There are many causes of insomnia and there are different ways how insomnia can present itself. As a generalization there are two types of manifesting insomnia. The first one is difficulty falling asleep and the second one is waking up in the middle of the night. There are those of course who are troubled by both types of insomnia but in this post we will look at those people who wake up in the middle of the night and then have difficulty falling back asleep.
Sometimes the Chinese medicine text books have simplified explanations where they state that inability to fall asleep is due to qi and blood deficiency and waking up in the night and then being unable to fall back asleep is due to yin deficiency.
Though this is correct, there is more to it than that.
The time that people wake up is an important diagnostic consideration
Firstly, we look at what time are people waking up in the night. Secondly, we need to look at why they are waking up. Sometimes it is a part of another problematic condition such as night sweats or nocturia. Night sweats and nocturia can have a number of different causes.
What is the cause of waking around midnight?
Some people complain of waking up around midnight. Chinese medicine theory stipulates that the day is divided into two hour segments that pertain to specific organ activity and the time 11pm to 1 am is the time of the gallbladder. This type of waking up around midnight usually entails some disturbing dream as if almost waking up in fright. They can also wake up from just the slightest sound and can often have palpitations when they awake. An herb formula that may be considered is Wen Dan Tang which is translated as Warm the Gallbladder Soup.
Can Liver problems cause you to wake in the night?
Other people wake up between 1-3 am which is the time of the liver. There are a number of different liver problems including blockage of Liver energy, an overheated Liver or a Liver that is deficient in blood. One example how an imbalanced liver can affect someone is that the person suddenly wakes up wide awake and often with thoughts about work and what to do. Traditional medicine views that the liver organ is responsible for planning and strategising and if the liver energy is weak, it can cause you can wake up during the liver time. An example of an herbal formula that may be used to address this issue is called Er Zhi Wan. This formula has only two herbs and can treat other symptoms like nightsweats and blurry vision.
What about waking up around 3am, the transition time between Liver and Lung?
In the cartoon above, the person has woken up at 3 am, which is the time transition between Liver and Lung. Chinese medicine talks about a liver/lung blockage. This time is significant as the Lung time is when the whole cycle starts at 3 am and the Liver finishes at 3 am. We ask Sohial Farzam, a registered doctor of TCM in Australia, who specialises in mental-emotional disorders, what this could mean.
Sohial says “Waking up at this time indicates a block at this time between the Liver and Lung and can represent a variety of emotional questions for us to explore.
Some of these emotional cues are repressed anger, holding a grudge, being stuck on memories of anger and resentment or even something as simple yet exhaustive as being stuck on a decision hence experiencing procrastination. Deeper seated loss of motivation and aspiration toward a meaningful and purposeful goal and or direction in life may also be the issue.
These points above are more representative of the imbalance that is carried in the liver. As the transition takes place, there may also be symptoms of consequently not being able to let go of the anger built inside and the resentment that we are carrying. Lungs represent the capacity and ability to let go and if we can’t process emotions and bring meaning to them we tend to hold onto long term grief and and the associated symptoms of loss. Grief here is not always related to losing someone we love but also losing something that is important to us such as our long-term job/career, a loving pet, a hobby that we can no longer attend to due to illness etc.
Although the liver is more representative of aspiration, the lung here at the time of 3-5am represents inspiration. Our ability to be inspired comes from within. As we inspire and take in a breath, we take in oxygen which brings us life. But soon after, we then expire and we breath out carbon dioxide, meaning we surrender that which no longer serves us. So a block in this time can alert us of holding onto things that block us, limit us, takes away our inspiration and that which no longer serves us. Once we can draw meaning to our experiences that block us, we can move forward with inspiration and energy with a brand new day that has been gifted to us”
Sohial’s explanation exemplifies that a simple sedative or herb acting as a sedative is not actually addressing the root cause of the emotional issues of the person. Listen hear to hear more about what Sohial Farzam has to say about depression.
Waking up in the night after a history of fevers.
Another common cause of waking in the night and being unable to get back to sleep is because of post sequela complications of a fever disease. Some texts refer to this as latent heat or dormant lingering pathogens. This is where the bug of the original disease causing the fever remains still in the body, lying dormant and the heat of the bug becomes active at night when the body is resting and resistance is down. An example of this is post shingles complications, where the herpes zoster virus is still playing havoc in the body, eventhough the person has overcome the early acute stage of painful blisters. They may complain about fatigue, waking during the night acompanied with night sweats. An appropriate formula here might be Zhi Zi Chi Tang in combination with another formula such as Suan Zao Ren Tang. There has been a study of this formula when used in combination with Zhi Zi Chi Tang, which is a famous herbal combination deveoped by herbalist and author Zhang Zhong Jin dating back from 200AD.
Are there are other causes of waking in the night?
In 2019 Will Maclean has released his new edition of Clinical Handbook of Internal Medicine which discusses many causes of insomnia and all their appropriate formula and variations. It is important to get the diagnosis correct before just picking some herbs from the internet and hoping for the best. Acupuncture NZ has over 700 members throughout New Zealand and can be contacted to find a member who is also qualified with an additional degree or training in Chinese herbs.
Heiko Lade has a Master’s degree in Traditional Chinese Medicine from the University of Technology with over 30 years experience.