不寐
Alias失眠
Traditional Chinese Medicine Definition
In traditional Chinese medicine, "Insomnia" is referred to as "不寐" (Bu Mian), which describes a condition where the patient finds it difficult to fall asleep or experiences poor sleep quality, resulting in a state of insufficient rest during the night. According to internal medicine in traditional Chinese medicine, the pathogenesis of insomnia is often related to the dysfunction of the heart, liver, spleen, and kidney, with the instability of the heart and mind being the key factor. "The Internal Medicine of Traditional Chinese Medicine" states: "Insomnia is often caused by excessive heart fire, which disturbs the heart and mind."
In clinical practice of traditional Chinese medicine, the differential diagnosis of insomnia primarily revolves around the core pathogenesis of "unstable heart and mind." Common triggers include emotional disorders, irregular diet, and excessive mental strain. During the differential diagnosis, attention should be paid to the following key points: first, differentiation of cold and heat, deficiency and excess, such as the liver fire disturbing the heart syndrome characterized by fire, and the phlegm-heat disturbing the heart syndrome characterized by phlegm-heat; second, the heart-spleen deficiency syndrome is characterized by palpitations and fatigue, while the heart-kidney disharmony syndrome is characterized by restlessness and soreness in the lower back and knees. The overall direction of treatment suggests that the principle of "dispelling excess and reinforcing deficiency" should be followed, adopting corresponding treatment methods based on different patterns, such as soothing the liver and reducing fire, clearing phlegm and heat, reinforcing the heart and spleen, and nourishing yin and reducing fire, to achieve the therapeutic effect of harmonizing yin and yang and calming the mind.
Common Syndrome Types and Key Points of Differentiation
肝火扰心证
Main Manifestations：不寐多梦，急躁易怒，头晕头胀，目赤耳鸣，口苦口干
Management Approach：疏肝泻火，镇心安神
痰热扰心证
Main Manifestations：心烦不寐，胸闷脘痞，泛恶嗳气，口苦，头重目眩
Management Approach：清化痰热，和中安神
心脾两虚证
Main Manifestations：多梦易醒，心悸健忘，神疲食少，面色少华
Management Approach：补益心脾，养血安神
心肾不交证
Main Manifestations：心烦不寐，心悸多梦，头晕耳鸣，腰膝酸软，潮热盗汗
Management Approach：滋阴降火，交通心肾
The above syndrome information is based on traditional Chinese medicine textbooks and clinical standards. Specific differentiation should be completed by a practicing traditional Chinese medicine physician in person.
Physician's Clinical Insights
In clinical practice, most insomnia patients present with a disharmony between the heart and kidney. During treatment, attention should be paid to the balance between excessive heart fire and insufficient kidney water.
— 朱永兵 中医执业医师
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参考文献：《中医内科学》（十三五规划教材）、《中医病证诊断疗效标准》(ZY/T001.1-94)、《中医病证分类与代码》(GB/T 15657-2021)