When the Heart Can't Let Go - Diagnosing and Treating Insomnia
She walked into the clinic quietly.
But as soon as the dam had burst, she started telling me about the thoughts that haunt her. They chase her through the day too, but she manages to release them into the crowded streets of the never-ending to-do lists.
But at nighttime, when the streets are empty, they don't let her run away, and besiege her. She's captured, and can't fall asleep.
After a few hours, the tiredness makes them flee to allow her a short slumber. But the guards doze off not long afterwards, and the chasers come again. They send troubling dreams into her mind, and wake her up.
Next he came. A 6 year old.
His eyes looked at me, and then looked away. Again and again. He's autistic, somewhere in the middle of the spectrum, quite verbal. Like many others on the spectrum, he suffers from insomnia. But he's not the only one who is not getting enough sleep.
Many mothers of autistic children will never hear their child call them "mom". But his mom told me how afraid she is of the sound of that word. Because he wakes up in horror and calls her "mom" about 7 times every night.
After she's toiling over him to put him to sleep comes the test: to get out of the room unnoticed. Every whisper that others wouldn't detect will make him call her again, and will bring her back to another 20 minutes of sitting in the dark.
At first glance, the two cases of insomnia seem similar. They both have difficulty falling asleep, they are light sleepers, and suffer from anxiety. But the treatment was completely different. Why?
To understand how to approach insomnia in Chinese medicine, we need to recognize a basic paradox:
No one can make himself sleep.
No one can actively practice the act of falling asleep. Nor can anyone make someone else sleep. Every person suffering from insomnia knows that. Parents of an autistic child, or any child for that matter, experience this truth daily.
Why can't we control falling asleep? Because sleeping is a function of the heart, and the heart functions cannot be forced. Love, insight, sleep- the emperor can't control them. He can only let go, and allow himself to fall in love, to fall asleep, or to have inspiration dawn on him. Doing by non-doing.
What gets in the way of letting go
According to Chinese herbal medicine, different deficiencies (especially of Yin/Blood) can cause weakness of the heart. The emperor can't let go because he's tired. It seems like a contradiction, but anyone who has ever seen a child going past his bedtime knows what it's about.
Deficiencies of Yin or Blood disturb the process of the Yang's anchoring, and lead to an uprise of heat that is hard to contain. Tian Wang Bu Xin Dan 天王补心丹- the heavenly emperor's special pill to tonify the heart- is a principal formula for these deficiencies.
But practitioners might forget that excesses (especially of heat and/or phlegm) can accumulate in the heart and disturb it. The emperor can't turn to its duties and let go because he's busy handling stagnation. First among the formulas that treat this pathomechanism is Huang Lian Wen Dan Tang 黄莲温胆汤- the main formula to clear phlegm-heat from the heart.
How to diagnose
By observation, other symptoms, tongue and pulse diagnosis.
The autistic child's mother told me he sweats so much at night, that there are white marks left on the sheets in the morning. He was skinny, and his tongue had no coating. The herbal treatment was based at first on Dao Chi San 导赤散. He started to wake up less frequently, and his anxiety was relieved gradually.
The woman who was haunted by her thoughts told me about burning urination, and her tongue had a thick yellow coating. Huang Lian Wen Dan Tang helped her heart find peace and quiet, and the insomnia disappeared with the herbal treatment, and five-element acupuncture.
The primary function of the heart
To enable sleep, the heart needs to let go. As practitioners, our job is to find out what's getting in the way. Usually, it will be a substance imbalance combined with an energetic one.
Acupuncture is excellent for treating the energetic level- if Gui 鬼 is involved, or an imbalance in one of the elements floods the heart with emotions. The herbs balance excesses and deficiencies with accuracy and elegance.
Together they restore the heart's ability to enable sleep, using its primary function:
Wu Wei 无为, non-doing.
Pnina Droyan practices Chinese Medicine in a Snoezelen room, and specializes in the treatment of children on the autistic spectrum. She has gone through a clinical internship in the treatment of cardiac problems in the outpatient department of the CACMS in Beijing, China. www.pninsky.com
This post is also available in: Hebrew