Acupuncture and herbs alleviate depression. Shaoxing Seventh People’s Hospital (Zhejiang) researchers tested the efficacy of combining acupuncture and herbal medicine in an integrated treatment protocol. Based on the data, the researchers conclude that a combination of the herbal formula Chai Hu Shu Gan San and acupuncture is effective for the relief of depression and is more effective than either treatment modality as a monotherapy. [1]

The study compared Chai Hu Shu Gan San and acupuncture monotherapies with combined therapy in 120 patients suffering from mild to severe depression. Outcome measures included clinical efficacy as determined by HAMD (Hamilton Depression Rating Scale) scores, serum cytokine, and neurotransmitter levels. The total effective rate in the combined group was 100% compared with 87.5% and 85% in the herbal and acupuncture monotherapy groups respectively. Patients in the combined therapy group also experienced greater improvements in serum cytokine and neurotransmitter levels (p<0.05).

The Chai Hu Shu Gan San monotherapy group (Group A) was comprised of 22 male and 18 female patients, ages 20–49 years (mean age 38.3 years), with a disease duration of 1–222 months (mean duration 23.5 months). Thirty patients had HAMD scores indicative of mild to moderate depression and 10 patients had scores indicative of severe depression.

The acupuncture monotherapy group (Group B) was comprised of 21 male and 19 female patients, ages 20–50 years (mean age 38.6 years), with a disease duration of 1–220.5 months (mean duration 24.2 months). In this group, 29 patients had HAMD scores indicative of mild to moderate depression and 11 patients had scores indicative of severe depression. The combined therapy group (Group C) was comprised of 20 male and 20 female patients, ages 21–49 years (mean age 38.2 years), with a disease duration of 1.5–218.5 months (mean duration 23.9 months). This group was also comprised of 29 patients with HAMD scores indicative of mild to moderate depression and 11 patients with scores indicative of severe depression. There were no statistically significant differences in baseline characteristics between the three groups (p>0.05).

 

Acupuncture and Herbs
All patients received usual care medical treatments for depression. In addition to conventional approaches to patient care, the patients in Group A were prescribed a modified version of Chai Hu Shu Gan San comprised of the following herbs:

  • Chen Pi 6g
  • Chai Hu 6g
  • Chuan Xiong 4.5g
  • Xiang Fu 4.5g
  • Zhi Ke 4.5g
  • Shao Yao 4.5g
  • Zhi Gan Cao 1.5g

The researchers comment that this herbal combination is traditionally indicated for the treatment of depression due to their properties of regulating qi, harmonizing the interior and exterior, harmonizing the liver, promoting circulation, and alleviating qi stagnation related depression. For patients with tongue ecchymosis, Dang Gui and Dan Shen were added to the formula. Each dose was decocted in water and divided in two doses to be taken twice daily. The patients in Group B received acupuncture treatment administered at the following acupoints:

  • Yintang (MHN3)
  • Baihui (GV20)
  • Sishencong (MHN1)
  • Shenting (GV24)
  • Neiguan (PC6)
  • Shenmen (HT7)
  • Sanyinjiao (SP6)
  • Hegu (LI4)
  • Taichong (LV3)
  • Taiyang (MHN9)

The acupoints are traditionally indicated for coursing wind, clearing heat, benefiting qi, clearing the head, and calming the mind. Treatment was administered daily for one hour each session. The patients in Group C were treated with both modified Chai Hu Shu Gan San and acupuncture as detailed above. All patients were treated for a total of six weeks.

 

Results
Clinical efficacy was determined by HAMD scores. The HAMD scale is comprised of 17 items relating to the physical and psychological symptoms of depression, with higher scores indicative of more severe depressive states. To calculate total clinical efficacy, the following method was utilized:

  • In patients with HAMD score reductions of ≥50%, the treatment was classed as clearly effective.
  • In patients with HAMD score reductions of 25–49%, the treatment was classed as effective.
  • In patients with HAMD score reductions of <25%, the treatment was classed as ineffective.

The clearly effective and effective scores were added together to give the total effective rates. In Group A (herb monotherapy), there were 15 clearly effective, 20 effective, and 5 ineffective cases, giving a total effective rate of 35/40 (87.5%). In Group B (acupuncture monotherapy), there were 15 clearly effective, 19 effective, and 6 ineffective cases, giving a total effective rate of 34/40 (85%). In Group C (combined acupuncture and herbal therapy), there were 19 clearly effective, 21 effective, and no ineffective cases, giving a total effective rate of 40/40 (100%). The total effective rate was significantly higher in Group C (p<0.05).

The study also measured serum cytokine levels, including IL-6 (interleukin-6), TNF-α (tumor necrosis factor alpha), and IL-1β (interleukin-1 beta). Increased levels of these pro-inflammatory cytokines are correlated with central nervous system changes and are used as biological markers of depression. Mean pre-treatment IL-6 levels (pg/mL) were 16.63 in Group A, 16.72 in Group B, and 16.59 in group C. Following treatment, the levels fell to 10.52, 10.35, and 6.20 respectively.

Mean pre-treatment TNF-α levels (ng/mL) were 2.63 in Group A, 2.70 in Group B, and 2.66 in group C. Following treatment, the levels fell to 1.48, 1.50, and 0.95 respectively. Mean pre-treatment IL-1β levels (pg/mL) were 3.24 in Group A, 3.30 in Group B, and 3.26 in group C. Following treatment, the levels fell to 1.99, 2.08, and 1.21 respectively. All three groups experienced improvements in serum cytokine levels and improvements were significantly greater in Group C (p<0.05).

The study measured serum neurotransmitter levels including 5-HT (serotonin), NE (norepinephrine), and BDNF (brain derived neurotrophic factor), all of which are frequently reduced in patients with depression. Mean pre-treatment 5-HT levels (ng/mL) were 87.97 in Group A, 88.10 in Group B, and 87.82 in group C. Following treatment, the levels rose to 105.02, 102.21, and 120.45 respectively.

Mean pre-treatment NE levels (ng/mL) were 0.12 in Group A, 0.14 in Group B, and 0.13 in group C. Following treatment, these levels rose to 0.19, 0.20, and 0.42 respectively. Mean pre-treatment BDNF levels (ng/mL) were 10.09 in Group A, 9.96 in Group B, and 10.10 in group C. Following treatment, the levels rose to 11.95, 11.23, and 17.45 respectively. Once again, all three groups experienced significant improvements and these were greatest in Group C (p<0.05).

The results of this study indicate that acupuncture combined with modified Chai Hu Shu Gan San is an effective treatment for depression and is more effective than either therapy alone. These findings are consistent with Traditional Chinese Medicine principles concerning combined therapeutic approaches to patient care.

 

1. Tong Weilong, Wu Jingzhu, Zhao Guiqin, Zhao Mingyong (2019) “Study on Effect of Modified Chaihu Shugan Powder Combined with Acupuncture in Patients with Depression and Influence for Related Indexes” Chinese Archives of Traditional Medicine Vol.37 (1) pp.227-229.

 

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