Chronic Insomnia | Reading a Case between Liver Fire and Spleen Deficiency across the Nine Layers

Model-case version note (October 10, 2026):The following model case was created during the former nine-layer phase. Its description and original numbering are preserved. Current MLMN has ten layers, L0–L9; prenatal or birth information has not been invented to fill gaps.See the current definition。

Case: A man in his fifties who has awakened repeatedly at night for over a year. His head feels heavy during the day; he is sleepy after meals, tends toward soft stools, and feels irritable. The tongue is pale with tooth marks and a slightly yellow greasy coating; the pulse is wiry and slippery.

About these cases: This page presents an educational model constructed to compare theoretical systems of East Asian medicine. The patterns, formulas, acupuncture points, and treatment methods mentioned are examples for examining classical theories. They do not indicate recommendations, treatment effects, or causal relationships for any particular patient.

Modern medical assessment should come first. Actual symptoms may involve conditions that cannot be assessed through East Asian medical frameworks alone. Seek prompt medical attention for sudden onset, severe symptoms, changes in consciousness, movement, or sensation, fever, chest pain, difficulty breathing, or persistent or worsening symptoms.

1. Conventional pattern differentiation and treatment

It is difficult to choose between liver fire blazing upward and heart–spleen deficiency. Irritability and a wiry pulse suggest liver fire; tooth marks, soft stools, and post-meal sleepiness suggest spleen deficiency; a greasy coating suggests phlegm-dampness. Choosing between Ryutanshakanto and Kihito remains unresolved. This uncertainty exposes the limits of a single-pattern model.

2. Mapping the case to the nine nine MLMN layers

L2 Etiology	Combined etiology: irregular diet (injuring the spleen) and stress (constraining the liver)
L3 Zang-fu	Liver and spleen are affected together (liver–spleen disharmony), rather than only one of them
L4 Qi, blood, and body fluids	Spleen deficiency → phlegm-dampness (tooth marks and greasy coating); phlegm obstructs qi circulation
L6 Six conformations	Disease dynamics extend from the half-exterior/half-interior to the interior; impaired shaoyang pivot (wiry pulse)
L7 Sanjiao	Phlegm-dampness stagnates in the middle jiao and clouds the heart-spirit of the upper jiao → insomnia from phlegm disturbing the spirit
L9 Temporal phase	Chronicity exceeding one year; consider a mixture of deficiency and excess

3. Comparative hypotheses within MLMN

Rather than choosing between two labels, the model is multidimensional: liver–spleen disharmony together with phlegm disturbing the spirit. Its theoretical starting point is neither simply draining the liver nor strengthening the spleen, but clearing middle-jiao (L7) phlegm-dampness to restore qi movement. This leads toward the reasoning of the Wendantang/Untanto family rather than either Ryutanshakanto or Kihito.

When it is difficult to decide which pattern applies, the answer is often overlapping layers rather than just one label.

Chronic Insomnia | Uncertainty between “Liver Fire or Spleen Deficiency” Reflects a Single-Pattern View

1. Conventional pattern differentiation and treatment

2. Mapping the case to the nine nine MLMN layers

3. Comparative hypotheses within MLMN

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