Internal Med Exam 3 Insomnia Flashcards
Insomnia due to HT-Fire Blazing - indications?
Insomnia that is usually acute, trouble falling and staying asleep, usually restless, toss and turn or fully awake. Maybe nightmares. Feel agitated, anxious. Usually hot in chest, face, upper body (Fire blazes upward). Can trigger palps. Canker sores, ulcers on tongue, mouth. May feel T is hot, burning, Usually thirsy for cold beverage, Urine concentrated. Face red. T: red w/yellow or white tc. P: rapid, forceful.
Insomnia due to HT-Fire Blazing - tx strategy?
clear HT, drain Fire, calm Spirit
Insomnia due to HT-Fire Blazing - basic Formula?
Zhu Sha An Shen Wan (Cinnabar Pill to Calm the Spirit) - Long Shi/Long Gu 15g. Huang Lian 18g, Dan Gui 7.5g, Sheng Di Huang 7.5g, Zhi Gan Cao 16.5g.
Insomnia due to LIV Qi Stagnation - indications?
Insomnia may be acute/chronic depending on causes. Long time to fall asleep or frequent waking OR wake v early OR wake and difficulty falling back asleep (can be all types insomnia). Usually v. tnese when sleeping, with clenched fists, tense neck, TMJ, wake w/tension HA. Sometimes restless, may have dreams. Emotions - overwhelming frustration/depression/stress, usually tension HA, neck/sholders tight, throat may feel tight or have plum pit qi. Chest tight, shallow breathing. PMS makes worse. May impact digestion - slow digestion, nausea, bloating, gas, irregular BMs (const/loose/diarrhea). Maybe mild irritability. T: normal, maybe darker if chronic. P: wiry.
Insomnia due to LIV Qi Stagnation - tx strategy?
soothe LIV, quiet Spirit
Insomnia due to LIV Qi Stagnation - basic Formula?
Chai Hu Shu Gan San (Bupleurum Powder to Dredge the LIV) OR Xiao Yao san. Cu Chao (vinegar fried) Chen Pi 6g, Chai Hu 6g, Chuan Xiong 4.5g, Chao Zhi Ke 4.5g, Shao Yao 4.5g, Zhi Gan Cao 1.5g, Xiang Fu 4.5g.
Insomnia due to LIV Heat/Fire - indications?
Heat: impatient, irritabile, restless, bitter taste in mouth, tendency to anger, warm feeling esp upper body, face sl red, sl thirsty, stool sl dry. Fire: feel HOT, v agitated, quick temper, face sig red, eyes red, burning. Frequent strong bitter taste in mouth, constipated with dry hard stool, urine concentrated and smelly. Very thirsty for Cold beverage. Sleep very restless. Maybe violent behavior. May have severe HA, high pitched tinnitus. T: red esp edges, sl to v yellow tc. P: wiry rapid, usually forceful.
Insomnia due to LIV Heat/Fire - tx strategy?
regulate LIV qi, clear Heat, drain Fire, sedate and calm Spirit
Insomnia due to LIV Heat/Fire - basic Formula?
Jia Wei Xiao Yao san (Augmented Rambling Powder) OR Long Dan Xie Gan Tang (Gentiana Decoction to Drain the Liver). Jia Wei Xiao Yao San is: Dang Gui 3g, Shao Yao 3g, Fu Ling 3g, chao Bai Zhu 3g, Chai Hu 3g, Mu Dan Pi 1.5g, chao Zhi Zi 1.5g, Zhi Gan Cao 1.5g
Insomnia due to Phlegm-Fire Harassing the Interior - indications?
Insomnia may be acute/chronic . Usually restless sleep, maybe difficulty falling asleep, frequently wake up, maybe dreams, maybe early waking. Lots of irritability. Lots of energy at night. Morning - foggy head, mind tired, unclear, not rested. Agitated, restless. Maybe palps, anxiety. Head foggy, heavy, difficulty concentrating. Maybe dizziness/vertigo. Maybe nausea. Maybe ST probs like acid reflux, heartburn, gnawing hunger but low appetite, yellow/green phlegm in throat esp in a.m. or thick post-nasal drip. Body feels heavy, sluggish and hot/warm. Thirst w/no desire to drink. Abd distention, fullness. Chest tight. Stools sticky, incomplete, burning sensation, foul odor, maybe mucus. Urine yellow, sl concentrated/cloudy, stong oder. T: red, puffy, swollen, thick yellow greasy tc. P: slipper, rapid. Sometmes wiry rapid.
Insomnia due to Phlegm-Fire Harassing the Interior - tx strategy?
clear Heat, transform Phlegm, harmonize ST, quiet Spirit
Insomnia due to Phlegm-Fire Harassing the Interior - basic Formula?
Wen Dan Tang (Warm the Gallbladder Decoction)
Insomnia due to Yin Deficiency with Vigorous Fire - indications?
Insomnia chronic, often with menopause/chronic stress/long-term emotional issues leading to yin damage. Usually pt feels v tired physically and mentally but can’t sleep. Trouble falling asleep, restless, frequent waking, or whole night unable to sleep. Sleep is light with many dreams. Exhausted in a.m. Feels warm at night, maybe nightsweats esp upper body. Sensitive to heat. Mental energy very low. Often triggered by anxiety (maybe anxious about insomnia also). Palps, forgetful, lightheaded/dizzy, hot palms/soles, chest feels hot, face sl red esp cheekbones, sometimes mouth sores (if F). Urine maybe concentrated with burn/irritation. Easily lose weight, emaciated. May have steaming bone d.o. maybe only in legs/spine. T: red, esp tip., less tc/peeled w/cracks. P: thin, rapid. May also have KD yin weakness s/s including heel pain etc.
Insomnia due to Yin Deficiency with Vigorous Fire - tx strategy?
nourish KID yin, drain HT Fire, calm Spirit
Insomnia due to Yin Deficiency with Vigorous Fire - basic Formula?
Liu Wei Di Huang Wan (6-Ingredient Pill with Rehmannia) + Huang Lian E Jiao Tang (Coptis and Ass-Hide Gelatin Decoction). Liu wei Di Huang Wan = Shu Di Huang 240g, Shan Zhu Yu 120g, Shan Yao 120g, Fy Ling 90g, Mu Dan Pi 90g, Ze Xie 90g. Huang Lian E Jiao Tang = Huang Lian 12g, Huang Qin 6, E Jiao 9g, Shao Yao 6g, stir 2 egg yolks into decoction - Ji Zi Huang is name of egg yolk
