Can’t Sleep, Heart Racing the Moment You Lie Down, Constant Sense of Doom? Doctor Zhang Xichun Cured Insomnia with Palpitations by Nourishing Yin, Soothing the Liver and Sending Stomach Qi Downward
Patient search terms: can’t sleep / sleepless night after night / heart fluttering / heart pounding / easily startled / a sense that something terrible is about to happen / dry stool Medical terms for this condition: insomnia (bu mei) with palpitations (jing ji / zheng chong) · yin deficiency with heat, phlegm-heat disturbing the heart · neurasthenia / anxiety state
Opening scene: a woman in her thirties, sleepless for seven or eight nights straight
Insomnia is bad enough for one rough night. But when it stretches to seven or eight nights in a row without a wink of sleep, what does a person become? Exhausted to the breaking point, drained as if the very life had been pulled out of her.
And here is what was more frightening than the sleeplessness — just as she was about to drift off, her heart would give a sudden violent “thump,” jolting her awake, and after waking her chest would pound and flutter for a long while before settling down. In a single night, this fright could strike several times.
💬 Note from Doctor Luo: That feeling — “my heart suddenly pounds, I startle awake, then I’m panicky” — many patients have described it to me: the heart suddenly goes thump-thump-thump, and you feel both terrified and flustered. What is that, mostly? It is heart qi insufficiency, insufficiency of upright qi. Today’s patient was the wife of Zhao Wenlin, Doctor Zhang Xichun’s cousin. She was in her late twenties, still young, and she had fallen ill with this “insomnia with palpitations.”
Who was the patient? The whole household rested on her shoulders alone
This lady was Doctor Zhang Xichun’s cousin’s wife. Her husband, Zhao Wenlin, was a xiaolian — a scholar of real learning, and because he had that learning he had to go out and teach as a private tutor to earn money. In those days, a family tutor was hired from far away and lived right at the school, often not coming home for half a year at a time.
💬 Note from Doctor Luo: With her husband away year-round, every single household matter fell on the wife. The workload was enormous, and the worry was even greater — so the cause of her illness is crystal clear: exhaustion of the heart from overthinking. Remember this: a great many women’s insomnia and heart palpitations have exactly this root.
How sick had she become? “I feel like someone is coming to seize me”
How did the illness unfold? At first it was just occasional insomnia — she went to bed late but could still sleep in the middle of the night. Then it grew worse and worse, until she reached total sleeplessness, seven or eight nights in a row, her body worn to the breaking point.
The most telling symptom was this: she would seem to fall asleep, then suddenly her heart would give a violent thump and she would start awake, her chest pounding and fluttering for a long while before calming down. And she carried a constant feeling of “惴惴然若人将捕之” — a restless dread, as if someone were about to seize her. It was as if something terrible were about to happen, as if someone were coming to grab her; her heart was full of fear.
💬 Note from Doctor Luo: People like this share another trait: they become hyper-aware of their own heart. Every beat feels abnormal; the heart feels hollow and weak, and they fear their heart is about to fail. Lying there they think, “Am I about to die?” Some patients have told me: the moment I lie down I can hear my heart pounding, and the fear keeps me from sleeping. Others say that when someone slams a table, or there’s a sudden “bang” nearby, everyone else is fine but they leap out of their skin — their heart goes pounding wildly, and that never used to happen. All of these are manifestations of palpitations (jing ji / zheng chong), rooted in insufficiency of upright qi and an unsettled spirit. During the worst of the pandemic a few years ago, patients told me the same thing: at night their hearts would race and they lay in bed too frightened to sleep. Same principle.
A whole cluster of symptoms: heat in the chest, shortness of breath, no appetite, a bowel movement once every four or five days
Beyond the sleeplessness and the racing heart, the lady also had: a constant feeling of heat in the chest (as if there were fire inside), breathing that seemed short (not enough qi), no appetite, and dry, bound stool — a bowel movement only once every four or five days.
💬 Note from Doctor Luo: Notice how this connects to the spleen and stomach, and to upright qi — when the spleen and stomach are injured, upright qi grows even weaker. Dry, bound stool in the body tells us there is likely heat, and also that qi is not descending properly. Her pulse? On the left, wiry and hard; on the right, slippery; heavy pressure found no real strength; the rate approached nearly six beats per respiration — a rapid pulse with no power on pressure is exactly the signature of insufficient upright qi with heat.
What did Doctor Zhang Xichun make of it? Overthinking heated the heart and consumed the blood; heat generated phlegm; phlegm clouded the mind
Doctor Zhang Xichun’s analysis was very clear: overuse of the mind heated the heart and consumed the blood — the heart fire blazed too fiercely and burned away the yin blood, so yin and blood became insufficient, producing deficiency heat; the deficiency heat slowly steamed the body’s fluids dry, and what remained congealed into phlegm — this is what the classics call “heat generating phlegm” (yin re sheng tan).
💬 Note from Doctor Luo: When yin blood is depleted, yin is too weak to anchor yang. At night, when the time comes to rest, yang cannot be drawn back inward — so she could not sleep. Where did the palpitations come from? Phlegm pooling beneath the heart. The heart belongs to fire; phlegm is a water-substance. Phlegm sitting there interferes with the workings of the spirit — this is what the ancients called phlegm clouding the heart (tan mi xin qiao). The shortness of breath? Stagnant phlegm in the upper burner blocking the rise and fall of qi. The dry, bound stool? Excessive fire with blood deficiency — the fluids in the intestines are insufficient. So how to treat it? Eight characters: resolve phlegm, send stomach qi downward, nourish yin and soothe the liver, and calm the spirit.
Breaking down the prescription: sheng zhe shi paired with sheng huai shan yao, modeled on the ancient Ban Xia Shu Mi Tang
The first herb Doctor Zhang Xichun wrote was sheng zhe shi (raw hematite), 6 qian — a generous dose. This is a mineral, heavy in substance, and its job is heavy downward suppression of rebellious qi — forcing the qi movement downward — while also steadying the spirit.
He paired it with sheng huai shan yao (raw Huaishan yam) — and these two together imitate the Ban Xia Shu Mi Tang (Pinellia and Sorghum Decoction) from the Huang Di Nei Jing (Yellow Emperor’s Inner Classic).
💬 Note from Doctor Luo: We discussed Ban Xia Shu Mi Tang earlier: the shu mi (sorghum) harmonizes stomach qi and nourishes the spleen and stomach, while ban xia (pinellia) sends the qi movement downward. When stomach qi descends, the whole body’s qi movement begins to turn, yang can be drawn back in, and sleep comes naturally. The Inner Classic states it plainly: “When the stomach is not harmonious, one cannot rest (wei bu he ze wo bu an).” If stomach qi will not descend and just sits there blocked, you certainly will not sleep well at night. Doctor Zhang Xichun used sheng zhe shi in place of ban xia (to send stomach qi down) and sheng huai shan yao in place of shu mi (to fortify the spleen and stomach), taking precisely the intent of that ancient formula. And the Huaishan yam carries a deeper meaning: it fortifies the spleen and stomach and supports upright qi. When the spleen and stomach’s upright qi is full, the liver’s dysfunction can be reined in — this is the principle of “when the earth is weak, the wood shakes” (tu xu ze mu yao): if the spleen and stomach are not regulated, the liver-wood flails wildly up above. Doctor Zhang Zhongjing wrote in the Jin Gui Yao Lue (Essential Prescriptions of the Golden Cabinet): “When you see disease of the liver, know that the liver will transmit to the spleen — therefore always strengthen the spleen first.” Even for an illness of the liver channel, you fortify the spleen and stomach first. That is treating the root, an impeccably orthodox strategy.
Next came gou qi zi (goji berry), sheng di huang (raw rehmannia), and tian dong (asparagus root) — all three are yin-nourishing herbs, because this patient was yin deficient. Gou qi zi nourishes the essence of the liver and kidney, and the moment it is combined with yin-nourishing herbs, it moves decisively in the direction of nourishing yin.
How did Doctor Zhang Xichun know there was phlegm inside her? First, the pulse — the right position was slippery, rolling like beads. Second, the tongue — although Doctor Zhang did not record the tongue, Doctor Luo infers it: the coating would have been somewhat thick, and beneath the coating the tongue body would have been red, because she was yin deficient. Once the phlegm is resolved, that yin-deficiency red tongue shows itself. So the formula needed both yin-nourishing herbs and phlegm-resolving herbs.
Then he added gua lou ren (trichosanthes seed), stir-fried and crushed, 6 qian. Trichosanthes is a heat-clearing, phlegm-resolving herb, but the peel and the seed each have their own emphasis:
💬 Note from Doctor Luo: Gua lou pi (trichosanthes peel) leans toward clearing heat, resolving phlegm, and widening the chest to move qi — used when phlegm-heat is combined with qi stagnation. Gua lou ren (trichosanthes seed), on the other hand, moistens dryness and resolves phlegm, and at the same time moistens dryness and frees the bowels. Doctor Zhang Xichun chose his herbs with extraordinary precision: this patient had dry, bound stool, so he selected the bowel-moistening, stool-freeing seed rather than the whole fruit. Sometimes we prescribe whole trichosanthes — peel and seed together — and it both resolves phlegm and moistens dryness, but for this particular patient Doctor Zhang Xichun deliberately chose the seed alone. That is the refinement of a master’s prescribing.
Next, qing ban xia (processed pinellia) — it both resolves phlegm and sends qi downward, one herb doing double duty. Then sheng hang shao (Hangzhou white peony) — softens and restrains the liver. Patients like this usually fall ill from emotional strain and overwork, so stagnant liver qi is a certainty; the peony softens the liver. Yuan zhi (polygala) — calms the spirit and links heart and kidney; Doctor Zhang Xichun held that its sour flavor also restrains the liver and checks liver fire. And yin chen (oriental wormwood) — soothes the liver and moves qi, dispersing the liver’s stagnation.
💬 Note from Doctor Luo: Here is a signature insight of Doctor Zhang Xichun: as we discussed before, chai hu (bupleurum) is a strong dispersing herb — but if the patient is yin deficient, the body cannot tolerate chai hu’s outward dispersion, so yin chen is used in its place. Finally, gan cao (licorice) 1.5 qian harmonizes the whole formula. When the decoction was ready, it was taken as one large bowl, followed by a tiny dose of zhu sha (cinnabar) powder, about 2 fen — a very small amount, just a pinch.
One herb deserves special attention: zhu sha (cinnabar) — “when the mind is truly scattered, nothing but cinnabar will do”
The most interesting thing in this prescription is the use of zhu sha (cinnabar). This mineral enters only the heart channel, and its function is to clear the heart, settle fright, and anchor the spirit with its heaviness. When a patient’s spirit is scattered and uneasy — restless, unable to settle, panicking day and night — TCM uses cinnabar to pin that chaotic state down.
💬 Note from Doctor Luo: Cinnabar was used constantly in ancient China — it colored the painted pottery, and in some places people used it to ward off evil. In Chinese medicine it is never decocted; it is ground into a fine powder, and the classical method is shui fei (water-grinding): grinding it bit by bit in water, filtering layer after layer to remove impurities, then drying it into powder; during the grinding, a magnet is also drawn through to pull out any iron, guaranteeing purity. Cinnabar’s main component is mercury sulfide — mercury is quicksilver, and it is toxic. But mercury sulfide does not dissolve in water, so when swallowed it is essentially not absorbed and does not poison — only a minuscule trace has any effect. But remember three rules: not for frequent use, not for long-term use, and never in large doses — Doctor Zhang used 2 fen, extremely small. And above all, never take it heated: once heated, the mercury is released as liquid quicksilver, and swallowing that means poisoning. Taken as a pill it is fine — it passes through the body almost entirely. In some countries, Chinese patent medicines containing cinnabar cannot be sold at all — because they do not understand how TCM uses it.
So why must this kind of illness use cinnabar at all? Doctor Luo shares his own hard-won experience:
💬 Note from Doctor Luo: For patients whose spirit is truly scattered — already restless beyond control, sometimes with full-blown nervous-system symptoms — when the mind is scattered, only a mind-anchoring medicine will do. Without this class of heavy settling herbs, the condition sometimes simply cannot be controlled. I once had an elderly relative who could not sleep at night, felt frantic and uneasy, and was convinced she had a tumor. I told her to take Zhu Sha An Shen Wan (Cinnabar Tranquility Pill) — not more than one pill. After that, I regulated everything else, and it was brought under control quickly. If she had not taken that pill first, she might not even have taken my other medicine — a frantic person tries one mouthful of some formula, feels some reaction, and refuses the rest. So my practice is: when a patient is in that panicked, desperate state, give one Zhu Sha An Shen Wan first — clearing heart fire on one side, anchoring the spirit on the other — and once that single dose steadies the mind, regulating everything else goes smoothly. The most artful herb in this prescription is the cinnabar.
A principle: medicine is always a balancing act
Because cinnabar is toxic and yet must be used, Doctor Luo takes the opportunity to teach an important principle:
💬 Note from Doctor Luo: Medicine is forever balancing cure against harm — the most effective treatment that injures the body the least: that is what medicine is. Sometimes perfection is impossible. Many Western antibiotics carry kidney or liver toxicity, which is why the package inserts say “for patients with renal failure, the dose must be determined by a physician.” So why use them at all? Because without them you may not be able to control the infection — at that moment saving the life comes first, and the harm is small; and the moment harm appears, you switch to a different antibiotic. TCM works the same way — “every medicine is three parts poison” — we too pursue balance: while treating your body, we choose the option that harms you the least. Suppose a person has a severe heat condition, toxic heat packed in the upper burner, throat so swollen and painful he can barely swallow, burning fever — we use Pu Ji Xiao Du Yin (Universal Benefit Toxin-Dispelling Drink). Will these cold herbs damage yang qi? Yes. But at that moment, clearing the toxic heat is the priority. Clear the heat first; if yang is a little wounded, then warm the yang and slowly regulate the spleen and stomach. That is medicine. Some people say Chinese herbs are toxic and TCM is unscientific — that is the talk of people who do not understand medicine. Western medicine also has plenty of toxic drugs. Anyone who truly understands medicine would never raise such a question; when people trade accusations like that, it is because neither side really understands the field.
The result: four doses, and she slept two hours a night; the palpitations were seventy to eighty percent cured
The prescription was filled and taken for four doses: the heat in her chest was gone — the yin-nourishing herbs had done their work; she could sleep two hours at night; the palpitations had improved seventy to eighty percent; her breathing was smooth, and the dry, bound stool was gradually improving. On the pulse, the left side had turned soft, though the right was still somewhat slippery — the phlegm had not fully cleared, but the rate was no longer racing as before.
Doctor Zhang Xichun adjusted the formula on the same foundation: still sheng zhe shi with sheng huai shan yao (harmonizing the stomach and sending qi down), still gou qi zi with sheng di huang (nourishing yin), and now he added lu dang shen (Lu codonopsis) and long yan rou (longan fruit) — the latter a very important herb for insomnia.
💬 Note from Doctor Luo: Over the years I have laid out several approaches to insomnia: for stagnant liver qi, Chai Hu Jia Long Gu Mu Li Tang (Bupleurum plus Dragon Bone and Oyster Shell Decoction) in modified form, used even as a foot bath; for liver yin deficiency, the approach Doctor Zhang Xichun uses today — softening the liver and nourishing liver yin; and for blood deficiency — blood-deficient people lose sleep, and what do we use? Long yan rou (longan fruit). I usually have patients steam longan fruit with American ginseng into Yu Ling Gao (Jade Spirit Paste); even longan alone nourishes blood and calms the spirit, and it works especially well for insomnia. Doctor Zhang Xichun used longan to nourish heart blood, and paired it with sheng zao ren (sour jujube seed, stir-fried and crushed), 4 qian, to nourish liver blood — when the blood of heart and liver is nourished, sleep recovers on its own. The gua lou ren stayed, resolving phlegm and moistening the bowels; the pinellia was removed; Hangzhou peony softened and restrained the liver; yuan zhi anchored the spirit and checked liver fire; and gan cao (licorice) 1 qian harmonized. This formula was taken as one large warm bowl — six doses, and she slept soundly through the night. All complaints were cured.
💬 Note from Doctor Luo: You see — a case this complicated, and Doctor Zhang Xichun finished it off completely in a few doses. What do we learn here? In springtime, yin-deficient people are especially prone to exactly these problems — Doctor Zhang shows us plainly how to nourish yin, how to nourish the liver, and how to send stomach qi downward. And there is the use of cinnabar: today there are so many people whose minds are scattered and restless, who feel something terrible is about to happen — when it truly reaches that point, one pill of Zhu Sha An Shen Wan will first anchor the spirit — don’t take more — and then nourish the heart and liver and regulate slowly. The effect can be very good.
Compiled from Doctor Luo Dalun’s explanation of Doctor Zhang Xichun’s case records; the case comes from Records of Chinese Medicine with Western Reference (《医学衷中参西录》).