Compiled by Joseph Brady MSTCM, L.Ac., Dipl. OM

Contact: taichiproj@earthlink.net | joe.brady@faculty.ccmu.edu

1529 York Street, Denver, CO 80206

Acknowledgements

Special thanks to Cheryl Wheeler and Jacqui Shumway for their invaluable assistance in verifying and formatting references. Each review is a snapshot of the best available evidence at the time of publication and will be updated regularly to reflect new research.

Author’s Note on AI Use

Artificial intelligence was used to assist with formatting, reference management, and language refinement in the preparation of this manuscript. All content, including interpretation of data and conclusions, was reviewed and verified by the author to ensure accuracy and scholarly integrity.

Chinese Medicine for Depression: Evidence Review

Depression is a leading global cause of disability, affecting 3.8%–14.3% of the population and often co-occurring with anxiety and chronic illness. While antidepressant medication and psychotherapy remain standard treatments, efficacy is limited—only about half of patients achieve remission—and side effects can reduce adherence. Traditional Chinese Medicine (TCM) offers complementary approaches, including acupuncture, herbal medicine, Tai Chi, Qigong, and lifestyle practices. This review synthesizes high-quality evidence using the GRADE framework.

Acupuncture

Evidence for acupuncture in depression is supported by multiple systematic reviews and meta-analyses. A Cochrane review of 64 trials (7,104 participants) found low-quality evidence that acupuncture moderately reduced depression severity compared with no treatment (SMD = –0.66) and smaller but significant effects versus control acupuncture (Smith et al., 2018). The 2019 meta-analysis by Armour et al. (64 RCTs, >7,000 participants) reported greater effects when combined with antidepressants (g = 0.84) than as monotherapy (g = 0.55).

Acupuncture as an adjunct to antidepressants appears most promising: pooled analyses show superior reductions in Hamilton Depression Rating Scale (HAM-D) scores compared to medication alone (Dang et al., 2024). However, GRADE ratings remain low to moderate due to trial heterogeneity, small sample sizes, and variable blinding. Acupuncture is generally safe, with minor adverse effects (e.g., bruising, fatigue).

Chinese Herbal Medicine

A 2024 network meta-analysis (198 RCTs, 8,923 participants) found several herbal formulations—such as Guipiwan, Ease Pill, Chaihu Jia Longgu Muli Decoction, Chai Hu Shu Gan San, and Xiaoyao Powder—outperformed placebo and, in some cases, were more effective than conventional antidepressants, with fewer adverse events (Dang et al., 2024). Combined herbal–antidepressant therapy improved response rates and reduced side effects.

A 2015 systematic review of pattern-based herbal prescriptions identified Xiaoyao decoction as most common for liver qi stagnation and spleen deficiency patterns, and Chaihu Shugan decoction for qi stagnation (Yeung et al., 2015). Evidence is low to moderate due to high heterogeneity, but clinical applicability is high when treatments are individualized by TCM pattern diagnosis.

Tai Chi and Qigong

Mind–body exercises show the strongest effect sizes among TCM modalities. A 2023 meta-analysis of 12 trials (731 participants) found Tai Chi significantly reduced depression in middle-aged and older adults (SMD = –1.21), with greater benefits for >24-week programs totaling >2,400 minutes of practice (Zeng et al., 2023). A network meta-analysis (30 trials, 2,806 participants) ranked Tai Chi highest for improving depression and anxiety among traditional Chinese exercises (Dong et al., 2023).

Qigong also has positive evidence. A meta-analysis in substance use disorder populations found reductions in depression (SMD = –0.27) and larger effects for anxiety (Liu et al., 2020). Tai Chi and Qigong interventions are very safe, with high adherence and no serious adverse events reported.

Integration and Multimodal Approaches

Observational and small RCT evidence suggests combining acupuncture with Tai Chi or herbal medicine may yield additive benefits. Integrated TCM-based programs have achieved large effect sizes (SMD = –2.05) compared with usual care, though GRADE is low due to limited trial quality and standardization.

Mechanisms

Acupuncture may modulate neurotransmitter systems, the corticostriatal reward circuit, neuroinflammation, and neuroplasticity. Herbal medicines act via multi-target mechanisms affecting monoamines, the hypothalamic–pituitary–adrenal axis, brain-derived neurotrophic factor, and glutamate transmission. Tai Chi and Qigong regulate the autonomic nervous system, reduce neuroinflammation, and improve hippocampal neurogenesis.

Conclusion

High-quality evidence supports Tai Chi and adjunctive acupuncture or herbal medicine as safe, effective complementary approaches for depression, with the strongest results seen when combined with conventional care. Effects on remission and relapse prevention require further study. Future research should prioritize large, well-designed, long-term trials that reflect real-world multimodal TCM practice.

Key References (GRADE-aligned order)

Armour, M., Smith, C. A., Wang, L. Q., et al. (2019). Acupuncture for depression: A systematic review and meta-analysis. Journal of Clinical Medicine, 8(8), 1140. https://doi.org/10.3390/jcm8081140

Smith, C. A., Armour, M., & Lee, M. S. (2018). Acupuncture for depression. Cochrane Database of Systematic Reviews, 3, CD004046. https://doi.org/10.1002/14651858.CD004046.pub3

Dang, C., Wang, Q., Li, Q., Xiong, Y., & Lu, Y. B. (2024). Chinese herbal medicines for the treatment of depression: A systematic review and network meta-analysis. Frontiers in Pharmacology, 15, 1295564. https://doi.org/10.3389/fphar.2024.1295564

Zeng, L., Zhao, X., Yu, Y., Hu, T., Li, C., Wu, M., & Yang, F. (2023). Effects of Tai Chi on depression of middle-aged and older adults: An updated systematic review and meta-analysis. BMC Complementary Medicine and Therapies, 23, 275. https://doi.org/10.1186/s12906-023-04207-1

Dong, Y., Kuang, X., Dong, L., Chao, G., Qi, J., Zhang, X., & Yao, J. (2023). Exploring the efficacy of traditional Chinese medicine exercise in alleviating anxiety and depression in older adults: A comprehensive study with randomized controlled trial and network meta-analysis. Frontiers in Psychology, 14, 1290471. https://doi.org/10.3389/fpsyg.2023.1290471

Liu, F., Cui, J., Liu, X., Chen, K., Chen, X., & Li, R. (2020). The effect of Tai Chi and Qigong exercise on depression and anxiety of individuals with substance use disorders: A systematic review and meta-analysis. BMC Complementary Medicine and Therapies, 20, 161. https://doi.org/10.1186/s12906-020-02967-8

Yeung, W. F., Chung, K. F., & Yu, Y. M. (2015). Prescription of Chinese herbal medicine in pattern‐based traditional Chinese medicine treatment for depression: A systematic review. Evidence-Based Complementary and Alternative Medicine, 2015, 160189. https://doi.org/10.1155/2015/160189