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ChineseHerbalFormulaXiaoYaoSanfor TreatmentofDepression
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2 Evidence Based Complementary and Alternative Medicine. Depression is most commonly treated with antidepres were included RCTs combined xiaoyansan with antidepres. sants in primary care 6 In addition there are other kind of sants compared with antidepressants and all the modified. psychological interventions such as cognitive behavior ther xiaoyaosan formula were included as well There were. apies interpersonal therapy psychotherapy and counseling no restrictions on population characteristics language and. The most widely prescribed antidepressants come from a publication type. class of medications known as selective serotonin reuptake Outcome measures include Clinical Comprehensive E ect. inhibitors SSRIs Besides of that atypical antidepressants Hamilton depression scale HAMD scores self rating. the older tricyclic antidepressants and monoamine oxidase depression scale SDS scores self rating anxiety scale SAS. inhibitors MAOIs The common side e ects include sex scores Hamilton Anxiety Scale HAMA scores clinical. ual problems drowsiness fatigue sleep di culties nausea global impression CGI scores the scale for TCM syndrome. weight gain nervousness dry mouth and blurred vision and symptom di erentiation TCM SSD scores and so. Stop taking drugs abruptly may cause antidepressant dis forth the criteria recover significant e ective e ective or. continuation syndrome such as spells extreme restlessness not e ective was also include in the outcome measurement. dizziness fatigue and aches and pains Duplicated publications reporting the same groups of partic. The Xiaoyaosan XYS decoction containing eight com ipants were excluded. monly used herbs Bupleurum root Chinese angelica root. white peony root poria bighead atractylodes rhizome 2 3 Data Extraction and Quality Assessment Two authors J. roasted ginger prepared licorice root menthol and pepper P Liu and Y Q Zhang extracted the data from the included. min been used for treatment of mental disorders such as trials independently The methodological quality of trials was. depression for centuries in China The mechanism of the assessed using the 6 criteria 6 election bias study design. description maybe soothing the liver invigorating the spleen confounders blinding data collection methods withdrawals. nourishing the blood to restore the normal menstruation and dropouts to following 3 categories Category A strong. and clearing away the liver fire due to blood deficiency quality four strong ratings with no weak ratings above. Category B moderate quality less than four strong ratings. Biochemically the XYS decoction also reversed CIS induced. and one weak rating Category C weak quality two or more. decreases in brain derived neurotrophic factor BDNF and. weak ratings, increases in tyroxine hydroxylase TrkB and neurotrophin. Quality assessment of included randomized controlled. 3 NT 3 in the frontal cortex and the hippocampal CA trials sequence generation allocation concealment blinding. subregion of participants personnel and outcome assessors incom. Currently xiaoyaosan used alone or integrated with plete outcome data selective outcome reporting and other. antidepressants has been widely used as an alternative and sources of bias. e ective method for the treatment of depression in China. Many clinical studies reported the e ectiveness ranging from 2 4 Data Synthesis The statistical package RevMan 4 3 2. case reports and case series to controlled observational was used for data analyses which was provided by The. studies and randomized clinical trials but the evidence for Cochrane Collaboration Dichotomous data were presented. its e ect is not clear The present paper aims to evaluate as risk ratio RR and continuous outcomes as mean. the beneficial and harmful e ects of xiaoyaosan wan for di erence MD both with 95 confidence interval CI. treatment of depression in randomized trials Meta analysis was performed if the intervention control. and outcome were the same or similar The statistical. 2 Methods heterogeneity was presented as significant when I square I 2. is over 50 or P 0 1 Random e ect model was used for. 2 1 Database and Search Strategies Literature searches the meta analysis if there was significant heterogeneity I 2. were conducted in National Knowledge Infrastructure 50 and fixed e ect model was used when the heterogeneity. 1999 2009 VIP Database for Chinese Technical Period was not significant I 2 50 7. icals 1989 2009 Chinese Biomedical Literature Database. 1995 2009 PubMed 1950 2009 and Cochrane library 3 Result. Issue 3 2009 and searched the reference list of retrieved. papers All of those searches ended the end of November 3 1 Description of Included Trials After primary search of. 2009 We used the search terms depression xiaoyaowan 5 databases 263 trials were screen out from electronic and. xiaoyaosan and xiaoyaotang Various combinations of manual searches Figure 1 and the majority were excluded. the terms were used depending on the database searched due to obvious ineligibility which including irrelevant. The bibliographies of included studies were searched for titles and abstract some papers being found from more. additional references than one database 141 trials with full text papers were. retrieved 122 RCTs were excluded because of reporting. 2 2 Inclusion Criteria All the parallel randomized con the depression complicated with other disease such as. trolled trials RCTs of all the prescriptions based on stroke and postpartum 60 trials were excluded because of. xiaoyaosan including pills powder decoction dosage form duplicated publication 22 trials were excluded due to the. compared with antidepressants in patients with depression animal studies and the rest 41 trials were noncontrolled. Evidence Based Complementary and Alternative Medicine 3. CNKI VIP CBM Cochrane library PubMed,N 173 N 52 N 38 N 8 N 13. Repetitions n 60,Title abstract Animal study n 22,Case report case series. traditional review n 41,114 studies excluded based. on the inclusion criteria,RCT included,Figure 1 Study selection process.
clinical trials including case report case series traditional based on xiaoyaosan using alone 9 17 19 23 30 or. review 114 out of the rest of 140 articles were excluded plus placebo 12 15 versus antidepressants one three arm. based on the inclusion criteria The treatment for depressive trial and the rest sixteen trials 7 8 10 11 13 14 16 20. neurosis bipolar disorders and depression in patients with 22 24 29 31 32 compared the prescriptions based on. psychological stress insomnia were excluded In the end 26 xiaoyaosan plus antidepressants versus antidepressants. RCTs were reviewed The characteristics of 26 randomized The total treatment duration ranged from 30 days to 3. trials are summarized in Table 1 month The variable prescriptions are presented in Table 1. The 26 RCTs involved 1837 patients with depression The di erent composition of formula Xiaoyaosan are pre. There was a wide variation in the age of subjects 17 80 sented in Table 2 Nineteen 19 of the 26 trials used the. years Twenty six 26 trials specified six diagnostic criteria hamilton depression scale HAMD as the outcome measure. four trials 7 17 22 25 31 32 used the China classification other 4 kinds of scales including self rating depression. and diagnostic criteria for mental disorder second edition scale SDS self rating anxiety scale SAS the scale for. CCMD 2 R alone six 8 9 11 18 20 24 26 28 30 TCM syndrome and symptom di erentiation TCM SSD. trials used the third edition CCMD 3 alone three trials the hamilton anxiety scale HAMA were also be used. combined international classification on the diagnosis of Side e ect was evaluated by asberg side e ect scale and. depression ICD 10 with CCMD 2 R 19 or CCMD 3 treatment emergent symptom side e ect TESS scale or. 12 15 one trials 21 combined the depression standard described in details Eleven 11 trials used four classes. in internal medicine of Chinese medicine and CCMD to evaluate treatment e ects including cure significant. 3 together one trial 16 used CCMD 3 and a ective e ective e ective ine ective while ten 10 trials used three. disorder in the western medicine and Chinese medicine classes except of cure according to the scores reducing rate. classification and diagnostic criteria on depression breaks. out two trials 10 29 used CCMD 3 and the diagnostic. criteria of Chinese medicine on depression and stagnation of 3 2 Methodological Quality of Included Trials Six 10 12. liver qi one trial 23 used CCMD 3 and depression of liver 15 16 23 26 out of 26 trials 23 08 were evaluated as. qi stagnation and spleen deficiency the last trial 13 used strong quality the rest of 20 trials 76 928 were evaluated. the depression standard in TCM on liver qi stagnation and as moderate quality The majority of the included trials were. spleen deficiency assessed to be moderate methodological quality The sample. The interventions included all the prescriptions based size of including trials varied from 24 to 200 patients None. on xiaoyaosan including pills powder decoction dosage of the 26 trials reported sample size calculation Ten trials. form alone with Maprotiline placebo or with antide described the randomization procedure six 10 12 15 16. pressants The controls included antidepressants alone or 23 26 trials used random number table four trials 8 17 25. the combination of danzhiXiaoyaosan DXS placebo and 30 used visiting time to realize the randomization One trial. antidepressants Eight trials investigated the prescriptions 23 used opaque envelopes to allocate concealment Only. 4 Evidence Based Complementary and Alternative Medicine. Table 1 Characteristics and methodological quality of included studies. Diagnosis Course Followup, Study ID Sample Intervention Control Outcome measure. standard week month, Du et al xiaoyao pill plus amitriptyline HAMD and TESS. 120 CCMD 3 6 8,8 fluoxetine paroxetine score side e ect. Huang and Shugan jieyu clinical e ect side,69 ICD 10 amitriptyline 6. Gan 9 formula e ect,clinical e ect,danzhi xiaoyao,Huo et al HAMD HAMA.
72 CCMD 3 decoction plus fluoxetine 6,10 and CJI score side. fluoxetine,clinical e ect,J Li et al xiaoyao pill plus. 60 CCMD 3 imipramine 8 HAMD score side,11 imipramine. HAMD score,Y J Li et CCMD 3 danzhixiaoyao,66 maprotiline 6 5 HT NE EDNF. al 12 ICD 10 powder,CORT IL 6 IL 1,clinical e ect,H Li et al xiaoyao powder.
80 Unclear fluoxetine 6 12 HAMD SDS score,13 plus fluoxetine. side e ect,Liu and danzhixiaoyao,of internal clinical e ect. Chen 2007 78 powder plus amitriptyline 8,medicine HAMD score. 14 amitriptyline,symptoms clinical,e ect HAMD,Luo et al CCMD 3 danzhixiaoyao. 66 maprotiline 6 SDS SAS and,2006 15 ICD 10 powder.
Asberg score side,clinical e ect,Ma 2007 xiaoyao pill plus. 60 CCMD 3 citalopram 8 12 HAMD and Tess,16 citalopram. score side e ect,CCMD 2 guipi xiaoyao clinical e ect SDS. et al 2004 200 venlafaxine 4,R pill score side e ect. R C clinical e ect,modifiedxiaoyao, Wang 2008 60 CCMD 3 amitriptyline 6 HAMD score side.
T Y Wang danzhixiaoyao clinical e ect SDS,61 R fluoxetine 6. 2001 19 decoction score side e ect,clinical e ect,xiaoyao pill plus HAMD and. Wang et al 68 CCMD 3 fluoxetine 6,doxepin HAMA score side. clinical e ect,Y Wang danzhixiaoyao,and Liu 60 CCMD 3 powder plus fluoxetine 8. CGI SI score side,21 fluoxetine,xiaoyao powder,Wei et al CCMD 2.
60 plus amitriptyline 4 clinical e ect,amitriptyline. symptoms clinical,Xian et al,60 CCMD 3 xiaoyao powder fluoxetine 6 e ect HAMD. danzhixiaoyao, Xiao 24 66 CCMD 3 powder plus clomipramine 8 clinical e ect. clomipramine, Evidence Based Complementary and Alternative Medicine 5. Table 1 Continued,Diagnosis Course Followup, Study ID Sample Intervention Control Outcome measure.
standard week month,xiaoyao powder, Yang and plus amitriptyline or clinical e ect TESS. 58 CCMD 2 12, Xie 25 amitriptyline or clomipramine score side e ect. clomipramine,modified clinical e ect,Yang et al, 64 CCMD 3 xiaoyao pill plus fluoxetine 12 3 HAMD score side. amitriptyline e ect,clinical e ect,Zhai et al CCMD 2 xiaoyao powder. 24 doxepin 8 HAMD and TESS,7 R plus doxepin,score side e ect.
clinical e ect,Zhang et xiaoyao pill plus,59 CCMD 3 fluoxetine 6 HAMD and TESS. al 27 fluoxetine,score side e ect,Zhang xiaoyao pill plus HAMD score side. 50 CCMD 3 fluoxetine 6,28 fluoxetine e ect,symptoms clinical. Zhao and xiaoyao powder,66 CCMD 3 amitriptyline 12 e ect HAMD. Jiang 29 plus,score side e ect,amitriptyline,symptoms clinical.
Zhou and e ect HAMD and,90 CCMD 3 xiaoyao powder fluoxetine 8. Li 30 SDS score side,xiaoyao pill plus HAMD score side. Zhu 31 60 CCMD 2 venlafaxine 10,venlafaxine e ect,xiaoyao powder. Zhu and Li clinical e ect side,60 CCMD 2 plus amitriptyline 8. amitriptyline, four 12 15 23 27 of the 26 trials employed a blinding control group on the four criteria outcome measurement.
procedure three of them using patients blinding doctors Two 17 19 trials compared the e ectiveness using the. blinding and assessors blinding and the other one 27 three criteria outcome measurement significant e ective. mentioned single blind without further details Seven trials SDS scores reduced rate 50 e ective 50 SDS scores. 8 10 12 15 21 25 reported the withdrawals dropouts reduced rate 30 not e ective SDS scores reduced. information Three trials 13 16 26 mentioned follow up rate 30 The Total e ective rate is the combination. and neither of them used intention to treat method The of cure significant e ective and e ective rate We. reporting quality of 26 trials according to quality assessment put these two di erent kinds of measurements together. tool for quantitative studies varied among di erent trials to evaluate the general e ectiveness The meta analysis. Table 3 showed no significant di erence between xiaoyaosan and. antidepressants on the Total e ective rate RR 1 05 1 00. 3 3 E ect of the Interventions Tables 4 6 1 11 P 0 07 Table 4. 3 3 1 Xiaoyaosan versus Antidepressants Western Medi. cine Eight 9 12 15 17 19 23 30 trials compared HAMD Scores Decrease Meanwhile four trials 12 15 18. xiaoyaosan with antidepressants 30 reported there are no significant di erence on the HAMD. scores decrease nor on the HAMD scores reduced rate 15. Clinical Comprehensive E ect Seven of the eight trials used after 6 weeks treatment Meta analysis of three trials showed. clinical comprehensive e ect to evaluate the outcome Five the same result in the fixed e ects model WMD 0 59. trials 9 15 18 23 30 used the percentage of HAMD scores 0 51 1 70 P 0 29 and random e ects model WMD. reduced rate to measure the outcome cure HAMD scores 0 43 2 14 2 99 P 0 74 with significant heterogeneity. reduced rate more than 75 significant e ective HAMD I 2 68 7 Table 5. scores reduced rate between 51 and 75 e ective, HAMD scores reduced rate from 25 to 50 and ine ective SDS Scores Decrease Four trails 15 17 19 30 reported the. HAMD scores reduced rate less than 25 None of the five SDS scores decreasing Meta analysis of four trials showed. trials showed significant di erence between treatment and significant di erence in favor of modified xiaoyao powder or. 6 Evidence Based Complementary and Alternative Medicine. Table 2 Composition of formula,ID Formulation Composition of formula. Du et al 8 pill Chinese patent medicine, Bupleuri 10 g Paeoniae lactiflorae 15 g Poriae cocos pararadicis 30 g Atractylodis macrocephalae 15 g. Moutan radicis 10 g Curcumae 10 g Angelicae sinensis 15 g Menthae haplocalycis 10 g Tritici aestivi. levis 30 g Polygoni multiflory 30 g Pseudostellariae heterophyllae 20 g Menstrual period remove Moutan. Huang and radicis Pseudostellariae heterophyllae Menthae haplocalycis plus Ligustici chuanxiong 10 g Persicae 10 g. Gan 9 Leonuri heterophylli 30 g Guanzhong 10 g typhae 10 g Trogopteri seu pteromi 10 g Follicular phase. remove Moutan radicis Menthae haplocalycis plus Cervi 15 g Epimedii 15 g Chrysanthemi indici 15 g. Lycii 15 g Luteal phase plus Gardeniae jasminoidis 10 g Ligustri lucidi 20 g Liquidam baris taiwanianae. 15 g Cyperi rotundi 10 g Rhapontici seu echinops 10 g. Bupleuri 10 g Paeoniae lactiflorae 12 g Angelicae sinensis 12 g Poriae cocos 20 g Atractylodis macro. cephalae 10 g Moutan radicis 12 g Gradeniae jasminodidis 10 g Curcumae l2 g Acori graminei 10 g. Fructus aurantii 10 g Draconis 30 g Ostreae 30 g Polygalae tenuifoliae 12 g Cizyphi spinosae 30 g Tritici. decoction aestivi levis 30 g Glycyrrhizae uralensis 10 g Zizyphi jujubae 5 Blood stasis plus Ligustici chuanxiong 12 g. Salviae milgiorrhizae 20 30 g Phelgm and dampness plus Citri reticulatae 10 g Pinelliae ternatae 10 g Yin. deficiency plus Lilii 30 g Anemarrhenae asphodeloibis 10 g Qi deficiency remove Gradeniae jasminodidis. plus Pseudostellariae heterophyllae 15 g Astriction plus Cannabis sativae 10 g or Radix et rhizome 10 g. Li et al 11 pill Chinese patent medicine, Li et al 2007 Chinese patent medicine bupleuri angelicae sinensis poriae cocos atractylodis macrocephalae gradeniae. 12 jasminodidis moutan radicis, Bupleuri 15 g Angelicae sinensis 15 g Atractylodis macrocephalae 15 g Paeoniae lactiflorae 10 g Poriae.
Li et al 13 decoction, cocos 10 g Menthae haplocalycis 6 g Glycyrrhizae uralensis 6 g. Bupleuri 8 g Gradeniae jasminodidis 6 g Ligustici chuanxiong 6 g Glycyrrhizae uralensis 6 g Moutan. radicis 10 g Taeoniae rubrae 10 g Atractylodis macrocephalae 10 g Draconis 30 g Ostreae 30 g Poriae. cocos 15 g Liver qi stagnation and abdominal distention plus Aucklandiae lappae 10 g Citri reticulatae. Liu and Chen, decoction 10 g Cyperi rotundi 6 g Insomnia plus Albizziae julibrissin 15 g Polygoni multiflory 15 g Poriae cocos. pararadicis 15 g Polygalae tenuifoliae 10 g Cizyphi spinosae 10 g Spleen and stomach deficiency plus. Pseudostellariae heterophyllae 10 g Citri reticulatae 10 g Phlegm and dampness and no appetite plus. Pinelliae ternatae 10 g Bambusae in taeniis 10 g Citri reticulatae 10 g Amomi 6 g. Bupleuri Angelicae sinensis Paeoniae lactiflorae Poriae cocos Atractylodis macrocephalae Moutan. Luo et al 15 powder,radicis Gradeniae jasminodidis. Ma 16 pill Chinese patent medicine, Bupleuri Astragali membranacei Codonotsitis pilosulae Angelicae sinensis Paeoniae lactiflorae Rehman. Wang et al niae glutinosae Artemisiae yinchenhao Atractylodis macrocephalae Poriae cocos Aucklandiae lappae. 17 Cizyphi spinosae Polygalae tenuifoliae Schisandrne chinensis Acori graminei Moutan radicis Moschus. Menthae haplocalycis Glycyrrhizae uralensis, Bupleuri 12 g Angelicae sinensis 20 g Paeoniae lactiflorae 12 g Atractylodis macrocephalae 12 g Lilii.
15 g Albizziae julibrissin 15 g Citri aurantii 10 g Pinelliae ternatae 12 g Gradeniae jasminodidis 10 g. Wang 18 decoction, Scutellariae baicalensis 10 g Bambusae textillis 15 g Curcumae 12 g Acori graminei 12 g Glycyrrhizae. uralensis 6 g Zizyphi jujubae 6, Bupleuri 10 g Paeoniae lactiflorae 12 g Angelicae sinensis 12 g Poriae cocos 20 g Atractylodis macro. cephalae 10 g Moutan radicis 12 g Gradeniae jasminodidis 10 g Curcumae 12 g Acori graminei 10 g. Fructus aurantii 10 g Draconis 30 g Ostreae 30 g Polygalae tenuifoliae 12 g Cizyphi spinosae 30 g Tritici. Wang 19 decoction aestivi levis 30 g Glycyrrhizae uralensis 10 g Zizyphi jujubae 5 Blood stasis plus Ligustici chuanxiong 12 g. Salviae milgiorrhizae 20 30 g Phlegm and dampness plus Citri reticulatae 10 g Pinelliae ternatae 10 g Yin. deficiency plus Lilii 30 g Anemarrhenae asphodeloibis 10 g Qi deficiency remove Gradeniae jasminodidis. plus Pseudostellariae heterophyllae 15 g Astriction plus Cannabis sativae 10 g or Radix et rhizome 10 g. Wang et al,pill Chinese patent medicine, Angelicae sinensis 10 g Paeoniae lactiflorae 12 g Bupleuri 12 g Atractylodis macrocephalae 10 g Poriae. decoction cocos 12 g Zingiberis o cinalis recens 10 g Glycyrrhizae uralensis 10 g Moutan radicis 10 g Gradeniae. jasminodidis 10 g, Qi stagnation and blood stasis plus Salviae milgiorrhizae Cyperi rotundi Linger strychnifoliae Ligustici. chuanxiong Taeoniae rubrae Qi stagnation leading to fire plus Salviae milgiorrhizae Gardeniae. jasminoidis Qi and blood deficiency plus Codonotsitis pilosulae Astragali membranacei Rehmanniae. Wei et al 22 decoction, glutinosae conquitae Palpitation plus Cizyphi spinosae Draconis ostreae Polygalae tenuifoliae Biotae.
orientalin Spleen and kidney deficiency plus Morindae o cinalis Curculiginis orchioidis Epimedii. Zingberis o cinalis Aconiticarmichaeli praeparata Corneum gigeriae galli. Evidence Based Complementary and Alternative Medicine 7. Table 2 Continued,ID Formulation Composition of formula. Xian et al Angelicae sinensis Paeoniae lactiflorae Poriae cocos Atractylodis macrocephalae Menthae haplocalycis. 23 Bupleuri Zingiberis o cinalis recens Glycyrrhizae uralensis. Bupleuri 30 g Menthae haplocalycis 12 g Atractylodis macrocephalae 10 g Poriae cocos 15 g Moutan. radicis 12 g Gradeniae jasminodidis 12 g Angelicae sinensis 12 g Paeoniae lactiflorae 10 g Zingiberis. o cinalis recens Glycyrrhizae uralensis 6 g Blood stasis Ligustici chuanxiong 12 g Phelgm and dampness. Xiao 24 decoction, plus Citri reticulatae 10 g Pinelliae ternatae 10 g Yin deficiency plus Anemarrhenae asphodeloibis 10 g. Qi deficiency plus Pseudostellariae heterophyllae 15 g Astriction plus Cannabis sativae 10 g or Radix et. rhizome l0 g, Bupleuri l5 g Atractylodis macrocephalae l0 g Paeoniae lactiflorae l0 g Angelicae sinensis l0 g Poliae cocos. l0 g Menthae haplocalycis 6 g Glycyrrhizae uralensis 6 g Qi stagnation leading to fire plus Gradeniae. Yang and Xie jasminodidis Moutan radicis Fructus aurantii Heart and spleen deficiency plus Codonotsitis pilosulae. 25 Astragali membranacei Polygalae tenuifoliae Dioscoreae oppositae Phlegm and Qi stagnation plus. Trichosanthis Pinelliae ternatae Madnoliae o cinalis Blood stasis plus Persicae Salviae milgiorrhizae. Ligustici chuanxiong Insomnia plus Cizyphi spinosae Polygoni multiflori Succinum. Yang et al Bupleuri Angelicae sinensis Paeoniae lactiflorae Poriae cocos Atractylodis macrocephalae Moutan. 26 radicis Gradeniae jasminodidis Menthae haplocalycis Glycyrrhizae uralensis. Zhai et al 7 pill Chinese patent medicine, Zhang et al Bupleuri Angelicae sinensis Paeoniae lactiflorae Atractylodis macrocephalae Poriae cocos Menthae. 27 haplocalycis Zingiberis o cinalis recens Glycyrrhizae uralensis. Zhang 28 pill Chinese patent medicine, Bupleuri 15 g Angelicae sinensis 15 g Paeoniae lactiflorae 15 g Atractylodis macrocephalae 15 g Poriae.
decoction cocos 15 g Moutan radicis 10 g Gradeniae jasminodidis 10 g Glycyrrhizae uralensis 10 g Menthae. haplocalycis 10 g Zingiberis o cinalis recens 10 g. Bupleuri 12 g Angelicae sinensis 12 g Atractylodis macrocephalae 9 g Poriae cocos 15 g Paeoniae. Zhou and Li lactiflorae 12 g Cizyphi spinosae 15 g Salviae milgiorrhizae 30 g Ligustici chuanxiong 12 g Carthami. 30 tinctolii 12 g Persicae 9 g Gradeniae jasminodidis 12 g Citri reticulatae viride 9 g Glycyrrhizae uralensis. Zhu 31 pill Chinese patent medicine, Heart and spleen deficiency plus Codonotsitis pilosulae Astragali membranacei Salviae milgiorrhizae. Polygalae tenuifoliae Cizyphi spinosae Asini liver and kidney yin deficiency plus Draconis Ostreae. Zhu and Li Amydae sinensis Asinilycii Moutan radicis Gradeniae jasminodidis Liver qi stagnation plus Curcumae. 32 Citri sarcodactylis Citri reticulatae Trichosanthis Massa fermentata Agastaches seu pogostemi Eupatorii. fortunei Spleen and kidney yang deficiency plus Cinnamomi cassiae Rehmanniae glutinosae conquitae. Corni o cinalis Schisandrne chinensis Acori graminei. decoction compare to antidepressants WMD 3 97 5 52 Clinical Comprehensive E ect Meta analysis of fourteen. 2 41 P 0 00001 Table 6 trials showed significant di erence in favor of combination. group on clinical comprehensive e ect RR 1 10 1 04 1 17. Other Outcomes TCM SSD Scores SAS Scores 5 HT BDNF P 0 0007 Table 4. etc One trial 15 showed that there are no significant. di erences on TCM SSD and SAS scores One trial 12 HAMD Scores Decrease Fourteen trials reported the HAMD. showed that after 6 weeks of treatment the serum level of 5 scores decrease The meta analysis of fifteen trials showed. hydroxytryptamine 5 HT and brain derived neurotrophic there are significant beneficial e ect on the combination. factor BDNF increased P 0 01 and the Interleukin group compare to the antidepressants using alone both in. 6 IL 6 level decreased in both groups without significant the fixed e ects model WMD 0 51 0 71 0 31 P. di erence between two groups the cortisol CORT level 0 0001 and random e ects model WMD 0 69 1 25. reduced significantly in the DXP group compared to Mapro 0 13 P 0 02 with significant heterogeneity I 2. tiline group 76 3, 3 3 2 Xiaoyaosan Plus Antidepressants versus Antidepres SDS Scores Decrease One trial 13 showed significant. sants Seventeen trials 7 10 11 13 14 16 20 22 24 29 benefit on SDS scores decreased in favor of combination. 31 32 compared the combination of xiaoyaosan or modified group after 6 MD 3 6 4 65 2 55 P 0 00001 weeks. xiaoyaosan plus antidepressants with antidepressants treatment Table 6. 8 Evidence Based Complementary and Alternative Medicine. Table 3 Quality assessment of included randomized controlled trials. Blinding of,participants Selective,Included Sequence Allocation Incomplete Other. personnel and outcome Risk of bias, trials generation concealment outcome data sourcesof bias. outcome reporting,Unclear Unclear Unclear Yes No Unclear High.
Unclear Unclear Unclear No No Unclear High,random Unclear Unclear No No Unclear Unclear. J Li et al,Unclear Unclear Unclear Yes No Unclear Unclear. Unclear Unclear Double blind Yes No Unclear Unclear. Unclear Unclear Unclear Yes No Unclear High,Unclear Unclear Unclear No No Unclear High. random Unclear Double blind Yes No Unclear Unclear. Ma 16 random Unclear Unclear Yes Yes Unclear Unclear. Wang et al,Unclear Unclear Unclear No No Unclear High. Wang 18 Unclear Unclear Unclear No No Unclear High. Wang 19 Unclear Unclear Unclear No No Unclear High. Wang et al,Unclear Unclear Unclear No Yes Unclear High.
Unclear Unclear Unclear No Yes Unclear High,Unclear Unclear Unclear No Yes Unclear High. Xian et al,random Yes Unclear No Yes Unclear Unclear. Xiao 24 Unclear Unclear Unclear No No Unclear High. Unclear Unclear Unclear No Yes Unclear High,Yang et al. random Unclear Unclear No No Unclear Unclear,Zhai et al. Unclear Unclear Unclear No No Unclear High, Unclear Unclear Single blind No No Unclear Unclear.
Unclear Unclear Unclear No No Unclear High,Unclear Unclear Unclear No No Unclear High. Unclear Unclear Unclear No No Unclear High,Zhu 31 Unclear Unclear Unclear No No Unclear High. Zhu and Li,Unclear Unclear Unclear No No Unclear High. Evidence Based Complementary and Alternative Medicine 9. Table 4 Analyses of clinical comprehensive e ect,Intervention. Trials Control n N RR 95 CI P Value,Xiaoyao powder versus antidepressants.
Xiaoyao powder versus amitriptyline 1 41 42 25 27 1 05 0 94 1 18 0 37. Danzhi Xiaoyao powder versus,1 28 32 30 31 0 90 0 78 1 05 0 18. maprotiline,Guipi Xiaoyao powder versus,1 94 100 86 100 1 09 1 00 1 20 0 06. venlafaxine,Modified Xiaoyao powder versus,1 29 30 28 30 1 04 0 92 1 16 0 55. amitriptyline,Danzyhih Xiaoyao decoction versus,1 29 34 22 27 1 05 0 83 1 31 0 69. fluoxetine, Xiaoyao powder versus fluoxetine 2 66 75 61 75 1 08 0 94 1 24 0 25.
Meta Analysis 7 287 313 252 290 1 05 1 00 1 11 0 07. Xioayao powder plus antidepressants,versus antidepressants. Xiaoyao pills powder plus,2 56 60 45 60 1 24 1 06 1 46 0 008. amitriptyline versus amitriptyline,Danzhi Xiaoyao decoction powder. 2 51 66 38 66 1 34 1 05 1 72 0 02,plus fluoxetine versus fluoxetine. Xiaoyao pills plus imipramine versus,1 26 30 25 29 1 01 0 82 1 23 0 96.
imipramine,Xiaoyao pills plus fluoxetine versus,2 56 71 54 66 0 97 0 82 1 14 0 69. fluoxetine,Danzhi Xiaoyao powder plus,1 38 40 28 38 1 29 1 05 1 58 0 01. amitriptyline versus amitriptyline,Xiaoyao pills plus citalopram versus. 1 28 30 28 30 1 00 0 87 1 14 1 00,citalopram,Xiaoyao pills plus doxepin versus. 1 32 35 29 33 1 04 0 88 1 22 0 63,fluoxetine,Danzhi Xiaoyao powder plus.
1 30 33 25 33 1 20 0 96 1 50 0 11,clomipramine versus clomipramine. Modified Xiaoyao pills plus,1 29 32 30 32 0 97 0 84 1 12 0 64. amitriptyline versus fluoxetine,Modified Xiaoyao powder plus. 1 31 33 30 33 1 03 0 90 1 19 0 64,amitriptyline versus amitriptyline. Xiaoyao powder plus doxepin versus,1 9 12 10 12 0 90 0 60 1 36 0 62.
Meta Analysis 14 386 442 342 432 1 10 1 04 1 17 0 001. Other Outcomes HAMA Scores CGI Scores One trial 10 mouth Bloating constipation tachycardia blurred vision. showed significant benefit on HAMA scores decreased in insomnia prolonged QT naupathia fatigue anxiety tremor. favor of combination group after 6 MD 2 4 4 23 anorexia palpitation asthenia oscitancy sweat akathisia. 0 57 P 0 01 weeks treatment tetter excitation hypertension bellyache dysuria transami. One trial 10 reported the outcome of CGI scores nase increased and sexual dysfunction Figure 3. It used modified DanzhiXiaoyao decoction plus fluoxetine Amitriptyline showed main side e ect including dry. versus fluoxetine showed better e ect on the combination mouth constipation dizziness blurred vision tachycardia. group MD 0 8 1 2 0 4 P 0 0001 somnolence and so forth 8 9 14 18 22 25 32. Imipramine chlorimipramine doxepin showed main side. 3 4 Publication Bias A funnel plot analysis of the 14 trials e ect including dry mouth constipation and other symp. comparing xiaoyaosan plus antidepressants to antidepres toms in alimentary canal 11 Fluoxetine paroxetine citalo. sants on Clinical Comprehensive E ect was generated and pram showed main side e ect including anxiety insomnia. it showed a significant asymmetry Figure 2 headache naupathia sexual dysfunction and tremor 8 13. 16 19 21 23 26 28 30 Venlafaxine showed main side, 3 5 Adverse E ect Twenty four out of twenty six trials men e ect including dry mouth sweat insomnia headache and. tioned the adverse e ect except two trials 22 24 Twenty anxiety 17 31. four trials reported the twenty seven specific symptoms Four trials 9 17 19 23 reported no side e ect in. including diarrhea dizziness and headache somnolence dry the herbal medicine group compared to the antidepressants. 10 Evidence Based Complementary and Alternative Medicine. Table 5 Analyses of score of HAMD,Trials WMD 95 CI P value. Xiaoyao powder versus antidepressants,Danzhi Xiaoyao powder versus. 2 2 39 0 55 5 33 0 11,maprotiline,Modified Xiaoyao powder versus. 1 1 11 0 21 2 43 0 10,amitriptyline, Xiaoyao powder versus fluoxetine 1 3 30 6 07 0 53 0 02.
Meta Analysis FEM 4 0 59 0 51 1 70 0 29,Meta Analysis REM 4 0 43 2 14 2 99 0 74. Xiaoyao powder plus antidepressants,versus antidepressants. Xiaoyao pills plus fluoxetine versus,1 0 06 1 50 1 62 0 94. amitriptyline,Xiaoyao pills plus fluoxetine versus. 1 1 88 0 20 3 56 0 03,paroxetine,Danzhi Xiaoyao decoction powder.
2 0 18 0 49 0 13 0 25,plus fluoxetine versus fluoxetine. Xiaoyao pills plus imipramine versus,1 0 10 2 35 2 15 0 93. imipramine,Xiaoyao pills plus fluoxetine versus,3 1 41 2 17 0 65 0 0003. fluoxetine,Danzhi Xiaoyao powder plus,1 5 84 8 76 2 92 0 0001. amitriptyline versus amitriptyline,Xiaoyao pills plus citalopram versus.
1 0 30 2 06 1 46 0 74,citalopram,Xiaoyao pills plus doxepin versus. 1 0 88 1 38 0 38 0 0006,fluoxetine,Modified Xiaoyao pills plus. 1 0 17 1 29 1 63 0 82,amitriptyline versus fluoxetine. Xiaoyao powder plus doxepin versus,1 0 80 4 84 3 24 0 70. Modified Xiaoyao powder plus,1 0 76 1 16 0 36 0 0002.
amitriptyline versus amitriptyline,Meta Analysis FEM 14 0 51 0 71 0 31 0 00001. Meta Analysis REM 14 0 69 1 25 0 13 0 02,FEM fixed e ects model REM random e ects model. Table 6 Analyses of score of SDS,Trials WMD 95 CI P value. Xiaoyao powder versus antidepressants, Danzhi Xiaoyao powder versus maprotiline 1 1 19 10 84 8 46 0 81. Guipi Xiaoyao powder versus venlafaxine 1 5 00 7 07 2 93 0 00001. Danzyhih Xiaoyao decoction versus fluoxetine 1 5 14 9 54 0 74 0 02. Xiaoyao powder versus fluoxetine 1 1 70 4 59 1 19 0 25. Meta Analysis FEM 4 3 97 5 52 2 41 0 00001, Xioayao powder plus antidepressants versus antidepressants.
Xiaoyao pills plus fluoxetine versus fluoxetine 1 3 60 4 65 2 55 0 00001. group Three trials reported side e ect in xiaoyaosan group 30 31 used treatment emergent symptom side e ect TESS. including headache dizziness and slightly diarrhea 15 18 scale scores one trial 15 used asberg side e ect scale scores. 30 Fifteen out of eighteen trials reported the combination the rest three trials 17 19 29 did not mentioned the tools. group has less side e ect compare to the antidepressants they used to evaluate the side e ect. group Twelve trials 7 15 19 21 25 29 31 mentioned A meta analysis of four trials 7 8 16 27 with. the side e ect are significant reduced in intervention group five comparison using TESS scale scores showed less side. compared to control group Seven trials 7 16 18 21 25 e ect WMD 2 51 3 18 1 84 P 0 00001 using. Evidence Based Complementary and Alternative Medicine 11. Review xiaoyao powder for depression version 01 70. Comparison 04 xiaoyaosan plus antidepressants,versus antidepressants. Outcome 02 scores of HAMD,Number of patients,10 5 0 5 10 10. Wang and Liu 26,Li et al 13,Zhao and Jiang 29,Luo et al 25. Huo et al 28,Wang et al 8,Yang et al 16,Li et al 31. Yang and Xie 10,Figure 2 Funnel plot, xiaoyaosan plus antidepressants compare to antidepressants.
using alone with significant heterogeneity I 2 87 2. There is another trial 18 showed modified xiaoyao decoc. tion had less side e ect compared to amitriptyline WMD. 1 86 2 57 1 15 P 0 00001 Trials,Hypertension Insomnia. Excitation Blurred vision,4 Discussion Tetter Tachycardia. Akathisia Constipation, Based on this paper and meta analyses of the outcome on Sweat Bloating. Clinical Comprehensive E ect HAMD scores SDS scores Oscitancy Dry mouth. HAMA scores and CGI scores the prescriptions based Asthenia Diarrhea. on xiaoyaosan including pills powder decoction dosage Palpitation Transaminase increased. form using alone or combined with antidepressants may Anorexia Dysuria. have beneficial e ects on patients with depression The Fatigue Bellyache. Naupathia Dizziness and headache, prescription xiaoyaosan may have the same e ectiveness as. Prolonged QT, antidepressants at the end point of the treatment with fewer.
side e ects The combination group may have significant Figure 3 Side e ect of including studies xiaoyaosan versus. beneficial e ect compared to the antidepressants group antidepressants. variable on onset time with less side adverse events We. tried to analysis the trend of xiaoyaosan s e ectiveness by Two meta analysis on HAMD scores showed significant. di erent followup time points as well heterogeneity It may due to the di erent intervention and. The SAS scales scores TCM SSD scales scores and the treatment time or the methodology quality The significant. outcome of the four criteria outcome measurement cure heterogeneity on TESS scales may due to the dosage of the. significant e ective e ective or ine ective showed that antidepressants. there are no significant di erences between the prescription According to the twenty six trials the xiaoyansan pre. group and antidepressants group Meanwhile the xiaoyaosan scription group and the combination of xiaoyaosan and. prescriptions 12 15 using alone may not as e ective as antidepressants group have less adverse events compared. antidepressants after 2 weeks treatment but after 4 or 6 to antidepressants group with significant di erences which. weeks treatment the e ectiveness tend to be no significant were showed by the TESS scales and Asberg side e ect scales. di erence between two groups We could clearly tell the We should consider several limitations before accepting. trend from the HAMD scores and the reduced rate 15 the findings of this paper First the quality of the included. of HAMD scores 12 15 The SDS scores showed the studies is generally moderate according to the quality. xiaoyansan prescriptions are significantly more e ective after assessment tool for quantitative Studies E ective Public. 4 weeks 17 and 6 weeks 19 treatment compared to Health Practice Project 2007 which was recommended. antidepressants on the Cochrane Handbook It also indicated that there. The combination of xiaoyaosan prescription plus antide are moderate risk of bias in most of the trials Due to. pressants group may have significant beneficial e ect com inadequate reporting of the allocation sequence allocation. pared to the antidepressants group The onset time are concealment blinding intention to treat analysis and drop. variable may depended on the form of prescription such as outs account in the majority of trials it was possible. pills and decoctions that there was performance bias and detection bias due. 12 Evidence Based Complementary and Alternative Medicine. to patients and researchers being aware of the therapeutic with well design and adequate sample size are warranted. interventions for the subjective outcome measures Most to support or refute the positive findings Trials should be. of the trials provided limited descriptions of study design reported according to the CONSORT Statement 34. randomization were mentioned but without further details In general comparing to three categories tricyclic. after randomly assignment of patients which do not allow a tertiary amines nontricyclic specific serotonin reup. proper judgment of the conduct of the trials Therefore we take inhibitors SSRIs of antidepressant drugs such as. canot draw a confident conclusion that there are significant Amitriptyline venlafaxine and Fluoxetine the prescription. beneficial e ects in patients with depression on combined based on xiaoyaosan in di erent forms appears to improve. groups or xiaoyaosan prescriptions using alone comparing. the symptoms with less adverse event The combination. to antidepressants The number of trials identified limits us. of xiaoyaosan and antidepressants may have shorter onset. to perform meaningful subgroup or sensitivity analyses to. time compare to antidepressants using alone The mech. illuminate robustness of the results in the review Sixteen. out of twenty seven trials didnot described the blinding in anism 12 may due to the regulating the levels of 5. details only two trials 12 15 used double dummy in their HT CORT BDNF IL 6 Since depression may occurred. study design recurrently with or without treatment a longer follow. Second Liu et al 33 found that some Asian countries up period with serial measurement of outcomes after the. including China publish unusually high proportions of treatment is important to determine the e ectiveness and. positive results considering all of the nineteen trials included long term e ect of the xiaoyaosan prescription Considering. are in Chinese the publication bias possibly existed We there are not su cient amount of high quality trials on. cannot explore quantitatively the possibility of publication xiaoyaosan prescription treating patients with depression. bias due to the small number of trials the e ectiveness of xiaoyaosan prescription need further. Third di erent modified xiaoyao prescriptions and rigorous trials to prove. di erent form of the prescriptions were used in the trials. eight trials 7 8 11 16 20 27 28 31 used fixed, xiaoyaowan throughout the treatment five trials used mod. Conflict of Interest, ified xiaoyaowan and one trial used modified xiaoyansan The authors declare that there is no conflict of interest. based on menstruation period of young female 9 The rest. thirteen trials 10 13 14 18 19 21 24 29 32 used modi. fied xiaoyao decoction according to syndrome di erentiation Acknowledgment. based on Chinese medicine theory the herbal compound This work is supported by a grant from the Ministry of. varied from 7 to 17 herbs Table 2 The treatment duration Science Project The Study of Clinical Evaluation of Tradi. varied from 30 days to 3 months tional Chinese Medicine in China and Australia Program. Fourth the use of composite outcome measures in 26 no 2009DFA31460 Y Zhang and J Wang have contributed. trials to evaluate overall improvement of symptoms limits equally to the work. the generalization of the findings The classification of cure. significant e ective e ective or ine ective and the Total. e ective rate are not internationally recognized and these References. outcome measurement are vague to interpret the e ect We. 1 A Jablensky R Schwarz and T L Tomov WHO collabo, suggest future trials to comply with international standards rative study onimpairments and disabilities associated with. in the evaluation of treatment e ect schizophrenic disorder Acta Psychiatrica Scandinavica vol. Most of the sample size in the including 26 trials is small 62 supplement 285 pp 152S 159S 1980. and there is a moderate risk of bias Further high quality 2 A Jablensky R Schwarz and T L Tomov WHO collabo. studies with larger sample size are needed to confirm the rative study on impairments and disabilities associated with. e ectiveness of xiaoyaosan in treating depression Proper schizophrenic disorder in Summary of the Global Burden. randomization techniques need to be clearly described and of Disease C J L Murray and A D Lopez Eds Harvard. fully reported Blinding and double dummy should be used University Press Cambridge Mass USA 1996. and reported clearly although the double dummy of the 3 R L Spitzer K Kroenke M Linzer et al Health related. herbal decoction might be very di cult blinding of patients quality of life in primary care patients with mental disorders. results from the PRIME MD 1000 study Journal of the. and outcome assessors should be used to minimize perfor. American Medical Association vol 274 no 19 pp 1511 1517. mance and assessment biases Intention to treat principle 1995. and appropriate method for including drop out into data. 4 W Chong Depression su erers grow in China China, analyses are also important in the design of the trials daily http www chinadaily com cn english doc 2005 03 08. Since di erent forms of xiaoyaosan prescriptions were used content 422677 htm. in patients with depression such as pills and decoctions 5 Depression patients exceeding 26 million in China http. they are likely to have di erent onset time according to english peopledaily com cn 200312 19 eng20031219 130779. the existed trials Therefore future clinical trials may focus shtml. on particular subgroups or large sample size to evaluate 6 L S Goldman N H Nielsen and H C Champion. the e ect of di erent forms of xiaoyaosan prescriptions on Awareness diagnosis and treatment of depression Journal. treating patients with depression Further randomized trials of General Internal Medicine vol 14 no 9 pp 569 580 1999. 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Clinical comparative study of Amitriptyline and SSRIs and on e ect of Danzhi Xiaoyao powder in treating depression. SSRIs combined with Chinese medicine or Tibetan drugs in Chinese Journal of Integrated Traditional and Western Medicine. treating senile depression in plateau district The Journal of vol 7 pp 642 644 2007. Altitude Medicine vol 15 no 2 pp 14 17 2005 27 H W Zhang C Y Wang H N Xu et al Clinical study. 9 A Z Huang and L C Gan Clinical observation of shugan on e ect of fluoxetine combined with Chinese medicine or. jieyu prescription in treating depression Journal of Shanghai tibetan drugs in treating senile depression in plateau district. University of Chinese Medicine vol 19 no 2 p 10 2005 Chinese Journal of Integrated Traditional and Western Medicine. 10 J Huo H P Fu J Yang et al The clinical research vol 26 no 3 pp 202 204 2006. of depressive dsorder dreated in DanZhixiaoyao decoction 28 L N Zhang The clinical observation on depression with. dombined with Fluoxetine Journal of Henan TCM University fluoxetine and xiaoyaowan The Medical Journal of Industrial. vol 5 pp 38 39 2008 Enterprise vol 3 p 43 2004, 11 J Li C L Liu S Z Lan et al The clinical observation of 29 H M Zhao and H Jiang The clinical observation on. Imipramine combined with xiaoyaowan treating depression modified xiaoyaosan and Amitriptyline treating 33 patients. Sichuan Mental Health vol 2 p 79 2008 with depression Journal of Beijing TCM vol 8 pp 498 500. 12 Y J Li H C Luo and R Q Qian E ect of Danzhi Xiaoyao 2007. powder on neuro immuno endocrine system in patients with 30 R Y Zhou and S Y Li Clinical observation on 45 cases of. depression Chinese Journal of Integrated Traditional and depression treated by soothing stagnation and invigorating. Western Medicine vol 27 no 3 pp 197 200 2007 blood circulation The Journal of Chinese Medicine vol 49. 13 H Li S Xu B Li et al Treatment of 41 patients with no 1 pp 41 42 2008. depression of liver qi stagnation and spleen deficiency type 31 C S Zhu The clinical observation on depression with. using xiaoyaosan and fluoxetine hydrochloride Journal of xiaoyaowan and Venlafaxine Chinese Journal of Integrated. Shanxi TCM vol 1 pp 49 50 2009 Traditional and Western Medicine vol 2 p 152 2002. 14 L P Liu and K J Chen Clinical observation of combination 32 J P Zhu and W F Li Comparative study of amitriptyline. therapy of western and traditional Chinese medicine for compared with amitriptyline combined with xiaoyao powder. treatment of depression Hubei Journal of Traditional Chinese for treatment of depression Sichuan Mental Health vol 9 no. Medicine vol 12 pp 23 24 2007 S1 pp 20 21 1996, 15 H C Luo R Q Qian X Y Zhao et al Clinical observation 33 J Liu E Manheimer Y Shi and C Gluud Chinese. on e ect of danzhi xiaoyao powder in treating depression herbal medicine for severe acute respiratory syndrome a. Chinese Journal of Integrated Traditional and Western Medicine systematic review and meta analysis Journal of Alternative. vol 26 no 3 pp 212 214 2006 and Complementary Medicine vol 10 no 6 pp 1041 1051. 16 C Ma The clinical controlled study of Xiaoyaowan plus 2004. citalopram treating patients with depression Journal of 34 The Consort Statement http www consort statement org. Health and Vocational Education vol 1 pp 139 140 2007. 17 C Y Wang J Lan and Y X Wang The clinical observation. on guipixiaoyaowan treating 100 patients with depression. Journal of Chinese General Practice vol 6 pp 62 63 2004. 18 R C Wang The clinical observation on depression with. modified xiaoyao powder Medical Journal of Chinese People. Health vol 1 pp 1504 1505 2008, 19 T Y Wang Modified danzhixiaoyao decoction treating. 34 patients with depression Chinese Journal of Integrated. Traditional and Western Medicine vol 9 pp 710 711 2001. 20 W A Wang Q Z Liu W G Liu C Z Liu and H L Chen, Therapeutic e ect of doxepin combined with xiaoyao pill. compared with fluoxetine for treatment of senile depression. Journal of Chinese Behavior Science vol 14 no 3 p 248 2005. 21 Y Wang and S S Liu The clinical observation on patients. with depression using DanzhiXiaoyao decoction and fluoxe. tine Journal of Community Medicine vol 5 pp 57 58 2007. 22 P Wei Y Li and Y C Li Xiaoyao powder for treatment. of 30 patients with depression Traditional Chinese Medicinal. Research vol 12 no 5 pp 54 55 1999, 23 H Xian Q S Tang and J Zhao Treatment of depression.
of liver qi stagnation and spleen deficiency type with therapy. of soothing liver and invigorating spleen Journal of Beijing. University of TCM vol 12 pp 856 859 2008, 24 Z J Xiao Clinical observation of integrative Chinese and. Western medicine on treatment of depression Guiding. Journal of TCM vol 4 pp 20 21 2008,MEDIATORS of,INFLAMMATION. The Scientific Gastroenterology Journal of,World Journal. Hindawi Publishing Corporation,Research and Practice. Hindawi Publishing Corporation,Hindawi Publishing Corporation.
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