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

title: "Acupuncture and Chinese Herbal Medicine for Chronic Insomnia: What a Network Meta-Analysis Found"

description: "A 59-trial network meta-analysis compares acupuncture, Chinese herbal medicine, their combination, and Western medication for adult chronic insomnia."

date: 2026

type: research-update

study_type: systematic_review

pubmed_id: "42876817"

TL;DR: A network meta-analysis of 59 randomized controlled trials ranked acupuncture plus Chinese herbal medicine highest for total efficacy in adult chronic insomnia, and acupuncture alone highest for sleep quality scores and fewest adverse events. The included trials had methodological limitations, so these rankings are provisional.

What the study found

Chronic insomnia is one of the most common sleep disorders, and it is associated with lower quality of life and reduced patient confidence in treatment. Acupuncture and Chinese herbal medicine are widely used for it, both alone and together, but direct comparisons among these modalities and against Western medication have been limited. This systematic review and network meta-analysis was designed to address that gap, pooling evidence across four intervention arms: acupuncture, Chinese herbal medicine, combined acupuncture and herbal therapy, and Western medication.

The authors searched eight databases, including PubMed, EMBASE, Cochrane Library, Web of Science, and several Chinese-language databases, from inception through June 1, 2026. Two reviewers independently screened studies, extracted data, and assessed risk of bias. The analysis included 59 RCTs. The protocol was registered in PROSPERO (CRD420261413406). Analyses were run in STATA 16 and R 4.5.3, and interventions were ranked using the surface under the cumulative ranking curve (SUCRA), where higher values indicate a higher estimated probability of being the best option on a given outcome.

For total efficacy, acupuncture plus herbal medicine ranked highest (SUCRA 92.0%), followed by acupuncture alone (74.7%), herbal medicine alone (33.1%), and Western medication (0.2%). The combination was significantly better than Western medication and herbal medicine alone, but the authors report no significant difference between the combination and acupuncture alone. This distinction matters: the top ranking of the combination reflects its estimated position, not a demonstrated advantage over acupuncture by itself.

For sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI), the ranking changed. Acupuncture alone ranked first (SUCRA 82.0%), followed by acupuncture plus herbal medicine (76.8%), herbal medicine alone (36.4%), and Western medication (4.9%). Acupuncture alone also ranked first for minimizing adverse events (SUCRA 78.8%), with herbal medicine (76.0%), the combination (45.2%), and Western medication (below 0.1%) following. Because SUCRA for adverse events is scored so that a higher value means fewer events, the Western medication figure indicates that arm carried the most adverse events in the pooled trials.

The authors are explicit that these findings are constrained by the quality of the underlying trials. Many RCTs in this field have small samples, variable reporting of blinding and allocation concealment, and heterogeneous outcome measures, and network meta-analysis inherits these weaknesses. The rankings should therefore be read as hypothesis-generating rather than definitive. The authors call for larger, rigorously designed trials to test them directly.

What this means for you

Study details

Sources

1. Efficacy of acupuncture, Chinese herbal medicine, combined acupuncture-herbal therapy, and western medication for adult chronic insomnia: a network meta-analysis. *Frontiers in Medicine*. PubMed. https://pubmed.ncbi.nlm.nih.gov/42876817/

2. PROSPERO registration CRD420261413406. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420261413406