夫胆为清静之府，与肝为运，以肾为源，当其阴阳和则开合得所，动静合宜，昼
得干动之功，夜得坤静之义。若有浊气，如火如痰者扰之，则不眠，无清气，若天若日
者，举之则多眠，更有肺金魄弱，肝魂无制，寐中而觉神魂飞扬者，更有肝受实邪，
疏泄用事，不能敛纳，而致魂归于肝者，更有心阴虚而不能寐者，更有胃不和而卧不安
者，更有肾神下竭，心火上炎，而烦躁不安者，以脉条分，焉有不中病情者乎。
《经》曰∶胃者，六腑之海，其气下行，阳明逆不得从其道，故不卧。又曰∶胃不
和，则卧不安，寐从阳而主上，寐从阴而主下，胃气上逆则壅于肺，而息有音，不得从
其阴降之道，故卧不安也。又曰∶卧则喘者，水气之客也。水病者其本在肾，其末在
肺，故为不得卧，卧则喘者，标本俱病也。此皆经言因病而致不得卧，未论及不得卧之
自为病也。《经》又曰∶卫气不得入于阴，常留于阳，留于阳则阳气满，阳气满则阳跷
盛，不得入于阴，则阴气虚，故目不瞑，行阳则寤，行阴则寐，此其常也失其常，则不
得静而藏魂，所以目不得瞑也。此经概言卫气不得入于阴而不得卧，尚未能尽心肾神
交，而入阴之至理也。若心主血而藏神，若元阴不足，则不能生血，血少则神无所根据
矣。夫人之神，寤则栖心，寐则归肾，故寐者，心神栖归于肾舍也，心虚则神不能归
舍于肾，故不能成寐，然肾虚，则不能藏纳心神于舍，故寐而不能沉，并不能久，是以
壮年肾阴强盛，则睡沉熟而长，老年阴气衰弱，则睡轻微而短。且有形之阴水既亏，则
无形之相火流烁，以致神魂散越，睡卧不宁，故不寐健忘两症，虽似心病，实多由乎
肾虚也。此张心求之理，并及以补所遗。
《灵枢》曰∶阳气尽，阴气盛，则目瞑，阴气尽，阳气盛，则寤矣。所以夜半之时，
万民皆卧，命曰合阴，盖斯时卫气已尽，营气方盛故耳，寐至夜半之后，则阴气已尽，
阳气方盛，故多寤者，老人阴虚，尤多犯此，是以少阴之病，但欲寐嗜卧耳。
大抵卫独行阳，则阳盛阴虚为不卧，卫久陷阴，则阴盛阳虚为多卧，此定论也。故
人久坐夜宴，及劳神过度，反不得眠，是卫气久留于阳，则阳气满而阳主动，其理可见
矣。然有因劳心过度，或房劳所伤、乃使神思间无形之阴不足，以致虚火乘心，患经月
昼夜不寐，虽寐而恍惚不宁者，须澄心息虑，内观养神。如用补阴药而反梦遗者，此
神中之火已降，诚佳兆也。不必疑于此而另更别药，人有形体壮盛，而病飞走狂越，似
乎痰火有余之症，用栀、柏、芩、连、知母寒凉之剂，而火愈作者，此正是神思间之火
动，而真水不足以配之，用药者不求其属，故无效也。当救肾水其火自降，即内经所言
寒之不寒，是无水也。
胆是清净的府库，与肝相表里协同运作，以肾为根本源头。当阴阳调和时，开合功能得当，动静适宜，白天发挥乾卦刚健主动的功能，夜晚体现坤卦柔顺静止的意义。如果有浊气，如火邪或痰湿等干扰，就会导致失眠；如果没有清气，像天空和太阳那样升举阳气，人就会多睡。还有肺金所藏的魄虚弱，肝魂失去制约，睡眠中神魂飞扬的人；有肝受到实邪侵袭，疏泄功能过亢，不能收敛纳藏，导致魂不能归附于肝的人；有心阴不足而不能入睡的人；有胃气不和而卧不安稳的人；有肾精下竭、心火上炎而导致烦躁不安的人。通过脉象逐一辨析，哪有不符合病情的呢？
《黄帝内经》说：胃是六腑的海，其气机应当下行。如果阳明胃气上逆，不能遵循其道，所以不能安卧。又说：胃不和，则卧不安。睡眠从阳主上升，从阴主下降。胃气上逆则壅塞于肺，呼吸有声，不能顺着阴降的道路，所以卧不安稳。又说：躺下就气喘的，是水气客居体内所致。水病的根本在肾，标末在肺，所以导致不能平卧，躺下就气喘，是因为标本都病了。这些都是经典论述因病导致不能安卧的情况，尚未论及因自身机能失调导致的不得卧。《黄帝内经》又说：卫气不能进入阴分，常停留在阳分。停留在阳分则阳气满盛，阳气满盛则阳跷脉旺盛，不能进入阴分，则阴气虚，所以眼睛闭不上（失眠）。行于阳分则清醒，行于阴分则睡眠，这是正常的规律。失去了正常规律，就不能安静地藏魂，所以眼睛闭不上。这段经文大概说的是卫气不能入阴导致不卧，还没有深入阐述心肾神交、入阴的根本道理。如果心主血而藏神，元阴不足，就不能生血，血少则神无所依托。人的神志，清醒时栖居于心，睡眠时回归于肾。所以睡眠，是心神栖归于肾舍的过程。心虚则神不能归舍于肾，所以不能成眠；然而肾虚，则不能藏纳心神于舍，所以睡眠不能深沉，也不能持久。因此壮年时肾阴强盛，睡眠就深沉熟睡且时间长；老年时阴气衰弱，睡眠就轻微短暂。而且有形之阴水既然亏损，无形之相火就会流烁妄动，导致神魂散越，睡卧不宁。所以不寐和健忘两个病症，虽然看似心病，实际上多由肾虚引起。这是张景岳（张心求）的理论，并补充了前人的遗漏。
《灵枢》说：阳气尽，阴气盛，则眼睛闭合（入睡）；阴气尽，阳气盛，则清醒。所以在夜半时分，万民皆卧，称为“合阴”，大概是因为此时卫气已尽，营气正盛。睡眠到夜半之后，阴气已尽，阳气方盛，所以容易醒来。老人阴虚，尤其容易犯此情况，所以少阴病表现为只想睡觉、嗜卧。
大抵卫气独自行于阳分，则阳盛阴虚导致不卧；卫气久陷于阴分，则阴盛阳虚导致多卧，这是确定的结论。所以人久坐、夜间宴饮，以及劳神过度，反而不能入睡，这是因为卫气久留于阳分，阳气满盛而阳主动，其中的道理由此可见。然而有因为劳心过度，或房劳损伤，使得神思间无形之阴不足，以致虚火乘袭心脏，患病经月昼夜不寐，即使睡着也恍惚不宁的，必须澄澈心神、平息杂念，内观以养神。如果使用补阴药反而出现梦遗，这是神中之火已降，确实是好兆头。不必对此怀疑而更换其他药物。人有形体壮盛，却患飞走狂越之症，似乎是有痰火有余的症状，使用栀子、黄柏、黄芩、黄连、知母等寒凉药剂，但火邪反而更盛，这正是神思间的火动，而真水不足以制约它，用药者没有探究病因所属，所以无效。应当救补肾水，其火自降，即《内经》所说的“用寒药治疗却不退热，是因为无水（阴虚）”。
The Gallbladder is the mansion of purity and tranquility, functioning in coordination with the Liver (Gan, 肝), and deriving its source from the Kidney (Shen, 肾). When Yin and Yang are harmonious, opening and closing are appropriate, and movement and stillness are suitable. During the day, it performs the function of Qian (Heaven, 乾) which is active and vigorous; at night, it embodies the meaning of Kun (Earth, 坤) which is quiet and receptive. If turbid Qi, such as Fire Evil (Huoxie, 火邪) or Phlegm-Dampness (Tanshi, 痰湿), disturbs this balance, insomnia occurs. If there is a lack of clear Qi, akin to the sky and sun failing to ascend, excessive sleepiness results. Furthermore, individuals with weak Po (Corporeal Soul, 魄) of the Lung Metal (Feijin, 肺金) and uncontrolled Hun (Ethereal Soul, 魂) of the Liver may experience flying spirits during sleep. Those whose Liver is affected by Excess Pathogens (Shixie, 实邪), causing hyperactive dispersing and draining functions, fail to consolidate and store, leading to the Hun not returning to the Liver. There are cases of Heart Yin Deficiency (Xin Yin Xu, 心阴虚) preventing sleep, cases of Stomach Disharmony (Wei Buhe, 胃不和) causing restless sleep, and cases of Kidney Essence Exhaustion (Shen Shen Xia Jie, 肾神下竭) with Heart Fire Flaring Up (Xin Huo Shang Yan, 心火上炎) resulting in irritability and restlessness. By analyzing pulse conditions item by item, how can one miss the true nature of the disease?
The Classic states: "The Stomach is the sea of the Six Fu Organs; its Qi descends. If Yangming Qi rebels and cannot follow its proper path, one cannot lie down." It also says: "When the Stomach is disharmonious, sleep is uneasy." Sleep involves Yang ascending and Yin descending. When Stomach Qi rebels upward, it obstructs the Lungs, causing noisy breathing, and fails to descend via the Yin pathway, hence restless sleep. It further states: "Panting when lying down indicates the invasion of Water Qi (Shuiqi, 水气)." The root of water diseases lies in the Kidney, while the branch lies in the Lungs; thus, inability to lie flat and panting upon lying down indicate that both root and branch are diseased. These are all instances described in classics where illness causes inability to sleep, but they do not discuss inability to sleep as a primary disorder itself. Another passage from the Classic states: "When Wei Qi (Defensive Qi, 卫气) cannot enter Yin, it remains in Yang. Remaining in Yang leads to fullness of Yang Qi; fullness of Yang Qi leads to exuberance of the Yang Qiao Vessel. Inability to enter Yin results in deficiency of Yin Qi, hence the eyes remain open (insomnia). Moving through Yang leads to wakefulness; moving through Yin leads to sleep. This is the normal state. Deviation from this norm prevents the tranquil storage of the Hun, resulting in inability to close the eyes." This text generally discusses Wei Qi's failure to enter Yin causing insomnia, but does not fully elaborate on the profound principle of Heart-Kidney Spirit interaction and entering Yin. If the Heart governs Blood and stores the Spirit, and if Primordial Yin (Yuanyin, 元阴) is insufficient, it cannot generate Blood. With little Blood, the Spirit has no foundation. The human Spirit resides in the Heart when awake and returns to the Kidney when asleep. Thus, sleep is the process of the Heart Spirit returning to the residence of the Kidney. If the Heart is deficient, the Spirit cannot return to the Kidney's residence, so sleep cannot be achieved. However, if the Kidney is deficient, it cannot store and accept the Heart Spirit into its residence, so sleep is not deep nor lasting. Therefore, in youth, when Kidney Yin is robust, sleep is deep, sound, and long; in old age, when Yin Qi declines, sleep is light and short. Moreover, when tangible Yin Water is depleted, intangible Ministerial Fire (Xianghuo, 相火) flares wildly, causing the scattering of Spirit and Soul, leading to restless sleep. Thus, although insomnia and forgetfulness seem to be Heart disorders, they are often actually caused by Kidney deficiency. This is the theory of Zhang Jingyue (Zhang Xinqiu), supplementing previous omissions.
The Ling Shu states: "When Yang Qi is exhausted and Yin Qi is abundant, the eyes close (sleep); when Yin Qi is exhausted and Yang Qi is abundant, one wakes up." Therefore, at midnight, when all people sleep, it is called "Conjunction of Yin" (Heyin, 合阴), because at this time Wei Qi has exhausted and Ying Qi (Nutritive Qi, 营气) is flourishing. After midnight, Yin Qi is exhausted and Yang Qi becomes abundant, so people tend to wake up. Elderly people with Yin Deficiency are particularly prone to this condition, which is why Shaoyin Disease presents as drowsiness and desire to sleep.
Generally, if Wei Qi travels alone in Yang, Yang Excess and Yin Deficiency lead to insomnia; if Wei Qi remains trapped in Yin for a long time, Yin Excess and Yang Deficiency lead to hypersomnia. This is a definitive conclusion. Therefore, prolonged sitting, late-night banquets, and excessive mental labor cause insomnia because Wei Qi remains in Yang, leading to Yang fullness and Yang activity, illustrating the principle clearly. However, some suffer from excessive mental labor or sexual exhaustion, causing an intangible Yin deficiency within their thoughts and spirit, allowing Deficient Fire to attack the Heart. They may suffer from day-and-night insomnia for months, and even when sleeping, feel vague and restless. Such cases require clearing the mind, stopping distracting thoughts, and internal observation to nourish the Spirit. If using Yin-nourishing herbs triggers nocturnal emissions, it indicates that the Fire within the Spirit has descended, which is indeed a good sign. One should not doubt this and change medications. Some individuals have robust physiques but exhibit symptoms of running away and madness, seemingly indicating excess Phlegm-Fire. Using cold-cooling agents like Gardenia (Zhizi, 栀子), Phellodendron Bark (Huangbai, 黄柏), Scutellaria Root (Huangqin, 黄芩), Coptis Rhizome (Huanglian, 黄连), and Anemarrhena Rhizome (Zhimu, 知母) may cause the Fire to flare up more intensely. This is precisely due to Fire stirring within the spirit-mind, while True Water (Zhen Shui, 真水) is insufficient to control it. Prescribers who do not seek the underlying cause will find no effect. One must rescue/nourish Kidney Water, and the Fire will subside naturally. This corresponds to the Nei Jing saying: "Treating with Cold [herbs] does not reduce heat, because there is no Water [Yin]."