A comprehensive review of the scientific literature from 2015 to 2025 has catalogued the pharmacological mechanisms through which traditional Chinese medicine (TCM) treats sleep disorders, identifying four major regulatory pathways involving central nervous system neurotransmitters, sleep-related cytokines, hypothalamic-pituitary-adrenal (HPA) axis hormones, and the gut microbiome.
Published in Phytomedicine by researchers from Jilin Agricultural University, Yanbian University, and Jilin University, the review covers active components from herbal medicines, Chinese patent medicines, and classical TCM prescriptions. It focuses primarily on insomnia, which frequently presents alongside depression and anxiety.
Key findings
The review synthesized studies on dozens of TCM compounds and formulations. It found that their sleep-promoting effects operate through parallel mechanisms:
Neurotransmitter regulation. Many TCM constituents modulate CNS neurotransmitter systems central to sleep-wake regulation, including gamma-aminobutyric acid (GABA), serotonin, dopamine, and norepinephrine. Ziziphi Spinosae Semen (suan zao ren), one of the most widely studied herbs, acts on GABA-A receptors with effects comparable to benzodiazepines in preclinical models but with a broader therapeutic window.
Sleep-related cytokines. Several herbal compounds influence inflammatory cytokine profiles, reducing IL-6 and TNF-alpha, that are known to disrupt sleep architecture when chronically elevated. This anti-inflammatory action may be particularly relevant for patients with comorbid inflammatory conditions.
HPA axis modulation. Chronic insomnia is associated with HPA axis hyperactivation and elevated cortisol. The review found that multiple TCM formulations restore HPA axis negative feedback regulation, lowering nocturnal cortisol levels and improving sleep continuity.
Gut microbiota. Emerging evidence points to TCM-induced changes in gut microbial composition as a mediator of improved sleep. Several herbal polysaccharides increased the abundance of short-chain fatty acid-producing bacteria, with downstream effects on the gut-brain axis.
Why it matters
Current first-line pharmacotherapy for insomnia, benzodiazepines and Z-drugs, carries risks of dependence, tolerance, and cognitive side effects. The review positions TCM as a multi-target alternative that may address both insomnia and its common emotional comorbidities through overlapping mechanisms.
The authors caution, however, that much of the evidence comes from preclinical studies and small clinical trials with methodological limitations. Rigorous randomized controlled trials with standardized extracts, defined active compound profiles, and objective sleep measures are needed before these therapies can be recommended in clinical guidelines.
Implications for future research
The review identifies several priorities: characterizing the specific active compounds responsible for sleep effects, establishing standardized extraction and quality control protocols, and designing adequately powered clinical trials with polysomnography or actigraphy outcomes rather than subjective sleep scales alone.
The authors also flag the potential for drug-herb interactions, particularly with sedative-hypnotics and antidepressants, as a safety concern requiring systematic investigation before TCM products are combined with conventional sleep medications.
Source
Zhongmei He et al. Treatment of sleep disorders with traditional Chinese medicine: Pharmacological activities and mechanisms. Phytomedicine (2026). DOI: 10.1016/j.phymed.2026.158402. PMID: 42308988.