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From the Townsend Letter
December 2009

 

Chinese Medicine
abstracted and translated by Bob Flaws, LAc, FNAAOM (USA), FRCHM (UK)


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Chinese Medicine and Depression: A Two-Wing Comparison Study

On pages 48–49 of issue 11, 2008, of Xin Zhong Yi (New Chinese Medicine), Zhang Qin-sheng published an article titled "Observations on the Therapeutic Effects of Treating 30 Cases of Depression with Shu Gan Jian Nao Tiao Yu Pian." A summary of this article is presented below.

Cohort Description
Altogether, 60 cases of unipolar depression were enrolled in this two-wing comparison study. All 60 cases met the Western medical diagnostic criteria for depression in the CCMD-3 (the Chinese equivalent to the ICD-9 [International Statistical Classification of Diseases and Related Health Problems]). They also met the Chinese medical diagnostic criteria for depressive condition in Zhong Yi Nei Ke Xue (Chinese Medicine Internal Medicine). Main symptoms included psychological depression, a low affect, anxiety and stress, and slowed response to stimuli. Accompanying symptoms included insomnia, impaired memory, headache, dizziness, heart palpitations, lassitude of the spirit, lack of strength, a predilection to great sighing, devitalized eating and drinking, decreased libido, abdominal distention, burping, a pale red tongue with thin, slimy fur, and a bowstring or bowstring, rapid pulse.

These 60 participants were randomly divided into two groups of 30. One, the treatment group, was treated with Chinese medicine; the other, the comparison group, was treated with Western medicine. In the treatment group, there were 12 males and 18 females 23–65 years of age who had suffered from depression for 3–40 months. In the comparison group, there were 13 males and 17 females aged 24–63 years who had suffered from depression for 3–39 months. None of the members of either group had previously been administered antidepressant medication. Therefore, in terms of sex, age, and disease duration, these two groups were considered statistically comparable for the purposes of this study.

Treatment Method
All members of the treatment group were administered Shu Gan Jian Nao Tiao Yu Pian (Soothe the Liver, Fortify the Brain and Regulate Depression Tablets), which consisted of:

Chai Hu (Radix Bupleuri)
Bai Shao (Radix Alba Paeoniae)
Mu Dan Pi (Cortex Moutan)
Zhi Zi (Fructus Gardeniae)
Shi Chang Pu (Rhizoma Acori Tatartinowii)
Yuan Zhi (Radix Polygalae), 12g each
Dang Gui (Radix Angelicae Sinensis)
Bai Zhu (Rhizoma Atractylodis Macrocephalae), 10g each
Fu Ling (Poria), 15g
Gan Cao (Radix Glycyrrhizae), 3g

These medicinals were processed and made into tablets, each tablet weighing 0.3 grams. Five tablets were orally administered each time two times per day.

All members of the comparison group were orally administered 20 milligrams one time per day of fluoxetine, manufactured by Eli Lilly in the US.

Eight weeks' administration equaled one course of treatment for both groups. Analyses of depression using the Hamilton Depression Rating Scale (HMD) and Zung's Self Depression Rating Scale (SDS) were carried out before treatment began and at the end of weeks two, four, six, and eight.

Study Outcomes
Using the HMD, "cured" was defined as a decrease in HMD score of more than 75%. "Marked effect" was then defined as a reduction of more than 50%. "Some effect" was defined as a reduction of more than 25%. "No effect" meant that any reduction in HMD score was less than 25%. The following table shows the outcomes of the two groups using HMD criteria.

Group

Cured

Marked Effect

Some Effect

No Effect

Total Effectiveness

Treatment

15

6

6

3

90.00%

Comparison

8

9

6

7

76.67%

Using the outcomes criteria found in Zhong Yao Xin Yao Lin Chuang Yan Jiu Zhi Dao Yuan Ze (Reference Criteria for Clinical Research in Chinese Medicinals and New Medicines), "cured" was defined as complete disappearance of clinical symptoms and a return to normal psychological status. "Marked effect" meant that the main symptoms were markedly reduced and the patient's psychological status had improved. "Some effect" meant that there was improvement in some of the symptoms and the patient's psychological status had improved. "No effect" meant there was no improvement in symptoms or psychological status. The following table shows the outcomes of the two groups based on these criteria.

Group

Cured

Marked Effect

Some Effect

No Effect

Total Effectiveness

Treatment

20

6

3

1

96.67%

Comparison

19

5

3

3

90.00%

The next table shows the changes in mean HMD scores in both groups at two-week intervals.

Group

Before Treatment

After Two Weeks Of Treatment

After Four Weeks of Treatment

After Six Weeks of Treatment

After Eight Weeks of Treatment

Treatment

22.81 ± 7.63

17.13 ± 6.28

12.27 ± 4.59

9.34 ± 3.59

4.27 ± 1.59

Comparison

21.23 ± 7.96

19.47 ± 6.11

13.10 ± 4.57

10.27 ± 3.59

6.27 ± 2.15

Finally, the last table shows the changes in mean SDS scores in both groups, also at two-week intervals.

Group

Before Treatment

After Two Weeks Of Treatment

After Four Weeks of Treatment

After Six Weeks of Treatment

After Eight Weeks of Treatment

Treatment

68.28 ± 13.95

46.44 ± 7.26

40.33 ± 3.81

19.13 ± 3.28

4.27 ± 1.62

Comparison

68.20 ± 11.88

52.30 ± 8.89

46.40 ± 4.85

19.47 ± 2.11

6.27 ± 1.59

Thus, one can see that the Chinese medicinal regime outperformed the Western drug therapy in every parameter studied. Further, in the treatment group, there was not a single adverse reaction. In the comparison group, four participants (13.3%) experienced headaches; three (10%) experienced nausea; two (6.67%) experienced anxiety; and two (6.67%) experienced abnormalities in blood, urine, stool, and/or liver-kidney function examination.

Discussion
According to Dr. Zhang, a doctor at the First Affiliated Hospital of the Henan University of Chinese Medicine, depression is mainly due to loss of regulation in the liver's function of governing coursing and discharge. Therefore, within this formula, Chai Hu courses the liver and resolves depression, regulates and outthrusts the liver qi. Shi Chang Pu and Yuan Zhi open the orifices and boost the intelligence. Together, these three are the sovereign medicinals in this formula. Dang Gui supplements and quickens the blood, while Bai Shao nourishes the blood and softens or emolliates the liver. Mu Dan Pi and Zhi Zi clear floating fire from within the blood. Bo He (sic; Herba Menthae Haplocalycis) courses and scatters liver depression, spreads and outthrusts depressive heat in the liver channel. These are the ministerial medicinals in this formula. Bai Zhu and Fu Ling fortify the spleen and quiet the spirit. Mix-fried Gan Cao relaxes the urgency of the liver. These medicinals help replete earth in order to repress wood. Hence they promote the source of engenderment and transformation of the constructive and blood. These are the adjuvant medicinals in this formula.

Copyright © Blue Poppy Press, 2009. All rights reserved.

Bob Flaws, LAc, has practiced Chinese medicine for more than 30 years. He is also one of the world's best-known authors, translators, and teachers of Chinese medicine.

 

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