Restful Sleep Formulas
As we begin to enter the summer season, the Fire Element comes into play. This Fire is the Fire of Vitality and the emotion associated with the Fire Element is delight and joy inherent in Being. During these troubled times, our sense of delight and joy are being strongly challenged by the basic fear of the extinction of existence originating in the Water Element via the Control Cycle. Although it has always been thus, we have recently become acutely aware of the uncertainty of life. This can be compounded by excess Wood energy causing frustration and anger when we cannot design and execute our plans in the manner to which we have been accustomed.
This constraint of Liver rises as Heat which scorches the Heart, which houses the Shen (神). Shen is a compound Chinese character meaning “that which expresses the will of Heaven”, and most frequently translated as “Mind” (in all its aspects). The resultant Shen disturbance from Heat, both Deficient and Excess, impairs the relationship with Earth and causes overthinking, worry, and anxiety. It also causes excessive grief and sadness in the Metal Element due to a widespread sense of loss.
How do you settle the disturbed Shen? By re-anchoring it to reality, the practice of mindfulness meditation serves to bring your awareness into the present moment. In this present moment, there is nothing out of order except your illusionary thoughts that would tell you otherwise. The second aspect of mindfulness is acceptance, which is the “letting go” that I wrote about in my Qi Gong article.
An additional aid for calming the Shen is to maintain adequate sleep. At night, when you sleep, the Shen rests in the Heart so that the mind can find refuge while the body engages in restoration of harmony and balance to be ready for another day of stress and challenges. While acupuncture can certainly help with Shen disturbance and provide relaxing relief, oftentimes, the proper use of herbs will prove to be a longer-term solution.
Of the eleven prepared Shen Calming formulas that Mayway Herbs sells, three include the character 安 (ān) in their name, which means “peaceful, calm, or quiet”. While they have slightly different presentations, all three formulas are used to provide normal, restful sleep.
An Mien Pian (安眠片 ānmián piàn) Peaceful Sleep Tablets
This modern formula is designed to address a combination of etiologies that disturb the Shen and inhibit restful sleep. An Mien Pian nourishes the Heart Yin and Liver Blood, clears Heart Heat, Resolves Phlegm and regulates digestion from Food Stagnation. The Heat in the Heart can be caused by deficiency Heat, stagnation of Liver Qi or intemperate consumption of food or alcohol. This Heat rises and disturbs the Heart, obviating the Shen’s ability to rest. Over time, the Heat also dries the Yin and Blood, which may then condense into Phlegm that blocks the Heart Orifice. This Phlegm can prevent the Spleen from producing new Qi and Blood.
Clinical indications for An Mien Pian are for sleep disturbances presenting with insomnia or complete inability to sleep, excessive dreaming, difficulty sleeping following a heavy meal, nervous exhaustion, anxiety, palpitations, irritability, restlessness, agitation, depression, forgetfulness, poor memory, poor concentration, mental fatigue, and red eyes. An Mien Pian is also indicated for Phlegm misting the Heart with accompanying disorientation, confusion and excessive brooding. The typical tongue is dry and red, or pale with red tip and possibly the sides. The pulse can be thin and rapid indicating Heat and Yin deficiency, and/or possibly wiry when there is Liver excess.
This elegant and simple formula is comprised of six herbs. The Emperor herb is Suan zao ren, which is sweet, sour, and neutral, entering the Heart, Liver, Gall Bladder, and Spleen channels. Its function is to calm Spirit and nourish the Heart Yin and Liver Blood. Suan zao ren is a quintessential herb for occasional disturbed sleep, irritability and anxiety due to Blood or Yin deficiency with upward flaring Fire.
Yuan zhi, the Deputy herb, is bitter, acrid, slightly warm and enters the Heart and Lung channels. Yuan zhi calms Spirit, restores the proper balance between Heart Fire and Kidney Water and opens the Heart Orifice to remove any Phlegm that may manifest as emotional or mental disturbances. One of the Assistants is Fu ling, which is bland, neutral and enters the Heart, Spleen, Kidney, and Lung channels. Fu ling’s role is to tonify the Spleen to transform Phlegm, quiet the Heart, calm Shen, and assist in removing Heat through urination.
A second Assistant is Zhi zi, which is bitter and cold, entering the Heart, Liver, Lung, and Stomach channels. Zhi zi effectively clears Heat from the Heart and Liver and cools the Blood, thus eliminating irritability of the Shen. The other Assistant is Shen qu, which is acrid, sweet, and warm, entering the Spleen and Stomach channels. Shen qu reduces Food Stagnation from accumulation and harmonizes the Stomach. Sweet and neutral Gan cao harmonizes and moderates the cold nature of Zhi zi while guiding the formula to the Heart, Spleen, and Stomach channels.
The standard dose is 4-6 tablets, 3x per day, although up to 8 tablets may be taken before bed. If daytime drowsiness occurs, shift the dosages to evening and bedtime. The formula may need to be taken for several days before it begins to take effect. These herbs are non-addictive and may be used long-term for several weeks to several months over the course of several years. Because of its downward action, the formula should be used with caution during pregnancy and since it is primarily tonifying, it should not be used in the early stages of acute infection or illness, such as cold or flu. Since Shen qu contains wheat, you may choose to avoid this formula if you have a wheat allergy.
An Shui Wan (安睡丸 ānshuì wán) Sleep Well Teapills
This rather large formula greatly resembles a combined modification of two classic formulas to promote calm and peaceful sleep. Tian Wang Bu Xin Dan (Emperor of Heaven Tonifies the Heart Formula) that combines the herbs Shu di huang, Dang gui, Wu wei zi, Suan zao ren, Mai men dong, Xuan shen, Dang shen, Fu ling, Jie geng, and Yuan zhi. These herbs strongly tonify the Heart and Kidney Yin and restore the proper balance between Fire and Water. The second classic formula is Gui Pi Tang (Restore the Spleen Soup) that joins Dang shen, Bai zhu, Fu ling, Yuan zhi, Dang gui, Suan zao ren, and Gan cao, in tonifying the Heart Blood and Spleen Qi. The prominent dose of Ye jiao teng and Fu xiao mai strongly calms the Shen, while Shi chang pu opens the Heart Orifices. The rest of the formula supports the Heart, Spleen and Kidney to resolve the multiple underlying deficiencies of Blood, Qi, and Yin.
The clinical presentation involves occasional insomnia, dream disturbed sleep, frequent waking, occasionally waking with anxiety, nightmares, and night sweats. May also present with occasional irritability, fatigue, forgetfulness, excessive thinking or worrying, over-active and restless mind, occasional poor memory or concentration, tendency towards occasional constipation or dry stools. The typical tongue presentation depends on the preponderance of the deficiency: red with little or no coat if Yin deficiency is predominant, pink or pale with a thin white coat if Blood and Qi deficiency are predominant. The tongue may have a dry yellowish coat if there is significant Heat from deficiency. The pulse also indicates deficiency and can be thin, weak, and may be rapid. It should be noted that this is an example of a strong deficiency presentation and consequently, use of this formula is contraindicated for conditions due to excess and during the early stages of acute infection or illness, such as cold or flu.
This teapill formula should be dosed at 8 pills 3x/day apart from meals, with an increased dose in larger patients or after the initial therapy. To help maintain normal sleep patterns, 8-16 pills may be administered 1-2 hours before bedtime. May be used medium to long-term for several weeks to several months and may be used periodically over the course of several years. Fu xiao mai/Triticum aestivum fruit is a type of wheat and those allergic to wheat may want to avoid this formula.
An Shen Bu Xin San/Wan (安神補心丸 ānshén bǔ xīn wán) Calm the Spirit, Tonify the Heart Formula
An Shen Bu Xin Wan was designed to rapidly calm and anchor the severely disturbed Shen and Hun with the heavy, down-bearing chief herb Zhen zhu mu, concha, or mother of pearl, making up almost half of the formula at 44%. The addition of Shi chang pu facilitates the unblocking of the Orifices, should they become blocked by Phlegm. Zhen zhu mu also clears Heart Fire when combined with Shi chang pu. The rest of the herbs work in concert to strengthen the Heart and Liver Yin and Blood and clears Heat to treat the underlying cause of the condition. Wu wei zi calms the Heart and Shen, resolves anxiousness and dream-disturbed sleep. Tu si zi tonifies both Kidney Yin and Yang, and when combined with Wu wei zi, reduces the occurrence of frequent dreaming. Ye jiao teng nourishes the Heart and calms the Shen due to Blood Deficiency and clears the Channels.
Dan shen is used for its ability to invigorate Blood, clear Heat from the Heart, and soothe irritability. Han lian cao nourishes Yin and clears heat from the Blood and is considered an important herbal couple with Nu zhen zi for Liver and Kidney Yin deficiency. When combined with Wu wei zi, Nu zhen zi is very useful for controlling night sweats. Finally, Di huang powerfully tonifies Yin and nourishes the Heart Blood.
Because of its relatively quick action to sedate and calm the Shen and Hun (魂 hún- Ethereal Soul), it is an invaluable formula to treat many disturbances due to stress or emotional shock. The Hun is that aspect of the human psyche that enters the body three days after birth, returning to Heaven (天 tiān) after death. The Hun is anchored in the Liver Blood and is associated with intuition, inspiration, relationship with others, creativity, dreaming, and imagination.
This formula also reestablishes the communication between the Kidney and Heart by subduing hyperactivity of Heart Fire, which may be due to Yin or Blood deficiency or Liver constraint. An Shen Bu Xin Wan supports emotional and mental stability and a grounded even mood, and strongly calms the mind and body. The formula benefits normal memory, thought processes, and a consistent sleep cycle. Additionally, it helps the body regulate normal heartbeat.
The clinical presentation is Heart and Liver Yin and Blood deficiency, deficiency Heat and Liver Yang rising, with severe disturbance of the Shen and Hun. It may also be used to treat Heart and Kidney not communicating, with severe Shen disturbance. Signs and symptoms include occasional anxiety, irritability, restlessness, agitation or over-active and restless mind, forgetfulness, occasional poor memory, or concentration. There may also be occasional sleeplessness, difficulty in falling asleep, excessive dreaming, nightmares, or dream disturbed sleep, heat intolerance, malar or facial flushing. An Shen Bu Xin Wan is also indicated in cases of Heart and Kidney not communicating resulting in severe Shen disturbance, and which may include many of the above symptoms along with chest tightness or oppression.
This teapill formula should be dosed at 8 pills 3x/day apart from meals, with an increased dose in larger patients or after the initial therapy. To help maintain normal sleep patterns, 8-16 pills may be administered 1-2 hours before bedtime. May be used medium to long-term for several weeks to several months and may be used periodically over the course of several years. The formula may be a bit cloying and patients should be monitored for signs of increased Spleen Qi deficiency. In the presence of mild food stagnation with a tendency to dampness or phlegm or for those with a weakened digestive system, the formula may be administered with Bao He San/Wan or Xiang Sha Liu Jun Zi San/Wan.
In conclusion, these three “Peaceful” formulas all calm the Shen and promote healthy sleep by addressing important deficiencies while treating various excess conditions that also engender Heat, which can disturb the Heart. Care should be taken to conduct a thorough assessment. Disturbed Shen can be caused by a variety of syndromes and sometimes you may have to differentiate similarly acting formulas based on small differences of presentation. TCM aside, at its core, peacefulness is a mindset. Find joy in the moment, let go of your ideas about what the future should be, control and settle your Shen, in repose. And get some sleep!
- Bensky, D. & Barolet, R., Formulas & Strategies, Eastland Press: 1990.
- Bensky, D. et al., Chinese Herbal Medicine Materia Medica, 3rd ed., Eastland Press: 2004.
- Chen, J. & Chen, T., Chinese Medical Herbology and Pharmacology, Art of Medicine Press: 2004.
- Chiang, M., The Chinese Heart: Chinese Medicine and Stress Management, Foreign Language Press: 2009.
- Macioccia, G., The Psyche in Chinese Medicine, Churchill Livingstone: 2009.
- Wrinkle, A. et al., A Practitioner’s Formula Guide, Elemental Essentials Press: 2008.
| Bio: Skye Sturgeon, DAOM, L.Ac.
Skye is the Quality Assurance Manager and Special Consultant for Mayway, USA. Skye was the former Chair of Acupuncture & East Asian Medicine and core faculty member at Bastyr University, core faculty member and Faculty Council Chair at the American College of Traditional Chinese Medicine, and President and Senior Professor of the Acupuncture & Integrative Medicine College, Berkeley. Before making Chinese medicine his career choice, Skye held various positions in the Natural Foods Industry for 12 years and prior to that was a clinical biochemist and toxicologist.