Intractable insomnia usually refers to a situation where insomnia symptoms persist for a relatively long time and the effect remains unsatisfactory even after various conventional treatment methods. Acupuncture treatment for intractable insomnia can start from the holistic concept. By regulating the balance of internal organs, qi and blood, and Yin and Yang in the human body, it can improve sleep conditions. The following are the specific treatment ideas:

First, make precise syndrome differentiation to clearly identify the cause and mechanism of the disease

Heart-kidney disharmony type: Kidney water fails to flow upward to the heart, leading to excessive heart fire and disturbing the heart spirit, which results in insomnia. Patients often have symptoms such as restlessness, insomnia, palpitations, dizziness, tinnitus, soreness and weakness in the waist and knees, hot flushes and night sweats.

Deficiency of both heart and spleen type: Excessive thinking, overwork of the heart and spleen, insufficient production of qi and blood, and failure to nourish the heart spirit, leading to insomnia. It is manifested as frequent dreams and easy awakening, palpitations, forgetfulness, fatigue, poor appetite, dizziness, and pale complexion, etc.

Liver depression with internal heat type: Emotional distress leads to liver qi stagnation, which then turns into internal heat, disturbing the heart and mind and causing insomnia. Most patients have symptoms such as insomnia and frequent dreams, irritability and anger, dizziness and head distension, red eyes and tinnitus, dry and bitter mouth, constipation and yellow urine.

Phlegm-heat internal disturbance type: Improper diet damages the spleen and stomach, abnormal transformation and transportation, internal generation of phlegm-dampness, depression turns into heat, and phlegm-heat ascends to disturb the heart spirit, causing insomnia. Symptoms such as insomnia, irritability, chest tightness, fullness in the epigastrium, bitter taste in the mouth with excessive phlegm, dizziness and vertigo often occur.

Deficiency of heart and gallbladder qi type: Sudden fright, hearing loud noises, seeing foreign objects, or being in danger and facing danger can lead to deficiency of heart and gallbladder qi, restlessness of the mind, and thus insomnia. It is manifested as restlessness and insomnia, being easily startled by things, being vigilant all day long, timidity and palpitations, shortness of breath and spontaneous sweating, and listlessness and weakness.

Second, select acupoints based on syndrome differentiation to regulate the qi and blood of the internal organs

Heart-kidney disharmony type: Select acupoints such as Shenmen, Neiguan, Taixi, Yongquan, Xinshu, and Shenshu. Shenmen and Neiguan calm the mind and soothe the spirit. Taixi and Yongquan nourish Yin and tonify the kidneys. The Heart Shu and Kidney Shu points regulate the functions of the heart and kidneys and connect them.

For the type of deficiency of both heart and spleen: Acupuncture at acupoints such as Xinshu, Pishu, Shenmen, Sanyinjiao, and Zusanli. The Heart Shu and Spleen Shu points nourish the heart and spleen. The divine gate calms the mind and soothes the spirit. Sanyinjiao and Zusanli strengthen the spleen, benefit qi, nourish blood and calm the mind.

Liver depression with internal heat type: Select acupoints such as Taichong, Xingjian, Qimen, Shenmen, and Neiguan. Taichong, Xingjian and Qimen soothe the liver and regulate qi, and clear liver fire. Shenmen and Neiguan calm the mind and soothe the spirit.

Phlegm-heat internal disturbance type: Acupuncture points such as Fenglong, Zhongwan, Neiting, Shenmen, and Neiguan. Promote the elimination of phlegm and dampness. Zhongwan promotes digestion, eliminates food stagnation and harmonizes stomach qi. The inner court clears and purges stomach fire. Shenmen and Neiguan calm the mind and soothe the spirit.

For the type of deficiency of heart and gallbladder qi: Select acupoints such as Shenmen, Neiguan, Qiuxu, Xinshu, and Danshu. Shenmen and Neiguan calm the mind and soothe the spirit. Qiu Xu is the original point of the Gallbladder Meridian, which can soothe the liver and gallbladder, calm the mind and soothe the spirit. The Heart Shu and Gallbladder Shu points regulate the functions of the heart and gallbladder and enhance the qi of the heart and gallbladder.

Third, acupuncture techniques can enhance the therapeutic effect

Combination of tonification and purgation: Adopt corresponding tonification and purgation techniques based on different syndrome types. For deficiency syndromes, such as those with deficiency of both heart and spleen and those with deficiency of heart and gallbladder qi, the tonic method is adopted, that is, the needle is inserted slowly and the needle is removed quickly, with light stimulation to stimulate the qi of the meridians and tonify the vital energy. For empirical cases, such as those of liver depression with internal heat and phlegm-heat disturbing the body, the purgative method is adopted, that is, the needle is inserted quickly and discharged slowly, with heavy stimulation, to eliminate the pathogenic factors and regulate the functions of the internal organs. For the type where the heart and kidney are not in harmony, the method of tonifying and purging moderately can be adopted to balance Yin and Yang.

Retention and insertion of the needle: Generally, the needle is retained for 20 to 30 minutes. During the retention period, the needle can be inserted every 5 to 10 minutes to maintain the sensation of the needle. Acupuncture techniques can be selected based on the patient’s condition, such as twisting, lifting and inserting, to enhance the intensity of stimulation and improve the therapeutic effect.

Special acupuncture techniques: For stubborn insomnia, some special acupuncture techniques can be combined, such as head acupuncture and ear acupuncture. For the head acupuncture, acupoints such as Shenting, Benshen and Sishencong can be selected to regulate the nerve function of the brain. Auricular acupuncture can select acupoints such as Shenmen, Xin, subcortical, and sympathetic. By stimulating these acupoints on the ear, it can regulate the functions of all internal organs throughout the body and improve sleep.

Fourth, comprehensive treatment to enhance the overall therapeutic effect

Moxibustion as an aid: For patients with a weak and cold constitution or insufficient qi and blood, moxibustion can be combined after acupuncture. Moxibustion on acupoints such as Guanyuan, Qihai and Zusanli can warm and unblock the meridians, dispel cold and dampness, nourish qi and blood, enhance the body’s resistance and improve sleep quality.

Massage and manipulation: While undergoing acupuncture treatment, massage and manipulation techniques can be combined, such as massaging the head, neck, shoulders and other areas. This can relieve muscle tension, promote blood circulation, relax the body and mind, and help improve sleep.

Psychological counseling: Patients with intractable insomnia often have psychological problems such as anxiety and depression, and psychological factors can further aggravate the symptoms of insomnia. Therefore, during the treatment process, it is necessary to pay attention to the patient’s psychological state, provide psychological counseling, help the patient build confidence in defeating the disease, and reduce psychological pressure.

Fifth, plan the treatment course and conduct regular evaluations and adjustments

Treatment course: Acupuncture treatment for intractable insomnia requires a process. Generally, 2 to 3 treatments are conducted per week, and a continuous treatment course lasts for 8 to 12 weeks. The specific course of treatment can be adjusted according to the patient’s condition and treatment effect.

Regular assessment: During the treatment process, it is necessary to regularly evaluate the patient’s sleep improvement, including the time it takes to fall asleep, sleep depth, sleep duration, and frequent dreaming, etc. Meanwhile, observe the changes in other symptoms of the patient, such as palpitations, dizziness, fatigue, etc. Based on the assessment results, the treatment plan should be adjusted in a timely manner, such as adjusting the acupoints, acupuncture techniques, and treatment frequency, to achieve the best therapeutic effect.