title: Effectiveness and safety of moxibustion for primary insomnia: a systematic review and meta-analysis.
abstract: BACKGROUND
  Primary insomnia is a widespread and refractory disease. Moxibustion therapy for insomnia shows some advantages compared with conventional therapies. This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate the effectiveness and safety of moxibustion therapy for insomnia.
  
  
  METHODS
  We conducted a comprehensive literature review of the CENTRAL, PubMed, EMBASE, Web of science, CNKI, VIP, and Wanfang Data databases from their inception to July 2015 for RCTs that compared moxibustion with western medications, oral Chinese medicine, or other methods of traditional Chinese medicine (TCM) in patients with primary insomnia. The primary outcome measure was effective rate and secondary outcome measure was adverse events. Data collection and analysis included risk of bias evaluation, meta-analysis, sensitivity analysis, publication bias and adverse events analysis according to corresponding criteria.
  
  
  RESULTS
  The study included 22 RCTs (1,971 patients). The quality of the studies was low. The overall meta-analysis demonstrated that moxibustion was more effective for insomnia than western medications, oral Chinese medicine and other TCM therapies (RR = 1.17, 95 % CI 1.12 to 1.23, P < 0.00001). Subgroup analyses demonstrated that moxibustion was more effective for insomnia than western medications (RR = 1.16, 95 % CI 1.09 to 1.24, P < 0.00001), oral Chinese medicine (RR = 1.11, 95 % CI 1.04 to 1.18, P = 0.002), and other TCM therapies (RR = 1.22, 95 % CI 1.15 to 1.30, P < 0.00001). There were no serious adverse effects associated with moxibustion therapy for insomnia, and the rate of adverse events was low.
  
  
  CONCLUSIONS
  It is difficult to get the conclusion regarding the effectiveness and safety of moxibustion for primary insomnia due to insufficient evidence, such as the high risk of bias in the included studies, small sample sizes, and few reports on adverse effects. Moxibustion should be considered as a novel therapeutic option for insomnia, and more rigorous clinical trials of moxibustion therapy for insomnia are needed to assess its effects.
authors.affiliation: Guangzhou University of Chinese Medicine, No.12, Jichang Road, Bai Yun District, Guangzhou, Guangdong, 510405, China.
authors.forename: Yu-Jiao
authors.initials: YJ
authors.lastname: Sun
authors.affiliation: Guangdong Hospital of Traditional Chinese Medicine, No.111, Dade Road, Yue Xiu District, Guangzhou, Guangdong, 510120, China.
authors.forename: Jia-Min
authors.initials: JM
authors.lastname: Yuan
authors.affiliation: Guangdong Hospital of Traditional Chinese Medicine, No.111, Dade Road, Yue Xiu District, Guangzhou, Guangdong, 510120, China. yangyo@vip.tom.com.
authors.forename: Zhi-Min
authors.initials: ZM
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008516:Medicine, Chinese Traditional; D008875:Middle Aged; D009071:Moxibustion / Q000009:adverse effects / Q000379:methods / Q000592:standards; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*
keywords: Insomnia; Moxibustion; Systematic Review