Effectiveness and safety of moxibustion for primary insomnia: a systematic review and meta-analysis

Insomnia is a sleep disorder that affects millions of people worldwide, characterized by difficulty falling asleep, maintaining sleep, or experiencing nonrestorative sleep. In industrialized countries, it is estimated that between 23% and 56% of the population suffers from this disorder, causing not only nighttime discomfort but also significant daytime consequences. Insomnia can lead to memory problems, depression, irritability, and increase the risk of cardiovascular disease, hypertension, and accidents. It also significantly compromises quality of life, affecting performance at work and in daily activities.

Despite its high prevalence, insomnia is still underdiagnosed and undertreated, with many people not seeking adequate medical care.

Conventional treatment for insomnia generally involves sedative medications and cognitive behavioral therapy. Although medications can be effective in the short term, their prolonged use is associated with a number of adverse effects, such as alterations in sleep architecture, rebound insomnia, dependence, and memory impairment. Cognitive behavioral therapy, in turn, is not always available because of the shortage of qualified therapists and the high costs. Given these limitations, many people seek alternative treatments, including traditional Chinese medicine.

Moxibustion, a technique that uses the burning of herbs over specific points on the body, has shown potential as a therapeutic alternative for insomnia in some Chinese studies, but its efficacy had not yet been systematically evaluated.

This study aimed to rigorously assess the efficacy and safety of moxibustion in the treatment of primary insomnia through a systematic review and meta-analysis. The researchers conducted a comprehensive search of several scientific databases, including PubMed, EMBASE, and Chinese databases, from inception through July 2015. Only randomized controlled trials comparing moxibustion with Western medications, oral Chinese medications, or other traditional Chinese medicine therapies in patients with primary insomnia were included. The primary outcome analyzed was the treatment efficacy rate, defined as the proportion of participants who showed improvement in sleep quality based on established criteria for evaluating insomnia treatment.

The secondary outcome was the occurrence of adverse events associated with moxibustion treatment.

A total of 22 randomized clinical trials were identified and analyzed, involving 1,971 patients. Of these, five studies compared moxibustion with Western medications, six compared it with oral Chinese medications, and eleven compared it with other traditional Chinese medicine therapies, such as acupuncture and massage. The overall analysis demonstrated that moxibustion was more effective for insomnia than all other treatment modalities tested, with a risk ratio of 1.17, indicating a 17% greater probability of improvement with moxibustion. When analyzed separately, the results showed that moxibustion was superior to Western medications, oral Chinese medications, and other traditional Chinese medicine therapies.

With regard to safety, only three studies reported adverse events, which were rare and mild, suggesting that moxibustion is a relatively safe therapy for insomnia.

Although the results suggest that moxibustion may be a promising therapeutic option for patients with insomnia, these findings should be interpreted with caution. The findings indicate that patients treated with moxibustion are more likely to experience improvement in sleep quality compared with those treated with conventional medications or other traditional therapies. This is particularly relevant given that moxibustion had a low incidence of adverse effects, unlike sedative medications, which often cause dependence, daytime drowsiness, and other unwanted effects. For health care professionals, these results suggest that moxibustion could be considered as an alternative or complement to conventional treatments, especially for patients who do not respond well to medications or who wish to avoid their adverse effects.

However, this study has important limitations that should be considered. The methodological quality of the included studies was deemed low, with a high risk of bias in several crucial aspects of the clinical research. Many studies did not adequately describe randomization methods, did not use appropriate techniques for blinding of participants and assessors, and did not provide sufficient information on how dropouts during treatment were handled. In addition, significant publication bias was detected, meaning that studies with negative results may not have been published, artificially inflating the observed benefits.

Only three studies reported safety data, limiting the ability to fully assess the adverse-event profile of moxibustion.

In conclusion, although this study suggests that moxibustion may be an effective and safe therapeutic option for primary insomnia, the available evidence is still insufficient to draw definitive conclusions about its efficacy and safety. The authors emphasize the need for more rigorous clinical studies, with better methodological quality, larger samples, and more detailed reporting of adverse events. For patients considering moxibustion as a treatment option, it is advisable to discuss with qualified health care professionals, weighing both the potential benefits and the limitations of the current evidence. Moxibustion should be viewed as a promising therapeutic option that warrants further investigation, but not as a treatment definitively shown to be superior to established conventional therapies.