Disease and Condition Overview
Insomnia is characterized by the inability to fall asleep or easily awaken, and difficulty to return to sleep after waking. In Chinese medicine, location of this disease is at the heart. Anxiety and worry, over extending oneself, affect the heart and the spleen, which causes the weakening of qi and blood, leading to malnourishment. Or it is caused by excess, indulgence in sex and damaged kidney, exhaustion of kidney yin, which in turn, causes empty fire, and disharmony between heart and kidney. Or it is caused by disharmony of spleen and stomach over a prolonged period of time, all the excess dampness producing phlegm, and accumulation of phlegm as a result, generates heat which rises upward to disturb the heart and mind. Or, it is caused by suppressing anger and frustration, prompting the uproar of liver fire and disquieting of heart and mind.

Clinically, it is important to differentiate between insomnia manifested from neurasthenia, neurosis and anemia, etc. During treatment, it is crucial to observe the changes m patient's psychological state and emotional well beings.

Pair-point Treatment Combinations

(1) Neiguan (PC61), Sanyinjiao (SP6)
Neiguan (PC6): on the palmer side of the forearm, on the line connecting Daling (PC7) and Quze (PC3), 2 cun superior to the wrist crease, between the tendons of m. palmaris longus and m. flexor carpi radialis.
Sanyinjiao (SP6): on the medial side of the lower leg, 3 cun superior to the prominence of the medial malleolus, in the depression near the posterior border of the tibia.
Neiguan (PC6) soothes the chest and regulates qi. Sanyinjiao (SP6) aids spleen stomach and tonifies both liver and kidney. Two points combined, they clear above and stabilize below, regulating qi at the middle jiao and overall yin and yang. Appropriate for all types of insomnia.

Needling techniques:
1. Neiguan (PC6) perpendicular insertion 1 cun.
2. Sanyinjiao (SP6) perpendicular insertion 1 cun.

(2) Zusanli (ST36), Ganshu (BLI8)
Zusanli (ST36): on the anteriolateral side of the lower leg, 3 cun inferior to Dubi (ST35), one finger breadth (middle finger) lateral to the anterior crest of the tibia.
Ganshu (BL18): on the back, below the spinous process of the ninth thoracic vertebra (T9), 1.5 cun lateral to the posterior midline.
Zusanli (ST36) lowers turbid. Ganshu (BL18) elevates clear. These two points regulate the elevating and lowering of turbid and clear, working in synergy, harmonize liver and stomach, strengthen stomach and spleen and also promote blood flow. Appropriate for insomnia caused by disharmony of liver and stomach.

Needling techniques:
1. Zusanli (ST36) perpendicular insertion 2 cun, the needling sensation must traverse down and felt at the toes.
2. Ganshu (BL18) perpendicular insertion 1 cun or moxa using moxa stick 10 minutes.

(3) Pishu (BL20), Weishu (BL21)
Pishu (BL20): on the back, below the spinous process of the eleventh thoracic vertebra (T11) 1.5 cun, lateral to the posterior midline.
Weishu (BL21): on the back, below the spinous process of the twelfth thoracic vertebra (T12), 1.5 cun lateral to the posterior midline.
The spleen governs the upward transportation and transformation while the stomach controls the harmonizing and descending functions, When used in combination, one elevates while the other lowers, achieving a balance to strengthen spleen and stomach. Appropriate for treating insomnia caused by dysfunctions of spleen and stomach.

Needling techniques:
1. Both points perpendicular insertion 1 cun.
2. Use the dao-qi, "guiding qi" method.
3. Or use warm needle moxa or apply moxa for 15 minutes after needling.

(4) Yingu (KI10), Xingjian (LR2)
Yingu (KI10) clears heat and tonifies yin, Xingjian (LR2) reduces liver and cools blood. While one tonifies, the other reduces, working in synergy, they tonify yin and clear empty heat. Appropriate for insomnia caused by yin deficiency heat rising upward and disturbing yang.

Needling techniques:
1. Yingu (KI10) perpendicular insertion 1 cun.
2. Xingjian (LR2) perpendicular insertion 0.5 cun.

(5) Xinshu (BL15), Shenmen (HT7)
Xinshu (BL15): on the back, below the spinous process of the fifth thoracic vertebra (T5), 1.5 cun lateral to the posterior midline.
Shenmen (HT7): at the wrist joint, on the radial side of flexor carpi ulnaris, in the depression at the proximal border of the pisiform bone.
Xinshu (BL15) is back-shu point; Shenmen (HT7) is yuan- source point. When used in conjunction, they work to nourish and calm the heart, stabilize nerves and strengthen will. Appropriate for treating all types of insomnia, especially for the type caused by the disharmony of the heart and the nerves.

Needling techniques:
1. Xinshu (BL15) perpendicular insertion 1 cun. Use the dao-qi, "guiding qi", method.
2. Shenmen (HT7) perpendicular insertion 0.5 cun, strong stimulation.

(6) Shenmen (HT7), Sanyinjiao (SP6)
Shenmen (HT7): at the wrist joint, on the radial side of flexor carpi ulnaris, in the depression at the proximal border of the pisiform bone.
Sanyinjiao (SP6): on the medial side of the lower leg, 3 cun superior to the prominence of the medial malleolus, in the depression near the posterior border of the tibia.
Shenmen (HT7) calms the mind, strengthens the will and regulates qi; Sanyinjiao (SP6) strengthens spleen and tonifies yin. The two points work to regulate qi blood, to harmonize yin and yang, harmonize the heart and kidney. Appropriate for treating insomnia caused by heart spleen deficiency, or heart kidney disharmony.

Needling techniques:
1. Shenmen (HT7) perpendicular insertion 0.5 cun, strong stimulation.
2. Sanyinjiao (SP6) perpendicular insertion 1 cun,

(7) Tongli (HT5), Zhaohai (KI6)
Tongli (HT5): on the palmer side of the forearm, on the radial side of the tendon of the flexor Carpi ulnaris, 1 cun proximal to the wrist crease.
Zhaohai (KI6): on the medial side of the foot, in the depression below the prominence of the mediai malleolus.
Tongli (HT5) tranquilizes the heart and calms the mind, Zhaohai (KI6) tonifies kidney and nourishes yin and connects to yin motility vessel. When used in conjunction, these two points, one fire, one water, clear heart, nourish kidney, calm the mind and strengthen the will. Appropriate for treating insomnia caused by kidney water deficiency, and heart fire not descending.

Needling techniques:
1. Tongli (HT5) perpendicular insertion 0.5 cun, strong stimulation.
2. Zhaohai (KI6) perpendicular insertion 1 cun.

(8) Tongli (HT5), Dazhong (KI4)
Tongli (HT5): on the palmer side of the forearm, on the radial side of the tendon of the flexor carp ulnaris, 1 cun proximal to the wrist crease.
Dazhong (KI4): on the medial side of the foot, posterior and anterior to the medial malleolus, in the depression medial and anterior to the border of the Achilles tendon.
Tongli (HT5) tranquilizes the heart and calms the mind; Dazhong (KI4) tonifies kidney and strengthens essence and stabilizes nerves. These two points work in synchrony to regular yin and yang, clear the heart while tonify kidney, which are fire and water. Appropriate for treating insomnia caused by yin deficiency, uprising of fire, which is the disharmony of heart and kidney.

Needling techniques:
1. Tongli (HT5) perpendicular insertion 0.5 cun, strong stimulation.
2. Dazhong (KI4) perpendicular insertion 1 cun.

(9) Shenmai (BL62), Zhaohai (KI6)
Shenmai (BL62): on the lateral side of the foot, in the depression directly below the lateral malleolus.
Zhaohai (KI6): on the medial side of the foot, in the depression below the prominence of the medial malleolus.
Shenmai (BL62) connects to yang motility vessel. Zhaohai (KI6) connects to yin motility vessel. When used in conjunction, one yin, one yang, they regulate yin yang, qi and blood, restore natural rhythm. Appropriate for treating insomnia caused by imbalance of yin and yang.

Needling techniques:
Shenmai (BL62), Zhaohai (KI6) both perpendicular insertion 1 cun, even method for 10 minutes.

Commentaries
Acupuncture is very effective in treating insomnia. However, before starting any treatment, it is crucial to perform systematic and thorough examinations to exclude any possibility of existing physiological diseases. Also, it is important to differentiate between symptoms, such as difficulty falling asleep, shallow sleep, and short sleep cycle are various different types. Treatment method should be selected and administered with care.
Difficulty falling asleep -- usually caused by inner heat rising to disturb clear yang, or disharmony of heart and kidney.
To treat insomnia caused by inner heat rising to disturb clear yang, select Yingu (KI10), Xingjian (LR2)
As for heart fire not descending or heart, kidney disharmony, select Tongli (HT5), Zhaohai (KI6) pair or Tongli (HT5), Dazhong (KI4).
Shallow sleep, easily awakened    in this case, it is essential to strengthen and regulate functions of spleen and stomach. Select Zusanli (ST36), Ganshu (BL18) or Pishu (BL20), Weishu (BL21).
Short sleep cycle -- select Shenmen (HT7), Sanyinjiao (SP6), or Xinshu (BL15), Shenmen (HT7). As for the disharmony of yin and yang, select Shenmai (BL62), Zhaohai (KI6).
General insomnia without particular symptom -- select Neiguan (PC6), Sanyinjiao (SP6).

It is critical to differentiate causes of insomnia. Those suffer from insomnia because of jetlag, any emotional stress, or changes in the environment, it is not considered as pathological, it is situational. Once the patient's situation improves, the symptoms will be relieved. For the elderly, their sleep cycle naturally shortens and become easily awakened. If there is not any additional symptom, it is considered natural. It is important to observe the appearance of symptoms and the patient's psychological and emotional state.