Associazione Medica per lo Studio dell’Agopuntura

Medical Association for the Study of Acupunture

Unamedicina

Centro Sheng-Hotel Estèe

 

Intermittent insomnia:
various treatment schemes  in Medicina Naturale

Carlo Di Stanislao, Maurizio Corradin, Dennis Konopacki.

Abstract: After having specified the psychological characteristics of insomnia, according to various schools, several treatment outlines, which are based on integrated Natural Medicine, are analyzed, with particular reference to Traditional Chinese Medicine, homeopathy, flower therapy and aromatherapy.

Key words: insomnia, Natural Medicine, acupuncture, phytotherapy, massage, diet, homeopathy, flower therapy, aromatherapy.

Insomnia is a more common than one would think and a recent survey has shown that 14% of the population complains of some sleep disturbance and are unsatisfied with the way they sleep. The percentage of the population suffering from this disorder increases with age, and in fact in the age range of 60-65 33% of women are affected by this problem (Gratton, 2002).

With this term is indicated the subjective sensation of not having rested sufficiently due to either the fact of not having slept for a sufficient time period or due to inadequate restorative capability of the sleep interval. The duration of sleep is not significant¹ for the diagnosis of insomnia, due to the fact that the perception of the amount of sleep needed is different for each individual (Gaillard, 1996). There are persons that sleep little more than 3 hrs without having any symptoms (people who belonged to this category were Winston Churchill, Napoleon, Pope John the XXIII, Pirandello, Thomas Edison, etc.) whereas others state that even after 10 hrs of sleep they still don’t feel completely rested. In order to define a sleep disorder it is extremely important to keep in mind that this disturbance is very subjective, and you can define insomnia as the inability to sleep well and consequently one does not feel to be either physically or mentally efficient during the course of the day. Notwithstanding that many chronic cases of insomnia, an organic etiological cause can be found, such a condition can be considered as an emotional state that goes well beyond a simple subjective emotional condition. In fact many of the problems that occur to all of us during the day can be relived during sleep with different interpretation of the events that can create a disturbance our emotional state². This reliving of facts, dialogues and discussions, all of which can be altered, can create a state of anxiety. This is the reason that each one of us has their own kind of insomnia: because in the dark and silence of the night each person activates their own being. Sleep disturbances can be used as an indicator of a person’s identity. To these subjective aspects one can add all the alterations of the perceptive mechanisms, that have a strong influence on the psychophysical equilibrium and general well being. This can set off a vicious cycle that can disturb the thought processes. For this reason there is interest to find a solution to this problem. A key to this solution may be found in the linkage between patient-disease-pharmaceutical treatments. The more the patient is able to be aware of the problem that is bothering him/her, the greater will be the ability to care for the disturbance as a non-disease. Various schools of thought have attacked this problem from different perspectives (Bolognini, 2002; Cagli, 2002; Lombardo et al., 2002).

Behavioral School. Primary insomnia can be explained in a large part to states of anxiety and depression. Anxiety interferes with the rapidity with which one falls asleep, while depression has its effect on the depth of sleep and the subsequent stages. According to the behavioural psychology school of thought, many illnesses can be derived from the variable capability of every person to adapt to environmental stimuli with the consequent eustress (adaptment) or a state of stress, (when one is not able to adapt). In this latter case it is necessary to determine the stimuli that for a given person provokes this state of stress, thereby allowing a behavioural treatment that would allow a deconditioning

Psychoanalitical School . According to the Freudian school of thought, insomnia can be correlated to a fear of thoughts, fantasies, or dreams that can create anxiety during sleep. Sleep is that period in which the rational mind can’t control the instinctive mind, which is present in all of us. Insomnia could represent the attempt of the rational mind to win back control over the instinctive mind.

Psychosomatic School. Insomnia is considered to represent the conflict of the individual to abandon oneself to sleep, which is considered to represent symbolically as a passive and/or dependent state. Insomniacs are individuals that are fearful of the instinctive world. They are very disciplined and filled with thoughts. They are incapable of letting themselves go. Their body is usually contracted as if they are always in a state of alarm, always ready to react to their surroundings.

It is currently felt, that the severe and persistent forms must be treated rapidly, in order to avoid damage to the organism. Up until a few years ago, in order to induce and maintain sleep, barbiturates where usually prescribed. This class of drugs is no longer the first choice due their toxicity and due to the fact that they reduced significantly the REM level of sleep, which can result in memory difficulties, mental confusion, reduced attention span. Currently there are two classes of drugs which are currently used: the benzodiazepines, which act on the phase of sleep induction; and tricyclic antidepressants, which can regulate sleep in general as well as act on depression. Both classes of drugs must be administered under strict medical control being that these pharmaceuticals have side effects, which can paradoxically cause a secondary insomnia. The hypnotics, in fact, loose their efficacy with time and thus a paradoxical reaction; the patient, fearing the beginning of a new series of sleepless nights can develop a state of anxiety, which in turn provokes insomnia (Balestrieri et al., 2000). According to many authors, drug therapy constitutes a rapid and efficacious cure, provided that it’s use is for a limited time period; the treatments offered by the alternative medicine require time and patience to find the right solution, even if in the long run they can be more efficacious. (Brigo, 2002; AAVV, 2001, Balestrieri et al., 2000). Little research, in Natural Medicine, has dealt with episodic insomnia in particular the stressful individual, familial or social factors. A death, firing from ones work, or a break up from a sentimental relationship, can all be causes for episodic insomnia which could be treated with acupuncture, phytotherapy, floral therapy and homeopathy (AAVV, 2001). Even though single therapies in Natural Medicine can be time consuming, when combined with other treatments the speed and efficiency can be increased making them a feasible treatment for episodic disturbances that necessitate a rapid solution.

Acupuncture and Traditional Chinese Medicine (massage, phytotherapy with western plants, diet)

According to the Traditional Chinese Medicine, the day and the night belong to the two energies Yin and Yang. These energies run throughout the universe, in nature and within man. Yang and Yin are everywhere and there is a reciprocal movement of one towards the other. Sleep is considered to be caused by a physiological fullness of the energy Yin at night (considered analogous to Water, to the interioriaztion, to the passive state etc.) associated with a simultaneous low energy level of the Yang (considered analogous to Fire, the exteriorization, activity) (Bottalo et al., 1999). In this field of medicine it is considered important to bear in mind the diet, emotional factors, as well the climate, all of which can either increase or decrease these two energies. By so doing these energies can either strengthen or weaken the various organs in the human body. In acupuncture, Insomnia is described as a fullness of Yang during the night simultaneous with an emptiness of the Yin. This is the opposite of the physiological state for sleep. In the chronic forms it is necessary to establish a state of fullness, emptiness and/or dysfunction of some Zang/Fu1 (De Berardinis et al., 1992), the episodic forms can be treated by making the Yang circulate and the Yin rise (Kespì, 1989) for example with the points H5, TB10, BL10, ST37.  One can use herbal teas (twice daily) that can be composed of (Di Stanislao, 2001 et al.):

-          Crataegus g 20

-          Escholtzia g 10

-          Passionflower g 10.

-          Valerian g 10

Another herbal tea that be taken in the evening would consist in:

-    Artichoke g 10

-          Equisetum  g 50

-          Mallow g 20 

-          Sweet clover g 20

-          Passionflower g 20 

-          Dandelion g 20 

It would be adviseable to avoid meats, chocolates, tea, coffee and replace these items with fish, white meats, cereals, use  little dressings and spices, salads and fresh fruit. (Bologna et al., 1999). With a little practice one could  learn to perform a linear massage (each night before going to sleep) along the meridians: Zu/Shou Yangming and Zu/Shou Shao Yin in order to disperse the excess of Yang and to favor the rise of the Yin towards the head. (Corradin et al., 2001). Frequently insomnia can be intermittent, having sudden awakening occurring at specified hours. In these cases, one must treat the “large circulation” by using the points that link the two meridians which do not exchange energy between themselves. The table below show treatment schemes that be utilized in either acupuncture or digital pressure (also with self massage described previously in the evening):

 

 

Time of Awakening	Meridians which are not communicating	Points (DeBerardinis,2001)
23-01	Sanjiao-Gall Bladder	5TB-40GB
01-03	Gall Bladder-Liver	37GB-3LR-14LR
03-05	Liver-Lung	14LR-1LU-10LU

As for the diet and “energetic” phytotherapy, the following Western plants can be used as shown in the Table below. (Bologna et al., 1999; Paoluzzi, 1997).

Time of Awakening	Advised foodstuffs	Phytotherapy[1]
23-01	Grain, Soya sprouts, spinaci, beef and pork, shrimp	Meliloto e Tarassaco
01-03	Shrimp, pork, rice (well-cooked), onions,  rhubarb, sesame, eel, snails, pork liver,	Tarassaco e Carciofo
03-05	rice (well-cooked), onions,  rhubarb, sesame, carrots, “crescione litchi”	Carciofo e Malva

 

Homeopathy(Bailey, 2001; Del Giudice, 1998)

There are numerous preparations listed in the homeopathic  text, Materia Medica, that can be comtemplated for the treatment of the symptom of insomma; one in particolar is Coffea cruda. This remedy is particularly indicated in those subjects who have a particularly accentuated mental activity, tending to favor the day over the night. This person who responds well to Coffea, usually does not suffer much for the insomnia but frequently looks for medical help due to other symptoms, i.e. migrain, nevralgia, skin rashes, palpitations, all of which are aggravated due to emotional stress. Coffea can be used also for children that are never sleepy or for students that have just passed a particularly difficult exam or in general for those individuals that had undergone circumstances that have required high mental activity and as a consequence cannot sleep due to emotional stress. The dosage is 3 granules of 9CH before going to sleep (or at least 3 hrs after the meal). In cases where there a strong depressive component, you add 3 granules 30CH at 10AM and 3PM Aurum^[2]. If there is instead a state of anxiety, give Calcarea carbonica, at the same strength and dosage.

Flowers of Bach (Scheffer, 2002; Mazzarella, 2001)

In Floral therapy the choice of the agent used is not based on the organic symptoms but rather exclusively on the negative emotions. Here the treatment is not aimed to eliminate the emotional state, as is the case with traditional drug therapies, but rather by stimulating the soul of each person with spiritual elements and with fine vibrations which are capable of intereacting with the emotive state. The remedies most frequently used are:

• Aspen (piopp poplar): For who has to sleep with the light on or the door open, that are afraid of the dark and of their own shadow and also those who are particularly subject  to panic crisis during the night and are afraid to be alone.

• Cherry plum (visciola):For those who are afraid that their own conflicts will be liberated during the night making them become more lively, for those who live a life which is always controlled and fear to let themselves go and hence are always under tension.

• Clematis (clematide): For those who upon falling asleep feel that their minds become filled with sensations and disturbing thoughts.

• Elm (olmo):For those who are overloaded with work and don’t feel able to cope with it, the night becomes a means by which one can free oneself from the anxiety generated by ones work during the day.

• Gorse (ginestra): For those suffering from depression, disillusioned with life and incapable to cope with the new day that will follow the night.

• Hornbeam (carpine): The vibrations intereact with the state of mental fatigue, with the sensation of not being able to succeed in spite of the fact that one had given his all, the feeling of not being able to go ahead, sleep doesn’t come because of being over tired.

• Mustrad (mostrada): For those that suffer from an exaggerated sadness for no apparent cause, sleep is seen as another sense of loss

• White chestnut (castagno bianco):The mind is overloaded and one can’t sleep because bad thoughts continue to come to mind

Aromatherapy (AAVV, 2002)

Some of the perfume essences are able to, if smelled at regular intervals, have an effect on the limbic system and on an emotional plain. Aromatherapy is actually an application of pyscho-aroma therapy and therefore helps the healing of both the body and the mind, making use of an infinite and personalized variety of pleasant scents. These scents can act on determined glands of the endocrine system, stimulating the release of neurochemical mediatore (adrenaline, endorphins, etc.) that can control to a certain extent our physiological equilibrium (homeostasis). For the forms of intermittent insomnia, the following scents can be used:

-          Polianthes tuberosa (tuberosa) (Fig. 1): this warm and seductive scent is a strong hypnotic. It is useful in women that suffer from insomnia and are depressed along with a reduced sexual drive.

-          Rosa centifolia (rosa turca) (Fig. 2): This angelic aroma stimulates the creatività. It is indicated in women suffering with insomnia and have one of the following conditions associated with it: prolapse, repeated abortions, steritlity.

-          Musk: Produced by the small male deer of Indù Kush[3] and the Himalayas (il moschus moschiferus, Fig. 3), this sedentary animal seminates little balls of musk from two sacks located on his underside as he walks through his territory. This musk is released during the mating season and its odor relays to the female of the species all the information concerning the age, state of health and genetic patrimony of the male. This odor can be considered the animals olifactroy ID and has an aphrodisiacal effect. This scent is indicated for males with insomnia and have a low sexual drive

-          Gray Amber:Gray Amber is produced by the sperm whale and is included in all the ancient pharmocoeia. (Fig. 4). It has a quite particolar animal scent but its sweetness is seductive to the female sense of smell. In effect, Grey Amber, as most aromatic animal scents, is a pheromone and acts upon the hormonal system by means of the sense of smell, without direct physical contact. It stimulates the production of estrogens and it is useful in menopausal insomnia or in women with hypoestrogenism

-           Zibet: The zibet (from the arab word Zabad) is a little african feline (Fig. 5). The aroma of Zibet is obtained by the purification the peri-anal secretions of the animal in alcohol. It is indicated for insomnia associated with agitation and anxiety in men.

-          Leather “Tartaro”: A mixture of warm woods and aromatic herbs and pheromonal extracts of the beaver and zibet, the scent of leather “tannato” calls to mind the leather shops of  Afghanistan. It is indicated for men that suffer from insomnia and consider themselves as being always conquerors or winners.

 

Treatment patterns

In all cases, acupuncture is performed two times a week and advising the patient to follow general dietetic rules (Buretta, 2002)[4] as well as dietetic rules related to the Energetic disfunctions observed (see above). In the more difficult and recurrent forms are added phytotherapy and homeopathy, this latter therapy is used above all if there are evident signs of anxiety and/or depression. In the more reactive emotional situations (mourning, separations etc.) one should use acupuncture, flowers of Bach, along with aromatherapy. Finally all patients can easily be trained in performing massage to themselves prior to going to sleep. In our experience, within 30-45 days there is an improvement in their sleep in 80% of all the cases treated.
 

Fig 1: Tuberosa
 

 
Fig. 2: Rosa turca
 

Fig. 3: Muschus muschiferus

 

Fig. 4: Grey Amber

Fig. 5: Zibet

 

Fig. 6: A photographic glimpse of Indù Kush.

Bibliography

• AAVV: La banca degli odori, www.profumo.it, 2002.

• AAVV: Come guarire l'insonnia con i metodi naturali, Ed. Fabbri, Milano, 2001.

• Bailey P.M.: Psicologia omeopatica: profili e personalità dei maggiori rimedi costituzionali, Ed. Salus Infirmorum, Padova, 2001.

• Balestrieri M., Bellantuono C.: L' insonnia. Strategie terapeutiche e uso razionale degli ipnotici, Ed. Il Pensiero Scientifico, Roma, 2000.

• Bologna M., Di Stanislao C., Corradin M. et al.: Dietetica Medica Scientifica e Tradizionale. Curarsi e prevenire con il cibo, Ed. CEA, Milano, 1999.

• Bolognini S.; L’empatia psicoanalitica, Ed. Bollati Boringhieri, Torino, 2002.

• Bottalo F., Brotzu R.: I Fondamenti della Medicina Tradizionale Cinese, ed. Xenia, Milano, 1999.

• Brigo B.: Insonnia. Prevenzione e cura naturale dei disturbi del sonno, Ed. Tecniche Nuove, Milano, 2002.

• Cagli V.: L' equivoco psicosomatico. Causalità fisica e causalità psichica nella genesi delle malattie, Ed. Armando, Roma, 2002.

• Corradin M., Di Stanislao C., Parini M. (a cura di): Medicina Cinese per lo shiatzu ed il tuina, voll I-II, Ed. CEA, Milano, 2001.

• De Berardinis D.: Armonia dei punti, policopie, Ed. AMSA, Roma, 2001.

• De Berardinis D., Di Stanislao C., Corradin M., Brotzu R.: Organi e Visceri in Medicina Cinese. La fisiologia, la clinica e la terapia, Ed. Sanli/Bimar, Roma, 1992.

• Del Giudice N.: Omeopatia. Un ponte tra biologia e psicologia. Vent'anni di ricerca della Fondazione omeopatica italiana, Ed. Nuova Ipsa, Palermo, 1998.

• Di Stanislao C., Giannelli L., Iommelli O., Lauro G.: Fitoterapia Comparata, Ed. Di Massa, Napoli, 2001. 

• Kespì J.M.: Cliniques, Ed. Guy Trèdaniel, Paris, 1989.

• Gaillard J.M. ; L’insonnia, Ed. Il Saggiatore, Milano, 1996.

• Gratton N.: Dormire bene. L'arte di addormentarsi e di vincere l'insonnia, Ed. San Paolo, Milano, 2002.

• Lombardo G.P., Foschi R.: La costruzione scientifica della personalità. Itinerari storici della psicologia, Ed. Bollati Boringhieri, Torino, 2002.

• Mozzarella B.: Fiori di Bach per il rilassamento, Ed. Xenia, Milano, 2001.

• Paoluzzi L.: Fitoterapia e Energetica, Ed. AICTO, Anguillara (RM), 1997.

• Scheffer M.: Esperienze con i Fiori di Bach, Ed., TEA, Milano, 2002.

• Turetta A.: L’insonnia, www.mybestlife.com, 2002.

 

Indirizzo per chiarimenti

Carlo Di Stanislao

E-mail: amsaaq@tin.it

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[1] Liquid Extract or Tintura Madre.

[2] At times this remedy, when taken with Coffea, can cause morning drowsiness. In these cases, 15 drops of Ferrum sidereum D20, on awakening.

[3] The mountain chain of Indù Kush is the natural border of the ancient India with Persia and Central Asia. From its high valleys fall the strong currents of the sacred river Indo. This part of the world seems suspended in time, remaining as it was centuries ago: both man and the country side remains uncontaminated by technology (Fig. 6). There the traveler can enjoy the clean air and experience the fascinating life style  which could instill the desire to change ones customs, dress and even religion.

[4]

·         Eliminate meat from the evening meal: meat has an amino acid Tyrosine, that  can stimulate the mental processes

·         The evening meal should be vegetarian and rich in starches (pasta and rice). Together with bananas, which are rich in a precursor of Serotonin, which induces sleep at the cerebral level.

·         Learn a relaxation method  (autogenous training, yoga, immaginative distention) so as to reduce muscle tension.

·         Since ancient times, for those that don’t suffer from allergies, a glass of hot milk before going to bed, is considered an excellent remedy

·         Once one is awoken it is better get out of bed prepare a camomilla or an herbal tea that contains  lavender, lime or passiflora.

·         Go to bed when you feel sleepy. Other activities such as eating, reading and watching the television shouldn’t be done in bed

·         Try and limit the number of hours involved activities that can excite the cerebral activity, such as intense studying or particularly strong physical activity

·         If a baby is not able to fall asleep when the parents leave him/her an old remedy is leave a garment of the mother near the child so as to give a sense of communication with the baby thereby making it feel reassured.

·         An ancient Egyptian tradition states that if one sleeps with the head directed towards the north this favours the fluidityof the blood to the brain. Confirmation of this was had from experiments performed at Berkeley Sleep Center, where it was possibile to show that when a person was allowed to sleep on a rotatable bed, there was a greater depth of sleep when the person was oriented in the northern direction. For this reason it may be worth the trouble to orient ones bed  so as to have the head in the northern direction.

·         Avoid taking stimulants so as to increase ones performance during the day. Sleep is constantly sacrificed for the sake  of the waking hours. By so doing  one does not respect the fundamental essence that controls and supports the equilibrium of man.