Insomnia (Bude Mian) is a common manifestation of yin-yang imbalance, but it primarily belongs to Yangming disease. If it were Shaoyin disease, the patient should manifest drowsiness (Yumi); the fact that they cannot sleep now indicates that yang qi has entered the Shaoyin meridian, which is not the typical presentation of Shaoyin disease.

Some cases arise after sweating or purging, some occur without such interventions, and some result from iatrogenic errors with fire therapy; treatments are detailed in their respective sections. Generally, insomnia is associated with heat syndromes. One specific case involves daytime restlessness and insomnia following sweating or purging in Taiyang disease. Although Ganjiang Fuzi Tang is used here, its purpose is to restore yang qi lost due to excessive sweating/purging, rather than to treat contracted cold pathogens.

While insomnia is a common symptom, if a Shaoyin patient presents with deep and fine pulse, spontaneous diarrhea, irritability, and inability to sleep, the prognosis is poor (death). Similarly, in Shanghan (Cold Damage), fever accompanied by diarrhea, cold extremities, irritability, and inability to lie down also indicates death. These conditions arise because righteous qi is weak and yang qi cannot recover.

The *Huoren Shu* states: Sweat is the fluid of fire; excessive sweating leads to clouded spirit, causing insomnia. Extreme heat causes unclear spirit, leading to insomnia. Severe purging damages blood; since the Heart governs blood, this causes insomnia. After recovery, if pathogenic heat has not dissipated and yin qi has not recovered, insomnia occurs.

[Taiyang Disease]
In Taiyang disease, if for two to three days the patient cannot lie down but wishes to rise, there must be stagnation in the epigastrium. With a faint pulse, this indicates cold accumulation. Use Guizhi Jia Houpo Xingzi Tang.

In Shanghan, if the pulse is floating and the patient is subjected to fire therapy, resulting in panic, mania, and restless tossing and turning, use Guizhi Qu Shaoyao Jia Shujie Longgu Muli Jiuni Tang.

After purging followed by sweating, if the patient is irritable and unable to sleep during the day but quiet at night, without vomiting, thirst, or exterior signs, with a deep and faint pulse and no significant body heat, use Ganjiang Fuzi Tang.

Patients prone to epistaxis should not undergo sweating; if sweated, they may experience sunken temples, tight pulse, fixed gaze, and insomnia (treated with Huangqin Shaoyao Tang).

After purging in Shanghan, if the patient has vexation, abdominal fullness, and restlessness, use Zhizi Houpo Tang.

After sweating, vomiting, or purging, if there is deficiency vexation, insomnia, tossing and turning, and inner discomfort (Aoni), use Zhizi Chidui Tang.

After sweating in Taiyang disease, if dryness in the stomach causes insomnia and thirst, giving small amounts of water will cure it.

[Yangming Disease]
Body heat, eye pain, nasal dryness, and inability to lie down, with long pulses at all three positions, indicate Yangming disease involvement. If the patient has difficulty urinating, alternating difficulty and ease in defecation, slight fever, wheezing, dizziness, and inability to lie down, there is dry stool in the intestines; use Dachengqi Tang.

In Yangming disease, with floating and tight pulse, dry throat, bitter taste, abdominal fullness, wheezing, fever, sweating, aversion to heat (not cold), and heavy body, if moxibustion is added, it will cause fright, irritability, and insomnia; use Zhizi Chi Tang.

[Shaoyin Disease]
In Shaoyin disease, if the patient desires sleep but after two to three days develops vexation and insomnia, treat with Huanglian Ejiao Tang.

Huanglian Ejiao Tang Formula:
Huanglian (4 liang), Huangqin (2 liang), Shaoyao (2 liang), Ejiao (3 liang), Ji Zi Huang (2 yolks). Boil the first three herbs in 5 sheng of water to obtain 2 sheng, strain, dissolve the Ejiao, let cool slightly, then mix in the egg yolks. Take 7 he warm, three times daily. (Cheng Wuji notes: Bitterness removes excess yang; Huanglian and Huangqin clear heat. Sweetness tonifies insufficient yin; Egg yolk and Ejiao nourish blood. Sourness astringes and drains; Shaoyao astringes yin and drains pathogenic heat. However, if illness persists after taking egg yolk, add Danggui, Renshen, Fuling, and Baizhu in equal parts to the previous four ingredients for immediate effect.)

If Shaoyin disease involves diarrhea, drowsiness, and after six to seven days presents with cough, vomiting, thirst, vexation, and insomnia, use Zhu Ling Tang (see Diarrhea section). If Shaoyin disease presents with drowsiness, deep and fine pulse, no vexation, desire to vomit, and progresses to spontaneous diarrhea with irritability and insomnia by the fifth or sixth day, the prognosis is death. Fever with diarrhea, cold extremities, irritability, and inability to lie down also indicates death.

Wu states: In Taiyang disease, with floating and rapid pulse, body ache, absence of sweat, irritability, and insomnia, induce sweating to cure. For Yangming superficial heat with headache, eye pain, body heat, nasal dryness, and long pulse, use Gegen Jiemo Tang to induce sweating. If there is spontaneous sweating, flooding and rapid pulse, interior-exterior heat, vexation, thirst, dry tongue, and desire to drink, use Baihu Jia Renshen Tang. If there is steaming heat and hard constipation, use Tiaowei Chengqi Tang to purge. If external Shanghan has resolved but worsens due to dietary indiscretion, causing stuffiness, dry retching, dry mouth, groaning, delirium, and insomnia, use Huanglian Jiedu Tang. If there is severe interior-exterior heat, dry tongue, and thirst, use Renshen Baihu Tang combined with Jiedu Tang. For Shaoyang fever, bitter taste, vexation, insomnia, and wiry-rapid pulse, use Xiao Chaihu Tang plus Huanglian and Shanzhizi. For deficient patients with insufficient fluids, add Maidong and Suanzaoren. After sweating in Taiyang disease, if insomnia occurs with floating-rapid pulse, slight fever, vexation, thirst, and dysuria, use Wuling San. If the pulse is large and rapid, use Renshen Baihu Tang or Zhuye Shigao Tang; do not use Wuling San. For deficiency vexation and insomnia after sweating/purging, select from Jiawei Wendan Tang, Suanzaoren Tang, Zhizi Wumei Tang, or Zhusha Anshen Wan.

Appendix:

Suanzaoren Tang: Treats deficiency vexation, rushing qi in the chest, and insomnia.
Suanzaoren (fried), Renshen, Fuling (1.5 qian each), Guixin (0.5 qian), Shigao (2.5 qian), Zhimu, Gancao (1 qian each), Shengjiang (3 slices). Decoct one dose in 2 zhong of water to 1 zhong, strain, and take before bed.

Qianjin Liushui Tang: Treats deficiency vexation and insomnia.
Maidong (decored), Banxia, Gancao, Huanglian, Yuanzhi, Renshen, Bibi (1 qian each), Fushen, Suanzaoren (1.5 qian each), Guixin (0.5 qian), Shengjiang (3 slices), Rice (1 he). Boil running water in 2.5 zhong until crab-eye bubbles form, stir with ladle ten thousand times to obtain 2 zhong of water, decoct herbs to 1 zhong, strain, and take warm.

Jiawei Wendan Tang: Treats deficiency vexation and insomnia after Taiyang disease, caused by Gallbladder cold.
Banxia (washed), Suanzaoren (fried, 1.5 qian each), Lv Zhishi, Chenpi, Gancao (1 qian each), Renshen (2.5 qian), Fushen (2 qian), Zhuru (one ball), Shengjiang (3 slices). Decoct in 2 zhong water to 1 zhong, strain, and take warm. If vexation and internal heat exist, double Huanglian and Maidong. If dry mouth and tongue, remove Banxia and add Maidong, Wuweizi, and Tianhuafen. If exterior heat remains, add Ruanmiao Chaihu. If interior deficiency with spontaneous diarrhea, remove Zhishi and add Baizhu and Fuling. If interior excess with vexation and tossing, add Shanzhiren.

Suanzaoren Soup: Treats insomnia day and night after vomiting/purging.
Suanzaoren (fried, 2.5 qian), Maidong, Fushen, Dangguishen (2 qian each), Gancao, Zhimu, Chuanxiong (1.5 qian each), Ganjiang (0.3 qian), Shengjiang (3 slices). Decoct as above.

Zhizi Wumei Tang:
Zhizi, Huangqin, Gancao, Renshen, Maidong (1 qian each), Chaihu (2 qian), Wumei (2 fruits), Shengjiang (3 slices), Zhuye (14 leaves). Decoct as above.

Huanglian Jiedu Tang: Treats extreme heat, dry retching, delirium, groaning, and insomnia.
Huanglian (2.5 qian), Huangqin, Huangbai (0.5 liang each), Zhizi (4 fruits). Decoct in 2.5 zhan water to 1.5 zhan, strain, and divide into two doses.