Acupuncture & Phlegm Heat Insomnia

abstracted & translated by

Honora Lee Wolfe, Dipl. Ac., FNAAOM

Keywords: Chinese medicine, acupuncture, insomnia, phlegm heat

According to Bob Flaws & James Lake, MD, in Chinese Medical Psychiatry, sleep disorders are due either to the presence of some evil qi harassing the heart spirit or nonconstruction and malnourishment of the heart spirit. In terms of evil qi which may harass the heart, these may consist of heat evils, phlegm, and blood stasis, and the main disease mechanisms of many psychiatric disorders, including sleep disorders, are a combination of phlegm and heat harassing the above. Recently, Chen Rui published an interesting study on the acupuncture treatment of phlegm heat insomnia. Titled, “A Clinical Audit of the Acupuncture Treatment of 120 Cases of Phlegm Heat Harassing Internally Pattern Insomnia,” this study appeared in issue #6, 2001, of Bei Jing Zhong Yi (Beijing Chinese Medicine) on pages 38-39. Below is an abstract of the salient points of that study.

Cohort description:

All 120 patients in this study met the WHO criteria of more than 60% sleep loss. In addition, these patients all met the criteria for phlegm heat insomnia appearing in Zhong Yi Bing Zheng Zhen Duan Zi Xiao Bian Sun (Criteria for Chinese Medical Disease & Pattern Diagnosis & Treatment Efficacy). Clinical symptoms of insomnia included difficulty falling asleep or easy waking with insomnia after waking, and if severe, possibly no sleep throughout the entire night. Accompanying symptoms included headache, dizziness, heart palpitations, impaired memory, profuse dreams. Symptoms of phlegm heat internally harassing included heart vexation, chest oppression, ductal glomus, a bitter taste in the mouth, profuse phlegm, dizziness, a red tongue with slimy, yellow fur, and a slippery or slippery, rapid pulse.

These 120 patients were divided into two groups of 60 patients each, a treatment group and a comparison group. In both groups, the oldest patient was 67 and the youngest was 27 years old. In the treatment group, there were 34 men and 26 women, with an average age of 43.2 years. In the comparison group, there were 28 men and 32 women, with an average age of 38.45 years.

Treatment method:

In the treatment group, each patient received acupuncture at Bai Hui (GV 20), Shen Ting (GV 24), Si Shen Cong (M-HN-1), Shen Men (Ht 7), Nei Guan (Per 6), Zhong Wan (CV 12), Feng Long (St 40), and Gong Sun (Sp 4). Each point was needled with a 1-1.5 inch fine needle. After obtaining the qi, even supplementing-even draining hand technique was used. This treatment was given once per day. In addition, patients in the treatment group received 1-2mg of an orally administered Western medical sedative called in Chinese Shu Le An Ding (literally, Soothing, Happy, Quiet & Tranquilizing).  The comparison group only received this same sedative. Ten days equaled one course of treatment for both groups, and three such courses were given.

Treatment outcomes:

Cure was defined as disappearance of the main clinical and accompanying symptoms with increase in the amount of sleep by more than 75% after stopping the sleeping medication. Marked effect was defined as remission of the main clinical symptoms and basic disappearance of the accompanying symptoms, with sleep increasing by 10-20% after stopping the sleeping medication. Some effect meant that the main clinical symptoms improved and the accompanying symptoms partially remitted, with sleep increasing 0-10% after stopping the sleeping medication. No effect meant that there was no change in the amount of sleep from before to after treatment.

Based on these criteria, in the treatment group, 24 cases (40%) were judged cured, 26 (43.33%) got a marked effect, eight (13.33%) got some effect, and two (3.33%) got no effect. In the comparison group, 14 cases (23.33) were judged cured, 14 (23.33%) got a marked effect, 24 (40%) got some effect, and eight (13.33%) got no effect. Therefore, the total amelioration rate in the treatment group was 96.66%, while it was only 86.66% in the comparison group. This suggests that the combination of acupuncture plus the Western sedatives is more effective for the treatment of phlegm heat internally harassing insomnia than the Western medications alone (P + 0.05). In addition, those patients in the treatment group who achieved cures or marked effects, did so in a median duration of treatment typically half that of patients with the same outcomes in the comparison group (11.82 ± 5.14 days to cure and 7.51 ± 4.15 days to marked effect).

Discussion:

According to Dr. Cui, this acupuncture protocol transforms phlegm and clears heat, harmonizes the center and quiets the spirit, regulates and rectifies the spleen and stomach. Thus it promotes the balance of yin and yang. At night, the defensive yang enters the constructive and yin aspects. When yin is level (or normal and calm), the yang is secreted and sleep is sound and long. Within this protocol, Bai Hui, Shen Ting, Si Shen Cong, Shen Men, and Zhong Wan boost the qi and harmonize the center, clam the heart and quiet the spirit.. Hence they achieve a definite therapeutic effect in terms of quieting the spirit and treating insomnia. However, in this case, there is not just nonconstruction and malnourishment of the spirit; there is also phlegm. Therefore, Feng Long, Nei Guan, and Gong Sun are added to strengthen the transformation of phlegm, thus achieving even better therapeutic effects.

As an acupuncturist working in the West, for me the interesting things about this protocol are that, first, it is nothing other than an example of point combination based on pattern discrimination. By this I mean that the formula consists of several points which are known to achieve an empirically reliable effect on the treatment of insomnia in general. To these have then been added several points which are not necessarily anti-insomnia points but are rather points which address the disease mechanism of phlegm. These added points are in no way secret or esoteric. Rather, they are well-known and, from that point of view, relatively prosaic. In other words, there was not anything extremely special about this protocol. Instead, it was relatively straight forward and pro forma. Secondly, this study suggests that acupuncture is effective for treating this specific pattern of insomnia, at least when performed at this frequency. Acupuncture does not treat all patterns of all diseases equally well, and it is important, especially for beginners, to know what acupuncture does and does not treat dependably well. This protocol does seem to be able to treat this particular pattern of insomnia quite well when performed intensively from a Western point of view. In addition, this study also suggests how long it typically takes to treat insomnia using this approach. Third, this study shows that the combination of acupuncture plus Western medicine works better than this Western medicine did all by itself. This is yet another piece of evidence for the integration of Chinese and Western medicines. It is a shame that this study was not three-winged (instead of only two-winged) and that the effect of acupuncture alone was not also compared and assessed.    

Copyright © Blue Poppy Press, 2002. All rights reserved.