Seven Proven Formulas for Treating Insomnia — National Master TCM Practitioner Zhu Liangchun

10. Seven Proven Formulas for Treating Insomnia — National Master TCM Practitioner Zhu Liangchun

Pathomechanism of Insomnia

Insomnia pathomechanism fundamentally belongs to yin-yang imbalance, with yang failing to enter yin. Zhu Liangchun in differentiating and treating insomnia emphasizes clarifying the excess/deficiency nature and the disease location. When liver stagnation transforms into fire, pathogenic heat disturbs the heart, mind is unsettled; when phlegm-heat accumulates in the gallbladder, phlegm turbidity blocks internally, stomach qi is disharmonious; when jueyin stagnant heat, heat consumes liver yin, the liver hun cannot be housed; when yin blood is deficient, the heart loses its nourishment, the spirit cannot keep its place; when liver stagnation with qi stagnation, qi mechanism is not smooth, heart spirit is depressed and stagnant; when yin and yang are both deficient, kidney yang is not vigorous, yin cannot gather yang. Different pattern types have different treatment methods; formula and herb selection each have their emphasis. Zhu Liangchun’s seven proven formulas for insomnia each correspond to different pattern types; clinically, formulas should be selected and modified according to pathomechanism characteristics.

Detailed Explanations by Formula

1. Banxia Kucao Jian (Pinellia and Prunella Decoction)

Composition: Ginger-processed Pinellia 12g, Prunella 12g, Coix Seed 60g (substituting for millet), Mother of Pearl 30g

Efficacy: Descends qi and gathers yang, transforms phlegm and harmonizes the middle burner

Primary Application: Insomnia from liver yang excess with phlegm (especially suitable for chronic liver disease with long-term deficiency)

This formula takes the Neijing Banxia Suli Mi Tang’s principle of “descending its qi is gathering its yang,” substituting Coix Seed for millet. Pinellia is born in the yin; Prunella withers by summer; the pairing of the two herbs subtly corresponds to the yin-yang waxing and waning principle. Pinellia harmonizes the stomach and descends counterflow; Prunella clears the liver and scatters nodules; Coix Seed strengthens the spleen and transforms phlegm; Mother of Pearl calms the liver and anchors yang. Especially suitable for chronic liver disease that has not responded to prolonged treatment, misdiagnosis, or long-term Western drug use causing chronic insomnia.

2. Wen Dan Tang with Modifications

Composition: Bamboo Shavings 10g, Processed Pinellia 10g, Gallbladder Arisaema 10g, Jujube 10g, Aurantium (Zhike) 6g, Red Tangerine Peel 6g, Licorice 6g, Poria 15g

Efficacy: Dries dampness and transforms phlegm, clears heat and resolves vexation, harmonizes the stomach and reaches the gallbladder

Primary Application: Insomnia from phlegm-heat disturbing the gallbladder

Wen Dan Tang derives from Yao Sengheng’s Ji Yan Fang, with the functions of drying dampness and transforming phlegm, clearing heat and resolving vexation, harmonizing the stomach and reaching the gallbladder. Zhu Liangchun added Gallbladder Arisaema to this formula to enhance phlegm-transforming power; suitable for gallbladder deficiency phlegm-heat insomnia, presenting with depressed and unhappy mood, deficiency vexation and fright-palpitating, bitter taste and salivation, easily startled, and vague dreams. Gallbladder Arisaema clears heat, transforms phlegm, and settles fright; combined with Pinellia and Bamboo Shavings, its phlegm-transforming heat-clearing power is more focused.

3. Peibu Shenyang Tang (Nourishing and Tonifying Kidney Yang Decoction)

Composition: Epimedium 15g, Curculigo 10g, Huai Yamo 15g, Lycium 10g, Human Placenta 6g, Licorice 5g, Raw Rehmannia 12g, Prepared Rehmannia 12g, Fat Polygonatum 12g, Calcined Cuttlefish Bone 18g, Rubia (Carbonized) 6g

Efficacy: Simultaneously tonifies yin and yang

Primary Application: Insomnia from yin-yang dual deficiency

Zhu Liangchun believes that chronic diseases “ultimately reach the kidneys” and “chronic ones always reach the kidneys”; many insomnia patients who have not responded to prolonged treatment have mostly consumed kidney yin and yang. This formula uses Epimedium, Curculigo, and Human Placenta to warm and tonify kidney yang; Raw and Prepared Rehmannia, Lycium, and Polygonatum to nourish kidney yin; Huai Yamo to strengthen the spleen and benefit the kidneys; Calcined Cuttlefish Bone and Carbonized Rubia to consolidate the lower jiao. The formula places yin and yang herbs side by side; yang generates and yin grows; suitable for yin-yang dual deficiency patterns with cold aversion and cold limbs, lower back soreness and seminal emission, and restless sleep. When using clinically, note that once yang decline is recovered, promptly shift emphasis to yin-nourishing; stop when the pathogen is hit.

4. Suanzaoren Tang with Modifications

Composition: Codonopsis 16g, Alchornea (Huan Pi) 16g, Arborvitae Seed 16g, Sour Jujube Seed 16g, Polygonum (Ye Jiao Teng) 20g, Millet 20g, Anemarrhena 12g, Chuanxiong 6g, Licorice 6g

Efficacy: Removes vexation and descends fire, disperses stagnation and calms the spirit

Primary Application: Insomnia from disharmonious heart qi, internal deficiency heat disturbing

This formula uses Zhang Zhongjing’s Suanzaoren Tang as the base: Sour Jujube Seed nourishes the liver and calms the spirit; Anemarrhena clears deficiency heat; Chuanxiong smoothly regulates qi and blood. Added Codonopsis tonifies qi and nourishes the heart; Alchornea disperses stagnation and calms the spirit; Arborvitae Seed nourishes the heart and calms the spirit; Polygonum guides yang into yin. Suitable for deficiency vexation inability to sleep, heart palpitations and shortness of breath, thin forceless pulse; compared to the original formula, it enhances qi-tonifying stagnation-dispersing power.

5. Banxia Tang with Modifications

Composition: Processed Pinellia 12g, Prunella 12g, Arborvitae Seed 12g, Salvia 12g, Mother of Pearl 30g (pre-decocted), Amber Powder 2.5g (taken internally), Lily Bulb 20g

Efficacy: Clears the liver and calms the spirit, communicates yin and yang

Primary Application: Insomnia from jueyin stagnant heat, liver yin damaged

This formula also takes Pinellia paired with Prunella to communicate yin and yang; added Salvia invigorates blood and cools it, clears the heart and removes vexation; Lily Bulb moistens the lungs and clears the heart; Arborvitae Seed nourishes the heart and calms the spirit; Mother of Pearl calms the liver and anchors yang; Amber Powder settles fright and calms the spirit. Compared to Banxia Kucao Jian, it adds blood-invigorating stasis-resolving and fright-settling functions; suitable for jueyin stagnant heat lingering long, liver yin already damaged, with evening excitement and insomnia. Amber Powder taken internally for its sedative and spirit-calming effect; Mother of Pearl pre-decocted for full medicinal efficacy extraction.

6. Ziyin Qingxin Fang (Yin-Nourishing Heart-Clearing Formula)

Composition: Raw Rehmannia 15g, Mulberry 15g, Scophularia 10g, Anemarrhena 10g, Coptis 5g, White Peony 12g, Poria Spirit (Fushen) 12g, Sour Jujube Seed 12g, Ophiopogon 12g, Raw Licorice 3g, Polygonum 30g

Efficacy: Nourishes yin and benefits the liver, clears the heart and calms the spirit

Primary Application: Insomnia from liver stagnation transforming into fire, blood not nourishing the heart

In this formula, Raw Rehmannia, Mulberry, Scophularia, and Ophiopogon nourish yin and cool blood; Coptis clears the heart and drains fire; White Peony nourishes blood and softens the liver; Poria Spirit, Sour Jujube Seed, and Polygonum nourish the heart and calm the spirit. Liver stagnation transforming into fire over time must consume yin and blood; when yin and blood are insufficient, the heart loses its nourishment; the formula simultaneously applies yin-nourishing and heat-clearing, liver-nourishing and spirit-calming; suitable for patterns with vexed insomnia, dry mouth and tongue, red tongue with thin rapid pulse.

7. Shugan Jieyu Fang (Liver-Dispersing Stagnation-Resolving Formula)

Composition: Nardostachys 6–12g (add late), Turmeric (Yujin) 12g, Salvia 12g, Alchornea 15g, Mahonia 15g, Wheat 30g, Polygonum 30g, Jujube 5 pieces, Licorice 5g

Efficacy: Disperses the liver and resolves stagnation

Primary Application: Insomnia from liver stagnation with qi stagnation, qi mechanism not smooth

Nardostachys is aromatic, opens stagnation, regulates qi, and calms the spirit; added late for its mellow aromatic quality. Turmeric moves qi and resolves stagnation; Alchornea disperses stagnation and calms the spirit; Salvia invigorates blood and cools the heart; Mahonia clears deficiency heat; Wheat, Jujube, and Licorice take the meaning of Ganmai Dazao Tang to nourish the heart and gently relieve urgency. The whole formula primarily disperses the liver and resolves stagnation, while also nourishing the heart and calming the spirit; suitable for mental depression, chest and flank distending fullness, and restless sleep. Nardostachys dosage 6–12g; for those with constitutionally deficient build, start with the small dose.

Summary

yin-nourishing heart-clearing and blood-tonifying spirit-calming as the pathway, covering Suanzaoren Tang modifications and the Yin-Nourishing Heart-Clearing Formula; phlegm-transforming, stagnation-dispersing, and warm-tonifying as the three wings, respectively corresponding to Wen Dan Tang modifications, Liver-Dispersing Stagnation-Resolving Formula, and Nourishing Kidney Yang Decoction. The seven formulas differentiate and treat by type, formulas follow patterns; this embodies Zhu Liangchun’s careful cause-analysis and pattern-differentiation treatment philosophy.

References:

[1] Xie Wei. Wondrous Teachings on Heart and Brain Disease Patterns [M]. Beijing: People’s Military Medical Press, 2008.

[2] Zhu Liangchun Academic Experience Inheritance Research Office. Nourishing Kidney Yang for Treating Chronic Diseases [N]. China TCM Report.

[3] Zhu Liangchun. Zhu Liangchun Medical Collection [M]. Beijing: People’s Medical Publishing House.

[4] Qiu Zhiji, Zhu Jianping, Ma Xuanqing. Zhu Liangchun’s Thinking in Treating Stubborn Insomnia [J]. Liaoning Journal of TCM.

10. 治療失眠的七首經驗方—國醫大師朱良春

失眠病機

失眠病機總屬陰陽失調、陽不入陰。朱良春辨治失眠，注重辨明病性虛實與病位所在。肝鬱化火者，邪熱擾心，心神不安；痰熱蘊膽者，痰濁內阻，胃氣不和；厥陰鬱熱者，熱耗肝陰，肝魂不藏；陰血虧虛者，心失所養，神不守舍；肝鬱氣滯者，氣機不暢，心神鬱抑；陰陽俱虛者，腎陽不振，陰不斂陽。不同證型治法各異，選方用藥各有側重。朱良春治療失眠的七首驗方，各對應不同證型，臨床宜根據病機特點選方化裁。

分方詳解

1. 半夏枯草煎

組成：姜旱半夏 12g、夏枯草 12g、薏苡仁 60g（代秫米）、珍珠母 30g

功效：降氣斂陽，化痰和中

主治：肝陽偏亢夾痰之不寐（尤宜慢肝久病體虛者）

此方取《內經》半夏秫米湯”降其氣即所以斂其陽”之義，以薏苡仁代秫米。半夏得陰而生，夏枯草至夏即枯，二藥配伍暗合陰陽消長之理。半夏和胃降逆，夏枯草清肝散結，薏苡仁健脾化痰，珍珠母平肝潛陽。尤適用於慢性肝病久治不愈、誤治或久服西藥致長期失眠者。

2. 溫膽湯加減

組成：竹茹 10g、法半夏 10g、膽南星 10g、大棗 10g、枳殼 6g、橘紅 6g、甘草 6g、茯苓 15g

功效：燥溼化痰，清熱除煩，和胃達膽

主治：痰熱擾膽之不寐

溫膽湯源於姚僧垣《集驗方》，有燥溼化痰、清熱除煩、和胃達膽之功。朱良春在此方基礎上加膽南星增強化痰之力，適用於膽虛痰熱不寐，症見鬱郁不舒、虛煩驚悸、口苦嘔涎、觸事易驚、夢寐不詳。膽南星清熱化痰定驚，與半夏、竹茹配伍，化痰清熱之力更專。

3. 培補腎陽湯

組成：淫羊藿 15g、仙茅 10g、懷山藥 15g、枸杞子 10g、紫河車 6g、甘草 5g、生地黃 12g、熟地黃 12g、肥玉竹 12g、煅海螵蛸 18g、茜草炭 6g

功效：陰陽並補

主治：陰陽俱虛之不寐

朱良春認為慢性病”窮必及腎””久必及腎”，許多失眠患者久治不愈，多耗損腎之陰陽。此方以淫羊藿、仙茅、紫河車溫補腎陽，生熟地黃、枸杞子、玉竹滋養腎陰，懷山藥健脾益腎，煅海螵蛸、茜草炭固澀下焦。方中陰陽藥物並列，陽生陰長，適用於畏寒肢冷、腰痠遺精、夜寐不寧之陰陽兩虛證。臨床使用時需注意陽衰得振後及時轉側重滋陰，中病即止。

4. 酸棗仁湯加減

組成：太子參 16g、合歡皮 16g、柏子仁 16g、酸棗仁 16g、夜交藤 20g、米 20g、知母 12g、川芎 6g、甘草 6g

功效：除煩降火，疏鬱安神

主治：心氣不和、虛熱內擾之不寐

此方以仲景酸棗仁湯為底，酸棗仁養肝安神，知母清虛熱，川芎調暢氣血。加太子參益氣養心，合歡皮解鬱安神，柏子仁養心安神，夜交藤引陽入陰。適用於虛煩不得眠、心悸氣短、脈細無力者，較原方增強了益氣解鬱之力。

5. 半夏湯加減

組成：法半夏 12g、夏枯草 12g、柏子仁 12g、丹參 12g、珍珠母 30g（先煎）、琥珀末 2.5g（吞服）、川百合 20g

功效：清肝寧神，交通陰陽

主治：厥陰鬱熱、肝陰受戕之不寐

此方亦取半夏配夏枯草交通陰陽之意，加丹參活血涼血、清心除煩，川百合潤肺清心，柏子仁養心安神，珍珠母平肝潛陽，琥珀末鎮驚安神。較半夏枯草煎多了活血化瘀與鎮驚之功，適用於厥陰鬱熱久羈、肝陰已傷、入暮興奮不寐者。琥珀末吞服取其鎮靜安神之效，珍珠母先煎以充分析出藥效。

6. 滋陰清心方

組成：細生地黃 15g、桑椹 15g、玄參 10g、知母 10g、川黃連 5g、白芍 12g、茯神 12g、酸棗仁 12g、麥冬 12g、生甘草 3g、夜交藤 30g

功效：養陰益肝，清心安神

主治：肝鬱化火、血不榮心之不寐

方中細生地黃、桑椹、玄參、麥冬滋陰涼血，川黃連清心瀉火，白芍養血柔肝，茯神、酸棗仁、夜交藤養心安神。肝鬱化火日久必耗陰血，陰血不足則心失所養，方中滋陰與清熱並施，養肝與安神同治，適用於心煩不寐、口乾舌燥、舌紅脈細數之證。

7. 疏肝解鬱方

組成：甘松 6~12g（後下）、廣鬱金 12g、丹參 12g、合歡皮 15g、十大功勞葉 15g、淮小麥 30g、夜交藤 30g、大棗 5枚、甘草 5g

功效：疏肝解鬱

主治：肝鬱氣滯、氣機失暢之失眠

甘松芳香開鬱、理氣安神，後下取其氣香醇正。廣鬱金行氣解鬱，合歡皮解鬱安神，丹參活血涼心，十大功勞葉清虛熱，淮小麥、大棗、甘草取甘麥大棗湯之義養心緩急。全方以疏肝解鬱為主，兼以養心安神，適用於精神抑鬱、胸脅脹悶、夜寐不安者。甘松用量6~12g，體質偏虛者從小量起用。

小結

朱良春治失眠七方，以半夏配夏枯草交通陰陽為線索，貫穿半夏枯草煎與半夏湯加減兩方；以滋陰清心、養血安神為路徑，覆蓋酸棗仁湯加減與滋陰清心方；以化痰、解鬱、溫補為三翼，分別對應溫膽湯加減、疏肝解鬱方、培補腎陽湯。七方分型論治，方隨證轉，體現了朱良春審因辨證的辨治思路。

參考文獻：

[1] 謝煒. 心腦病證妙諦[M]. 北京:人民軍醫出版社, 2008.

[2] 朱良春學術經驗傳承研究室. 培補腎陽治療慢性病[N]. 中國中醫藥報.

[3] 朱良春. 朱良春醫集[M]. 北京:人民衛生出版社.

[4] 邱志濟, 朱建平, 馬璇卿. 朱良春治療頑固失眠的思路[J]. 遼寧中醫雜誌.