倪 多痛阳升。阴液无以上注。舌涸赤绛。烦不成寐。当益肾水以制心火。（心火）
鲜生地 元参 麦冬 绿豆皮 银花 竹叶心
吴 少阳郁火。不寐。（胆火）
丹皮 半夏 钩藤 桑叶 茯苓 橘红
程（氏） 上昼气逆填脘。子夜寤不肯寐。乃阳气不降。议用温胆汤。温胆去枳实加金斛 滚痰
丸二钱五分。
顾（四四） 须鬓已苍。面色光亮。操心烦劳。阳上升动。痰饮亦得上溢。灵枢云。阳气下交入阴。阳跷脉
满。令人得寐。今气越外泄。阳不入阴。勉饮酒醴。欲其神昏假寐。非调病之法程。凡中年已后。
男子下元先损。早上宜用八味丸。晚时用半夏秫米汤。（阳跷脉虚）
某 阳不交阴。夜卧寐躁。小半夏汤。
赵（氏） 呕吐眩晕。肝胃两经受病。阳气不交于阴。阳跷穴空。寤不肯寐。灵枢方半夏秫米汤主
之。
又 接用人参温胆汤。
某（四二） 脉涩。不能充长肌肉。夜寐不适。脾营消索。无以灌溉故耳。当用归脾汤意温之。（脾营虚）
嫩黄 于术 茯神 远志 枣仁 当归 炙草 桂圆 新会皮
某 肝阳不降。夜无寐。进酸枣仁法。（胆液亏阳升虚烦）
枣仁 知母 炙草 茯神 小麦 川芎
某 不寐六十日。温胆诸药不效。呕痰不适。明系阳升不降。用金匮酸枣仁汤。
枣仁 知母 茯苓 川芎 炙草
陈 阴精走泄。复因洞泻。重亡津液。致阳暴升。胃逆。食入欲呕。神识不静无寐。议酸枣仁汤。
枣仁（五钱） 炙草（五分） 知母（二钱） 茯苓（二钱）
某（三三） 寤不成寐。食不甘味。 羸。脉细数涩。阴液内耗。厥阳外越。化火化风。燔燥煽动。此属阴损。
最不易治。姑与仲景酸枣仁汤。
枣仁（炒黑勿研三钱） 知母（一钱半） 云茯神（三钱） 生甘草（五分） 川芎（五分）
田 脏液内耗。心腹热灼。阳气不交于阴。阳跷穴空。令人寤不成寐。灵枢有半夏秫米法。但
此病乃损及肝肾。欲求阳和。须介属之咸。佐以酸收甘缓。庶几近理。（肝肾阴亏阳浮）
龟胶 淡菜 熟地 黄柏 茯苓 萸肉 五味 远志
又 咸苦酸收已效。下焦液枯。须填实肝肾。
龟鹿胶 熟地 苁蓉 天冬 萸肉 五味 茯苓 羊内肾
不寐之故。虽非一种。总是阳不交阴所致。若因外邪而不寐者。如伤寒疟疾等暴发。营卫
必然窒塞。升降必然失常。愁楚呻吟。日夜难安。当速去其邪。攘外即所以安内也。若因里
病而不寐者。或焦烦过度。而离宫内燃。从补心丹。及枣仁汤法。或忧劳愤郁。而耗损心脾。
宗养心汤。及归脾汤法。或精不凝神。而龙雷震荡。当壮水之主。合静以制动法。或肝血无
藏。而魂摇神漾。有咸补甘缓法。胃病则阳跷穴满。有灵枢半夏秫米汤法。胆热则口苦心
烦。前有温胆汤。先生又用桑叶丹皮山栀等。轻清少阳法。营气伤极。人参人乳并行。阳浮
不摄。七味八味可选。余如因惊宜镇。因怒宜疏。饮食痰火为实。新产病后为虚也。（邵新甫）
徐评 不寐之因不一。案中十不得一。博考方知。
倪某：多痛导致阳气升浮。阴液无法上注滋养，舌体干枯呈深红色绛色，心烦意乱无法入睡。应当滋补肾水以制约心火。（心火亢盛）
鲜生地、玄参、麦冬、绿豆皮、金银花、竹叶心
吴某：少阳经郁结化火，导致失眠。（胆火旺盛）
牡丹皮、半夏、钩藤、桑叶、茯苓、橘红
程氏：白天上午气逆堵塞胃脘，半夜醒来不肯再睡，这是阳气不能下降。建议采用温胆汤治疗。将温胆汤中的枳实去掉，加入金钗石斛，并配合滚痰丸二钱五分服用。
顾某（四十四岁）：胡须鬓发已经变白，面色光亮。因操心烦劳，导致阳气上升浮动，痰饮也随之上溢。《灵枢》说：“阳气下交入于阴分，阳跷脉充盈，人就能入睡。”如今气机外泄，阳气不能入阴，勉强饮酒醴，想要通过神志昏沉来假寐，这不是调理疾病的正确方法。凡是中年以后，男子的下元（肾气）先受损，早上宜用八味丸，晚上时用半夏秫米汤。（阳跷脉虚）
某人：阳气不能交合于阴，夜间卧床时睡眠躁动不安。用小半夏汤。
赵氏：呕吐眩晕，肝和胃两经受病。阳气不能交合于阴，阳跷穴空虚，醒来后不肯再睡。《灵枢》记载的半夏秫米汤主治此症。
又方：接续使用人参温胆汤。
某人（四十二岁）：脉象涩滞，肌肉消瘦不长，夜间睡眠不适。这是脾营消耗枯竭，无法灌溉周身所致。应当参考归脾汤之意进行温补。（脾营虚）
嫩黄芪、白术、茯神、远志、酸枣仁、当归、炙甘草、桂圆肉、新会皮
某人：肝阳不能下降，夜间无眠。给予酸枣仁法治疗。（胆液亏虚，阳升虚烦）
酸枣仁、知母、炙甘草、茯神、小麦、川芎
某人：失眠六十天，温胆类药物治疗无效，呕吐痰涎不适。明显是阳气上升不能下降。使用《金匮要略》中的酸枣仁汤。
酸枣仁、知母、茯苓、川芎、炙甘草
陈某：阴精走泄，又因严重腹泻，再次亡失津液，导致阳气暴升，胃气上逆，进食欲呕，神识不宁静而失眠。议定使用酸枣仁汤。
酸枣仁（五钱）、炙甘草（五分）、知母（二钱）、茯苓（二钱）
某人（三十三岁）：醒来无法入睡，饮食无味，身体消瘦，脉象细数且涩。阴液在内耗损，厥阳在外越散，化火化风，燔灼干燥煽动。这属于阴分亏损，最不容易治疗。暂且给予张仲景的酸枣仁汤。
酸枣仁（炒黑勿研三钱）、知母（一钱半）、云茯神（三钱）、生甘草（五分）、川芎（五分）
田某：脏腑津液在内耗损，心腹热灼，阳气不能交合于阴，阳跷穴空虚，使人醒来无法入睡。《灵枢》有半夏秫米之法。但此病损伤了肝肾，想要求得阳气调和，必须用介壳类的咸味药，佐以酸收甘缓之品，才大致合理。（肝肾阴亏，阳气浮越）
龟胶、淡菜、熟地黄、黄柏、茯苓、山茱萸、五味子、远志
又方：咸苦酸收的方法已见效，但下焦津液枯涸，必须填补充实肝肾。
龟鹿胶、熟地黄、肉苁蓉、天冬、山茱萸、五味子、茯苓、羊内肾
关于失眠的原因，虽然不止一种，但总是由于阳气不能交合于阴所致。如果是因为外邪导致的失眠，如伤寒、疟疾等突发疾病，营卫之气必然窒塞，升降功能必然失常，痛苦呻吟，日夜难安，应当迅速祛除邪气，攘除外邪即是安养内里。如果是因里病导致的失眠，或因焦烦过度，导致离宫（心）内燃，应选用补心丹及酸枣仁汤法；或因忧劳愤郁，耗损心脾，遵循养心汤及归脾汤法；或因精气不能凝神，导致龙雷之火震荡，当壮水之主，结合静以制动之法；或因肝血无藏，导致魂摇神漾，有咸补甘缓之法；胃病则阳跷脉满，有《灵枢》半夏秫米汤法；胆热则口苦心烦，前文有用温胆汤，先生又用桑叶、丹皮、山栀等，轻清少阳之法；营气伤极，用人参、人乳并行；阳浮不摄，可选七味丸或八味丸。其余如因惊吓宜镇惊，因愤怒宜疏肝，饮食痰火为实证，新产病后为虚证。（邵新甫评）
徐评：失眠的原因不一，医案中十种情况不到一种，广泛考证才知道。
Ni: Frequent pain causes the ascending of Yang Qi. Yin fluids fail to ascend and nourish, resulting in a dry, crimson-red tongue, irritability, and inability to sleep. The treatment should tonify Kidney Water to control Heart Fire. (Heart Fire)
Fresh Rehmanniae Radix (Sheng Dihuang), Scrophulariae Radix (Xuanshen), Ophiopogonis Radix (Maidong), Mung Bean Skin (Lvdoupi), Lonicerae Flos (Jinyinhua), Bamboo Leaf Heart (Zhuyexin)
Wu: Shaoyang constraint generates internal heat, leading to insomnia. (Gallbladder Fire)
Moutan Cortex (Danpi), Pinellia Rhizome (Banxia), Uncaria Ramulus cum Uncis (Gouteng), Mulbai Folium (Sangye), Poria (Fuling), Tangerine Peel (Juhong)
Cheng: In the morning, rebellious Qi fills the epigastrium; at midnight, he wakes up and cannot return to sleep. This is due to Yang Qi failing to descend. It is proposed to use Wendan Decoction (Warm the Gallbladder Decoction). Remove Zhi Shi (Aurantii Fructus) from Wendan Decoction, add Dendrobii Caulis (Jinhuo), and administer Guntan Wan (Rolling Phlegm Pill) 2.5 qian.
Gu (44 years old): Beard and sideburns are already grey, complexion is bright/lustrous. Due to mental worry and overwork, Yang Qi ascends and moves turbulently, causing phlegm-fluids to overflow upwards. The *Ling Shu* states: "When Yang Qi descends and enters the Yin, and the Yang Qiao vessel is full, one can sleep." Now, Qi leaks outward, and Yang does not enter Yin. Forcing alcohol intake to induce a stupor for fake sleep is not the correct method for treating illness. Generally, after middle age, men's lower Yuan (Kidney Qi) is damaged first. In the morning, Bawei Wan (Eight-Ingredient Pill with Cinnamon and Aconite) is suitable; at night, Banxia Shumi Tang (Pinellia and Millet Decoction) is used. (Deficiency of Yang Qiao Vessel)
Certain patient: Yang fails to interact with Yin, resulting in restless sleep at night. Use Xiaobanxia Tang (Minor Pinellia Decoction).
Zhao: Vomiting and vertigo indicate pathology in both the Liver and Stomach channels. Yang Qi fails to interact with Yin, and the Yang Qiao acupoint is empty, causing wakefulness without desire to sleep. The Banxia Shumi Tang recorded in the *Ling Shu* governs this condition.
Subsequent prescription: Renshen Wendan Tang (Ginseng Warm the Gallbladder Decoction).
Certain patient (42 years old): Pulse is choppy, unable to nourish muscles. Nighttime sleep is uncomfortable. This is due to the depletion of Spleen Ying (Nutritive Qi), which fails to irrigate the body. One should apply the principle of Guipi Tang (Restore the Spleen Decoction) to warm and tonify. (Spleen Ying Deficiency)
Tender Astragali Radix (Huangqi), Atractylodis Rhizoma (Baizhu), Poria (Fushen), Polygalae Radix (Yuanzhi), Ziziphi Spinosae Semen (Suanzaoren), Angelicae Sinensis Radix (Danggui), Honey-fried Licorice Root (Zhigancao), Longan Aril (Guiyuan), Xin Hui Pi (Xinhui Chenpi)
Certain patient: Liver Yang fails to descend, causing no sleep at night. Administer the Suanzaoren method. (Deficiency of Gallbladder Fluid, Ascending Yang causing deficiency irritability)
Ziziphi Spinosae Semen (Suanzaoren), Anemarrhenae Rhizoma (Zhimu), Honey-fried Licorice Root (Zhigancao), Poria (Fushen), Triticum Granum (Xiaomai), Ligusticum Chuanxiong Rhizoma (Chuanxiong)
Certain patient: Insomnia for sixty days, ineffective against Wendan-type medicines, vomiting phlegm discomfort. Clearly, Yang rises but fails to descend. Use Suanzaoren Tang from *Jin Gui Yao Lue*.
Ziziphi Spinosae Semen (Suanzaoren), Anemarrhenae Rhizoma (Zhimu), Poria (Fuling), Ligusticum Chuanxiong Rhizoma (Chuanxiong), Honey-fried Licorice Root (Zhigancao)
Chen: Yin essence leaks out, compounded by severe diarrhea, leading to further loss of body fluids, causing sudden violent ascent of Yang, rebellious Stomach Qi, nausea upon eating, restlessness of consciousness, and insomnia. It is proposed to use Suanzaoren Tang.
Ziziphi Spinosae Semen (Suanzaoren, 5 qian), Honey-fried Licorice Root (Zhigancao, 0.5 qian), Anemarrhenae Rhizoma (Zhimu, 2 qian), Poria (Fuling, 2 qian)
Certain patient (33 years old): Wakes up unable to sleep, food tastes bland, emaciation, pulse is fine, rapid, and choppy. Internal consumption of Yin fluids, Jue Yang escapes outward, transforming into fire and wind, scorching dryness and stirring movement. This belongs to Yin damage, most difficult to treat. Temporarily administer Zhang Zhongjing’s Suanzaoren Tang.
Ziziphi Spinosae Semen (Suanzaoren, stir-fried black, not ground, 3 qian), Anemarrhenae Rhizoma (Zhimu, 1.5 qian), Cloud Poria (Yun Fushen, 3 qian), Raw Licorice Root (Sheng Gancao, 0.5 qian), Ligusticum Chuanxiong Rhizoma (Chuanxiong, 0.5 qian)
Tian: Internal consumption of organ fluids, burning heat in heart and abdomen, Yang Qi fails to interact with Yin, Yang Qiao acupoint is empty, causing wakefulness without ability to sleep. The *Ling Shu* has the Banxia Shumi method. However, this disease damages Liver and Kidney. To seek Yang harmony, one must use salty substances from shellfish/shells, assisted by sour-astringent and sweet-moderating herbs, which is reasonable. (Liver-Kidney Yin Deficiency, Floating Yang)
Testudinis et Chelonis Carapax et Plastrum (Guijiao), Mytilus Edulis (Dancie), Prepared Rehmanniae Radix (Shudihuang), Phellodendri Cortex (Huangbai), Poria (Fuling), Corni Fructus (Yurou), Schisandrae Fructus (Wuweizi), Polygalae Radix (Yuanzhi)
Subsequent prescription: The salty-bitter-sour-astringent method has shown efficacy, but Lower Jiao fluids are dried up. Must fill and solidify Liver and Kidney.
Testudinis et Chelonis Carapax et Plastrum (Guilu Jiao), Prepared Rehmanniae Radix (Shudihuang), Cistanche Deserticola (Rongshu), Asparagus Cochinchinensis (Tiantong), Corni Fructus (Yurou), Schisandrae Fructus (Wuweizi), Poria (Fuling), Sheep Kidney (Yang Neishen)
The cause of insomnia, although varied, always results from Yang failing to interact with Yin. If caused by external pathogens, such as sudden onset of Cold Damage or Malaria, Ying and Wei Qi must be obstructed, and ascending-descending functions abnormal, causing suffering and groaning, difficult day and night. One must quickly eliminate the pathogen; expelling the exterior is equivalent to calming the interior. If caused by internal diseases, such as excessive anxiety burning the Heart (Li Gong), use Buxin Dan and Suanzaoren Tang methods; or worry/overwork damaging Heart and Spleen, follow Yangxin Tang and Guipi Tang methods; or essence failing to spirit, causing Dragon-Lei fire agitation, strengthen the Master of Water, combining stillness to control movement; or Liver Blood failing to store, causing soul shaking, use salty-tonifying and sweet-moderating methods; Stomach disease leads to fullness of Yang Qiao vessel, using Ling Shu’s Banxia Shumi Tang method; Gallbladder Heat leads to bitter taste and irritability, previously using Wendan Tang, Mr. Ye also used Sangye, Danpi, Zhizi, etc., light-clearing Shaoyang method; Ying Qi severely injured, use Ginseng and Human Milk together; Yang floating and uncontrolled, choose Qiwei or Bawei pills. Others: if due to fright, sedate; if due to anger, soothe; diet-phlegm-fire are excess syndromes; postpartum/post-illness are deficiency syndromes. (Commentary by Shao Xinpu)
Xu’s Commentary: Causes of insomnia are diverse; cases cover less than one-tenth. Extensive research reveals the truth.