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Chinese Medicine Links Liver Disease with Insomnia


Looking to Traditional Chinese Medicine helps explain why someone with liver disease keeps waking in the middle of the night – and also provides insight on how to slumber soundly.

To qualify as a productive, emotionally stable and capable human being, sleep is an absolute necessity. Unfortunately, many of us are not getting enough sleep. A complete system of healthcare that has been helping people achieve wellness for over 2,000 years, Traditional Chinese Medicine (TCM) describes several reasons why those with a liver condition might be particularly vulnerable to insomnia.

According to the U.S. Centers for Disease Control and Prevention, 50 to 70 million Americans adults have a sleep or wakefulness disorder. Although liver disease is frequently asymptomatic, insomnia is one of the more frequently reported complaints. Healthcare providers often see people with liver disease having difficulty sleeping between 1 a.m. and 3 a.m. – a scenario that is justified by TCM theory.

When referring to the liver in Western medicine, it is understood that the physical organ is implied. However, referring to the liver in TCM encompasses much more. In accordance with TCM, the ‘liver’ refers to an entire system that may include:

  • The liver organ
  • The liver meridian (pathway)
  • Liver patterns
  • Liver-related emotions

Waking in the Middle of the Night

We spend a third of our lives sleeping; at least that proportion of sleep-to-wake time is what is considered ideal. However, waking in the middle of the night interferes with the deepest, most restorative stage of sleep. According to TCM theory, sleep is a result of the natural rhythm of energy circulation that shifts in two-hour intervals:

  • The body energy clock describes when the body’s qi (energy) moves through different organ systems.
  • During sleep, qi is drawn inward to restore the body.
  • At 11 p.m., the yin qi (passive, receptive energy) is at its strongest. This is the ideal time for the body to return to enter a deep restful state.
  • Between 1 a.m. and 3 a.m., blood and energy (qi) are strongest in the liver organ and its energetic network. Therefore, sleeping during this time is critical for the liver to be able to function optimally.

Besides those working a swing shift or needing to get up and use a restroom, TCM practitioners describe several different reasons people wake up between 1 a.m. and 3 a.m.:

  1. Toxins are ineffectively processed during the liver’s most active time. Thus, those with chronic liver disease may have trouble sleeping between 1 a.m. and 3 a.m.
  2. There is an additional toxin load to be processed in those who drink alcohol. Thus, many who have been drinking have trouble sleeping between 1 a.m. and 3 a.m.
  3. Emotions such as anger, frustration and rage impair the liver’s ability to function smoothly. Thus, those with unresolved anger, frustration or rage may have trouble sleeping between 1 a.m. and 3 a.m.

Lifestyle Adjustments to Improve Liver Health

When working to improve sleep in patients who wake between 1 a.m. and 3 a.m., TCM practitioners’ goals are to improve the health of the entire liver system. Besides performing acupuncture and prescribing herbal formulae, they are likely to counsel patients on the following lifestyle adjustments that improve liver health:

  • Nutrition – Avoid foods that are harmful to the liver system, such fried foods, fatty foods, alcohol, excessive caffeine and excessive dairy. Include foods beneficial to the liver system, such as oatmeal, rye bread, lima beans, cashews, zucchini, arugula, green beans, lemons, limes and avocados.
  • Stress Relief – Take a break from stress and mental work by stretching, breathing, walking, laughing or creating. Practicing yoga, taking a bike ride, spending a day in the mountains, singing in a choir, playing a game or taking an art class are all great ways to shift the mind to a more relaxed, open place.
  • Physical Activity – Exercising regularly (in the daytime) at a moderate intensity keeps blood and energy moving freely through the liver – a necessity for liver cell function and repair. However, avoid over-strenuous exercise and stop if you become exhausted.
  • Release Stuck Emotions – Repressed rage, anger and frustration impair liver health, so finding ways to release these emotions is crucial. The longer these emotions are held in, the more harm they could cause the liver. If self-expression or relaxation does not help, working with a professional therapist can help release these feelings.

Everyone wants to sleep well because we feel our best on a good night’s rest. The body has many jobs to perform while we slumber away – with the liver being on duty from 1 a.m. to 3 a.m. Those with chronic liver disease may have to work a bit harder than those with a healthy liver to sleep though the night, but it is possible… and worth it! The knowledge gleaned from Traditional Chinese Medicine helps put the liver’s relationship with insomnia in perspective. In addition, this knowledge also prioritizes nutrition, stress relief, exercise and the release of pent-up emotions to facilitate deep sleep between the late hours of 1 a.m. and 3 a.m., The Connection Between Sleep and the Liver, Tracy Thiessen, Retrieved May 23, 2015,, 2014., The Chinese Body Clock: Why do I feel differently at different hours of the day?, Marlies, Retrieved May 23, 2014, Wellness McUniverse, 2014., Insufficient Sleep is a Public Health Epidemic, Retrieved May 23, 2014, US Centers for Disease Control and Prevention, 2014., Chinese Clock Holds Key to Liver Health, Melissa Sokulski, Retrieved May 23, 2014, Natural News Network, 2014., Conquering Insomnia, Nicole Cutler, L.Ac., Retrieved May 23, 2014, Natural Wellness, 2014., TCM and Insomnia, Wei Liu, MPH, LAc, Changzhen Gong, PhD, MS, Retrieved May 23, 2014, American Academy of Acupuncture and Oriental Medicine, 2014., Ancient Wisdom for Healthy Sleep (Part 2), Jingduan Yang, MD, Retrieved May 23, 2014, Epoch Times, 2014., My Liver is What?, Chad Dupuis, Retrieved May 23, 2014, Yin Yang House, 2014., 21 Ways to Improve Your Liver Health, Carrie Demers, MD, Retrieved May 23, 2014, Yoga International, 2014.

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About the Author

Nicole Cutler, L.Ac., MTCM, Dipl. Ac. (NCCAOM)®

Nicole Cutler, L.Ac., MTCM is a long time advocate of integrating perspectives on health. With a Bachelor's degree in Neuroscience from the University of Rochester and a Master's degree in Traditional Chinese Medicine from Five Branches Institute, Nicole has been a licensed acupuncturist since 2000. She has gathered acupuncture licenses in the states of California and New York, is a certified specialist with the National Acupuncture Detoxification Association, has earned diplomat status with the National Commission of Chinese and Oriental Medicine in Acupuncture and Chinese Herbology and is a member of the Society for Integrative Oncology. In addition to her acupuncture practice that focuses on stress and pain relief, digestion, immunity and oncology, Nicole contributes to the integration of healthcare by writing articles for professional massage therapists and people living with liver disease.

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