Posted by Frank Griffo on Sep 12th 2025
Sleep
Clinical Guide to Insomnia
This practical overview is one you can hand to patients and use in the clinic — covering sleep hygiene that actually sticks, how wake times map to patterns, and when to reach for Gui Pi Tang (Restore), Tian Wang Bu Xin Dan (Cordis), Suan Zao Ren Tang (Zizyphus), Er Xian Tang (Equinox), Jia Wei Xiao Yao San (Grace & Ease), or Lunalux.
Sleep hygiene is not a magic wand, but as a foundational intervention it is low risk, empowering, and pairs well with herbal strategies and CBT-I. Talk to your patients about building good habits around sleep to empower them give them a good foundation on which to build an effective treatment protocol. A friendly way to build momentum is to focus on one or two behaviors per week and celebrate small wins.
Start here
- Circadian Rhythm: choose a consistent wake-up time and bed time every day to set the circadian rhythm.
- Wind-down ritual (about 90 minutes): dim lights, warm shower, light stretch, five minutes of breathing.
- Bed equals sleep and intimacy only; if awake longer than about 20 minutes, get up, reset, and return when sleepy.
- Caffeine: eliminate at least eight hours before bed and/or reduce entirely.
- Alcohol: keep alcohol light and early.
- Cool, dark, quiet bedroom (about 64–66°F) and morning outdoor light exposure daily.
- Exercise: morning or early afternoon exercise. Avoid heavy workouts in the evening.
TCM: Why the time your patient wakes matters
From a Chinese medical lens, insomnia reflects a mismatch between the spirit and its anchors, often involving Heart, Kidney, Liver, and Spleen. Wake times are helpful clues. The 1–3 am window often flags Liver involvement; the 4:30–5:00 am window can reveal depletion as yang rises. Frequent wakes without a strict time often point to yin-blood deficiency or Heart–Kidney miscommunication, especially during menopause.
Four common presentations and pattern logic
1) Trouble falling asleep (sleep latency over about 30–45 minutes)
This looks like tired but wired with mental overactivity, palpitations, poor memory, a pale tongue, and a thin pulse. It points to Heart and Spleen qi-blood deficiency failing to settle the spirit. The treatment is to nourish blood, tonify qi, and calm the spirit.
2) Waking consistently between 1–3 am
This is classically associated with the Liver period. If irritability, rib-side tension, vivid dreams, and mild heat signs are present, think Liver constraint with under-nourished fluids. Treatment should focus on calming the liver, tonifying liver blood and Liver/Kidney yin if necessary. If heat is stong with signs of sweating and restlessness then stronger heat clearing treatment should be considered.
3) Waking around 4:30–5:00 am
Pre-dawn waking that feels like light second-half sleep suggests yin-blood depletion or Lung or Heart qi weakness and the yang rises with dawn. Gentle spirit-calming with yin and blood support can help lengthen second-half sleep.
4) Regular waking many times per night
Frequent wakes can happen multiple times per night or even hourly. The patient may go back to sleep quickly or stay awake each time. This often presents with night sweats, heat intolerance, dryness, and mood lability. This points to Heart–Kidney miscommunication and yin deficiency heat.
5) Emotional fragility
Emotional agitation with fragile mood changes, crying spells, irritability, and easily broken sleep. Gently nourish Heart (and Spleen), ease constraint, and calms the shen. These generally are anxiety-spectrum presentations with insomnia.
Formulas and evidence snapshots
Lunalux — mixed onset with heat, agitation, and restless mind and body
Pattern fit: Liver blood support with gentle heat clearing and blood nourishment for patients who report sleep latency plus waking.
Clinic use: consider as a single go-to for insomnia sleep support. This formula addresses several causes of poor sleep. It establishing an internal pattern that is foundational for good sleep: cool body, calm mind, tension free, relaxed.
Gui Pi Tang (Restore) — falling asleep with rumination
Pattern fit: Heart and Spleen qi-blood deficiency with overthinking, palpitations, and fatigue.
Clinic use: helpful when sleep latency is long along with daytime fatigue and cognitive symptoms. Works well with morning light and a strict rise time.
Tian Wang Bu Xin Dan (Cordis) — waking frequently with heat
Pattern fit: Heart–Kidney yin deficiency with deficiency heat, vexation, palpitations, and dry mouth.
Clinic use: especially useful when patients note heat signs with light, broken sleep. Often used for menopause related insomnia and general yin deficiency with heart symptoms.
Suan Zao Ren Tang (Zizyphus) — difficulty staying asleep with vexation
Pattern fit: Liver blood deficiency with deficiency heat disturbing the Heart, light sleep with frequent waking, irritability, night sweats, dry mouth or throat.
Clinic use: a reliable choice when patients wake repeatedly and feel tired and warm, especially in perimenopause; consider if the tongue is slightly red and the pulse is thin and wiry.
Er Xian Tang (Equinox) — menopausal insomnia and frequent waking
Pattern fit: Heart–Kidney miscommunication with yin deficiency heat and night sweats.
Clinic use: helps stabilize sleep continuity in the menopausal transition while addressing heat and night sweats; combine with cooling bedroom strategies.
Jia Wei Xiao Yao San (Grace & Ease) — pre-dawn waking (about 4:30–5 am)
Pattern fit: yin-blood depletion with light second-half sleep and gentle anxiety.
Clinic use: helpful when patients fall asleep fine but wake pre-dawn and can’t drift back.
Gan Mai Da Zao Tang (Pax) — Emotional
Pattern fit: heart qi and blood deficiency with constraint.
Clinic use: a common choice when a patient is experiencing high anxiety or emotional fragility short term or long term. Can be used morning and evening.
Clinical pearls by presentation
- Falling asleep with rumination: morning light walk and early worry journaling; Gui Pi Tang (Restore) when fatigue, palpitations, and low appetite or memory stand out.
- Waking 1–3 am with irritability: dial down evening alcohol and spices; gentle evening movement; Tian Wang Bu Xin Dan (Cordis) when yin depletion or deficiency heat accompanies the pattern.
- Frequent wakes with vexation or night sweats: consider Suan Zao Ren Tang (Zizyphus), especially in perimenopausal patterns with a slightly red tongue and thin-wiry pulse.
- Pre-dawn 4:30–5 am wake: cooler bedroom, slow nasal breathing on waking, yin-blood support via Grace & Ease.
- Menopausal waking: track hot-flash timing and use nighttime cooling strategies; Equinox aligns when Heart–Kidney discord and deficiency heat dominate.
- Mixed onset and maintenance: keep behaviors tight; Lunalux for most presentation.
References
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- Edinger, J. D., Arnedt, J. T., Bertisch, S. M., et al. (2021). Behavioral and psychological treatments for chronic insomnia disorder in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 17(2), 255–262. Link | PMCID
- Yang, X. Q., Li, M., Zhao, K., et al. (2019). Tian Wang Bu Xin Dan for insomnia: A systematic review and meta-analysis. Frontiers in Pharmacology, 10, 1347. PMCID | PubMed
- Yeh, C. H., Wang, Y. Y., Chiang, Y. C., et al. (2011). Suan Zao Ren Tang as an original treatment for sleep difficulty in climacteric women: A randomized, double-blind, controlled trial. Evidence-Based Complementary and Alternative Medicine, 2011, 673813. PMCID | PubMed
- Kwon, C.-Y., et al. (2024). Effectiveness and safety of East Asian herbal medicine for menopausal insomnia: A systematic review and meta-analysis of randomized controlled trials. Frontiers in Pharmacology. Link | PMCID
- Yeung, W. F., Chung, K. F., Poon, M. M., et al. (2012). Chinese herbal medicine for insomnia: A systematic review of randomized controlled trials. Sleep Medicine Reviews, 16(6), 497–507. PubMed
- Wu, H.-C., et al. (2011). Improving sleep quality in climacteric women with insomnia: A randomized head-to-head trial between Jia-Wei-Xiao-Yao San and Suan Zao Ren Tang. European Journal of Integrative Medicine. Abstract
- American Academy of Sleep Medicine. Practice Guidelines index (accessed Sept 2025). Link