What this is
- This review explores how acupuncture may alleviate insomnia through the microbiome-gut-brain () axis.
- Insomnia affects many individuals and is linked to various health issues.
- Acupuncture is highlighted as a safe, non-drug treatment option with potential benefits for insomnia.
- The review discusses mechanisms including gut microbiota modulation and inflammatory response regulation.
Essence
- Acupuncture may improve insomnia by regulating the microbiome-gut-brain axis, influencing gut microbiota, and modulating inflammatory responses.
Key takeaways
- Acupuncture treatment can enhance gut microbiota diversity and balance, potentially improving sleep quality.
- The review identifies four main pathways through which acupuncture affects insomnia: immune response, neuroendocrine regulation, vagus nerve signaling, and gut microbiota metabolites.
- Acupuncture may inhibit inflammation and improve the intestinal barrier, which is crucial for sleep regulation.
Caveats
- Current research is limited, with a focus on animal models rather than extensive clinical trials.
- The mechanisms linking gut microbiota modulation to sleep improvement require further investigation.
- Long-term efficacy of acupuncture for insomnia remains inconclusive due to insufficient follow-up data.
Definitions
- microbiome-gut-brain (MGB) axis: A bidirectional communication system involving gut microbiota, the gut, and the brain, influencing health and behavior.
Simplified
1. Introduction
Insomnia is a sleep disorder characterized by difficulty falling asleep or staying asleep, resulting in poor sleep quality. This condition affects the optimal functioning of the human body and is often accompanied by daytime fatigue, lack of concentration, irritability, or apathy.[1] A large body of research shows that the occurrence and development of various diseases, including obesity, cardiovascular disease, psychiatric disease, and diabetes, are closely entwined with insomnia.[2–5] Additionally, chronic insomnia can increase the risk of mortality.[6] Epidemiological surveys estimate that ~19% to 50% of individuals worldwide experience symptoms of insomnia, showing a progressively increasing trend.[7]
Acupuncture is a therapeutic approach rooted in traditional Chinese medicine (TCM), characterized by its ease of application, affordability, and patient acceptance.[8] Compared with hypnotics and sedatives, acupuncture offers the benefits of high safety and absence of drug dependence for treating insomnia.[9] Additionally, acupuncture has a good therapeutic effect on anxiety and depression symptoms complicated by insomnia.[10] Unlike Western medicines that only focus on insomnia symptoms, personalized acupuncture therapy can increase or decrease acupuncture points based on the patient’s unique symptoms, thereby enhancing treatment results.[11] Consequently, acupuncture has become the preferred treatment for many individuals suffering from insomnia. However, the mechanism of acupuncture in the treatment of insomnia remains incompletely understood, necessitating further research to refine its theory.
In recent years, research into the correlation between intestinal microbiota and insomnia has deepened, making the theory of the regulation of insomnia through microbiome–gut–brain (MGB) axis a new research hotspot. This review systematically explores the mechanism of acupuncture in treating insomnia by adjusting the intestinal microbiota (Fig. 1), providing a new objective basis for acupuncture’s efficiency in insomnia treatment.
The mechanism of acupuncture in treating insomnia by adjusting the intestinal microbiota. Acupuncture treatment can inhibit inflammation, improve the tight connectivity of the intestinal mucosal barrier, adjust the release and production of brain–gut peptides, regulate hypothalamus–pituitary–adrenal axis-related pathways, and control the vagus nerve pathway, thereby alleviating insomnia symptoms.
2. Literature search and selection
We conducted a systematic search across PubMed, Web of Science, Embase, and China National Knowledge Infrastructure databases using the following combined keywords: “microbiota–gut–brain (MGB) axis,” “insomnia,” “acupuncture therapy,” “gut microbiota,” “short-chain fatty acids (SCFAs),” “intestinal mucosal barrier,” “immune inflammation,” “brain-gut peptides,” “serotonin,” “ghrelin,” “hypothalamic–pituitary–adrenal (HPA) axis,” “vagus nerve,” and “enteric nervous system.” The literature search focused on articles published from January 2000 to August 2024, with supplementary inclusion of manually screened reference lists. Inclusion criteria mandated relevance to at least one of the following topics: acupuncture intervention, insomnia improvement, or MGB axis mechanisms. Studies lacking control groups, incomplete microbiota analyses, or case reports were excluded, ensuring methodological rigor in literature selection.
3. Correlation between MGB axis and insomnia
3.1. MGB axis
The gut microbiome, also known as intestinal microbiota, refers to the normal microorganisms that colonize the human gastrointestinal tract and coexist in symbiosis with more than 1013 to 1018 intestinal microbes in humans.[12] Among them, Firmicutes and Bacteroidetes are the most numerous, accounting for ~92% of the human microbiome.[13] The gut microbiota play a key role in coordinating brain development and behavior,[14] whereas the brain can also adjust the structure and diversity of the gut microbiota,[15] creating a bidirectional regulatory channel known as the MGB axis. Studies have shown that the gut microbiota regulates brain function through 4 main pathways that facilitate this bidirectional information flow.
The first pathway is dominated by metabolites of the gut microbiota, particularly short-chain fatty acids (SCFAs), which participate in the vagus nerve, immune, and neuroendocrine pathways. First, SCFAs can reverse microglia damage[16]; they also regulate the production of brain-derived neurotrophic factor, which signals the brain via the vagus nerve.[17] Second, SCFAs can mediate the immune response by regulating the size and function of regulatory T-cells, thereby influencing brain function.[18] Third, SCFAs play a vital part in the production and release of 5-hydroxytryptamine (5-HT), which has extensive projections to the brain and regulates important functions such as sleep and mood.[19]
The second pathway involves the immune system, where the gut microbiota is essential for inhibiting pathogenic bacterial colonization and protecting the intestinal barrier.[20] When the gut microbiota is disrupted, intestinal permeability increases, leading to translocation of gram-negative bacteria containing lipopolysaccharide that can overactivate the immune system,[16] resulting in elevated concentrations of pro-inflammatory cytokines and damage to central nervous system (CNS) cells.[21] Additionally, the diversity of the gut microbiota directly affects the maturation and activation of microglia in the CNS.[22]
The third is the neuroendocrine pathway, in which gut microbiota serves as the main producer of neurotransmitters.[23] These neurotransmitters affect their production and synthesis by regulating the metabolism and content of amino acids in certain intestinal endocrine cells and neurotransmitter precursors. Excessive or insufficient production of these neurotransmitters can affect the CNS function.[24] Additionally, gut microbiota can influence the hypothalamic–pituitary–adrenal (HPA) axis by regulating corticotropin-releasing factor and cortisol levels,[21] making the HPA axis a key factor in mental disorders such as anxiety, depression, and insomnia.[25]
The fourth is the vagus nerve pathway. In this pathway, the vagus afferent nerve reaches the mucosal and intestinal muscle layer near enteroendocrine cells, mucosal immune cells, and neurons of the enteric nervous system (ENS). These structures form synapses with intestinal epithelial cells and enteroendocrine cells, rapidly conducting signals from the intestinal lumen to the vagus nerve through glutamatergic and serotonergic pathways. The cell bodies of the vagus afferent nerves reside in the nodular ganglia, where vagus nerve fibers project to the nucleus of the solitary tract, area postrema, and dorsal nucleus of the vagus nerve. This information transmission pathway is referred to as the gut microbiome–ENS–vagus–brain pathway.[26,27]
3.2. Gut microbiota and insomnia
Modern research has indicated that the gut microbiota regulates the host’s circadian rhythm in various ways, and it is important for etiology and pathogenesis of insomnia.[28] Gut-derived neurotransmitters (such as 5-HT and gamma-aminobutyric acid) can directly affect the brain and interact with the CNS.[29,30] Notably, these neurotransmitters can interact with afferent neurons of the vagus nerve, influencing the neural circuits involved in sleep–wake regulation, thereby altering sleep–wake structure.[31] Meanwhile, gut microbiota metabolites such as SCFAs play a vital part in improving sleep and regulating circadian rhythms. Szentirmai et al found that butyrate can induce an increase in non-rapid eye movement sleep in mice, suggesting that certain receptors or specific pathways within the hepatic portal vein can promote sleep through the action of butyrate.[32] In addition, intestinal immune function is a key factor affecting sleep. Several studies have shown that pro-inflammatory cytokines can influence sleep structures.[33–35] When the balance of the gut microbiota is broken, the intestinal barrier function is impaired, triggering an inflammatory response and promoting the production of pro-inflammatory cytokines.[36] Take together, the gut microbiota and its metabolites play an important part in the MGB axis and are indispensable in the pathophysiology of intestinal homeostasis and sleep.
4. TCM theory analysis of MGB axis and insomnia
In exploring the pathogenesis of insomnia, TCM emphasizes the relationships between the gastrointestinal tract and the brain. The brain is considered the residence of the original spirit. The concept that “stomach disharmony leads to restless sleep” dates back to the Su Wen, aligning with the modern theory of the MGB axis. Here, “stomach” is not limited to its modern definition; it encompasses the large intestine, small intestine, spleen, stomach, and Yangming meridian. As stated in the Miraculous Pivot: “The large intestine and small intestine all belong to the stomach, and they are the foot Yangming stomach channel.[37]” The following analysis will explore the relationship between “stomach disharmony” and “restless sleep” from 2 perspectives.
The meridians can connect upward and downward, communicate inside and outside, and serve as the channels for the flow of qi and blood in the human body.[38] According to the Miraculous Pivot: “The foot Yangming stomach channel, starting from the radix nasi, follows the hairline to the point where the forehead meets the skull.” This indicates that the foot Yangming stomach channel can extend to the brain. The “Revised Popular Guide to ‘Treatise on Cold Damage’” states that “The branches of the stomach meridian extend to the heart and brain. When an evil fire obstructs these pathways, it blocks the orifices of the spirit, resulting in confusion and delirium.” Pathologically, when the Yangming meridian is filled with qi and blood and evil heat accumulates in the stomach, it disturbs the meridians and obscures the clarity of the mind, potentially leading to insomnia. This demonstrates the close relationship between the brain and the “stomach” through the meridians.
The spleen is the foundation of acquired constitution and the source of qi and blood production, regulating qi movement in the body. The small intestine separates the clear from the turbid, whereas the large intestine transmits dross. Altogether, the spleen and stomach metabolize human fluids. As stated in Dong-yuan’s Proven Formulas: “The stomach and intestines are rewound, but the qi cannot be transformed.” If the stomach and intestines are impaired, the body’s qi movement becomes disordered, leading to abnormal fluid metabolism and the accumulation of phlegm-rheum. Phlegm-rheum obstructs the flow and transforms into heat, which disturbs the spirit and causes insomnia. Additionally, dysfunction of the spleen and stomach prevents the clear yang from ascending and the turbid yin from descending, disrupting the harmony of the 9 orifices and resulting in a restless mind that affects sleep.
5. Acupuncture mechanism in treating insomnia by modulating the MGB axis
Acupuncture is an effective treatment for insomnia. A recent randomized controlled trial demonstrated that acupuncture had a sleep-promoting effect in the short to medium term.[39] Zhao et al conducted a meta-analysis showing that acupuncture treatment, when administered at least 12 times, significantly improved sleep efficiency and duration in patients with insomnia.[40] Recently, the development of the MGB axis theory has led to new insights into the mechanisms by which acupuncture treats insomnia. The following sections will elaborate on the potential mechanisms of acupuncture in treating insomnia based on the MGB axis theory from 4 perspectives.
5.1. Acupuncture regulates gut microbiota and SCFAs
Modern studies indicate that acupuncture can adjust the ecological stability of gut microbiota and balance the number and proportion of probiotics and pathogens in the host.[41] Zhang et al performed electroacupuncture intervention in mice for 2 weeks and found that electroacupuncture increased the abundance of probiotics, such as Brault bacteria and Lactobacillus, whereas reducing opportunistic pathogens such as Prevotella and Helicobacter.[42] Two recent studies suggest that increased abundance of Bacteroidetes may serve as a biomarker for identifying insomnia.[34,43] Additionally, another study found that the relative abundance of lactobacilli in the left fusiform gyrus in patients with chronic insomnia was significantly negatively correlated with regional homogeneity, suggesting that gut microbiota can influence brain function.[44] Hong et al stimulated insomnia in mice through acupuncture at Baihui (DU20), Sanyinjiao (SP6), and Shenmen (HT7), reporting improved sleep status, a decrease in intestinal Bacteroides, and increase in Lactobacillus.[45] This led to the conclusion that acupuncture may improve the sleep–wake cycle by regulating intestinal microbiota abundance.
Gut microbiota metabolites, such as SCFAs, have been shown to affect sleep physiology by regulating inflammatory factor levels, downregulating HPA axis reactivity, promoting the secretion and release of 5-HT, and activating vagus nerve receptors.[27,46–49] SCFAs secreted by probiotics such as Enterobacter faecalis and Agassobacter in the gut can inhibit intestinal colonization by opportunistic pathogens and reduce inflammatory factor production.[50] Ouyang et al performed moxibustion on the Guanyuan (RN4) in elderly rats for 40 days, finding that the relative abundance of lactobacilli increased, consequently raising the levels of SCFAs in the intestine.[51] Ke et al found that electroacupuncture increased acetic acid levels, which in turn reduced intestinal inflammation.[52] These studies collectively showed that acupuncture could regulate SCFA levels in the gut.
In summary, acupuncture treatment effectively improves insomnia, potentially by regulating intestinal microbiota and SCFA levels and thereby improving the MGB axis pathway.
5.2. Acupuncture regulates the intestinal mucosal barrier and immune inflammation
Modern research has found that inflammation plays a significant role in the pathogenesis of metabolic and neurodegenerative diseases associated with sleep deprivation[53,54] and is closely related to the intestinal mucosal barrier.[55] Typically, the gut microbiota regulates this barrier. When exogenous pathogenic microorganisms invade, probiotics such as bifidobacteria interact with intestinal mucosal cells to form a biological barrier that protects the intestinal microecosystem.[56] However, when the balance of the intestinal microbiota is disrupted, the intestinal barrier is compromised, allowing microbiota metabolites (such as lipopolysaccharide) to enter the circulatory system. These metabolites interact with endotoxin-binding proteins and aberrantly activate the Toll-like receptor 4/myeloid differentiation factor 88/nuclear factor kappa-B pathway, inducing inflammatory responses and promoting the production of pro-inflammatory cytokines such as TNF-α, IL-6, and IL-1β.[36,57] Additionally, pro-inflammatory cytokines can further damage tight junctions and increase intestinal permeability.[58] Cai et al measured serum levels of diamine oxidase, D-lactate, intestinal fatty acid-binding protein, and endothelin in 45 patients with chronic insomnia and 30 healthy volunteers, finding that these intestinal epithelial barrier markers were significantly positively correlated with sleep efficiency.[59] They hypothesized that the occurrence and progression of insomnia disorder may be related to intestinal barrier damage. Therefore, regulating the intestinal flora, repairing the intestinal mucosal barrier, and improving inflammation are essential for treating insomnia.
Acupuncture effectively regulates intestinal microbiota, repairs the intestinal mucosal barrier, and improves the inflammatory response.[60–63] Bao et al found that acupuncture helped restore the balance of the gut microbiota and increased the abundance of anti-inflammatory bacteria and bacteria that produce SCFAs, thereby enhancing gut barrier integrity and inhibiting the inflammatory response.[64] Bao et al performed moxibustion treatment on rats at bilateral Tianshu (ST25) and Zusanli (ST36) for 7 consecutive days, and finding a significant increase in the relative DNA abundance of Lactobacillus and Bifidobacterium in the intestinal tract, a decrease in Escherichia coli, an increase in the expression of NOD-like receptor family pyrin domain containing 6, and a decrease in the expression of apoptosis-associated Speck-like protein containing a CARD and cysteine-requiring aspartate protease-1.[65] Transmission electron microscopy images showed that moxibustion alleviated mucosal injury in the colon. These findings suggest that moxibustion can balance gut microbiota, improve intestinal inflammation, and alleviate mucosal damage. In a recent study, electroacupuncture at Zusanli (ST36) and Kunlun (BL60) inhibited the expression of Toll-like receptor 4, MYD88, and nuclear factor kappa-B, thereby improving the inflammatory response.[66] In addition, electroacupuncture at Zusanli (ST36) can attenuate the distortion of intestinal glial cells and increase the expression of zonula occludens-1 protein, thereby maintaining intestinal barrier function and reducing intestinal permeability.[67] In summary, acupuncture can improve the MGB axis pathway, potentially by regulating the intestinal flora, inhibiting the inflammatory response, and improving the tight connectivity of the intestinal mucosal barrier, offering therapeutic benefits for patients with insomnia.
5.3. Acupuncture regulates neuroendocrine pathways
5.3.1. Acupuncture regulates the release and production of brain–gut peptides
Brain–gut peptides are bioactive peptides distributed in the brain and gastrointestinal tract. They can facilitate bidirectional information transmission and play a huge part in regulating the functional activities of the gastrointestinal tract and CNS.[68] Modern studies have shown that changes in the content of brain–gut peptides, such as 5-HT and growth hormone releasing peptide (ghrelin), affect patients’ sleep–wake cycle,[69,70] and the secretion and synthesis of these brain–gut peptides are regulated by the gut microbiota.[19,71]
5-HT is one of the first substances found as a participating factor in the adjustment of sleep–wake structures, playing a crucial role in the preparation, triggering, and maintenance of sleep.[72] Physiological studies have demonstrated that 5-HT induces sleep by inhibiting the midbrain reticular activation system or the locus coeruleus–norepinephrine system.[73] Additionally, early research indicates that probiotics, such as Lactobacillus and Bifidobacterium, can enhance tryptophan metabolism and support the direct conversion of tryptophan to 5-HT.[74] Ogawa et al found in animal studies that dysregulation of gut microbiota leads to a sharp decline in 5-HT levels, thereby affecting the sleep–wake cycle.[75] Therefore, 5-HT may participate in the communication between gut microbiota and the sleep regulatory system. Studies have shown that electroacupuncture stimulation at Baihui (GV20) and Zusanli (ST36) can increase the abundance of probiotics such as Lactobacillus and Bifidobacterium,[76] whereas acupuncture can increase tryptophan content in the peripheral system, elevate the level of 5-HT in the blood, and accelerate the transport of tryptophan in the blood, thereby promoting the synthesis of 5-HT.[77]
Ghrelin is a multifunctional brain–gut peptide hormone that is widely expressed in the cerebral cortex, hypothalamus, hippocampus, striatum, and other regions. It plays an important part in multifaceted brain functions such as sleep, memory, and neuroprotection.[78,79] Ghrelin induces arousal and inhibits non-rapid eye movement sleep and rapid eye movement sleep.[80] Szentirmai et al injected ghrelin into the ventricles and hypothalamus of rats, demonstrating a strong arousal effect.[81] Another study found an inverse correction between firmicutes and ghrelin levels in humans and rodents, suggesting that ghrelin may be integral to the bidirectional communication between gut microbiota and the sleep regulatory system.[82,83] Concurrently, Ouyang et al reported a significant increase in the abundance of Firmicutes in the gut of mice after 40 days of moxibustion on Guanyuan (RN4).[51] In addition, acupuncture and thermal moxibustion can reduce ghrelin levels in mice.[84]
Therefore, acupuncture can improve sleep, possibly by regulating gut microbiota composition, facilitating brain–gut interactions, promoting the release of 5-HT, and inhibiting ghrelin production.
5.3.2. Acupuncture inhibits hyperactivity of the HPA axis
The HPA axis involves the neuroendocrine system and plays an important part in the MGB axis.[85,86] It is influenced by circadian oscillators, which regulate sleep and maintain bioalertness.[87] An overactive HPA axis impairs sleep quality by causing sleep fragmentation, decreased slow-wave sleep, and shortened sleep duration, which is thought to be induced by increased plasma levels of corticotropin-releasing hormone (CRH) and cortisol (CORT).[88,89] Acupuncture can ameliorate sleep by regulating HPA axis-related pathways. Some studies have indicated that acupuncture can downregulate the expression of CRH and adrenocorticotropic hormone in the hypothalamus and pituitary gland, thereby reducing CORT release.[90] This hypothesis has been demonstrated in several studies.[91,92] Xie et al found that rats with insomnia have improved sleep and restored abnormally elevated levels of hypothalamic corticosterone, adrenocorticotropic hormone, and CRH after electroacupuncture.[93] In addition, Lv et al confirmed that abundance differences in gut microbiota are closely related to the expression of HPA axis-related factors through correlation analysis.[94] If the gut microbiota is out of balance, the stage generation of corticosterone in the ileum will be affected, resulting in a persistent increase in CORT.[95] Probiotic pretreatment in rats has also been shown to reduce the hyperresponsiveness of the HPA axis.[96] Acupuncture is able to reverse the imbalance of the gut microbiota and increase the abundance of probiotics in the gut. Xie et al performed electroacupuncture treatment on Zusanli (ST36) and Yanglingquan (GB34) in mice for 2 weeks and found that the abundance of probiotics in the intestine is increased.[97] Furthermore, electroacupuncture can reduce the ratio of Firmicutes to Bacteroidetes, which is often considered a relative measure of the balance or dysbiosis of the gut microbiota, suggesting that electroacupuncture can reverse imbalances in gut microbiota.[98] Therefore, acupuncture can achieve therapeutic effects on patients with insomnia, possibly by regulating the intestinal microbiota, adjusting the content of HPA axis-related factors, and improving the MGB axis pathway.
5.4. Acupuncture regulates the vagus nerve pathway
The vagus nerve is a brain–gut information pathway between the CNS and ENS. Gut microbes and their metabolites can affect neurons in the ENS and interact with the afferent pathway of the vagus nerve, thereby affecting the neural circuits involved in sleep–wake regulation.[99] Probiotics have been found to modulate vagus nerve-dependent pathways, which in turn increase the expression of central γ-aminobutyric acid A-type receptors (GABAAR) in mice.[100] However, these effects can be blocked by vagotomy, suggesting that GABAAR and the vagus nerve are jointly involved in the 2-way exchange of information between gut microbiota and the brain’s sleep regulation system.[101]
Acupuncture has been shown to modulate vagus nerve activity and increase GABAAR expression. A recent study showed that electroacupuncture stimulates the vagus nerve and acts on GABAAR to improve sleep.[102] Furthermore, electroacupuncture reportedly activates the GABAergic system, increases GABAAR expression and activity, enhances neurosuppressive effects, and improves sleep quality.[103,104] In addition, acupuncture has been shown to increase the DNA abundance of intestinal probiotics. Xiao et al found that the DNA abundance in probiotics such as Lactobacillus and Bifidobacterium was significantly increased by electroacupuncture treatment at Baihui (DU20) and Zusanli (ST36) in mice.[105]
Therefore, acupuncture may prolong sleep duration and improve sleep conditions by increasing the abundance and diversity of intestinal probiotics, regulating vagus nerve pathways, and increasing GABAAR expression.
6. Research limitations and future directions
While significant progress has been achieved in this field, current research efforts remain constrained by some limitations. First, investigations remain disproportionately focused on preclinical animal models, with insufficient clinical trials validating therapeutic mechanisms in human populations. Most studies inadequately address the ecological dynamics of human gut microbiota, particularly their spatiotemporal interactions with environmental confounders that substantially shape microbial community architecture. Furthermore, translational gaps persist between mechanistic insights into host–microbe crosstalk and their clinical applications in precision medicine. Consequently, applying multi-omics technologies in clinical research holds significant value.
Second, although accumulating evidence indicates that acupuncture may alleviate insomnia through modulation of the MGB axis, the precise effector pathways and molecular targets governing this neuromicrobial interplay remain uncharacterized. Notably, critical gaps persist in direct neurobiological validation of the causal chain linking microbial modulation to cerebral functional reorganization. To address these limitations, future investigations should integrate functional magnetic resonance imaging and metabolomics to longitudinally assess gut microbiota dynamics and neural pathway alterations during acupuncture interventions.
Finally, while preliminary clinical evidence supports short-term efficacy, the long-lasting therapeutic effects of acupuncture remain inconclusive due to insufficient long-term follow-up data. Furthermore, significant methodological heterogeneity in subject selection criteria and acupoint combination protocols may compromise the comparability of research outcomes. Future investigations should establish standardized acupoint selection guidelines, implement multicenter randomized controlled trials with large cohorts, and extend follow-up durations to strengthen the evidence base.
7. Conclusion
The MGB axis plays an important part in the onset and progression of insomnia. Currently, the main pathways identified to improve insomnia include the immune, neuroendocrine, vagus nerve, and bidirectional information transmission pathways dominated by gut microbiota metabolites. Existing evidence indicates that acupuncture treatment can inhibit inflammation, improve the tight connectivity of the intestinal mucosal barrier, adjust the release and production of brain–gut peptides, regulate HPA axis-related pathways, and control the vagus nerve pathway, thereby alleviating insomnia symptoms.
This review highlights the possible mechanism by which acupuncture therapy regulates the MGB axis to improve insomnia and provides modern theoretical support for acupuncture in the treatment of insomnia. We anticipate that with advancing research, the therapeutic role of the MGB axis in insomnia will be comprehensively elucidated, thereby accelerating the modernization of traditional medical practices and providing novel objective evidence for acupuncture in insomnia management.
Author contributions
Conceptualization: Yipeng Gao.
Methodology: Yipeng Gao.
Visualization: Yipeng Gao.
Writing – original draft: Yipeng Gao.
Writing – review & editing: Yipeng Gao, Xueping Yu.