Written By Jun Heo(許浚, 1539~1615), Translated by Namil Kim, Wung Seok Cha et al., Published by Ministry of Health & Welfare (Korea)
06 Insomnia Caused by Vexation of the Deficiency Type 虛煩不睡 허번으로 잠들지 못하는 것
① In the Divine Pivot (靈樞), it is said, “Huangdi (黃帝) asked, ‘When people cannot close their eyes and fall asleep, what kind of qi causes it?’ Bogao (伯高) answered, ‘Defense qi circulates the yang aspect during the daytime, and circulates the yin aspect during the night time. It always starts from the kidney meridian and runs in the five viscera and six bowels. If reverting qi enters the five viscera and six bowels, defense qi only guards the outside and cannot enter the yin aspect. If defense qi only runs in the yang aspect, yang qi becomes exuberant. If yang qi is exuberant, only the yang heel vessel becomes full, and it cannot enter the yin aspect. Therefore, yin qi becomes deficient and the eyes cannot be closed. If the patient drinks 1 je [the term of herbal decoction which means 20 packages] of a Pinellia Decoction, yin and yang circulate, the patient would fall asleep immediately.
To prepare this prescription, first whip 8 doe of water flowing out from 1000 ri (A Korean unit which counts distance, 1 ri ≒ 0.4 km) for a long period. Take 5 doe of limpid water from it and boil. Use reed as firewood. When the water boils up, put 1 doe of waxy rice and 5 hop of Pinelliae Tube Preparata (半夏). Boil it slowly until the water boils down to 1.5 doe and remove the residue. Drink 1 small cup 3 times a day, and increase the dose until the patient gets better. When the patient is suddenly taken ill, make the patient take the medicine, go to bed and sweat, and the disease will be cured. Take the medicine three times and chronic diseases will be cured.'”
② When the patient does not have a fever, but the head and eyes are confused and painful, and the mouth and throat are dry without thirst, and when the mind is clear and the patient cannot fall asleep, all these conditions are vexation of the deficiency type.
③ After suffering from a serious disease, if the patient cannot fall asleep due to a vexation of the deficiency type, a Warm Gallbladder Decoction is mainly used. If it is a serious case, add Cinnabaris (朱砂) and Bovis Calculus (牛黃) to Augment Base
Powder. [The prescription is mentioned in the chapter on Summer-heat].
④ When the patient feels heat alone, it is a vexation of the deficiency type. When the patient is anxious standing up or lying down and cannot fall asleep, this is a vexation. You should use a Bamboo Leaf and Gypsum Decoction [the prescription is mentioned in the chapter on Cold] or Sour Jujube Seed Decoction.
⑤ There are two kinds of insomnia. If the patient is weakened after suffering from a serious disease or if an old person’s yang qi is debilitated and cannot fall asleep, add Zizyphi Semen (酸棗仁) (stir-baked) and Astragali Radix (黃芪) to a Six Gentlemen Decoction. [The prescription is mentioned in the chapter on Phlegm]. If phlegm is in the gallbladder meridian, the spirit cannot return to its proper place and the patient cannot fall asleep. In this case, add Arisaematis Rhizoma and Zizyphi Semen (酸棗仁) (stir-baked) to a Warm Gallbladder Decoction.
⑥ Vexation of the deficiency type is when the patient’s chest feels agitated, harassed, and uneasy. In the Inner Classic (內經), it is said, “When yin is deficient, it produces interior heat.” It is mostly caused by a yin deficiency that produces heat inside. In the case of Cold Damage, after using vomiting or purgation methods, if the patient suffers acute gastroenteritis, vomiting and diarrhea, and the patient’s fluid and humor is exhausted, the patient thus easily gets a vexation of the deficiency type.
⑦ When the patient cannot fall asleep due to a vexation of the deficiency type, use Stabilize the Will Paste, Sour Jujube Seed Decoction, High Pillow for Good Sleep and No Worries Powder, Mother of Pearl Pill, or Pubescent Angelica Decoction.
⑧ When the patient is too anxious, the gallbladder gets cold and he/she cannot fall asleep at night time, add Zizyphi Semen (酸棗仁) (stir-baked) and Thujae Semen (柏子仁) (stir-baked) in a Formula to Settle the Will [the prescription is mentioned in the chapter on Spirit], and coat with Cinnabaris (朱砂) and Olibanum (乳香). Take 50 of these pills at a time with a decoction of Zizyphi Fructus (大棗). An Augmented Gallbladder-Warming Decoction is also generally used in this case.[B162] ⑨ In the case of a psychotic disorder, the patient cannot fall asleep; also in the case of Cold Damage, the patient cannot fall asleep. [It is mentioned in each related chapter].
- Sour Jujube Seed Decoction 酸棗仁湯 산조인탕: It treats insomnia due to a vexation of the deficiency type, and insomnia from a vexation caused by inducing vomiting and purgation methods in Cold Damage. 2.5 don of Gypsum Fibrosum (石膏), 1.5 don of Zizyphi Semen (stir-baked) (酸棗仁) and Ginseng Radix (人蔘) each, 1 don of Anemarrhenae Rhizoma (知母), Poria Sclerotium Rubra (赤茯苓) and Glycyrrhizae Radix (甘草) each, and 5 pun of Cassiae Cortex Interior (桂心). Mince these drug to make 1 package and decoct in water with 3 pieces of Zingiberis Rhizoma Crudus (生薑).
- Warm Gallbladder Decoction 溫膽湯 온담탕: ① It cures cases when the heart and gallbladder are deficient, when the patient gets easily frightened, has bad dreams and when the patient cannot fall asleep because of a vexation of the deficiency type. 2 don of Pinelliae Tuber (半夏), Citrus Unshius Pericarpium (陳皮), Poria Sclerotium (白茯苓) and Ponciri Fructus Immaturus (枳實) each, 1 don of Bambusae Caulis in Taeniam (靑竹茹), and 5 pun of Glycyrrhizae Radix (甘草). Mince these drugs to make 1package and decoct in water with 5 pieces of Zingiberis Rhizoma Crudus (生薑) and 2 Zizyphi Fructus (大棗). ② Fright palpitations, fearful throbbing, and loss of consciousness and insomnia are caused by phlegm and drool that flow into the heart. Phlegm qi should be controlled, so this prescription is mostly used.
- Augmented Gallbladder-Warming Decoction 加味溫膽湯 가미온담탕: ① It treats the same diseases as mentioned above. 3.5 don of Pinelliae Tuber (半夏), 2.2 don of Citrus Unshius Pericarpium (陳皮), 1.5 don of Bambusae Caulis in Taeniam (竹茹) and Ponciri Fructus Immaturus (枳實) each, and 1 don of Zizyphi Semen (stir-baked) (酸棗仁),Polygalae Radix (遠志), Schisandrae Fructus (五味子), Ginseng Radix (人蔘), Rehmanniae Radix Preparata (熟地黃), Poria Sclerotium (白茯苓), and Glycyrrhizae Radix (甘草) each. Mince these drugs and divide in 2 packages, decoct in water with 5 pieces of Zingiberis Rhizoma Crudus (生薑) and 2 Zizyphi Fructus (大棗).[B182] ② This prescription is a Warm Gallbladder Decoction with Zizyphi Semen (酸棗仁), Schisandrae Fructus (五味子), Polygalae Radix (遠志), Ginseng Radix (人蔘), and Rehmanniae Radix Preparata (熟地黃) added. Patients who have deficient qi and deficient blood in the heart and liver must take this medicine.
- Stabilize Will Paste 寧志膏 영지고: ① It treats insomnia due to vexation of the deficiency type or uneasiness due to dreaming about dangerous incidents. 2 nyang of Zizyphi Semen (stir-baked) (酸棗仁), 1 nyang of Ginseng Radix (人蔘), 5don of Cinnabaris (朱砂), and 2.5 don of Olibanum (乳香). Grind these drugs into powder, knead with boiled down honey, and make pills as big as a bullet. Melt 1 pill in warm alcohol and take it. It can be taken with a Zizyphi Fructus (大棗) decoction. ② When a woman has serious loss of blood, anxiety, and insomnia, grind 7.5 don of Cinnabaris (朱砂), Zizyphi Semen (stir-baked) (酸棗仁), Ginseng Radix (人蔘), Hoelen cum Radix (白茯神) and Succinum (琥珀) each, and 2 don of Olibanum (乳香) into powder. Take 1 don of this powder with a decoction of Junci Medulla (燈心草) and Zizyphi Fructus (大棗).
- Sour Jujube Seed Decoction 酸棗仁湯 산조인탕: It treats insomnia or too much sleep. Use the same quantities of Zizyphi Semen (stir-baked a little) (酸棗仁), Ginseng Radix (人蔘), and Poria Sclerotium (白茯苓). Grind these drugs into powder, put 1 don of this powder in 1 cup of water and boil down until 7/10th remain. If you want to induce sleep, take it cold; if you want to reduce sleep, take it warm.
- High Pillow for Good Sleep and No Worries Powder 高枕無憂散 고침무우산: It treats insomnia caused by deficiencies in the heart and gallbladder. When no prescriptions are effective, take this medicine and it cures marvelously. 5 don of Ginseng Radix (人蔘), 3 don of Gypsum Fibrosum (石膏), 1.5 don of Citrus Unshius Pericarpium (陳皮), Pinelliae Tuber (半夏), Poria Sclerotium (白茯苓), Ponciri Fructus Immaturus (枳實), Bambusae Caulis in Taeniam (竹茹), Liriopis Tuber (麥門冬), Longan Arillus (龍眼肉), and Glycyrrhizae Radix (甘草) each, and 1 don of Zizyphi Semen (stir-baked) (酸棗仁). Mince these drugs, divide into 2 packages, and decoct in water.
- Mother of Pearl Pill 眞珠母丸 진주모환: It treats uneasiness of the spirit and ethereal soul, fright palpitations, and insomnia. 7.5 don of Margaritifera Usta Concha (珍珠母), 1.5 nyang of Rehmanniae Radix Preparata (熟地黃) and Angelica Gigantis Radix (當歸) each, 1 nyang of Ginseng Radix (人蔘), Zizyphi Semen (stir-baked) (酸棗仁), Thujae Semen (柏子仁), Rhinocertis Cornu (犀角) and Hoelen cum Radix (白茯神) each, and 5 don of Aquillariae Lignum (沈香) and Fossilia Mastodi Dcumis (龍齒) each. Grind theses drugs into powder, knead in honey, make pills as big as the seed of the royal foxglove tree, and coat the exterior of the pills with Cinnabaris (朱砂). Take 40~50 pills with a decoction of Mcumhae Herba (薄荷) two times a day. In this prescription, Margaritifera Usta Concha (珍珠母) is the sovereign medicine, and Fossilia Mastodi Dentis (龍齒) is the minister medicine, Margaritifera Usta Concha (珍珠母) is the best among medicines that enter the liver meridian. Fossilia Mastodi Dentis (龍齒) and liver fall under the same category. People only know that Fossilia Mastodi Dentis (龍齒) and Tigris Oculus (虎睛) can calm the heart; however, they do not know that Fossilia Mastodi Dentis (龍齒) eases the ethereal soul and Tigris Oculus (虎睛) tranquilizes the corporeal soul. A dragon metamorphoses, so it makes the ethereal soul move ceaselessly; a tiger is silent, so it makes the corporeal soul stay on guard. If the corporeal soul is uneasy, use Tigris Oculus (虎睛); if the ethereal soul wanders, use Fossilia Mastodi Dentis (龍齒).
- Pubescent Angelica Decoction 獨活湯 독활탕: It treats the same diseases as mentioned above. 7 pun of Araliae Continentalis Radix (獨活), Osterici Radix (羌活), Ginseng Radix (人蔘), Angelicae Decursivae Radix (前胡), Asiasari Radix et Rhizoma (細辛), Pinelliae Tuber (半夏), Adenophorae Radix (沙蔘), Schisandrae Fructus (五味子), Poria Sclerotium (白茯苓), Zizyphi Semen (stir-baked) (酸棗仁), and Glycyrrhizae Radix (甘草) each. Mince these drugs to make 1 package and decoct in water with 3 pieces of Zingiberis Rhizoma Crudus (生薑) and 1 Mume Fructus Praeparatum (烏梅).
07 Insomnia Caused by the Wandering Ethereal Soul 魂離不睡 혼이 떠나서 잠들지 못하는 것
There was a brother of Siming shan, his spirit qi was uneasy, so as he lay down, his ethereal soul and corporeal soul wandered away. His body was on the bed but his spirit and ethereal soul were separated from him. He also had fright palpitations, nightmares, and could not fall asleep. He changed his doctor several times to cure his disease but this had no effect. Xu Xueshi (許學士) examined him and said, “According to your pulse, the liver is affected by pathogenic qi, it is not a disease of the heart. When a normal person whose liver is not affected lies down, the ethereal soul returns to the liver and the spirit becomes calm, so one can sleep. In this case, the pathogenic qi intrudes into the liver while it is deficient. The liver keeps the ethereal soul,
so if the pathogen is in the liver, there is no place for the ethereal soul to return. That is why the ethereal soul wanders as it is separated from the body when you lie down. The liver controls anger, so when it gets worse even you are angered a little.” Then he gave him a Mother of Pearl Pill and Pubescent Angelica Decoction. [These two prescriptions are mentioned above]. He took the medicine for a month and he was cured.
08 Insomnia Due to Lingering Thoughts 思結不睡 생각이 맺혀 잠들지 못하는 것
A woman had too many thoughts so she hadn’t slept for two years. Dairen (戴人) said, “Both pulses are moderate because the spleen was affected by pathogenic qi. The spleen controls thoughts, that is why it becomes like that.” and devised a plan with her husband to make her angry. He received a fortune, he drank for days then quit without giving even one prescription. The woman got very angry, she sweated a lot, then she fell asleep exhausted that night and did not wake up for 8~9 days. After that, she ate food and her pulse returned to normal. This is because the gallbladder is deficient and could not control the spleen which supervises thoughts, so the patient had insomnia. As the doctor stirred up anger in her, the gallbladder could
control the spleen again, and she fell asleep.
09 Sleep of Old People and Sleep of Young People Are Different 老少之睡不同 노인의 잠과 젊은이의 잠
Huangdi (黃帝) asked, “Old people cannot fall asleep at night, and young people do not sleep during the daytime. Which qi causes it?” Qibo (岐伯) answered, “In young people, qi and blood are abundant, the flesh is smooth, the pathway of qi circulation is smooth, and the circulation of nutrient and defense does not escape its ordinary course. That is why their spirits are clear during the daytime and sleep at night. In old people, qi and blood are weak, the flesh is emaciated, the pathway of qi circulation is blocked so the qi of the five viscera collide with each other, and nutrient qi is weak so defense qi flows in its place. That is why their minds are not clear and during the daytime and cannot fall asleep in night.”
10 Yin and Yang and Deficiency and Excess of Sleep 睡辨陰陽虛實 잠의 음양 허실
Too much sleep due to Cold Damage or miscellaneous diseases is due to a yang deficiency and excessive yin; insomnia is due to a yin deficiency and excessive yang. A preference for bright places appertains to yang, and it is because source qi is excessive. A preference for dark places appertains to yin, and it is because source qi is deficient. To sleep facing the wall appertains to yin, and it is because source qi is deficient. To sleep facing outside appertains to yang, and it is because source qi is excessive.
