Which Chinese herbal formulas ranked best for insomnia?

Which Chinese herbal formulas ranked best for insomnia? What a 2025 network meta-analysis found

A new network meta-analysis (NMA) pooled 186 randomized trials of Chinese herbal medicines (CHM) for insomnia. Unlike a standard meta-analysis that compares two treatments at a time, an NMA compares many options simultaneously and ranks them by probability of being best for key outcomes. This analysis focused on sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI), a commonly reported composite ‘effective rate,’ and adverse events (safety).

Which formulas ranked best for sleep quality (PSQI)?

On the PSQI outcome, the top five by SUCRA (a probability-based ranking measure; higher is better) were:

Rank	Intervention	SUCRA
1	Guipi decoction (Gui Pi Tang)	94.94
2	Shenqi Schisandra tablet (SST)	85.54
3	Chaihu Longgu Muli decoction (CLMD)	85.32
4	Suanzaoren (Ziziphus seed)	84.26
5	Wuling capsule	82.42

These rankings indicate which options had the highest probability of being among the most effective at improving sleep quality across the network. Rankings are not the same as absolute effect sizes; always examine individual trials when possible.

How strong is the evidence? (NMA, briefly)

The review adhered to PRISMA-NMA guidance and synthesized direct and indirect evidence in a Bayesian framework. Across the included studies, the overall risk of bias was characterized as low–to–moderate. Because formulas, comparators, and product compositions vary, treat the SUCRA ranks as probabilistic guidance—not guarantees.

What about the “effective rate” outcome?

The ‘effective rate’ is a composite outcome commonly used in Chinese trials (e.g., thresholds of symptom improvement). On this metric, the top performers were:

1. Longdan Xiegan decoction (LXD)
2. Chaihu Longgu Muli decoction (CLMD)
3. Guipi decoction
4. Huanglian Wendan decoction (HLWDD)
5. Chaihu Shugan powder (CSP)

Safety notes

For adverse events (AEs), Jieyu pill and trazodone ranked among the safest options, with CLMD also in the top tier. Notably, while Shenqi Schisandra tablet (SST) ranked highly for PSQI, it ranked lower on the safety outcome—a reminder to review evidence across all outcomes. Safety in the real world also depends on product quality, ingredient sourcing, dose, and potential herb–drug interactions.

How does PSQI translate to real life?

PSQI scores range from 0 to 21; lower is better. A change around 3 points is often cited as meaningful for individuals, though context matters. The NMA provides relative rankings rather than a single ‘points-better’ number for each head-to-head pairing. Use the rankings to shortlist options, then consult individual trials for absolute PSQI changes and treatment durations.

Dosing and product variability: is there a “best dose”?

There isn’t one standardized ‘best dose’ across all included products. Traditional decoctions specify grams of raw herb equivalents, while modern tablets/capsules often standardize to markers (e.g., lignans in Schisandra, jujubosides in Ziziphus). For consumer products, look for clear Latin names and plant parts, batch certificates of analysis, and reputable GMP manufacturing. Coordinate with a clinician—especially if you use sedatives, antidepressants, anticoagulants, or have liver/kidney conditions.

Context box: What is a network meta-analysis (NMA)?

A network meta-analysis compares many treatments simultaneously by combining direct head‑to‑head trials and indirect comparisons within a single statistical network. It produces relative effects and ranks options using SUCRA, a probability score from 0–100%. Rankings depend on the quality and heterogeneity of the underlying trials and should be interpreted alongside absolute effects.

Bottom line

If you’re building an insomnia resource, prioritize deeper reading on Gui Pi Tang, CLMD, Suanzaoren, Wuling capsule, and—cautiously—Shenqi Schisandra tablet for PSQI. For overall ‘effective rate,’ surface LXD, CLMD, Guipi decoction, HLWDD, and CSP. Treat rankings as a map of options, not prescriptions; product quality and clinical context matter.

FAQ

Is there a single best dose for these formulas?

No. Trials used varied products and regimens. Use brand-specific guidance with clinician oversight, especially if you take sedatives, antidepressants, or other interacting medicines.

How big of a PSQI change matters?

PSQI ranges 0–21; an individual clinically meaningful change is often around 3 points, but context matters. Check absolute changes and durations in specific trials for any product you’re considering.

Are formulas safer than standard hypnotics?

Some formulas ranked well on safety (e.g., CLMD), and many CHM options ranked ahead of several hypnotics on PSQI or effective rate. However, safety depends on product quality and your medications; consult a clinician.

What if I’m already on sleep meds or SSRIs?

Don’t self-combine. Discuss with a clinician—herb–drug interactions and additive sedation are real considerations.

Citation & links

Wang Q, Lu Y, Dang C, Xiong Y, Li W. Medicine (Baltimore). 2025;104(33):e43789.

DOI: Page

Publisher page: Medicine (Baltimore)

Attribution & use notes

This summary is written in original words and presents facts (e.g., rankings) derived from the cited article. Do not copy publisher figures or tables without permission on a commercial website. For verbatim reuse of any figure or table, request permission from the publisher.

“Study overview: network meta-analysis of Chinese herbal medicine for insomnia (Medicine, 2025).”