Comparative Utility of Acupuncture and Western Medication in the Management of Perimenopausal Insomnia: A Systematic Review and Meta-Analysis

Table 1

Study characteristics of 15 included studies.

Author, year

Group/size

Age (year)

Insomnia duration (m = month, act y = year)

Diagnostic system

TCM syndrome type

Acupuncture interventions

Acupoints

Prescription in control group (Western medication)

Outcome measure tool

Acupuncture/acupuncture + Western medication compared with Western medication

Follow-up

Adverse events

Ma et al. 2017 [42]

(i) EA/n = 37; (ii) Progynova + medroxyprogesterone/n = 36

(i) EA/49.77 ± 2.68; (ii) Progynova + medroxyprogesterone acetate/49.11 ± 2.10

(i) EA/17.70 ± 9.93m; (ii) Progynova + medroxyprogesterone acetate/18.27 ± 8.61 m

CCMD-2

NR

(i) 30 min/day, 3 days/week for 12 weeks; (ii) sparse-dense wave, 2/15 Hz

CV4; EX-CA1; EX-HN3; HT7; SP6; ST25

(i) A total of 3 treatment cycles. Each treatment cycle includes Progynova 1 mg daily for 21 consecutive days (with medroxyprogesterone acetate 10 mg daily added from day 14 to day 21) and then stop medication for 7 days

(i) PSQI; (ii) KI; (iii) MENQOL; (iv) FSH; (v) E2

(i) Compared with Progynova + medroxyprogesterone acetate  < 0.05; (ii) Compared with Progynova + medroxyprogesterone acetate  > 0.05; (iii) Compared with Progynova + medroxyprogesterone acetate  > 0.05; (iv) Compared with Progynova + medroxyprogesterone acetate  > 0.05; (v) Compared with Progynova + medroxyprogesterone acetate  < 0.05

(i) Available data for 3 months follow-up

(i) EA/n = 3 (two for hematoma; one for mild dizziness); (ii) Progynova + medroxyprogesterone acetate/n = 4 (two for breast tenderness; one for mild headache; one for colporrhagia)

Chen et al. 2013 [43]

(i) EA/n = 38; (ii) Alprazolam/n = 32

(i) EA/48.00 ± 6.00; (ii) Alprazolam/48.00 ± 7.00

(i) EA/6.90 ± 0.20 m; (ii) Alprazolam/6.50 ± 0.30 m

DSM-IV, CDTE-TCM

NR

(i) 30 min/day for 20 days (7 days off every 10 days); (ii) Continuous wave, 0.7 Hz

EX, GV20, HT7, KI3, KI7, KI10, LR3, PC6, SP6, SP9, SP10

(i) Alprazolam 0.4 mg/day for 20 days

(i) AIS

(i) Compared with Alprazolam  < 0.05

No follow-up

(i) EA/n = 0; (ii) Estazolam/n = 8 (development of drug dependence after treatment)

Du et al. 2017 [44]

(i) EA/n = 41; (ii) Estazolam/n = 41; (iii) Herbal medicine/n = 41; (iv) EA + Herbal medicine/n = 42

(i) EA/50.17 ± 2.46; (ii) Estazolam/50.45 ± 3.19; (iii) Herbal medicine/49.76 ± 3.05; (iv) EA + Herbal medicine/50.61 ± 2.62

(i) EA/2.33 ± 0.72 y; (ii) Estazolam/2.06 ± 0.85 y; (iii) Herbal medicine/1.93 ± 1.05 y; (iv) EA + Herbal medicine/1.96 ± 0.99 y

CCMD-3

NR

(i) 30 min/day, 6 days/week for 4 weeks; (ii) Continuous wave, >50 Hz

PC6, SP6, Sishenzhen (1.5 Cun apart from GV20), Dingshenzhen (0.5 Cun up to EX-HN3, and 0.5 Cun up to GB14)

(i) Estazolam 1 mg/day, 7 days/week for 4 weeks

(i) PSQI; (ii) KI; (iii) WHOQOL-BREF; (iv) FSH; (v) E2

(i) Compared with Estazolam  < 0.05; (ii) Compared with Estazolam  < 0.05; (iii) Compared with Estazolam  < 0.05; (iv) Compared with Estazolam  < 0.05; (v) Compared with Estazolam  < 0.05

No follow-up

(i) EA/n = 6 (mild tension before EA); (ii) Estazolam/n = 26 (dizziness, daytime sleepiness); (iii) Herbal medicine/n = 4 (gastrointestinal discomfort); (iv) EA + Herbal medicine/n = 8 (gastrointestinal discomfort, mild tension)

Kang 2015 [47]

(i) MA/n = 31; (ii) Estazolam/n = 33

(i) MA/47.50 ± 4.20; (ii) Estazolam/49.20 ± 3.90

(i) MA/15.90 ± 6.70 m; (ii) Estazolam/16.60 ± 6.30 m

CCMD-3

(i) Heart and gallbladder Qi deficiency

(i) 40 min/day, 6 days/week for 4 weeks

EX, EX-HN1, GB13, GB15, GV16, GV20, GV24, scalp acupoint (1 Cun up to GB15)

(i) Estazolam 1 mg/day, 7 days/week for 4 weeks

(i) PSQI; (ii) KI

(i) Compared with Estazolam  < 0.05; (ii) Compared with Estazolam  < 0.01

No follow-up

(i) MA/n = 0; (ii) Estazolam/n = 1 (mild nausea)

Lai 2016 [48]

(i) MA/n = 34; (ii) Eszopiclone/n = 33

(i) MA/51.28 ± 4.19; (ii) Eszopiclone/51.47 ± 4.03

(i) MA/8.33 ± 3.85 m; (ii) Eszopiclone/9.08 ± 3.83 m

CCMD-3, CDTE-TCM

(i) Incoordination between heart and kidney

(i) 30 min/day, 6 days/week for 3 weeks (acupuncture at specific time)

BL62, KI6, LU7, SI3

(i) Eszopiclone 1 mg/day, 7 days/week for 3 weeks

(i) PSQI; (ii) KI

(i) compared with Eszopiclone  > 0.05; (ii) compared with Eszopiclone  < 0.01

No follow-up

(i) MA/n = 2 (hematoma); (ii) Eszopiclone/n = 3 (one for dizziness; two for thirsty)

Li and Wang 2014 [49]

(i) MA/n = 120; (ii) Estazolam/n = 120

(i) MA/48.20 ± 0.00; (ii) Estazolam/47.80 ± 0.00

(i) MA/1.10 ± 0.20 y; (ii) Estazolam/0.80 ± 0.20 y

CCMD-3

NR

(i) 30 min/day for 30 days

SP6, SP8, Shenguan

(i) Estazolam 2 mg/day for 30 days

(i) PSQI

(i) Compared with Estazolam  < 0.01

No follow-up

NR

Li et al. 2018 [50]

(i) MA/n = 60; (ii) Alprazolam/n = 62

(i) MA/51.00 ± 4.00; (ii) Alprazolam/50.00 ± 4.00

(i) MA/11.20 ± 5.20 m; (ii) Alprazolam/10.20 ± 5.30 m

CDTE-TCM

NR

(i) 30–40 min/day, 5 days/week for 9 weeks

BL13, BL15, BL17, BL18, BL20, BL23, HT7

(i) Alprazolam 0.4–0.8 mg/day, 7 days/week for 9 weeks

(i) PSQI; (ii) FSH; (iii) E2; (iv) LH

(i) Compared with Alprazolam  < 0.05; (ii) Compared with Alprazolam  < 0.05; (iii) Compared with Alprazolam  < 0.05; (iv) Compared with Alprazolam  < 0.05

(i) Follow-up 30 days; NR for valid data

NR

Lu et al. 2014 [50]

(i) MA/n = 52; (ii) Estazolam/n = 52

(i) MA/49.70 ± 0.00; (ii) Estazolam/49.30 ± 0.00

(i) MA/3-7m; (ii) Estazolam/2-6m

CCMD-3, ICD-10

NR

(i) 30 min/day for 30 days

(i) CV12, EX-HN1, GB20, GV20, HT7, LR3, LR14, SP6, SP15

(i) Estazolam 1 mg/day for 30 days

(i) PSQI

(i) MA compared with Estazolam  < 0.05

No follow-up

NR

Ma 2014 [46]

(i) EA/n = 45; (ii) Estazolam/n = 45

(i) EA/50.04 ± 2.67; (ii) Estazolam/50.42 ± 2.96

(i) EA/13.36 ± 7.47 m; (ii) Estazolam/13.51 ± 7.76 m

CCMD-2

(i) Excessive Liver fire due to emotional suppression; (ii) Disturbance of heart due to phlegm heat; (iii) Yin deficiency leading to excessive fire; (iv) Heart and spleen deficiency; (v) Heart and gallbladder Qi deficiency

(i) 30 min/day, 3 days/week for 4 weeks; (ii) Continuous wave, >50 Hz

PC6, SP6, Sishenzhen (1.5 Cun apart from GV20), Dingshenzhen (0.5 Cun up to EX-HN3, and 0.5 Cun up to GB14)

(i) Estazolam 1 mg/day, 7 days/week for 4 weeks

(i) PSQI; (ii) HAMD

(i) Compared with Estazolam  < 0.01; (ii) Compared with Estazolam  < 0.01

No follow-up

No adverse events

Qin 2018 [51]

(i) MA/n = 34; (ii) Estazolam/n = 33

(i) MA/51.97 ± 2.27; (ii) Estazolam/50.85 ± 2.77

(i) MA/18.44 ± 7.55 m; (ii) Estazolam/20.58 ± 9.25 m

CCMD-3, ICD-10, CDTE-TCM

(i) Deficiency of kidney and hyperactivity of liver

(i) 30 min/day, 5 days/week for 4 weeks

BL17, BL18, BL23, EX, EX-HN1, GV20, KI3, LR3

(i) Estazolam 1–2 mg/day, 7 days/week for 4 weeks

(i) PSQI; (ii) HAMA; (iii) light-sleep (%); (iv) deep-sleep (%); (v) REM (%); (iii)-(v) are recorded by MSMSMS

(i) Compared with Alprazolam  > 0.05; (ii) Compared with Estazolam  < 0.05; (iii) Compared with Estazolam  < 0.05; (iv) Compared with Estazolam  < 0.05; (v) Compared with Estazolam  < 0.05

No follow-up

(i) MA/n = 3 (hematoma); (ii) Estazolam/n = 7 (two for dizziness; two for daytime sleepiness; three for fatigue)

Yang et al. 2017 [52]

(i) MA/n = 81; (ii) Estazolam/n = 81

(i) MA/48.17 ± 4.12; (ii) Estazolam/49.45 ± 3.98

(i) MA/7.13 ± 1.96 m; (ii) Estazolam/7.53 ± 2.11 m

CCMD-2

(i) Liver and kidney Yin deficiency

(i) 30 min/day, 15 days/month (one treatment every other day) for 3 months

CV12, HT7, KI3, PC6, ST36, ST40, four scalp acupoints (middle 1/3 of frontal apical band, posterior 1/3 of frontal apical band, anterior 1/3 of skull base band, middle 1/3 of skull base band)

(i) Estazolam 1 mg/day, 10 days/month for 3 months

(i) PSQI; (ii) FSH; (iii) E2; (iv) LH

(i) Compared with Estazolam  < 0.05; (ii) Compared with Estazolam  < 0.05; (iii) Compared with Estazolam  < 0.05; (iv) Compared with Estazolam  < 0.05

No follow-up

NR

Zhang et al. 2017 [53]

(i) MA/n = 31; (ii) Estazolam/n = 30

(i) MA/50.45 ± 3.50; (ii) Estazolam/48.97 ± 2.88

(i) MA/20.38 ± 20.53 m; (ii) Estazolam/20.36 ± 20.44 m

GDTICA, CDTE-TCM

(i) six syndromes with liver as the core

(i) 30 min/day, 5 days/week for 4 weeks

BL17, BL18, EX, EX-HN1, GV20, LR3

(i) Estazolam 1 mg/day, 7 days/week for 4 weeks

(i) PSQI; (ii) KI; (iii) HAMA; (iv) HAMD

(i) Compared with Estazolam  < 0.01; (ii) Compared with Estazolam  < 0.05; (iii) Compared with Estazolam  < 0.05; (iv) Compared with Estazolam  < 0.01

No follow-up

(i) MA/n = 1 (hematoma); (ii) Estazolam/n = 1 (two for dizziness, fatigue, and daytime sleepiness; two for memory loss)

Gao and Niu 2014 [54]

(i) MA + Estazolam/n = 32; (ii) Estazolam/n = 32

(i) MA + Estazolam/49.13 ± 2.47; (ii) Estazolam/49.50 ± 2.51

(i) MA + Estazolam/6.00 ± 3.12 m; (ii) Estazolam/5.88 ± 2.70 m

CCMD-3

NR

(i) 20 min/day, 6 days/week for 4 weeks

EX-B2

(i) Estazolam 2 mg/day for 4 weeks

(i) PSQI

(i) Compared with Estazolam  < 0.05

No follow-up

NR

Ma 2016 [55]

(i) MA + Estazolam/n = 35; (ii) Estazolam/n = 35

(i) MA + Estazolam/49.80 ± 3.22; (ii) Estazolam/50.34 ± 2.99

(i) MA + Estazolam/10.74 ± 6.95 m; (ii) Estazolam/10.91 ± 7.19 m

CCMD-3

NR

(i) 7 days/week for 4 weeks (NR for needle retention time)

EX, HT7, KI3, KI7, KI10, LR3, SP6, SP10, ST36

(i) Estazolam 2 mg/day, 7 days/week for 4 weeks

(i) PSQI; (ii) FSH; (iii) E2

(i) Compared with Estazolam  < 0.01; (ii) Compared with Estazolam  < 0.05; (iii) Compared with Estazolam  < 0.05

No follow-up

NR

Zhu et al. 2016 [56]

(i) MA + Estazolam/n = 37; (ii) Estazolam/n = 37

(i) MA + Estazolam/49.86 ± 3.15; (ii) Estazolam/49.27 ± 3.58

(i) MA + Estazolam/2.99 ± 4.24 m; (ii) Estazolam/2.97 ± 3.42 m

CCMD-3

Heart and spleen deficiency

(i) 20 min/day, 5 days/week for 4 weeks (acupuncture at 15 : 00 P.M.-17 : 00 P.M.)

CV12, EX, EX-HN1, GV20, GV24, HT7, KI3, LR3, SP9, ST25

(i) Estazolam 1 mg/day, 5 days/week for 4 weeks

(i) PSQI

(i) Compared with Estazolam  > 0.05

No follow-up

NR

NR, no report; MA, manual acupuncture; EA, electroacupuncture; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition); CCMD-2, Chinese Classification of Mental Disorders (Second Edition); CCMD-3, Chinese Classification of Mental Disorders (Third Edition); ICD-10, International Classification of Diseases (10th edition); GDTICA, Guidelines for Diagnosis and Treatment of Insomnia in Chinese Adults (2012 Edition); CDTE-TCM, Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in TCM; AIS, Athens Insomnia Scale; PSQI, Pittsburgh Sleep Quality Index; KI, Kupperman index; MENQOL, Menopause-Specific Quality of Life; HAMA, Hamilton Anxiety Scale; HAMD, Hamilton Depression Scale; WHOQOL-BREF, World Health Organization’s quality of life scale-brief form questionnaire; MSMSMS, micromovement sensitive mattress sleep monitoring system; REM, Rapid eye movement sleep; FSH, follicle stimulating hormone; LH, luteinizing hormone; E2, estradiol; Progynova, Progynova (estradiol valerate tablets); BL13, Feishu; BL15, Xinshu; BL17, Geshu; BL18, Ganshu; BL20, Pishu; BL23, Shenshu; BL62, Shenmai; CV4, Guanyuan; CV12, Zhongwan; EX, Anmian; EX-B2, Jiaji; EX-CA1, Zigong; EX-HN1, Sishencong; EX-HN3, Yintang; GB13, Benshen; GB14,Yangbai; GB15, Toulinqi; GB20, Fengchi; GV14, Dazhui; GV16, Fengfu; GV20, Baihui; GV24, Shenting; HT7, Shenmen; KI3, Taixi; KI6, Zhaohai; KI7, Fuliu; KI10, Yingu; LR3, Taichong; LR14, Qimen; LU7, Lieque; PC6, Neiguan; SI3, Houxi; SP6, Sanyinjiao; SP8, Diji; SP9, Yinlingquan; SP10, Xuehai; SP15, Daheng; ST25, Tianshu; ST36, Zusanli; ST40, Fenglong; Shenguan, Tianhuangfuxue; six syndromes with liver as the core (liver stagnation (stasis); excessive liver fire due to emotional suppression; disturbance of liver Yang; deficiency of kidney and hyperactivity of liver; liver depression invading the stomach; liver depression invading the heart).