Chinese Herbal Remedies and Acupuncture for Anxiety

Anxiety is the most common “mental illness” in the United States. ¹ 1. "Facts and Statistics - Anxiety & Depression Association of America." https://adaa.org/understanding-anxiety/facts-statistics × Almost one out of every five adults faces an anxiety disorder.

Chinese herbal formulas and acupuncture are two treatment modalities that aim to modulate the body’s stress response to manage anxiety. The most characteristic stress response involved in anxiety is the sympathetic activity in the hypothalamic-pituitary-adrenal (HPA) axis.

Think about it. When a stressful event happens, such as almost getting in a car accident or a message pops up on your phone reminding you about a work presentation tomorrow, your body responds by releasing hormones into the bloodstream. These hormones are your body’s messengers, communicating that something stressful is going on. And these communicators include noradrenaline, cortisol, adrenocorticotropic hormone (ACTH), and many others.  ² 2. "The hypothalamic-pituitary-adrenal axis in anxiety and panic." https://www.scielo.br/j/pn/a/ntmrGcyxwtJ86SJ5xRXLNNP/?format=pdf&lang=en ×

While a conventional medication might attempt to interrupt or block a hormone in this pathway, acupuncture and Chinese herb formulas attempt to support the communication pathways to calm your initial interpretation that an event is stressful.

Anxiety Attacks: Chinese Herbs’ Role in The Stress Response

A double-blind randomized controlled trial evaluated a Chinese herb formula’s effect on stress and anxiety after a stressful event. The 89 participants were divided into three groups: control, placebo, and Gan Mai Da Zao Tang formula (GMDZ).  ³ 3. "Chinese phytotherapy to reduce stress, anxiety, and improve quality of life: randomized controlled trial." https://www.scielo.br/j/reeusp/a/4fwVMZTJVgXPqbS79Gk8nmz/abstract/?lang=en ×

The study evaluated stress through the Stress Symptoms List and anxiety through the Anxiety Inventory-Trait and State questionnaire at baseline and after three weeks the GMDZ formula significantly reduced stress levels in comparison to the placebo and control groups (p=0.025). No significant differences occurred in the anxiety group suggesting further studies with longer intervention periods or a greater sample size might be necessary to produce significant data (IBID).

A mouse model study evaluated the effect of three Chinese herbs (Rhizome Chuanxiong, Radix Scutellaria, and Radix Phellodendri) on the HPA axis. The study proposed that these herbs could modulate the HPA axis and promote hippocampal precursor cell proliferation to strengthen the brain’s response to chronic mild stress. ⁴ 4. "Three Chinese herbal medicines promote neuroproliferation in vitro, and reverse the effects of chronic mild stress on behavior, the HPA axis, and proliferation of hippocampal precursor cell in vivo." https://pubmed.ncbi.nlm.nih.gov/23000114/ ×

The measured effect included plasma corticosterone levels (a hormone involved in the HPA axis) and hippocampal precursor cell proliferation. Oral administration of these three Chinese herbal medicines reduced the elevation of plasma corticosterone levels and increased hippocampal precursor cell proliferation, which is the opposite of that seen in a controlled chronic stress response (IBID).

Medications and Chinese Herbs Combined: A Holistic Approach to Treatment

One option for conventional anxiety treatment is Paroxetine. This medication can take four weeks before the therapeutic benefits are detected and therefore, another medication, Diazepam is often prescribed during that time. A study in 2017 explored whether a Chinese formula of Suanzaorentang and Zhizichitang could provide a benefit during that period instead. ⁵ 5. "Modified Suanzaorentang Had the Treatment Effect for Generalized Anxiety Disorder for the First 4 Weeks of Paroxetine Medication: A Pragmatic Randomized Controlled Study." https://www.researchgate.net/publication/316706229_Modified_Suanzaorentang_Had_the_Treatment_Effect_for_Generalized_Anxiety_Disorder_for_the_First_4_Weeks_of_Paroxetine_Medication_A_Pragmatic_Randomized_Controlled_Study ×

The study randomly assigned 156 patients with Generalized Anxiety Disorder to receive Paroxetine, Paroxetine with Diazepam, or Paroxetine with one of the above formulas for four weeks. The study measured anxiety levels every week through the Hamilton Anxiety Scale Test and the Self-Rating Anxiety Scale.

After four weeks, the overall effectiveness in the Paroxetine and Chinese herbs group was 90%, while the Paroxetine group was 74.42%, and the Paroxetine and Diazepam group was 93.88%. While the Paroxetine and Diazepam combination was slightly more effective for more of the sample than the Paroxetine and MSZRT combination, Diazepam is thought to produce more disruptive side effects than MSZRT (IBID).

Acupuncture and Anxiety Reduction

A systematic review published in 2018 analyzed 13 studies and concluded that there is significant evidence supporting acupuncture therapy for anxiety disorder management. Not only do the therapies produce effective outcomes, but fewer side effects than conventional treatments. ⁶ 6. "Acupuncture and electroacupuncture for anxiety disorders: A systematic review of the clinical research." https://www.sciencedirect.com/science/article/abs/pii/S1744388118300689 ×

One of these studies included a randomized controlled clinical study in China in 2008. Participants who had recently had a stroke and were diagnosed with anxiety, either received 30 acupuncture sessions once a day or Alprazolam, an anti-anxiety medication, three times a day, for four weeks. ⁷ 7. "Clinical Observation on Post-stroke Anxiety Neurosis Treated by Acupuncture." https://www.sciencedirect.com/science/article/pii/S0254627208600436 ×

The researchers found anxiety to be relieved in both groups with a success rate of over 80% (p<0.01). The study measured anxiety outcomes through the Hamilton Anxiety Scale. No significant difference was noted between the groups (p>0.05), suggesting that acupuncture was as effective as Alprazolam. The acupuncture group did not notably produce side effects, which was unlike the Alprazolam group.

A 2019 randomized crossover study explored acupuncture’s effect on exam anxiety. The sample included first-year medical students in Brazil. The study hoped to look at whether acupuncture could reduce pre-examination anxiety in comparison to a placebo (sham acupuncture) or no therapy. ⁸ 8. "The effect of acupuncture on exam anxiety in medical students: a randomized crossover study." https://www.elsevier.es/es-revista-revista-internacional-acupuntura-279-articulo-the-effect-acupuncture-on-exam-S1887836919300286 ×

Twenty students were randomized to one of the three groups for anatomy exams and proceeded to a one-month wash-out period before moving to a different group. A visual analog scale measured levels of anxiety before and after each intervention (IBID).

The study found anxiety levels to significantly reduce in the anxiety group and placebo group on both the day before an exam and the day of an exam in comparison to the non-intervention group (p<0.05). This data supports the potential for short-term interventions prior to a stressful event (IBID). Do you have anything coming up soon that might cause you some excess stress?

Lastly, a study interestingly began last year exploring the potential for acupuncture to reduce anxiety related to a coronavirus infection. ⁹ 9. "Acupuncture and related interventions for anxiety in coronavirus disease 2019." https://pubmed.ncbi.nlm.nih.gov/32791723/ ×  Stay tuned for those results!

Take-Aways

Acupuncture and Chinese herbs can significantly reduce anxiety and support the body’s stress response along the HPA axis. Each of these mentioned studies suggests that there is great potential for further research to show how these treatment modalities can be applied for anxiety disorders. When considering anxiety relief, think about holistic ways you can support your body.