A Difficult Case of Insomnia

Steve is a 40 year old male who had been suffering from insomnia for many years. He used to sleep only two or three hours a day and could not fall asleep after waking. He was tired and experienced feelings of coldness of the limbs and like insects creeping under his skin. He also had three bowel movements a day with the first one occurring just half an hour after getting up in the morning. He told me that when the insomnia improved somewhat after treatment his appetite would become poor, while when the insomnia got worse, his appetite improved. He tried different therapeutic approaches, and after acupuncture the feeling of insect creeping under the skin was relieved. Warmth at Guan Yuan brings comfort to him.

The tongue is pale with toothmarks and the fur is whitish and moist.

Pulse is weak, slippery and rapid.

Diagnosis: Kidney yang floating

Treatment Principle: Tonify the kidney Yang and induce the floating Yang back to its origin

Prescription:

Jiao Tai Wan with modification.

Acupuncture at KI3, RN 4, RN 6, LR 3.

Moxibustion at Guan Yuan or Shen Que

Avoid eating raw or cold food.

Rubbing the lower abdomen at home.

Analysis: This case is typical of kidney Yang deficiency, but in comparison with other types of kidney Yang deficiency, this type is marked by Yang floating. The Yang floating type is usually more severe than ordinary kidney Yang deficiency and is more difficult to treat, so this case lasted a long time. His excessive appetite came from excessive floating Yang in the upper part, and the insomnia resulted from up-floating Yang disturbing the spirit. As a result of the Yang deficiency, there was coldness in the limbs and a pale tongue with toothmarks. As a result, the floating Yang was forced back to the kidney and his appetite would become poor while the insomnia improved. When the Yang Qi floated again, his appetite improved while the insomnia became worse. The feeling of insects creeping under the skin is another typical manifestations of Yang deficiency. Since Yang Qi is in charge of moving other Yin liquids, when Yang Qi is deficient  it will have not enough strength to move, resulting in the itchy feeling.