Insomnia, night waking: the TCM perspective on difficult nights (the Shen, the Heart, the Yin) and the place of acupuncture.
By Dr Alexandre Fleury · Physician acupuncturist · ~4 min read · Updated October 2026
Trouble falling asleep, waking in the middle of the night, waking too early, sleep that doesn’t feel restful: sleep problems are very common. An occasional difficult night is unremarkable. When these problems become recurrent, they weigh on mood, concentration and health.
We speak of chronic insomnia when difficulties occur at least three nights a week for more than three months, with an impact during the day. Stress, pain, menopause, irregular schedules, caffeine, screens and certain illnesses can all be causes.
First-line treatment is cognitive behavioural therapy for insomnia (CBT-I). Sleeping pills are reserved for short periods and should never be stopped abruptly without medical advice.
For TCM, at night the Shen (the spirit) must “come home”, meaning settle in the Heart, nourished by Blood and Yin. When Yin or Blood are lacking, or when a “fire” agitates the Heart, the Shen drifts and sleep slips away. Several profiles are distinguished:
TCM also looks at the meridian clock: each organ is thought to have its own period of the night (the Liver from 1am to 3am, for example). This is a traditional framework that guides my questioning. Waking at a fixed time is not in itself a sign of illness.
Several reviews of the literature suggest an improvement in sleep in people treated, but with studies of varying quality; the most recent Cochrane review considers the evidence insufficient to draw firm conclusions. Acupuncture can be offered alongside sleep-hygiene measures or CBT-I.
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This article is for informational and educational purposes. It does not replace a medical consultation and is not personalised advice.
