Abstract
Insomnia, a common sleep disorder, affects general well-being, hastens the onset of other diseases, and impairs work performance. Hypnotic medications are efficacious in the short term but have obvious side effects. Acupuncture, often used to treat insomnia in traditional Chinese medicine (TCM), is considered to be beneficial in restoring the normal sleep-wake cycle by regulating and restoring the natural flow of qi (energy power). The three main TCM theories for treating insomnia by acupuncture are the tranquilization disturbance, zangfu disturbance (disequilibrium of internal organs), and imbalance of yin and yang theories. Moxibustion, another treatment for insomnia, is usually combined with acupuncture. Acupuncture and moxibustion with tuina (exercise massage), acupuncture with Chinese herbal injection, electroacupuncture, and acupuncture with medication or psychotherapy are other interventions. Some acupuncture-based methods such as needle-rolling acupuncture, auricular acupoint plaster therapy, phlebotomy, and acupoint catgut-embedding therapy are used as well. Although most clinical trials have shown that acupuncture and its combination therapies are significantly effective in insomnia, the beneficial effects may have been overvalued, because of small sample size, nonstrict inclusion and exclusion criteria, flawed methodology, short follow-up, or nonstandardized evaluation. Therefore, clinical studies of high methodological quality are needed to verify the efficacy of acupuncture, moxibustion, and other combination therapies in insomnia.
Highlights
Insomnia is a common sleep disorder; its predominant features are difficulty in initiating or maintaining sleep or nonrestorative sleep [1]
The purpose of this review is to critically examine the efficacy of acupuncture, moxibustion, and other combination therapies as alternative treatments for insomnia
Zangfu Disturbance Theory (Disequilibrium of Internal Organs) In the chapter “Xieke” of one of the earliest traditional Chinese medicine (TCM) books, Huangdi Nei Jing-Linshu (5000 years old), it is stated that insomnia results from zangfu disturbance, so acupuncture should be mainly performed at the acupoints for zangfu
Summary
Insomnia is a common sleep disorder; its predominant features are difficulty in initiating or maintaining sleep or nonrestorative sleep [1]. In traditional Chinese medicine (TCM), the clinical manifestations of insomnia are attributed to deficiency of both the heart and the spleen, and the symptoms are dreamy sleep, palpitation, forgetfulness, lassitude, decreased food intake, postprandial abdominal distension, dull complexion, loose stools, pale tongue proper with thin-white coating, and thread-weak pulse [7]. Hypnotic medications (e.g., benzodiazepine receptor agonists) and cognitive-behavioral therapy (CBT) are the first-line treatments in western medicine [9]. Hypnotic medications are efficacious in the short term but have limited long-term benefits and are associated with side effects such as residual daytime sedation, cognitive impairment, and dependence [10]. Several Chinese clinical trials of acupuncture and moxibustion for insomnia have shown improvements in sleep quality, daytime functioning, and quality of life [15] [16]. The purpose of this review is to critically examine the efficacy of acupuncture, moxibustion, and other combination therapies as alternative treatments for insomnia
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