Table 1.
Study characteristics of 15 included studies.
| Author, year | Group/size | Age (year) | Insomnia duration (m = month, act y = year) | Diagnostic system | TCM syndrome type | Acupuncture interventions | Acupoints | Prescription in control group (Western medication) | Outcome measure tool | Acupuncture/acupuncture + Western medication compared with Western medication | Follow-up | Adverse events |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Ma et al. 2017 [42] | (i) EA/n = 37 (ii) Progynova + medroxyprogesterone/n = 36 |
(i) EA/49.77 ± 2.68 (ii) Progynova + medroxyprogesterone acetate/49.11 ± 2.10 |
(i) EA/17.70 ± 9.93m (ii) Progynova + medroxyprogesterone acetate/18.27 ± 8.61 m |
CCMD-2 | NR | (i) 30 min/day, 3 days/week for 12 weeks (ii) sparse-dense wave, 2/15 Hz |
CV4; EX-CA1; EX-HN3; HT7; SP6; ST25 | (i) A total of 3 treatment cycles. Each treatment cycle includes Progynova 1 mg daily for 21 consecutive days (with medroxyprogesterone acetate 10 mg daily added from day 14 to day 21) and then stop medication for 7 days | (i) PSQI (ii) KI (iii) MENQOL (iv) FSH (v) E2 |
(i) Compared with Progynova + medroxyprogesterone acetate p < 0.05 (ii) Compared with Progynova + medroxyprogesterone acetate p > 0.05 (iii) Compared with Progynova + medroxyprogesterone acetate p > 0.05 (iv) Compared with Progynova + medroxyprogesterone acetate p > 0.05 (v) Compared with Progynova + medroxyprogesterone acetate p < 0.05 |
(i) Available data for 3 months follow-up | (i) EA/n = 3 (two for hematoma; one for mild dizziness) (ii) Progynova + medroxyprogesterone acetate/n = 4 (two for breast tenderness; one for mild headache; one for colporrhagia) |
| Chen et al. 2013 [43] | (i) EA/n = 38 (ii) Alprazolam/n = 32 |
(i) EA/48.00 ± 6.00 (ii) Alprazolam/48.00 ± 7.00 |
(i) EA/6.90 ± 0.20 m (ii) Alprazolam/6.50 ± 0.30 m |
DSM-IV, CDTE-TCM | NR | (i) 30 min/day for 20 days (7 days off every 10 days) (ii) Continuous wave, 0.7 Hz |
EX, GV20, HT7, KI3, KI7, KI10, LR3, PC6, SP6, SP9, SP10 | (i) Alprazolam 0.4 mg/day for 20 days | (i) AIS | (i) Compared with Alprazolam p < 0.05 | No follow-up | (i) EA/n = 0 (ii) Estazolam/n = 8 (development of drug dependence after treatment) |
| Du et al. 2017 [44] | (i) EA/n = 41 (ii) Estazolam/n = 41 (iii) Herbal medicine/n = 41 (iv) EA + Herbal medicine/n = 42 |
(i) EA/50.17 ± 2.46 (ii) Estazolam/50.45 ± 3.19 (iii) Herbal medicine/49.76 ± 3.05 (iv) EA + Herbal medicine/50.61 ± 2.62 |
(i) EA/2.33 ± 0.72 y (ii) Estazolam/2.06 ± 0.85 y (iii) Herbal medicine/1.93 ± 1.05 y (iv) EA + Herbal medicine/1.96 ± 0.99 y |
CCMD-3 | NR | (i) 30 min/day, 6 days/week for 4 weeks (ii) Continuous wave, >50 Hz |
PC6, SP6, Sishenzhen (1.5 Cun apart from GV20), Dingshenzhen (0.5 Cun up to EX-HN3, and 0.5 Cun up to GB14) | (i) Estazolam 1 mg/day, 7 days/week for 4 weeks | (i) PSQI (ii) KI (iii) WHOQOL-BREF (iv) FSH (v) E2 |
(i) Compared with Estazolam p < 0.05 (ii) Compared with Estazolam p < 0.05 (iii) Compared with Estazolam p < 0.05 (iv) Compared with Estazolam p < 0.05 (v) Compared with Estazolam p < 0.05 |
No follow-up | (i) EA/n = 6 (mild tension before EA) (ii) Estazolam/n = 26 (dizziness, daytime sleepiness) (iii) Herbal medicine/n = 4 (gastrointestinal discomfort) (iv) EA + Herbal medicine/n = 8 (gastrointestinal discomfort, mild tension) |
| Kang 2015 [47] | (i) MA/n = 31 (ii) Estazolam/n = 33 |
(i) MA/47.50 ± 4.20 (ii) Estazolam/49.20 ± 3.90 |
(i) MA/15.90 ± 6.70 m (ii) Estazolam/16.60 ± 6.30 m |
CCMD-3 | (i) Heart and gallbladder Qi deficiency | (i) 40 min/day, 6 days/week for 4 weeks | EX, EX-HN1, GB13, GB15, GV16, GV20, GV24, scalp acupoint (1 Cun up to GB15) | (i) Estazolam 1 mg/day, 7 days/week for 4 weeks | (i) PSQI (ii) KI |
(i) Compared with Estazolam p < 0.05 (ii) Compared with Estazolam p < 0.01 |
No follow-up | (i) MA/n = 0 (ii) Estazolam/n = 1 (mild nausea) |
| Lai 2016 [48] | (i) MA/n = 34 (ii) Eszopiclone/n = 33 |
(i) MA/51.28 ± 4.19 (ii) Eszopiclone/51.47 ± 4.03 |
(i) MA/8.33 ± 3.85 m (ii) Eszopiclone/9.08 ± 3.83 m |
CCMD-3, CDTE-TCM | (i) Incoordination between heart and kidney | (i) 30 min/day, 6 days/week for 3 weeks (acupuncture at specific time) | BL62, KI6, LU7, SI3 | (i) Eszopiclone 1 mg/day, 7 days/week for 3 weeks | (i) PSQI (ii) KI |
(i) compared with Eszopiclone p > 0.05 (ii) compared with Eszopiclone p < 0.01 |
No follow-up | (i) MA/n = 2 (hematoma) (ii) Eszopiclone/n = 3 (one for dizziness; two for thirsty) |
| Li and Wang 2014 [49] | (i) MA/n = 120 (ii) Estazolam/n = 120 |
(i) MA/48.20 ± 0.00 (ii) Estazolam/47.80 ± 0.00 |
(i) MA/1.10 ± 0.20 y (ii) Estazolam/0.80 ± 0.20 y |
CCMD-3 | NR | (i) 30 min/day for 30 days | SP6, SP8, Shenguan | (i) Estazolam 2 mg/day for 30 days | (i) PSQI | (i) Compared with Estazolam p < 0.01 | No follow-up | NR |
| Li et al. 2018 [50] | (i) MA/n = 60 (ii) Alprazolam/n = 62 |
(i) MA/51.00 ± 4.00 (ii) Alprazolam/50.00 ± 4.00 |
(i) MA/11.20 ± 5.20 m (ii) Alprazolam/10.20 ± 5.30 m |
CDTE-TCM | NR | (i) 30–40 min/day, 5 days/week for 9 weeks | BL13, BL15, BL17, BL18, BL20, BL23, HT7 | (i) Alprazolam 0.4–0.8 mg/day, 7 days/week for 9 weeks | (i) PSQI (ii) FSH (iii) E2 (iv) LH |
(i) Compared with Alprazolam p < 0.05 (ii) Compared with Alprazolam p < 0.05 (iii) Compared with Alprazolam p < 0.05 (iv) Compared with Alprazolam p < 0.05 |
(i) Follow-up 30 days; NR for valid data | NR |
| Lu et al. 2014 [50] | (i) MA/n = 52 (ii) Estazolam/n = 52 |
(i) MA/49.70 ± 0.00 (ii) Estazolam/49.30 ± 0.00 |
(i) MA/3-7m (ii) Estazolam/2-6m |
CCMD-3, ICD-10 | NR | (i) 30 min/day for 30 days | (i) CV12, EX-HN1, GB20, GV20, HT7, LR3, LR14, SP6, SP15 | (i) Estazolam 1 mg/day for 30 days | (i) PSQI | (i) MA compared with Estazolam p < 0.05 | No follow-up | NR |
| Ma 2014 [46] | (i) EA/n = 45 (ii) Estazolam/n = 45 |
(i) EA/50.04 ± 2.67 (ii) Estazolam/50.42 ± 2.96 |
(i) EA/13.36 ± 7.47 m (ii) Estazolam/13.51 ± 7.76 m |
CCMD-2 | (i) Excessive Liver fire due to emotional suppression (ii) Disturbance of heart due to phlegm heat (iii) Yin deficiency leading to excessive fire (iv) Heart and spleen deficiency (v) Heart and gallbladder Qi deficiency |
(i) 30 min/day, 3 days/week for 4 weeks (ii) Continuous wave, >50 Hz |
PC6, SP6, Sishenzhen (1.5 Cun apart from GV20), Dingshenzhen (0.5 Cun up to EX-HN3, and 0.5 Cun up to GB14) | (i) Estazolam 1 mg/day, 7 days/week for 4 weeks | (i) PSQI (ii) HAMD |
(i) Compared with Estazolam p < 0.01 (ii) Compared with Estazolam p < 0.01 |
No follow-up | No adverse events |
| Qin 2018 [51] | (i) MA/n = 34 (ii) Estazolam/n = 33 |
(i) MA/51.97 ± 2.27 (ii) Estazolam/50.85 ± 2.77 |
(i) MA/18.44 ± 7.55 m (ii) Estazolam/20.58 ± 9.25 m |
CCMD-3, ICD-10, CDTE-TCM | (i) Deficiency of kidney and hyperactivity of liver | (i) 30 min/day, 5 days/week for 4 weeks | BL17, BL18, BL23, EX, EX-HN1, GV20, KI3, LR3 | (i) Estazolam 1–2 mg/day, 7 days/week for 4 weeks | (i) PSQI (ii) HAMA (iii) light-sleep (%) (iv) deep-sleep (%) (v) REM (%) (iii)-(v) are recorded by MSMSMS |
(i) Compared with Alprazolam p > 0.05 (ii) Compared with Estazolam p < 0.05 (iii) Compared with Estazolam p < 0.05 (iv) Compared with Estazolam p < 0.05 (v) Compared with Estazolam p < 0.05 |
No follow-up | (i) MA/n = 3 (hematoma) (ii) Estazolam/n = 7 (two for dizziness; two for daytime sleepiness; three for fatigue) |
| Yang et al. 2017 [52] | (i) MA/n = 81 (ii) Estazolam/n = 81 |
(i) MA/48.17 ± 4.12 (ii) Estazolam/49.45 ± 3.98 |
(i) MA/7.13 ± 1.96 m (ii) Estazolam/7.53 ± 2.11 m |
CCMD-2 | (i) Liver and kidney Yin deficiency | (i) 30 min/day, 15 days/month (one treatment every other day) for 3 months | CV12, HT7, KI3, PC6, ST36, ST40, four scalp acupoints (middle 1/3 of frontal apical band, posterior 1/3 of frontal apical band, anterior 1/3 of skull base band, middle 1/3 of skull base band) | (i) Estazolam 1 mg/day, 10 days/month for 3 months | (i) PSQI (ii) FSH (iii) E2 (iv) LH |
(i) Compared with Estazolam p < 0.05 (ii) Compared with Estazolam p < 0.05 (iii) Compared with Estazolam p < 0.05 (iv) Compared with Estazolam p < 0.05 |
No follow-up | NR |
| Zhang et al. 2017 [53] | (i) MA/n = 31 (ii) Estazolam/n = 30 |
(i) MA/50.45 ± 3.50 (ii) Estazolam/48.97 ± 2.88 |
(i) MA/20.38 ± 20.53 m (ii) Estazolam/20.36 ± 20.44 m |
GDTICA, CDTE-TCM | (i) six syndromes with liver as the core | (i) 30 min/day, 5 days/week for 4 weeks | BL17, BL18, EX, EX-HN1, GV20, LR3 | (i) Estazolam 1 mg/day, 7 days/week for 4 weeks | (i) PSQI (ii) KI (iii) HAMA (iv) HAMD |
(i) Compared with Estazolam p < 0.01 (ii) Compared with Estazolam p < 0.05 (iii) Compared with Estazolam p < 0.05 (iv) Compared with Estazolam p < 0.01 |
No follow-up | (i) MA/n = 1 (hematoma) (ii) Estazolam/n = 1 (two for dizziness, fatigue, and daytime sleepiness; two for memory loss) |
| Gao and Niu 2014 [54] | (i) MA + Estazolam/n = 32 (ii) Estazolam/n = 32 |
(i) MA + Estazolam/49.13 ± 2.47 (ii) Estazolam/49.50 ± 2.51 |
(i) MA + Estazolam/6.00 ± 3.12 m (ii) Estazolam/5.88 ± 2.70 m |
CCMD-3 | NR | (i) 20 min/day, 6 days/week for 4 weeks | EX-B2 | (i) Estazolam 2 mg/day for 4 weeks | (i) PSQI | (i) Compared with Estazolam p < 0.05 | No follow-up | NR |
| Ma 2016 [55] | (i) MA + Estazolam/n = 35 (ii) Estazolam/n = 35 |
(i) MA + Estazolam/49.80 ± 3.22 (ii) Estazolam/50.34 ± 2.99 |
(i) MA + Estazolam/10.74 ± 6.95 m (ii) Estazolam/10.91 ± 7.19 m |
CCMD-3 | NR | (i) 7 days/week for 4 weeks (NR for needle retention time) | EX, HT7, KI3, KI7, KI10, LR3, SP6, SP10, ST36 | (i) Estazolam 2 mg/day, 7 days/week for 4 weeks | (i) PSQI (ii) FSH (iii) E2 |
(i) Compared with Estazolam p < 0.01 (ii) Compared with Estazolam p < 0.05 (iii) Compared with Estazolam p < 0.05 |
No follow-up | NR |
| Zhu et al. 2016 [56] | (i) MA + Estazolam/n = 37 (ii) Estazolam/n = 37 |
(i) MA + Estazolam/49.86 ± 3.15 (ii) Estazolam/49.27 ± 3.58 |
(i) MA + Estazolam/2.99 ± 4.24 m (ii) Estazolam/2.97 ± 3.42 m |
CCMD-3 | Heart and spleen deficiency | (i) 20 min/day, 5 days/week for 4 weeks (acupuncture at 15 : 00 P.M.-17 : 00 P.M.) | CV12, EX, EX-HN1, GV20, GV24, HT7, KI3, LR3, SP9, ST25 | (i) Estazolam 1 mg/day, 5 days/week for 4 weeks | (i) PSQI | (i) Compared with Estazolam p > 0.05 | No follow-up | NR |
NR, no report; MA, manual acupuncture; EA, electroacupuncture; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition); CCMD-2, Chinese Classification of Mental Disorders (Second Edition); CCMD-3, Chinese Classification of Mental Disorders (Third Edition); ICD-10, International Classification of Diseases (10th edition); GDTICA, Guidelines for Diagnosis and Treatment of Insomnia in Chinese Adults (2012 Edition); CDTE-TCM, Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in TCM; AIS, Athens Insomnia Scale; PSQI, Pittsburgh Sleep Quality Index; KI, Kupperman index; MENQOL, Menopause-Specific Quality of Life; HAMA, Hamilton Anxiety Scale; HAMD, Hamilton Depression Scale; WHOQOL-BREF, World Health Organization's quality of life scale-brief form questionnaire; MSMSMS, micromovement sensitive mattress sleep monitoring system; REM, Rapid eye movement sleep; FSH, follicle stimulating hormone; LH, luteinizing hormone; E2, estradiol; Progynova, Progynova (estradiol valerate tablets); BL13, Feishu; BL15, Xinshu; BL17, Geshu; BL18, Ganshu; BL20, Pishu; BL23, Shenshu; BL62, Shenmai; CV4, Guanyuan; CV12, Zhongwan; EX, Anmian; EX-B2, Jiaji; EX-CA1, Zigong; EX-HN1, Sishencong; EX-HN3, Yintang; GB13, Benshen; GB14,Yangbai; GB15, Toulinqi; GB20, Fengchi; GV14, Dazhui; GV16, Fengfu; GV20, Baihui; GV24, Shenting; HT7, Shenmen; KI3, Taixi; KI6, Zhaohai; KI7, Fuliu; KI10, Yingu; LR3, Taichong; LR14, Qimen; LU7, Lieque; PC6, Neiguan; SI3, Houxi; SP6, Sanyinjiao; SP8, Diji; SP9, Yinlingquan; SP10, Xuehai; SP15, Daheng; ST25, Tianshu; ST36, Zusanli; ST40, Fenglong; Shenguan, Tianhuangfuxue; six syndromes with liver as the core (liver stagnation (stasis); excessive liver fire due to emotional suppression; disturbance of liver Yang; deficiency of kidney and hyperactivity of liver; liver depression invading the stomach; liver depression invading the heart).