Drowsiness refers to the symptom of wanting to sleep at all times, day or night, being able to be awakened when called, and wanting to sleep again after waking up.

This condition is referred to as "hao wo" (fond of lying down), "shi wo" (inclined to lie down), "shan mian" (good at sleeping), "an wo" (peaceful lying down), and "duo wo" (frequent lying down) in the Neijing. In the "Treatise on Cold Damage Diseases," it is called "yu mei" (desire to sleep) and "duo mian shui" (excessive sleepiness). In the Jingui Yaolue, it is referred to as "yu wo" (desire to lie down) and "yu mian" (desire to sleep). Later generations have also used terms such as "xi mian" (fond of sleeping), "xi wo" (fond of lying down), "yu mian shui" (desire to sleep), "duo shui" (excessive sleep), "duo mei" (frequent sleep), and "wo mei" (lying down to sleep) to describe it.

Drowsiness is different from "unconsciousness." Unconsciousness is a state of mental confusion and loss of consciousness, whereas in drowsiness, the mind is clear, but the spirit is weary and sluggish, with a constant desire to sleep, and the person can be awakened when called. After recovering from a serious illness, when yin-yang is restored, a person may sleep peacefully and wake up refreshed, which is quite different from drowsiness.

bubble_chart Pattern Analysis

1. Spleen Deficiency with Dampness Retention︰Drowsiness, heaviness of the head as if wrapped, fatigue and heaviness in the limbs, reduced appetite, fullness and oppression in the middle epigastrium, sticky mouth without thirst, loose stools, swelling of the dorsum of the feet, white and greasy tongue coating, and soggy and slow pulse. This condition is caused by exposure to rain or wading through water, sitting or lying on damp ground, excessive consumption of raw or cold foods, or inherent internal dampness abundance, leading to dampness encumbering spleen yang. Therefore, somnolence is accompanied by signs of dampness overwhelming yang and obstruction of qi movement, such as heaviness of the head as if wrapped, heaviness in the limbs, fullness and oppression in the middle epigastrium, loose stools, or even swelling of the dorsum of the feet. This is what the Treatise on Pathogenic Factors refers to as: "Heaviness of the body, fatigue, and a tendency to sleep are due to dampness in the spleen meridian." If dampness lingers for a long time and congeals into phlegm due to cold, obstructing clear yang, the state of somnolence becomes more pronounced. The treatment involves warming the middle and resolving dampness, using Stomach Poria Decoction.
2. Deficiency of Both Heart and Spleen︰Fatigue and somnolence, dull complexion, anorexia and diarrhea, palpitation and shortness of breath, women with menstrual irregularities, pale and profuse flow, pale and tender tongue texture, white coating, and thin weak pulse. Zabing Yuanliu Xizhu states: "Somnolence is a disorder of the heart and spleen. One cause is the heart's unconsciousness and turbidity, rendering it unable to govern itself; the other is the deficiency of heart fire, which fails to generate earth and promote transportation." Deficiency of both heart and spleen leading to somnolence often arises from post-illness maladjustment, excessive contemplation, improper diet, or loss of blood, resulting in the depletion of heart blood and insufficiency of spleen qi. When the heart spirit lacks nourishment, mental haziness and timidity with a tendency to sleep occur. The key diagnostic points are: fatigue and somnolence, dull complexion, palpitation and shortness of breath, anorexia and diarrhea, pale and tender tongue texture, and thin weak pulse. Treatment should focus on tonifying and replenishing the heart and spleen, using Returning to Spleen Decoction. This syndrome differs from somnolence due to dampness encumbering spleen yang. Deficiency of both heart and spleen somnolence is a purely deficient pattern, clinically manifested as symptoms and signs of weakness and insufficiency of both heart and spleen qi and blood. In contrast, somnolence due to dampness encumbering spleen yang is a root deficiency with branch excess pattern, presenting both signs of spleen deficiency failing to transport and symptoms of dampness obstructing the clear yang from ascending. The two are distinctly different.
3. Kidney Yang Deficiency︰Fatigued and wanting to lie down, listless, scanty urine with edema, cold pain in the lumbar region, coldness in the lower legs and knees, fear of cold with curling up, cyanotic lips and nails, purplish-dark tongue texture with moist white coating, and faint-thin pulse. Treatment should focus on warming and tonifying kidney qi, using {|104|}Right-Restoring Pill{|105|} or {|106|}Kidney Qi Pill{|107|}, etc.
4. Kidney Essence Insufficiency︰Sloth and somnolence, tinnitus deafness, forgetfulness, sluggish thinking, dull expression, insufficient energy for tasks, pale tongue texture, and weak fine pulse. Mostly caused by excessive labor injury, prolonged illness unhealed, or aging and physical decline, leading to kidney essence deficiency and insufficiency, emptiness of the marrow sea, dizziness, and drowsiness. Lingshu. Hai Lun: "When the marrow sea is insufficient, the brain experiences tinnitus, soreness in the calves, dizziness, blurred vision, and a tendency to rest and lie down." The main symptoms for pattern identification include dizziness and somnolence, mental fatigue and sloth, tinnitus deafness, and lack of energy when performing tasks. The difference between the two syndromes lies in: the former primarily manifests as kidney yang deficiency, while the latter is characterized by yin essence deficiency and emptiness of the marrow sea. Although both exhibit patterns of kidney deficiency, their emphases differ, thus distinguishing them. The treatment for kidney essence insufficiency somnolence employs methods to replenish essence and nourish the marrow, such as Left-Restoring Pill and Great Life-Endowing Pill, which may be selected for use.

bubble_chart Documentation

1. Zabing Yuanliu Xizhu-The Origins of Sleeplessness and Excessive Sleep: "During the long summer, one feels lazy and weary, with weak limbs, falling asleep as soon as one sits down. This is due to the inherent weakness of the qi in the lung and spleen meridians, further exacerbated by the oppressive summer heat. It is advisable to use Summerheat-Clearing Qi-Replenishing Decoction. After an illness, excessive sleepiness persists with lingering feverishness, indicating residual heat and unrecovered vital qi. In such cases, Shen's Polyghace Seche Decoction is recommended."
2. Leizheng Zhicai-Excessive Sleep: "Excessive sleep is a condition of yang deficiency and yin excess. The Lingshu states: 'The foot taiyang meridian passes through the neck and enters the brain, connecting to the root of the eyes, known as the eye system. It enters the brain between the two tendons in the neck, branching into the yang and yin heel vessels, where yin and yang intersect. When yang enters yin and yin emerges into yang, they meet at the inner canthus. When yang qi is abundant, the eyes remain open; when yin qi is abundant, the eyes close.' The mind becomes clouded and turbid, losing self-control... To clarify the spirit, herbs such as Ophiopogon Tuber, Acorus, bud tea, and Nanzhu can be used."