{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T05:00:03Z","timestamp":1790312403769,"version":"4.1.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Insomnia causes daytime impairment and reduced quality of life. We evaluated the comparative efficacy and safety of Traditional Chinese Medicine (TCM) treatment strategies for insomnia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Nine databases (PubMed, Embase, Web of Science, Cochrane CENTRAL,\n                      <jats:uri>ClinicalTrials.gov<\/jats:uri>\n                      , CNKI, Wanfang, VIP, SinoMed) were searched through January 2026 for randomized controlled trials (RCTs). Primary outcomes were ISI and PSQI scores; secondary outcomes included clinical efficacy and adverse events (AEs). Data were synthesized using frequentist network meta-analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twelve RCTs involving 1,260 participants were included, evaluating five strategy nodes: TCM alone, TCM plus Western medicine (WM), WM alone, placebo, and CBT-I. For ISI, TCM plus WM ranked highest (SUCRA 89.7%) and significantly improved scores versus placebo (OR 2.84, 95% CI 1.42\u20135.68) and WM (OR 1.96, 95% CI 1.08\u20133.56). For PSQI, TCM plus WM showed the highest probability of improvement (SUCRA 71.9%) with greater reduction versus placebo (MD\u202f\u22122.31, 95% CI\u202f\u22123.65 to \u22120.97). For clinical efficacy, SUCRA values were 86.6% for TCM plus WM, 77.2% for TCM, 20.9% for WM, and 15.3% for placebo. For AEs (higher SUCRA indicating better safety), SUCRA values were 94.8% for WM, 43.9% for TCM plus WM, 31.1% for placebo, and 30.2% for TCM. Sensitivity analysis excluding secondary insomnia confirmed robust findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Integrated TCM-WM and TCM therapies demonstrate clinical efficacy and acceptable safety for insomnia management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      The review protocol was prospectively registered in the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) (Registration number: INPLASY202680041; DOI:\n                      <jats:ext-link>10.37766\/inplasy2026.8.0041<\/jats:ext-link>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1912776","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:27:26Z","timestamp":1790310446000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative effectiveness of traditional Chinese medicine treatment strategies for insomnia: a systematic review and network meta-analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Yan","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Neurology and Geriatrics, Changsha Hospital of Traditional Chinese Medicine (Changsha No. 8 Hospital)","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiuying","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology and Geriatrics, Changsha Hospital of Traditional Chinese Medicine (Changsha No. 8 Hospital)","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaqin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurology and Geriatrics, Changsha Hospital of Traditional Chinese Medicine (Changsha No. 8 Hospital)","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanfang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology and Geriatrics, Changsha Hospital of Traditional Chinese Medicine (Changsha No. 8 Hospital)","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yini","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurology and Geriatrics, Changsha Hospital of Traditional Chinese Medicine (Changsha No. 8 Hospital)","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2653","DOI":"10.1001\/jama.2012.6219","article-title":"JAMA patient page. Insomnia","volume":"307","author":"Punnoose","year":"2012","journal-title":"JAMA"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"18","DOI":"10.5005\/jp-journals-10069-0131","article-title":"Insomnia: an update on epidemiology, diagnosis and non-pharmacological management","volume":"19","author":"Francis","year":"2024","journal-title":"Indian J Sleep Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"ITC33","DOI":"10.7326\/AITC202103160","article-title":"Insomnia","volume":"174","author":"Sutton","year":"2021","journal-title":"Ann Intern Med"},{"key":"ref4","first-page":"227","article-title":"A review on insomnia: the sleep disorder","volume":"7","author":"Devi","year":"2018","journal-title":"Pharma Innov J"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"75","DOI":"10.14423\/SMJ.0000000000000769","article-title":"Cognitive Behavioral therapy in the treatment of insomnia","volume":"111","author":"Haynes","year":"2018","journal-title":"South Med 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Rev"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"101193","DOI":"10.1016\/j.eujim.2020.101193","article-title":"Hong Kong Chinese medicine clinical practice guideline for insomnia","volume":"39","author":"Zhong","year":"2020","journal-title":"Eur J Integr Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1089\/acm.2018.0249","article-title":"Traditional use of Chinese herbal medicine for insomnia and priorities setting of future clinical research","volume":"25","author":"Ni","year":"2019","journal-title":"J Altern Complement Med"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"102186","DOI":"10.1016\/j.ctim.2019.08.020","article-title":"Clinical effectiveness of Tui Na for insomnia compared with estazolam: a systematic review and meta-analysis of randomized controlled trials","volume":"47","author":"Feng","year":"2019","journal-title":"Complement Ther 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