In Hong Kong's fast-paced urban life, poor sleep has become almost commonplace. Some lie awake for hours; others wake at night and cannot return to sleep; still others rise at 3 or 4 a.m. and stay alert until morning. Long-term reliance on sleeping pills may bring temporary relief but often leads to increasing doses, diminishing effect, and daytime grogginess or memory issues. TCM views insomnia as an expression of yin-yang imbalance among the zang-fu organs — pattern identification must come first.
Heart-kidney disharmony: cannot fall asleep
The most common complaint is lying awake for a long time before sleep arrives. TCM calls this heart-kidney non-interaction: the heart belongs to fire, the kidney to water. Normally heart fire descends and kidney water ascends so yin and yang merge and sleep follows. When overwork or chronic illness weakens kidney yin, insufficient water fails to restrain heart fire; the restless spirit cannot settle. Palpitations, forgetfulness, dry mouth, and sore lower back may accompany this pattern. Care often focuses on connecting heart and kidney, nourishing yin, and clearing deficiency heat.
Liver qi stagnation with heat: vivid dreams and light sleep
If falling asleep is relatively easy but dreams are constant and any noise wakes you — with difficulty returning to sleep — liver qi stagnation transforming into fire disturbing the heart is a common pattern. Modern work pressure and suppressed emotion may stagnate liver qi, which over time generates fire that agitates the spirit. Irritability, chest tightness, and headache may appear. Treatment may soothe liver qi, clear fire, and calm the spirit, alongside stress management and relaxation practice.
Heart-spleen deficiency: early waking with fatigue
Waking between 3 and 5 a.m. and staying awake, with daytime exhaustion and poor appetite, suggests heart-spleen dual deficiency. The spleen generates qi and blood; the heart houses the spirit. Chronic worry or irregular eating injures heart and spleen; insufficient qi and blood fail to nourish the spirit, leading to early waking and post-wake fatigue. Pale complexion and a pale tender tongue may be seen. Care often tonifies heart and spleen and nourishes blood to calm the spirit.
Phlegm-heat disturbance: chest fullness and snoring
Some insomnia patients also report chest tightness, a heavy head, loud snoring, and a thick yellow greasy tongue coating — signs of phlegm-heat internally. Excess rich food and alcohol may impair spleen transformation, generating phlegm-dampness that stagnates into heat; phlegm-heat harasses the heart-mind, causing shallow sleep, vivid dreams, and sleep-talking. Treatment may clear phlegm-heat, harmonise the stomach, and calm the spirit, with dietary adjustment.
Acupuncture and daily habits
Beyond internal herbs, acupuncture is frequently used for insomnia. Points such as Shenmen, Neiguan, Anmian, and Sanyinjiao may be selected and modified for individual constitution. Some patients notice gradual sleep improvement over two to four weeks of consistent care — responses vary. Daily habits matter: limit screens before bed, reduce caffeine, and keep regular sleep times. If insomnia is affecting your quality of life, an internal medicine consultation can help identify your pattern and build a tailored plan.