In my clinic, I’ve worked with patients who were literally desperate to get a good night’s sleep. Trouble falling asleep and waking up in the middle of the night, sometimes several times, is a common symptom of chronic underlying organ imbalances. Short-term acute symptoms of insomnia (the inability to sleep fully or be refreshed by sleep) are often a result of the accumulation of tension in the mind and body during the day. Unresolved interpersonal or inner conflicts, worry and pressure at work may all result in sleeping problems.
Different types of insomnia
I had two patients with different varieties of insomnia and with different causes behind their sleep troubles. Nicole was twenty-four and full of energy. She came into the clinic because she had bouts of energetic bursts interspersed with depression and a seeming inability to get a good night’s sleep for several weeks. She consumed a lot of sugar and caffeinated beverages.
Richard’s case was more complicated and of much longer standing. At forty-five, he had seen several doctors and tried different medications, but he still could not sleep regularly. He had intense headaches and some emotional instability—his wife called me several days after I met him to tell me that Richard would sometimes wake in the night in a cold sweat and sit upright with his eyes wide open.
With all patients, and especially complicated cases, I first apply the eight principles of Chinese medicine, which are reflected in the following questions: Is the pathological process (disease-causing agent or influence) acting on the surface of the body or deep within? Is the process involved with a depletion or surplus of either vital energy or vital substances such as hormones? Are the active processes of the body too cranked up or too slow? Are the body and its processes too hot or too cold? Asking these questions, and observing the general health habits of the patient, their genetic makeup, and reading what the pulse and tongue have to say, the practitioner tries to understand the processes in each individual that lead to the symptoms of poor sleep.
For Nicole, most of the pathology was on the surface. Her tongue was fairly normal, except for a red tip, which generally shows a lot of nervous system activity. Richard’s imbalances had penetrated much more deeply, into his internal organs. He showed severe depletion of “kidney yin.” The kidney system in Chinese medicine generally relates to the hormonal system, whereas the yin substances involve the fluids of the body such as actual hormones, neurotransmitters, and enzymes. This kind of depletion normally results from years of pushing ourselves beyond the limits of our normal resources—for instance, with caffeine and sugar, among other factors.
The difference in programs between the two patients reflects the emphasis of a traditional system of medicine focusing on the differences between people, rather than overemphasizing symptoms. Experience has shown me that the former approach is often more effective—not necessarily for quickly eliminating symptoms, but for achieving longer-lasting results and for supporting the health of the patient, which invariably leads to a better quality of life.
Conventional diagnosis: Muscle tension, insomnia, mild depression.
Traditional diagnosis: Heart “fire” (sympathetic nervous system highly activated); depletion of digestive fire and capacity (spleen qi deficiency).
Treatment plan: Sedate heart fire and support digestive vitality with foods and herbs.
Expected results and timeline: Two-month course of treatment; good results.
Lifestyle changes: Cut back on or eliminate caffeine—use herbal teas to substitute for the ritual of drinking hot liquids. A cold shower in the morning can approximate that first jolt of caffeine, though it may take some getting used to.
Herbs: A formula of 40 percent California poppy (Eschscholzia californica), 20 percent kava (Piper methysticum), 20 percent passionflower (Passiflora incarnata), and 20 percent nettle leaf (Urtica dioica), 3 capsules of the powdered extract twice daily (3 g total), with meals.
Diet: Getting enough minerals is a traditional way of calming an ungrounded nervous system. I recommend plenty of mineral-rich foods, especially calcium- and magnesium-rich ones, such as leafy greens. In addition, a calcium-magnesium supplement (1,200 mg of calcium and 600 to 800 mg of magnesium) may help.
Richard’s healing program
Conventional diagnosis: Severe insomnia, mood disorder, migraine headaches.
Traditional diagnosis: Hyperactive liver syndrome accompanied by severe depletion of the kidney organ system and yin substances.
Treatment plan: Calm and regulate the liver system and tonify the kidneys and yin substances.
Expected results and timeline: One- to two-year course of treatment with herbs, diet, acupuncture, and healthy lifestyle changes; slow progress.
Lifestyle changes: I suggested starting with twenty minutes of yoga each morning. Yoga, which means “union,” helps us integrate our inner world with the outer body in a way that promotes a sense of ease and contentment. The practice begins with simple stretches, coordinated with breathing and gentle but increasingly deep concentration on what our body is feeling and doing.
Diet: For a hyperactive liver, simple, nongreasy, mostly vegetarian fare works best. Eat about 40 percent fresh fruits and vegetables, mostly raw in the summer and lightly cooked in the winter; 30 percent whole grains and well-cooked beans; 10 percent organic and high-quality meat and fish; 10 percent nuts, seeds, and organic dairy; and about 10 percent “comfort” foods of the patient’s choice.
Medications: Richard had tried all of the major pharmaceutical and over-the-counter sleeping aids. He was taking the most popular drug, Ambien, but had also tried tricyclics, selective serotonin reuptake inhibitors (such as Zoloft),and antihistamines (such as Benadryl). These worked for a while, he reported, but ultimately he began to feel anxious.
Herbs: Liver-calming and cooling herbs such as burdock root (Arctium lappa), dandelion root (Taraxacum officinale), yellow dock (Rumex crispus), gentian (Gentiana lutea), and Oregon grape root (Mahonia aquifolium) are indicated here. They can be used regularly, before meals, in tincture form (up to 1 teaspoon of tincture in a little water or herb tea) or in powdered extract form, in capsules or tablets—take 2 or 3 capsules or tablets twice daily around mealtimes. Reishi (Ganoderma lucidum) is a favorite of mine for people with sleeping imbalances and hyperactive livers; take 2 capsules twice daily. Additionally, I recommended a long-term course of herbs to support Richard’s kidney system and yin substances. These formulas (such as Liu Wei Di Huang Wan) can be purchased from herb shops.
After consulting the literature for interactions between St. John’s wort (Hypericum perforatum), calming herbs (such as kava), and Ambien, I started Richard on a formula to help lift his mood and hopefully to regulate serotonin metabolism, reducing the need for pharmaceuticals. The calming formula consisted of 50 percent California poppy and 50 percent St. John’s wort, 2 to 3 capsules of the extract powder, two or three times daily. Additionally, I had him take 1 or 2 high-potency kava gel caps (80 percent kavalactones) before bedtime.
Sleeping problems can be very persistent, or they can ease up quickly. In Nicole’s case, as I expected, she responded well. With regular acupuncture, and following the rest of the program consistently, she felt a decided difference within about a week, and that kept her coming back. Good results are always the best promotion for natural medicine. As for Richard, after a year, he was still working with the natural program and slowly improving. The best testimony was that he continued to come back. He told me that his sleep had improved about 20 percent after several months and that he felt significantly better than he had with the medications. As a natural skeptic, that’s why I still believe in the holistic approach. Considering everything, people keep telling me they feel better.
Christopher Hobbs’s case studies are gleaned from his thirty years of studying and practicing herbalism. Hobbs, a fourth-generation botanist and herbalist, is an Herbs for Health editorial adviser and licensed acupuncturist. He is the coauthor of Vitamins for Dummies (IDG, 1999) and many other books.
“Case studies” is not intended to replace the advice of your health-care provider.