Sleep medicine in TCM · Clinician-review draft
TCM pattern differentiation for insomnia
‘Insomnia’ is too broad to differentiate directly. Start by identifying the disturbed part of sleep—falling asleep, maintaining sleep, early waking, dream disturbance or unrefreshing sleep—then test the pattern families that could produce that presentation.
Try an interactive insomnia case- First split
- Sleep onset vs maintenance vs early waking
- Then assess
- Agitation · Heat · deficiency · Phlegm · digestion
- External evidence
- Tongue body/tip/coat and pulse
- Avoid
- Inferring a pattern from clock time alone
Questions that open the right branches
- What exactly happens: difficulty falling asleep, repeated waking, early waking, vivid dreams or non-restorative sleep?
- Is the mind agitated, worried, fearful or simply unable to settle?
- Are there palpitations, night sweating, five-centre Heat, thirst, bitter taste or mouth ulcers?
- Is there epigastric fullness, reflux, nausea or late-evening food aggravation?
- Are heaviness, chest oppression, phlegm or a greasy tongue coat present?
- How longstanding is the problem, and what changed around its onset?
Pattern families to distinguish
| Candidate | Useful supporting cluster | Important separator |
|---|---|---|
| Heart Fire | Marked agitation, palpitations, thirst, mouth/tongue ulcers | Red tongue tip and a rapid pulse with clear full-Heat signs |
| Liver Fire | Irritability, bitter taste, red eyes, headache | Liver Heat signs predominate rather than mouth/tongue-ulcer signs |
| Heart Yin Deficiency | Dream-disturbed sleep, palpitations, night sweating, five-centre Heat | Deficiency-Heat picture with thin rapid pulse rather than full excess |
| Heart–Kidney disharmony | Insomnia with palpitations plus tinnitus or low-back/Kidney signs | Both upper Heart agitation and lower Kidney deficiency evidence |
| Phlegm-Heat | Restlessness with chest oppression, nausea or phlegm | Greasy yellow coat and slippery rapid pulse |
| Food retention | Restless sleep after eating, epigastric fullness, belching or reflux | Clear digestive timing and retention signs |
Timing is context, not a verdict
A recurring waking time can guide a follow-up question, but it does not establish an organ pattern. The accompanying symptom cluster, tongue and pulse determine whether that timing is meaningful.
Document sleep opportunity, schedule, substances, medication and environmental disturbance so a TCM hypothesis is not built on an unexamined non-pattern cause.
Move from reading to reasoning
Test the distinctions in an interactive case.
The assistant asks for evidence that can change the ranking and keeps missing observations visible.