Acupuncture combined with herbal medicine is effective for the treatment of generalized anxiety disorder (GAD). Ganzhou City Third People’s Hospital (Jiangxi, China) researchers conducted a clinical trial and confirm that not only is Chinese medicine (acupuncture and herbs) effective, but it is also more effective than a popular selective serotonin reuptake inhibitor (SSRI). [1]

The study’s outcome measures included the HAM-A (Hamilton Depression Rating Scale), the SAS (Zung Self-Rating Anxiety Scale), and the treatment total effective rate. Although both groups saw improvements across all areas, they were significantly greater in the TCM (Traditional Chinese Medicine) group, with a total effective rate of 97.5% compared with 80% in the paroxetine group.

A total of 80 patients with a clinical diagnosis of GAD were randomly assigned to receive treatment with either paroxetine (an SSRI medication) or acupuncture and herbs. The paroxetine group was comprised of 27 male and 13 female patients, ages 21–71 years (mean age 37.82). Of these patients, 23 had an educational background of undergraduate level or above, 12 completed high school, and 5 completed junior high. The TCM group was comprised of 26 male and 14 female patients, ages 20–73 years (mean age 38.17). Of these patients, 25 had an educational background of undergraduate level or above, 11 completed high school, and 4 completed junior high. There were no statistically significant differences between the two groups in terms of baseline characteristics.

Inclusion criteria for the study were a clinical diagnosis of GAD with a HAM-A (Hamilton Anxiety Rating Scale) score of <29 but ≥14, and a TCM diagnosis of liver depression transforming into fire with symptoms including headaches, dizziness, dry mouth with a bitter taste, sensations of stuffiness in the chest, and irritability. Exclusion criteria were elevated GPT (glutamic-pyruvic transaminase) levels indicative of liver or heart dysfunction, an elevated renal function index, anxiety combined with depression or depressive episodes within the previous 3 months, pregnancy, and cognitive impairment.

 

Treatment
Patients in the paroxetine group were prescribed a 20 mg dose of the drug to be taken daily, after breakfast. This dose was titrated up to a maximum of 60 mg daily, if required. Patients in the TCM group were treated with acupuncture and a modified Dan Zhi Xiao Yao San formula. This is commonly used in TCM for the treatment of liver depression transforming into fire. It has the functions of clearing heat and dampness, coursing the liver to relieve depression, promoting healthy liver function, benefiting liver blood, and protecting the spleen. The modified formula used in the study was comprised the following herbs:

  • Chao Zhi Zi 15g
  • Mu Dan Pi 15g
  • Bai Shao 15g
  • Bo He 15g
  • Fo Shou 15g
  • Chai Hu 15g
  • Fu Ling 15g
  • Bai Zhu 15g
  • Dang Gui 9g
  • Sheng Jiang 9g
  • Gan Cao 3g

Each day, the herbs were decocted in water to a volume of 300 ml and split into two 150 ml doses. They were consumed while warm every morning and evening for a total of two weeks. Acupuncture was administered at the following acupoints, which were selected for their functions of coursing the liver and relieving depression:

  • Taichong (LV3)
  • Shenmen (HT7)
  • Danzhong (CV17)
  • Qimen (LV14)
  • Xingjian (LV2)

Needles were inserted using a balanced reinforcing-reducing method and the angle and depth were adjusted if the patient experienced any discomfort. After obtaining deqi, needles were retained for a total of 30 minutes. Treatment was administered daily for 5 days, followed by a 2 day rest period. Treatment was administered for a total of 2 weeks.

 

Results
Primary outcome measures for the study were the HAM-A and SAS. The HAM-A is a 21-item scale covering various physical and psychological symptoms of anxiety and depression, with higher scores indicative of increasingly severe symptoms. Mean pre-treatment HAM-A scores were 27.91 in the paroxetine group and 27.86 in the TCM group. Following treatment, mean HAM-A scores fell to 8.18 in the paroxetine group and 5.79 in the TCM group.

The SAS is a 20-item self-rated scale covering various symptoms of anxiety and their frequency, with higher scores indicative of severe symptoms. Mean pre-treatment SAS scores were 43.83 in the paroxetine group and 43.74 in the TCM group. Following treatment, mean SAS scores fell to 32.80 in the paroxetine group and 26.43 in the TCM group. Although both groups saw significant improvements in both HAM-A and SAS scores, improvements were significantly greater in the TCM group (p<0.05).

The total effective rates for each treatment group were calculated. Patients with a HAM-A score of ≤7 or showing improvements of >75% were classified as recovered. For patients showing improvements of 50–75%, the treatment was classified as markedly effective. For patients showing improvements of 25–49%, the treatment was classified as effective. For patients showing improvements of <25%, the treatment was classified as ineffective. The cured, markedly effective, and effective cases in each group were added together to give the total effective rates.

In the paroxetine group, there were 7 recovered, 12 markedly effective, 13 effective, and 8 ineffective cases, giving a total effective rate of 80%. In the TCM group, there were 12 recovered, 15 markedly effective, and 12 effective cases with just 1 ineffective case, giving a total effective rate of 97.5%. The total effective rate was significantly higher in the TCM group compared with the paroxetine group (p<0.05).

The results of this study indicate that TCM treatment combining acupuncture and herbs is effective for the relief GAD symptoms and may be more effective than traditional SSRIs such as paroxetine. These findings are specific to patients with GAD that also fulfil the TCM parameter of liver depression transforming into fire.

 

Reference:
1. Zhu Haifang, Luo Junting, Fang fengfeng (2019) “Clinical observation of generalized anxiety disorder with Chinese medicine combined with acupuncture” Contemporary Medicine Vol. 25(7) pp.91-93.

 

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