| Background Insomnia is the most common form of sleep disorder. The prevalence of insomnia symptoms with daytime consequences in the population worldwide was approximately 9-15% (Ohayon, 2002), whereas 8-18% of the population were dissatisfied with their sleep quality and quantity. Evidence supporting the use of Chinese herbal medicine (CHM) and acupuncture for insomnia has been based on anecdotal reports. There has been no systematic review (SR) on the randomized controlled trials (RCTs) of CHM for insomnia. A few SRs of acupuncture for insomnia have been published with various limitations. Thus, it is worth conducting an updated SR to examine the current evidence of CHM and acupuncture for treating insomnia Study Objective 1. To identify the Chinese herbal medicine and acupuncture treatment that are effective in improving quantity and quality of sleep, reducing relapse, enhancing quality of life, and overall functioning; 2. To classify the study results according to the TCM syndromes (證型); 3. To identify the possible mechanism; if reported; 4. To identify possible side effects of Chinese herbal medicine and acupuncture for insomnia. Conclusions 1. Gui Pi Tang was the most commonly used standardized formula, while Suan Zao Ren (Ziziphus jujuba) was the most frequently used single herb. Further studies with a double-blind placebo-controlled design are needed to accurately determine the benefits and risks of CHM for insomnia. 2. Meta-analyses of the moderate-quality RCTs found that acupressure as monotherapy fared marginally better than sham control. Studies that compared auricular acupressure and sham control showed equivocal results. It was also found that acupressure, reflexology, or auricular acupressure as monotherapy or combined with routine care was significantly more efficacious than routine care or no treatment. 3. There was a limited consistency in pattern-based TCM treatment of insomnia across practitioners. Except for Gui Pi Tang, An Shen Ding Zhi Wan, and Wen Dan Tang which were used more commonly for deficiency of both the heart and spleen, internal disturbance of phlegmheat, and qi deficiency of the heart and gallbladder, respectively, the selection of herbal formula for other patterns and patternbased prescription of individual herbs and acupoints were not consistent. Suanzaoren (Semen Z. spinosae), Fuling (Poria), Yejiaoteng (Caulis P. multiflori), Gancao (Radix Glycyrrhizae), Baishao (Radix P. alba), Shenmen (HT7), Yintang (EX-HN3), Sanyinjiao (SP6), Baihui (GV20), Anmian (EX-HN22), and Sishencong (EX-HN1) were commonly used, but nonspecifically for many patterns. |