Efficacy of Traditional Chinese Medicine External Therapies in Treating Insomnia in Patients With Chronic Hepatitis B: Systematic Review and Meta-Analysis

To systematically evaluate the efficacy of traditional Chinese medicine (TCM) external therapies in treating insomnia in patients with chronic hepatitis B (CHB). PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, CQVIP and SinoMed were searched for randomised controlled trials (RCTs) on the treatment of insomnia in patients with CHB using TCM external therapies from the establishment of each database until 31 January 2024. A total of six Chinese articles were included, involving 500 patients. The overall response rate of TCM external therapies for CHB combined with insomnia was superior to that of the control group (odds ratio [OR] = 3.08, 95% confidence interval [CI]: [1.86, 5.12], p < 0.001). Additionally, subgroup analysis showed significant effects of acupuncture (OR = 3.51, 95% CI: [1.80, 6.86], p = 0.001) and other external therapies (OR = 2.58, 95% CI: [1.19, 5.62], p = 0.02). Moreover, TCM external therapies substantially improved the Pittsburgh Sleep Quality Index (mean difference [MD] = −2.08, 95% CI: [−2.86, −1.29], p < 0.001) and the Insomnia Severity Index (MD = −3.17, 95% CI: [−4.07, −2.26], p < 0.001). The group using TCM external therapies showed significantly lower SAS scores than the control group (MD = −6.52, 95% CI: [−12.23, −0.82], p = 0.02). One study reported a higher incidence of adverse reactions in the group treated with TCM external therapies than in the control group (p < 0.05). Another study found that the group treated with TCM external therapies had a significantly lower recurrence rate (15.38%) than the control group (35.90%) (p < 0.05). Traditional Chinese medicine external therapies are clinically effective for CHB combined with insomnia, as they can improve sleep quality and relieve insomnia symptoms.