Part 3 of 8 in the "how TCM assesses poor sleep" series. The other seven are listed at the foot.

You came about sleep, and the practitioner asks about appetite, bowels and how warm your hands and feet run. That is not a detour — this part says what the two pieces of theory behind it mean, and why they turn into questions.

The short version

• The WHO's standard terminology for TCM describes 心主神明 as: "the heart dominates the vital activities and governs mental, conscious and thinking activities."
• The Integrative Medical Centre of the Chinese University of Hong Kong writes that in the theory, sleep problems are chiefly the heart's responsibility — but all the organ systems take part in yang entering yin, so the whole state is looked at together.
• "An unsettled stomach, unsettled sleep" is not a metaphor. The Hong Kong Department of Health's sleep guide is specific: eating too much or drinking too much in the evening leads to a bloated stomach or frequent trips to the toilet, which affect sleep; going to bed hungry makes falling asleep hard.
• So appetite, digestion, dinner time and night-time trips to the toilet all get asked about. A question about appetite is sometimes a question about mood.

First, the things that cannot wait

You snore with pauses in breathing, or wake up gasping; daytime sleepiness is severe enough to affect driving or work safety — see a doctor for investigation first.

Mood is persistently low, anxiety is hard to control, or you have thoughts of harming yourself — this is not something to wait on. Call 999 now, or go to the nearest hospital emergency department. To talk to someone, the Ministry of Health's Talian HEAL 15555 is open every day from 8 am to 12 midnight, public holidays included; Befrienders KL is open 24 hours on 03-7627 2929. You can also contact your doctor.

The full list, and the reason for each, are in part 8. TCM and Western medicine complement each other; it is not a choice between them.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

I. 心主神明: why sleep problems reach the "heart" at all

The WHO's standard terminology for TCM describes 心主神明 (the heart governs the spirit) as: "the heart dominates the vital activities and governs mental, conscious and thinking activities."

For the word 神 itself, the same standard gives three senses: "dominance of life activities", "outer manifestation reflecting the life activities", and "state of mind, mood and mental activities".

So in TCM theory, sleep problems are chiefly the heart's responsibility — that is the wording of the Chinese University of Hong Kong's Integrative Medical Centre article. The same article goes on: but all the organ systems take part in yang entering yin, which is why the practitioner looks closely at age, sex and daily habits. (What "yang entering yin" means is part 2 — in short, the active force of the day withdrawing at night into the quiet side; that sentence is our summary of the definitions, not the standard's own wording.)

Worth being clear: the "heart" in those sentences is not the anatomical organ. It is the theory's concept, a different object from the heart a Western examination looks at. For what 「肝气」 and 「心神」 mean, see the sister article: Stress and Sleep — What "Liver Qi" and "Heart Shen" Mean in TCM.

II. 胃不和则卧不安: this one is not a metaphor

The Chinese University of Hong Kong's Integrative Medical Centre article quotes 胃不和则卧不安 (an unsettled stomach, unsettled sleep) too — at the point where it turns to stomach bloating and discomfort in relation to sleep.

The Hong Kong Department of Health's Chinese Medicine Regulatory Office, in its sleep guide, is specific: eating too much or drinking too much in the evening leads to a bloated stomach or frequent trips to the toilet, which affect sleep; going to bed hungry makes falling asleep hard.

The same guide adds that a measured dinner can reduce the number of times one gets up at night for the toilet.

So in the theory, an "unsettled stomach" is not a metaphor: a dinner that is too big, too much to drink, going to bed hungry — these are its concrete forms. That is why appetite, digestion, dinner time and night-time trips to the toilet all get asked about.

III. So these are the things a practitioner asks

Other signals from the body — appetite, digestion, bowel and bladder, palpitations, how warm your hands and feet run.

Why it is asked: the Chinese University of Hong Kong article says TCM theory holds that all the organ systems take part in sleep, so the whole state is looked at together. Appetite and digestion go back to section II's unsettled stomach; night-time trips to the toilet are what the Hong Kong Department of Health's sleep guide places next to drinking or eating too much in the evening.

Mood shows through here too: the Chinese University of Hong Kong article writes that in the theory, excessive worrying knots the qi and harms the spleen, leading to no appetite for food or drink and weaker digestion. So a question about appetite is sometimes a question about mood.

Palpitations are asked about because the theory makes sleep problems chiefly the heart's responsibility, in that article's wording; hands and feet are a question about the yang side — the WHO standard says the qualities of yang qi include warming. Those two sentences are our reading of the definitions, not the sources' own words.

How mood and stress themselves are asked about, and why, is part 5.

The words in this part

All four come from the three sources quoted above. They are the theory's words, not test results.

• 心主神明 (xīn zhǔ shén míng) — the WHO standard: the heart dominates the vital activities and governs mental, conscious and thinking activities. The "heart" in that sentence is the theory's concept, not the anatomical organ.
• 神 (shén) — the same standard gives three senses: dominance of life activities, outer manifestation reflecting the life activities, and state of mind, mood and mental activities.
• 胃不和则卧不安 — a saying the Chinese University of Hong Kong article quotes, where it turns to stomach bloating and sleep. The Hong Kong Department of Health's sleep guide gives it concrete forms: too much food, too much to drink, going to bed hungry.
• Yang qi (阳气) — the WHO standard says its qualities include warming, activating and excitation. A question about hands and feet is a question about that side; the full account is part 2.

Frequently asked

I came about sleep — why am I being asked about my bowels? Because TCM theory holds that all the organ systems take part in sleep, so the whole state is looked at together; that is the Chinese University of Hong Kong article's wording. Night-time trips to the toilet are what the Hong Kong Department of Health's sleep guide places next to drinking or eating too much in the evening, so they bear on sleep directly.

I get palpitations — is that a "heart" problem? The "heart" in this part is the theory's concept, not the heart an examination looks at, and attaching a theory name to yourself is precisely what this part does not do. If palpitations come with noticeable weight change, tremor or heat intolerance, part 8 lists that as a situation to see a doctor about first.

Do not: take this part's mention of the "heart" as an explanation already found for your palpitations — that needs investigation.

The other seven parts

• Part 1: What inquiry is, how it works online, what one consultation produces
• Part 2: What TCM theory holds sleep to be
• Part 4: What is asked about the sleep itself and the daytime
• Part 5: Why mood, stress and your current medication are asked about
• Part 6: Poor sleep: what is usually done
• Part 7: How to keep a 7-day sleep log, and how to read one
• Part 8: When to see a doctor first

👉 If you are not sure where to begin with your own poor sleep, you are welcome to book an online consultation with HansMed, where a practitioner registered under the T&CM Act 2016 can assess it with you; if anything in "First, the things that cannot wait" above or in part 8 applies, see a doctor first.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

Sources

• World Health Organization, WHO international standard terminologies on traditional Chinese medicine, 2022 (ISBN 978-92-4-004232-2), entries 7, 73, 505 — https://www.who.int/publications/i/item/9789240042322
• Integrative Medical Centre, The Chinese University of Hong Kong, 〈失眠因陽氣難入陰　拆解4大對象人群〉, published 1 January 2024 — https://hkiim.cuhk.edu.hk/imc/tc/press/d/%E5%A4%B1%E7%9C%A0%E5%9B%A0%E9%99%BD%E6%B0%A3%E9%9B%A3%E5%85%A5%E9%99%B0%E3%80%80%E6%8B%86%E8%A7%A34%E5%A4%A7%E5%B0%8D%E8%B1%A1%E4%BA%BA%E7%BE%A4
• Chinese Medicine Regulatory Office, Department of Health, Hong Kong, 〈中医养生－睡眠篇〉 (PDF, 3 pp.) — https://www.cmro.gov.hk/files/gb/useful_information/public_health/feature_articles/TCM_019.pdf
• Ministry of Health Malaysia, Hospital Pendang (Kedah State Health Department), Info Kesihatan 2024 — https://jknkedah.moh.gov.my/hpendang/index.php?option=com_sppagebuilder&view=page&id=139
• Befrienders Kuala Lumpur — https://www.befrienders.org.my/

本文是「睡不好，中医会怎么评估」系列的第 3 篇，共 8 篇。其余七篇列在文末。

您是为睡不好来的，医师却问起食欲、大小便和手脚温度。这不是在绕路——这一篇说明那两句理论话是什么意思，以及它们为什么会变成问题。

一分钟看完

• 世界卫生组织的中医术语标准对「心主神明」的说明是：心主宰生命活动，并主管精神、意识与思维活动。
• 香港中文大学中西医结合医务中心的文章说，睡眠问题在理论里「主责于心」，但五脏六腑都参与阳气入阴的过程——所以整体状态一起看。
• 「胃不和则卧不安」不是比喻。香港卫生署的睡眠篇写得具体：晚上进食过饱或饮水太多，会胃中饱胀或夜尿频繁而影响睡眠；过饥则难以入睡。
• 所以食欲、消化、晚餐时间、夜里起来上厕所的次数，都会被问到。问食欲，有时是在问心情。

先说不能等的几件事

睡觉时打鼾伴随呼吸暂停、或被憋醒；白天严重嗜睡，影响驾驶或工作安全——请先就医做检查。

情绪持续低落、焦虑难以控制，或出现伤害自己的念头——这不是可以等的事。请立刻拨打 999，或前往最近的医院急诊部。若想找人谈一谈，卫生部的 Talian HEAL 15555 每天早上 8 时至午夜 12 时开放，包括公共假期；Befrienders KL 24 小时热线：03-7627 2929。您也可以联络您的医生。

完整清单与每一项的理由，见第 8 篇。中医与西医是互相补位的关系，不是二选一。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

一、「心主神明」：为什么睡眠问题会牵到「心」

世界卫生组织的中医术语标准对「心主神明」的说明是：心主宰生命活动，并主管精神、意识与思维活动。

「神」这个字，同一份标准给了三层意思：生命活动的主宰、生命活动的外在表现、精神情志与思维活动。

所以在中医理论里，睡眠问题「主责于心」——这是香港中文大学中西医结合医务中心那篇文章的话。同一篇文章接着说：但五脏六腑都参与阳气入阴的过程；因此医师会细看年龄、性别与生活习惯。（「阳气入阴」是什么意思，在第 2 篇——简单说，是白天那股活跃的力量到了夜里收进安静的那一边；这一句是本文依定义作的整理，不是标准的原句。）

要注意这里说的不是解剖学上的那颗心脏。「心」在上面这些句子里是理论的概念，和西医检查里的心脏不是同一个对象；「肝气」与「心神」两个词的定义，在姐妹篇：压力与睡眠：中医理论中的「肝气」与「心神」是什么。

二、「胃不和则卧不安」：这一句不是比喻

香港中文大学中西医结合医务中心的文章也引用了「胃不和则卧不安」这句话——是在讲胃胀不适与安眠的关系时引用的。

香港卫生署中医药规管办公室的〈中医养生－睡眠篇〉说得具体：晚上进食过饱或饮水太多，会胃中饱胀或夜尿频繁而影响睡眠；过饥则难以入睡。

同一份资料也提到，晚餐有节可以减少夜间起床如厕的次数。

所以在理论里，「胃不和」不是比喻：晚餐太饱、水喝太多、饿着上床，都是它的具体样子。食欲、消化、晚餐时间、夜里起来上厕所的次数，因此都会被问到。

三、所以医师问的是这几样

身体的其他线索：食欲、消化、大小便、有没有心悸、手脚温度。

为什么问：香港中文大学的那篇文章说中医理论认为五脏六腑都参与睡眠，所以整体状态一起看。食欲与消化对应上面第二节的「胃不和则卧不安」；夜里起来上厕所的次数，香港卫生署的睡眠篇把它和晚上饮水太多、进食过饱放在一起。

情绪也会从这里露出来：香港中文大学的文章写道，理论认为过度思虑会使气结、伤脾，导致不思茶饮、影响消化能力。所以问食欲，有时是在问心情。

心悸被问到，是因为理论把睡眠问题「主责于心」，这是上面那篇文章的说法；手脚温度问的是「阳」那一边——世界卫生组织的标准说阳气的性质是温煦。这两句是本文依定义作的整理，不是原句。

情绪与压力本身怎么被问、为什么问，在第 5 篇。

这篇出现的几个词

四个词都来自上面引用的那三份资料。它们是理论的词，不是检查项目。

• 心主神明（xīn zhǔ shén míng）——世界卫生组织的标准说：心主宰生命活动，并主管精神、意识与思维活动。句子里的「心」是理论的概念，不是解剖学上的心脏。
• 神（shén）——同一份标准给了三层意思：生命活动的主宰、生命活动的外在表现、精神情志与思维活动。
• 胃不和则卧不安——香港中文大学那篇文章引用的一句话，用在讲胃胀不适与安眠的关系时。香港卫生署的睡眠篇给了它具体的样子：过饱、饮水太多、过饥。
• 阳气（yáng qì）——世界卫生组织的标准说它的性质包括温煦、推动、兴奋等。问手脚温度，问的是这一边；完整说明在第 2 篇。

常见问题

我睡不好，为什么医师问我大便？ 因为中医理论认为五脏六腑都参与睡眠，所以整体状态一起看——这是香港中文大学那篇文章的说法。夜里起来上厕所的次数，香港卫生署的睡眠篇把它和晚上饮水太多、进食过饱放在一起，所以它和睡眠直接相关。

我有心悸，是不是「心」的问题？ 这一篇说的「心」是理论的概念，不是检查里的心脏；把一个理论名称套到自己身上，是这一篇明确不做的事。心悸如果伴随明显的体重变化、手抖或怕热，第 8 篇把它列为请先就医做检查的情况。

不要这样做： 不要因为这一篇提到「心」，就把自己的心悸当成已经有了解释——那需要检查。

这个系列的另外七篇

• 第 1 篇：问诊是什么、线上怎么看，一次问诊会得到什么
• 第 2 篇：中医理论怎么理解「睡」
• 第 4 篇：问睡眠本身与白天，是在问什么
• 第 5 篇：为什么问情绪、压力和我在吃的药
• 第 6 篇：睡不好，一般怎么做
• 第 7 篇：7 天睡眠记录怎么记、怎么读
• 第 8 篇：什么时候要先看西医

👉 如果您不确定「我这种睡不好，该从哪里谈起」，欢迎透过汉方中医的线上问诊，由依 2016 年 T&CM 法令注册的医师为您评估；若您有本文「先说不能等的几件事」与第 8 篇列出的情况，请先看医生。

无论身在何处，与持证中医师对坐。

汉方现代中医

资料来源

• 世界卫生组织，WHO international standard terminologies on traditional Chinese medicine，2022（ISBN 978-92-4-004232-2），词条 7、73、505 — https://www.who.int/publications/i/item/9789240042322
• 香港中文大学中西医结合医务中心〈失眠因阳气难入阴　拆解4大对象人群〉，发布于 2024 年 1 月 1 日 — https://hkiim.cuhk.edu.hk/imc/tc/press/d/%E5%A4%B1%E7%9C%A0%E5%9B%A0%E9%99%BD%E6%B0%A3%E9%9B%A3%E5%85%A5%E9%99%B0%E3%80%80%E6%8B%86%E8%A7%A34%E5%A4%A7%E5%B0%8D%E8%B1%A1%E4%BA%BA%E7%BE%A4
• 香港卫生署中医药规管办公室〈中医养生－睡眠篇〉（PDF，3 页） — https://www.cmro.gov.hk/files/gb/useful_information/public_health/feature_articles/TCM_019.pdf
• 马来西亚卫生部，Hospital Pendang（吉打州卫生局）Info Kesihatan 2024 — https://jknkedah.moh.gov.my/hpendang/index.php?option=com_sppagebuilder&view=page&id=139
• Befrienders Kuala Lumpur — https://www.befrienders.org.my/