Acupuncture for senile insomnia: A systematic review of acupuncture point

This study represents a comprehensive and methodologically robust analysis of the acupuncture points used in the treatment of insomnia in older adults, a condition affecting approximately 50% of the geriatric population and associated with serious consequences such as cardiovascular disease, dementia, and significant reduction in quality of life. Senile insomnia is a growing concern given global population aging and the limitations of conventional pharmacologic treatments, which frequently cause dependence, tolerance, and adverse effects in older patients. The investigators conducted a rigorous systematic review, analyzing 265 initial studies from Chinese and international databases, including CNKI, Wanfang, CSTJ, PubMed, and ScienceDirect, applying well-defined inclusion and exclusion criteria that resulted in the final selection of 94 high-quality studies. The methodology used the TCM Inheritance Support System (TCMISS) for advanced statistical analysis, including frequency analysis, association rules, and network topology.

The results revealed a consistent pattern of point selection, with 90 acupuncture points identified across 879 total uses. Shenmen (HT-7) emerged as the most used (68 times), followed by Sanyinjiao (SP-6) with 62 uses and Baihui (GV-20) with 54 uses. This hierarchy reflects the therapeutic logic of traditional Chinese medicine, where Shenmen, as the source point of the Heart meridian, exerts a central sedative function, while Sanyinjiao, the meeting point of the Liver, Spleen, and Kidney meridians, harmonizes multiple organ systems essential for sleep. Meridian analysis showed predominance of the Bladder meridian (167 uses) and the Governor Vessel (92 uses), reflecting the importance of the dorsal Shu points for harmonizing internal organs and the role of the Governor Vessel in regulating bodily Yang.

The anatomical distribution of points showed a preference for the lower limbs (35.4% of selections) and the head and neck region (23.1%), demonstrating balanced application of the principles of proximal and distal point selection in acupuncture. Specific point analysis identified the Five Shu points as the most frequently used (268 uses), followed by source points, indicating that acupuncturists prioritize points with fundamental energetic functions. The most used point combinations were Shenmen-Sanyinjiao (53 times), Shenmen-Baihui (41 times), and Shenmen-Neiguan (39 times), demonstrating that Shenmen forms the therapeutic core, frequently combined with points that nourish Yin, regulate Qi, and calm Shen. Association rule analysis confirmed Shenmen, Neiguan, and Sanyinjiao as the points with the greatest statistical confidence, while network topology analysis identified Sanyinjiao, Zusanli, and Shenmen as central points with the highest combined utilization rate.

Cluster analysis revealed five main therapeutic groups, each representing a specific treatment strategy: Group 1 focuses on tonifying original Qi through Conception Vessel points; Group 2 combines Heart nourishment with Qi regulation; Group 3 harmonizes Yin and Yang through Heart-Kidney coordination; Group 4 strengthens the Spleen and clears phlegm; and Group 5 is based on dorsal Shu points to regulate multiple organs. These findings have significant clinical implications, providing practitioners with a solid scientific basis for point selection in the treatment of senile insomnia. The consistency of results across studies suggests that these protocols are not only theoretically grounded but also clinically validated. The study also demonstrates how acupuncture offers a safe and effective alternative to sedative medications, particularly important for older adults who are more vulnerable to adverse pharmacologic effects.

Limitations include the predominance of Chinese-language studies, possible publication bias, and variability in diagnostic criteria across the analyzed studies. Future research should focus on randomized clinical trials directly comparing the identified protocols and investigating the neurobiological mechanisms underlying the efficacy of these specific points.