Introduction: The causes and treatment methods of "excessive sleepiness."

Lingshu·Great Confusion Treatise": "The Yellow Emperor asked: 'What causes people to sleep excessively?' Qibo replied: 'This person has a large gastrointestinal tract and rough skin, with the flesh not well separated... Therefore, when the gastrointestinal tract is large, the defensive qi lingers for a long time; when the skin is rough and the flesh is not well separated, the qi moves slowly and lingers in the yin for a prolonged period. When the qi is not clear, it leads to drowsiness, hence excessive sleep.'

The Spiritual Pivot: Cold and Heat" states: "When yang qi is abundant, the eyes remain open; when yin qi is abundant, the eyes close.

Closing the eyes and excessive sleepiness refer to the clinical condition known as "somnolence syndrome," also called "excessive sleepiness." It is characterized by a constant desire to sleep, being able to be awakened when called, but falling back asleep shortly after.

There was once a female worker, nearly forty years old, who had been experiencing excessive sleepiness and fatigue for half a year. She would sleep deeply for 12 hours each night, yet still felt drowsy during the day, especially in the afternoon. Sometimes, she would even fall asleep before finishing her meal.

She had a plump physique, chest tightness, and a tendency to sigh. Her pulse was soggy, her tongue coating was white, greasy, and moist, and her tongue body was pale and swollen. Examinations had ruled out conditions such as brain tumors.

The Treatise on the Spleen and Stomach: On Deficiency of the Spleen and Stomach in the Lung" states: "Deficiency of the spleen and stomach leads to fatigue and drowsiness." "Danxi's Experiential Therapy: Dampness" also notes: "When the spleen and stomach are affected by dampness, there is heaviness, weakness, fatigue, and a tendency to sleep.

It is evident that spleen deficiency with excessive dampness is also one of the causes of prolonged retention of defensive qi in the yin aspect, leading to drowsiness.

Insufficiency of spleen qi, failure of heart yang to spread, phlegm-dampness obstructing the orifices, and prolonged retention of defensive qi in the yin aspect clearly result in drowsiness. The treatment strategy is to open blockages and promote orifice function, activate yang to invigorate the spleen, and resolve dampness and phlegm.

Prescribed Wendan Decoction with modifications, along with Suhexiang Pills, taken orally, 1 pill each time, twice daily. After 3 doses, chest tightness decreased and energy improved, enabling the patient to sit through an entire movie.

The prescription has already taken effect, so we continue with the same approach, administering five consecutive doses. All symptoms have subsided, except for the tendency to fall asleep early in the evening. The condition was further resolved with traditional Chinese medicine for regulation.

Suhexiang Wan, originating from the "Taiping Huimin Heji Jufang," is primarily composed of aromatic substances that open the orifices and warm and resolve turbidity. It is an excellent remedy for treating various conditions caused by cold pathogens, phlegm-dampness, and turbid pathogens accumulating internally, leading to obstruction of qi movement.

It is commonly used for conditions such as stroke-induced syncope, lockjaw, and cold limbs due to cold obstruction, as well as for abdominal distension and pain, cholera-like vomiting and diarrhea, and loss of consciousness caused by exposure to cold-dampness or turbid phlegm-damp qi.

In this case, its pungent and aromatic properties were utilized to restore the movement of defensive qi, thereby normalizing sleep and wakefulness. Therefore, as long as the syndrome differentiation is accurate and the formula is appropriately composed, rapid and effective results can be achieved.

It was once used for postpartum heatstroke with coma, widespread white miliaria, crimson tongue with greasy coating; combined with Sanren Tang and Ganlu Xiaodu Dan administered via nasal feeding, one dose resulted in regaining consciousness, and a second dose led to fever reduction and mental clarity, gradually progressing toward recovery.

It was also used for a case of violent coughing and vomiting blood after a fit of rage due to liver depression transforming into fire and qi rebellion disturbing blood, combined with herbs to clear and descend lung qi, achieving excellent results. There have also been reports of its successful use in rescuing children poisoned by cassava (Guangdong Medical Journal, Issue 1, 1996).

Ancient texts also record the use of Suhe Xiang for emergency treatment of falls from heights resulting in coma; the flexible application and adaptation of methods lie in the hands of the physician.

Regarding the pathogenesis of somnolence, the "Neijing" also discusses it from the perspective of the Foot Shaoyin Kidney Meridian and the slackness of qi and blood in the elderly.

The Spiritual Pivot: Meridians" states: "The kidney meridian of foot-shaoyin... governs diseases of the kidney, manifesting as heat in the mouth, dryness of the tongue, swelling of the throat with upward qi, dryness and pain in the throat... flaccidity and coldness of the limbs with a tendency to sleep, heat and pain in the soles of the feet.

The Spiritual Pivot: Heavenly Years" notes: "At sixty years of age, the heart qi begins to decline, leading to suffering from worry and sorrow, slackness of blood and qi, hence a preference for lying down.

Treatise on Cold Damage Diseases: Pulse and Syndrome Patterns of Shaoyin Disease and Their Treatment" also states: "In shaoyin disease, the pulse is faint and thin, with a constant desire to sleep.

The first issue of Taiwan's "Datong Traditional Chinese Medicine" in 1984 reported a case: "An elderly woman from Kowloon Tong suddenly developed a condition characterized by deep, lethargic sleep and inability to wake."

For several weeks without waking, "the pulse is deep and thin, the body cold," it is considered that the sovereign fire is weakened, the heart yang cannot suppress and contain the multitude of yin, the spleen yang is not vigorous, leading to a sudden outbreak of yin qi above, water dampness not moving, dispersing into the vast space, and in old age the kidney yang is also weakened, causing the defensive qi's movement to be obstructed and lingering in yin, resulting in excessive sleep and inability to sleep.

Later physicians used moxibustion therapy, "at the Gaohuangshu point on the Foot Taiyang Bladder Meridian," directly moxibusting 10 cones, after which the limbs warmed and the spirit awakened, "then at Zusanli (bilateral) each moxibusting one cone, guiding the fire back to its source," "then administering Sini Tang" and actually "covering with a blanket and recovering."

Moxibustion therapy often can immediately lift severe and chronic illnesses, saving people from peril, but unfortunately, there are not many practitioners currently.

The Gaohuang point has the function of invigorating heart yang and clearing and dispersing yin gloom, assisted by Zusanli, suppressing yin and strengthening yang, and further taking Sini Tang to restore yang and rescue from collapse, complementing each other, yin qi can be swept away, the firmness of heaven can be restored, and then the deep sleep can be awakened.

The etiology and pathogenesis of excessive sleepiness are also extremely complex, and physicians should carefully comprehend them to achieve significant and rapid efficacy when applied. This has been documented extensively in historical literature.

The *Classic of Difficult Issues*, Chapter 49, discusses the theory of spleen pathogens, stating: "How can one know it is caused by improper diet and overexertion? ... Thus, it is known that when spleen pathogens invade the heart, there is a preference for bitter flavors. The symptoms include fever, heavy body sensation, excessive sleepiness, and flaccidity of the limbs, with a pulse that is floating, large, and moderate."

Sun Simiao of the Tang Dynasty, in *Essential Formulas for Emergencies Worth a Thousand Gold*, Chapter on Spleen Deficiency and Excess, also approaches the condition from the perspective of the spleen: "For those with heavy body sensation, inability to eat, tasteless food, a feeling of emptiness and fullness in the epigastrium, frequent desire to lie down, and excessive sleepiness, acupuncture should be applied to the stomach cavity (epigastrium) and Taicang, and Jianzhong Decoction or this Pingwei Pill formula should be administered."

Jianzhong Decoction: Cinnamon Twig Decoction with maltose added.

Pingwei Pill Formula: Almond, Salvia, Sophora, Lepidium, Scrophularia, Ligusticum, Cinnamon Heart.

The "Jiyang Gangmu" states: "When pathogenic qi resides in the upper burner and food and drink are consumed, the defensive qi becomes trapped and blocked internally, unable to reach the yang aspect externally, thus leading to sudden excessive sleepiness."

The "Shengji Zonglu" from the Song Dynasty, however, attributes it to "gallbladder heat causing excessive sleep," stating: "To treat gallbladder heat with unsettled spirit, drowsiness, and excessive sleep, use the Banxia Decoction formula: Pinellia, raw Rehmannia, Polygala, red Poria, Scutellaria, and sour jujube seed."

The "Taiping Shenghui Fang" points out: "Excessive sleep due to gallbladder heat arises from stagnation of the nutritive and defensive qi, disharmony between yin and yang, excessive phlegm in the chest and diaphragm, and congestion in the organs, leading to mental confusion and excessive sleep day and night. This is all due to accumulated heat not being eliminated and excess qi in the liver and gallbladder, thus causing excessive sleep."

The "Taiping Shenghui Fang" records formulas such as the Antelope Horn Powder (composed of antelope horn powder, Ophiopogon japonicus, Sichuan rhubarb, Akebia quinata, licorice, Asparagus cochinchinensis, Saposhnikovia divaricata, Pinellia ternata), Poria Spirit Powder (composed of Poria cocos, Ophiopogon japonicus, Dictamnus dasycarpus, Lycium chinense root bark, Scutellaria baicalensis, Ziziphus jujuba seed, Adenophora stricta, antelope horn powder, licorice), Ginseng Powder (composed of ginseng, red Poria cocos, bezoar, Notopterygium incisum, Polygala tenuifolia, Sichuan Cimicifuga foetida, Ophiopogon japonicus, rhinoceros horn shavings), and Polygala Pill (composed of Polygola tenuifolia, ginseng, Sophora flavescens, horse skull ash, Poria cocos, Acorus calamus, cinnabar, iron powder), among others, for "treating gallbladder heat with excessive sleepiness."

Additionally, regarding the treatment of excessive sleepiness, there is the "Sleep-Stopping Formula" from the Tang Dynasty's *Supplement to the Prescriptions Worth a Thousand Gold*: tiger bone, dragon bone, and turtle shell, ground and sieved into a powder, taken with water in a dosage of one square-inch spoonful twice daily to treat excessive sleepiness and the desire to close the eyes; as well as a powder made from ephedra (with nodes removed), atractylodes, and licorice, taken with decoction in a dosage of one square-inch spoonful three times daily.

There is also the "Divine White Powder" from the *Feng Sui Jing* mentioned in *New Book for Infants and Children*, which consists of medicated leaven, ginseng, poria, patchouli leaves, licorice, astragalus, white aconite, and large aconite, finely ground and taken with half a qian of seaweed soup.

There is the "Sheng Yang He Wei Tang" from the "Differentiation of Internal and External Injuries," which is composed of Astragalus, Pinellia, Ginseng, Licorice, Angelica, Saposhnikovia, White Peony, Notopterygium, Tangerine Peel, Poria, Atractylodes, Coptis, Ginger, and Jujube.

In summary, the historical literature on the treatment of excessive sleepiness is indeed rich, encompassing both established principles and flexible adaptations, yet all remain aligned with the fundamental tenets of the *Inner Canon*. It is essential to examine and explore these in depth.