April 3, 2009 9:34 WSPC WS-AJCM SPI-J000 00677

The American Journal of Chinese Medicine, Vol. 37, No. 2, 207–213

© 2009 World Scientific Publishing Company
Institute for Advanced Research in Asian Science and Medicine

A Mini Review of Traditional Chinese

Medicine for the Treatment of
Depression in China
Am. J. Chin. Med. 2009.37:207-213. Downloaded from www.worldscientific.com

Hui Zhao, Xia Wan and Jia-Xu Chen

by STONY BROOK UNIVERSITY on 01/24/15. For personal use only.

School of Pre-clinical Medicine, Beijing University of Chinese Medicine

Beijing 100029, China

Abstract: To systematically evaluate the effectiveness of Chinese herbal medicine for treat-
ing depression in China, the electronic medical database from China National Knowledge
Infrastructure (CNKI) was searched using Chinese and the date is set, from 1st January 1994
to 1st August 2008. The 18 studies that met the entry criteria along with 1,260 randomized
patients were included in this review. All studies with words like “randomization” or “quasi-
randomization” in their abstracts were included, whether they used blinding or not. The results
showed that the Chinese medicine treated group did not decrease the scores of the self-rating
depression scale (−1.02, 95% CI −2.16 ∼ 0.12, p = 0.08) and the scores of the Hamilton
depression scale (−0.45, 95% CI −0.98 ∼ 0.08, p = 0.10). The results showed there is no
evidence to support that traditional Chinese medicine for depression has improved, which may
be due to the low quality in all the trials. Therefore, more qualified, randomized controlled
clinical trials are warranted to assure its efficacy.

Keywords: Depression; Systematic Review; Traditional Chinese Medicine.

Introduction

The World Health Organization (WHO) estimated that 3% of the adults in the world are
suffering from depression and in some countries, the proportion may be higher. However, in
China, the lowest estimate made by Department of Health is about 2% numbering 26 million
depression patients. Depression is a common emotional disturbance and its incidence is
increasing day by day. While enjoying a new life in a new century, people are suffering from
the mental miseries brought by increasing competition and various kinds of pressures entailed
thereafter. It is mainly caused by social factors, and it severely influences psychological and

Correspondence to: Dr. Jia-Xu Chen, School of Pre-clinical Medicine, Beijing University of Chinese Medicine,
P.O. Box 83, No. 11, Beisanhuan Donglu, Chaoyang District, Beijing, 100029, China. Tel: (+86) 10-6428-7074,
Fax: (+86) 10-6428-6231, E-mail: chenjx@bucm.edu.cn

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208 H. ZHAO et al.

somatic health. This kind of psychological disorder is just one part of predominance on which
Chinese medicine can exert its characteristics. Although, traditional Chinese medicine has
been widely used as an alternative method for the treatment of depression in China, it is still
necessary to evaluate which therapeutic method and/or which Chinese herbal medicine is
effective in the treatment of depression by systematic review.

Materials and Methods

Search Strategy for Identification of Studies

Studies were found using the China National Knowledge Infrastructure (CNKI) database.
The electronic search was done in Chinese and the date was set from 1st January 1994 to
Am. J. Chin. Med. 2009.37:207-213. Downloaded from www.worldscientific.com

1st July 2008. Keywords combination: depression and treatment or therapy and Chinese
by STONY BROOK UNIVERSITY on 01/24/15. For personal use only.

medicine or traditional Chinese medicine.

Criteria for Considering Studies for this Review

All studies, in adults diagnosed with depression by the criteria of Western medicine,
with words like randomized and quasi-randomized controlled trials in their abstracts were
included, whether they used blinding or not. Eighteen studies meeting the entry criteria were
downloaded and fully printed.

Collection and Analysis of Data

All reports were screened by the reviewers’ critical appraisal. The study qualities like
random- allocation and allocation concealment, conduction of double blinding, handling
of lost cases and following-up were assessed by Jadad score. RevMan 4.2.8 conducted the
heterogeneity test, Meta-analysis.

Results

Twenty RCTs studies were searched out. 1,599 patients who suffered depression were divided
into the groups of Chinese medicine treated, Chinese medicine therapy accompanied with
other treatment and control treated including 19 routine therapies of Western medicine with
1 of the 19 (Chen et al., 2001b) as a blank control, the other (Fang and Cai, 2007) as a
Chinese medicine control. Terminal indices were unanimous in 3 studies (Zhai et al., 2001;
Xia et al., 2006; Zhang, 2007), no Western medicine or Western medicine accompanied with
other treatment or blank control in 1 study (Fang and Cai, 2007), and two control groups
were set (Western medicine therapy or blank control or Western medicine accompanied with
Tibetan medicine) in 2 studies (Chen et al., 2001b; Zhang et al., 2006). Then the 18 studies
were matched with the inclusion criteria in all.
As shown in Table 1, 18 studies with 1,260 random-allocated participants were included.
Compared with groups in Western medicine, Western medicine integrated with other ther-
apies or the blank control, it did not decrease the scores of the self-rating depression scale
 April 3, 2009 9:34 WSPC
Table 1. Analysis of Chinese Medicine for the Treatment of Depression

Scores of SDS Scores of HAMD

TRADITIONAL CHINESE MEDICINE FOR DEPRESSION IN CHINA

Am. J. Chin. Med. 2009.37:207-213. Downloaded from www.worldscientific.com

Chinese Medicine Control SMD Chinese Medicine Control SMD

WS-AJCM SPI-J000
by STONY BROOK UNIVERSITY on 01/24/15. For personal use only.

Reference Group N Mean ± SD N Mean ± SD (95% CI) N Mean ± SD N Mean ± SD (95% CI)

Yuleshu & 19 35.24 ± 5.95 19 34.15 ± 6.27 0.17 (−0.46, 0.81) 19 11.56 ± 5.91 19 10.82 ± 6.25
0.12 (−0.52,0.76)
Fluoxetine
Chen et al., 2001b
Yuleshu & 19 35.24 ± 5.95 18 40.54 ± 6.25 −0.85 (−1.53,−0.17) 19 11.56 ± 5.91 18 18.48 ± 6.28
−1.11(−1.81, −0.41)
blank control

00677
Chen et al., 2001b
Chaihushugansan+ 37 37.33 ± 2.46 41 52.43 ± 3.31 −5.09 (−6.02, −4.16)
Tongyoutang &
Radiochemotherapy
Meng et al., 1999
or symptom treatment
Shujiesan + acupoints 34 41.87 ± 8.84 27 48.30 ± 9.80 −0.68(−1.20, −0.16)
Ruan, 2002
dressing & Fluoxetine
Jieyutiaoshentang & 31 47.98 ± 21.34 30 49.58 ± 15.94 −0.08 (−0.59, 0.42) 31 10.71 ± 8.97 30 8.71 ± 7.75
0.24 (−0.27, 0.74) Maprotiline
Tan et al., 2007
Jieyu pill & 28 9.71 ± 4.78 29 8.9 ± 6.68 0.14 (−0.38, 0.66) 28 39.91 ± 10.65 29 38.45 ± 9.65
0.14 (−0.38, 0.66)
Maprotiline

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Table 1. (Continued)

Scores of SDS Scores of HAMD

Am. J. Chin. Med. 2009.37:207-213. Downloaded from www.worldscientific.com

Chinese Medicine Control SMD Chinese Medicine Control SMD

WS-AJCM SPI-J000
by STONY BROOK UNIVERSITY on 01/24/15. For personal use only.

Reference Group N Mean ± SD N Mean ± SD (95% CI) N Mean ± SD N Mean ± SD (95% CI)

Shen et al., 2004

Recipe of TCM &
−0.33 (−0.79,0.13) 38 11.80 ± 6.40 35 13.80 ± 5.60
Youke capsules
Guo et al., 2001
Danzhixiaoyaosan & radio 50 6.24 ± 6.20 30 21.33 ± 6.72
−2.34 (−2.92, −1.75)

H. ZHAO et al.
chemotherapy or symptom treatment

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Liu, 2002
Tiaoshentongluotang + Fluoxetine 36 20.26 ± 3.21 45 14.12 ± 2.76
2.05 (1.50, 2.59)
& Fluoxetine
Ren and Zheng, 2004
Recipe of TCM + Fluoxetine 30 10.29 ± 3.67 29 10.26 ± 3.15
0.01 (−0.50, 0.52)
& Fluoxetine
Zhang et al., 2006
Recipe of TCM+ Fluoxetine 30 10.29 ± 3.67 31 10.45 ± 4.73
−0.04 (−0.54, 0.46)
& Tibetan medicine
Zhang et al., 2006
Gengxinfang & 30 15.47 ± 6.88 30 23.63 ± 8.04
−1.08 (−1.62, −0.53)
 April 3, 2009 9:34 WSPC
Table 1. (Continued)

Scores of SDS Scores of HAMD

Chinese Medicine Control SMD Chinese Medicine Control SMD

TRADITIONAL CHINESE MEDICINE FOR DEPRESSION IN CHINA

Am. J. Chin. Med. 2009.37:207-213. Downloaded from www.worldscientific.com

Reference Group N Mean ± SD N Mean ± SD (95% CI) N Mean ± SD N Mean ± SD (95% CI)

WS-AJCM SPI-J000
by STONY BROOK UNIVERSITY on 01/24/15. For personal use only.

Nylestriol
Dong et al., 2004
Tongluoxiaoyutang & 62 11.23 ± 8.75 62 11.58 ± 7.89
−0.04 (−0.39, 0.31)
Fluoxetine Xie, 2007
Xuefuzhuyutang + Clomipramine 34 6.71 ± 3.64 34 12.06 ± 4.24
−1.34 (−1.87, −0.83)
& Clomipramine
Niu et al., 2006b

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Shujiesan + Acup 42 9.60 ± 5.80 34 8.90 ± 6.20
0.12 (−0.34, 0.57)
&Paroxetine Chen et al., 2004
Recipe of TCM + Acup 50 13.12 ± 2.14 50 16.33 ± 4.37
−0.93 (−1.34,−0.51)
+ Paroxetine & Paroxetine
Niu et al., 2006a
Xiaoyuyin + Acup 30 5.02 ± 1.73 30 14.73 ± 2.91
−4.00 (−4.90,−3.11)
& Fluoxetine
Shi and Shi, 2006
Jieyu pill & Venlafaxine 41 14.48 ± 6.20 45 9.62 ± 5.06
0.86 (0.41,1.30) Tao, 2006
Random effect model −1.02 (−2.16, 0.12) p = 0.08
−0.45 (−0.98, −0.08) p = 0.10

SD: Standard Difference; SMD: Standardised Mean Difference; SDS: self-rating depression scale; HAMD: Hamilton depression scale.

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212 H. ZHAO et al.

(−1.02, 95%CI − 2.16 ∼ 0.12, p = 0.08) and the scores of the Hamilton depression scale
(−0.45, 95% CI −0.98 ∼ 0.08, p = 0.10).

Conclusions

Jadad scores of the 18 studies were 1 ∼ 2 which means that they were low-quality studies. No
report was noted about concealment of random scheme, count of sample size and analysis of
willing treatment. The application of blindness was reported in 2 studies (Zhang et al., 2006;
Niu et al., 2006b). Four studies (Chen et al., 2001b; Chen et al., 2004; Niu et al., 2006a;
Shen et al., 2004) reported the follow-up observations. Seven studies (Zhang et al., 2006;
Tan et al., 2007; Xie, 2007; Niu et al., 2000a, 2006b; Shi and Shi, 2006; Shen et al., 2004)
Am. J. Chin. Med. 2009.37:207-213. Downloaded from www.worldscientific.com

reported the analysis of comparability between the group. No assessment of life quality was
by STONY BROOK UNIVERSITY on 01/24/15. For personal use only.

reported at all. Although the results showed there is no evidence to support that traditional
Chinese medicine for depression has improved, Chinese medicine may have beneficial effects
in patients with depression, because of the low quality of all the trials. A good design of
multi-centered, randomized, parallel-controlled and blinding trials is needed in order to make
further studies, with the aim of providing better EBM evidences (A class A level). Therefore,
the authors suggest that the efficacy of TCM should be seriously evaluated according to the
principle of evidence-based medicine, even though abundant clinical experiences, especially
case reports, have been repeated and lasted for thousands of years (Chen et al., 2001a; Chen
and Hu, 2006).

Acknowledgments

This research has been supported by a grant from China National Funds for Distinguished
Young Scientists (30825046).

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