TRADITIONAL

CHINESE MEDICINE AS TREATMENT FOR MENTAL DISORDERS 1

Traditional Chinese Medicine as Treatment for

Mental Disorders

Fig. 1. Photo. Xu Ying. Chinese Medicine. Web. Retrieved November 21, 2014.
http://blog.eteacherchinese.com/chinese-tradition/chinese-medicine/

Michelle Eva Morholt, WCSN

Westminster College
School of Nursing and Health Sciences
NURS 405-Psychiatric-Mental Health Nursing
Prof. Jennifer Stock, MSN, FNP-BC
November 29, 2014

TRADITIONAL CHINESE MEDICINE AS TREATMENT FOR MENTAL DISORDERS 2

Abstract
Over the past half-century, Eastern and Western medicines have begun to be utilized in
conjunction with each other to address peoples health worldwide. Here in the United States, as
our culture and people simultaneously expand, diversify, and assimilate, a variety of
complementary-alternative medicine (CAM) modalities, that are primarily based on traditional
and classical Chinese medicine, have become widely accepted as effective health maintenance,
disease preventative, and even disease treatment measures by the public and health practitioners
alike. In 1977, Engel encouraged the need for an emergence of a new medical model. His
proposed biopsychosocial model, to be utilized for all of medicine, focuses on assessing clients
holistically. This approach to practicing medicine directly challenges the prevailing biomedical
approach that dominates Western medicine, which considers health based on purely biological
factors and defines health as merely an absence of disease (p. 129). In China, a scientifically
driven anti-religious communist influence has allowed for the emergence of traditional Chinese
medicine (TCM) and the integration of Western medicine into their society. This evidence-based
practice review not only seeks to shed some light on the concepts and foundations of TCM,
highlight the most recent data related to the use of TCM herbal prescriptions for psychiatric
mental disorders, but also aims to demonstrate when utilizing both Eastern and Western
medicines' interventions that appropriate collaborative nursing and medical care for clients with
mental disorders are best addressed by adhering to a holistic approach that recognizes the
society, culture, heart/emotion, mind/thought, and body inter-connection.
Keywords: complementary alternative medicine, CAM, traditional Chinese medicine,
TCM, biopsychosocial model, biomedical model, Eastern medicine, Western medicine,
evidence-based practice, herbal prescriptions, psychiatric mental disorders.

TRADITIONAL CHINESE MEDICINE AS TREATMENT FOR MENTAL DISORDERS 3

Discussion
One of the most influential and revered books regarding Chinese medicine, The Yellow
Emperors Canon of Internal Medicine, was written nearly 2000 years ago. Translated by Bing
in 1997, this text emphasized, all diseases are rooted in spirit (p. 49). In fact, according to
Flaws and Lake, the authors of the premier Chinese Medical Psychiatry textbook and clinical
manual for the diagnosis and treatment of psychiatric disorders with acupuncture and Chinese
medicine entitled Chinese Medical Psychiatry: A Textbook & Clinical Manual: Including
Indications for Referral to Western Medical Services, psychiatry was a recognized specialty in
China as early as the 14th century (p. 25). In response to the cultural and communist revolutions
that took place in China in the later half of the twentieth century, traditional Chinese medicine
evolved from classical Chinese medicine (CCM) in an effort to streamline the educational
process of practitioners. Furthermore, TCM diverged from CCM in that it de-emphasized
psychological, supernatural, and religious aspects of approaches to medicine.
Despite this, many Chinese
people and medical practitioners
recognize the relationship between
the environment, heart, mind, and
body. In fact, TCMs
acknowledges the interrelation
between the five essential phases
of elements, four seasons, seven
emotions, and their corresponding
viscera (see Fig. 2). It is explained

Fig. 2. Photo. Im Mad as Hell and Im Going to Take it with Lemon in my Water. Web.
November 21, 2014. www.http://cookusinterruptus.com/blog/?tag=traditional-chinesemedicine

TRADITIONAL CHINESE MEDICINE AS TREATMENT FOR MENTAL DISORDERS 4

in the Emperors Canon, that any excess in a particular emotion may give rise to disharmony,
interruption of the movement of energy and fluids, or qi, resulting in illnesses (p. 194).
Furthermore, it is recognized that all humans are unique individuals, different in character and
constitution (p. 532). Our personalized characters and constitution ultimately effect our reaction
to stress stimuli; having a direct effect on our overall health and well-being. It is also accepted in
TCM that social standing and perceived support systems also influence mental and overall
health. Tan, Wu, and Chens 2013 article entitled Chinese Medicine for Mental Disorder and its
Applications in Psychosomatic Diseases reports, TCM emphasizes that when we make a
diagnosis, we must inquire in advance about the three states on the patient: noble or humble, rich
or poor, and happy or miserable (p. 62).
According to Townsends 2014 textbook Essentials of Psychiatric Mental Health
Nursing, Concepts of Care in Evidence-Based Practice:
Restoring the balance of yin and yang is the fundamental concept of Asian health
practices. Yin and yang represent opposite forces of energy, such as negative/positive,
dark/light, cold/hot, hard/soft, and feminine/masculine. The belief is that illness occurs
when there is a disruption in the balance of these energy forces. (p. 102).
In addressing a variety of mental disorders, TCM utilizes numerous modalities including
acupuncture, medicinal herbal preparations, cupping, tai chi, and qigong. By and large research
regarding the use of TCM as treatment methods for mental disorders has focused on herbal
prescriptions. A few of these studies are reviewed below.
In their 2010 study, Successful Treatment with Yokukansan for Behavioral and
Psychological Symptoms of Parkinsonian Dementia, Kawanabe, Yoritaka, Simura, Oizumi,
Tanaka, and Hattori explored the preparation comprised of seven herbal plants called
Yokukansan, a Japanese Kampo prescription based on the TCM herbal prescription, Yi gan san.
Their purpose was to demonstrate Yokukansans effectiveness in addressing behavioral and

TRADITIONAL CHINESE MEDICINE AS TREATMENT FOR MENTAL DISORDERS 5

psychological symptoms of dementia (BSPD). While their sample size was small (n=14),
comprised of seven subjects with Parkinson disease and seven with Parkinson disease with
dementia, their findings were promising and warrant further trails. After four weeks of
Yokukansan treatment (2.5g of powder dissolved in plain hot water ingested three times a day=
7.5g/day) administered in conjunction with Aricept/donepezil and Seroquel/quetiapine fumarate
for four of the subjects, all participants experienced a reduction in BSPD symptoms specifically
a decline in the incidence and duration of visual hallucinations, delusions (p=0.027), and
improvement of Mini-Mental State Examination for seven of the participants (p=0.039),
disinhibition, and anxiety (p=0.018) (p. 285). Additional benefits included a decrease in
agitation, aggressive behavior and insomnia. None of the subjects experienced significant
changes in cognitive function, ability to perform activities of daily living, and diagnostic
laboratory tests including kidney and liver function tests as well as comprehensive metabolic
blood and electrolyte panels. Also, none of the subjects experienced the emergence of
extrapyramidal effects.
Despite the lack of achieving statistically significant data, the exciting results of this
study is the inference that Yokukansan treatment can be administered in conjunction with
pharmaceuticals commonly prescribed to Parkinson patients with dementia who are not
achieving desired effects, without experiencing an increase of adverse side effects, ultimately
resulting in a reduction in Parkinsonian symptoms.
Additional studies have been conducted in an effort to identify the mechanism of action
of Yokukansan. Taneno, Ukai, Ono, Saito, Hashimoto, and Saito in 2008, report in their study
entitled, Neuroprotective Effects of Yi-Gan-san Against Beta Amyloid-induced Cytotoxicity on
Rat Cortical Neurons, that Yokukansan contain compounds with an affinity for serotonin and

TRADITIONAL CHINESE MEDICINE AS TREATMENT FOR MENTAL DISORDERS 6

dopamine receptors, protects against A-induced cytotoxicity provoked by glutamate in cortical
neurons, and reduces the release of glutamate in the hippocampus of rats (p. 1704).
Another TCM prescription administered for general anxiety disorders (GAD) is
Yiqiyangxin. Fourteen herbaceous plants comprise the compound of Yigiyangxin. Research
findings reported in the 2012 study, Efficacy of Yiqiyangxin Chinese Medicine Compound
Combined with Cognitive Therapy in the Treatment of Generalized Anxiety Disorders by Wang,
Ding, Xu, Zeng, and Xiao, demonstrated that this TCM prescription combined with cognitive
behavioral therapy significantly reduces the recurrence of GAD after pharmaceutical withdrawal.
The 202 randomly selected and assigned GAD patients were studied for one year (n=93
treatment group participants received Yiqiyangxin in conjunction with cognitive therapy; n=109
control group participants received Paxil/paroxetine hydrochloride combined with cognitive
therapy). GAD symptoms were assessed among the treatment and control group participants by
utilizing the Hamilton Anxiety Scale (HAMA) and self-report questionnaires (SAS) prior to
receiving Yigiyangxin intervention, three and six months of receiving treatments, and six months
after withdrawal for Yigiyangxin prescription. Treatment group subjects received 10g of
powdered herbs on an empty stomach twice daily (20g/day).
Statistically significant results were garnered after three months of treatment. Reduction
in HAMA and SAS scores were demonstrated in both the control and treatment groups (p=0.05).
However, six months after the completion of the administration of Yigiyangxin, treatment
subjects' HAMA (t=6.699) and SAS (t=9.714) scores were lower than the control group
(p=<0.05) (p.820). The total effective rate (recovery + apparent effect + effectiveness) was found
to be 78.9% in the control group and 81.7% in the treatment group (p. 821). No participants

TRADITIONAL CHINESE MEDICINE AS TREATMENT FOR MENTAL DISORDERS 7

experienced significant changes in diagnostic lab tests including urinary, kidney and liver
function tests and comprehensive metabolic blood and electrolyte panels (p. 818).
Conclusion
As our world becomes increasingly amalgamated and the prevailing biomedical model
utilized in the United States and Western medicine is continually questioned and challenged, it is
vital empirical research be conducted to assure that clients are offered the best evidence-based
interventions and practices that promote clients' safety while providing effective disease
prevention, health maintenance, and disease treatment methods. Manheimer, Wieland,
Kimbrough, Cheng, and Berman 2009 research entitled Evidence from the Cochrane
Collaboration for Traditional Chinese Medicine Therapies concluded, Most Cochrane
systematic reviews of TCM are inconclusive, due specifically to the poor methodology and
heterogeneity of the studies reviewed (p. 1001). Moreover, Flaws and Lake report, From the
Chinese pattern alone, we cannot fully know and understand the ultimate course of many
diseases (p. 87).
Admittedly, further research regarding the effectiveness of TCM and CAM is required. It
is necessary that the design and reporting of these trials follow international standards. This
research is necessary and will assure that the best evidenced-based practices will be available to
clients. However, it is important to note that this body of research is an enormous undertaking
one that will require immense effort and a great deal of time. Furthermore, nearly all the TCM
research studies authors recognized the need for additional controlled trials to validate the
effectiveness of TCM herbal prescriptions, but noted difficulties in conducting blind research
with a treatment and control/placebo groups given the distinctive taste of TCMs herbal
preparations.

TRADITIONAL CHINESE MEDICINE AS TREATMENT FOR MENTAL DISORDERS 8

Additional challenges TCM herbal prescriptions face in their widespread acceptance
amongst western researchers and providers relates to the varying strength and purity of utilized
herbs. To address this concern, careful and exact data must be provided that assesses the
chemical components and potency found in TCM herbal prescriptions. Moreover, prior to TCM
herbs being distributed to providers and distributed to clients, control measures must be enacted
in the prorogation of these herbs. Furthermore, these herbs must validated to be homogenous to
those employed in research studies. These measures may not be realistic to achieve in
prescriptions that are comprised of herbs that are not grown under stringent standards however,
on a commercial scale it is reasonable to believe this can be realized.
Perhaps in the meanwhile, clients and health practitioners can continue to explore the
numerous ancient and modern texts related to Chinese medicine that have been chronicled
throughout the centuries. As systematic research of high-quality randomized blind and doubleblind controlled trials continue to be conducted, we as health care practitioners must consider the
wisdom of Jonas, Linde, and Walach. Their work, How to Practice Evidence-based
Complementary and Alternative Medicine, asserted that six kinds of knowledge should ideally be
considered in the course of reaching evidence-based treatment decisions, one of which is patient
preferences and meaning (1999, p. 73). With that in mind, the best practice when assisting
clients who are afflicted with mental health disorders, may be simply listening to our clients, and
supporting their preferences and perceptions of CAM and TCM, while paying special attention to
the outcomes of the informal research they independently conduct everyday.

TRADITIONAL CHINESE MEDICINE AS TREATMENT FOR MENTAL DISORDERS 9

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Kawanabe, T., Yoritaka, A., Shimura, H., Oizumi, H., Tanaka, S., & Hattori, N. (2010).
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Photographer unknown. Photo from online article: Im mad as hell and Im going to take it with
lemon in my Water. (2011, May 11). Web. Retrieved November 21, 2014.
www.http://cookusinterruptus.com/blog/?tag=traditional-chinese-medicine

TRADITIONAL CHINESE MEDICINE AS TREATMENT FOR MENTAL DISORDERS 1

0

Photographer Uknown. Photo from online blog. Xu Ying. Chinese Medicine. (2014). Web.
Retrieved November 21, 2014. http://blog.eteacherchinese.com/chinese-tradition/chinesemedicine/
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