Hello everyone, I am Dr. Li Weiwei.
Throughout the summer, with rising temperatures and humid air, sleep at night has become less restful, leading to an increase in patients visiting the clinic for sleep issues. Sleep problems are governed by the heart and are closely related to daily emotions and lifestyle habits, making it especially important to carefully inquire about patients’ daily lives and conduct tongue and pulse diagnosis.
This summer, I treated an interesting case of sleep issues in a child, which I would like to share. The patient was a 4.5-year-old girl who had difficulty falling asleep every night, experienced frequent nightmares, and would cry and scream loudly, waking her parents and grandparents in other rooms. This issue had persisted for several years, causing distress for the entire family.
After a detailed examination at a Western hospital, including MRI, CT, and EEG, all results were normal, and no medication was prescribed. However, due to prolonged restless nights, the child was noticeably underweight and had a yellowish complexion.
During the physical examination, the child’s tongue left a deep impression on me, with a crimson tip and a thick, greasy white coating on the middle and back of the tongue, resembling a creamy strawberry.
Upon further inquiry, the parents mentioned that the elderly at home often overfed her with snacks, leading to a foul mouth odor and dry stools resembling sheep droppings, while the child’s temper was also becoming increasingly irritable. This is a typical manifestation of food stagnation and accumulation of heat. The family’s well-meaning feeding did not convert into nutrition but instead accumulated in the child’s spleen and stomach, becoming a burden that over time transformed into heat, affecting her sleep.
Considering the child’s red tongue tip, frequent nightmares, and yellow urine, which are signs of excessive heart fire, I treated her with a modified Dao Chi San (Guide Out Red Powder). The formula included Sheng Di Huang (Rehmannia Root) to clear the heart and nourish yin, Deng Xin Cao (Juncus) and Dan Zhu Ye (Lophatherum) to guide heat downward, Shi Chang Pu (Acorus) and Long Chi (Dragon’s Tooth) to resolve phlegm and calm the spirit, and Yuan Zhi (Polygala) and Fu Shen (Poria) to nourish the heart and calm the spirit, combined with Jiao San Xian (Fried Three Immortals) and Bing Lang (Betel Nut) to eliminate gastrointestinal stagnation.
Two weeks later, during the follow-up visit, the parents reported a significant reduction in the child’s nighttime crying, from crying every night to only 4 nights of crying in the past two weeks, and the duration of crying was also shorter than before. The whole family cooperated by reducing the variety of foods offered to the child, and the signs of food stagnation improved significantly, with stools changing from hard and difficult to pass to a more normal shape. The thick greasy coating on the child’s tongue had also thinned. I made slight modifications to the original formula and continued the child on herbal medicine for another two weeks.
During the third visit, the child had gone on a summer vacation out of town, and the parents informed me that her nighttime crying had completely resolved. She can now sleep through the night, and her temper has also softened considerably. This is a sign that the internal heat has gradually diminished. The previously thick and greasy tongue coating has disappeared, but the tip of the tongue remains slightly red, so I continued with Dao Chi San to clear the heart and nourish yin, removing the calming and spirit-stabilizing herbs from the formula.
Considering that the child had poor nutritional status due to prolonged food stagnation and inadequate sleep, I adjusted the formula to include Qi Wei Bai Zhu San (Seven Flavor Atractylodes Powder) to regulate her spleen and stomach. I also advised the parents that although the illness has been cured, they must ensure a balanced diet in the future to reduce the child’s gastrointestinal burden; otherwise, if food stagnation and constipation occur again, the possibility of recurring nighttime crying is high.
This case vividly illustrates the principle that “if the stomach is not harmonious, sleep will be disturbed.” Throughout the three treatment sessions, the child’s tongue coating gradually improved, indicating that the child’s “organ energy is clear and responsive to recovery.”
I recommend that parents focus on the child’s needs during feeding. They can observe the child’s tongue coating daily; if the coating is clean, the child can eat a bit more. If the coating is thick and there is bad breath, and the child is reluctant to eat, then they should eat lightly and skip a couple of meals. Over time, this will help the child’s spleen and stomach to be harmonious, allowing for better sleep and growth.
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Author | Li Weiwei
Layout | Zhou Hui
Proofreading | Li Weiwei Zhou Hui
Review | Zhuzi
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