1. Insomnia Etiology, differentiation and treatment

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

3. Etiology and Pathogenesis Over anxiety,overwork Deficient kidney Yin, inability of water to nourish the fire, over anxiety, excessive heart fire Damaged by improper diet Liver damaged by mental depression Impairing the heart and spleen Insufficiency of qi and blood Disharmony of the heart and kidney Stagnation of phlegm and food Disorder of stomach qi Impairment of liver Yin, liver stagnation turning into fire Hyperactivity of liver Yang Loss of nourish -ment of the heart, mental derange -ment Insomnia

4. Differentiation Deficiency of the Heart and Spleen: Main manifestations:difficulty in going to sleep, easy to wake up with excessive dreams during sleep. Accompanying Symptoms and Signs: palpitations, amnesia, spontaneous sweating, lusterless complexion, fatigue, weakness, abdominal distension, loose stool. Tongue and Pulse: a pale tongue with a thin whitish coating, a thready and weak pulse.

5. Hyperactivity of Fire due to Yin Deficiency Main manifestations: Insomnia, restlessness, or easy to wake up after a short sleep. Accompanying Symptoms and Signs: Hot sensation in the palms and soles, severe palpitation, night sweating, a dry mouth and throat, dizziness, tinnitus, amnesia, seminal emissin, soreness and weakness of the waist and knees. Tongue and Pulse: a red tongue, a thready rapid pulse

6. Disorder of Stomach Qi Main manifestations:restlessness and insomnia Accompanying symptoms and signs:vexation with a full sensation in the heart, gastric distension,belching,dizziness,even vomiting with phlegm Tongue and pulse diagnosis:a yellow and greasy tongue coating,a slippery or wiry pulse

7. Flaring-up of excessive Liver Fire Main manifestation: sleeplessness with dizziness and headache Accompanying symptom and signs: irritability and easy to be scared, redness of the eyes, tinnitus, a bitter taste in the mouth, hypochondriac pain, etc. Tongue and Pulse: a red tongue with a thin yellowish coating, a wiry and rapid pulse

8. Acupuncture Treatment

9. Principle The points of Heart Meridian and Three Foot Yin Meridians are selected as main points. Reinforcing is applied for deficiency syndrome, while reducing for excess syndrome to calm the heart and smooth the mind. Acupuncture is desirable in the afternoon or in the evening before sleep.

10. Prescription:Shenmen(HT7),Sishencong(EX- HN1),Sanyinjiao(SP6),Anmian(EX). Additional Points:Xinshu (BL15),Pishu (BL20)for deficiency of the heart and spleen,Xinshu (BL15),Taixi (KI3),Zhaohai (KL6) for disharmony between the heart and kidney,Xingjian(LR2),Ganshu(BL18), for upward disturbance of the liver-fire,Zhongwan (CV36) for dysfunction of the stomach.

11. Other Therapies EarAcupuncture:Subcortex,Sympathesis,Heart,Ki dney,Endocrine,Ear Shenmen,etc. Cutaneous Acupuncture:Tap the regions along the Governor Vessel and the Bladder Meridians from head to back with mild stimulation from above downward,with strong stimulation in lumbo- sacrum until local redness appears.