Liver Depression/Depressive Heat Insomnia

abstracted & translated by
Bob Flaws, L.Ac., FNAAOM (USA), FRCHM (UK)

Keywords: Chinese medicine, Chinese herbal medicine, psychiatry, insomnia

While many Western practitioners of Chinese medicine immediately think yin vacuity when they hear the complaint of insomnia, liver depression transforming heat is an extremely common disease mechanism. Liver depression is almost endemic in the Western adult population. Even in China it was traditionally said “The hundreds of diseases are due to depression,” “The liver is the thief of the five viscera and six bowels,” and “In adults, blame the liver.” Therefore, in my opinion, before immediately thinking this complaint is due to disease mechanisms of the heart or kidneys, one should first rule out the liver. On page 81 of issue #10, 2008 of Xin Zhong Yi (New Chinese Medicine), Luo Jing published an article titled “The Treatment of 76 Cases of Insomnia (Liver Depression Transforming Fire Pattern) by the Methods of Coursing the Liver & Draining Fire.” A summary of this article is presented below.

Cohort description:

One hundred twenty-six patients with a confirmed diagnosis of non-organic insomnia were randomly divided into two groups – a treatment group and a comparison group. The diagnostic criteria used in this two-wing comparison study were based on the ICD-10. Clinical symptoms included difficulty falling asleep, easy waking from sleep with insomnia after waking, and even whole night long insomnia, headache, dizziness, heart palpitations, impaired memory, and profuse dreams. In the treatment group, there were 32 males and 44 females 19-56 years of age, with an average age of 47.21 years. These patients had suffered from insomnia for from one month to five years, with an average disease duration of 3.5 years. In the comparison group, there were 22 males and 28 females aged 22-60 years, with an average age of 46.92 years. These patients had suffered from insomnia for from two months to five years, with an average disease duration of 3.4 years. These two groups were considered statistically comparable for the purposes of this study in terms of sex, age, and disease duration.

Treatment method:

All members of the treatment group were orally administered the following Chinese medicinal formula:

Long Dan Cao (Radix Gentianae)

Zhi Zi (Fructus Gardeniae)

Zhi Qiao (Fructus Aurantii), 12g each

Huang Qin (Radix Scutellariae)

Bai Shao (Radix Alba Paeoniae)

Qing Pi (Pericarpium Citri Reticulatae Viride)

stir-fried Suan Zao Ren (Semen Zizyphi Spinosae), 10g each

mix-fried Gan Cao (Radix Glycyrrhizae), 6g

If there was gallbladder timidity and easy fright, Long Gu (Fossilia Ossis Mastodi) and Mu Li (Concha Ostreae) were added.

If there was chest oppression and rib-side distention, Yu Jin (Tuber Curcumae) and Xiang Fu (Rhizoma Cyperi) were added.

One packet of these medicinals was decocted in water and administered per day. During the time these patients were being treated, they were also counseled to keep a smooth, easy mind and emotions, regulate their lifestyle, and to get adequate physical exercise.

All members of the comparison group were orally administered one milligram of estazolam once per day in the evening.

Two weeks equaled one course of treatment in both groups, and outcomes were analyzed after two successive courses.

Study outcomes:

Clinical cure was defined as a return to normal sleep or at least more than six hours of sleep per night, the sleep was deep, and after waking, the patient felt normal mentally. Marked effect was defined as marked improvement in sleep, with the duration of sleep increased by three hours or more per night, and deeper sleep than before treatment. Some effect was defined as decrease in the symptoms but sleep still not lasting more than three hours per night. No effect meant that, after treatment, there was no obvious improvement in sleep or the insomnia got even worse. The following table shows the outcomes baed on these criteria in the two groups.

Therefore, the Chinese medicinal protocol was markedly more effective than the Western drug regime in terms of total effectiveness. In addition, the members of the two groups were followed up three months after the end of treatment. In the treatment group, there were five cases of relapse for a recidivism rate of 13.98%. In the comparison group, there were 11 cases of relapse for a recidivism rate of 45.83%.

Discussion:

According to Dr. Luo, most cases of insomnia are due to damage by the seven affects. If the psyche loses its regulation, this may give rise to liver depression transforming fire. This then leads to vexation, agitation, irritability, and insomnia. In this case, Dr. Luo believes that the treatment principles should mainly be to course the liver and drain fire. Within the above formula, Long Dan Cao, Zhi Zi, and Huang Qin are meant to clear the liver and drain fire. Zhi Qiao, Qing Pi, and Xiang Fu course the liver, rectify the qi, and resolve depression. Bai Shao nourishes the blood and emoliates the liver. Stir-fried Suan Zao Ren calms the heart and quiets the spirit. When all these medicinals are used together, they course the liver and drain fire, rectify the qi, resolve depression, and quiet the spirit. In those patient presenting a pattern of liver depression transforming fire, they get a markedly better therapeutic effect than estazolam. If patients are counseled psychologically, their lifestyle is regulated, and they get plenty of physical exercise, the therapeutic effects are even better.

Copyright © Blue Poppy Press, 2008. All rights reserved.