Efficacy of acupuncture, Chinese herbal medicine, combined acupuncture-herbal therapy, and western medication for adult chronic insomnia: a network meta-analysis.

BACKGROUND

Chronic insomnia is a prevalent sleep disorder that significantly impairs quality of life and reduces patient confidence in treatment. Acupuncture, Chinese herbal medicine, and their combination have shown promise in the management of this condition. However, comparative research on these Chinese medicine modalities themselves and vs. Western medication remains scarce.

METHODS

PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and the Chinese Biomedical Literature Database were comprehensively searched from database inception to June 1, 2026. Two reviewers independently screened studies, extracted data, and assessed the risk of bias in the eligible studies. Network meta-analysis was conducted using STATA 16 and R 4.5.3.

RESULTS

Fifty-nine randomized controlled trials (RCTs) involving 4 interventions were included. According to the surface under the cumulative ranking curve (SUCRA) analysis, for total efficacy (TE), acupuncture plus herbal medicine ranked the highest (92.0%), followed by acupuncture (74.7%), herbal medicine (33.1%), and Western medicine (0.2%). For Pittsburgh Sleep Quality Index (PSQI), acupuncture ranked first (82.0%), followed by acupuncture plus herbal medicine (76.8%), herbal medicine (36.4%), and Western medicine (4.9%). For adverse events, where a higher SUCRA indicates fewer events, acupuncture ranked first (78.8%), followed by herbal medicine (76.0%), acupuncture plus herbal medicine (45.2%), and Western medicine (<0.1%).

CONCLUSION

Combination therapy (acupuncture plus herbal medicine) showed the highest probability of being the most effective intervention for total efficacy based on SUCRA analysis, and significantly outperformed Western medication and herbal medicine alone. However, no significant difference was observed between combination therapy and acupuncture alone. Acupuncture alone ranked first for improving sleep quality (PSQI) and minimizing adverse events. Given the methodological limitations of the included studies, high-quality, rigorously designed RCTs are warranted to validate these findings.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420261413406, Identifier CRD420261413406.