Treating Insomnia with Shen-Related Acupoints

In addition to HT7 which is often selected in the protocol to treat insomnia, there are seven more Shen-related acupoints are presented and discussed for acupuncture practitioners to consider for treating insomnia. The result in this study shows Chinese names of the acupoints represent underlying functions for practitioners to follow based on the severity.


Introduction
It is estimated that one-third of adults have experienced the symptoms resulted from insomnia like falling asleep difficultly, sleep efficiency less than 85% sleep, or latency more than 30 minutes [1] while approximately 6% meet the criteria of insomnia in diagnosis, which suggests insomnia is absolutely a common sleep disorder worldwide [2]. Acupuncture is the one of the common modalities used to treat insomnia resulting in functional impairments to increase the risk of fatal health conditions like cardiovascular disease and depression in the long term, in the Chinese communities and around the world at present to restore the normal sleep-wake cycle [3]. Different from the Western medicine developed for less than three hundred years, traditional Chinese medicine (TCM) is the major healthcare system that has been developed for thousands of years. The philosophy the Western medicine follows in the development is the hypothetical deduction while Chinese medicine resides in the inductive reasoning [4], which obviously needs attention for the future development. In the TCM, the constitution of humans and patterns of the disharmony in the body are generally classified into the eight categories of Yin-Yang, External-Internal, Cold-Hot, and Deficiency-Excess with the essential materials like Qi, Blood, and fluid accompanied by Zang-Fu organs differentiation [5].

Three TCM Treasures
It is understood that the human body in the TCM is seen as a microcosm of the universe and as a whole clinically in diagnosis and treatment. One can stay healthy when Yin and Yang are balanced to bring the body, mind and spirit into harmony. On the other hand, the Ying-Yang theory points out that the three treasures Jing (Essence), Qi, and Shen (Spirit) are essential for sustaining the human life in the TCM. From the aspect of Ying-Yang theory, Jing (Essence) is viewed as Ying, which refers to the essential substance and seems to have the high similarity to genes. Prenatal Jing is recognized by the ancient TCM masters that it is an important substance passed from parent to child, and may cause serious health issues in development, growth, and reproduction. Qi, the required energy of the body classified as Yang, represents functions like coordinating organs, warming the body up, transforming food into useful substances, and defending the body against external evil Qi (pathogens) as the source of all movements of the body.
Normally speaking, both Jing and Qi collaborate with each other shown in Figure 1 for the manifestation of Shen. Shen, which can to some extents imply the consciousness, mental functions, mental health, and vitality [6], can serve as the key tool for diagnosis with pattern identification derived from the Ying-Yang theory, which distinguishes TCM from the Western medicine and indicates that a disease represents the loss of the balance between Yin and Yang [7].

Pathological View of Insomnia
Insomnia is understood to be the loss of the Yin-Yang balance [8], indicating the fighting between Yin and Yang. The most important key to the successful treatment outcomes requires the experi-enced TCM practitioners and acupuncturists to rely on the pattern identification for the accurate diagnosis to give the prescriptions with the four skills-looking, smelling, questioning, and pulse taking. In other words, pattern, which can surely distinguish the TCM from the Western medicine, should be the key concern for the TCM and acupuncture practitioners in the decision-making of treatments. The positive and correct identification of patterns developed with the Yin-Yang theory must be strictly followed for the expected outcomes since a disease is the presentation of the loss of balance between Yin and Yang as shown in Figure 2 [5,9]. Shen is believed to reside in the Heart which is in charge of governing the Blood Vessels that need to be nourished by the Blood. When the Heart blood is deficient to fail to nourish the Shen, Shen is disturbed to lead to  Characteristics of Yin and Yang.
b. Sequence of selecting Shen-related acupoints

Understanding Shen-Related Acupoints
Chinese characters, different from the alphabet languages only representing forms and sounds, are called ideographs with three features in forms, sounds and meanings. It is argued that the language may be a barrier to hinder the TCM and acupuncture learners from acquiring the accurate meaning an acupoint refers to [11]. In other words, understanding the meanings in Chinese of the acupoints may provide the better path to get the whole picture of Shen-related acupoints.In addition to HT7 (Shenmen), which has been often used in the most protocols as the main acupoint in the studies treating insomnia to effectively improve the quality of sleep [12][13][14][15], there are seven more Shen-related acupoints, which can  Table 1 show that the Heart-Kidney represents the Yin-Yang, while Kidney-Bladder indicates the exterior-interior relationship.  [4]. In terms of the functions, Shen-related acupoints shown above seem to play the roles guiding practitioners with meanings in Chinese to establish the priority of use in practice. Judging from the Chinese meanings of acupoints, the practitioners are stongly advised to follow the sequence in Figure 2 to treat insomnia with the severity of insomnia.

Discussion
The meanings of acupoints in Figure 2 definitely explain the popularity of HT7 selected in the protocol to treat insomnia because an acupuncturist cannot treat insomnia at all without opening the door to the Shen. Acupuncture has been widely used for long and verified to reduce the symptoms of insomnia effectively [16]; however, it cannot be ignored that only the accurate selection of acupoints can play a crucial role for efficiency. HT7 selected along in the trial is verified crucial for the successful outcomes with its meaning in Chinese [3], which seems to imply that the functions of HT7 in the protocol treating insomnia indicate the language barrier deserves the attention clinically and academically [11]. On the other hand, HT7 also suggests the relationship between Prenatal In other words, tonififying DU11 and DU24 on the Governing Vessel can enable Wind to be dispersed to boost Spleen qi again.

Conclusion
Whether or not language can be a barrier for the TCM and acupuncture learners in the West remains uncertain. However, this study shows that each acupoint bears a specific meaning presenting the underlying functioins, which can enable learners and practitioners to explore the real actions. The concepts of Qi, Jing, and Shen in TCM and acupuncture theories are valuable criteria for diagnosis and treatments for insomnia since they are vital for human life. It deserves more research to link theses concepts with scientific evidence in the future, even though they are not convincing and cannot be explained and recognized accurately and properly by the biomedicine at present.