Background The incidence of insomnia among young males in southern of Hainan is high, but its Traditional Chinese Medicine (TCM) syndromes and their diagnosis and treatment demands remain unclear.

Objective To analyze the distribution of TCM syndromes and medication patterns for insomnia in young males in Southern Hainan.

Methods Young male patients diagnosed with insomnia who were treated in the TCM outpatient department of Hainan Hospital of PLA General Hospital from June 1, 2018, to June 1, 2019, were selected as study subjects. Their diagnostic and treatment information was collected, including age, TCM syndrome classification, prescription details, and herbal medicine usage. Association rule analysis of herbal prescriptions was performed using R language, and high-frequency herb cluster analysis was conducted using SPSS software.

Results Among the 902 patients (aged 30.7±6.2 years), the distribution of TCM syndromes for insomnia was as follows: heart-kidney imbalance (529 cases, 58.6%), liver-fire disturbing the heart (145 cases, 16.1%), heart-spleen deficiency (98 cases, 10.9%), phlegm-heat disturbing the heart (100 cases, 11.1%), and heart-gallbladder deficiency (30 cases, 3.3%). The medication involved 225 Chinese herbal medicines and 27 Chinese patent medicines. The top five most frequently used herbs were Poria, Wild Jujube Seed, Liquorice, Schisandra Berry, and Salvia Root. Herbs with cold properties were the most common (33.9%), the primary flavors were sweet and bitter, and the meridian tropisms primarily involved the liver meridian and heart meridian. Association analysis under the conditions of support ≥20% and confidence ≥80% showed that the combination of Wild Jujube Seed, Salvia Root, and Schisandra Berry had both high support (32.21%) and high confidence (91.94%). Cluster analysis yielded four core herb groups, including Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), Chaihu Longmu Tang (Bupleurum and Dragon Bone Decoction), Fuling Gancao Tang (Poria and Liquorice Decoction), and Zaoren Anshen Jiaonang (Wild Jujube Seed Calming Capsule).

Conclusion Insomnia cases among young males in southern of Hainan primarily present with heart-kidney yin deficiency syndrome in TCM diagnosis, with yin-nourishing and blood-tonifying herbal medicines constituting the core therapeutic approach.