Insomnia (Bude Wo), in miscellaneous diseases, mostly belongs to internal fire. In Shanghan (Cold Damage) disease, there are exterior heat, interior heat, heat at the half-exterior half-interior level, and heat in the Qi level and Blood level; there is insomnia due to excessive sweating or purgation leading to deficiency vexation (Xufan); and there is insomnia due to residual heat after recovery from a febrile disease. If the pulse is floating and rapid, with body fever and pain, no sweat, and inability to sleep, it is a Taiyang (Greater Yang) exterior syndrome, suitable for Qianghuo Tang (Notopterygium Decoction). If there is fever with profuse sweating, thirst, difficulty in urination, and inability to sleep, it is Heat Accumulation in the Bladder of the Taiyang channel, treated with Wuling San (Five-Ingredient Powder with Poria). For Yangming (Yang Brightness) disease presenting with eye pain, dry nose, inability to sleep, body fever, and a long pulse, this is a Yangming exterior syndrome, treated with Gange Tang (Pueraria Decoction). If there is vexing thirst requiring copious water intake, dry tongue, scorched lips, and a long and rapid pulse, this is a Yangming interior syndrome, treated with Renshen Baihu Tang (Ginseng White Tiger Decoction). If there is difficulty in urination, use Zhuling Tang (Polyporus Decoction). If there is steaming fever, profuse sweating on hands and feet, hard stool, and signs indicating purgation is indicated, use Chengqi Tang (Gut-Clearing Decoction) to purge. If there is Shaoyang (Lesser Yang) Gallbladder heat, with a string-tight pulse, use Xiaochaihu Tang (Minor Bupleurum Decoction) plus Qianghuo (Notopterygium Rhizome) and Fangfeng (Saposhnikovia Root). If the pulse is string-tight and rapid, use Zhilian Chaihu Tang (Gardenia and Coptis Bupleurum Decoction) plus Zhuru (Bamboo Shavings). If the exterior pathogen has resolved but there is heat in the Liver and Gallbladder, use Longdan Xiegan Tang (Gentian Liver-Draining Decoction). If there are signs indicating purgation, use Daichaihu Tang (Major Bupleurum Decoction). If the febrile disease has just healed, food was ingested too early, causing slight vexation at dusk, reduce dietary intake and use Zhizi Chidui Tang (Gardenia and Fermented Soybean Decoction) plus Zhishi (Immature Bitter Orange). If after a febrile disease, fire is flourishing causing vexation, use Huanglian Xiexin Tang (Coptis Heart-Purging Decoction). If excessive sweating and purgation led to deficiency vexation and insomnia, use Mizhi Anshen Wan (Secret Formula Spirit-Calming Pill). If Gallbladder fluid floods the Heart and Gallbladder fire transforms into phlegm, use Jiami Danning Wan (Home Secret Star-Arisaema Pill). *Zhunsheng* states: Insomnia is always a heat syndrome. If there is pathogen in the exterior, disturbing the meridians, release the exterior is appropriate. If there is pathogen in the interior, fire disturbing within, clear the interior is appropriate. If there is pathogen at the half-exterior half-interior level with fire in the Gallbladder channel, clear the Shaoyang is appropriate. If there is heat in the Yangming and the Stomach is disharmonious, clear heat and harmonize the Stomach is appropriate. If residual heat remains causing vexation, true Yin is consumed by heat; nourish Yin and clear fire is appropriate. If deficiency vexation from sweating/purgation leads to insufficient Shen-Qi (Spirit-Energy), nourish Yin and tonify deficiency is appropriate.

In Taiyang disease, after sweating, if profuse sweating occurs, drying the Stomach, causing vexation and insomnia, and the patient desires water, give small amounts of water; when the Stomach Qi harmonizes, the patient recovers. This is because profuse sweating caused loss of Jin-Ye (Body Fluids), drying the Stomach, causing vexation and insomnia, and thirst for water; thus giving water moistens the Stomach dryness, stopping vexation and allowing peaceful sleep.

In Taiyang disease, if for two to three days one cannot sleep but only wishes to rise, there must be stagnation in the epigastrium; if the pulse is faint and weak, this indicates pre-existing Cold-Fluid (Hanfen). If purgation is wrongly applied, and diarrhea stops, Jie-Xiong (Tie-Up Chest) will certainly develop. If diarrhea does not stop, purgation after four days results in Xiere-Li (Collateral Heat Diarrhea).

In Taiyang disease for two to three days, inability to sleep implies merely meridian unrest; why wish to rise? There must be Phlegm-Fluid stagnating in the epigastrium. If the pulse is faint and weak, this indicates pre-existing Cold-Stagnation, not Heat-Stagnation; wrongly applying purgation causes the pathogen to fail to descend, resulting in Jie-Xiong. If diarrhea has not stopped, the pathogen has already descended; after four days, it should manifest as Xiere Li (Collateral Heat Diarrhea).

After sweating, vomiting, or purging, deficiency vexation and insomnia occur. If severe, the patient tosses and turns with inner restlessness (Ao-Nao), treated primarily with Zhizi Chidui Tang (Gardenia and Fermented Soybean Decoction).

After sweating, vomiting, or purging, deficiency vexation and insomnia usually require tonification. However, tossing and turning with inner restlessness indicates heat pathogen still knotting in the chest; thus this decoction treats Ao-Nao.

If a patient has difficulty urinating, bowel movements alternating between difficult and easy, occasional slight fever, wheezing, dizziness, and inability to sleep, there is Dry-Stool (Zao-Shi); use Da Chengqi Tang (Major Gut-Clearing Decoction).

"Difficulty urinating" is an intertextual reference to interior heat; "bowel movements alternating between difficult and easy" is an intertextual reference to interior heat; "occasional slight fever" is an intertextual reference to tidal fever; "wheezing, dizziness, and inability to sleep" is an intertextual reference to extreme excess and fullness. Therefore, it is said there is Dry-Stool, and strong purgation is indicated.

In Shaoyin (Lesser Yin) disease, after transmission for more than two to three days, if there is heart vexation and inability to sleep, treat primarily with Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction).

Shaoyin disease mentions "transmission," referring to the internal transmission of Yang pathogen. After two to three days, heart vexation and insomnia indicate flourishing Fire of the Hand-Shaoyin Heart; thus this formula is used.

In Shaoyin disease, if diarrhea persists for six to seven days, accompanied by cough, vomiting, thirst, heart vexation, and insomnia, treat primarily with Zhufu Tang (Donkey-Skin Decoction).

Shaoyin diarrhea often involves heat transmitting to the Lower-Jiao. Now, cough, vomiting, thirst, heart vexation, and insomnia indicate that Dry-Fire of the Upper-Jiao Hand-Shaoyin has injured Yin, causing these symptoms.

Qianghuo Tang: See "Aversion to Cold." For insomnia due to exterior heat, use this formula to disperse the exterior.

Wuling San: See "Difficulty Urinating." For insomnia due to difficulty urination, use this formula.

Gange Tang: See "Malaria-like Symptoms." For Yangming exterior heat causing insomnia, disperse the exterior. If there is thirst, scorched lips, and copious water drinking, add Zhi Mu (Anemarrhena Rhizome) and Shigao (Gypsum Fibrosum).

Renshen Baihu Tang: See "Tidal Fever." For Yangming exterior heat causing insomnia, use the aforementioned Gange Tang; for interior heat causing insomnia, use this formula.

Da Chengqi Tang: See "Hard Stool." For heat knotting in the intestines and stomach, abdominal distension, hard stool, and insomnia, use this formula.

Zhilian Chaihu Tang
Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Guangpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Zhuru (Bambusae Caulis in Taenia), Banxia (Pinelliae Rhizoma), Zhizi (Gardeniae Fructus), Chuanlian (Coptidis Rhizoma).
For insomnia due to Shaoyang pathogenic heat, use this formula.

Longdan Xiegan Tang
Longdancao (Gentianae Radix), Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Chuanlianhua (Coptidis Rhizoma), Maimendong (Ophiopogonis Tuber), Chen Danning (Arisaema cum Bile), Zhimu (Anemarrhenae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Zhen Qingdai (Indigo Naturalis), Shanzhi (Gardeniae Fructus).
When Liver and Gallbladder have fire, eyes cannot close; when Gallbladder fluid floods the Heart, eyes cannot rest. Thus, this formula adds Danning (Arisaema cum Bile) and Qingdai (Indigo Naturalis) to resolve Gallbladder channel phlegm.

Daichaihu Tang: See "Tidal Fever." For Shaoyang syndrome causing insomnia, especially when purgative signs are present, use this formula.

Zhizi Chidui Zhishi Tang: See "Inner Restlessness." For early recovery from febrile disease where food was ingested too early, causing slight evening vexation and nighttime insomnia, use this formula, adding digestive-promoting herbs.

Huanglian Xiexin Tang
Huanglian (Coptidis Rhizoma), Maimendong (Ophiopogonis Tuber), Chi Fuling (Poria with Red Core), Gancao (Glycyrrhizae Radix et Rhizoma), Mutong (Akebiae Caulis).
For insomnia due to internal injury with insufficient Heart Qi, use Zaoren Tang (Ziziphus Seed Decoction) with warm herbs to tonify Heart Qi. For insufficient Heart Blood, use Zhusha Anshen Wan (Cinnabar Spirit-Calming Pill) or Tianwang Buxin Dan (Emperor of Heaven's Heart-Nourishing Pill) to tonify Heart Blood. To cool Heart Fire, since this is in the Febrile Disease section, use this formula.

Zhusha Anshen Wan
Huanglian (Coptidis Rhizoma), Baifushen (Poria Cum Pararhapidos), Maimendong (Ophiopogonis Tuber), Shengdi (Rehmanniae Radix), Zaoren (Ziziphi Spinosae Semen).
When Heart Fire is flourishing and Heart Blood is not yet deficient, treat primarily with Huanglian Xiexin Tang; when Heart Blood is deficient, treat with Anshen Wan.

Jiami Danning Wan
Chen Danning (Arisaema cum Bile), Qingdai (Indigo Naturalis), Haishi (Lapis Aragonitae), Longdancao (Gentianae Radix), Gancao (Glycyrrhizae Radix et Rhizoma).
When Gallbladder fire is flourishing causing insomnia, use Huanglian Chaihu Tang or Longdan Xiegan Tang. If Gallbladder fire transforms into phlegm and Gallbladder fluid floods the Heart, use this formula.