Chinese Herbal Medicine for Postpartum Depression: A Systematic Review of Randomized Controlled Trials

Table 1

Characteristics of included randomized controlled trials.

Study ID	Diagnosis standard	Sample size; I/C	Age (year); I/C	Course of disease; I/C	Syndrome differentiation of TCM	Therapeutical method of TCM	Intervention	Control	Duration	Follow-up	Outcome
Cai 2015 [28]	CCMD-III	71/40	32.5 ± 4.5/34.5 ± 2.5	41.6 ± 6.7 d/39.7 ± 5.3 d	Stagnation of liver and la tortura and deficiency of both heart and spleen	Relieving liver qi and invigorating the spleen, tonifying qi and blood.	Shugan jianpi kaixin decoction + sertraline + vitamin D drops + cognitive therapy, behaviour therapy + relaxation therapy + music therapy	Sertraline + vitamin D drops + cognitive therapy, behaviour therapy + relaxation therapy + music therapy	NR	NR	Effective rate, HAMD scores, EPDS scores, SCL-90 scores
Chen et al. 2015 [29]	CCMD-III	30/30	26.1 ± 1.2/25.3 ± 0.4	0.87 ± 0.14 y/0.85 ± 0.16 y	NR	NR	Fuling shenzhi shuangxin pill + sertraline hydrochloride tablets, fluoxetine hydrochloride tables	Sertraline hydrochloride tablets, fluoxetine hydrochloride tables	4 m	NR	Effective rate, adverse events
Chen et al. 2011 [30]	DSM-IV	38/38	30.2 ± 1.5/30.0 ± 1.8	3.8 ± 1.2 m/4.1 ± 1.0 m	NR	NR	Self-made qingyu pingxin decoction + Fluoxetine	Fluoxetine	1 m	NR	Effective rate, adverse events
Ding et al. 2010 [31]	DSM-IV	40/30	27.46 ± 5.215/25.42 ± 4.441	27.15 ± 11.841 d/24.21 ± 9.718 d	NR	NR	Modification decoction of xiaoyao san + Mirtazapine	Mirtazapine	8 w	NR	Obvious effective rate, effective rate, HAMD scores, adverse events
Fan 2011 [32]	DSM-IV	52/52	29.3/28.6	35.5 d/37.7 d	NR	NR	Modification mixture of tianwang buxin decoction + fluoxetine	Fluoxetine	4 w	6 m	Effective rate, adverse events
Fang 2014 [33]	CCMD-III	57/56	26.8 ± 2.9/27.4 ± 3.2	11.2 ± 3.8 w/10.5 ± 3.5 w	NR	NR	Self-made tiaoxue jieyu decoction + venlafaxine hydrochloride sustained-release tablets	Venlafaxine hydrochloride sustained-release tablets	8 w	NR	SAS scores, MADRS scores, adverse events
Gao 2010 [34]	DSM-IV	36/28	25–35/25–35	NR	NR	Tonifying qi and blood, psyche-nourishing and tranquilizing mind.	Modification mixture of yulin decoction	Fluoxetine	6 w	NR	Effective rate, adverse events
Guo et al. 2011 [35]	DSM-IV	38/34	26.14 ± 2.5/25.84 ± 2.7	NR	NR	Strengthening heart and spleen, relieving liver qi stagnation.	Modification decoction of chaihu shugan san and ganmai dazao tang	Fluoxetine	4 w	NR	HAMD scores, effective rate, adverse events
Hao 2015 [36]	DSM-IV	28/28	27 ± 9/27 ± 8	24.5 ± 2.8 w/23.4 ± 3.2 w	NR	NR	Shugan jieyu capsule + citalopram	Citalopram	6 w	NR	HAMD scores, effective rate, adverse events
He and Ren 2008 [37]	DSM-IV	47/44	26.1 ± 2.5/25.8 ± 2.7	NR	NR	NR	Modification decoction of xiaoyao san + fluoxetine	Fluoxetine	4 w	NR	HAMD scores, effective rate, adverse events
Hu 2013 [38]	DSM-IV	50/50	27.6 ± 2.5/26.3 ± 2.7	21 ± 5.4 d/22 ± 5.5 d	NR	NR	Xiaoyao pill + fluoxetine	Fluoxetine	6 w	NR	Effective rate, HAMD scores, adverse events
Jiang et al. 2012 [39]	CCMD-III	35/35	27 ± 5.4/26 ± 5.7	4.5 ± 0.8 m/4.7 ± 0.9 m	NR	NR	Zhen yuan capsule + duloxetine	Duloxetine	8 w	NR	HAMD scores, cure rate, effective rate, adverse events
Jin and Ying 2013 [40]	DSM-IV	50/50	26 ± 3/27.0 ± 2.5	7 ± 4 m/8 ± 3 m	NR	Strengthening heart and spleen, relieving liver qi stagnation.	Shugan jieyu capsule + paroxetine	Paroxetine	8 w	NR	Effective rate, HAMD scores
Lei and Fu 2015 [41]	CCMD-III, DSM-V	49/49	27.38 ± 5.69/27.68 ± 5.53	NR	NR	NR	Jieyu xiaoyou decoction + amitriptyline	Amitriptyline	6 w	NR	Cure rate, effective rate, EPDS scores, adverse events
Li et al. 2013 [42]	DSM-IV	75/75	25.4 ± 3.6/25.8 ± 3.2	NR	NR	NR	Modification decoction of taohe chengqi and xiao chaihu	Fluoxetine	6 w	NR	EPDS scores, HAMD scores, effective rate, adverse events
Li and Zhang 2014 [43]	DSM-IV	30/30	26.4 ± 6.5/26.4 ± 6.5	NR	NR	NR	Self-made jieyu xiaoyou decoction + fluoxetine	Fluoxetine	4 w	6 m	Effective rate, adverse events
Liang et al. 2012 [44]	DSM-IV	60/60	26.12 ± 4.1/25.74 ± 5.01	22 ± 7.65 d/21 ± 6.73 d	NR	NR	Xiaoyao pill + fluoxetine	Fluoxetine	6 w	NR	Effective rate, HAMD scores, adverse events
Lin et al. 2008 [45]	DSM-IV	37/31	27.14 ± 4.75/26.57 ± 4.16	NR	NR	Relieving liver qi and invigorating the spleen.	Electuary of xiaoyao san + paroxetine	Paroxetine	6 w	NR	Effective rate, obvious effective rate, HAMD scores
Liu 2015 [46]	CCMD-III	43/39	29.23 ± 8.91/28.39 ± 8.31	NR	Deficiency of qi and blood	NR	Huo li su oral liquid + sertraline hydrochloride	Sertraline hydrochloride	8 w	NR	HAMD scores, aerum norepinephrine, aerum 5-hydroxytryptamine, effective rate, adverse events
Lv 2007 [47]	DSM-IV	30/30	24.9 ± 2.1/25.2 ± 1.8	NR	Deficiency of both heart and spleen	Strengthening heart and spleen.	Gui pi decoction + supportive psychotherapy	Supportive psychotherapy	4 w	NR	Effective rate, HAMD scores, estradiol, progesterone
Mi et al. 2014 [48]	DSM-IV	43/43	31.23 ± 5.33/31.48 ± 5.81	10.19 ± 2.98 d/11.09 ± 2.01 d	Liver depression and spleen deficiency	Invigorating the spleen and regulating the liver.	Decoction of jianpi tiaogan + fluoxetine hydrochloride dispersible tablets	Fluoxetine hydrochloride dispersible tablets	4 w	NR	Effective rate, EPDS scores
Pan and Wu 2013 [49]	CCMD-III	30/30	26.23 ± 33.45/25.68 ± 35.26	1.56 ± 1.25 m/1.45 ± 1.50 m	NR	NR	Pill of danzi xiaoyao san + Venlafaxine	Venlafaxine	12 w	24 w	Obvious effective rate, effective rate, HAMD scores, adverse events
Qian 2014 [50]	DSM-IV	39/38	25.7 ± 4.5/25.3 ± 4.4	4.2 ± 2.3 m/4.3 ± 2.5 m	NR	NR	Shugan jieyu capsule	Paroxetine	8 w	NR	HAMD scores, effective rate, adverse events
Ran 2013 [21]	DSM-IV	42/40	30.26 ± 3.57/31.26 ± 4.05	NR	NR	NR	Decoction of danzhi xiaoyao san + venlafaxine hydrochloride sr capsules + health and physical education + psychological counseling	Venlafaxine hydrochloride sr capsules + health and physical education + psychological counseling	12 w	NR	HAMD scores, clinical control rate, effective rate
Ren 2009 [51]	DSM-IV	30/30	25.6/26.1	12.5 d/12.1 d	NR	NR	Modification decoction of xiaoyao san + Fluoxetine	Fluoxetine	6 w	NR	Effective rate, adverse events
Shao et al. 2011 [52]	DSM-IV	50/50	28.1/28.4	29.5 d/37.3 d	NR	Relieving liver qi stagnation, tranquilizing the mind, regulating spleen and stomach.	Xiao chaihu decoction + paroxetine	Paroxetine	30 d	NR	Effective rate, HAMD scores, adverse events
Shi 2013 [53]	DSM-IV	40/36	29/29	NR	NR	NR	Self-made liqi yangxue decoction + Fluoxetine hydrochloride	Fluoxetine hydrochloride	4 w	NR	Effective rate, adverse events
Su 2014 [54]	DSM-IV	59/29	21.8/25.4	22.5 d/24.3 d	NR	Nourishing the blood and tranquilizing mind, regulate qi removing stagnation.	Shugan jieyu decoction + paroxetine	Paroxetine	6 w	NR	Cure rate, HAMD scores, adverse events
Sun 2012 [55]	DSM-IV	32/33	23.7 ± 2.6/23.4 ± 2.7	127.4 ± 33.7 d/129.3 ± 34.6 d	NR	Relieving liver qi stagnation, blood activating and stasis dissolving, regulating psychiatry.	Modification decoction of xiaoyao san + fluoxetine	Fluoxetine	3 m	NR	HAMD scores, obvious effective rate, effective rate, adverse events
Wang et al. 2011 [56]	DSM-IV	27/29	29.2 ± 1.6/29.4 ± 1.9	4.6 ± 1.4 m/4.5 ± 1.2 m	NR	Enriching blood, stabling qi, relieving qi stagnation.	Self-made rougan decoction + fluoxetine	Fluoxetine	4 w	NR	Effective rate, adverse events
Wang 2012 [57]	DSM-IV	30/30	30.07 ± 3.3/30.43 ± 3.43	NR	Deficiency of both heart and spleen	Strengthening heart and spleen.	Shenqi jieyu granules	Placebo	6 w	NR	Effective rate, clinical control rate, EPDS scores, Chinese medicine symptom score, estradiol, progesterone, adverse events
Wang et al. 2015 [58]	DSM-IV	46/46	27.3 ± 4.6/28.1 ± 4.1	NR	Stagnation of liver qi	NR	Modification mixture of self-made jieyu rougan decoction + mirtazapine + vitamin D drops + psychological counseling	Mirtazapine + vitamin D drops + psychological counseling	6 w	NR	Effective rate, HAMD scores
Wang et al. 2014 [59]	DSM-IV	31/32	31.23 ± 2.22/32.01 ± 1.79	9.39 ± 4.28 d/9.03 ± 3.69 d	NR	NR	Wu ling capsule + sertraline hydrochloride	Sertraline hydrochloride	4 w	NR	Effective rate, estradiol, progesterone, serum OFQ level, serum 5-hydroxytryptamine, adverse events
Wei et al. 2009 [60]	CCMD-III	32/32	27.38 ± 5.135/26.72 ± 4.658	27.03 ± 11.956 d/26.09 ± 9.663 d	Both of liver depression and spleen deficiency and stagnant heat	NR	Xiaoyao pill + sertraline	Sertraline	6 w	NR	Obvious effective rate, effective rate, HAMD scores, adverse events
Wu et al. 2014 [61]	DSM-IV	35/35	23.7 ± 2.6/24.5 ± 2.7	NR	NR	Relieving liver qi stagnation, blood activating and stasis dissolving, regulating psychiatry.	Xiaoyao powder + Sertraline	Sertraline	3 m	NR	HAMD scores, obvious effective rate, effective rate, adverse events
Xu et al. 2006 [62]	DSM-IV	30/15	27.6/27.4	38.6 d/37.3 d	NR	NR	Bu xin pill	Paroxetine	3–6 m	NR	Effective rate, cure rate, adverse events
Xu et al. 2013 [63]	DSM-IV	50/50	30.43 ± 3.43/30.07 ± 3.34	NR	Kidney deficiency and liver stagnation	Nourishing kidney deficiency, regulating qi and tranquilizing the mind.	Yinao jieyu fang granule	Placebo	6 w	NR	Effective rate, estradiol, progesterone, adverse events
Zhang et al. 2014 [64]	ICD-X	48/48	27.03 ± 5.12/26.72 ± 4.67	27.38 ± 11.95 d/26.09 ± 9.66 d	NR	NR	Shugan jieyu capsule	Fluoxetine	6 w	NR	Effective rate, HAMD scores, adverse events
Zhang 2015 [65]	CCMD-III	48/48	26.8 ± 4.3/25.9 ± 4.8	4.3 ± 0.7 m/4.1 ± 0.8 m	NR	NR	Shugan jieyu capsule	Citalopram	6 w	NR	HAMD scores, effective rate, adverse events
Zhang and Liu 2009 [66]	DSM-IV	46/42	29.04 ± 3.9/29.12 ± 4.26	38.2 d/41.7 d	NR	NR	Wu ling capsule + fluoxetine + psychological therapy	Fluoxetine + psychological therapy	6 w	NR	HAMD scores, effective rate, adverse events
Zhao and Lin 2006 [67]	DSM-IV	45/42	29.04 ± 3.99/29.12 ± 4.26	NR	NR	Normalizing qi dynamic	Decoction of chaihu shugan san + fluoxetine	Fluoxetine	4 w	NR	HAMD scores, effective rate, adverse events
Zheng 2013 [68]	DSM-IV	54/54	30.44 ± 5.2/30.56 ± 5.13	10.28 ± 3.35 d/9.48 ± 3.35 d	Deficiency of qi and blood and blood stasis	Strengthening primordial qi, activating and nourishing blood, tranquilize the mind.	Shen gui ren mixture + psychological counseling	Psychological counseling	6 w	NR	Effective rate, EPDS scores, Chinese medicine symptom score, adverse events
Zheng 2015 [26]	DSM-IV	39/39	28.6 ± 4.1/29.0 ± 4.3	4.2 ± 0.5 m/4.0 ± 0.4 m	NR	Relieving liver qi stagnation, blood-activating and stasis-dissolving, d regulating psychiatry.	Decoction of shenghua xiaoyao san + paroxetine	Paroxetine	8 w	NR	Effective rate, adverse events
Zhou 2013 [69]	CCMD-III	25/25	22–32/22–32	NR	NR	NR	Self-made yangxue ningshen decoction + sertraline	Sertraline	40 d	NR	Effective rate, HAMD scores, adverse events
Zhou et al. 2015 [70]	DSM-IV	30/30	26.15 ± 2.6/25.85 ± 2.9	NR	NR	NR	Modification mixture of yueju wan and ganmai dazao tang + psychological therapy	Psychological therapy	4 w	NR	HAMD scores, effective rate
Zhu 2008 [71]	DSM-IV	50/50	28.1/28.4	25.9 d/37.3 d	NR	NR	Yangxin jieyu decoction	Paroxetine	30 d	NR	Effective rate, HAMD scores, adverse events
Zhu 2014 [72]	DSM-IV	32/31	23.32 ± 1.86/23.42 ± 2.06	NR	NR	Relieving liver qi stagnation, enriching blood and promoting blood flow, enriching blood to anchor the mind, clearing heat and relieving fidgetiness.	Modification mixture of suan zao ren decoction	Paroxetine	4 w	NR	Effective rate, HAMD scores, adverse events

I: intervention group; C: control group; TCM: traditional Chinese medicine; DSM: diagnostic and statistical manual of mental disorders; CCMD: Chinese classification of mental disorders; ICD: international classification of diseases; NR: not reported; d: day; w: week; m: month.