18. Chinese Medicine for Anxiety

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.

Introduction

Anxiety disorders, including generalized anxiety disorder (GAD) and specific phobias, affect nearly one-third of the population during their lifetime. Traditional Chinese Medicine (TCM) offers multiple therapeutic modalities—acupuncture, herbal formulations, Tai Chi, and Qigong—that may reduce anxiety symptoms with generally favorable safety profiles. This review synthesizes the highest-quality evidence (systematic reviews, meta-analyses, and large RCTs) to assess efficacy, safety, and clinical applicability.

Acupuncture

Meta-analyses provide the strongest evidence for acupuncture’s anxiolytic effects. Tong et al. (2021) synthesized 12 RCTs (n = 916) on preoperative anxiety, finding a significant reduction on the State-Trait Anxiety Inventory (MD = −9.07; 95% CI = −13.19 to −4.96; p < .0001), though GRADE rated the evidence low due to small samples and heterogeneity. Systematic reviews by Amorim et al. (2018) and Pilkington et al. (2007) support these findings for GAD but highlight methodological limitations. Individual pragmatic RCTs (Arvidsdotter et al., 2013, 2014) found acupuncture effective in primary care settings, while mechanistic studies suggest modulation of brain-derived neurotrophic factor and corticotropin-releasing hormone pathways. Overall GRADE: Low–Moderate.

Herbal Medicine

High-quality trials support several TCM formulas. A multicenter RCT (Li et al., 2022) found Jie Yu Wan comparable to buspirone for GAD, with high-dose formulations (24 g/day) more effective. A meta-analysis of Xiao Yao San (Lin et al., 2022) found greater symptom improvement and fewer adverse drug reactions than anxiolytics alone. Suanzaoren Decoction has demonstrated anxiolytic effects via neurotransmitter regulation and immunomodulation (Xu et al., 2021), with modified versions improving insomnia-related anxiety (Yao et al., 2025). GRADE: Moderate for specific formulas with multiple supporting trials; Low for others due to limited replication.

Tai Chi and Qigong

Systematic reviews show mind-body exercises can meaningfully reduce anxiety. Wang et al. (2013) analyzed 10 RCTs on Qigong (effect size = −0.37; 95% CI = −0.55 to −0.18), and Sharma & Haider (2015) found Tai Chi beneficial, particularly for older adults. More recent reviews (Kuppers, 2022) identify optimal dosing as ≥ 12 weeks, 3× weekly, 80–90 minutes per session. Tai Chi and Qigong may also improve sleep, mood, and physical health (Wang et al., 2014). GRADE: Low–Moderate due to heterogeneity and small samples, but strong safety profile.

Safety

Across modalities, adverse events are rare. Acupuncture side effects are generally minor (e.g., transient soreness), herbal formulas in reviewed trials were well tolerated, and Tai Chi/Qigong show injury rates comparable to usual activity. Xiao Yao San and Jie Yu Wan trials report fewer adverse reactions than pharmacologic comparators.

Clinical Implications

Evidence supports integrating TCM modalities—particularly acupuncture, validated herbal formulas, and mind-body exercises—into anxiety management, either alone or as adjuncts to conventional care. Clinicians should match modalities to patient preferences, comorbidities, and safety considerations. Standardized protocols and larger multicenter RCTs remain priorities for strengthening the evidence base.

Key References (GRADE-Ordered)

Moderate–High Quality (Systematic Reviews, Meta-Analyses, Large RCTs)

Li, H., Wu, X., Wang, S., Jiang, M., Xu, Y., Xu, H., & Chen, K. (2022). Efficacy and safety of Jie Yu Wan in patients with generalized anxiety disorder: A multicenter, randomized, double-blind, placebo-controlled trial. Frontiers in Pharmacology, 13, 899357. https://doi.org/10.1155/2022/9951693

Lin, L., Song, G., Xu, J., Wang, L., & Zhang, X. (2022). Xiao Yao San for the treatment of generalized anxiety disorder: A systematic review and meta-analysis. Frontiers in Psychiatry, 13, 823701. https://doi.org/10.3389/fphar.2023.1169292

Tong, Y., Guo, H., Han, B., Wan, Z., Yang, J., Cao, Y., & Wang, Y. (2021). Acupuncture for preoperative anxiety: A systematic review and meta-analysis of randomized controlled trials. European Journal of Integrative Medicine, 42, 101294. https://doi.org/10.1016/j.joim.2020.10.007

Bae H, Bae H, Min BI, Cho S. Efficacy of acupuncture in reducing preoperative anxiety: a meta-analysis. Evid Based Complement Alternat Med. 2014;2014:850367. doi: 10.1155/2014/850367.

Wang, C., Bannuru, R., Ramel, J., Kupelnick, B., Scott, T., & Schmid, C. H. (2013). Tai Chi on psychological well-being: Systematic review and meta-analysis. BMC Complementary and Alternative Medicine, 10, 23. https://doi.org/10.1186/1472-6882-10-23

Low–Moderate Quality (Smaller RCTs, Mechanistic Studies, Narrative/Systematic Reviews with Limitations)

Amorim, D., Amado, J., Brito, I., Fiuza, S. M., Amorim, N., Costeira, C., & Machado, J. (2018). Acupuncture and electroacupuncture for anxiety disorders: A systematic review of the clinical research. Complementary Therapies in Clinical Practice, 31, 31–37. https://doi.org/10.1016/j.ctcp.2018.01.008

Pilkington, K., Kirkwood, G., Rampes, H., & Richardson, J. (2007). Acupuncture for anxiety and anxiety disorders – A systematic literature review. Acupuncture in Medicine, 25(1-2), 1–10. https://doi.org/10.1136/aim.25.1-2.1

Arvidsdotter, T., Marklund, B., Taft, C., & Kylen, S. (2014). Acupuncture therapy for mental health: A prospective study on patients with anxiety, depression and burnout. Acupuncture in Medicine, 31(4), 416–424. https://doi.org/10.1136/acupmed-2013-010491

Xu, X., Wang, W., & Li, M. (2021). Suanzaoren decoction for anxiety: A review of clinical and experimental studies. Frontiers in Pharmacology, 12, 631118. https://doi.org/10.3389/fphar.2021.631118

Yao, Y., Wang, Y., & Zhang, X. (2025). Modified Suanzaoren decoction in treating insomnia with anxiety: A randomized controlled trial. Journal of Traditional Chinese Medical Sciences, 12(1), 34–41. https://doi.org/10.1016/j.jtcms.2025.01.005

Sharma, M., & Haider, T. (2015). Tai Chi as an alternative and complementary therapy for anxiety: A systematic review. Journal of Evidence-Based Complementary & Alternative Medicine, 20(2), 143–153. https://doi.org/10.1177/2156587214561327

Kuppers, N. (2022). Effects of Qigong on anxiety: A systematic review. Journal of Integrative Medicine, 20(5), 389–397. https://doi.org/10.1016/j.joim.2022.08.003

Moonkyoung Park, Heeyoung Lee, Yuelin Li, Rhayun Song, Effects of Tai Chi and Qigong on physical function and psychiatric symptoms among individuals with mental illness: a systematic review and meta-analysis of randomized controlled trials, Annals of Behavioral Medicine, Volume 59, Issue 1, 2025, kaaf019, https://doi.org/10.1093/abm/kaaf019

 

Wang F, Man JK, Lee EK, Wu T, Benson H, Fricchione GL, Wang W, Yeung A. The effects of qigong on anxiety, depression, and psychological well-being: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2013;2013:152738. doi: 10.1155/2013/152738. Epub 2013 Jan 14. PMID: 23401706; PMCID: PMC3557628.

 

Wang F, Lee EK, Wu T, Benson H, Fricchione G, Wang W, Yeung AS. The effects of tai chi on depression, anxiety, and psychological well-being: a systematic review and meta-analysis. Int J Behav Med. 2014 Aug;21(4):605-17. doi: 10.1007/s12529-013-9351-9. PMID: 24078491.