Review Article

Classification of Insomnia Using the Traditional Chinese Medicine System: A Systematic Review

Table 2

Clinical features of the 10 most common TCM patterns for insomnia.

TCM patternsSleep-related symptomsNon-sleep-related symptoms and signsTongue featuresPulse features

Excess patterns
Liver-qi stagnation  transforming into fire Insomnia, difficulty falling asleep, excessive dreamingVexation, irritability, bitter taste, constipation, reddish eyes, yellow urine, headache, dizziness, hypochondriac pain, impatience, reddened complexion, thirst, poor appetite, oppression in the chest, tinnitus, hypochondriac distension, favour of drinking, reddish urine, pain in the chest and hypochondrium, frequent sighingRed tongue with yellow coatingRapid and string-like pulse, fine pulse
Internal disturbance of  phlegm-heat Insomnia, restless sleepDizziness, vexation, bitter taste, profuse sputum, oppression in the chest, gastric stuffiness, heavy headedness, acid regurgitation, poor appetite, belching, headache, nauseaRed tongue with yellow and slimy coatingSlippery and rapid pulse
Liver fire flamingupward Insomnia, difficulty falling asleepVexation, bitter taste, dry mouth, reddish eyes, tinnitus, irritability, constipation, dizziness, dizziness with headache, dry throat, nocturnal emission, feverish sensations in the palms and soles, hypochondriac pain, impatience, reddened complexion, night sweating, palpitation and restless, aphthous stomatitis, backache, poor memory, yellow urineThin coating, yellow coating, red in the tip of tongue, red tongue, scanty coating, no coatingRapid, string-like pulse, fine pulse
Stomach disharmony Difficulty falling asleep, excessive dreaming, difficulty staying asleep, insomnia with vexation, restless sleep, unrefreshing sleep, insomnia, shallow sleepVexation, belching, dizziness, dry mouth, dry throat, feverish sensations in the palms, soles, and chest, night sweating, gastric stuffiness, stuffiness and pain in stomach and abdomen, sore knees, backache, hot flashes, constipation, flusteredness, poor appetite, oppression in the chest, stuffiness in stomach and abdomen, sloppy stool, tinnitusSlimy coating, red tongue, scanty coating, thick coating, white coating, yellow coatingSlippery pulse, fine pulse, rapid pulse, string-like pulse, weak pulse
Stomach qi disharmony *Abdominal distention, belching**

Deficiency patterns
Deficiency of both theheart and spleen Excessive dreaming, difficulty staying asleep, difficulty falling asleep, insomnia, half asleepPalpitation, lassitude, reduction in luster complexion, poor memory, dizziness, fatigue, tasteless, weary limbs, poor appetite, sloppy stoolPale tongue with thin coating, white thin coatingFine and weak pulse
Hyperactivity of fire dueto yin deficiency Insomnia, difficulty staying asleep, insomnia with vexation, excessive dreaming, difficulty falling asleepTinnitus, palpitation, poor memory, dizziness, feverish sensations in the palms, soles and chest, dry mouth, backache, vexation, nocturnal emission, acid regurgitation, sore knees, sweating, dry throat, seminal emission, poor appetite, bitter taste, hot flashes, reddened cheeksRed tongue, scanty coating, slimy coating, white coating, yellow coatingFine and rapid pulse, slippery pulse
Qi deficiency of theheart and gallbladder Insomnia, excessive dreaming, frequent awakening with a start, difficulty falling asleep, difficulty falling asleep alone, difficulty staying asleepPalpitation, fatigue, susceptibility to fright, dyspnea, pale and large amount of urine, vexation in sitting and lying down, thoughtfulPale tongue, thin coatingFine and string-like pulse
Heart-kidney  noninteraction Insomnia, excessive dreaming, difficulty falling asleep, difficulty falling asleep with vexation, insomnia with vexation, difficulty staying asleep, restless sleepBackache, dizziness, tinnitus, palpitation, vexation, feverish sensations in the palms, soles, and chest, seminal emission, night sweating, sore knees, dry mouth, susceptibility to fright, aphthous stomatitis, cold extremities, fright palpitation, irritability, reddened complexion, reddish eyes, poor memory, dry throat, hot flashes, impatience, nocturnal emission, spermatorrheaRed tongue, scanty coating, thin coating, pale tongue, yellow coating, red in the tip of the tongueFine and rapid pulse, string-like pulse, sunken pulse, weak pulse
Heart deficiency with  timidity Excessive dreaming, sleeping late at night, frequent awakening with a startPalpitation, susceptibility to fright, dyspnea, oppression in the chest, gastric stuffinessPale tongue, thin coating, white coatingFine and string-like pulse, weak pulse

Symptoms mentioned in more than 50% of the studies that described the TCM pattern are bolded.
*No study provided information regarding sleep-related symptoms and tongue and pulse features of stomach qi disharmony.