Chen FP, Jong M-S, Chen Y-C, et al. Prescriptions of Chinese herbal medicines for insomnia in Taiwan during 2002. eCAM. 2009; 1-9.

Insomnia, a common health problem, is characterized by the inability to fall asleep, remain asleep, or have nonrestorative sleep. Western medicine therapy for insomnia includes prescribed medications such as benzodiazepines, antidepressants, anticonvulsants, or over-the-counter antihistamines. Chinese herbal medicines (CHMs) are frequently used to treat insomnia. The aim of this study was to explore the frequency and pattern of CHM use in subjects with insomnia for the year 2002 in Taiwan.

In Taiwan, the use of traditional Chinese medicine (TCM) is reimbursed by the National Health Insurance (NHI) program, and people there may choose either practitioners of Western medicine or practitioners of TCM. Because all claims data are available to researchers in an electronic format, say the authors, a large-scale survey of pharmaco-epidemiologic issues is feasible.

The NHI Bureau releases all claims data to the public electronically under the National Health Insurance Research Database (NHIRD) project. The authors obtained the database of TCM claims from NHIRD, including the office-visit files and corresponding prescription files for the year 2002. TCM physicians in Taiwan code for office-visit claims with a diagnosis based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) designation. For this study, the authors chose the data of subjects with a single diagnostic code for insomnia among the recorded TCM visits.

Patient management via TCM often includes a single prescription from a TCM physician that may contain an individual Chinese herb or multiple herbs of various dosages.

Of the 22,520,776 valid NHI beneficiaries at the end of 2002, 6,221,426 subjects (27.6%) used TCM during that year, and 16,134 subjects (0.3%) visited TCM clinics and subsequently used CHMs for insomnia. Among those subjects with insomnia, 29,801 CHM prescriptions were dispensed.

The peak age of the subjects with insomnia treated by TCM was between 40 and 49 years (25.3%), followed by 30 to 39 years (23.8%) and 50 to 59 years (17.0%). Women used CHM for insomnia more frequently than did men.

The authors report that the most common individual Chinese herb prescribed for insomnia was fo-ti (Polygonum multiflorum) [Editor's note: The authors use the term "shou-wu-teng" which is the stem of fo-ti], and the most commonly prescribed Chinese herbal formula prescribed for insomnia was Suan-zao-ren-tang. Fo-ti has been reported to have anti-inflammatory, anti-atherosclerogenic, and neuroprotective effects in animal studies. According to the authors, no clinical research exists in Western literature verifying its sedative or anxiolytic effects. The formula Suan-zao-ren-tang has been used to treat insomnia for centuries. The authors cite a clinical trial which concluded that the formula improved the quality of sleep without significant adverse side effects, as well as several animal studies in which the formula's sedative and hypnotic effects are reported.

The authors report an average of 4.8 Chinese herbs in a single prescription for subjects with insomnia. The most common number of herbal components in the prescribed herbal formulae or individual Chinese herbs for subjects with insomnia was 6 (20.0%), followed by 5 (17.3%) and 3 (15.8%).

The most commonly prescribed CHM drug combination for treating insomnia was Suan-zao-ren-tang with Long-dan-xie-gan-tang, while the most common triple-drug combination was Suan-zao-ren-tang, silk tree (Albizia julibrissin), and fo-ti.

Which Chinese herbal formulae or drugs are the most effective in treating insomnia in clinical practice is unclear, say the authors. Once the effective Chinese herbs for treating insomnia are identified and confirmed in clinical trials, further research can be conducted to identify the bioactive ingredients of these herbs. "The therapeutic effects and safety of these Chinese herbal formulae or individual herbs used in the treatment of insomnia requires further elucidation through efficiency-based clinical studies or well-designed randomized, double-blind, placebo-controlled trials."