A 2026 meta-analysis of seven small randomized trials found that Chinese herbal acupoint patches may improve self-rated sleep in stroke survivors with diagnosed sleep problems. However, the evidence was rated very low certainty, the results varied sharply between studies, and safety was reported inadequately.
The trials involved 608 people, all treated in China between 2013 and 2025. Every study added patches to a background treatment and compared that approach with the same background treatment alone. The review did not test patches as a replacement for standard post-stroke care.
What the trials found
Across six trials involving 536 participants, sleep quality scores were 2.69 points lower with the patches than with background care alone. The measure used was the Pittsburgh Sleep Quality Index, or PSQI, which assesses sleep quality, time needed to fall asleep, sleep duration and efficiency, night waking, sleep medication use, and daytime problems. Scores range from 0 to 21, with lower scores indicating better sleep.
Across five trials involving 466 people, participants receiving patches also had higher odds of meeting each study’s definition of improvement. But those definitions differed from one trial to another, making the combined result harder to interpret.
The apparent benefit was larger when patches were added to conventional medical care alone than when they were added to care that already included another active therapy. The review authors considered this comparison exploratory because each subgroup included only a few trials.
Why the findings remain uncertain
The sleep results were extremely inconsistent between studies. The statistical measure of inconsistency, I², was 95%. The trials also differed in their herbs, acupuncture points, treatment schedules, treatment duration and background care.
Most participants received patches made with powdered herbs mixed into a paste or patch and taped to the skin. The most common approach used powdered Evodia rutaecarpa fruit on Yongquan, or KI1, on the sole of the foot. Other studies used cinnamon or herbal blends on points at the wrist, navel, back or leg.
Treatment lasted from 30 minutes to 24 hours a day, for 10 days to four weeks. No trial used objective sleep measures such as wrist actigraphy or overnight sleep studies, and none followed participants after treatment ended.
The review also identified several safeguards that were missing. None of the trials reported concealing group assignments from staff, participants or outcome assessors. No study had a protocol or registry record. Because the search did not include trial registries, gray literature or theses, publication bias could not be ruled out.
Mood results need particular caution
Two trials involving 182 people measured anxiety and depression. Scores on the Hamilton Anxiety Rating Scale were lower with patches, as were scores on the Hamilton Depression Rating Scale. Both findings were rated very low certainty.
The researchers warned that the mood effects may be overestimated. The trials did not describe blinding the people who rated anxiety and depression, identify which Chinese version of the anxiety scale was used, or explain how raters were trained. The depression result was also highly inconsistent between the two studies.
Safety was barely assessed
Only two of the seven trials reported side effects. One described dry mouth, dizziness or fatigue, and skin allergy in the patch group. Another reported one case of nausea. The other five trials did not state whether side effects were monitored.
Because there was no follow-up after treatment stopped, the studies could not assess delayed reactions, relapse or lasting sleep benefits. The safety of the patches therefore remains uncertain.
What the findings mean for stroke survivors
These results suggest that herbal acupoint patches could be considered, at most, as an add-on to established post-stroke care. They do not establish the patches as a treatment for sleep problems, and they should not replace standard post-stroke treatment.
The review authors called for larger, multicenter trials with registered protocols, blinded outcome assessors, standardized herbs and acupuncture points, objective sleep measurements and follow-up after treatment ends. Until stronger evidence is available, the size and durability of any benefit remain unclear.
AI tools were used to assist with the preparation of this article.
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