
Non-rapid eye movement total
333.55
(31.19)
357.15
(28.40)
0.015
Stage 2
242.53
(42.78)
267.33
(33.68)
0.050
Stage 3
26.13
(6.99)
23.85
(10.37)
0.398
Stage 4
36.35
(18.77)
45.25
(14.52)
0.092
Delta
62.48
(21.10)
69.10
(15.75)
0.203
Group A (treated)
Group B (control) Non-rapid eye movement total
358.0
(39.90)
326.55
(50.33)
0.001
Stage 2
252.78
(53.17)
234.05
(60.97)
0.078
Stage 3
34.20
(14.17)
30.82
(17.58)
0.374
Stage 4
48.38
(35.66)
39.38
(30.48)
0.024
Delta
82.58
(47.24)
70.20
(44.81)
(0.040)
113
114
6 Cli Clinical Evaluation
Table 6.4 REM sleep Variable
Night 1
Night 2
P
X
SD
X
SD
REM sleep (total)
96.60
(22.64)
119.33
(22.86)
<0.001
Latency of REM sleep
106.0
(53.62)
99.98
(53.22)
0.567
REM sleep (%)
1.92
(4.54)
22.93
(4.38)
<0.001
Number of cycles
1.15
(1.09)
4.50
(1.10)
0.217
Duration episode stage 1
15.93
(10.71)
17.13
(12.42)
0.713
Duration episode stage 2
29.83
(18.93)
27.63
(11.22)
0.677
Duration episode stage 3
22.24
(10.82)
39.53
(14.20)
<0.001
Duration episode stage 4
27.54
(13.31)
26.09
(14.11)
0.832
REM sleep (total)
102.23
(30.14)
106.13
(27.93)
0.467
Latency of REM sleep
129.63
(74.16)
114.35
(55.55)
0.412
REM sleep (%)
19.90
(5.70)
20.71
(5.03)
0.449
Number of cycles
4.45
(1.10)
4.45
(1.19)
1.000
Duration episode stage 1
18.15
(10.23)
20.0
(11.24)
0.625
Duration episode stage 2
22.55
(12.57)
21.43
(13.12)
0.741
Duration episode stage 3
26.63
(8.97)
29.66
(11.31)
0.388
Duration episode stage 4
29.09
(15.03)
28.03
(13.87)
0.734
Group A (treated)
Group B (control)
Table 6.5 Continuity of sleep Variable
Night 1
Night 2
P
X
SD
X
SD
Number of sleep stage changes
72.0
(18.87)
56.44
(15.42)
<0.001
Total arousals
42.60
(18.70)
37.85
(22.15)
0.201
Number of sleep stage changes
65.05
(16.92)
61.50
(17.93)
0.295
Total arousals
31.60
(13.30)
34.60
(20.44)
0.423
Group A (treated)
Group B (control)
Clinical Study on Acupuncture and Insomnia
Table 6.6 The Jenkins Sleep Questionnaire “
Jenk1”: For how many days during the last month have you had difficulties in falling asleep?
Jenk2”: For how many days during the last month have you had difficulties in maintaining sleep?
Not at all
–1
–1
1–3 days
–2
–2
4–7 days
–3
–3
8–14 days
–4
–4
15–21 days
–5
–5
22–31 days
–6
–6
“
Table 6.7 The Medical Outcomes Study: Energy and Fatigue module questionnaire (MEF) “
MEFa”: Feel exhausted?
“
MEFb”: Have lots of energy?
“
MEFc”: Feel enthusiasm and vitality?
“
MEFd”: Have enough energy to do what you wanted to do?
MEFe”: Feel tired?
Never
–1
–6
–6
–6
–1
Very little
–2
–5
–5
–5
–2
From time to time
–3
–4
–4
–4
–3
Quite often
–4
–3
–3
–3
–4
Most of the time
–5
–2
–2
–2
–5
Always
–6
–1
–1
–1
–6
“
Table 6.8 The Medical Outcomes Study: Sleep module (MS) MSa: Have MSa: Have difficulties falling asleep?
MSb: Wake MSb: Wake up and could not go to sleep again?
MSc: Wake MSc: Wake up short of breath with a headache?
MSd: Sleep MSd: Sleep enough to feel rested after waking up?
MSe: Sleep MSe: Sleep as much as you needed?
MSf: Have MSf: Have difficulty in staying awake during the day?
Never
–1
–1
–1
–6
–6
–1
Very little
–2
–2
–2
–5
–5
–2
From time to time
–3
–3
–3
–4
–4
–3
Quite often
–4
–4
–4
–3
–3
–4
Most of the time
–5
–5
–5
–2
–2
–5
Always
–6
–6
–6
–1
–1
–6
115
116
6 Cli Clinical Evaluation
e r e t g p n a e r i e m t v u a A s p t l n a e t i t o a t p m r u e S p
6 . 0 1
9 3 0 7 2 3 0 8 0 3 5 2 3 0 0 1 5 9 8 6 1 1 1 1 – 2 – 1 1 1 1 1 1 1 1 1 1
f S M
2 0 1 0 1 0 1 0 1 1 1 1 1 1 1 1 1 2 0 0
e S M
1 0 1 1 1 1 2 3 1 1 1 2 1 1 0 1 0 1 3 0
–
–
–
–
–
d S M
2 1 1 1 2 0 3 3 1 1 0 0 1 1 1 1 1 2 3 1
c S M
1 2 0 2 1 0 0 2 0 1 2 0 0 0 0 0 1 2 0 1
b S M a S M e F E M
–
–
–
–
–
1 1 0 0 2 0 2 0 2 0 1 2 1 1 1 1 0 1 2 1
1 2 1 1 4 1 1 0 1 1 1 1 1 1 2 1 2 1 0 2 –
1 1 1 0 1 0 1 1 1 1 1 0 2 1 0 0 1 2 2 0
d F E M
3 1 0 0 1 1 3 1 0 2 0 1 1 1 1 1 1 1 1 0
c F E M
2 3 0 0 1 0 2 1 1 1 1 1 1 0 1 0 1 1 1 0
b F E M
2 3 1 0 2 1 2 1 1 1 1 1 1 1 1 1 1 1 1 0
a F E M
1 2 0 0 2 0 1 1 1 1 1 1 1 0 1 1 0 3 2 0
2 k n e J
2 1 0 0 0 0 1 0 2 1 1 1 2 1 1 1 4 1 2 1
1 k n e J
0 0 4 2 4 1 1 1 0 1 0 1 0 1 2 2 2 1 1 2
9 . t 6 n e e i t l a b P a T
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 1 1 1 1 1 1 1 1 1 1 2 u u u u u u u u u u c u c u c u c u c u c u c u c u c u c u c c c c c c c c c c A A A A A A A A A A A A A A A A A A A A
) A p u o r G ( t n e m s s e s s a e v i t c e j b u S
–
–
–
–
–
–
–
–
–
–
. ) t n e i t a p r e p e g a r e v a s t n i o p 6 . 0 1 ( t n e m e v o r p m i d r a w o t , . e i . , s e u l a v e v i t i s o p d r a w o t d n e r t r a e l c a w o h s s t n e i t a p l l a s n o i t p e c x e o w t h t i W : e t o N
Clinical Study on Acupuncture and Insomnia
e r e t g p n a e r i e m t v u a A s p t l n a e t i t o t a p m r u e S p
) B p u o r G ( t n e m s s e s s a e v i t c e j b u S
5 4 . 3
6 8 3 4 4 7 9 4 4 6 1 2 4 3 4 2 1 2 2 7 – – 1 –
f S M
0 0 1 2 1 0 0 1 0 1 0 0 2 0 0 1 1 0 0 1
e S M
1 2 0 1 0 1 1 0 0 2 0 0 0 0 0 1 0 0 0 1
d S M
1 1 0 0 1 1 0 1 0 1 0 0 0 0 0 0 0 2 0 0
c S M
–
–
–
–
–
–
2 0 0 1 0 1 0 0 0 0 0 0 2 0 0 0 0 0 0 0
b S M
1 1 2 0 0 1 1 0 0 0 0 0 1 0 0 0 2 0 0 2
a S M
3 1 0 2 1 1 2 1 1 0 0 0 0 0 0 0 0 0 0 2
e F E M
0 0 2 0 1 1 0 0 1 0 0 0 1 1 1 0 0 0 0 1
d F E M
0 1 0 1 0 1 1 1 0 1 0 1 0 0 1 0 0 0 0 1
c F E M
0 1 0 1 1 1 2 0 0 0 0 0 0 1 0 0 1 0 0 1
b F E M
1 0 1 2 1 1 1 1 0 0 0 1 0 0 1 0 1 0 1 2
a F E M
1 1 1 0 0 0 0 1 1 1 1 0 0 1 1 0 0 0 1 2
2 k n e J 1 k n e J
0 1 . t 6 n e e i t l a b P a T
117
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 2
0 1 0 0 0 0 1 1 3 0 0 0 0 0 0 0 0 0 0 2 –
0 1 1 6 7 8 9 1 . 2 . 3 . 4 . 5 . . . . . . . 1 c c c c c c c c c c c a a a a a a a a a a a l l l l l l l l l l l P P P P P P P P P P P
2 1 . c a l P
3 1 . c a l P
4 1 . c a l P
5 1 . c a l P
6 1 . c a l P
7 1 . c a l P
8 1 . c a l P
9 1 . c a l P
0 2 . c a l P
. ) e g a r e v a s t n i o p 5 4 . 3 ( t c e f f e o b e c a l p a s p a h r e p d n a A p u o r G n a h t r e k a e w , t c e f f e e v i t i s o p a d e w o h s s t n e i t a p l l a , s n o i t p e c x e e e r h t h t i W : e t o N
118
6 Cli Clinical Evaluation
Fig.6.1 Subjective assessment of Group A.
25 20 t c e f f e c i t u e p a r e h T
15 10 5 0 –5
–10
1 . 2 . 3 . 4 . u u u u c c c c A A A A
5 . 6 . u u c c A A
7 2 3 4 5 6 7 8 9 0 . 8 . 9 . 0 1 u u u 1 . 1 . 1 . 1 . 1 . 1 . 1 . 1 . 1 . 1 . 2 . c c c u u u u u u u u u u u A A A c c c c c c c c c c c A A A A A A A A A A A
Patient number
Fig.6.2 Subjective assessment of Group B.
25 20 t c e f f e c i t u e p a r e h T
15 10 5 0 –5
–10
1 2 3 4 5 6 7 8 9 0 . 2 . 3 . 4 . 5 . 6 . 7 . 8 . 9 . 0 1 c c c c c c c c c 1 . 1 . 1 . 1 . 1 . 1 . 1 . 1 . 1 . 1 . 2 . a l a l a l a l a l a l a l a l a c c c c c c c c c c c l a a a a a a a a a a a P P P P P P P P P l l l l l l l l l l l P P P P P P P P P P P
Patient number
for this phenomenon, we can assume that acupuncture reduces a stressful situation. The subjective assessment of sleep also points to an improvement after acupuncture. It is, however, interesting to note that the control group also also felt felt bett better er subj subject ectiv ivel elyy, alth althou ough gh not not as obviously as the acupuncture group. It remains to be seen whether this is due to a placebo phenomenon. Interestingly, the patients in the control group seem to sleep less well after a series of sham needlings, especially when judged objectively by polysomnography. Patient recruitment was not easy. Originally, it
was was plan planne nedd to incl includ udee pati patien ents ts with with rece recent nt insomnia of not more than 1 year in order to show that three to five sessions of acupuncture would be suffici sufficient ent to effect effect treatme treatment. nt. Howe Howeve ver, r, this this type of patient was not willing to participate in a strictly controlled study of 4 –6 weeks’ duration, to spend 2 nights in a sleep laboratory, and to regularly go to the doctor for a problem that seemed transient. As the majority of the patients in this study were suffering from chronic insomnia, it is quite conceivable that the study design of three to five sessions is too short a treatment period for such patients. Of the 20 patients treated, we consider
Other Clinical Studies on Insomnia and Other Sleep Disorders
six (30%) to have good results and 11 (55%) only fair results. Although it was not expected that all 20 would benefit, the fact that only 30% were considered to have had good results is not considered a satisfactory result. Patients who have been suffering from insomnia for, for example, more than 10 years will most likely need a longer treatment period in order to be satisfied with the results and to stop stop taking taking medica medicatio tion, n, the latter latter probab probably ly being one of the few measurable measurable criteria criteria of treattreatment success. This reasoning tallies with Chinese studies that recommend 3 –6 months of therapy for long-term insomnia. Howeve However, r, our encouragi encouraging ng results results after only three to five sessions even in cases of chronic insomnia seem to confirm the theory that carefully individualized acupuncture is more effective than frequently performed standardized acupuncture. The influence of the therapist himself or herself also cannot be excluded, since it is not possible to perform double-blind acupuncture studies. There are numerous indications that the intention of the treating practitioner plays a role in therapy, but this factor has yet not been quantified. On the other hand, the patient’s attitude toward therapist and therapy also influences the outcome and probably plays a role in separating responders from from nonres nonrespon ponder ders. s. This, This, howe howeve ver, r, appli applies es to many fields of human medicine, although it would be less applicable to cases of successful acupuncture treatment in veterinary medicine, in which the animal will not have any prior knowledge or preconceived preconceived ideas about the treatment. t reatment. Even though these issues have not yet been explored scientifically, the results of our study are encouraging enough to recommend individualized individualized acupuncture according to the TCM method for the treatment of insomnia.
Other Clinical Studies on Insomnia and Other Sleep Disorders Over the last three decades, there have been a number of publications on the therapeutic benefits to be derived from acupuncture in all types of sleep disorder. Previously, the only studies that have attempted to objectively demonstrate a measurable electrophysiological effect using polysom-
nogra nograph phyy were were Russia Russiann (Dall (Dallaki akian an et al. 1985, 1985, Kochetkov et al. 1983, Tabeeva and Akhtiamov 1980). Recently, more and more studies have been attempted with an objective evaluation, mostly in China. All the studies tend to demonstrate that acupuncture has a beneficial effect on sleep disorders: A Russian study in 1980 of 15 patients presenting secondary psychogenic insomnia showed a marked subjective and objective improvement after acupuncture treatment (Tabeeva and Akhtiamov 1980). Another Russian study in 1983 on 41 hypochondria chondriacal cal patients patients suffering suffering from insomnia insomnia and treated by acupuncture showed an objective improvement. The authors suggest a thalamoc lamocorti ortical cal site site of action action for for acupun acupunctur cturee (Kochetkov et al. 1983). In 1993, a Japanese polygraphic study of a case of insomnia demonstrated a decrease in superficial sleep in favor of an increase in deep sleep (Shinomiya (Shinomiya et al. 1993). A Belgian study in 1987 involving 10 cases of second secondary ary insomn insomnia ia due to uremic uremic pruriti pruritiss treate treatedd with with electr electro-a o-acup cupunc uncture ture showe showedd a clear clear improvem improvement ent compared compared with a control control group (Duo 1987). ●
●
●
●
The following Chinese studies have explored the effects of acupuncture on insomnia: Fifteen out of 16 insomniac patients showed a clear improvement in a 1977 study after injection of lidocaine into the auricular acupuncture point points. s. All All the patien patients ts mainta maintaine inedd this this improvement over a follow-up of 3 months (Lee 1977). In 1985, 86 cases of insomnia were treated using da ling PC-7 and wei guan TB-5. There were 39 cases of complete recovery, 36 of partial improvement, and 11 with little improvement ment.. The The ther therap apeu euti ticc prot protoc ocol ol was not not described (Ren 1985). In 1988, a similar study involving 62 patients with insomnia treated by selective ear point stiSemen vaccariae vaccariae (ear seeds) mulation mulation using using Semen seeds) showed a success rate of 95% compared with a control group receiving a standardized treatment, which showed only 64% improvement (Yang 1988). In 1989, 10 cases of somnambulism were treated with acupuncture and herbs, with eight ●
●
●
●
119
120
6 Cli Clinical Evaluation
●
●
●
●
●
●
●
cures, one failure, and one withdrawal after 30 – 60 sessions (Li 1989). In 1990, a study tested the therapeutic efficacy of plum blossom stimulation of yin tang EXHN-3 in insomnia (Xu 1990). In 1990, a study was carried out on 160 participants, half of whom were treated using the same same auri auricu cula larr poin points ts,, and and half half of wh whom om received 10mg of diazepam. At the start of the study, the diazepam group showed a greater improvement. However, after 30 days of treatment, the auricular acupuncture group showed better results (P < 0.01) (Lian and Yan Yan 1990). In 1994, 124 cases of dyssomnia were treated si shen cong EX-HN-1, with a combination of si EX-HN-1, bai hui GV-20, shen men HT-7, and tai xi KI-3, on a daily basis, with a 3-day break every 7–10 days. The average duration of treatment was 30 days. After treatment, 59% of patients showed a total recovery, 21% a marked improvement, 8% a partial improvement, and 12% no change (Xie et al. 1994). In 2000, 38 cases of insomnia were treated with moxibustion on yong quan KI-1 on a daily basis for 15–20minutes, which yielded a 100% success rate (Ren 2000). In 2007, a randomized controlled study of the effect of acupuncture on sleep quality was carried out on 46 patients with primary insomnia who were divided into one group treated with acupuncture acupuncture and one control group.The points points bai hui GV-20, shen ting GV-24, GV-24, and shen men HT-7 HT-7 were were selec selected ted.. The control control group was was given estazolam orally. The results showed an effectiveness in 83.3% of the acupuncture group vers versus us 72.7 72.7% % in the the cont contro roll grou groupp (P <0.05). <0.05). Estazolam was better at prolonging sleep time, but acupuncture proved superior in the treatment ment of somnip somnipath athyy and decrea decreased sed dayti daytime me performance (Xuan et al. 2007). In 2007, 276 patients with insomnia were randomly assigned to two groups. One group was treated treated with with electr electro-a o-acup cupunct uncture ure at si shen shen cong EX-HN-1. EX-HN-1. The control group received an oral treatment of Tian Meng Meng (Sweet Dreams) over a total period of 3 weeks. The results were moni monito tore redd by somn somnog ogra raph phyy. Both Both grou groups ps showed showed a significa significant nt improv improvemen ement,t, although although the electro-acupuncture group improved more (P <0.01) (Tang et al. 2007). A 2007 study divided 200 patients with insom-
●
●
●
nia randomly into a test group and a control group. The test group was treated with the needling method to regulate wei qi (defensive energy) and strengthen the brain with bai hui GV-20, da zhui GV-14, shen mai BL-62, zhao hai KI-6, and the ear points yuan zhong and shen tr eated with si shen men. The control group was treated EX-HN-1, shen men HT-7, and san yin jiao cong EX-HN-1, SP-6. Acupuncture was given once daily for 15 days. The Pittsburgh Sleep Quality Index (PSQI) was used to score before and after treatment. The result resultss showe showedd a total total effec effectiv tivee rate rate of 89.0% in the test group and 65.0% in the control grou groupp (P < 0.01); 0.01); the differ differenc encee between between the PSQI scores before and after was – 9.15 ± 5.68 in the test group, – 5.64 ± 5.73 in the control group (P <0.01) (Gao et al. 2007). A 2007 review of 878 papers on treating insomnia with with auricul auricular ar acupun acupunctur cturee showed showed the recovery and improvement rates to be significantly higher than were seen in patients treated with diazepam (P <0.05). The efficacy of using Semen vaccariae was better than that seen for the controls (P < 0.01), 0.01), while while treatme treatment nt with with magnetic pearls did not show any statistical significance (P = = 0.28). Six commonly used auricular acupuncture points were shen men, heart, occiput, subcortex, brain, and kidney (Cheuk et al. 2007). A 2008clinical study on the visceral differentiation-based acupuncture therapy for insomnia involved involved 70 cases of participants with insomnia who were randomly divided into a treatment group and a control group. group. The former was was treated by acupuncture acupuncture based on visceral visceral differentia differentia-tion and the latter by routine acupuncture therapy. The clinical effects were significantly better in the treatment group than that of the control group (P <0.05) (Li Ling et al. 2008). A 2009 study on electro-acupuncture for primary insomn insomnia ia invo involv lved ed a random randomize izedd concontrolled trial on 60 Chinese adult volunteers presenting insomnia for 3 nights or more per week for at least 3 months. The treated group received electro-acupuncture at yin tang EX-HN EX-HN3, bai hui GV-20, bilateral ear shen men, si shen cong EX-HN-1, and an mien mien EX-HN-54 three times per week for 3 weeks. The control group received sham acupuncture using Streitberger place placebo bo needle needless at the same same points points.. Resu Results lts showed a slight advantage of electro-acupunc-
Other Clinical Studies on Insomnia and Other Sleep Disorders
●
●
ture over sham acupuncture in the short-term treatment of primary insomnia (Yeung et al. 2009). A 2009 study on the influence of auricular plaster therapy on sleeping structure in patients with obstructive sleep apnea syndrome showed that the auricular plaster therapy significantly improved improved the hypov hypoventil entilatio ationn index, index, respirarespiratory parameters, as well as the sleeping parameters such as the time and rate of sleep at Stages 1 and 2, and the waking time and rate (Wang et al. 2009). In 2009, a study was carried out on the effect of acupun acupunctur cturee on blood blood oxyg oxygen en satura saturatio tionn in patien patients ts with with obstruc obstructiv tivee sleep sleep apnea apnea–hypopnea syndrome. Thirty patients with OSAHS were treated with acupuncture at shang lian quan EX-HN-15, feng fu GV-16, ya men GV-15, and feng chi GB-20for three to five sessions per week for a total of 30 sessions. The following parame paramete ters rs were were evalu evaluat ated ed befo before re and after after treatment: apnea/hypopnea index (AHI), mean blood oxygen saturation (MSaO 2), the lowest blood oxygen saturation (LSaO 2), oxygen desaturation ≥ 4% index (ODI4), the mean blood oxygen saturation of oxygen desaturation when SaO2 <90%, the longest time of oxygen saturation ≥ 4%. The effective rate of acupuncture was 23.3% for OSAHS. After acupuncture, AHI and ODI4 significantl icantlyy reduce reducedd (P <0.01); LSaO2 significantly increased (P < 0.01); 0.01); MSaO2 and the mean blood oxygen saturation of oxygen desaturation when oxyg oxygen en satura saturatio tionn SaO2 < 90% signi significa ficantl ntlyy enhanced (P < 0.05); the longest time of oxygen saturation ≥ 4% did not significantly change (Xu et al. 2009).
List of some other references of Western and Chinese studies: “Effects of individualized acupuncture on sleep quality in HIV disease ” (Phillips 2001). “Effects of acupuncture therapy on insomnia ” (Sok et al. 2003). ●
●
●
●
●
●
● ●
●
●
●
Intradermal acupuncture on Shen men HE-7 and nei-kuan acupoints in patients with insomnia after stroke” (Kim et al. 2004). “Acupunctur Acupuncturee increases increases nocturnal nocturnal melatoni melatoninn secretion and reduces insomnia and anxiety: a preliminary report” (Katzman et al. 2004). “Acupuncture for insomnia in pregnancy – a prospe prospectiv ctive, e, quasi quasi-ra -rando ndomis mised, ed, contro controlle lledd study” (Da Silva et al. 2005). “Role ole of acup acupun unct ctur uree in the the trea treatm tmen entt of insomnia: a comprehensive review ” (Kalvapalli and Singareddy 2007). ”Acupuncture for insomnia ” (Cheuk et al. 2007). “Treat reatme ment nt of mode modera rate te obst obstruc ructi tive ve slee sleepp apnea syndrome with acupuncture: a randomised, placebo-controlled pilot trial ” (Freire et al. 2007). “A systematic review of the effects of acupuncture in treating insomnia ” (Huang et al. 2009). “Acupuncture for the treatment of insomnia; a syst system emic ic revi review ew of rand random omis ised ed cont contro roll lled ed trials, involving 3811 patients, comparing acupunc punctur turee treat treatme ment nt vers versus us no treat treatme ment nt;; acupressure versus placebo acupressure; acupuncture and herbs versus herbs alone. The conclusion states that acupuncture appears to be affective in the treatment of insomnia ” (Cao et al. 2009). “Auriculo Auriculothera therapy py and aircrew aircrew with circadian circadian desync desynchro hronos nosis: is: aerome aeromedic dical al impli implicat cation ionss” (Little and Niemtzow 1999/2000). This study involved only five patients, but the treatment seems a promising alternative for jet lag management. “
Basically, all the studies reviewed show the efficacy of acupuncture treatment in insomnia. The few few studie studiess compar comparing ing acupun acupunctur cturee with with drug drug treatments even show the superiority of acupuncture in its recuperative effects and on daytime activity and performance. per formance.
121
Appendices
Appendix 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . Appendix 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . Glossary . Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
124 129 134 137 144
124
Appendices
Appendix 1 Index of Sleep-related Symptoms and Acupuncture Points
Agitation
Shen men HT-7, men HT-7, xi xi men PC-4, men PC-4, tai tai bai SP-3, guan SP-3, guan chong TB-1, chong TB-1, zheng zheng ying GB-17, ying GB-17, yin yin tang EX-HN-3, tang EX-HN-3, yi yi ming EX-HN-14/ ming EX-HN-14/an an mien EX-HN-54 mien EX-HN-54
All insomnia
Shen men HT-7, men HT-7, si si shen cong EX-HN-1 cong EX-HN-1
Anxiety when lying down
Shen feng KI-23 feng KI-23
Anxiety
Yong quan KI-1, quan KI-1, ling ling xu KI-24, xu KI-24, nei nei guan PC-6, guan PC-6, da da ling PC-7, ling PC-7, zhong zhong chong PC-9, chong PC-9, yu yu ji LU-10, da LU-10, da du SP-2, du SP-2, que que pen ST-12, pen ST-12, da da ju ST-27, ju ST-27, feng feng long ST-40, long ST-40, xin xin shu BL-15, shu BL-15, pi pi shu BL-20, gao BL-20, gao huang shu BL-43, shu BL-43, shen shen tang BL-44, tang BL-44, hun hun men BL-47, men BL-47, tou tou lin qi GB-15, hou GB-15, hou ding GV-19, ding GV-19, bai bai hui GV-20, shen GV-20, shen ting GV-24, ting GV-24, guan guan yuan CV-4, yuan CV-4, jiu jiu wei CV-15, si CV-15, si shen cong EX-HN-1 cong EX-HN-1
Attachment
Da ling PC-7 ling PC-7
Cannot sleep at all
Lao gong PC-8 gong PC-8
Difficulty falling asleep
Tian jing TB-10 jing TB-10
Discontentment
Da ling PC-7, ling PC-7, lao lao gong PC-8 gong PC-8
Dislike of neck tightness
Que pen ST-12 pen ST-12
Dream of flowers
He gu LI-4 gu LI-4
Dream of untilled fields
Qu chi LI-11 LI-11
Dream of falling or sinking
Di ji SP-8, tian SP-8, tian yu TB-16 yu TB-16
Dream of standing on the head
Tian yu TB-16 yu TB-16
Dream of climbing/singing
Feng long ST-40 long ST-40
Dream of landscapes
He gu LI-4 gu LI-4
Dream of narrow passes
Da du SP-2, du SP-2, hou hou xi SI-3 SI-3
Dream of ruins
Da du SP-2 du SP-2
Dream of snakes
Xuan shu GV-5 shu GV-5
Dream of the dead
Xin shu BL-15; shu BL-15; also zu also zu qiao yin GB-44 yin GB-44 + shang + shang qiu SP-5 qiu SP-5
Dream of sex
Tian zhu BL-10, zhu BL-10, xin xin shu BL-15, shu BL-15, shen shen shu BL-23 shu BL-23
Dreams of humiliation
Xia xi GB-43 GB-43
Drooling + eye crusting
Bai hui GV-20 GV-20 or si or si shen cong EX-HN-1 cong EX-HN-1 + que + que pen ST-12 pen ST-12 + wei + wei yang BL-39 yang BL-39 and guan and guan chong TB-1 chong TB-1
Dropping (feeling of)
Di ji SP-8 SP-8
Eating to sleep
Liang men ST-21; men ST-21; also bai also bai hui GV-20 GV-20 + que + que pen ST-12 pen ST-12 + zu + zu san li ST-36 ST-36 and li and li dui ST ST45
Enuresis (children)
Xin shu BL-15 shu BL-15
Excessive dreaming
Shen men HT-7, men HT-7, yin yin bai SP-1, li SP-1, li dui ST-45, hou ST-45, hou xi SI-3, xin SI-3, xin shu BL-15, shu BL-15, ben ben shen GB-13, shen GB-13, zu qiao yin GB-44
Appendix 1
Eye crust + drooling
Bai hui GV-20 GV-20 or si or si shen cong EX-HN-1 cong EX-HN-1 + que + que pen ST-12 pen ST-12 + wei + wei yang BL-39 yang BL-39 and guan and guan chong TB-1 chong TB-1
Falling asleep all the time
Er jian LI-2 jian LI-2
Fear of the dark
Zhong chong PC-9 chong PC-9
Fear
Tai xi KI-3, zhu KI-3, zhu bin KI-9, bin KI-9, xin xin jian LR-2, jian LR-2, qu qu chi LI-11, xin LI-11, xin shu BL-15, shu BL-15, lu lu xi TB-19, shuai TB-19, shuai gu GB-8, xin GB-8, xin hui GV-22 GV-22
Frequent waking
Shen men HT-7 men HT-7
Fright wind
Yong quan KI-1, quan KI-1, tai tai chong LR-3 chong LR-3
Guilt, embarrassment
Tai yuan LU-9, yuan LU-9, gong gong sun SP-4, sun SP-4, xi xi men PC-4, men PC-4, nei nei guan PC-6 guan PC-6
Infantile crying
Jian shi PC-5 PC-5
Infantile fears
Yin bai SP-1 SP-1
Infantile insomnia (pain)
Kun lun BL-60 lun BL-60 (dentition)
Infants needing to be carried
You men KI-21, men KI-21, shang shang qiu SP-5 qiu SP-5
Insomnia after midnight
Liang men ST-21 men ST-21
Insomnia before midnight
Nao hu GV-17 hu GV-17
Insomnia from emotions
Kun lun BL-60 lun BL-60
Insomnia from excitement
Tai yuan LU-9 yuan LU-9
Insomnia from fatigue
San yin jiao SP-6, jiao SP-6, tian tian zhu BL-10, zhu BL-10, yi yi xi BL-45, he BL-45, he gu LI-4, gu LI-4, zhej zhej jin GB-23, jin GB-23, tao tao dao GVdao GV13
Insomnia from fear
Xia xi GB-43 GB-43
Insomnia from irritability
Bai hui GV-20 GV-20 + que + que pen ST-12 pen ST-12 + + zu san li ST-36 ST-36 and li and li dui ST-45 ST-45
Insomnia from nervousness
Que pen ST-12 pen ST-12
Insomnia from sadness
Tian jing TB-10 jing TB-10
Insomnia from weakness
He gu LI-4 gu LI-4
Insomnia from worry
Shen cang KI-25, cang KI-25, da da ju ST-27 ju ST-27
Insomnia in children
Shao shang LU-11 shang LU-11
Insomnia with agitation
Zhao hai KI-6, shu KI-6, shu fu KI-27 fu KI-27
Insomnia
Shen men HT-7, men HT-7, shao shao fu HT-8, fu HT-8, yong yong quan KI-1, quan KI-1, tai tai xi KI-3, shen KI-3, shen cang KI-25, cang KI-25, yu yu zhong KI-26, jian KI-26, jian shi PC-5, nei PC-5, nei guan PC-6, guan PC-6, da da ling PC-7, ling PC-7, xin xin jian LR-2, jian LR-2, tai tai chong LR-3, chong LR-3, zhong zhong fu LU-1, fu LU-1, yun yun men LU-2, men LU-2, tai tai yuan LU-9, yuan LU-9, yu yu ji LU-10, da LU-10, da du SP-2, du SP-2, gong gong sun SP-4, sun SP-4, san san yin jiao SP-6, jiao SP-6, zu zu san li ST-36, hou ST-36, hou xi SI-3, jing SI-3, jing ming BL-1, ming BL-1, gao gao huang shu BL-43, shu BL-43, shen shen tang BL-44, shen BL-44, shen mai BL-62, guan BL-62, guan chong TB-1, chong TB-1, lu lu xi TB-19, wan TB-19, wan gu GB-12, gu GB-12, ben ben shen GBshen GB13, tou 13, tou lin qi GB-15, zheng GB-15, zheng ying GB-17, ying GB-17, feng feng chi GB-20, ling GB-20, ling tai GV-10, qiang GV-10, qiang jian GVjian GV GV-22, qi hai CV-6, jiu CV-6, jiu wei CV-15, yin CV-15, yin 18, hou 18, hou ding GV-19, ding GV-19, bai bai hui GV-20, xin GV-20, xin hui GV-22, qi tang EX-HN-3, tang EX-HN-3, si si shen cong EX-HN-1, cong EX-HN-1, yi yi ming EX-HN-14 ming EX-HN-14 / / an mien EX-HN-54 mien EX-HN-54
Jerking at night
Si zhu kong TB-23 kong TB-23
Jet lag
Wei guan TB-5 (with he (with he gu LI-4) gu LI-4)
Likes to lie down
San jian LI-3, jian LI-3, shou shou wu li LI-13 LI-13
Mental restlessness
Shao fu HT-8, fu HT-8, shen shen feng KI-23, feng KI-23, shen shen cang KI-25, cang KI-25, lao lao gong PC-8, gong PC-8, yin yin bai SP-1 SP-1
Mouth dryness, thirst
Bai hui GV-20 GV-20 + que + que pen ST-12 pen ST-12 + xia + xia ju xu ST-39 xu ST-39 and shao and shao ze SI-1 ze SI-1
Needing silence
Nei ting ST-44 ting ST-44
Night crying in children
Zhong chong PC-9 chong PC-9
Night terrors
Jian shi PC-5, han PC-5, han yan GB-4, yan GB-4, shuai shuai gu GB-8, gu GB-8, zhe zhe jin GB-23, jin GB-23, guan guan yuan CV-4 yuan CV-4
125
126
Appendices
Nighttime itching
Bai hui GV-20 GV-20 + que + que pen ST-12 pen ST-12 + yang + yang ling quan GB-34 quan GB-34 and zu and zu qiao yin GB-44 yin GB-44
Nightmares
Yin bai SP-1, shang SP-1, shang qiu SP-5, qiu SP-5, nei nei ting ST-44, ting ST-44, li li dui ST-45, zan ST-45, zan zhu BL-2, zhu BL-2, tian tian zhu BLzhu BL10, ben 10, ben shen GB-13, shen GB-13, tou tou lin qi GB-15, zu GB-15, zu qiao yin GB-44 yin GB-44
Nocturia
San yin jiao SP-6 jiao SP-6
Nocturnal spermatorrhea
Xin shu BL-15, shu BL-15, shen shen shu BL-23 shu BL-23
Obsessive thinking
Da du SP-2, du SP-2, shang shang qiu SP-5 qiu SP-5
Oppression/ghost
Yin bai SP-1 SP-1
Persistent insomnia
Shu fu KI-27 fu KI-27
Psychic stress
Ling xu KI-24 xu KI-24
Restless extremities
Nei ting ST-44 ting ST-44
Restless legs
Qu quan LR-8, quan LR-8, lu lu xi TB-19 TB-19 (with TB-2), yang TB-2), yang ling quan GB-34, quan GB-34, yang yang jiao GB-35; jiao GB-35; also bai hui GV-20 GV-20 + que + que pen ST-12 pen ST-12 + wei + wei zhong BL-40 zhong BL-40 and zhi and zhi yin BL-67 yin BL-67
Restlessness/sleep
Tian chi PC-1, tian PC-1, tian fu LU-3, fu LU-3, yin yin bai SP-1, gong SP-1, gong sun SP-4, sun SP-4, he he gu LI-4 gu LI-4 with tai with tai chong LR-3, si LR-3, si zhu kong TB-23, kong TB-23, yi yi ming EX-HN-14 ming EX-HN-14 / / an mien EX-HN-54 mien EX-HN-54
Seeing ghosts
Xin jian LR-2 jian LR-2
Sensitive to noise
Yi ming EX-HN-14 ming EX-HN-14 / / an mien EX-HN-54 mien EX-HN-54
Sexual dreams
xin shu BL-15, shu BL-15, shen shen shu BL-23 shu BL-23 Tian zhu BL-10, zhu BL-10, xin
Sleep-talking (ghost talk)
Shen men HT-7, men HT-7, tian tian fu LU-3 fu LU-3
Sleep-walking
An mien I mien I EX-HN-52, an EX-HN-52, an mien II mien II EX-HN-53
Sleepiness
Er jian LI-2, jian LI-2, li li dui ST-45, jing ST-45, jing ming BL-1, ming BL-1, shen shen mai BL-62, ri BL-62, ri yue GB-24 yue GB-24
Sleeping with open eyes
Shao shang LU-11 shang LU-11
Superficial sleep
Pi shu BL-20, shu BL-20, xin xin shu BL-15, shu BL-15, gan gan shu BL-18 shu BL-18
Teeth grinding
He gu LI-4; gu LI-4; also bai also bai hui GV-20 GV-20 + que + que pen ST-12 pen ST-12 + shang + shang ju xu ST-37 xu ST-37 and shang and shang yang LI-1
Tired but cannot sleep
You men KI-21 men KI-21
Vague fear feeling
Hun men BL-47 men BL-47
Visual dreams
Yong quan KI-1 quan KI-1
Waking between 1 a.m. and 3 a.m.
Zhong fu LU-1, fu LU-1, yun yun men LU-2, men LU-2, ting ting hui GB-2 GB-2
Waking in a bad mood
Yu zhong KI-26 zhong KI-26
Waking to eat
Hui zong TB-7 zong TB-7
Waking with a puffy face
Zhong fu LU-1 fu LU-1
Waking with laziness
Tai bai SP-3 SP-3
Waking with puffy eyes
Tian fu LU-3 fu LU-3
Worry
Da du SP-2, du SP-2, xia xia xi GB-43 GB-43
Appendix 1
Acupuncture Points Containing the Characters Shen Characters Shen,, Ling Ling,, and Gui and Gui Acupuncture Points Containing the Character Shen Character Shen— 神
Pin Pin yin yin
Chin Chines ese e char charac acte terr
Engl Englis ish h tran transslati lation on
Chan Channe nell and and poin pointt
Indi Indica cattions ions
Shen men
神門
Spirit door
HT-7
Depression, anxiety, insomnia, hysteria, loss of memory, retardation
Shen dao
神道
Spirit path
GV-11
Sadness, fear, amnesia, regrets
Shen ting
神庭
Spirit hall
GV-24
Severe anxiety, mania, hysteria, nightmares
Shen feng
神封
Spirit seal
KI-23
Mental restlessness, anxiety when lying down
Shen cang
神藏
Spirit storage
KI-25
Insomnia, mental restlessness, negativity, waking up in a bad mood
Ben shen
本神
Spirit root
GB-13
For anger, anxiety or depression
Acupuncture Points Containing the Character Ling (Soul) Ling (Soul)— 靈
Pin yin
Chinese character
English translation
Channel and point
Ling dao
靈道
Path of the Soul
HT-4
Cheng ling
承靈
Suppor ting the Soul
GB-18
Qing ling
青靈
Blue- Green Soul
HT-2
Ling xu
靈虛
Soul Ruins
KI-24
Ling tai
靈台
Soul Tower
GV-10
127
128
Appendices
Acupuncture Points Containing the Character Gui (Ghost) (Ghost) 鬼
Pin yin
Chinese character
English translation
Channel and point
Chi ze but ze but also called gui called gui tang or tang or gui gui shou
鬼堂
Ghost palace
LU-5
鬼受
Ghost reception
Tai yuan, yuan, also called gui called gui xin
鬼心
Ghost heart
LU-9
Shao shang, shang, also called gui called gui xin
鬼信
Ghost sincerity
LU-11
Shou san li , also called gui called gui xie
鬼邪
Ghost evil
LI-10
Qu chi , also called gui called gui tui or gui or gui chen
鬼腿
Ghost leg
LI-11
鬼臣
Ghost minister
鬼床
Ghost bed
鬼林
Ghost forest
Zu san li , also called gui called gui xie
鬼邪
Ghost evil
ST-36
Yin bai , also called gui called gui yan or yan or gui gui lei
鬼眼
Ghost eye
SP-1
鬼壘
Ghost pile
Shen mai , also called gui called gui lu
鬼路
Ghost road
BL-62
Jian shi , also called gui called gui lu or lu or gui gui ying
鬼路
Ghost road
PC-5
鬼營
Ghost camp
Da ling, ling, also called gui called gui xin
鬼心
Ghost heart
PC-7
Lao gong, gong, also called gui called gui ying or ying or gui gui lu or lu or gui gui ku
鬼營
Ghost camp
PC-8
鬼路
Ghost road
鬼窟
Ghost cave
Cheng jiang, jiang, also called gui called gui shi
鬼市
Ghost market
CV-24
Feng fu, fu, also called gui called gui xue or xue or gui gui zhen or zhen or gui gui lin
鬼穴
Ghost hole
GV-16
鬼枕
Ghost pillow
鬼林
Ghost forest
Xin hui , also called gui called gui men
鬼門
Ghost door
GV-22
Shang xing, xing, also called gui called gui tang or tang or gui gui gong
鬼堂
Ghost temple
GV-23
鬼宮
Ghost palace
鬼市
Ghost market
鬼宮
Ghost palace
鬼客廳
Ghost reception
Jia che, che, also called gui called gui chuang or chuang or gui gui lin
Shui gou, gou, also called gui called gui shi or gui or gui gong or gong or ke ke ting
ST-6
GV-26
Point Combinations for the Treatment of “Possessions” Sun Si Miao’s 13 Ghost Points— Treatment Treatment for Possessions
The protocol according to Master Yuen calls for three points to be treated at a time, starting with the set of points corresponding to the symptom patterns, and running through the whole set of 13 points. After each treatment, the needles have to be thrown to the ground.
●
●
First set: GV-26 gui gong or or gui shi and LU-11 gui xin and SP-1 gui yan for changes in behavior, start startin ingg to see see thin things gs,, thin thinki king ng and and seei seeing ng things differently Second set: PC-7 gui xin for something sitting on the chest; BL-62 gui lu for going places one does does not know, know, yin-type -type place places, s, eyes eyes wide wide open; GV-16 gui xue or ghui zhen for strange dreams
Appendix 2
●
●
Third set: ST-6 gui chuang or or gui lin for introversion, withdrawal, hiding places; CV-24 gui shi for talking to imaginary people, schizophrenia; PC-8 gui ying or or gui ku for delusions, paranoia, conspiracy theory Fourth set: GV-23 gui tang ; CV-1 gui cang for self-mutilation, self-mutilation, suicidal thoughts, risk-taking; risk-taking; LI-11 gui tui or gui chen for paleness, a hollow stare, aimless walking; gui fong (which some tang ) for hysteria, violent consider to be yin tang dementia, biting the tongue
Worsley’s Seven Dragons — for for Internal and External Demons
The Seven Dragons to chase out the internal demons: – Extra point (1/4 Cun below jiu wei CV-15) – Tian shu ST-25 – Lan wei xue EX-LE-13 – Jie xi ST-41 The treatment is done in a spiral form: Start in order from the point below CV-15 Followed by ST-25, on the right for women, left for men Followed Followed by ST-25 on the opposite side Followed by lan wei xue on the left for women right for men Followed by lan wei xue on the opposite side Followed by jie xi St-41 on the right r ight for women, left for men End with jie xi ST-41 on the opposite side After 20–30 minutes, remove needles in exactly the reverse reverse order order (i.e. starting with with ST-41. . .) ●
● ●
● ●
● ●
● ●
●
The External Dragons for external demons (the impression of something hovering around): – Bai hui GV-20 – Da zhu BL-11, shen shu BL-23, pu can BL-61
Appendix 2 Working with Dreams, by Solange Montakab-Pont
Dreams can be a great source of information, providing us with indications about imbalances in patients’ physical bodies as well as in their lives. In
general, the same messages are received from the body–mind combination in dreams as they are in waking life. While awake, the language of the body or of the emotions is reduced to manifestations of pain or of discomfort. But in the dream state, there is more fluidity and freedom, as if all options and possibilities are available and can be tapped into. The hun (ethereal soul) and shen have access to all of these different realms of reality and can draw from all experiences, both personal and collective. Modern psychoanalytic schools, namely the Jungian tradition, propose that all emotions, desires, and the issues that the individual is dealing with in everyday life can be expressed without censure in a dream. The Chinese tradition places great emphasis on the diagnostic significance of dreaming (see Chapter (see Chapter 5). 5). Energetic and Physiological Effects of Dreams
During dreaming, the body undergoes noticeable changes: changes: adrenalin adrenalinee levels levels rise, blood blood pressure pressure increases, and the heartbeat alters. Actions and feeling feelingss in dreams dreams produce produce electrochem electrochemical ical responses in the body. Most people have experienced waking up and feeling sick from a bad dream or feeling rejuvenated from a good dream. This and other probable biochemical changes that occur during the dream phase back up theories put forward by the proponents of psychosomatic theory. Dreams affect the physical body, and can even help repair it, providing a veritable self-healing process (Shinomiya et al. 1993). In the mid-1980s, the neuroscientist and pharmacologist Candace Pert discovered the chemical interrelation between the mind, behavior, and the neuroendocrine and immune systems in the form of neuropeptides (Pert 1999). These discoveries form the basis of psycho-neuroimmunology (PNI). Molecules of Emotion Emotion, Pert explains In her book Molecules that this mind –body interaction primarily takes the form of emotion –body communication, communication, that is, the human physiology is connected to the emotions. Pert works with dreams and believes that dreams are direct messages from the body–mind combin combinati ation on,, givin givingg one valua valuable ble info informa rmatio tionn about what is happening physiologically physiologically as well as emotionally. One of the important functions of dreaming appears to be emotional processing. Ideally, the
129
130
Appendices
best way to bring about change and a state of balance is by consciously directing one ’s dream, for example through lucid dreaming. However, other methods, such as hypnosis, biofeedback, various body-oriented therapies, acupuncture, and guided imagery, appear to trigger the same psycho-physiological responses in a patient when dreaming. In her inspiring article Dreams: A Creative Portal to Healing , Wendy Pannier states: “ The limbic system speaks in the language of symbolic imagery: workworking with dream imagery in the waking state can help help chang changee percep perceptio tions ns and resol resolve ve conflict conflicts, s, which are critical keys for mind –body healing” (Pannier 2006). The Place of Dreams in Modern Psychotherapy
Fritz Fritz Perls Perls (1893 (1893–1970), 1970), the found founder er of Gestal Gestaltt therapy (Price 1985), who was inspired by the theories of Freud and Jung, believed that dreams contain the rejected, disowned parts of the self. Perls rejected rejected the notion notion that dreams are part of a universal symbolic language. He believed that each dream is unique to the individual who dreams it. For him, every component of a dream is an aspect of the self. Perls established a sort of dialogue in which the dreamer takes on different roles, interacting with the characters or objects of the dream, in order to acknowledge feelings that have been overlooked or buried. How to Use Dreams in Psychotherapy
Many traditions, both Eastern and Western, agree that dreams are a window to the inner world. In a ther therap apeu euti ticc sens sense, e, this this mean meanss that that patie patient ntss’ dreams may provide not only excellent indications to the origins of their problems, but also a means for them to get in touch with hidden aspects of their psyche. In 1967, Vasily Kasatkin, a psychiatrist working at the Leningrad Neurosurgical Institute, published his work Theory of Dreams. He studied the content of 10240 dreams from 1200 individuals over a 40year period, and came to the the following following conclusions: conclusions: Illness is associated with an increase in dream recall. Illness causes dreams to become stressful and nightmarish. ●
●
●
●
●
Stress Stressful ful and and night nightmar marish ish dream dreamss genera generallllyy appear before the first symptoms symptoms of an illness. Drea Dreams ms caus caused ed by illn illnes esss are are long longer er than than dreams caused by ordinary stress, and persist throughout the night and the duration of the illness. The content of the dream can reveal the location and seriousness of the illness.
See also Chapter 4, “Excessive Dreaming”, page 74. Among the various descriptions and traditions of dreams mentioned in Chapter 5, three types are particularly important to healing: Releasing dreams—the individual simply gets rid of suppre suppresse ssedd emotio emotions ns by experi experienc encin ingg them in a dream scenario. Teaching dreams—the individual gains insights into their psycho-emotional psycho-emotional patterns. Healing dreams—the mind regains the power to readjust or heal the body. ●
●
●
Numerous studies on the mind –body connection have been conducted in recent decades demonstrating that imagery and visualization have some definite physiological responses in the body, not unlike the psycho-physiological changes brought about by some dreams (Pannier 2006). Accor Accordin dingg to Belle Belleruth ruth Napar Naparste stek, k, the main main operating principles underlying visualization are as follows (Naparstek 1995): The body does not discriminate between sensory images in the mind and what is considered to be reality. In a relaxed, meditative state, the body is capable of more rapid and intense healing, growth, learning, and change. Imagery and visualization work helps individuals feel better about themselves because they have a sense of mastery over what is happening to them. Those who are better able to believe that they can cope with problems tend to have better treatment outcomes.
●
●
●
However, visualization practices have limitations, for instance when there is some form of resistance or when the patient: Is unable to relate to the imagery or to visualize situations Is unable to focus and concentrate Is fixated on how things are, that is, the disease, rather than the desired outcome ●
● ●
Appendix 2
● ● ●
Is not able to involve all the senses Is not able to feel the visualization in the body Gives more credibility to the external reality than to internal healing powers
Dreams provide dreamers with images that are deeply meaningful to them, using symbols that they can relate to and accept without resistance. Ther Theref efor ore, e, comb combin inin ingg thes thesee pers person onal al dream dream images with an adapted visualization method has a much stronger impact on the individual. The ideal dream therapy would thus enable the patient to engage in lucid dreaming (see below), during which the consciousness shen would direct the hun to the content and the unraveling of the dream (see Chapters 2 and 5).
●
●
●
Lucid Dreaming
Lucid or conscious dreaming is a dream state during which the dreamer is aware that he or she is dreaming and can therefore control the dream to a certain extent. In the lucid state, the subject is able to confront threats and, as a result, to become more self-confident and to overcome fears and anxiety. This state of lucidity can be used as a tool to improve skills, to prepare for upcoming challenges, to fulfill fantasies, or to solve problems. There are two types of lucid dream: A dream-initiated lucid dream (DILD) starts as a normal dream during which the dreamer realizes that it is a dream. A wake-ini wake-initiat tiated ed lucid lucid dream (WILD) occurs occurs when the dreamer goes from a normal wakefulness directly into a dream state, with no apparent change in consciousness level.
●
●
Lucid dreaming has been subjected to scientific research, and its existence is now well established (LaBerge 1990, Watnabe 2003): Many Many aspe aspects cts of brai brainn acti activi vity ty durin duringg the the dream state are the same as during waking. What is learned or practiced in a lucid dream state state is similar similar to the type of training and preparation undergone in the waking state. At least half of all adults have had one lucid drea dream m in thei theirr lif lifetim etime, e, and and many many hav have reported having lucid dreams without even trying (Snyder and Gackenbach 1988). Flying is often associated with lucid dreams. With prac-
●
●
tice, lucid dreaming can be learned and practiced at will (LaBerge and Levitan 1995). As Pert’s resear research ch demons demonstrat trated, ed, emotio emotions ns impa impact ct the the body body’s phys physio iolo logy gy (Pert (Pert 1999 1999). ). Therefor Therefore, e, transform transforming ing nightmari nightmarish sh images images into positive, healing images can change the messages sent to the immune system. During dreams, one can bypass conscious resistance and the normal waking logic to allow limbic system logic to take over and change the image. As the limbic amygdala responds to perceptions, one can change the body ’s physiology by changing these perceptions. Dream Yoga has been practiced by Tibetan Buddhists since the 8th century CE. During Dream Yoga, full waking consciousness is maintained while in the dream state (Mullin 1997). Witho Without ut regula regularr practic practice, e, lucid lucid dream dreaming ing is sporadic and not easy to enhance at will. From a practical point of view, this means that when a patient is unable to have lucid dreams, the therapist, based on the assessments made of the patient patient’s dream imagery, can propose a combination of active visualization and guided suggestions. The positive images then reinforce the messages sent to the amygdala, which in turn stimulate the body’s healing process (Colic 2007).
Dream Analysis
One has to be careful not to use dream dictionaries as a trustwo trustworth rthyy source source for for interp interpret reting ing one’s dreams. Each dream, like each individual person, is unique. Symbols—the language of dreams —may be universal, but, depending on one ’s culture and conditioning, they do not always represent the same thing. A dog means something different to someone who dislikes or even hates dogs than it does to someone who loves them. Thus, the personal associations with the subject of the dream are much more meaningful than any information a dream dream dictio dictionary nary might might provid provide. e. Acquir Acquiring ing the ability to interpret dreams is a powerful tool for learning about deep secrets and hidden feelings. Dream dictionaries can, at most, inspire one to explore one’s dreams and offer a starting point for understanding them. When analyzing dreams, every detail, even the most trivial symbol, can be significant and must
131
132
Appendices
be considered. Each symbol represents a feeling, a mood, a memory, or something from the unconscious. One should look closely at the characters, animals, objects, places, emotions, and even colors ors and and numb number erss tha that are are depi depict cted ed in one one’s dreams. As with dream dictionaries, great care and discernment are required when referring to any systems in which different body parts or different diseases eases are relat related ed to specifi specificc psycho psycho-em -emoti otiona onall patterns. This same caution should be taken when approaching approaching Chinese medicine. For example, a disease located in the lumbar or knee area relates to a kidney kidney dishar disharmon monyy patter pattern. n. Since Since the kidney kidneyss react to fear, it is sometimes assumed that lumbar pain pain sign signifi ifies es a fear fear of chan change ge,, and and knee knee pain pain means a fear of death. But every person is unique, and consequently every illness and symptom has a different significance. The therapist has to be able to evaluate the significance of a given symptom in relation to the patient ’s life context and avoid systematic labeling and categorizations. Louise Hay ’s book You Can Heal Your Life contains a chapter in which she classifies physical problems and body parts, indicating the cause of a problem and providing new positive affirmation for healing (Hay 1999). In my opinion, such classification is very limiting and can lead to false beliefs about the cause and cure of a disease when used by a patient without the support of an adequately trained professional. This type of general classification can easily mislead patients and deny them the opportunity to undergo their own process of self-discovself-discovery. I am much more interested in the hidden roots of disease and in getting involved with the patient’s hidden processes, their personal feelings, and interpretations. Dream symbolism and dream work in a therapeutic setting are extremely useful for this purpose.
painting (painting on wet paper, a variant of the lavis technique). Otherwise, most dream work is done in one-to-one sessions. During During the initia initiall consul consulta tatio tion, n, patien patients ts are instructed in how to increase their capacity to recall dreams and how to keep a dream journal. Methods for recalling dreams: Self-suggestion Self-suggestion in the morning and in the afternoon: “ I will remember my dreams at night” Self-suggestion in the evening before going to sleep: “Soon dreams will be coming and I will remember them in the morning” Having Having a pen and writing pad at the bedside Keeping a dated dream journal When possible, painting or drawing some part of the dream image ●
●
● ● ●
In follow-up sessions, after the acupuncture needles have been removed, the therapist helps the patient into a guided fantasy. The theme of this fantasy is inspired by the most relevant dreams and patterns that the patient has shared with the therapist. The therapist ’s aim is to guide patients in exploring some of their issues more deeply, especially to replay scenes in a manner in which patients are empowered and can face and deal with the fears and dangers encountered in the dream. The The foll follow owin ingg aspe aspects cts are are impo importa rtant nt wh when en doing this kind of work: The therapist should adopt a receptive rather than a directive attitude, without making any judgments. The integrity of the dream and the dreamer should be kept intact. A very useful sentence when making suggestions about the meaning of someone’s dreams is: “ If this were my dream or my creation... .” This acknowledges acknowledges that anything one says about someone else ’s dream or creation will be one’s own projections. It should be focused on what the patient is actually experiencing and feeling rather than on objectiv objectivee facts, facts, general general considera consideration tions, s, or symbolism. The therapist should keep a compassionate passionate attitude without becoming emotionally involved. involved. Not getting fixated on the specific problem allows the therapist to see the context from the patient’s point of view. The therapist should respect the patient with authenticity and understanding, without prejudice, dice, judgment, judgment, solutions solutions,, and manipula manipulation tion.. ●
●
●
Integrating Dream Work into an Acupuncture Session
I work with dreams in two ways. One way is to get participants to share their dreams in a workshop setting. Here, the vision and the input from others bring about a change in perspective for the dreamer and opens up new possibilities. The second way is to get participants to explore their dreams or hidden issues through clay modeling or water
●
Appendix 2
●
The dream ream and and the the drea dreame merr hav have to be resp respect ected ed.. The The crea creato torr of the the dream dream bett better er understands the meaning of their dreams. Also, the the limi limits ts a pati patien entt migh mightt set set hav have to be respected. Clear and respectful communication should be facilitated. This means that the therapist should help help the patien patientt to unders understan tandd uncon unconsci scious ous messa messages ges rather rather than than interp interpret reting ing them them or providin providingg ready-made ready-made solutions solutions and advice. advice. Patients know better than anyone what their problems are, and they can find their way to healing and what they need. The main mistake in trying to help is to believe that we understand what another person is telling us, when in fact we are interpreting or projecting our own ideas onto the situation.
●
Heart-to-heart communication is very important in healing so as to stay in contact with the deeper self, from where all profound transformations arise.
Therapists have to remember that patients can overcome their obstacles, and that they have all the resources they need for doing just that. Heart-to-heart communication is essential for keeping the atmosphere of equality that is fundamental between two persons, even though one is directing the healing and the other is receiving it. Treatment or healing is a sharing experience. It is a sharing between two human beings who are searching and suffering. One of them plays the role of the giver, and the other the role of the receiver and reciprocates.
133
134
Glossary of Chinese Terms Used in the Book
Pin yin
English
Chinese
An
Calm, quiet, peace
安
An Mian
Peaceful sleep
安眠
Chong Mai
Penetrating vessel
衝脉
Da Chang
Large intestine
大肠
Dai Mai
Belt / girdling vessel
带脉
Gallbladder
胆
Di
Earth, soil
地
Ding
Settle, stabilize
定
Du Mai
Governing vessel
督脉
Dan
Fan
Restlessness/vexation
烦
Fei
Lung
肺
Liver
旰
Bone
骨
Gui
Ghost, unnamed spirit, demon
鬼
He
Sea
合
Huang
Vital membranes
肓
Hun
Ethereal soul
魂
Jin
Sinews, muscles
筋
Jing
River, channel
经
Well
井
Jing Bie
Divergent channels
经別
Jing Jin
Sinew, tendino-muscular channels
经筋
Jing Qi
Essence, essential qi essential qi
精气
Gan Gu
Jing
Jue Yin
Terminal yin Terminal yin
厥陰
Kuang
Mania
狂
Taxation
劳
Soul, spirit
靈
Connecting
絡
Luo Mai
Connecting/network channels/vessels
经脉
Mai
Vessel, channel
脉
Ming
Destiny, life, mandate
命
Mu
Collecting point
募
Brain
脑
Bladder
膀胱
Lao
Ling Luo
Nao Pang Guang
Glossary of Chinese Terms Used in the Book
Pin yin
English
Chinese
Spleen
睥
Po
Corporeal / animal soul
魄
Qi
Qi
气
Qi Jing Ba Mai
Eight extraordinary vessels
奇经八脉
Qing
Clear, quiet
清
Ren Mai
Conception vessel
任脉
San Jiao
Triple burner / triple warmer
三焦
Lesser yang Lesser yang
少陽
Lesser yin Lesser yin
少陰
Kidney
肾
Shen
Spirit, consciousness, intelligence, mind, emotions
神
Shi
Repletion, excess
实
Stream
俞
Transport point / back transport
俞/ 背俞
Marrow
髓
Supreme yang Supreme yang
太陽
Supreme yin Supreme yin
太陰
Heaven
天
Tian chuang
Window of heaven/sky
天窗
Tu
Earth phase
土
Stomach
胃
Defensive qi Defensive qi
卫气
Five moving forces, five phases
五行
Cleft/accumulation
郗
Small intestine
小肠
Heart
心
Pericard
心包
Vacuity, deficiency
虛
Blood
血
Yang Ming
Yang brightness
陽明
Yang Qiao Mai
Yang motility / stepping vessel
陽蹻脉
Yang Wei Mai
Yang binding / linking vessel
陽維脉
Yi
Intellect, thought, intention
意
Yin Qiao Mai
Yin motility / stepping vessel
陰蹻脉
Yin Wei Mai
Yin binding / linking vessel
陰維脉
Spring
滎
Nourishing energy
營气
Source
原
Viscera and bowels, yin bowels, yin and and yang yang organs organs
脏腑
Pi
Shao Yang
Shao Yin
Shen
Shu
Shu / bei shu Sui
Tai Yang
Tai Yin
Tian
Wei
Wei Qi
Wu Xing Xi
Xiao Chang Xin
Xin Bao
Xu Xue
Ying
Ying Qi Yuan Zang Fu
135
136
Appendices
Pin yin
English
Chinese
Zao
Mental agitation / irritability
躁
Zheng Jing
Primary channels
正经
Zhi
Will power
志
Uterus
子胞/ 包
Zi Gong / Bao
137
Bibliography
Chinese Classical Texts
Contemporary Texts
Bai Zheng Fu [Ode of one hundred patterns] by Gao Wu Ming ca. 1529. J Chin Herb Med and Acu 2008; 1 (12): PharmTao.com Bei Ji Qian Jin Yao Fang [Essential prescriptions worth a thousand in gold for every emergency]. Volumes 2– 4 on Gyneco ynecolog logyy. Sun Sun Si Miao Miao (625CE) (625CE).. Englis Englishh translation by Wilms S. The Chinese Medicine Database, 2007 Bei Ji Qian Jin Yao Fang [Supplement to essential prescriptions worth a thousand in gold] by Sun Si Miao (625CE). Beijing Shi, Zhong Yi Gu Ji Chu Ban She, 1997 Huang Di Nei Jing [Yellow emperor s classic of medicine]. cine]. Medical Medical texts texts dating dating back back to ca. 100 BCE BCE – 100CE, compiled during the Han dynasty (220BCE – 200CE). Comprising two parts: Su Wen and Ling Shu. French translation by Van Nghui N. SOCEDIM, Marseille, France, 1973 Huang-ti Su Wen Hsuan Ming Fang Lun (An Advanced Book of Su Wen with a Supplement of Prescriptions) by Liu Wansu, 1186. 5 volumes. Kyoto, 1740 Ling Shu [Spiritual pivot]. French translation by Van Nghui N. et al. A. Robert, Marseille, France, 1995 Meng Zhan Yi Zhi [Lofty principles of dream interpretation] by Chen Shi Yuan, 1562. Shanghai, Shang Wu Yin Shu Guan, 1939 Nan Jing [The classic of difficulties]. First appeared in the Han dynasty, attributed to Bian Que. English translation by Flaws B. Blue Poppy Press, Boulder, CO, 1998 Su Wen [Simple questions]. English translation by Veith I, University of California Press, 1966 Yi Lin Gai Cuo [Correcting the errors in the forest of medicine] by Wang Qing-Ren, 1830. Translated by Yushin Chung et al. Blue Poppy Press, Boulder, CO, 2007 Zhen Jiu Da Cheng [The great compendium of acupuncture and moxibustion] by Yang Jizhou, 1601. English translation by Wilcox L. Chinese Medicine Database, 2006 Zhen Jiu Jia Yi Jing [Classique ordonné de l acupuncture] by Huangfu Mi (215–281CE). French translation by Milsky C. and Andrès G. Guy Trédaniel Editeur, Paris, France, 2004 Zhen Jiu Jia Yi Jing [Systematized classic of acupuncture and moxibustion] by Huangfu Mi (ca. 282 CE). Translation of the Jia Yi Jing by Yang S. and Chace C. Blue Poppy Press, Boulder, CO, 1994
Amaro JA. How to beat jet lag. Contemporary applications for jet lag from ancient principles. http://www. principles. http://www. iama.edu/JetLag/JetLag.htm. Published iama.edu/JetLag/JetLag.htm. Published April 11, 2002. Accessed Accessed October 24, 2011 American American Academy Academy of Sleep Sleep Medicine. Medicine. International International Classi Classifica fication tion of Sleep Sleep Disord Disorders ers:: Diagnos Diagnostic tic and Coding Manual (ICSD-2). 2nd ed. Darien, IL: American Academy of Sleep Medicine; 2005 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-III R. 3rd ed. Arlington, VA: APA; 1987 American Psychiatric Association. DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Publishing; 2000 America Americann Sleep Sleep Disord Disorders ers Associ Associati ation. on. The Intern Internaational Classification of Sleep Disorders: Diagnostic and Coding Manual. Rochester, MN: American Sleep Disorder Association; 1990 Anand BK, China GS, Singh B. Some aspects of electroencephalographic studies in yogis. Electroencephalogr Clin Neurophysiol 1961;13:452–456 Artemidorus D. The Interpretation of Dreams: Oneirocritica. 2nd ed. Translated by White R. Torrance, CA: Original Books; 1990 Association for the Study of Dreams. http://www.IASDreams.org Auteroche B, Navailh P. Le Diagnostic en Médecine Chinoise. Paris: Maloine; 1983 Balbo M, Leproult R, Van Cauter E. Impact of sleep and its disturbances on hypothalamo-pituitary-adrenal axis activity. Int J Endocrinol 2010; 2010: 769234. Published online June 9, 2010. doi:10.1155/2010/ 759234 Barasch MI. Healing Dreams. Exploring the Dreams that Can Transf ransform orm Your Life. Life. New York: ork: Riverh Riverhead ead Books; 2000 Becker-Carus Becker-Carus VC, Heyden T, Kelle A. Die Wirksamkeit Wirksamkeit von Akupunktur Akupunktur und Einstellungs Einstellungs-Ents -Entspannun pannungstrain gstraining ing zur Behandlung primärer Schlafstörungen. Z Klin Psychol Psychopathol Psychother 1985;33(2):161–172 Blechner M. The Dream Frontier. Hillsdale, NJ: Analytic Press; 2001 Born J, Rasch J, Gais S. Sleep to remember.Neuroscientist 2006;12:410–424 Buclin T, Baudet J, Biollaz J. Concepts pharmacologiques du trait traitem emen entt des des insomn insomnie ies. s. Med Med et Hygie Hygiene ne 1992;50:1157–1162
ʼ
ʼ
138
Appendices
Cao H, Pan X, Li H, Liu J. Acupuncture for treatment of insomnia: a systemic review of randomized controlled trials. J Altern Complement Med 2009;15 (11):1171–1186 Callaway JC. A proposed mechanism for the visions of dream sleep.Med Hypotheses 1988;26:119 –124 Cappucio F, Cooper D, D Elia L, Strazzullo P, Miller M. Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J (2011). First published online February 7, 2011 doi:10.1093/eurheartj/ehr007 http:// eurheartj.oxfordjournals.org/content/early/2011/02/ 03/eurheartj.ehr007. Accessed October 24, 2011 Cartwright RD. Functions of dreams. In: Carskadon MA, ed. Encyclopedia of Sleep and Dreaming. New York: Macmillan; 1993:254–257 Cheuk DK, Yeung WF, Chung KF, Wong V. Acupuncture for insomnia. Cochrane Database Syst Rev 2007;(3): CD005472 Colic M. Kanna s lucid dreams and the use of narrative practices to explore their meaning. Int J Narrative Ther Community Work 2007;(4):19–26 Colin D, Barry C. Tout sur la Médecine Chinoise. 5000 ans au service de votre santé. Paris: M.A. Éditions; 1989 Copinschi G, Van Onderbergen A, L Hermite-Balériaux, et al. Effects of the short-acting benzodiazepine triazolam, taken at bedtime, on circadian and sleep-related hormon hormonal al profil profiles es in norma normall men. men. Slee Sleep1990;1 p1990;133 (3):232–244 Coutts R. Dreams as modifiers and tests of mental schemas: an emotional selection hypothesis. Psycholog Rep 2008;102(2):561 –574 Crick F, Mitchison G. The function of dream sleep. Nature 1983;304:111–114 Dallakian IG, Vein AM, Kochetkov VD, et al. Relation between clinico-physiologic indices of sleep and the nature of stress and ref lexotherapy lexotherapy application [Article in Russian]. Zh Nevropatol Psikhiatr Im S S Korsakova. 1985;85(4):534–539 Da Silva JB, Nakamura MU, Cordeiro JA, Kulay LJ. Acupuncture for insomnia in pregnancy—a prospective, quasi-randomised, controlled study. Acupunct Med 2005;23(2):47–51 Davenas E, Beauvais F, Amara J, et al. Human basophil degranulation triggered by very diluted antiserum against IgE. Nature 1988;333(6176):816–818 de Coux H. La peur et le rêve: 8th Symposium. Aix en Provence: Edition De Verlaque; Verlaque; 1991 Dement W, Kleitman N. Cyclic variations in EEG during sleep and their relation to eye movements, body motilit motilityy and dreamin dreaming. g. Electro Electroenc enceph ephalog alogrr Clin Neurophysiol 1957;9:673–690 Dijk D-J, Lockley SW. Functional genomics of sleep and circadi circadian an rhythm rhythm.. Invite Invitedd review review:: Integr Integrati ation on of human sleep-wak sleep-wakee regulation regulation and circadian circadian rhythrhythmicity. J Appl Physiol 2002;92(2):852–862 Duo LJ. Electrical needle therapy of uremic pruritis. Nephron 1987;47(3):179–183 ʼ
ʼ
ʼ
Fabas-Eyraud P. Troubles du Sommeil [thesis]. Paris: Association Française d Acupuncture; 1979;60:54 Faraday A. The Dream Game. New York: HarperCollins; 1990 Ferenczi S. To whom does one relate one s dreams? In: Rickman J, ed. Further Contributions to the Theory and Technique of Psycho-Analysis. New York: Boni and Liveright; 1927:349 Ferrie JE, Shipley MJ, Cappuccio FP, et al. A prospective study of change in sleep duration: associations with mortality in the Whitehall II cohort. Sleep 2007;30 (12):1659–1666 Fietze I, Penzel T, Baumann G, Bonner G, Kamke W, Podszus T. Versorgung von Patienten mit obstruktiver Schlafapnoe Schlafapnoe in kardiologisc kardiologischen hen Praxen und Kliniken. DMW 2010;135(5):178–183 Ford Ford CW. Compas Compassio sionat natee Touch. ouch. The Body Body s Role in Healing and Recovery. Berkeley, CA: North Atlantic Books; 1999 Freire AO, Sugai GCM, Chrispin SF, et al. Treatment of moderate obstructive sleep apnea syndrome with acupun acupunctur cture: e: a random randomise ised, d, place placebo-c bo-cont ontroll rolled ed pilot trial. Sleep Med 2007;8(1):43–50 Freud S. The Interpretation of Dreams. New York: Modern Library; 1994 Friedmann J, Globus G, Huntley A, Mullaney D, Naitoh P, Johnson L. Performance and mood during and after gradual sleep reduction. Psychophysiology 1977;14 (3):245–250 Fruehauf H. All disease comes from the heart: the pivotal role of the emotions in classical Chinese Medicine. http://www.classicalchinesemedicine.org/wpcontent/uploads/2010/04/emotions_Fruehauf.pdf. Published April, 2004. Accessed October October 2009 Gackenbach J. Manifest Content Analysis of Sleep Laboratory Collected Lucid and Nonlucid Dreams. In: Tenth Anniversary Issue of Lucidity Letter, Section C: Predisposing posing Facto Factors rs and Individ Individual ual Differen Difference ces, s, 1991. 1991. http://sawka.com/spiritwatch/manifest.htm. http://sawka.com/spiritwatch/manif est.htm. Accessed October 24, 2011 Gaillard JM, ed. Le sommeil: Ses mechanismes et ses troubles. Lausanne: Payot; 1990 Gallbach MR. Learning from Dreams. Einsiedeln, Switzerland; Daimon Verlag: 2006 Gao XY, Wei YL, Shao SJ, et al. Multiple central clinical studies on the needling method for regulating wei and strengthening strengthening brain for treatment of insomnia. insomnia. Zhongguo Zhen Jiu 2007;27(8):623–625 Garfield P. Creative Dreaming: Plan and Control Your Dreams to Develop Creativity, Overcome Fears, Solve Problems, and Create a Better Self. New York: Fireside; 1995 Genton P. Benzodiazépines: dépendance et sevrage. Bulletin Veille Sommeil. June 1990 Goldenberg F. Pharmacologie du sommeil. Physiologie du sommeil. Paris: Masson; 1984 Griffin J, Tyrell I. Human Givens: A New Approach to Emotional Health and Clear Thinking. Chalvington: Human Givens Publishing; 2003 ʼ
ʼ
ʼ
Bibliography
Griffin Griffin J, Tyrell yrell I. An Idea Idea in Practic Practice. e. Chalvin Chalvington gton:: Human Givens Publishing; 2007 Gumustekin K, Seven B, Karabulut N, et al. Effects of sleep deprivation, nicotine, and selenium on wound healing in rats [Abstract]. Int J Neurosci 2004;114 (11):1433–1442 Gurdjieff GI. Beelzebub ’s Tales to His Grandson. New York: Harcourt, Harcourt, Brace 1950. Republished by Penguin Arkana, 1999 Hall C, Van de Castle R. The Content Analysis of Dreams. New York: Appleton-CenturyAppleton-Century-Crofts; Crofts; 1966 Hanh TN. The Miracle of Mindfulness Mindfulness.. Boston: Boston: Beacon; Beacon; 1987 Hanin B, Marks J. Dépendance aux benzodiazépines et syndrome de sevrage. Psychiatr Psychobiol 1988;3: 347–364 Hartm Hartman annn E. Makin Makingg conne connect ction ionss in a safe safe plac place: e: is dreaming psychotherapy? Dreaming 1995;5:213–228 Hay LL. You Can Heal Your life. Carlsbad, CA: Hay House, Inc.; 1999 Hobson JA. Dreaming: An Introduction to the Science of Sleep.Oxford: Sleep. Oxford: Oxford University University Press; 2002 Hobson JA, McCarley R. The brain as a dream state of sex: an activation-synthesis hypothesis of the dream process. Am J Psychiatry 1977;134:1335–1348 Horlemann J. Schmerzverarbeitung, Schmerzgedachtnis und Schlafqualitat. Dtsch Med Wochenschr 2009; 134(suppl 4):S127 –S131 Horne Horne J. Why We Sleep Sleep.. Oxford Oxford:: Oxford Oxford Unive Universit rsityy Press; 1988 Horne JA, Wilkinson S. Chronic sleep reduction. Psychophysiology 1985;22:69–78 Hoss RJ. Dream Language: Self-understanding Through Imagery and Color. Ashland, OR: Innersource; 2005 Huang W, Kutner N, Bliwise DL. A systematic review of the effect effectss of acupun acupunctur cturee in treati treating ng insomn insomnia. ia. Sleep Med Rev 2009;13(1):73 –104 Jenni OG, Molinari L, Caflisch JA, Largo RH. Sleep duration from ages 1 to 10 years: variability and stability in comparison comparison with growth. growth. Pediatrics Pediatrics 2007:120: e769–e776 Ji XP. XP. Teaching round: insomnia. J Tradit Chin Med 1987;7(1):73–76 Jiang Y. Application of Biao Ben differentiation in acupuncture puncture therapy therapy.. J Tradit Tradit Chin Med 1994;14(4) 1994;14(4):: 259–261 Jones CR, Campbell SS, Zone SE, et al. Familial advanced sleepsleep-pha phase se syndro syndrome: me: a shortshort-per period iod circad circadian ian rhythm rhythm varian variantt in humans humans.. Nat Nat Med 1999;5( 1999;5(9): 9): 1062–1065 Jouvet M. Le sommeil et le rêve. Paris: Odile Jacob; 1992 Jung CG. The Practice of Psychotherapy. Psychotherapy. The Practical Use of Dream Dream Analys Analysis. is. New York: York: Routle Routledg dgee & Kegan Paul; 1934 Jung CG. General aspects of dream psychology. In: Jung CG. Dreams. Translated by Hull, RFC. Princeton, NJ: Princeton University Press; 1974: 23–66 Jung CG. Dreams. New York: York: Routledge; Routledge; 2002
Kalavapalli R, Singareddy R. Role of acupuncture in the treatment treatment of insomnia: insomnia: a comprehe comprehensiv nsivee review. review. Complement Ther Clin Pract 2007;13(3):184–193 Kasatkin VN. Teoriya Snovidenii [Theory of dreams]. Leningrad: Meditsina; 1967 Kasatkin VN. Theory of Dreams. In: Van de Castle R. Our Drea Dreamin mingg Mind Mind.. New New York: ork: Balla Ballant ntine ine Book Books; s; 1994:362–364 Katzman MA, Spence DW, Kayumov L, et al. Acupuncture increases nocturnal melatonin secretion and reduces insomnia and anxiety: a preliminary report. J Neuropsychiatry Clin Neurosci 2004;16(1):19–28 Kesp Kespii JM. Acupun Acupunctu cture. re. Moulins Moulins-le -les-M s-Met etz: z: Maison Maison-neuve; 1982 Kim YS, Lee SH, Jung WS, et al. Intradermal acupuncture on shen-men and nei-kuan acupoints in patients with insomnia after stroke. Am J Chin Med 2004;32 (5):771–778 King DP, Zhao Y, Sangoram AM, Takahashi JS, et al. Positional cloning of the mouse circadian clock gene. Cell 1997;89(4):641–653 Koche Kochetk tkov ov VD, Mikhailo Mikhailova va AA, Dallak Dallakian ian IG. Reflex Reflex-otherapy of neurotic patients with depressive-hypochondriacal manifestations [in Russian]. Zh Nevropatol Psikhiatr 1983;83(12):1853–1855 Kramer M. The selective mood regulatory function of dreaming: an update and revision. In: Moffitt A, Kramer M, Hoffmann R, eds. The Functions Function s of Dreaming. Albany Albany,, NY: NY: Stat Statee Unive Universi rsity ty of New New York Press Press;; 1993:139–196 Kumar K. A study on the impact of stress and anxiety through yoga nidra. Indian J Trad Knowl 2006;7 (3);401–404 Kumar, K. Effect of yoga nidra on hypertension and other other psychol psychologi ogical cal co-rel co-relat ates. es. Yoga the Scienc Sciencee 2005;3(7) Kumar R, Birrer BV, Macey PM, et al. Reduced mammillary body volume in patients with obstructive sleep apnea. Neurosci Lett 2008;438(3):330 –334 LaBerge S. Lucid dreaming: psychophysiological studies of consciousness during REM sleep and cognition. In: Bootzen RR, Kihlstrom JF, Schacter DL, eds. Sleep and Cognition. Washington, DC: American Psychological Association; 1990:109–126 LaBerge S. Healing through lucid dreaming. In: Tenth Anniv Ann ivers ersary ary Issue Issue of Lucidit Lucidityy Lette Letter, r, Section Section B: Other Other Applications, Applications, 1991. http://www.spiritwatch. 1991. http://www.spiritwatch. ca/healing_through_lucid_dreaming.htm. Accessed October 20, 2011 LaBerge S, Levitan L. Validity established of dreamlight cues for eliciting lucid dreaming. Dreaming 1995;5 (3):159–168 Laurent D. Précis d acupuncture traditionnelle. Paris: Guy Trédaniel editeur; 1987 Lee T-N. Injection of auricular points in the treatment of insomnia. Am J Chin Med 1977;5(1):71–77 Leproult R, Copinschi G, Buxton O, Van Cauter E. Sleep loss results in an elevation of cortisol levels the next evening. Sleep 1997;20(10):865 –870 ʼ
139
140
Appendices
Li JR. 10 cases of somnambulism treated with combined acupuncture and medicinal herbs. J Tradit Chin Med 1989;9(3):174–175 Lian N, Yan Q. Insomnia treated by auricular pressing therapy. therapy. J Tradit Chin Med 1990;10(3):174–175 Ling L, Jiang XM, Xue JW, Wang M, Ke R. Clinical study on the visceral visceral differentia differentiation-ba tion-based sed acupuncture acupuncture therapy for insomnia. J Tradit Chin Med 2008;28 (4):270–273 Little JR, Niemtzow RC. Auriculotherapy and aircrew with circadian desynchronosis: aeromedical implications. Med Acupunct 1999/2000;11(2):18 –20 Loomis AL, Harvey EN, Hobart GA III. Cerebral states during sleep, as studied by human brain potentials. J Exp Psychol 1937;21:127–144 Lyons T, Pannier W. The Healing Power of Dreams and Nightm Nightmare ares: s: The IASD Dream Dream Work Work with with Cancer Cancer Patients Project. http://www.healingpowerofdreams. com/Pannier_Lyons%5B1%5D.pdf. Accessed com/Pannier_Lyons%5B1%5D.pdf. Accessed September 6, 2010 Macciocia G. Foundations of Chinese Medicine. London: Churchill Livingstone; 1989 Macciocia Macciocia G. The Psyche in Chinese Chinese Medicine. London: Churchill Livingstone; 2009 Marano HE. Bedfellows: insomnia and depression. Psychology Today Magazine. http://cms.psychologytoday.com/articles/pto-20030715–000001 000001.htm .html.l. PubPublished July 1, 2003. Last reviewed May 25, 2007. Accessed September September 27, 2005 Marks GA, Shaffery JP, Oksenberg A, Speciale SG, Roffwarg HP. A functional role for REM sleep in brain maturation. Behav Brain Res. 1995;69:1–11 Martino TA, Oudit GY, Herzenberg AM, et al. Circadian rhythm disorganization produces produces profound cardiovascular and renal disease in hamsters. Am J Physiol Regul Integr Comp Physiol 2008;294(5):R1675 20 08;294(5):R1675–R1683 Mayo Clinic. Light therapy – why it s done. http://www. done. http://www. mayoclinic.com/health/light-therapy/MY00195/ DSECTION=why_its_done. Published DSECTION=why_its_done. Published October 7, 2010. Accessed October 24, 2011 Mignot E. Dépendance et sevrage aux benzodiazépines. Bulletin Veille Sommeil, 1991 Mirmiran M, Scholtens J, Van de Poll NE, Uylings HBM, Van der Gugten, J, Boer GJ. Effects of experimental suppre suppress ssion ion of active active (REM) (REM) sleep sleep during during early early development upon adult brain and behavior in the rat. Dev Brain Res 1983;7:277 –286 Moffatt ME. Nocturnal enuresis: psychologic implications tions of treatm treatment ent and non treatm treatment ent.. J Pediat Pediatrr 1989;114(4 pt 2):697–704 Montakab H, Langel G. L effet de l acupuncture dans le traitement de l insomnie. Etude clinique d évaluation subjective et objective. Schweizerische Medizinische zinische Wochensc Wochenschrift hrift 1994;124(su 1994;124(suppl. ppl. 62):49– 54 Mullin GH. Readings on the Six Yogas of Naropa. Ithaca, NY: Snow Lion Publications; 1997 Nagoshi E, Saini C, Bauer C, Laroche T, Naef F, F, Schibler U. Circadian gene expression in individual fibroblasts: ʼ
ʼ
ʼ
ʼ
ʼ
cell-autonomous and self-sustained oscillators pass time to daughter cells. Cell 2004;119(5):693 –705 Naparstek B. Staying Well with Guided Imagery. Clayton, Victoria: Warner Books; 1995 Nation National al Sleep Sleep Founda Foundation tion.. Let sleep sleep work work for for you. you. http://www.sleepfoundation.org/article/hot_topics/ let-sleep-work-you. Published let-sleep-work-you. Published 2002. Accessed September 6, 2011 Nhat Hanh, Thich. Phép la cua su tinh thuc [The Miracle of Mindfulness: An Introduction to the Practice of Meditation]. Translation by Mobi Ho. Boston: Beacon Press; 1999 Norbu, CN. Dream Yoga and the Practice of Natural Light. Ithaca, NY: Snow Lion Publications; 1992 Norment RG. Healing through dreamwork. http://www. dreamwork. http://www. healingpowerofdreams.com/HealingThroughDreamwork-1.pdf. Publishe Publishedd November November 2007. Accessed Accessed October 29, 2010 NPR. NPR. The The scie scienc ncee behin behindd drea dreams ms and and nigh nightma tmare res. s. http://www.npr.org/templates/story/story.php? storyId=15778923. Publis Publishe hedd Octo Octobe berr 30, 30, 2007 2007.. Accessed September September 6, 2011 Oldenburg Oldenburg O. Schlafbezog Schlafbezogene ene Atmungsst Atmungsstörung örungen en bei kardiologischen Patienten – ein ungelöstes Problem. Dtsch Med Wochenschr 2010;135(5):177 Opp MR. Sleeping to fuel the immune system: mammalian sleep and resistance to parasites. BMC Evol Biol. 2009;9:8 doi: 10.1186/1471–2148–9–8 Oudiette D, Leu S, Pottier M, Buzare MA, Brion A, Arnulf I. Dreamlike mentations during sleepwalking and sleep sleep terrors terrors in adults adults.. Sleep Sleep 2009;32 2009;32(12 (12):1 ):1621 621– 1627 Pannier W. Dreams: a creative portal to healing. http:// healing. http:// www.healingpowerofdreams.com/articles/dreams_ healing_portal.htm. Presented healing_portal.htm. Presented October 2006. Accessed September 6, 2011 Patel SR, Malhotra A, Gottlieb DJ, et al. Correlates of long sleep duration. Sleep.2006;29(7):881 –889 Paul, MA, Miller JC, Gray G, Buick F, Blazeski S, Arendt J. Circadian phase delay induced by phototherapeutic devices. Sleep Research 2007;78(7): 645 –652 Payne JD, Nadel L. Sleep, dreams, and memory consolidation: dation: the role of the stress stress hormone hormone cortisol. cortisol. Learn Mem 2004;11;671–678 Perlis ML, Smith LJ, Lyness JM, Matteson SR, Pigeon WR, Jungquist CR, Xin Tu. Insomnia as a risk factor for onset of depression in the elderly. Behavioral Sleep Medicine 2006;4(2):104 –113. DOI: 10.1207/ s15402010bsm0402_3 Pert CB. Molecules of Emotion. The Science Between Mind–Body Medicine. Simon & Schuster; 1999 Phillips KD, Skelton WD. Effects of individualized acupuncture on sleep quality in HIV disease. J Assoc Nurses Aids Care 2001;1(1):27 –39 Price D. Excerpts from an interview with Dick Price conducted by Wade Hudson, Esalen Institute (1985). www.esalen.org/air/essays/dick_price.html. Accessed October 20, 2011
Bibliography
Psychologist World (1998). Stages of sleep.http://www. sleep .http://www. psychologistworld.com/sleep/stages.php. Accessed October 20, 2011 Puhan MA, Suarez A, Lo Cascio C, Zahn A, Heitz M, Braendli O. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. BMJ 2006;332(7536):266 – 270 Rama Sri Swami. Enlightenment Without God [Mandukya Upanishad]. Hinesdale, PA: Himalayan Intl. Inst. of Yoga Science; 1982 Rechtschaffen A, Kales A, eds. A Manual of Standardized Terminology, Terminology, Techniques Techniques and Scoring Scoring System System for Sleep Stages of Human Subjects. Washington: Public Health Health Service Service,, US Governm Government ent Printin Printingg Office Office;; 1968 Ren JJ. 38 cases of insomnia treated with moxibustion on KI-1/Yongquan. Zhongguo Zhen Jiu 2000;20(2): 90 Ren Y. 86 cases of insomnia treated by double point needling – Daling through to Waiguan. J Tradit Chin Med 1985;5(1):22 Requ Requena ena Y. Terrai Terrains ns et Patholo Pathologie gie en Acupun Acupunctu cture. re. Paris: Maloine; 1980 Riemann D, Voderholzer U. Primary insomnia: a risk factor to develop depression? Journal of Affective Disorders 2003;76(1–3):255–259 Rowland R. Experts challenge study linking sleep, life span. http://archives.cnn.com/2002/HEALTH/02/14/ http://archives.cnn.com/2002/HEALTH/02/14/ sleep. sleep.stu study/ dy/ind index. ex.htm html.l. Publish Published ed Februa February ry 15, 2002. Accessed April 22, 2007 Roy-Byrne PP, Hommer D. Benzodiazepine withdrawal: overview and implications for the treatment of anxiety. Am J Med 1988;84:1041 –1052 Saper CB, Scammell TE, Lu J. Hypothalamic regulation of sleep sleep and circad circadian ian rhythm rhythms. s. Nature Nature 2005;4 2005;437: 37: 1257–1263. doi:10.1038/nature04284 Scheer Scheer FA, Wright KP, KP, Kronauer Kronauer RE, Czeisler CA. PlastiPlasticity of the intrinsic period of the human circadian timing system. PLoS One 2007;2(1):e721 Schulz H. Rethinking sleep analysis. Comment on the AASM Manual for the Scoring of Sleep and Associated Events, Events, J Clin Sleep Med 2008;4(2): 99 –103 Scott J, Barlow T. Acupuncture in the Treatment of Children. 3rd ed. Seattle, WA: Eastland Press; 1999 Shah NA, Botros NA, HK Yaggi, Mohsenin V. Obstructive Sleep Apnea is Associated with an Increased Risk of Coronary Artery Disease and Death. Paper presented at the American Thoracic Society International Conference, May 21, 2007 Sharma VK. Adaptive significance of circadian clocks. Chronobiol Int 2003;20(6):901–919 Shinomiya, et al. An effect of acupuncture therapy for sleep disorder. Sleep Research 1993 Siegel B. Love, Medicine and Miracles. New York: Harper & Row; 1986 Simont Simonton on C, Simont Simonton on S, Creigh Creighton ton J. Getting Getting Well Well Again. Los Angeles: JP Tarcher; 1978 Sionneau P. Troubles Psychiques en Médecine Chinoise. Paris: Guy Trédaniel editeur; 1996
Snyder Snyder TJ, Gackenbach Gackenbach JI. Individual Individual differences differences assoassociat ciated ed with with luci lucidd drea dreami ming ng.. In Gack Gacken enba bach ch JI, JI, LaBerge S, eds. Conscious Mind, Sleeping Brain: Perspectives on Lucid Dreaming. New York: Plenum; 1988 Sok SR, Erlen JA, Kim KB. Effects of acupuncture therapy on insomnia. J Adv Nurs 2003;44(4):375–384 Solms M. Dreaming and REM sleep are controlled by diff differ eren entt brai brainn mech mechan anis isms ms.. Beha Behavv Brai Brainn Sci Sci 2000;23(6):843–850 Stein H, ed. The Collected Clinical Works of Alfred Adler, vols 1–12. San Francisco, CA and Bellingham, WA: Alfred Adler Institute of San Francisco and Northwestern Washington; 2006 Stephan JM. Les troubles du sommeil du nourrisson: traitement traitement par stimulation stimulation électro-acu électro-acupunctur puncturale. ale. Méridien 1990;(87):149–167 Step Stephen henss L. Nightma Nightmares res.. http://web.archive.org/web/ 20070831193305/http://www.psychologytoday. 20070831193305/http://www.psychologytoday. com/conditions/nightmare.html. Publis Published hed 2006. 2006. Accessed November November 21, 2011 Stickgold, R. Sleep dependent memory consolidation. Nature Nature 2005;437:127 2005;437:12722–1278. doi:10.1038/ doi:10.1038/natur naturee 04286 Stickgold R, Hobson JA, Fosse R, Fosse M. Sleep, learning, and dreams: off-line memory reprocessing. Science 2001;294(5544):1052–1057 Straif K, Baan R, Grosse Y, et al. Carcinogenicity of shiftwork work,, paint paintin ing, g, and and firefire-fig fight hting ing.. Lance Lancett Onco Oncoll 2007;8(12):1065–1066 Sullivan K. Recurring Dreams: A Journey to Wholeness. Freedom, CA: The Crossing Press; 1998 Swierzew Swierzewski ski SJ. Sleep Sleep stages. stages. http://www.sleepdisorderchannel.com/stages. derchannel.com/stages. Published December 2000. Last modified May 2011. Accessed November 21, 2011 Tabeeva DM, Akhtiamov I. Effect of auricular acupuncture on the organization of night sleep.Klin-Med (Mosk) 1980a;58(10):102 –105 Tabeeva DM, Akhtiamov I. Change in the structure of night sleep in agrypnic syndrome patients under the influence of reflexotherapy [in Russian]. Zh Nevropatol Psikhiatr Im SS Korsakova. 1980b;80(1):101– 103 Taj MJ. Pharmacological effects on REM. Sleep Review: The Journal for Sleep Specialists. Issue Stories; May – June 2002. http://www.sleepreviewmag.com/issues/ http://www.sleepreviewmag.com/issues/ articles/2002–05_07.asp. Accessed 05_07.asp. Accessed October 24, 2011 Takahashi J. Molecular and genetic analysis of the mammalian circadian clock system. http://www.hhmi. org/research/investigators/takahashi.html. Last org/research/investigators/takahashi.html. Last updated October 13, 2010 Takaha Takahashi shi J. Intern Internal al body body temper temperatu ature re turns turns back back circadian clocks. clocks. http://www.hhmi.org/news/takahashi 20101015.html. Published 20101015.html. Published October 15, 2010 Tang SC, Liu JM, Liu GL. Clinical observation on effect of elec electri tricc acup acupun unct cture ure at Sish Sishen enco cong ng in treat treating ing insomnia. insomnia. Chinese Chinese J Integr Integr Med 2007;27(11):1030 2007;27(11):1030– 1032
141
142
Appendices
Tarnow E. How dreams and memory may be related. Neuro-Psychoanalysis 2003;5(2):177–182 Taylor K. Chinese Medicine in Early Communist China. London: RoutledgeCurzon; 2005 Thompson RC. The Epic of Gilgamesh: Complete Academic Translation Translated from the Cuneiform Tablets Tablets in the British Museum Literally into English Hexameters. Charleston, SC: Forgotten Books; 1928. Republished 2007 Trowbridge B. The Hidden Meaning of Illness. Disease as a Symbol and Metaphor. Virginia Beach, VA: ARE Press; 1996 Tsai YD. Stat Statee of Consci Conscious ousnes ness, s, Halluc Hallucinat ination ion and Mind–Body Interaction – A Theory of Dreams, Meridians and Related Phenomena. National Cheng-Kung University University,, Taiwan, Taiwan, 1995. http://myw http://myweb. eb.ncku. ncku.edu. edu. tw/~ydtsai/mindbody/. Accessed October 24, 2011 Turner urner TH, Drummon Drummondd SPA, SPA, Salama Salamatt JS, Brown Brown GG. Effects of 42 hr sleep deprivation on component processes of verbal working memory. Neuropsychology 2007;21:787–795 Ullman M. Dream workshops and healing. http://siivola. org/monte/papers_grouped/copyrighted/Dreams/ Dream_Workshops_and_Healing.htm. Published 1980. Accessed Accessed November 21, 2011 Van Cauter E, Leproult R, Plat L. Age-related changes in slow-wave sleep and REM sleep and relationship with growth hormone and cortisol levels in healthy men. JAMA 2000;284:861–868 Van Dongen HP, Maislin G, Mullington JM, Dinges DF. The cumulat cumulativ ivee cost cost of additio additional nal wakef wakefulne ulness: ss: dosedoseresponse response effects effects on neurobehavio neurobehavioral ral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep 2003;26(2):117 –126 Vedfelt Vedfelt O. The Dimensions of Dreams: The Nature, FuncFunction and Interpretation of Dreams. Translated by Tindall K. London: Jessica Kingsley Publishers; 2002 Von Gontard A, Eiberg H, Hollmann E, et al. Molecular genetics of nocturnal enuresis: linkage to a locus on chromosome 22. Scand J Urol Nephrol Suppl 1999; 202:76–80 Walker MP. Sleep and Cognition III: Memory (Declarative Facts). Lecture given at the University of California, Berkeley, Berkeley, October 7, 2009 Wallach JV. Endogenous hallucinogens as ligands of the trace amine receptors: a possible role in sensory perception. Med Hypotheses 2009;72(1):91 –94 Wang XH, Xiao LY, Wang BF, Yuan YD, Pan WS, Shi YZ. Influence of auricular plaster therapy on sleeping structure in OSAS patients. J Tradit Chin Med 2009; 29(1):3–5 Wang XM. The effect of acupuncture in 90 cases of seque sequelæ læ of brain brain concus concussio sion. n. J Tradit radit Chin Chin Med 1988;8(2):127–128 Wang XZ. l Insomnie et l Hypersomnie en Médecine Traditionnelle Chinoise. Translated by Shan LS. Forbach, France: Institut Yin-Yang; Yin-Yang; 1999 Wangyal T. The Tibetan Yogas of Dream and Sleep. Ithaca, NY: Snow Lion Publications; 1998 ʼ
ʼ
Watanabe T. Lucid dreaming: its experimental proof and psychological conditions. J Int Soc Life Inf Sci (Japan) 2003;21(1):159 –162 Wever ever RA. The The Circ Circad adia iann Syste ystem m of Man. Man. Berli Berlin: n: Springer; 1979 Wilmer H. How Dreams Help. Einsiedeln, Switzerland; Daimon Verlag; 2000 Wyatt JK, Ritz-De Cecco A, Czeisler CA, Dijk DJ. Circadian temper temperatu ature re and melat melatoni oninn rhyth rhythms, ms, sleep, sleep, and neurobehavioral function in humans living on a 20h day. Am J Physiol 1999;277(4):R1152–R1163 Xie L, Xie L, Dong X. 124 cases of dyssomnia treated with with acupun acupunctur cturee at sishen sishengc gcong ong points points.. J Tradit radit Chin Med 1994;14(3):171–173 Xu J, Niu YX, Piao MX, Liu Z, Wu LZ, Liang RL. Effect of acupuncture on blood oxygen saturation in patients of obstructive sleep apnea-hypopnea syndrome [in Chinese]. Zhongguo Zhen Jiu 2009;29(1):84–86 Xu R. The application of bloodletting in acupuncture therapy. J Tradit Chin Med 1990;10(4):274 –275 Xuan YB, Guo J, Wang LP, Wu X. Randomized and controlled study on effect of acupuncture on sleep quality in patients with primary insomnia. Zhongguo Zhen Jiu 2007;27(12):886–888 Yang CL. Clinical observation of 62 cases of insomnia treated by auricular point imbedding therapy. J Tradit Chin Med 1988 Sep;8(3):190 –192 Yeung WF, Chung KF, Zhang SP, Yap TG, Law AC. Electroacupuncture for primary insomnia: a randomized controlled trial. Sleep 2009;32(8):1039–1047 Young oung T, Peppar Peppardd PE, Gottli Gottlieb eb DJ. DJ. Epidem Epidemiolog iologyy of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002;165:1217 – 1239 Yuen JC. Endocrinology in Chinese Medicine. Lecture given at the Academy of Chinese Healing Arts, Winterthur, Switzerland, October 2008 Zager A, Andersen ML, Ruiz FS, Antunes IB, Tufik S. Effects of acute and chronic sleep loss on immune modulation modulation of rats. Am J Physiol Regul Integr Comp Physiol 2007;293:R504–R509 Zao CX. Lectures on formulating acupuncture prescriptions—selections and matching of acupoints. Acupuncture treatment of insomnia. J Tradit Chin Med. 1987;7(2):151–152 Zee A. Quantum Theory in a Nutshell. 2nd ed. Princeton: Princeton University Press; 2010:xxiii (Preface) Zhang Jie (2004). Memory process and the function of sleep. J Theoretics 2004;6 –6. http://www.journaloftheoretics.com/Articles/6–6/Zhang.pdf. Accessed March 13, 2006 Zhang Jie (2005). Continual-activation theory of dreaming, ing, Dynamic Dynamical al Psycho Psycholl 2005 2005–2006. http://www. goertzel.org/dynapsyc/2005/ZhangDreams.htm. Accessed Accessed March 13, 2006 Zhang QL, Chen HY, Shi Y, Ng CS, Chan SM, Yung KK. Auricular Auricular acupuncture acupuncture treatment treatment for insomnia: insomnia: a systematic review. J Altern Complement Med 2007; 1(6):669–676
Bibliography
Personal Communicatio Communications ns Dr. Michel Frey, MD, is a specialist in acupuncture, ethnomedicine, nomedicine, and PMA (Procréation (Procréation Médicalement Médicalement Assistée). He is the president of Conseil Supérieur National d l’Acupuncture Traditionnelle, and Founding Director of the Ecole d ’Acupuncture Traditionnelle. Publications bearing his name include: Mieux vivre grâce à la médecine chinoise (Le Pré aux Clerks, 2007); Yin Yang, Faites un bébé zen avec la médecine chinoise (Médicis, 2004); 150 maladies, 600 remèdes acupuncture,, com(Fran (France ce Loisirs Loisirs;; 2009); 2009); and L’ acupuncture prendre cette médecine (Librairie You-Feng, You-Feng, 2010). Dr. Kamran Ghaffari, MD, FRCPsych, is a psychiatrist specializing in cognitive behavior therapy and currently practices in Zurich, Switzerland. He is also the The Function of Assessment Within Psychoauthor of The logical logical Therapie Therapies: s: A Psychody Psychodynami namicc View (Karnac, 2004). Dr. Gerald Langel, MD, is the Founding Director and Senior Medical Officer of the Centre d ’Analyse et d’Investigation du Sommeil, a sleep specialist, and co-author co-author of the study project on Acupuncture Acupuncture and Insomnia.
Roland Solère is an acupuncturist and osteopath, codirector of the Ecole d’Acupuncture Traditionnelle), and origina originator tor of the Functio Functional nal Reeq Reequil uilibra ibratio tionn Method. Master Master Jeffrey Jeffrey C. Yuen Yuen is an 88th-genera 88th-generation tion Master of the Yu Qing Huang Lao Pai (Jade Purity Yellow Emperor Lao Zi School) ordained by Master Yu Wen, and 26th generation of Quan Zhen Long Men Pai (Complete Reality Dragon Gate School) ordained by Master Lu Xin Xu. Involved in the study of Daoism and the classics of Chinese medicine since early childhood, Master Yuen is very active in the fields of TCM, Daoism, Daoism, qi gong , and tai chi, and is currently the chairman of the Eastern United States Taoist Association and the president of the International Tai Chi Institute, besides being an adviser on the board of numerous other institutions. His input on dream analysis was an invaluable addition to Chapter 5, with references and commentaries to Chen Shi (Analysis and ConYuan’s work, the Meng Zhan Yi Zhi (Analysis clusion of Dreams) (1562), a text that has not yet been translated.
143
144
Index Page numbers in italics refer to illustrations or tables
A
abdominal masses 66 abdominal pain 74 acne 38, 69, 38, 69, 79 79 activation synthesis dream theory 7, 96 , 97 addictions 50 adenosine 5 agitation 20, 38, 20, 38, 43 43,, 48, 48, 68–69, 69, 79, 124 alcohol 12 allergy 42 amenorrhea 50 amnesia 41, 41, 72 amphetamines 12 an mian 13 anger 37, 40 37, 40–42, 68, 42, 68, 76, 76, 78 78,, 84 angina 36, 66, 36, 66, 68 68–69, 72, 69, 72, 79 79 anuria 42 anxiety 35–36, 39 36, 39–43, 43, 50–51, 51, 68–69, 78 69, 78–81, 81, 84, 84, 124 apathy 66, 71 66, 71,, 73–74, 74, 82 appetite loss 36, 66, 36, 66, 71, 71, 74, 74, 76, 76, 78 78,, 80, 80, 83, 101 83, 101 jet lag and 84 arthralgia 43 asthma 32, 38, 32, 38, 50 50,, 74, 81 74, 81 auriculotherapy see ear acupuncture B
barbiturates 12 benzodiazepines 12 bitter taste 35, 37, 35, 37, 68 68–69, 69, 76, 78, 76, 78, 81, 81, 84 bladder 22 damp–heat 74 qi vacuity 100 bladder ( zu tai yang ) channels 46–47 bloating 30–31, 31, 38, 66, 38, 66, 69, 69, 71 71,, 74, 83 blood (wei qi) 19–20 circulation 14–16, 16, 15 disorders 35
heat 20 liver blood not nourishing the kidney jing 102 stagnation 20 stasis 68, 69, 68, 69, 72, 72, 79 79 heart 36, 36, 68, 68, 69, 69, 79 liver 105 upper body 66 vacuity 20, 32, 20, 32, 66 66 case study 56–57 heart 36, 58 36, 58–59, 59, 68, 75, 68, 75, 79 79,, 81 liver 37, 40, 37, 40, 58 58–60, 68, 60, 68, 79, 79, 82–83, 105 83, 105 blurred vision 36, 36, 42, 42, 65–66, 68, 66, 68, 71, 75, 71, 75, 80 80–81 brain development 2 bruxism (tooth grinding) 10, 30–31, 31, 35, 35, 74, 126 74, 126 Buddhist tradition 90, 99 90, 99 C
caffeine 12 calm insomnia 20 Chen Shi Yuan 92–93 chest oppression 34, 36, 34, 36, 38, 38, 42 42– 43, 51, 43, 51, 66, 66, 68, 68, 71 71,, 76, 78 76, 78,, 80, 82 80, 82 chest pains 36, 66, 36, 66, 68 68–69, 72 69, 72,, 79 22, 23,, 24 chong mai 22, 23 insomnia and 42 chronobiological disorders 10, 84–88 chronotype 5 circadian rhythm 4–5, 5 desynchronization 84–88 sleep disorders 5, 84 5, 84–88 case studies 54, 55 54, 55–56 situational 10 see also jet lag; shift work clock protein 4 cocaine 12 colds 38, 38, 74, 81 74, 81 Confucianism 92, 92, 99 confusion, jet lag and 84 congestion 36, 84 36, 84 consciousness 20, 20
constipation 74 continual-activation dream theory 7, 97 7, 97,, 97 convulsions 37, 37, 42, 42, 49 infantile 48 correspondence system 18, 18, 19 cosmogenic order 18, 19 cough 38, 38, 74, 81 74, 81 craving 41 D dai mai 22, 23 22, 23
insomnia and 42 damp–heat 38 bladder 74 lower burner 74 triple burner 37 danger, dream interpretations 101–103 Daoist tradition 91–92, 92, 98, 99 98, 99 Darwinian random though mutations 7 deafness 37, 37, 43, 73 43, 73 depressants 12 depression 36, 39 36, 39–41, 43 41, 43,, 50, 50, 66, 66, 68–69, 71 69, 71,, 74, 82 74, 82 dermatitis 50 developmental dreams 95, 96 diarrhea 43, 71 43, 71,, 73, 82 73, 82 dietary advice 52, 53 52, 53 digestive problems 50 dimethyltryptamine (DMT) 7 discontentment 124 dizziness 36–37, 42 37, 42,, 48–49, 66, 49, 66, 68, 71 68, 71–72, 75 72, 75–76, 78 76, 78–82, 84 82, 84 22, 22 dong qi 22, dreams 6–7, 21 7, 21,, 36–38, 51 38, 51,, 124, 124, 126 as reality 98–99 brain activity during 8, 8, 9, 75, 75, 94–95 classification 96 –97 developmental developmental dreams 95, 96
dream analysis 131–132 dream theories 7–8
Index
Buddhist tradition 90 Chinese tradition 90–95 Greek mythology 89 Hindu traditions 89 Middle Eastern traditions 89 modern dream theories 94–95, 95 emotional effects 75, 75, 129–130 excessive dreaming 74–76, 79 76, 79,, 81–82, 124 82, 124 explanation 74–75 influencing factors 93–94 interacting dreams 95–98, 96 –97
interpretations and therapeutic strategies 101–106 dreams of control/direction/ movement/navigation 104–105, 106 dreams of fear/danger/threat 101–103, 103, 106 dreams of home/property/ territory/boundaries/ valuables 103–104, 106 dreams of night terrors/ghosts 105–106, 106 dreams of vulnerability/ exposure 105, 105, 106 importance of 106–108 lucid dreaming 90, 91, 90, 91, 98 98,, 131 of falling 81–83 explanation 81–82 of flying 35–36, 36, 68–69, 69, 75–76, 76, 78, 80 78, 80–81, 81, 84 explanation 80–81 physiological effects 75 psychotherapy psychotherapy and 130–131 sexual 82–84, 124 84, 124,, 126 explanation 83 significance of 99–101, 107 sleep-talking and 69 sleep-walking and 67, 68 67, 68 transformational dreams 97 , 98 working with 129–133 drug addiction 50 dry mouth 35, 74, 35, 74, 125 125 dry skin 37–38, 76, 38, 76, 79, 79, 81 81 dry throat 36–38, 76 38, 76,, 79, 79, 81, 84 81, 84 du mai 22, 22, 23 insomnia and 42, 48 42, 48 dysmenorrhea 50 dyssomnia 9–10
E
ear acupuncture 50–51 jet lag treatment 86, 86, 86 ear blockage 32 earth phase pathologies 38 eczema 43, 50 43, 50 edema 50, 50, 71, 71, 73, 82 73, 82 jet lag and 84 embarrassment 125 embryo 90 emotional selection theory 7, 95 7, 95,,
stomach, case study 60–61 fire phase pathologies 35–37 five elements 18, 19 36, 38,, 76, 84 76, 84 “five palm” heat 36, 38 five wills 39 food stagnation 69–70 forgetfulness 65–66, 71, 66, 71, 73 73,, 82– 83 Freud, Sigmund 94 frustration 40, 41 40, 41 fu (bowels) 22 fulfilment dream theory 8, 97 8, 97–98, 98,
96
emotions 21, 21, 39–40 dreaming and 75 emotional restlessness restlessness 35 insomnia treatment and 40–42 releasing 40–41 energy drinks 12 enuresis 35, 72 35, 72–74, 124 74, 124 case study 61–62 explanation 72 envy 37, 68, 37, 68, 76, 76, 78, 78, 84 84 epilepsy 42, 49, 42, 49, 50 50 excitability 42 exercises 51–52 exophthalmia 42 exploding head syndrome 10 extraordinary vessels vessels 14, 22 14, 22–23, 23,
97
G
gallbladder 22 qi vacuity 37–38, 76, 38, 76, 79, 79, 82, 82, 100 gallbladder ( zu shao yang ) channels 47 gastritis 38, 79 38, 79 gates 90–91 ghost points 128–129 Greek mythology 89 grief 40–42 growth hormones 2 gui 18 guilt 125
23
eye symptoms 37, 42 37, 42–43, 48 43, 48–50, 68–69, 79 69, 79 floaters 82 red eyes 38 F fan (vexation) 20, 37 20, 37–38, 38, 68
fatigue 36–39, 66 39, 66,, 69, 69, 74, 76, 74, 76, 79, 79, 82–83 jet lag and 84 mental 66, 71 66, 71,, 73, 82 73, 82 fear 41–43, 50, 43, 50, 73 73,, 77, 77, 82, 125 82, 125 case studies 54–55, 55, 64 dream interpretations 101–103 of change 40 fetus 90 fever 42, 43 42, 43 tidal 34 fire heart 35, 40, 35, 40, 41 41,, 42, 69, 42, 69, 78, 78, 81 81 liver 37, 41 37, 41,, 68, 76, 68, 76, 78, 78, 84 84 case study 60 phlegm 36, 68 36, 68,, 76, 78, 76, 78, 80 80
H
halitosis 38, 69, 38, 69, 79 79 hate 41 headaches 37, 42 37, 42–43, 49, 43, 49, 65 65–66, 68, 72, 68, 72, 76 76,, 78–81, 81, 84 jet lag and 84 morning 71 heart 20, 21 20, 21,, 40 blood stasis 36, 68 36, 68,, 69, 79 69, 79 blood vacuity 36, 68, 36, 68, 75, 75, 79, 79, 81 81 case study 58–59 fire 35, 40, 35, 40, 41 41,, 42, 69, 42, 69, 78, 78, 81 81 out of harmony 76, 84, 76, 84, 102–103 pain 37, 43, 37, 43, 84 84 phlegm harrassing the heart 106 qi repletion 100 qi vacuity 36, 76, 36, 76, 79 79,, 82, 83, 82, 83, 100 will of 39 vacuity 36, 39, 36, 39, 68 68–69 yang vacuity yin vacuity 36, 38 36, 38–39, 39, 76, 76, 84
145
146
Appendices
heart diseases 35, 35, 68, 69 68, 69 heart (shou shao yin ) channels 44 herbal teas 52 Hindu traditions 89 hip pain 42 horary points 86–87, 87 HT-7 shen men 44 HT-8 shao fu 44 hun 16, 18 16, 18–20, 18, 21, 39, 21, 39, 40 40 dreaming and 75, 75, 93, 94 93, 94 hunger 38, 79 38, 79 hypertension 35, 37 35, 37,, 48, 50, 48, 50, 68–69, 84 69, 84 hypopnea syndrome 10 hypotension 43 hysteria 41 I
immune function 1 impotence 42 incontinence 73–74 insomnia 10, 11 10, 11–12, 29 12, 29–64, 29, 76, 79, 76, 79, 82, 82, 124, 124, 125 125 calm insomnia 20 case studies 53–64 causes 12, 12, 29 clinical studies 109–121 methodology 110–111 patients 109–110 results 111–119 diagnosis 30–32 jet lag and 84 treatment 32–53 ear acupuncture 50–51, 51, 50 emotions and 40–42 exercises (qi gong ) 51–52 extraordinary channels and 42–43 in Western medicine 12 movement of blood disorders 35 wei qi disorders movement of wei 32–35, 33, 34 overview of treatment strategies 52–53 point combinations 51 seasonal desynchronization 43 zang fu pathologies 35–39 insomnia-1 point 50–51, 51, 50 insomnia-2 point 50–51, 51, 50 integrating dreams theory 96 , 97 interacting dreams 95–98, 96 –97
internal wind 37, 37, 42, 68 42, 68 irritability 35, 37, 35, 37, 40 40–42, 68, 42, 68, 74, 74, 76, 78 76, 78–82, 84 82, 84 itching 35 J
jealousy 37, 37, 68, 68, 76, 78, 76, 78, 84 84 Jenkins Sleep Questionnaire 112, 115
jet lag 32, 52, 32, 52, 53, 53, 84 84–87, 125 87, 125 explanation 84–85 prevention 86–87 treatment 85–86 ear acupuncture 86, 86 jing bie 65 joy 42 Jung, Carl Gustav 94 K
kidney 22–23 dream interpretations and 101–103 kidneys not grasping lung qi 102 liver blood not nourishing the kidney jing 102 out of harmony 76, 84, 76, 84, 102–103 qi repletion 100 qi vacuity 40, 40, 43, 73, 43, 73, 82, 82, 100, 100, 102 will of 39 yang vacuity vacuity 39, 68 39, 68–69, 71, 69, 71, 73 73,, 82, 102 82, 102 yin vacuity 36, 38 36, 38–39, 43, 39, 43, 76, 76, 84 84 kidney ( zu shao yin ) channels 44 L
large intestine 22 qi vacuity 100 large intestine (shou yang ming ) chan channe nels ls 46 libido, weak 73, 82 73, 82 life curriculum 90–91, 98 91, 98 life cycles 90–91 light therapy 52 Ling Shu 91 liver 20, 21 20, 21,, 91 blood stasis 105 blood vacuity 37, 40 37, 40,, 68, 68, 79, 82–83, 83, 105
case studies 58–60 dream interpretations and 104–105 fire 37, 41 37, 41,, 68, 76, 68, 76, 78, 78, 84 84 case study 60 qi repletion 100 84, 104–105 qi stagnation 84, 104 qi stasis 68, 82 68, 82–83 qi vacuity 100 case study 58–59 symptoms 68 will of 39 wind 81 yang rising rising 79, 81, 79, 81, 105 105 yin vacuity 37, 76, 37, 76, 79, 79, 81 81 liver ( zu jue yin ) channels 44–45 longevity related to sleep time 6 lucid dreaming 90, 91 90, 91,, 98, 98, 131 lumbar pain 36, 38 36, 38–39, 42 39, 42–43, 66, 43, 66, 69, 71 69, 71,, 73, 73, 76, 82, 76, 82, 84 84 lung heat 38 qi repletion 100 qi vacuity 38, 74 38, 74,, 81, 81, 100, 105 100, 105 will of 39 yin vacuity 105 lung (shou tai yin ) channels 45 luo (connecting channels) 16, 41 16, 41 bleeding 41 M
manic behavior 41, 41, 78 master Omega point 50, 50 Medical Outcomes Study (MOS) Energy and Fatigue module questionnaire (MEF) 112, 115 Sleep module questionnaire (MS) 112, 112, 115 melatonin 85 memory 2 dreams and 7 excitations of long-term memory 97, 97 impairment 36, 41 36, 41,, 66, 79 66, 79,, 101 memory consolidation dream theory 97, 97 menopausal syndrome 34 menstrual problems amenorrhea 50 menstrual cycle 42, 68, 42, 68, 83 83 painful periods 66, 72 66, 72 mental activity 17, 17 , 20, 30 dreaming and 8, 8, 9, 75, 94 75, 94–95
Index
restlessness 35, 35, 41, 41, 84, 125 84, 125 mental fatigue 66, 71, 66, 71, 73 73,, 82 mental relaxation 16–17 mental schemata, testing and selection 7 metal phase pathologies 38 midday–midnight clock 85 Middle Eastern traditions 89 ming 90, 91 90, 91 mood-regulating dream theory 96 , 98 muscle cramps 35 muscle tension 35, 35, 50 N
narcolepsy 10, 65 10, 65 nausea 36, 42, 36, 42, 66, 66, 68 68–69, 71 69, 71,, 76, 78, 80 78, 80 jet lag and 84 neck stiffness 42 neck tension 31, 31, 35 Nei Jing 91 nervousness 37, 37, 39, 49 39, 49–50 neuralgia, facial 43 night sweating 34–36, 38, 36, 38, 76, 76, 84 84 night terrors 10, 76 10, 76–77, 79, 77, 79, 125 125 case studies 61–62, 63 62, 63–64 explanation 79 nightmares 29, 31 29, 31–32, 32, 35–38, 41 38, 41,, 51, 51, 74–82, 84 82, 84,, 126 case studies 57–58, 58, 60, 61 60, 61–62 dream interpretations 101–103 explanation 77–78 sleep-talking and 69 sleep-walking and 68 nighttime food cravings 31, 31, 35 nighttime thirst 35 nocturia 10, 53 10, 53,, 72–74, 126 74, 126 explanation 72–73 nocturnal emission 83 noetic theory 99 non-rapid eye movement (non-REM) 2, 10, 2, 10, 69, 69, 77, 77, 80 80 nose bleeds 42 nose blockage 32 numbness 79 O
obesity 38, 38, 50, 50, 71, 80 71, 80 obsessions 40–41, 50 41, 50,, 126 obstructive sleep apnea 10, 32 10, 32,, 34, 70 34, 70
case study 62–63 oneiric Darwinism 95, 96 otitis 43 overexcitement 37, 37, 41, 41, 84 oversensitivity 43 P
pain 42, 43 42, 43,, 50 abdominal 74 chest 36, 66 36, 66,, 68–69, 69, 72, 79 72, 79 heart 37, 43 37, 43,, 84 hip 42 lumbar 36, 38 36, 38–39, 42 39, 42–43, 66, 43, 66, 69, 71 69, 71,, 73, 76, 73, 76, 82, 82, 84 84 palpitations 36–39, 39, 43, 43, 49, 66, 49, 66, 68–69, 75 69, 75–76, 78 76, 78–79, 81 79, 81–84 panic attacks 42, 42, 101 paralysis 42 parasomnia 10 Parkinson’s disease 42 parotid its 43 pen points 86–87, 87 pericardium heat 84 qi repletion 36 qi vacuity 36 pericardium (shou jue yin ) channels 44–45 periodic limb movement disorder 10 Pert, Candace 95, 129 95, 129 phlegm accumulation 105–106 fire 36, 68, 36, 68, 72, 72, 76, 76, 78, 78, 80 80 harrassing the heart 106 misting the mind 66, 71, 66, 71, 80 80,, 105 phototherapy 52 placebo effects 109 po 18–19, 93 19, 93,, 94 polysomnography 4, 111 4, 111–112 positron emission tomography (PET) 8 premenstrual breast distension 68, 68, 83 premonitory dreams 98 processing dreams 98 pruritis 29, 31 29, 31,, 42, 49, 42, 49, 50 50 psychosis 49, 65 49, 65 psychosomatic dream theory 7–8, 96 , 98 ptosis 43 pulse 35–39, 66 39, 66–69, 71 69, 71–76, 76, 78– 84
Q qi 108
circulation clock 85, 85 repletion 41 heart 100 kidney 100 liver 100 lung 100 pericardium 37 sinking, spleen qi 104 stagnation, liver 84, 104 84, 104–105 stasis, liver 68, 82 68, 82–83 vacuity 40 bladder 100 gallbladder 37–38, 76, 38, 76, 79, 79, 82, 82, 100 heart 36, 76, 36, 76, 79, 79, 82, 82, 83 83,, 100 kidney 40, 43, 40, 43, 73 73,, 82, 100, 82, 100, 102 large intestine 100 liver 58–59, 59, 100 lung 38, 74, 38, 74, 81, 81, 100, 100, 105 105 pericardium 36 small intestine 100 spleen 38, 40, 38, 40, 53, 53, 59, 59, 71 71,, 74, 83, 83, 100, 103 100, 103 stomach 100 Qi Bo 99–100 qi gong 51–52 R
rapid eye movement (REM) sleep 1, 2 1, 2,, 4, 21 4, 21 brain development and 2 ultradian rhythm 5 Raynaud disease 50 reality 98–99 rebound phenomena 12 releasing dreams 96 , 97 REM see rapid eye movement (REM) sleep REM sleep behavior disorder 10 ren mai 22, 23, 22, 23, 24, 24, 101 101 insomnia and 42, 42, 48 restless legs syndrome (RLS) 10, 29–31, 31, 35, 35, 126 restlessness 20, 20, 30, 35 30, 35–38, 48, 38, 48, 50, 50, 68, 75 68, 75–76, 78 76, 78–82, 84, 82, 84, 126 126 mental/emotional 35, 35, 41, 41, 84, 125 retardation 41 reverse learning theory 96 , 97
147
148
Appendices
“running
piglet” syndrome 42,
101 S
sadness 40–42, 81 42, 81 Seven Dragons 129 sexsomnia 10 sexual dreams 82–84, 84, 124, 126 124, 126 explanation 83 sexual dysfunction 37 sexual perversions 37, 37, 84 shen 16–17, 19 17, 19–20, 20, 39, 39, 40, 108 calming 41–42 shen men 50, 50, 50 shi shui 65–67 shift work 32, 32, 52, 87 52, 87–88 case study 54 shock 72 shortness of breath 36–37, 37, 39, 39, 66, 66, 69, 69, 76, 79, 76, 79, 82 82–83 shoulder tension 35 shu points 40–41 SI-3 du mai 46 sinusitis 43 skin hyperesthesia 43 sleep 1, 43 1, 43 amount of 5–6, 6 associated physiological processes 1–2 anabolism/somatic growth 2 brain development/ development/ ontogenesis 2 memory 2 restoration/rejuvenation 1 circadian rhythm 4–5, 5 consequences of inadequat in adequatee sleep 6 evaluation 111 in Chinese medicine 13–27, 27, 28 organization 24–25 stages 2–4, 3 ultradian rhythm 5 sleep apnea 10, 10, 29, 31 29, 31,, 70–72, 80 72, 80 explanation 70–71 obstructive 10, 32, 10, 32, 34, 34, 70 70 case study 62–63 sleep debt 1 sleep deprivation studies 1 sleep disorders 9–11 circadian rhythm disorders 5, 84–88 case studies 54, 55 54, 55–56 situational 10
classification 11 dyssomnia 9–10 parasomnia 10 secondary disorders 10 see also specific disorders
sleep paralysis 10 sleep sex 10 sleep spindles 4 sleep-talking 10, 29, 10, 29, 31, 31, 37, 37, 51, 51, 69–70, 76 70, 76,, 79, 81 79, 81,, 126 explanation 69 sleep-walking 10, 29, 10, 29, 31, 31, 37 37–38, 49, 49, 66–69, 69, 76, 79, 76, 79, 81 81–82, 126 82, 126 case studies 57, 60 57, 60–61 explanation 67 sleepiness 65–67, 67, 71, 71, 80, 82 80, 82–83, 126 see also somnolence small intestine 22 qi vacuity 100 small intestine (shou tai yang ) channels 46 snoring 29, 31 29, 31–32, 34, 32, 34, 36, 36, 38, 38, 53, 53, 66, 76, 66, 76, 78, 78, 80 80 case study 62–63 sleep apnea and 70, 71 70, 71 somnambulism see sleep-walking somnolence 65–67 space 25, 25, 26–27, 27, 26 spasms 37, 37, 43, 50 43, 50 spermatorrhea 42, 83, 42, 83, 126 126 spleen 20 dream interpretations and 103–104 qi sinking 104 qi vacuity 38, 38, 40, 71, 40, 71, 74 74,, 83, 83, 100, 100, 103 case studies 53, 59 53, 59 vacuity with dampness 104 will of 39 vacuity 71, 71, 73, 82 73, 82 yang vacuity spleen ( zu tai yin ) channels 45 sputum 66, 66, 71, 71, 80 steaming bone syndrome 34 sterility 42 stimulants 12 stomach 22 fire, case study 60–61 heat 38, 79 38, 79 hyperacidity 50 qi vacuity 100 stomach ( zu yang min) channels 46 stress 50 stroke 49, 66 49, 66,, 72
suprachiasmatic nucleus (SCN) 4, 85 sweating 66, 71 66, 71 T
tachycardia 35, 50, 35, 50, 68 68–69, 69, 84 thirst 38, 38, 74, 74, 79, 84 79, 84,, 125 nighttime 38 threat, dream interpretations 101–103 tics 37 tidal fevers 34 time 25, 26 25, 26 tinnitus 36, 38, 36, 38, 42 42–43, 48, 43, 48, 66 66,, 73, 73, 76, 76, 79, 84 79, 84 tongue 35–39, 66 39, 66–69, 69, 71–76, 78–84 ulceration 35, 69, 35, 69, 78, 78, 81 81 tooth grinding (bruxism) 10, 10, 30– 31, 31, 35, 74 35, 74,, 126 tranquilizer/relaxation point 50, 50
transformational dreams 97 , 98 trauma 66, 66, 72 trembling 37 triple burner 22 damp heat 37 triple burner (shou shao yang ) channels 47 tumors 72 U
ultradian rhythm 5 urination, frequent 67, 67, 69, 69, 71, 73–74, 74, 82 urogenital problems 50 V
vascular diseases 50 vertigo 50 vomiting 42 W
water phase pathologies 38–39 weakness 42, 66, 42, 66, 83 83 wei qi circulation 14–16, 15, 16 , 21, 22 21, 22 disorders 32–35, 33, 34 whiplash injury 66 wills 39
Index
Window of the Sky points 65 wood phase pathologies 37–38 worry 40–42, 42, 50, 81, 50, 81, 126 126 case study 53 wound healing 1 wu ji (four seasons) 18 wu xiang (five (five directions) 18 correspondence system wu xing correspondence 18, 19 X xie qi 100–101 xue 19–20
Y yang 13–14, 13, 14, 25
liver, rising 79, 79, 81, 81, 105 organization 23, 23, 24, 26 repletion 42, 42, 99, 100 99, 100
spatial distribution 26–27, 27 stasis 42 vacuity heart 36, 36, 39, 68 39, 68–69 kidney 39, 68 39, 68–69, 71, 69, 71, 73, 73, 82 82,, 102 spleen 71, 71, 73, 82 73, 82 yang qiao mai 23, 24, 23, 24, 25, 25, 26 26 insomnia and 42–43 symptoms 24 yang wei mai 23, 25 23, 25 insomnia and 43 symptoms 24 yi 17–18 yin 13–14, 13, 14, 25 accumulation 65 organization 23–24, 24, 26 repletion 65, 99, 65, 99, 100 100 spatial distribution 26–27, 27, 27 temporal movements 26, 30 26, 30 vacuity 42
heart 36, 38 36, 38–39, 76, 39, 76, 84 84 kidney 36, 38 36, 38–39, 43, 39, 43, 76, 76, 84 84 liver 37, 37, 76, 79, 76, 79, 81 81 lung 105 yin qiao mai 23, 23, 25, 25, 26 insomnia and 42 symptoms 24, 24, 31 yin tang 48 23, 24, 25, 24, 25, 27 27,, 27 , 102 yin wei mai 23,
insomnia and 43 symptoms 24–25, 31, 25, 31, 32 32 Z zang fu f u vacuity 100 zang zao 19–20 zao (agitation) 20 zhi points 40–41
Zhuang Zi 92
149
