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Ye Z, Lai H, Ning J, Liu J, Huang J, Yang S, Jin J, Liu Y, Liu J, Zhao H, Ge L. Traditional Chinese medicine for insomnia: Recommendation mapping of the global clinical guidelines. JOURNAL OF ETHNOPHARMACOLOGY 2024; 322:117601. [PMID: 38122913 DOI: 10.1016/j.jep.2023.117601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/07/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Traditional Chinese Medicine (TCM) represents a rich repository of empirically-developed traditional medicines. The findings call for more rigorous study into the efficacy, safety, and mechanisms of action of TCM remedies to strengthen the evidence base. AIM OF THE STUDY To systematically review the quality of insomnia clinical practice guidelines that involve TCM recommendations and to summarize the certainty of evidence supporting the recommendations, strength, and consistency of recommendations, providing valuable research references for the development of future insomnia guidelines. MATERIALS AND METHODS We systematically searched PubMed, Web of Science, Embase, CNKI, Wanfang, Chinese Biomedical Literature Database, Chinese Medical Association, Chinese Sleep Research Society, Medsci, Medlive, British National Institute of Health and Clinical Excellence (NICE), and the International Guidelines Collaboration Network (GIN) for clinical practice guidelines on insomnia from inception to March 5, 2023. Four evaluators conducted independent assessments of the quality of the guidelines by employing the AGREE II tool. Subsequently, the guideline recommendations were consolidated and presented as evidence maps. RESULTS Thirteen clinical practice guidelines addressing insomnia, encompassing 211 recommendations (consisting of 127 evidence-based and 84 expert consensus recommendations), were deemed eligible for inclusion in our analysis. The evaluation results revealed an overall suboptimal quality, with the "scope and purpose" domain achieving the highest score (58.1%), while the "applicability" domain garnered the lowest score (13.0%). Specifically, it was observed that 74.8% (n = 95) of the evidence-based recommendations were supported by evidence of either very low or low certainty, in contrast to the expert consensus recommendations, which accounted for 61.9% (n = 52). We subsequently synthesized 44 recommendations into four evidence maps, focusing on proprietary Chinese medicines, Chinese medicine prescriptions, acupuncture, and massage, respectively. Notably, Chinese herbal remedies and acupuncture exhibited robust support, substantiated by high-certainty evidence, exemplified by interventions such as Xuefu Zhuyu decoction, spleen decoction, body acupuncture, and ear acupuncture, resulting in solid recommendations. Conversely, proprietary Chinese medicines needed more high-certainty evidence, predominantly yielding weak recommendations. As for other therapies, the level of certainty was predominantly categorized as low or very low. Recommendations about magnetic therapy, bathing, and fumigation relied primarily on expert consensus, needing more substantive clinical research evidence, consequently forming weak recommendations. Hot ironing and acupoint injection recommendations were weakly endorsed, primarily based on observational studies. Furthermore, interventions like qigong, gua sha, and moxibustion displayed a relatively limited number of clinical studies, necessitating further exploration to ascertain their efficacy. CONCLUSIONS Our analysis revealed a need for substantial improvement in the quality of all the included guidelines related to insomnia. Notably, recommendations for Traditional Chinese Medicine (TCM) treatments predominantly rely on low-certainty evidence. This study represents a pioneering effort in the utilization of recommendation mapping to both present and identify existing gaps in the evidence landscape within TCM therapies, thus setting the stage for future research initiatives. The evidence supporting TCM therapy recommendations must be fortified to achieve a more substantial level of recommendation and higher certainty. Consequently, there exists a critical and pressing demand for high-quality clinical investigations dedicated to TCM, with a specific focus on ascertaining its long-term efficacy, safety, and potential side effects in the context of insomnia treatment. These endeavors are poised to establish a robust scientific foundation to inform the development of TCM therapy recommendations within the insomnia guidelines.
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Affiliation(s)
- Ziying Ye
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Honghao Lai
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jinling Ning
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jianing Liu
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China
| | - Jiajie Huang
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China
| | - Sihong Yang
- Institute of Basic Research of Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China; China Center for Evidence Based Traditional Chinese Medicine, Beijing, China
| | - Jiayue Jin
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China; Beijing University of Chinese Medicine, Beijing, China
| | - Yajie Liu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jie Liu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hui Zhao
- Institute of Basic Research of Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China; China Center for Evidence Based Traditional Chinese Medicine, Beijing, China.
| | - Long Ge
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China; World Health Organization Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China.
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Salm S, Rutz J, van den Akker M, Blaheta RA, Bachmeier BE. Current state of research on the clinical benefits of herbal medicines for non-life-threatening ailments. Front Pharmacol 2023; 14:1234701. [PMID: 37841934 PMCID: PMC10569491 DOI: 10.3389/fphar.2023.1234701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023] Open
Abstract
Herbal medicines are becoming increasingly popular among patients because they are well tolerated and do not exert severe side effects. Nevertheless, they receive little consideration in therapeutic settings. The present article reviews the current state of research on the clinical benefits of herbal medicines on five indication groups, psychosomatic disorders, gynecological complaints, gastrointestinal disorders, urinary and upper respiratory tract infections. The study search was based on the database PubMed and concentrated on herbal medicines legally approved in Europe. After applying defined inclusion and exclusion criteria, 141 articles were selected: 59 for psychosomatic disorders (100% randomized controlled trials; RCTs), 20 for gynecological complaints (56% RCTs), 19 for gastrointestinal disorders (68% RCTs), 16 for urinary tract infections (UTI, 63% RCTs) and 24 for upper respiratory tract infections (URTI) (79% RCTs). For the majority of the studies, therapeutic benefits were evaluated by patient reported outcome measures (PROs). For psychosomatic disorders, gynecological complaints and URTI more than 80% of the study outcomes were positive, whereas the clinical benefit of herbal medicines for the treatment of UTI and gastrointestinal disorders was lower with 55%. The critical appraisal of the articles shows that there is a lack of high-quality studies and, with regard to gastrointestinal disorders, the clinical benefits of herbal medicines as a stand-alone form of therapy are unclear. According to the current state of knowledge, scientific evidence has still to be improved to allow integration of herbal medicines into guidelines and standard treatment regimens for the indications reviewed here. In addition to clinical data, real world data and outcome measures can add significant value to pave the way for herbal medicines into future therapeutic applications.
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Affiliation(s)
- Sandra Salm
- Institute of Pharmaceutical Biology, Goethe University, Frankfurt, Germany
- Institute of General Practice, Goethe University, Frankfurt, Germany
| | - Jochen Rutz
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Marjan van den Akker
- Institute of General Practice, Goethe University, Frankfurt, Germany
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Public Health and Primary Care, Academic Centre of General Practice, KU Leuven, Leuven, Belgium
| | - Roman A. Blaheta
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
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Wang J, Zhao H, Shi K, Wang M. Treatment of insomnia based on the mechanism of pathophysiology by acupuncture combined with herbal medicine: A review. Medicine (Baltimore) 2023; 102:e33213. [PMID: 36930068 PMCID: PMC10019201 DOI: 10.1097/md.0000000000033213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/15/2023] [Indexed: 03/18/2023] Open
Abstract
Insomnia is a sleep disorder which severely affects patients mood, quality of life and social functioning, serves as a trigger or risk factor to a variety of diseases such as depression, cardiovascular and cerebrovascular diseases, obesity and diabetes, and even increases the risk of suicide, and has become an increasingly widespread concern worldwide. Considerable research on insomnia has been conducted in modern medicine in recent years and encouraging results have been achieved in the fields of genetics and neurobiology. Unfortunately, however, the pathogenesis of insomnia remains elusive to modern medicine, and pharmacological treatment of insomnia has been regarded as conventional. However, in the course of treatment, pharmacological treatment itself is increasingly being questioned due to potential dependence and drug resistance and is now being replaced by cognitive behavior therapy as the first-line treatment. As an important component of complementary and alternative medicine, traditional Chinese medicine, especially non-pharmacological treatment methods such as acupuncture, is gaining increasing attention worldwide. In this article, we discuss the combination of traditional Chinese medicine, acupuncture, and medicine to treat insomnia based on neurobiology in the context of modern medicine.
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Affiliation(s)
- Jie Wang
- Department of Pain, Datong Hospital of Traditional Chinese Medicine, Shanxi Province, Datong, China
| | - Haishen Zhao
- Department of Rehabilitation, Luchaogang Community Health Service Center, Pudong New District, Shanghai, China
| | - Kejun Shi
- Department of Rehabilitation, Luchaogang Community Health Service Center, Pudong New District, Shanghai, China
| | - Manya Wang
- Department of Rehabilitation, Luchaogang Community Health Service Center, Pudong New District, Shanghai, China
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Lee JE, Jung IC, Lee SY, Lim JH, Kim BK, Cho E. The Cost-Effectiveness Analysis of Gamiguibi-Tang versus Hwangryunhaedok-Tang for Patients with Insomnia Disorder Based on a Randomized Controlled Trial. Healthcare (Basel) 2022; 10:healthcare10112157. [PMID: 36360498 PMCID: PMC9690131 DOI: 10.3390/healthcare10112157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/13/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Insomnia is associated with poor quality of life and loss of productivity, and is a significant economic burden on society. Gamiguibi-tang (GGBT) is the most frequently prescribed herbal medicine for insomnia treatment. Hwangryunhaedok-tang (HHT) is used as an insured herbal medicine for insomnia in the Korean National Health Insurance (NHI) system. This study aims to evaluate the cost-effectiveness of GGBT versus HHT in patients with insomnia disorders based on clinical trial data; (2) Methods: The EuroQol five-dimension scale (EQ-5D) was used to estimate quality-adjusted life-years (QALY). Direct and non-direct medical costs and lost productivity costs were estimated. The cost-effectiveness of GGBT was compared with HHT treatments over six weeks from a societal perspective; (3) Results: A total of 81 patients who underwent GGBT (n = 56) and HHT (n = 25) treatment completed the clinical trial. The EQ-5D score improved significantly more in the GGBT than in the HHT group (0.02 vs. −0.03, p < 0.05). The QALYs for six weeks were slightly greater in GGBT (0.0997) than in the HHT group (0.0987); however, the total costs incurred were approximately 9% less in GGBT ($934) than in the HHT group ($1029). GGBT was found to be a more economically dominant treatment option compared to HHT for treating insomnia; (4) Conclusions: Among herbal medicines, GGBT may be a cost-effective option for treating insomnia from a societal perspective in Korea.
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Affiliation(s)
- Ji-Eun Lee
- College of Pharmacy, Sookmyung Women's University, Seoul 04310, Korea
| | - In-Chul Jung
- Department of Oriental Neuropsychiatry, College of Korean Medicine, Daejeon University, Daejeon 34520, Korea
| | - So-Young Lee
- College of Pharmacy, Sookmyung Women's University, Seoul 04310, Korea
| | - Jung-Hwa Lim
- Department of Neuropsychiatry, School of Korean Medicine, Pusan National University Korean Medicine Hospital, Pusan National University, Yangsan 50612, Korea
| | - Bo-Kyung Kim
- Department of Neuropsychiatry, School of Korean Medicine, Pusan National University Korean Medicine Hospital, Pusan National University, Yangsan 50612, Korea
| | - Eun Cho
- College of Pharmacy, Sookmyung Women's University, Seoul 04310, Korea
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Yeo JJ, Lee JW, Kim KS, Hyun MK. Effectiveness of Acupuncture, Mind and Body Practices, and Natural Products for Insomnia: an overview of systematic reviews. J Pharmacopuncture 2022; 25:186-198. [PMID: 36186098 PMCID: PMC9510140 DOI: 10.3831/kpi.2022.25.3.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/02/2022] [Accepted: 08/02/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives This overview summarizes the evidence for the effectiveness and safety of complementary therapies for insomnia through systematic reviews (SRs) and meta-analyses (MAs). Methods A comprehensive literature search on SRs and MAs for complementary therapies for insomnia was conducted using six databases. Results This overview included 30 SRs/MAs. The Pittsburgh Sleep Quality Index (PSQI) analysis of insomnia included 383 randomized controlled trials and 31,748 participants. Twenty-four SRs/MAs (80%) out of 30 SRs/MAs reported a positive result, and six SRs/MAs reported a partially positive result. The most frequently used form of acupuncture reported a positive effect in 89.5% (17/19) of SRs/MAs and a superior effect to western medicine, sham/placebo, and no treatment. The lack of protocol registration and the excluded studies list resulted in generally poor methodological and reporting quality in SRs/MAs with AMSTAR 2. Conclusion This overview confirmed that complementary therapies positively affected the PSQI scores in patients with insomnia. However, better-designed primary studies are needed to strengthen the relevant evidence in the future. A more stringent assessment of multiple systematic reviews 2 must be followed when performing SR and MA.
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Affiliation(s)
- Jin Ju Yeo
- Department of Preventive Medicine, Dongguk University Graduate School of Korean Medicine, Seoul, Republic of Korea
| | - Jang Won Lee
- Department of Preventive Medicine, Dongguk University Graduate School of Korean Medicine, Seoul, Republic of Korea.,Department of Preventive Medicine, College of Korean Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - Kyung Sik Kim
- Department of Korean Medicine, College of Korean Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - Min Kyung Hyun
- Department of Preventive Medicine, College of Korean Medicine, Dongguk University, Gyeongju, Republic of Korea
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Huang S, Huang Q, Zhou Z, Zhang J, Zhan Y, Liang Z. The Efficacy of V. odorata Extract in the Treatment of Insomnia: A Systematic Review and Meta-Analysis. Front Neurol 2022; 13:730311. [PMID: 35734476 PMCID: PMC9207380 DOI: 10.3389/fneur.2022.730311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
Aim This systematic review and meta-analysis was performed to assess the effect of Viola odorata (V. odorata) extract in the treatment of insomnia. Methods PubMed, EMBASE, and Cochrane Library databases, as well as references of related articles, were searched. Finally, four articles with five clinical trials including 224 patients were included in the analysis. Results The obtained results indicated a greater improvement in total PSQI scores (MD,−4.67; P = 0.0002), subjective sleep quality score (MD,−0.91; P = 0.003), sleep duration score (MD,−0.77; P < 0.00001), and ISI score (MD,−6.30; P = 0.009) in the Viola extract group compared with the placebo group. However, the Viola extract group did not significantly differ in sleep latency (MD,−0.85; P = 0.08), habitual sleep efficiency (MD,−0.61; P = 0.21), sleep disturbances (MD,−0.36; P = 0.11), and daytime dysfunction (MD,−0.94; P = 0.12) from the placebo group. Conclusions Viola extract supplement led to a greater improvement in total PSQI scores, subjective sleep quality score, sleep duration score, and ISI score compared with the placebo group of patients with chronic insomnia.
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Affiliation(s)
- Shuangfeng Huang
- The Second Clinical Medical College, Binzhou Medical University, Yantai, China
| | - Qianqian Huang
- Department of Gastroenterology, People's Hospital of Jimo District, Qingdao, China
| | - Zhongbao Zhou
- Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Junliang Zhang
- Department of Neurology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Yan Zhan
- Department of Neurology, Yantai Affiliated Hospital of Binzhou Medical University, The Second Clinical Medical College of Binzhou Medical University, Yantai, China
- Yan Zhan
| | - Zhigang Liang
- Department of Neurology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
- *Correspondence: Zhigang Liang
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Liu Y, Liu Y. Herbal Medicine for Slowing Aging and Cardiovascular Risk: Mechanisms and Safety. Curr Vasc Pharmacol 2020; 18:305-306. [PMID: 32519621 DOI: 10.2174/157016111804200507075606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Yanfei Liu
- Graduate School Beijing, University of Chinese Medicine Beisanhuan North Road Chao Yang District, Beijing, China
| | - Yue Liu
- Cardiovascular Disease Centre, Xiyuan Hospital of China Academy of Chinese Medicine Sciences No.1 of Xiyuan Caochang Road Haidian District, Beijing, China
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