Evidence-Based Complementary and Alternative Medicine

Evidence-Based Complementary and Alternative Medicine / 2015 / Article
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Evidence-Based Patient Classification for Traditional Chinese Medicine

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Review Article | Open Access

Volume 2015 |Article ID 160189 | 12 pages | https://doi.org/10.1155/2015/160189

Prescription of Chinese Herbal Medicine in Pattern-Based Traditional Chinese Medicine Treatment for Depression: A Systematic Review

Academic Editor: Guo-Zheng Li
Received16 Apr 2014
Accepted21 Sep 2014
Published09 Jun 2015

Abstract

Traditional Chinese medicine (TCM) treatments are often prescribed based on individuals’ pattern diagnoses. A systematic review of randomized controlled trials in Chinese and English literatures on TCM pattern-based treatment for depression has therefore been conducted. A total of 61 studies, 2504 subjects, and 27 TCM patterns were included. Due to the large variation of TCM pattern among participants, we only analyzed the top four commonly studied TCM patterns: liver qi depression, liver depression and spleen deficiency, dual deficiency of the heart, and spleen and liver depression and qi stagnation. We found that Xiaoyao decoction was the most frequently used herbal formula for the treatment of liver qi depression and liver depression with spleen deficiency, while Chaihu Shugan decoction was often used for liver depression and qi stagnation. Bai Shao (Paeonia lactiflora Pall.) and Chai Hu (Bupleurum chinense DC.) were commonly used across different TCM patterns regardless of the prescribed Chinese herbal formulas. The rationale underlying herb selection was seldom provided. Due to the limited number of studies on TCM pattern-based treatment of depression and their low methodological quality, we are unable to draw any conclusion regarding which herbal formulas have higher efficacy and which TCM patterns respond better to CHM.

1. Introduction

According to the Global Burden of Disease Study 2010, major depressive disorder (MDD) was ranked the second leading cause of years lived with disability, accounting for 8.2% of all years lived with disability [1]. The World Mental Health Survey Initiative showed that the average lifetime prevalence for major depressive episode based on the Diagnostic and Statistical Manual, Fourth Edition [2], was 14.6% in 10 high-income countries and 11.1% in 8 low- to middle-income countries [3]. Pharmacotherapy is currently the most commonly used treatment for MDD because of its reported effectiveness; however, complaints such us nausea, headache, insomnia, agitation, weight gain, daytime somnolence, and sexual dysfunction are common during the course of treatment, leading to early termination in some patients. The use of psychotherapy as an alternative is no better because of its time-intensive nature, limited access to skilled providers, high cost, and requirement of patients’ participation and motivation. Faced with the limitations of the currently available treatments, complementary and alternative medicine for depression is very common. A national representative survey in the United States found that 53.6% of people with depression reported using some forms of complementary and alternative therapies to treat depression during the past 12 months [4].

Chinese herbal medicine (CHM) is one of the oldest medical treatments in the world and it is a common form of complementary and alternative medicine therapy for MDD [5, 6]. Previous studies have been conducted to examine the efficacy of CHM for depression [714]; however, limited information is available on pattern-based CHM treatment. According to the traditional Chinese medicine (TCM) theory, eight major parameters, yin and yang, external and internal, hot and cold, and excess and deficiency, are used to describe the patterns of bodily disharmony. Additional systems, such as qi, blood, and body fluid differentiation and zang fu (organ) differentiation are also used [15]. In terms of the TCM theory, the onset of depression is often due to “damages” by extreme emotions. Liver qi is first affected, followed by disharmony of the qi mechanism of the five viscera, particularly liver, spleen, and heart, resulting in a loss of regulation of the qi and blood. The liver depression may repress the spleen and lead to consumption and damage of the heart qi. If heart loses its nourishment and the restfulness to heart shen (spirit) occurs, it will lead to unstable and depressed mood. When qi depression is prolonged, it will accumulate and transform into fire [16, 17].

TCM pattern differentiation is a diagnostic conclusion of the pathological changes of a disease state based on an individual’s symptoms, physical signs, pulse form, and tongue appearance. Although it is believed that pattern-based TCM treatment will provide better efficacy, previous studies regarding the additional benefits of TCM pattern differentiation are scarce. One randomized controlled trial (RCT) found that the therapeutic effect of Chinese herbal treatment according to TCM pattern was more sustainable than a standard formula in treating irritable bowel syndrome [18]. It has also been reported in rheumatoid arthritic patients that TCM pattern diagnoses can guide the use of Western medicine [19]. To the best of our knowledge, no systematic review has been conducted on pattern-based CHM treatment for depression. Given the high prevalence of depression and its frequent presentation to TCM practitioners, it is important to review the current application of pattern differentiation in CHM treatment for depression. The objectives of this paper were (1) to summarize the commonly diagnosed TCM patterns in patients with depression and (2) to find out the current practice of pattern-based CHM treatment for depression.

2. Materials and Methods

The present study was part of our systematic review on Chinese herbal medicine for depression [11, 20]. Two researchers (Ka-Yan Ng and Yee-Man Yu) independently searched nine Chinese language databases (China Journals Full-text Database, China Proceedings of Conference Full-text Database, Chinese Biomedical Literature Database, China Doctor Dissertations Full-text Database, China Master Theses Full-text Database, Chinese Science and Technology Documents Database, Chinese Dissertation Document Bibliography Database, Taiwan Electronic Periodical Services, and WanFang Database) and seven English language databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine, PsycINFO, and ProQuest Dissertations and Theses A&I) using the grouped terms “depression or depressive or dysthymia or mood disorder or “affective disorder” or “affective symptoms” or MDD” and “Chinese herb or herbal medicine or traditional Chinese medicine or TCM or Chai-Hu-Shu-Gan-San or ChaiHuShuGan or Xiao-Yao-San or XiaoYao or Ban-Xia-Hou-Pu-Tang or BanXiaHouPu or Gan-Mai-Da-Zao-Tang or GanMaiDaZao or Gui-Pi-Tang or GuiPi or Wen-Dan-Tang or WenDan or Yue-Ju-Wan or Yue-Ju” and the equivalent Chinese terms. We imposed no language restriction. We also checked the reference lists of the included papers and previous systematic reviews [714] for relevant articles.

2.1. Selection Criteria

Studies included in this review were RCTs that described TCM patterns of depressed subjects who received CHM treatment for depression. In order to obtain a full coverage of the topic, we had not set any specification for outcome measure and study quality. In addition, to derive a general picture of TCM pattern utilization, studies were excluded if they (1) had less than 30 subjects; (2) examined male or female only; (3) focused on subjects aged below 18 or above 70 years; (4) focused on a particular life transition period or a specific TCM pattern; (5) had no statistical information regarding the frequency of individual TCM pattern; or (6) were duplicated publications.

2.2. Data Extraction Process

Any disagreement about the eligibility of a study was resolved by discussion between the two researchers who independently selected the relevant publications and by consultation with the senior authors (Wing-Fai Yeung and Ka-Fai Chung). One author extracted the data (Ka-Yan Ng) and the other (Yee-Man Yu) checked the extracted data. For each study, the following variables were extracted: study design, sample size, mode of recruitment, sampling and diagnostic procedure, inclusion and exclusion criteria, and participants’ characteristics including age, gender, and duration of depression. TCM patterns, treatment principles, treatment regimen and outcome of TCM treatments were obtained. All Chinese to English translations were deduced primarily from the World Health Organization (WHO) International Standard Terminologies on Traditional Medicine in the Western Pacific Region [21] and additionally from Traditional Chinese Internal Medicine [22], a commonly used English-language TCM textbook in China.

2.3. Study Quality Assessment

We assessed the methodological quality using the Jadad scale [23]. Points are awarded if the study is described as randomized, 1 point; has appropriate randomization method, 1 point; is described as double-blind, 1 point; uses appropriate blinding method, 1 point; or has description of withdrawals and dropouts, 1 point. A Jadad scale score ≥3 represents better quality trials.

2.4. Statistical Analysis

SPSS version 20.0 was used for statistical analysis. Data were summarized using mean (SD) and 95% confidence intervals (CIs).

3. Results

The search yielded 5097 potential titles for review, of which 929 were duplicated records and 3594 were excluded for reasons of irrelevance. The full text of 574 was retrieved for detailed assessment, of which 278 were excluded for various reasons (Figure 1). Of the 296 studies on CHM for depression, 61 of them examined pattern-based treatment. A total of 27 different TCM patterns were identified in the 61 studies. We analyzed the most commonly studied TCM patterns: liver qi depression, liver depression and spleen deficiency, dual deficiency of the heart and spleen, and liver depression and qi stagnation and liver-kidney yin deficiency. These four commonly studied TCM patterns were described in 42 of the 61 studies (68.9%) and involved 1762 subjects accounting for 70.4% of the total 2504 subjects (Table 1). Eighteen of the 42 studies examined CHM alone and the other 24 studies examined CHM plus antidepressants [2465]. The 1762 participants had a mean age of 40.7 years, of which 59.0% were female. The participants were suffering from depression unspecified in 33 of the 42 studies, six studies on poststroke depression and three on depression comorbid with diabetes. The diagnosis of depression was based on 17-item or 24-item Hamilton Depression Rating Scale (HAMD17/24) in 36 studies, the Chinese Classification of Mental Disorder Second/Second-revised/Third Edition (CCMD-2/2-R/3) in 35 studies, Zung Self-rating Depression Scale (SDS) in seven studies, and one study each using DSM-IV, Clinical Global Impression Scale (CGI), and International Classification of Diseases Version 10 (ICD-10). The response to intervention was assessed by the HAMD17/24 in 34 studies and by effective rate in 33 studies.


TCM patternChinese nameNumber of subjects diagnosed with the TCM pattern (%) (total = 1762)Number of studies that examined the TCM pattern (%) (total = 42)a

Liver qi depression 肝氣鬱結797 (45.2%)19 (45.2%)
Liver depression and spleen deficiency 肝鬱脾虛425 (24.1%)13 (31.0%)
Dual deficiency of the heart and spleen 脾兩虛315 (17.9%)9 (21.4%)
Liver depression and qi stagnation 肝鬱氣滯225 (12.8%)8 (19.0%)

Six studies examined more than one TCM pattern.

The criteria used for TCM pattern diagnosis were reported in 27 of the 42 studies. The criteria were based on the TCM Syndrome Diagnostic Standard (), New Guidelines for TCM Clinical Research (), TCM Diagnostic Standard for Depression (), Chinese Professional Association of Integrative Medicine Diagnostic Criteria for Mental Disorders, Version 1991/2001 (), Chinese Classification and Diagnostic Criteria of Mental Disorders (), and TCM textbooks (). However, none of the studies described other details of the diagnostic procedure and the background of practitioners who made the pattern diagnosis.

3.1. Methodological Quality

Twenty-three (54.8%) of the 42 studies were described as randomized but the randomization method, blinding, and dropouts were not presented; hence, these 23 studies only had a Jadad scale score of one. Seventeen studies (40.5%) had a Jadad scale score of two, and only two studies (4.8%) obtained a Jadad scale score of four.

3.2. Pattern-Based CHM Treatment
3.2.1. Liver qi Depression

According to the TCM theory, liver qi depression is an impairment of the liver function, obstructing free movement of qi and resulting in stagnation of qi in liver [21]. Nineteen studies examined CHM treatment in patients with liver qi depression. Seven studies used CHM alone and 12 used CHM-antidepressant combination. Xiaoyao decoction was investigated in 13 (68.4%) of the 19 studies, while other CHM formulas were studied in only one to two studies. Seventeen studies reported the ingredients of the CHM formulas for the treatment of liver qi depression. Chai Hu (Bupleurum chinense DC.) was the most commonly used herb, followed by Bai Shao (Paeonia lactiflora Pall.), Dang Gui (Angelica sinensis (Oliv.) Diels), Fu Ling (Poria Cocos (Schw) Wolf.), and Bai Zhu (Atractylodes macrocephala Koidz.). These five herbs were chosen for treating liver qi depression in more than half of the 17 studies that had reported the CHM ingredients (Table 2). The mean effective rate of Xiaoyao decoction for the treatment of liver qi depression was 84.7% and the mean HAMD change score was 19.1 (Table 3); for Xiaoyao decoction-antidepressant combination for liver qi depression, it was 86.0% and 19.1, respectively (Table 4). Tables 3 and 4 present the overall efficacy of pattern-based CHM monotherapy and CHM-antidepressant combination for liver qi depression.


Liver qi depression Liver depression and spleen deficiency Dual deficiency of the heart and spleen Liver depression and qi stagnation

Number of studies that examined the TCM pattern = 19 = 13 = 9 = 8
Commonly used Chinese herbal formula
(, % of studies that examined the TCM pattern)
Xiaoyao decoction
(13, 68.4%)
Xiaoyao decoction
(9, 69.2%)
Guipi decoction (2, 22.2%);
Ningcao Wangyou decoction (2, 22.2%)
Chaihu Shugan decoction
(5, 62.5%)
Number of studies that provided the composition of herbal formula = 17 = 9 = 8 = 6
Number of studies that provided TCM treatment principle = 6 = 4 = 3 = 4
Composition of herbal formula (% of studies that provided the formula’s composition)a
 Bai He [Lilium brownii F.E.Br. ex Miellez]11.8%///
 Bai Shao [Paeonia lactiflora Pall.]70.6%100%50.0%100%
 Ban Xia [Pinellia ternata (Thunb.) Makino]17.6%11.1%37.5%16.7%
 Bai Zhu [Atractylodes macrocephala Koidz.]52.9%55.6%25.0%16.7%
 Bei Mu [Fritillaria cirrhosa D.Don]//25.0%/
 Bing Pian [Dryobalanops aromatica Gaertn. f.]//12.5%/
 Bo He [Mentha haplocalyx Briq.]29.4%33.3%//
 Bo Zi Ren [Platyclatus orientalis (L.) Franco]//50.0%/
 Chan Su [Bufo bufo gargarizans Cantor]//12.5%/
 Chai Hu [Bupleurum chinense DC.]94.1%77.8%50.0%83.3%
 Cao Bai Zhu [Atractylodes macrocephala Koidz.]5.6%22.2%//
 Chen Pi [Citrus reticulata Blanco]17.6%33.3%25.0%33.3%
 Chuan Xiong [Ligusticum striatum DC.]17.6%22.2%25.0%83.3%
 Chi Wu Jia Pi [Acanthopanax gracilistylus W.W.Sm.]//12.5%/
 Dang Gui [Angelica sinensis (Oliv.) Diels]64.7%55.6%12.5%16.7%
 Dan Pi [Paeonia  ×  suffruticosa Andrews]29.4%11.1%/16.7%
 Dan Shen [Salvia miltiorrhiza Bunge.]11.8%11.1%25.0%/
 Da Zao [Ziziphus jujuba Mill.]11.8%/50.0%/
 Fu Ling [Poria Cocos (Schw) Wolf.]58.8%88.9%50.0%33.3%
 Fo Shou [Citrus medica L.]/22.2%37.5%/
 Gan Cao [Glycyrrhiza uralensis Fisch.]29.4%22.2%62.5%33.3%
 Gan Cao (Honey-toasted) [Glycyrrhiza uralensis  Fisch.]35.3%33.3%25.0%16.7%
 Gui Yuan [Dimocarpus longan Lour.]//37.5%/
 Gui Zhi [Cinnamomum cassia (L.) J.Presl]//12.5%/
 He Huan Hua [Albizia julibrissin Durazz.]5.9%//16.7%
 He Huan Pi [Albizia julibrissin Durazz.]29.4%22.2%37.5%50.0%
 Huang Lian [Coptis chinensis Franch.]//12.5%/
 Huang Qin [Scutellaria baicalensis Georgi]5.9%11.1%12.5%/
 Huang Qi (Honey-toasted)  [Astragalus  membranaceus (Fisch.) Bunge]//12.5%/
 Jiang [Zingiber officinale Roscoe]23.5%/25.0%/
 Mai Dong [Ophiopogon japonicus (Thunb.) Ker  Gawl.]5.9%/12.5%/
 Mu Xiang [Aucklandia lappa DC.]/22.2%12.5%/
 Niu Huang [Bos taurus domesticus Gmelin.]//12.5%/
 Qing Pi [Citrus reticulata Blanco]/11.1%25.0%33.3%
 Ren Shen [Panax ginseng C.A.Mey.]//12.5%/
 Rou Gui [Cinnamomum cassia (L.) J.Presl]//12.5%/
 She Xiang [Moschus berezovskii Flerov]//12.5%/
 Di Huang [Rehmannia glutinosa (Gaertn.) DC.]/11.1%12.5%/
 Shi Chang Pu [Acorus tatarinowii Schott]41.2%11.1%//
 Su He Xiang [Liquidambar orientalis Mill.]//12.5%/
 Tai Zi Shen [Pseudostellaria heterophylla (Miq.) Pax  ex Pax et Hoffm.]/11.1%12.5%/
 Xiang Fu [Cyperus rotundus L.]23.5%44.4%/83.3%
 Xiao Mai [Triticum aestivum L.]5.9%/25.0%/
 Ye Jiao Teng [Reynoutria multiflora (Thunb.)  Moldenke]5.9%//16.7%
 Yu Jin [Curcuma wenyujin Y.H.Chen & C.Lin]41.2%11.1%50.0%100%
 Yuan Zhi [Polygala tenuifolia Willd.]23.5%/37.5%16.7%
 Zao Ren [Ziziphus jujuba var. spinosa (Bunge) Hu ex  H.F.Chow]35.3%11.1%25.0%16.7%
 Zhi Ke [Citrus  ×  aurantium L.]35.3%66.7%/83.3%
 Zhi Zi [Gardenia jasminoides J.Ellis]41.2%11.1%/16.7%

Individual herbs used in at least 10% of the studies on a particular TCM pattern were listed.

Chinese herbal formula Type of casesMean effective rate in % (range, 95% CI)Mean HAMD change score (range, 95% CI)

Liver qi depression
 Xiaoyao decoction/pill ( = 4)Depression ( = 4) 84.7 (70.0–93.3, 80.8–84.7)19.1 (12.8–26.0, 18.4–19.9)
 Chaihu Shugan decoction ( = 2)Depression ( = 1); poststroke depression ( = 1)90.0 (86.7–93.3, 88.8–91.2)15.0 (14.6–15.4, 14.9–15.1)
 Jieyu Heji ( = 1)Depression ( = 1)51.0 (NA)NR
 Yushu pill ( = 1)Depression ( = 1)74.3 (NA)NR
 All ( = 8)85.1 (51.0–93.3, 77.3–80.9)17.7 (12.8–26.0, 17.2–18.63)
Liver depression and spleen deficiency
 Xiaoyao decoction/pill ( = 1)Depression comorbid diabetes ( = 1)NR7.3 (NA)
 Yiqiyangyin Shuganjieyu decoction ( = 1)Depression comorbid diabetes ( = 1)83.3 (NA)12.1 (NA)
 Chaihu Shugan decoction ( = 1)Depression ( = 1)92.1 (NA)NR
 All ( = 3)87.7 (83.3–92.1, 86.2–89.2)9.7 (7.3–12.1, 8.9–10.5)
Dual deficiency of the heart and spleen
 Guipi decoction ( = 1)Depression ( = 1)NRNR
 Xiaochaihu Tang ( = 1)Depression ( = 1)NRNR
 Anshen Jieyu Fang decoction ( = 1)Depression comorbid diabetes ( = 1)NR10.7 (NA)
 Jieyu Yi Hao ( = 1)Depression ( = 1)90.0 (NA)11.4 (NA)
 Shexiang Baoxin pill ( = 1)Depression ( = 1)92.2 (NA)NR
 All ( = 5)91.5 (90.0–92.2, 91.3–91.6)10.8 (10.7–11.4, 10.6–11.0)
Liver depression and qi stagnation
 Chaihu Shugan decoction ( = 2) Depression ( = 2) 89.8 (86.7–93.0, 88.8–90.9)17.3 (13.9–20.7, 16.2–18.4)
 Shujiele Wutang pill ( = 1) Depression ( = 1)91.4 (NA)18 (NA)
 All ( = 3)90.4 (86.7–93.0, 89.7–91.0)17.5 (13.9–20.7, 16.9–18.2)
All studies ( = 18) a85.0 (51.0–93.33, 84.1–85.9)15.4 (7.3–26.0, 15.0–15.8)

One study studied more than one TCM pattern; NA: not applicable; NR: not reported.

Chinese herbal formula Type of cases Mean effective rate in % (range, SD, 95% CI)Mean HAMD change score (range, 95% CI)

Liver qi depression
 Xiaoyao decoction/pill ( = 9)Depression ( = 6); poststroke depression ( = 3)86.0 (70.0–94.3, 85.1–87.0)19.1 (11.4–23.2, 18.4–19.9)
 Banxia Houpu decoction ( = 1)Depression ( = 1)97.2 (NA)16.0 (NA)
 Kaiyu Quhuo decoction ( = 1)Depression ( = 1)100 (NA)NR
 All ( = 11)88.3 (70.0–100.0, 87.4–89.2)17.8 (11.4–23.2, 17.5–18.2)
Liver depression and spleen deficiency
 Xiaoyao decoction/pill ( = 8)Depression ( = 8)86.0 (66.7–95.1, 84.6–87.4)21.5 (20.4–23.0, 21.3–21.7)
 Self-invented formula ( = 1)Depression ( = 1)91.7 (NA)NR
 Kuaiwei Shugan pill ( = 1)Depression ( = 1)NR12.2 (NA)
 All ( = 10)86.8 (66.7–95.1, 85.6–88.0)20.1 (12.2–23.0, 19.6–20.5)
Dual deficiency of the heart and spleen
 Guipi decoction ( = 1)Depression comorbid diabetes ( = 1) 92.1 (NA)NR
 Ningcao Wangyou decoction ( = 2)Depression ( = 2)53.8 (NA)a16.8 (NA)a
 Ganmai Dazao decoction plus  Suanzaoren decoction ( = 1)Poststroke depression ( = 1)100.0 (NA)6.0 (NA)
 All ( = 4)77.0 (53.8–100.0, 68.7–85.2)11.4 (6.0–16.8, 9.5–13.3)
Liver depression and qi stagnation
 Chaihu Shugan decoction ( = 3) Depression ( = 2); poststroke depression ( = 1)80.0 (NA)a15.0 (8.9–21.1, 12.8–17.1)
 Xiaoyao decoction/pill ( = 2) Depression ( = 2)NRNR
 All ( = 5)80.0 (NA)15.0 (8.9–21.1, 12.8–17.1)
All studies ( = 24)b86.3 (53.8–100.0, 85.5–87.2)17.7 (6.0–22.6, 17.4–18.0)

Only one study presented the data; bfive studies studied more than one TCM pattern; NA: not applicable; NR: not reported.
3.2.2. Liver Depression and Spleen Deficiency

According to the TCM theory, liver depression and spleen deficiency is a pathological change in which the transporting and transforming function of the spleen is affected by depressed liver qi, leading to spleen deficiency [21]. Of the 13 studies on liver depression and spleen deficiency, three studies examined CHM alone and 10 investigated CHM-antidepressant combination. The most frequently used CHM formula was also Xiaoyao decoction, which was used in 9 of the 13 studies. Nine of the 13 studies provided ingredients of the CHM formulas. The commonly used single herbs for the treatment of liver depression and spleen deficiency were Bai Shao (Paeonia lactiflora Pall.), Fu Ling (Poria Cocos (Schw) Wolf.), Chai Hu (Bupleurum chinense DC.), Zhi Ke (Citrus aurantium L.), Dang Gui (Angelica sinensis (Oliv.) Diels), and Bai Zhu (Atractylodes macrocephala Koidz.) (Table 2). Only one study was conducted on Xiaoyao decoction monotherapy for liver depression and spleen deficiency, and the HAMD change score was 7.3 (Table 3). The mean effective rate of Xiaoyao decoction-antidepressant combination for liver depression and spleen deficiency was 86.0% and the mean HAMD change score was 20.1 (Table 4). Tables 3 and 4 show the overall efficacy of pattern-based CHM monotherapy and CHM-antidepressant combination for liver depression and spleen deficiency.

3.2.3. Dual Deficiency of the Heart and Spleen

Dual deficiency of the heart and spleen is a condition in which both heart blood and spleen qi are deficient, leading to disordered heart function and an impairment of the transporting and transforming function of spleen [21]. There was significant variation in the TCM pattern-based CHM treatment for dual deficiency of the heart and spleen. Of the 10 relevant studies, seven different CHM formulas were used. Guipi Tang and Ningcao Wangyou Tang were each used in two studies, while other CHM formulas were only examined once. The frequently used single herbs for dual deficiency of the heart and spleen were Gan Cao (Glycyrrhiza uralensis Fisch.), Bai Shao (Paeonia lactiflora Pall.), Chai Hu (Bupleurum chinense DC.), Fu Ling (Poria Cocos (Schw) Wolf.), Bo Zi Ren (Platyclatus orientalis (L.) Franco), Da Zao (Ziziphus jujua Mill.), and Yu Jin (Curcuma wenyujin Y. H. Chen & C. Lin) (Table 2). The mean effective rate of CHM monotherapy for dual deficiency of the heart and spleen was 91.5% and the mean HAMD change score was 10.8 (Table 3); for CHM-antidepressant combination, it was 77.0% and 11.4, respectively (Table 4).

3.2.4. Liver Depression and qi Stagnation

Liver depression and qi stagnation is a pathological change in which liver is depressed, leading to impeded circulation of qi and stagnation of qi movement [21]. The most frequently used CHM formula for liver depression and qi stagnation was Chaihu Shugan decoction (Table 3). The commonly used single herbs were Bai Shao (Paeonia lactiflora Pall.), Yu Jin (Curcuma wenyujin Y. H. Chen & C. Lin), Chai Hu (Bupleurum chinense DC.), Chuan Xiong (Ligusticum striatum DC.), Xiang Fu (Cyperus rotundus L.), Zhi Ke (Citrus × aurantium L.), Xiang Fu (Cyperus rotundus L.), and He Huan Pi (Albizia julibrissin Durazz.) (Table 2). The mean effective rate of CHM monotherapy for liver depression and qi stagnation was 90.4% and the mean HDRS change score was 17.5 (Table 3); for CHM-antidepressant combination, it was 80.0% and 15.0, respectively (Table 4).

4. Discussion

This study is the first systematic review of English and Chinese literature, involving 61 studies and 2504 subjects on the classification and treatment of depression using the TCM diagnostic system. We found that the TCM pattern diagnoses for depression were diverse. Among 27 different TCM patterns identified, liver qi depression was the most commonly diagnosed TCM pattern in people with depression, followed by liver depression and spleen deficiency, dual deficiency of the heart and spleen, and liver depression and qi stagnation. With regard to CHM treatment, Xiaoyao decoction was the most frequently used herbal formula for the treatment of liver qi depression and liver depression and spleen deficiency, while Chaihu Shugan decoction was often used for liver depression and qi stagnation. For dual deficiency of the heart and spleen, no single formula could be regarded as commonly used across TCM practitioners. The results suggest that TCM practitioners may be more consistent in the treatment of depression involving liver depression than other patterns. The abundance of low-quality studies highlights that knowledge and experience in conducting high-quality RCTs may be limited. It further suggests that institutional review boards and publishing journals should play an active role in monitoring the standards of clinical trials.

The present paper found that Bai Shao (Paeonia lactiflora Pall.), which has a function of nourishing the blood and emolliating the liver, and Chai Hu (Bupleurum chinense DC.), which can sooth the liver, were commonly used to treat depression regardless of the TCM pattern. Animal studies have found that extract from Bai Shao produces antidepressant effects in chronic unpredictable stress-induced depression model in mice and rats [66]. The antidepressant effects are likely mediated by inhibition of the monoamine oxidase activity and oxidative stress, upregulation of neurotrophins, and modulation of the function of the hypothalamic-pituitary-adrenal axis [66]. Pharmacological studies of Chai Hu have shown that it has hepatoprotective, anti-inflammatory, antipyretic, analgesic, and immunomodulatory effects [6770]; however, its antidepressant effects remain unclear. According to a TCM textbook, Chai Hu is a “Sovereign” herb in Xiaoyao decoction and Chaihu Shugan decoction [69]. The “Sovereign” herb is used for treating the principal diseases based on the TCM theory; the “Minister” herb has synergistic effects with “Sovereign” herbs and helps to alleviate other accompanying symptoms; the “Assistant” herb is for enhancing the therapeutic effects and modulating the adverse effects of “Sovereign” and “Minister” herbs, while the “Courier” herb is used for harmonizing the actions of the others [66]. Therefore, some of the commonly used herbs identified in this review may not primarily be targeted at depression; instead, they indirectly alleviate depression by enhancing or harmonizing the actions of other herbs. In view of the common use of Chai Hu in the treatment of depression, further studies on its antidepressant effects are warranted.

Xiang Fu (Cyperus rotundus L.) and He Huan Pi (Albizia julibrissin Durazz.) were specifically used for liver depression and qi stagnation, and Bo Zi Ren (Platyclatus orientalis (L.) Franco), which has a function of nourishing the heart and tranquilizing shen, was specific for dual deficiency of the heart and spleen. Yu Jin (Curcuma wenyujin Y. H. Chen & C. Lin) was commonly used for liver depression and qi stagnation and dual deficiency of the heart and spleen, Fu Ling (Poria Cocos (Schw) Wolf.) for liver qi depression, liver depression and spleen deficiency, and dual deficiency of the heart and spleen, and Dang Gui (Angelica sinensis (Oliv.) Diels) and Bai Zhu (Atractylodes macrocephala Koidz.) for liver qi depression and liver depression and spleen deficiency. Since three of the four commonly diagnosed TCM patterns in people with depression involve liver depression and two involve spleen deficiency, the prescription of Chinese herbs for different TCM patterns are inevitably overlapping. A lack of consistency across TCM practitioners in their selection of herbal formulas and pattern-based prescription of individual herbs may also lead to variation in CHM treatment [70]. Considering the limited number of studies available, further research on pattern-based CHM treatment for depression is warranted.

Due to the studies’ variation in study design and inadequate methodological quality, it is difficult to conclude which herbal formulas have higher efficacy and which TCM patterns respond better to CHM. As a whole, there is no evidence to suggest CHM-antidepressant combination has higher efficacy than CHM monotherapy for depression. We found that the effective rate was generally high for pattern-based treatment in liver qi depression and was similar between CHM monotherapy and CHM-antidepressant combination. For liver depression and spleen deficiency, the efficacy of CHM monotherapy and CHM-antidepressant combination was similar in terms of effective rate, but it was lower with CHM monotherapy in terms of mean HAMD change score (9.7 versus 20.1 for CHM-antidepressants combination). For dual deficiency of the heart and spleen, the efficacy of pattern-based CHM treatment was relatively weaker, especially CHM-antidepressant combination, which had a mean effective rate of 77.0% and mean HAMD change score of 11.4. For liver depression and qi stagnation, the efficacy of CHM monotherapy and CHM-antidepressant combination was similar, except for a relatively low mean effective rate of CHM-antidepressant combination (80.9% versus 90.4% for CHM monotherapy). It is clear that further studies with better methodological quality are needed to delineate the efficacy of pattern-based CHM treatment in depression.

There are some methodologic limitations of the study. First, there is no “gold standard” in the classification of TCM patterns, and the criteria for each pattern might be different between researchers. Future studies using both Western and Chinese medicine systems in diagnosis and severity assessment may facilitate Western-Chinese medicine integration in the understanding and treatment of depression. Although we reported the pattern diagnosis by the authors, the procedure and quality of the diagnostic process was uncertain. Such uncertainties would inevitably lead to discrepancies in the selection of herbs in treatment. Although a large number of studies were reviewed, this paper only summarized the effective rate and HAMD change score based on RCTs; meta-analysis was not possible due to difference in study design and low methodological quality of the studies.

Despite the limitations, the present study, for the first time, systematically and comprehensively summarized important data on pattern-based CHM treatment for depression. Our data should be useful for both clinical practice and future research. More high quality studies incorporating TCM pattern differentiation and treatment principle are needed to examine the efficacy of TCM treatments and the additional benefit of pattern differentiation.

5. Conclusion

We found that liver qi depression, liver depression and spleen deficiency, dual deficiency of the heart and spleen, and liver depression and qi stagnation were the most commonly studied TCM patterns in people with depression. In addition, Bai Shao (Paeonia lactiflora Pall.) and Chai Hu (Bupleurum chinense DC.) were commonly used across different TCM patterns regardless of the prescribed Chinese herbal formulas. Due to the limited number of studies on TCM pattern-based treatment of depression and their low methodological quality, we are unable to draw any conclusion regarding which herbal formulas have higher efficacy and which TCM patterns respond better to CHM.

Conflict of Interests

The authors have no conflict of interests to report.

Acknowledgment

The study was supported by the Chinese Medicine Research Fund of the Hospital Authority of Hong Kong (Project no. HACMR001).

References

  1. A. J. Ferrari, F. J. Charlson, R. E. Norman et al., “Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010,” PLoS Medicine, vol. 10, no. 11, Article ID e1001547, 2013. View at: Publisher Site | Google Scholar
  2. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association, Washington, DC, USA, 4th edition, 1994.
  3. E. Bromet, L. H. Andrade, I. Hwang et al., “Cross-national epidemiology of DSM-IV major depressive episode,” BMC Medicine, vol. 9, no. 1, article 90, 2011. View at: Publisher Site | Google Scholar
  4. R. C. Kessler, J. Soukup, R. B. Davis et al., “The use of complementary and alternative therapies to treat anxiety and depression in the United States,” The American Journal of Psychiatry, vol. 158, no. 2, pp. 289–294, 2001. View at: Publisher Site | Google Scholar
  5. M. C. Hsu, D. Creedy, W. Moyle, L. Venturato, S. L. Tsay, and W. C. Ouyang, “Use of complementary and alternative medicine among adult patients for depression in Taiwan,” Journal of Affective Disorders, vol. 111, no. 2-3, pp. 360–365, 2008. View at: Publisher Site | Google Scholar
  6. N. A. Qureshi and A. Mohammed, “Mood disorders and complementary and alternative medicine: a literature review,” Neuropsychiatric Disease and Treatment, vol. 9, pp. 639–658, 2013. View at: Publisher Site | Google Scholar
  7. F. Qin, X.-A. Wu, Y. Tang, Q. Huang, Z.-J. Zhang, and J.-H. Yuan, “Meta-analysis of randomized controlled trials to assess the effectiveness and safety of free and easy Wanderer plus, a polyherbal preparation for depressive disorders,” Journal of Psychiatric Research, vol. 45, no. 11, pp. 1518–1524, 2011. View at: Publisher Site | Google Scholar
  8. H. Zhao, X. Wan, and J.-X. Chen, “A mini review of traditional Chinese medicine for the treatment of depression in China,” The American Journal of Chinese Medicine, vol. 37, no. 2, pp. 207–213, 2009. View at: Publisher Site | Google Scholar
  9. L. Butler and K. Pilkington, “Chinese herbal medicine and depression: the research evidence,” Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 739716, 14 pages, 2013. View at: Publisher Site | Google Scholar
  10. M. J. Kou and J. X. Chen, “Integrated traditional and Western medicine for treatment of depression based on syndrome differentiation: a meta-analysis of randomized controlled trials based on the Hamilton depression scale,” Journal of Traditional Chinese Medicine, vol. 32, no. 1, pp. 1–5, 2012. View at: Publisher Site | Google Scholar
  11. W.-F. Yeung, K.-F. Chung, K.-Y. Ng, Y.-M. Yu, E. Tat-Chi Ziea, and B. Fung-Leung Ng, “A meta-analysis of the efficacy and safety of traditional Chinese medicine formula Ganmai Dazao decoction for depression,” Journal of Ethnopharmacology, vol. 153, no. 2, pp. 309–317, 2014. View at: Publisher Site | Google Scholar
  12. X. K. Qing, P. Li, M. Han et al., “Systematic review of randomize controlled trials of Xiaoyao powder in treatment of depression,” Journal of Traditional Chinese Medicine, vol. 51, no. 6, pp. 500–505, 2010. View at: Google Scholar
  13. Y. Wang, R. Fan, and X. Huang, “Meta-analysis of the clinical effectiveness of traditional Chinese medicine formula Chaihu-Shugan-San in depression,” Journal of Ethnopharmacology, vol. 141, no. 2, pp. 571–577, 2012. View at: Publisher Site | Google Scholar
  14. J. Liu, Y. Zhang, M. Han, Z. Liu, J. Wang, and Q. He, “Chinese herbal formula Xiao Yao San for treatment of depression: a systematic review of randomized controlled trials,” Evidence-Based Complementary and Alternative Medicine, vol. 2012, Article ID 931636, 13 pages, 2012. View at: Publisher Site | Google Scholar
  15. W. Yang, F. Meng, and Y. Jiang, Diagnostics of Traditional Chinese Medicine, Academy Press, Beijing, China, 1998.
  16. R. N. Schnyer and B. Flaws, Curing Depression Naturally with Chinese Medicine, Blue Poppy Press, Boulder, Colo, USA, 1998.
  17. Y. Wang, M. Li, X. Dai, and G. Fan, Internal Chinese Medicine, Shanghai Scientific and Technological Documentation Publishing House, Shanghai, China, 1997.
  18. A. Bensoussan, N. J. Talley, M. Hing, R. Menzies, A. Guo, and M. Ngu, “Treatment of irritable bowel syndrome with Chinese herbal medicine: a randomized controlled trial,” Journal of the American Medical Association, vol. 280, no. 18, pp. 1585–1589, 1998. View at: Publisher Site | Google Scholar
  19. Q.-L. Zha, Y.-T. He, and J.-P. Yu, “Correlations between diagnostic information and therapeutic efficacy in rheumatoid arthritis analyzed with decision tree model,” Chinese Journal of Integrated Traditional and Western Medicine, vol. 26, no. 10, pp. 871–876, 2006. View at: Google Scholar
  20. W.-F. Yeung, K.-F. Chung, K.-Y. Ng, Y.-M. Yu, E. T.-C. Ziea, and B. F.-L. Ng, “A systematic review on the efficacy, safety and types of Chinese herbal medicine for depression,” Journal of Psychiatric Research, vol. 57, no. 7, pp. 165–175, 2014. View at: Publisher Site | Google Scholar
  21. World Health Organization, WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region, World Health Organization, Western Pacific Region, 2007.
  22. B. Peng and J. Xie, Traditional Chinese Internal Medicine, People's Medical Publishing House, Beijing, China, 2nd edition, 2007.
  23. A. R. Jadad, R. A. Moore, D. Carroll et al., “Assessing the quality of reports of randomized clinical trials: is blinding necessary?” Controlled Clinical Trials, vol. 17, no. 1, pp. 1–12, 1996. View at: Publisher Site | Google Scholar
  24. B. Lin and J. Xia, “Clinical observation on modified chaihu shugan san on depression,” Journal of New Chinese Medicine, vol. 4, no. 8, pp. 36–37, 2011 (Chinese). View at: Google Scholar
  25. B. Y. Yan, “Clinical observation on integrated traditional Chinese and Western medicine in treating depression,” Guangming Journal of Chinese Medicine, vol. 24, no. 9, pp. 1761–1762, 2009 (Chinese). View at: Google Scholar
  26. B. Zhou and H. Yan, “Efficacy of integrated traditional Chinese and Western medicine on 30 cases of depression caused by liver stagnation and spleen deficiency,” Tianjin Journal of Traditional Chinese Medicine, vol. 29, no. 4, pp. 329–331, 2012 (Chinese). View at: Google Scholar
  27. D. L. Zhaou, J. Xia, J. Li, and Y. Y. Ma, “Clinical observation on treatment of depressive disorder by fluvoxamine combined with Xiaoyao pills,” Sichuan Mental Health, vol. 25, no. 2, pp. 97–99, 2012 (Chinese). View at: Google Scholar
  28. E. P. Xu, “Treatment of danzhi xiaoyao san combining fluoxetine in treating 70 cases of post-stroke depression,” Research of Chinese Medicine, vol. 19, no. 4, pp. 31–32, 2006 (Chinese). View at: Google Scholar
  29. F. Mou and X. Y. Zhou, “Clinical observation of Shexiang baoxin pills in treating 129 cases of depression,” Chinese Traditional Patent Medicine, vol. 26, no. s1, pp. 69–70, 2004 (Chinese). View at: Google Scholar
  30. F. Zhang, “Xiaoyao San treatment of depression 60 cases,” Journal of Practical Traditional Chinese Internal Medicine, vol. 26, no. 6, pp. 37–38, 2012 (Chinese). View at: Google Scholar
  31. G.-H. Yu, S.-C. Liang, and Q.-Z. Sun, “Study on modified xiaoyao decoction combining clomipamine in treating depression,” Chinese Journal of Integrated Traditional and Chinese Medicine, vol. 27, no. 4, pp. 318–320, 2007 (Chinese). View at: Google Scholar
  32. H. D. Zhang and H. Su, “Clinical comparative study of paroxetine combined with Xiaoyao pill of depression,” Modern Journal of Integrated Traditional Chinese and Western Medicine, vol. 18, no. 33, pp. 4060–4063, 2009 (Chinese). View at: Google Scholar
  33. H. Li, S. Xu, B. Li et al., “Xiaoyao San combining fluoxetine in treating 41 cases of depression caused by liver depression and spleen deficiency,” Shaanxi Journal of Traditional Chinese Medicine, vol. 30, no. 1, pp. 49–50, 2009 (Chinese). View at: Google Scholar
  34. H. M. Wang and Q. H. Dong, “Clinical observation of anseng jieyu fang in treating depression in patients with type 2 diabetes,” Journal of New Chinese Medicine, vol. 44, no. 10, pp. 72–73, 2012 (Chinese). View at: Google Scholar
  35. H. Y. Wang, B. J. Zhang, X. Liu, and Y. D. Tao, “Clinical observation on treatment of first-episode depression by duloxetine combined with Xiaoyaowan mixture,” Sichuan Mental Health, vol. 26, no. 1, pp. 32–34, 2013 (Chinese). View at: Google Scholar
  36. H. Zhang and S. H. Li, “Kaiyu quhuo tang combining fluoxetine capsule in treating 44 cases of depression,” Shaanxi Journal of Traaditional Chinese Medicine, vol. 33, no. 6, pp. 674–675, 2012 (Chinese). View at: Google Scholar
  37. J. Huo, H. P. Fu, J. Yang et al., “The clinical research of depressive disorder treated in dan-zhi decoction for ease combined fluoxetine,” Journal of Henan University of Chinese Medicine, vol. 23, no. 136, pp. 38–39, 2010 (Chinese). View at: Google Scholar
  38. J. P. Xian, Q. Zhou, and X. D. Li, “Clinical observation of modified xiaoyao san combining paroxetine in treating depression,” Contemporary Medicine, vol. 16, no. 13, pp. 154–155, 2010 (Chinese). View at: Google Scholar
  39. J. R. Zhang, “Effect of xiao chaihu tang in treating 40 cases of depression,” Beijing Journal of TCM, vol. 22, no. 5, pp. 38–39, 2003 (Chinese). View at: Google Scholar
  40. J. Y. Zheng, “Observation on the efficacy of Ganmai Dazao Tang combining Suan Zaoren Tang in treating post-stroke depression,” Beijing Journal of Traditional Chinese Medicine, vol. 28, no. 4, pp. 291–292, 2009. View at: Google Scholar
  41. J. Z. Zhang, “Efficacy analysis on integrated traditional Chinese and Western medicine in treating 64 cases of depression,” Chinese Journal of Practical Nervous Diseases, vol. 15, no. 10, pp. 39–40, 2012 (Chinese). View at: Google Scholar
  42. K. Cheng, H. Yan, and K. J. Duan, “Clinical observation on the efficacy of self-invented Chinese medicine in treating depression,” Clinical Journal of Traditional Chinese Medicine, vol. 20, no. 4, pp. 375–376, 2008 (Chinese). View at: Google Scholar
  43. L. J. Mao, Y. Lu, and W. X. Song, “Observation on the efficacy of yushu pills in treating 70 cases of depression,” Chinese Journal of Integrative Medicine on Cardio-cerebrovascular Disease, vol. 4, no. 12, pp. 1047–1048, 2006 (Chinese). View at: Google Scholar
  44. L. R. Li, Z. X. Chen, and L. Kong, “Jieyu heji on 50 cases of depression,” Guanming Journal of Chinese Medicine, vol. 25, no. 12, pp. 2206–2207, 2010 (Chinese). View at: Google Scholar
  45. M. Zhang and W. Z. Xiao, “Clinical observation on Danzhi Xiaoyao powder in treating depression in patients with diabetes,” Journal of Liaoning University of TCM, vol. 10, no. 2, pp. 108–109, 2008 (Chinese). View at: Google Scholar
  46. P. Zhou, L. Q. Chen, X. M. Peng et al., “Clinical observation on banxia houpu decoction combining fluoxetine in treating depressive adolescents,” Chinese Journal of Integrative Medicine on Cardio-cerebrovascular Disease, vol. 9, no. 2, pp. 247–248, 2011 (Chinese). View at: Google Scholar
  47. R. C. Wang, “Clinical observation on modified xiaoyao san in treating depression,” Medical Journal of Chinese Peoples Health, vol. 20, no. 13, pp. 1504–1505, 2008 (Chinese). View at: Google Scholar
  48. R. X. Yang, Y. Dong, and D. M. Wang, “Clinical observation on Shujiele Watang pills in treating depression,” Chinese Medicine Focus, vol. 1, no. 5, pp. 16–17, 2002 (Chinese). View at: Google Scholar
  49. S. Y. Liu, “Observation of chaihushugan powder plus psychological nursing intervention therapy on acute poststroke depression,” Journal of Emergency in Traditional Chinese Medicine, vol. 8, no. 8, pp. 1205–1207, 2012 (Chinese). View at: Google Scholar
  50. W. F. Long and Z. H. Dan, “Jieyu Yi Hao in treating 30 cases of depression caused by dual deficiency of the heart and spleen,” Journal of New Chinese Medicine, vol. 43, no. 3, pp. 38–39, 2010 (Chinese). View at: Google Scholar
  51. W. X. Huang, Y. H. Yin, and J. J. Hu, “Chaihu Shugan powder combining deanxit on 32 cases of post-stroke depression,” Fujian Journal of Traditional Chinese Medicine, vol. 41, no. 5, pp. 21–22, 2010 (Chinese). View at: Google Scholar
  52. X. Gao, “Xiaoyao powder combined with escitalopram oxalate tablets in the treatment of Depression,” China Modern Doctor, vol. 50, no. 1, pp. 66–70, 2012 (Chinese). View at: Google Scholar
  53. Y. C. Ma, Z. X. Chen, W. D. Jin et al., “Preliminary observation on treating depression in the integrative medicine,” Clinical Journal of Chinese Medicine, vol. 3, no. 1, pp. 6–7, 2011 (Chinese). View at: Google Scholar
  54. Y. F. Ma, “Study on modified xiaoyao san combining fluoxetine in treating 80 cases of post-stroke,” Journal of Noah China Coal Medical University, vol. 12, no. 2, pp. 187–188, 2010 (Chinese). View at: Google Scholar
  55. Y. J. Li, H. C. Luo, and R. Q. Qian, “Effect of danzhi xiaoyao san on depressive patients’ neuro -immune-endocrine system,” Chinese Journal of Integrative Medicine, vol. 27, no. 3, pp. 197–200, 2007 (Chinese). View at: Google Scholar
  56. Y. K. Huang, J. Chen, and Y. Q. Huang, “Clinical observation on the treatment efficacy of Xiayao pills on 62 cases of depression caused by liver qi depression,” Fujian Journal of Traditional Chinese Medicine, vol. 40, no. 5, pp. 3–4, 2009 (Chinese). View at: Google Scholar
  57. Y. L. Liu and S. L. Dong, “Observation on the efficacy of Danzhi Xiaoyao San in treating depression in patients with hypertension,” Chinese Journal of Integrated Traditional and Chinese Medicine, vol. 28, no. 3, pp. 280–281, 2008 (Chinese). View at: Google Scholar
  58. Y. M. Guo, C. F. Liu, and J. J. Yang, “Chinese medicine on 38 cases of depression,” China's Naturopathy, vol. 9, no. 10, pp. 56–57, 2001 (Chinese). View at: Google Scholar
  59. Y. M. Song, “Treating 30 cases of depression using the method of Shugan Jieyu liqi,” Chinese Medicine Modern Education of China, vol. 9, no. 16, pp. 7–8, 2011 (Chinese). View at: Google Scholar
  60. Y. Wang and S. S. Liu, “Clinical observation on danzhi xiaoyao san combining fluoxetine in treating depression,” Journal of Community Medicine, vol. 5, no. 11, pp. 57–58, 2007 (Chinese). View at: Google Scholar
  61. Y. Q. Jian, “Pattern-based integrated traditional Chinese and Western medicine treatment on 30 cases of depression,” Liaoning Journal of Traditional Chinese Medicine, vol. 28, p. 236, 2001 (Chinese). View at: Google Scholar
  62. Y. X. Wang, Y. B. Gao, H. Zhou, Z. Guan, and X. Z. Shang, “Qi-Yin nourishing method to treat diabetes with depression,” World Journal of Traditional Chinese Medicine, vol. 5, no. 6, pp. 397–399, 2010 (Chinese). View at: Google Scholar
  63. Z. Lian and Q. Wu, “Treatment efficacy analysis of chaihu shugan powder combining fluoxetine in treating post-stroke depression,” Guangming Journal of Chinese Medicine, vol. 24, no. 1, pp. 101–102, 2009 (Chinese). View at: Google Scholar
  64. Z. X. Bao, Q. Tian, W. Zhou, W. Sun, and G. P. He, “Clinical observation of influence of Zhuyang Shuxin recipe on TCM syndrome of patients with depression with syndrome of liver and kidney yang deficiency,” Chinese Archives of Traditional Chinese Medicine, vol. 30, no. 10, pp. 116–118, 2012 (Chinese). View at: Google Scholar
  65. Z. X. Chen, Y. C. Ma, W. D. Jin et al., “Clinical study on the treatment of depressive patients caused by different TCM pattern using integrated traditional Chinese and Western medicine,” International Journal of Traditional Chinese Medicine, vol. 33, no. 5, pp. 421–424, 2011 (Chinese). View at: Google Scholar
  66. Q.-Q. Mao, S.-P. Ip, Y.-F. Xian, Z. Hu, and C.-T. Che, “Anti-depressant-like effect of peony: a mini-review,” Pharmaceutical Biology, vol. 50, no. 1, pp. 72–77, 2012. View at: Publisher Site | Google Scholar
  67. H.-X. Sun, “Haemolytic activities and adjuvant effect of Bupleurum chinense saponins on the immune responses to ovalbumin in mice,” Vaccine, vol. 24, no. 9, pp. 1324–1331, 2006. View at: Publisher Site | Google Scholar
  68. D. Xie, X. Jia, B. Cai, and L. Zhang, “Experimental study on anti-inflammatory and analgesic effects of volatile oil of Bupleurum chinense and B. scorzonerifolium,” Asian Journal of Pharmaceutical and Clinical Research, vol. 15, pp. 108–110, 2007. View at: Google Scholar
  69. Y. Yang, Chinese Medical Formulae, Beijing Shi: Ren min wei sheng chu ban she, Beijing, China, 2001, (Chinese).
  70. W.-F. Yeung, K.-F. Chung, M. M.-K. Poon et al., “Prescription of Chinese herbal medicine and selection of acupoints in pattern-based traditional Chinese medicine treatment for insomnia: a systematic review,” Evidence-based Complementary and Alternative Medicine, vol. 2012, Article ID 902578, 16 pages, 2012. View at: Publisher Site | Google Scholar

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