Spring Drowsiness and Nighttime Wakefulness: The Ascending and Descending of Yang Qi Falls Out of Order

In mid-spring, as yang qi surges forth between heaven and earth, plants sprout branches and unfold leaves, and the body’s qi and blood likewise rise and spread outward and upward. Yet many people, precisely in this season, feel drowsy and heavy-eyed during the day, eyelids as if weighted with lead; but at night, they become unexpectedly alert and toss and turn, unable to sleep. Spring qi communicates with the Liver, which governs free coursing and stores blood and shelters the ethereal soul. When the Liver’s ascending and outward-moving qi becomes misaligned with the rhythm of yin-yang alternation between day and night, drowsiness and wakefulness become reversed at opposite ends. Is this simply the normal state of spring drowsiness, or is it a signal from the body?

Suwen · Shengqi Tongtian Lun states: “Yang qi governs the exterior during the course of a day. At dawn, human qi begins to arise; at midday, yang qi flourishes; at sunset, yang qi becomes deficient, and the qi gates close.” Yang qi should rise with the sunrise and subside with the sunset. If it fails to rise at dawn and fails to subside at sunset, daytime drowsiness and nighttime wakefulness become two sides of the same coin. Understanding the trajectory of yang qi throughout a single day allows us to understand why the body, in such beautiful spring light, is so sleepy that it cannot keep its eyes open, yet once lying down, remains unusually awake.

I. Beneath the Surface of Day-Night Reversal Lies a Disrupted Rhythm of Yin-Yang Transition

Daytime drowsiness and nighttime alertness may appear to be a mere sleep schedule problem, but from the perspective of Chinese medicine, they point to an imbalance in the ascent, descent, exit, and entry of yin and yang. Daytime belongs to yang, when one is awake and active; nighttime belongs to yin, when one lies down and rests. Whether yang qi can smoothly rise to the body surface in the morning and quietly hide within the yin aspect at night depends on the smoothness of the pathway by which “yang enters yin.” Spring is the season when shaoyang qi arises. If the Liver and Gallbladder’s ascending qi is either excessive or insufficient, the day-night rhythm of yang qi will lose its cadence.

Lingshu · Dahuolun long ago clarified: “When defensive qi cannot enter the yin aspect but remains persistently in the yang aspect, yang qi becomes full. When yang qi is full, the yang qiao vessel becomes replete. When it cannot enter the yin aspect, yin qi becomes deficient, and thus the eyes cannot close.” This passage precisely explains the mechanism of nighttime insomnia: defensive qi should sink into the yin aspect at night, but for various reasons it remains lodged in the yang aspect, making it difficult for a person to fall asleep. Conversely, if in the morning defensive qi cannot promptly emerge from the yin aspect, how could one possibly feel refreshed? Daytime drowsiness and nighttime wakefulness are actually two ends of the same ascending-descending mechanism gone awry.

At the turn of the seasons, the body’s self-regulation of yin and yang naturally requires time. In spring, the temperature alternates between warmth and cold; the earth’s qi rises while the sky’s qi remains unsettled. If the body fails to keep pace with this outward-and-upward movement, it often manifests as nighttime wakefulness and daytime drowsiness. This is not simply a matter of “not sleeping enough,” but rather a signal of rhythm imbalance sent by the body during seasonal transition. For those whose eyes cannot stay open during the day, their nighttime alertness often reflects yang qi failing to be restrained when it should be collected; for those who are very alert at night, their morning drowsiness often results from yin blood being insufficient to fully nourish and contain yang qi.

II. The Same Daytime Drowsiness and Nighttime Wakefulness, Yet Three Different Constitutional Imbalances

Clinically, the manifestation of being unable to keep one’s eyes open during the day yet feeling very alert at night commonly appears in three different constitutional types. Their commonality lies in unfavorable yin-yang interaction; the difference lies in the direction in which yin, yang, qi, and blood are each depleted. If one sees only the word “insomnia” and indiscriminately calms the spirit, or sees “drowsiness” and simply tonifies qi, the treatment may become more and more deviated.

Constitution A: Insufficient Yin Fluid with Floating Deficiency Fire — Yang Entering Yin Loses Its Foundation

In people of this constitution, daytime drowsiness is often accompanied by dry mouth and throat, and heat in the palms and soles. At night, although they feel exhausted, their minds keep running like a movie, with racing thoughts and difficulty settling down. Their drowsiness and wakefulness are closely related to the phrase “yin failing to restrain yang.” Yin fluid is the “bed” for yang qi. When yin is deficient, yang qi has no place to rest at night, so it naturally floats outward, leaving one tossing and turning.

Suwen · Yinyang Yingxiang Da Lun (Chapter 5) states: “Yin is within, serving as the guardian of yang; yang is without, serving as the function of yin.” Yin fluid guards yang qi from within, while yang qi acts as the functional expression of yin fluid on the outside; the two maintain each other in mutual dependence. When yin fluid is excessively consumed — for example, through chronic late nights, overthinking, or high mental stress — yang qi loses the material foundation to sustain itself during the day, and even when it rises, it is a “deficient hyperarousal” that eventually gives way to overpowering drowsiness. At night, when yin blood is insufficient to restrain yang, yang qi wanders outside the body, and one remains wide awake. Such individuals often have a reddish tongue body with scant or absent coating, and a fine, rapid pulse.

Constitution B: Spleen Deficiency with Dampness Excess, Clear Yang Not Ascending — Yang Qi Wants to Rise but Cannot

In another group of people with daytime drowsiness and nighttime wakefulness, the daytime drowsiness carries a heavy sensation. The head feels as if wrapped in a damp towel, the limbs are heavy and sluggish, symptoms are especially obvious after meals, and stools tend to be sticky and unformed. At night, although they do not suffer total sleeplessness like the yin-deficient type, their sleep is shallow and filled with dreams, and they still feel tired after waking. The key to this constitution lies in the phrase “spleen deficiency with dampness encumbrance.” The spleen governs the upbearing of clarity, and the stomach governs the downbearing of turbidity. When the spleen and stomach cannot transport and transform properly, the clear yang qi transformed from food and water essence cannot ascend to the head. When the orifices of the head lose nourishment, how can one not feel drowsy?

In traditional Chinese medicine theory, the spleen and stomach serve as the pivot of qi movement’s ascent and descent. Clear yang emerges from the upper orifices by virtue of the spleen’s upward conveying strength; turbid yin exits from the lower orifices by virtue of the stomach’s downward conveying strength. If the spleen’s upbearing of clarity is insufficient, clear yang becomes stagnant in the middle burner. Above, it cannot nourish the brain and orifices; below, it cannot interact with kidney water. During the day, one experiences dizziness and somnolence; at night, yang cannot enter yin, and sleep is shallow and unsettled. This constitution is closely related to springtime dampness — as rain increases in late spring, external dampness triggers internal dampness, the burden on the spleen increases, and daytime drowsiness with nighttime wakefulness becomes more pronounced. In dampness-encumbered individuals, the tongue is often swollen with tooth marks at the edges and covered with a white or yellow greasy coating.

Constitution C: Liver Qi Stagnation, Shaoyang Pivot Dysfunction — The Day-Night Switch Gets Stuck

Another type of daytime drowsiness and nighttime wakefulness is closely connected to emotions and stress. Such individuals feel drowsy during the day but are reluctant to sleep, feeling as though something is pressing on their minds. Once lying down, they repeatedly replay daytime conversations in their heads or feel anxious about unfinished tasks. They wake before dawn and find it difficult to fall back asleep. The Liver governs free coursing, regulating the movement of qi throughout the body, and is also responsible for the upbearing and pivotal rotation of shaoyang qi. When Liver qi stagnates, the shaoyang pivot fails to rotate smoothly, and the transition of yang qi at the boundary between day and night becomes stuck.

Shanghan Lun, clause 263, states: “Shaoyang disease is characterized by bitter taste in the mouth, dry throat, and dizziness.” When shaoyang qi movement is inhibited, not only do these typical signs appear, but the rhythm of yin-yang alternation between day and night is also affected. People of this constitution often have a bitter taste in the mouth, dry throat, and distension in the flanks. When emotions fluctuate, the symptoms of daytime drowsiness and nighttime wakefulness worsen. Their drowsiness is not true yang qi deficiency, but rather yang qi being suppressed when it should have risen; their wakefulness is likewise not genuine mental vigor, but rather ministerial fire stagnating without descending, disturbing the mind. Examining the tongue and pulse, one commonly finds a reddish tongue margin, thin yellow coating, and a wiry or wiry-fine pulse.

III. Regulation Does Not Focus on “Treating Sleep” but on Straightening the Deviation in the Uninterrupted Circulation of Qi

Since the mechanisms underlying daytime drowsiness and nighttime wakefulness differ among constitutions, the approach to regulation cannot be uniform. Chinese medicine emphasizes “treating different diseases with the same method and the same disease with different methods.” Though the goal of rising with the sun and resting with the sun is the same, the paths to reach it vary considerably. Using Suanzaoren (Ziziphus seed) indiscriminately to calm the spirit, or Huangqi (Astragalus) to tonify qi, without differentiating the constitution, may actually produce the opposite effect — nourishing yin may hinder the spleen, tonifying qi may fuel fire, and this path is deviated from the very start.

For those with yin fluid depletion, the focus of care lies in reducing the consumption of yin blood and appropriately consuming foods that help nourish yin fluid, such as white fungus, lily bulb, mulberry fruit, and black sesame. The key lies in coordinating daily rhythm — nighttime is when yin qi is in command. If one still binge-watches shows or scrolls through a phone during this time of stillness, with the glow of the screen, yin fluid will never have an opportunity to repair itself. It is advisable to create a gradually quieting transitional period before sleep, allowing the mind to undergo a process of “gathering in.”

For those with spleen deficiency and dampness excess, the focus of regulation is on the two words “transportation and transformation.” In terms of diet, reduce consumption of raw, cold, sticky, and greasy foods to lighten the burden on the spleen and stomach. Appropriately consume foods that fortify the spleen and eliminate dampness, such as Chinese yam, Poria, and coix seed. If daytime drowsiness is truly unbearable, it is not advisable to rely on coffee or strong tea to forcefully refresh oneself — that is equivalent to driving spleen yang to work under overload, making nighttime alertness even more excited. A brief walk after meals to help the spleen and stomach move is more beneficial for the upbearing of clear yang than taking a long midday nap.

For those with Liver qi stagnation, the key to regulation lies in coursing and freeing the qi mechanism, enabling the shaoyang pivot to rotate freely. The diet should be light, with little alcohol, avoiding rich, fatty, sweet, and heavy flavors that may promote Liver-Gallbladder damp-heat. Emotional regulation is especially important — spring qi communicates with the Liver, and the Liver delights in free and unrestrained movement and dislikes depression. Exposing oneself to the generative qi of nature and stretching the limbs in the spring sunshine does more to promote the upbearing of shaoyang qi than any food ingredient. If one feels that stagnation is deep, it is advisable to consult a licensed Chinese medicine practitioner at a formal medical institution to determine an individualized approach through pattern differentiation.

Three constitutions, three types of imbalance, yet daytime drowsiness and nighttime wakefulness all stem from the disordered rhythm of yang qi exiting and entering. In clinical practice, there are certainly many patients who belong purely to a single pattern, but mixed and complex presentations are more common — yin deficiency combined with dampness stagnation, Liver depression with Spleen deficiency, all entangled with each other. At such times, distinguishing the principal contradiction from the secondary contradiction becomes particularly crucial. Whether yin deficiency is the root and deficiency fire is the branch, whether dampness encumbrance is the root and clear yang failing to ascend is the branch, or whether Liver depression is the root and pivotal dysregulation is the branch — this can only be discerned through the comprehensive analysis of the four diagnostic methods.

Jingyue Quanshu · Bumei states: “Although insomnia patterns are not all the same, understanding the two words ‘evil and upright’ covers them completely. Sleep is rooted in yin, with the spirit as its governor. When the spirit is at peace, one sleeps; when the spirit is not at peace, one cannot sleep.” This statement reveals the fundamental nature of sleep — whether the spirit can remain calm depends on whether yin and yang can interact, and whether yin and yang can interact depends on whether qi movement ascends and descends in an orderly manner. Daytime drowsiness is yang failing to exit; nighttime wakefulness is yang failing to return. Allowing the yang qi dormant within the body to unfold like spring grass at daybreak, and to settle like a weary bird returning to the forest at nightfall, is not something that can be achieved by a single food ingredient or a single method. It requires the coordinated cooperation of diet, daily routine, emotions, and exercise across multiple dimensions.

The next time spring drowsiness strikes or you wake in the middle of the night, take note of your body’s signals — is it yin deficiency with dry mouth, thirst, and burning sensations in the five centers, or dampness encumbrance with a heavy head as if wrapped and fatigue in the limbs, or Liver depression with flank distension and racing thoughts? Observing your tongue coating and pulse, and noticing how your body changes across seasons and emotional states, is the most fundamental starting point for understanding your constitutional deviations. The body never lies; every kind of drowsiness and wakefulness it presents has its own internal logic and order, waiting to be read and set right.

References:

1. The original text of Huangdi Neijing · Suwen can be consulted in the TCM ancient literature database: https://tcmdata.cintcm.com/

2. WHO strategy document on traditional medicine: https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine

3. Official website of the National Administration of Traditional Chinese Medicine: https://www.satcm.gov.cn/

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