Chinese herbal medicine for insomnia: A systematic review and network meta-analysis

Insomnia represents a significant public health issue, with a notable impact on the global burden of disease. Traditional pharmacological interventions, while effective, often entail limitations and adverse effects, necessitating the exploration of alternative therapeutic modalities. Chinese herbal medicines, with their extensive historical use and presumed multifaceted pharmacological actions, emerge as potential candidates for insomnia management.

In strict adherence to the PRISMA-NMA guidelines, we systematically reviewed randomized controlled trials (RCTs) that investigated the therapeutic effects of Chinese herbal medicines on insomnia. The primary outcomes assessed were improvements in sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI), clinical effectiveness rates, and the incidence of adverse reactions. Comprehensive searches were conducted across several databases including MEDLINE, Cochrane Library, EMBASE, Wanfang Data, CNKI, and gray literature. Both direct and indirect evidence was synthesized using Bayesian network meta-analysis techniques to ascertain the relative performance of various herbal interventions.

The analysis included 186 RCTs involving 13 different herbal interventions. Overall, the included studies exhibited a low-to-moderate risk-of-bias. Key findings from our study suggest that for PSQI scores, the top 5 treatments were guipi decoction, shenqi schisandra tablet, chaihu longgu muli decoction (CLMD), suanzaoren, and wuling capsule. Notably, the highest rankings for effective rate were achieved by longdan xiegan decoction, CLMD, guipi decoction, Huanglian Wendan decoction, and chaihu shugan powder. In terms of safety, jieyu pill, trazodone, and CLMD were the top 3, indicating superior safety profiles among all treatments. Crucially, both the PSQI scores and the effective rate, alongside the safety profile of most Chinese herbal medicines, were generally superior to conventional pharmaceutical treatments.

The study provides robust evidence that certain herbal medicines may offer effective and safe alternatives for managing insomnia, potentially reducing the reliance on conventional pharmacological interventions.