When east meets west: Understanding the traditional Chinese medicine diagnoses on insomnia by Western medicine symptomatology

Introduction: Insomnia sub-classification by the Western diagnostic systems has unsatisfactory validity and reliability. On the contrary, traditional Chinese medicine (TCM) diagnosis is sometimes used to guide treatment decisions. This cross-sectional study compared groups of insomnia patients with different TCM diagnoses in terms of Western medicine symptomatology. Methods: Baseline data of two randomized controlled trials on insomnia were studied. TCM diagnosis was made by consensus between two TCM practitioners, with the help of a 92-item symptom checklist designed for TCM diagnosis in subjects with insomnia. Other data include sleep diary and actigraphy, insomnia symptoms, general sleep disturbances, comorbid medical and psychiatric disorders, physical and psychiatric symptoms, and sleeprelated dysfunctional cognitions and behaviors. Results: The four commonest TCM diagnoses among 365 subjects with insomnia disorder (mean age 51.7 years; 77.3% females) were dual deficiency of the heart-spleen, non-interaction between the heart and kidney, depressed liver qi transforming into fire, and yin deficiency with effulgent fire, with prevalence 31.8%, 25.8%, 18.4%, and 10.1%, respectively. We found minimal interrelationships between the TCM and Western medicine systems. Only the mean Hamilton Depression Rating Scale score was significantly lower in non-interaction between the heart and kidney compared to dual deficiency of the heart-spleen and yin deficiency with effulgent fire (ANOVA: F [3310] = 4.64, p = 0.003). Conclusion: Limited by an excessive focus on sleep-related variables, our results show minimal relationships between the TCM and Western diagnostic systems of insomnia. An integrative TCM-Western approach in clinical practice may be a key to personalized treatment of insomnia.