Introduction

Insomnia is a common symptom in which sleep quality or quantity is inadequate or non restorative even though there is enough sleep opportunity. Recently insomnia is considered not only just as a symptom but as a coherent collection of symptoms, a syndrome, which can exist associated with various causes that lead to concrete disorders. Insomnia is classified in four types: difficulty falling asleep (sleep onset insomnia), frequent or sustained awakenings (sleep maintenance insomnia), early morning awakenings (sleep offset insomnia); and persistent sleepiness regardless of sleep of adequate duration (nonrestorative sleep). Disturbance of nocturnal sleep pattern can be transient if it last less than one month or chronic, if takes more than one month. Even though elderly are particularly affected, insomnia affects all age groups. The causes of insomnia are: psychiatric disorders including depression and anxiety, Drug and alcohol abuse, sleep apnea, chronic pain disorder, congestive heart failure, chronic obstructive pulmonary disease, bladder problems causing frequent urination, the various dementias that produces night-time agitation and others. Environmental factors such as noise, a move to a new environment, a newborn in the household, and a troublesome sleep partner (snoring and excessive movements) may lead to insomnia. The classical therapeutic approach include elimination of psicostimulants, sleep hygiene, and pharmacologic treatments with sedatives, hypnotics and others. Traditional Chinese Medicine can frequently help in sleep disorders through the regulation of Zang s´ functions; balance between Qi and Xue, and between Yin – Yang. According to Traditional Chinese Medicine inappropriate emotions, improper food intake can produce stagnation of qi, which can be transformed in fire. The fire ascends and damage heart, the Zang who house the mind, and insomnia appears. The deficiency of yin and xue, insufficiency of Spleen, Gall Bladder produce disturbs in heart and then insomnia occurs.

Case history

A 47-years-old female patient with chronic insomnia lasting 6 month was remitted to our department of traditional chinese medicine. In the evaluation, she had a history of Hypertension since 1986 after delivery of her daughter, and Diabetes Mellitus since august 2005, both treated and controlled with conventional medication. The chief complain was insomnia,  pain and numbness on neck and right superior limb. Her Insomnia consists of in difficulty falling asleep with restlessness, frequent awakenings almost every hour, no nonrestorative sleep lasting 5 to 6 hours and consequent tiredness during day. Pain was intense, 8 in scale 0 to 10, with 0, no pain and 10, insupportable pain.

On physical examination we found an obese of second degree patient (body mass index; 36,9), contraction of muscles in right interscapular, bilateral paravertebral, neck region. Tongue examination: Red, purple tongue with thin coating; multiple small fissures on third anterior and posterior body of the tongue. Pulse: It was found weak pulse, thin and slippery at superficial level, the right pulse less thin and more slippery at superficial level than the left pulse. She looks older that the chronological age.

According to the diagnostics principles of TCM the main unbalance of the patient was Deficiency of Kidney Yin and Qi and Deficiency Qi of Spleen. She has secondary unbalances: Disharmony between Heart and Kidney, Hyperactivity of Liver Yang and Stagnant Qi in channels and collaterals.

Treatment

We use different therapeutic resources as ear acupuncture therapy, Chinesse Massage Tuina and control of Bu Nei Wei Yin. The general strategy was to tonify Qi and Yin of Kidney as well as Qi and Xue of Spleen; to promote free circulation of Qi and Xue in Channels and Colaterals; to reinforce Water of Heart in order to release the Heart’s Fire ; to regulate Heart and Liver; to harmonise Heart and Kidney. Tuina Massage was then applied rectifying the passages of Qi at vertebral level. In control of Bu Nei Wei Yin, the patient was advised to avoid yang activities at night, to evade spicy food at least 3 hours before sleep, to be aware about the first sensation of sleepiness at night in order to go bed (to be aware about the internal mutation Yin Yang at that level), and create a quiet environment without noise for sleeping. Auricular therapy with small seeds was applied in the points Spleen, Kidney, Lung, Shenmen, H-3, Sp-3 (auricular representation of points and channels) and kept in those points for 6 days. Patient was instructed to practice 4 stimulations daily, 1 min and half. The evaluation and treatment was done every week, for 6 weeks.

Result

The pain at the beginning was intense, 8 in visual analogue scale(VAS) 0 to 10, with 0, no pain and 10, insupportable pain. For practical reasons we used a subjective individual scale (SIS) with 0 being no pain,  10 being the intensity of patient’s pain at the first moment of evaluation and treatment and 5 the half of these initial intensity of pain. After finishing the first week the patient’s pain decreased to 6 in SIS. The second week it decreased to 4 in SIS. The third week, to 3. The fourth week the pain was in 2 and after finishing the fifth the pain decreased to 0 in SIS and VAS. She follows without pain 6 month after that until now. The numbness disappeared after the first week. The sleep disorder became better after the first week of treatment. She was able to fall asleep easily and the restlessness before sleep disappears. After the second week, she was able to fall sleep without difficulties and she didn’t awake during sleep. After the thirst week, she could also sleep 7 hours without awaking and no tiredness during day. In this moment, she is able to fall sleep without difficulties during all night without awakenings. We observe also positive changes in familial dynamic.

Comments

With and integral approach, which take into consideration the whole of the patient, and the use of therapeutic resource of traditional Chinese medicine, we realize an adequate balance in the cycle of rest and activities. Even though the chronic illness, the time of evolution and characteristics of insomnia and the chronic pain, it was possible to balance with those resources of Traditional Chinese Medicine.


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