《灵枢》大惑论云∶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，故目不瞑矣。卫气留于阴，不得行于阳，留于阴则阴
气盛，阴气盛则阴跷满，不得入于阳则阳气虚，故目闭也。寒热病论云∶足太阳有通项入于脑者，正
属目本，名曰眼系，头目苦痛，取之在项中两筋间。入脑乃别，阴跷阳跷，阴阳相交，阳入阴，阴出
阳，交于目锐 。阳气盛则 目，阴气盛则瞑目。四十六难曰∶老人卧而不寐，少壮寐而不寤者，何
也？然经言少壮者血气盛，肌肉滑，气道通，荣卫之行不失于常，故昼日精、夜不寤。老人血气衰，
肌肉不滑，荣卫之道涩，故昼日不能精，夜不寐也。故知老人不得寐也。海藏云∶胆虚不眠，寒也。
酸枣仁炒为末，竹叶汤调服。胆实多睡，热也。酸枣仁生为末，姜茶汁调服。
《素问》帝曰∶人有卧而有所不安者，何也？岐伯曰∶脏有所伤，及精有所倚，则卧不安，故人
不能悬其病也。羌活胜湿汤，治卧而多惊，邪在少阳、厥阴也。诸水病者，故不得卧，卧则惊，惊则
咳甚。
《灵枢》邪客篇，帝问曰∶夫邪气之客人也，或令人目不瞑不卧出者，何气使然？
伯高曰∶五谷入于胃也，其糟粕、津液、宗气分为三隧，故宗气积于胸中，出于喉咙，以贯心脉，而
行呼吸焉。营气者，泌其津液，注之于脉，化以为血，以荣四末，内注五脏六腑，以应刻数焉。卫气
者，出其悍气之 疾，而先行于四末、分肉、皮肤之间，而不休者也。昼日行于阳，夜行于阴，常从
足少阴之分间，行于五脏六腑。今厥气客于五脏六腑，则卫气独卫其外，行于阳不得入于阴。行于阳
则阳气盛，阳气盛则阳跷陷，（陷当作满。）不得入于阴，阴虚故目不瞑。黄帝曰∶善。治之奈何？伯高
曰∶补其不足，泻其有余，调其虚实，以通其道，而去其邪。饮以半夏汤一剂，阴阳已通，其卧立至。
黄帝曰∶善。此所谓决渎壅塞，经络大通，阴阳和得者也。愿闻其方，伯高曰∶其汤方，以流水千里
以外者八升，扬之万遍，取其清五升煮之，炊以苇薪火，沸置秫米一升，（秫米，北人谓之黄米，可以
酿酒。）治半夏五合，徐炊令竭为一升半，去其滓，饮汁一小杯，日三，稍益，以知为度。故其病新发
者，覆杯则卧，汗出则已矣。久者三饮而已也。《素问》逆调论，阳明者，胃脉也。胃者，六腑之海，
其气亦下行，阳明逆不得从其道，故不得卧也。《下经》曰∶胃不和则卧不安，此之谓也。《金匮》
虚劳，虚烦不得眠，酸枣汤主之。《本事方》鳖甲丸。《圣惠方》治骨
蒸烦心不得眠，用酸枣仁一两，水一大盏半，研绞取汁，下米二合，煮粥候熟，下地黄汁一合，更煮
过，不计时服之。胡洽治振悸不得眠，人参、白术、茯苓、甘草、生姜、酸枣仁六物煮服。（以上皆
补肝之剂。）温胆汤，治大病后虚烦不得眠。（并《内经》半夏汤，皆去饮之剂。）六一散加牛黄，
治烦不得眠。戴云∶不寐有二种，有病后虚弱及年高人阳衰不寐，有痰在胆经，神不归舍，亦令不寐。
虚者，六君子汤加炒酸枣仁、炙黄 各一钱。痰者，宜温胆汤减竹茹一半，加南星、炒酸枣仁各一钱，
下青灵丹。大抵惊悸健忘，怔忡失志，心风不寐，皆是胆涎沃心，以致心气不足。若用凉心之剂太过，
则心火愈微，痰涎愈盛，病愈不减，惟当以理痰气为第一义，导痰汤加石菖蒲半钱。喘不得卧，以喘
法治之。厥不得卧，以香港脚法治之。
《灵枢·大惑论》说：卫气不能进入阴分，常停留在阳分；停留在阳分则阳气充盛，阳气充盛则阳跷脉旺盛，不能进入阴分则阴气虚弱，所以眼睛无法闭合（失眠）。卫气停留在阴分，不能在阳分行使功能；停留在阴分则阴气充盛，阴气充盛则阴跷脉满溢，不能进入阳分则阳气虚弱，所以眼睛闭合（嗜睡）。《灵枢·寒热病论》说：足太阳膀胱经有通向头部进入脑部的脉络，正连接眼珠根部，称为“眼系”；头部和眼睛剧烈疼痛时，取穴在颈部两筋之间。该脉络进入脑部后分支，阴跷脉与阳跷脉相交，阳气入于阴，阴气出于阳，二者在目内眦相交。阳气盛则睁眼不闭，阴气盛则闭目入睡。《难经·四十六难》说：老人睡觉但不安寐，年轻人睡着却不醒来，这是为什么呢？回答说：经书说年轻人血气旺盛，肌肉滑利，气道通畅，营气和卫气的运行不失常态，所以白天精神饱满，夜晚睡得深沉。老人血气衰弱，肌肉不滑利，营卫运行的通道涩滞，所以白天精神不振，夜晚也不能安睡。因此知道老人失眠的原因。海藏（张元素）说：胆虚导致失眠，属于寒证。将酸枣仁炒熟研成粉末，用竹叶汤送服。胆实导致多睡，属于热证。将生酸枣仁研成粉末，用姜茶汁送服。
《素问》中黄帝问：有人睡觉时感到不安稳，是什么原因呢？岐伯回答：脏腑受到损伤，以及精气有所偏倚，就会导致睡眠不安，所以人不能脱离疾病的影响而安然入睡。羌活胜湿汤，治疗睡觉时多惊悸，病邪在少阳经和厥阴经。所有水肿病患者，所以不能平卧，平卧则惊恐，惊恐则咳嗽加剧。
《灵枢·邪客篇》，黄帝问道：邪气侵入人体，有的使人眼睛无法闭合、不能入睡，是什么气造成的呢？伯高说：五谷进入胃后，其糟粕、津液、宗气分为三条通道，所以宗气积聚在胸中，出于喉咙，贯通心脉，从而进行呼吸。营气，分泌津液，注入脉中，化生为血液，以滋养四肢末端，向内灌注五脏六腑，以应合时间的变化。卫气，发出其剽悍滑疾之气，先行于四肢末端、分肉之间、皮肤之中，而不休息。白天行于阳分，夜晚行于阴分，通常从足少阴肾经的分野间，行于五脏六腑。现在厥逆之气客居于五脏六腑，则卫气独自护卫于外，行于阳分而不能进入阴分。行于阳分则阳气盛，阳气盛则阳跷脉陷（注：“陷”字当作“满”），不能进入阴分，阴虚所以眼睛无法闭合。黄帝说：好。怎么治疗呢？伯高说：补其不足，泻其有余，调节虚实，以疏通其道，去除邪气。服用半夏汤一剂，阴阳得以通畅，睡眠立刻恢复。黄帝说：好。这就是所谓的疏通壅塞，经络大通，阴阳调和。请问方子，伯高说：汤剂的配方，用流动千里之外的水八升，扬之万遍，取其清水五升来煮，用芦苇做燃料烧火，水沸后放入秫米一升（秫米，北方人称为黄米，可以用来酿酒）、制半夏五合，慢慢煎煮直到剩余一升半，去掉药渣，每次饮用一小杯，每天三次，逐渐增加剂量，以见效为度。所以新发病的人，喝完药盖一下被子就能入睡，出汗就好了；病程久的，喝三次就好了。《素问·逆调论》说，阳明经是胃的经脉。胃是六腑的海，其气也下行，如果阳明之气逆乱不能顺从其道路，所以不能入睡。《下经》说：胃不和则卧不安，说的就是这个道理。《金匮要略》虚劳篇提到，虚烦不得眠，用酸枣汤主治。《本事方》中的鳖甲丸。《圣惠方》治疗骨蒸烦心不得眠，用酸枣仁一两，水一大盏半，研磨绞取汁液，加入米二合，煮粥待熟，加入地黄汁一合，再煮过，不限时间服用。胡洽治疗振悸不得眠，用人参、白术、茯苓、甘草、生姜、酸枣仁六味药煮服。（以上都是补肝的方剂。）温胆汤，治疗大病后虚烦不得眠。（均出自《内经》半夏汤，都是去痰饮的方剂。）六一散加牛黄，治疗烦躁不得眠。戴云说：不寐有两种情况，有病后虚弱及老年人阳气衰微导致的不寐，有痰在胆经，神志不归舍，也导致不寐。属虚证的，用六君子汤加炒酸枣仁、炙黄芪各一钱。属痰证的，宜用温胆汤减去一半竹茹，加南星、炒酸枣仁各一钱，送服青灵丹。大抵惊悸健忘，怔忡失志，心风不寐，都是由于胆涎沃心，导致心气不足。如果使用清心凉心的药物太过，则心火更微弱，痰涎更旺盛，病更加不减，只应当以理痰气为第一要义，用导痰汤加石菖蒲半钱。因喘促而不能平卧，按治喘的方法处理。因厥逆而不能平卧，按治脚气的方法处理。
The *Ling Shu* (Spiritual Pivot) in the chapter "Da Huo Lun" (Discussion on Great Confusion) states: When Wei Qi (Defensive Qi) cannot enter the Yin aspect, it remains constantly in the Yang aspect. Remaining in the Yang aspect causes Yang Qi to be full; when Yang Qi is full, the Yang Qiao vessel becomes vigorous. Inability to enter the Yin aspect leads to deficiency of Yin Qi, thus resulting in inability to close the eyes (insomnia). When Wei Qi remains in the Yin aspect and fails to circulate in the Yang aspect, remaining in Yin causes Yin Qi to be full; when Yin Qi is full, the Yin Qiao vessel becomes full. Inability to enter the Yang aspect leads to deficiency of Yang Qi, thus resulting in closed eyes (hypersomnia). The chapter "Han Re Bing Lun" (Discussion on Cold-Heat Diseases) in the *Ling Shu* states: There are pathways from the Foot Taiyang Bladder Meridian that pass through the neck into the brain, directly connecting to the root of the eye, named "Eye System". For severe pain in the head and eyes, select points located between the two tendons in the middle of the neck. Upon entering the brain, these pathways branch off. The Yin Qiao and Yang Qiao vessels intersect; Yang enters Yin, and Yin exits Yang, intersecting at the inner canthus of the eye. When Yang Qi is excessive, the eyes remain open; when Yin Qi is excessive, the eyes close for sleep. The *Nan Jing* (Classic of Difficult Issues), Chapter 46, states: Why do the elderly sleep but not rest deeply, while the young sleep soundly without waking? The answer is: The classics state that the young have abundant blood and Qi, smooth muscles, and unobstructed Qi channels, so the circulation of Ying Qi (Nutritive Qi) and Wei Qi does not deviate from normal patterns. Thus, they are energetic during the day and sleep deeply at night. The elderly have declining blood and Qi, non-smooth muscles, and sluggish channels for Ying and Wei Qi circulation, thus lacking energy during the day and unable to sleep peacefully at night. Hence, we understand the cause of insomnia in the elderly. Haizang (Zhang Yuansu) stated: Deficiency of the Gallbladder causing insomnia is due to Cold. Processed (fried) Sour Jujube Seed powder should be taken with Bamboo Leaf Decoction. Excess in the Gallbladder causing hypersomnia is due to Heat. Raw Sour Jujube Seed powder should be taken with Ginger and Tea Juice.
In the *Su Wen* (Basic Questions), the Yellow Emperor asked: Why do some people feel uneasy when lying down? Qibo answered: Injury to the Zang organs and deviation of Jing Essence lead to restless sleep; thus, one cannot escape the influence of disease to sleep peacefully. Qiang Huo Sheng Shi Tang (Notopterygium Decoction for Overcoming Dampness) treats restlessness and frequent fright during sleep, where pathogenic factors reside in the Shaoyang and Jueyin meridians. All patients with water diseases (edema) cannot lie flat; lying flat induces fright, and fright exacerbates coughing.
In the *Ling Shu* chapter "Xie Ke Pian" (Chapter on Pathogenic Invasion), the Yellow Emperor asked: What Qi causes some people to be unable to close their eyes and sleep after pathogenic invasion? Bo Gao replied: When grains enter the stomach, their dregs, fluids, and Zong Qi (Gathering Qi) divide into three pathways. Thus, Zong Qi accumulates in the chest, emerges from the throat, penetrates the Heart vessels, and facilitates respiration. Ying Qi secretes fluids, injects them into the vessels, transforms them into Blood, nourishes the four extremities, and internally irrigates the five Zang and six Fu organs, corresponding to time cycles. Wei Qi emits its fierce, rapid, and slippery Qi, circulating first in the four extremities, intermuscular spaces, and skin without rest. It travels in the Yang aspect during the day and in the Yin aspect at night, usually passing through the divisions of the Foot Shaoyin Kidney Meridian to circulate among the five Zang and six Fu organs. Now, if Jue Qi (Rebellious Qi) lodges in the five Zang and six Fu organs, Wei Qi alone guards the exterior, traveling in the Yang aspect and unable to enter the Yin aspect. Traveling in Yang causes Yang Qi to be excessive; excess Yang Qi causes the Yang Qiao vessel to be full (note: "sunken" in text should be "full"). Unable to enter Yin, Yin deficiency results in inability to close the eyes. The Yellow Emperor said: Excellent. How to treat it? Bo Gao said: Tonify deficiency, drain excess, regulate emptiness and fullness, unblock the pathways, and eliminate pathogens. Administer one dose of Ban Xia Tang (Pinellia Decoction); once Yin and Yang are unblocked, sleep returns immediately. The Yellow Emperor said: Excellent. This is what is meant by dredging obstructions, achieving thorough meridian patency, and harmonizing Yin and Yang. Please explain the prescription. Bo Gao said: The decoction formula uses eight sheng of flowing water from a distance of a thousand li, stirred ten thousand times, taking five sheng of the clear water for boiling. Cook using reed fire. When boiling, add one sheng of Shu Mi (Glutinous Millet, known as Huang Mi in the North, used for brewing wine) and five he of prepared Ban Xia (Pinellia Tuber). Simmer slowly until reduced to one and a half sheng. Remove dregs. Drink one small cup, three times daily, gradually increasing the dose until efficacy is observed. For newly onset illness, sleep comes upon covering the cup with a lid, and sweating cures it. For chronic cases, three doses suffice. The *Su Wen* chapter "Ni Diao Lun" (Discussion on Reverse Regulation) states: The Yangming Meridian is the Stomach Meridian. The Stomach is the Sea of the Six Fu organs, and its Qi also descends. If Yangming Qi rebels and cannot follow its proper pathway, insomnia results. The *Xia Jing* states: "If the Stomach is disharmonious, sleep will be uneasy," which refers to this principle. The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) in the Xu Lao (Consumptive Disease) section mentions that for deficiency vexation and insomnia, Suan Zao Ren Tang (Sour Jujube Decoction) is the primary treatment. The *Ben Shi Fang* (Formulas of Ability) includes Bie Jia Wan (Turtle Shell Pill). The *Sheng Hui Fang* (Holy Benefit Formulas) treats bone-steaming, vexation, and insomnia using one liang of Sour Jujube Seed, one and a half da zhan of water, ground and squeezed for juice, added with two he of rice, cooked into porridge, then mixed with one he of Di Huang Juice (Rehmannia Juice), taken at any time. Hu Qia treated palpitations and tremors with insomnia using Ren Shen (Ginseng), Bai Zhu (Atractylodes Macrocephala Rhizome), Fu Ling (Poria), Gan Cao (Licorice Root), Sheng Jiang (Fresh Ginger), and Suan Zao Ren (Sour Jujube Seed) boiled together. (All above are Liver-tonifying formulas.) Wen Dan Tang (Warm the Gallbladder Decoction) treats deficiency vexation and insomnia after major illnesses. (Along with Ban Xia Tang from the *Nei Jing*, these are phlegm-fluid resolving formulas.) Liu Yi San (Six-to-One Powder) added with Niu Huang (Calculus Bovis) treats irritability and insomnia. Dai Yun stated: Insomnia has two types: one is weakness after illness or Yang deficiency in the elderly; the other is Phlegm in the Gallbladder Meridian causing the Spirit to lose its residence. For deficiency, use Liu Jun Zi Tang (Six Gentlemen Decoction) added with fried Suan Zao Ren and roasted Huang Qi (Astragalus Root), each one qian. For Phlegm, use Wen Dan Tang reducing Zhu Ru (Bamboo Shavings) by half, adding Nan Xing (Arisaema Cum Bile) and fried Suan Zao Ren, each one qian, taken with Qing Ling Dan. Generally, palpitations, forgetfulness, Zheng Chong (palpitations with anxiety), loss of will, and Wind of the Heart causing insomnia are all due to Gallbladder fluid flooding the Heart, leading to Heart Qi deficiency. If cooling the Heart agents are used excessively, Heart Fire becomes weaker, Phlegm-Saliva becomes more abundant, and the disease persists. The primary principle must be regulating Phlegm-Qi, using Dao Tan Tang (Guide Out Phlegm Decoction) added with Shi Chang Pu (Acorus Rhizome), half a qian. For dyspnea preventing lying down, treat according to dyspnea protocols. For Jue (cold extremities/reversal) preventing lying down, treat according to Hong Zhang (foot swelling/beriberi) protocols.