Research Progress in the Treatment of Depression in Traditional Chinese Medicine

: With the continuous development of modern social economy, fast-paced lifestyle, high consumption economic burden, and busy study pressure make the incidence of depression continue to increase. By reviewing the relevant literature of traditional Chinese medicine treatment of depression in recent years, we first analyzed the cognitive evolution of depression from the perspective of traditional Chinese medicine. Secondly, we systematically elaborated on depression from the perspectives of etiology, pathogenesis and internal organs. Finally, we summarized various aspects of TCM treatment methods to understand the current status and specific methods of TCM treatment of depression. Through this article, we further provided more reference value and ideas for the treatment of depression and expanded the avenues of modern treatment, which achieved better therapeutic effect.


Introduction
Depression is a psychiatric disorder characterized by persistent depressed mood, slow thinking, and delayed cognitive function and mobility [1].The onset of depression is inseparable from the interaction of social environment, physiological and psychological factors under big data.Depression, one of the most common psychiatric disorders worldwide, has a high rate of disability and recurrence [2].With the continuous development of modern society, people's economic and work pressure is increasing, mental state and psychological problems are increasing, and the incidence of depression is increasing, seriously endangering people's physical and mental health, and also bringing great pain and psychological torture to families.At present, research data show that the suicide rate of patients with depression has reached 12%~14% [3].The World Health Organization believes that by 2030, the burden of depression will top the list [4], as shown in Figure 1 and Figure 2. Patients with depression often have different degrees of mental disorders, emotional expression disorders and physical disorders, and the course of the disease is often protracted, and the clinical manifestations are complex and diverse.
At present, the main treatment of depression in Western medicine is the simple use of antidepressant therapy, and the commonly used Western drugs in clinical practice are tricyclic antidepressants TCA and selective 5-HT reuptake inhibitors (SSRIs), such as amitriptyline, sertraline, paroxetine, citalopram, etc.However, the effect of antidepressant drugs is single, there are obvious individual differences, there are limitations in the treatment effect, and even adverse reactions, which will make patients in the case of long-term treatment, produce a certain dependence or addiction, easy to occur withdrawal reactions, making the condition repeatedly difficult to heal.The description of depression in Chinese medicine can be classified as "depression, sleeplessness, plum core qi, lily disease, dirty mania, and porpoise disease".Traditional Chinese medicine emphasizes the integrity of the human body itself, and on the basis of dialectical treatment, it combines local lesions with overall changes to improve the level of diagnosis and treatment, rational and precise use of medicine, and achieve the optimization of treatment effects.
Figure 1: The WHO anticipate that by 2030, the burden of depression will top the list Figure 2: Twitter screenshot from the WHO

TCM's understanding of depression
Although there is no name for depression in Chinese medicine, "Yu" has been discussed as early as the "Yellow Emperor's Internal Canon"."Suwen Six Yuan Zhengji Dazhi" said: "Mu Yu Dazhi, fire Yu Fangzhi, soil Yu seizure, gold Yu Leak, water Yu folded".Put forward the name of "five depressions" and the treatment principles."Suwen, Yin and Yang should be like the Great Treatise" says: "People have five internal organs and five qi to generate joy, anger, sorrow and fear", and discusses the relationship between the five internal organs and emotional activities.In the Han Dynasty, Zhang Zhongjing mentioned the evidence of epidepress, half-surface and half-li yu, and liyu in the Six Classics of "Typhoid Fever", and recorded in the "Outline of Jin Kuang" about dirty mani, plum core gas, porpoise gas, lily disease and other diseases.Wei Jin physician Chao Yuanfang discussed the view of "treating depression due to weakness", and Sun Simiao believed that the onset of depression was closely related to the liver [6].In the Yuan Dynasty, Zhu Zhenheng first advocated the "Six Yu" theory, elaborated on the characteristics of qi, blood, phlegm, humidity, heat, and food depression, and created special prescriptions for the treatment of depression such as Yueju Pill and Liuyu Soup.The Ming Dynasty physician Yu Chuan first adopted the name of Yuzheng in "Medical Zhengzhuan Yuzheng".Xu Chunfu compiled and collected the relevant expositions of successive generations of physicians on Yuzheng in the "Complete Book of Ancient and Modern Medical System", and Zhang Jingyue added to the treatment principles of depression such as anger, depression, and depression in the "Complete Book of Jingyue", expanding the scope of Yuzheng on the basis of the original theory.Ye Tianshi of the Qing Dynasty believed that Yu was mostly caused by emotions, and could not be affected by the heart, spleen, liver and gallbladder [7].In modern times, Yu Zheng's theoretical system has been continuously enriched and improved, and even summarized the rules governing the textbook version.

Etiology of depression
The etiology of depression is mainly related to emotional and physical factors.Seven emotions are too much, emotional stimulation is too large, and qi machine stagnation appears.The human constitution is different, and the physiological functions and psychological characteristics of the human body are also specific.Some people have weak self-regulation ability and insufficient ability to adapt to changes in the external and social environment, resulting in different subjective feelings in psychology and spirituality, and different emotional activities, especially emotional reactions such as sadness, anger and anger.The pathogenesis of depression is mostly caused by emotional stimulation and seven emotions injury, resulting in liver loss, spleen loss of healthy luck, heart loss of nourishment, and internal organ qi and blood disorders.Although the lesion is mainly in the liver, it will also affect the heart, spleen and kidneys.The occurrence of depression is due to emotional injury, liver loss, loss of qi, so that the liver is depressed, transverse and transgressive, and there is liver and spleen discord.The spleen is unlucky, and the lack of biochemistry affects the production of qi and blood, forming a deficiency of the heart and spleen or mental loss.Thinking hurts the spleen, and the temper is knotted for a long time, resulting in stagnation and moisture resistance, metaplasia of phlegm and dampness, and the formation of phlegm depression or dampness.Diet accumulation, food accumulation is not easy to produce phlegm dampness, long-term accumulation of heat, the formation of fire.If the liver is depressed for a long time, it will lead to hyperactivity of heart and yang, depletion of yin essence, yin and yang, and the appearance of heart and kidney yin deficiency or yin deficiency and fire.In the early stage of depression, most of them are mainly pathological evil facts such as qi, blood, phlegm, moisture, food, and fire, and the six depressions coexist and affect each other, so the early stage is mainly empirical.In the later stage, long-term illness depletes the healthy qi of the human body, and the deficiency of qi and blood essence is insufficient, and most of them are mainly false evidence or false and real inclusions [8].

Treat depression from the heart
The heart governs the gods and controls all conscious, thinking, spiritual and emotional activities of the human body.The heart is the "master of the five internal organs", and the coordination and cooperation of the five internal organs are inseparable from the dominance of the heart."Lei Jing" says: "Although the five internal organs have their own characteristics for emotional injuries, if we look for their origin, they all originate from the heart.""Lingshu• Kou Wen" says: "Sorrow and sorrow will make the heart beat, and the heart will shake all the internal organs."The main pathogenesis of depression syndrome is the blockage of qi due to excessive emotions or insufficient emotions.If a certain emotion is too depressed, the mind and heart will be affected first, consuming the blood and qi of the heart and disrupting the mind.Moreover, the mind and heart yin are inseparable from the warm and promoting effect of the heart yang.Tang Zonghai also mentioned in "Blood Syndrome Theory" that "the heart is the fire organ, and the candle illuminates all things."Insufficient heart yang will lead to blood stasis, heart failure, and symptoms of depression such as mental fatigue, listlessness, and low mood.Wang Yali [9] believes that mental disorder is one of the important pathogenesis of depression syndrome, so when treating depression syndrome, attention should be paid to regulating the mind.Fang Cambridge [10] found in clinical research that the heart rate variability of patients with depression has obvious abnormal characteristics compared with healthy people.Treatment from the perspective of heart theory can significantly improve depression.Zhou Shaohua [11] believes that the onset of depression is closely related to heart dysfunction.The treatment method is mainly to nourish the heart and calm the mind, combined with the methods of nourishing heart yin, replenishing the heart and spleen, and communicating with the heart and kidneys, emphasizing the treatment of depression from the heart.importance of certification.Wu Jianlin [12] believes that the main location of depression is in the heart, and the onset of the disease is closely related to the mind and heart yang.He proposed that the treatment of depression should be to relieve depression and invigorate the mind.

Treat depression from the liver
The main drainage of the liver has the effect of unclogging and regulating the whole body qi machine.The lifting movement of the qi machine of the human organs is inseparable from the release and rise of liver qi.Liver loss is too late or too much, which will lead to liver qi stagnation or liver qi reversal.Liver qi stagnation is mainly manifested as dull pain in the chest and flank, sullenness, sadness and crying.The liver qi reversal is mainly manifested as short-temperedness, irritability, red face, red ears, red eyes, swollen and painful eyes, etc. "Medical Guan" said: "Give one side to cure its woody depression, and all depressions will be healed."What is the case?The liver has the effect of regulating emotions.Liver qi is vented normally, qi machine is unimpeded, qi and blood are harmonized, emotions are comfortable, and mood is happy.Liver qi stagnation or liver qi rise too much, will cause emotional sadness, anxiety or impatience, irritability and excitement and other emotions.Similarly, abnormal emotional activity can also lead to abnormal lifting and lowering of qi machines.The liver is angry, and anger is angry.Anger accumulates for a long time and hurts liver qi, and liver qi is depressed, resulting in depression and causing depression.It can be seen that emotional activity is closely related to the drainage function of the liver.Moreover, the main pathogenesis of Yuzheng is due to poor mood, among which the normal function of the liver is the key to the pathogenesis of Yuzheng.Zhang Xiaoyun [13] believes that the drainage of the liver master is the premise of Si Kai and Zhi Zhi.Liver loss and leakage are the basic elements of depression.
Wang Xingkuan [14] advocated that the treatment of depression should be based on liver relief and emotional adjustment, believing that liver and gallbladder loss and qi stagnation are the main pathogenesis.Li Yingcun [15] believed that the occurrence of Yuzheng was closely related to the liver, and made good use of Dunhuang Diarrhea Liver Soup to relieve liver depression and regulate the qi machine.Song Xiaoxiao et al. [16] believe that the occurrence of depression is mainly related to liver loss and leakage, and advocate that on the basis of the treatment of liver relief and depression, it is also necessary to take into account the treatment of regulating the qi machine, clearing the liver and purging the fire, and practicing gas and phlegm.

Treating depression from the spleen
The position of the spleen in the middle of the focus is the "foundation of the day after tomorrow".The life activities of the human body are inseparable from the subtle nutrition of the water valley, and the physiological functions of the heart, liver, spleen and lungs are supported by the subtle substances of the spleen and qi movement."Suwen Taiyin Yangming Treatise" said: "The spleen of the soil also, rule the central government, often with four hours and four organs, each for 18 days, and must not be alone in the time."The spleen is the lifting hub of the gas machine, and the main lift clears and reduces turbidity.If the temper is deficient or insufficient, it cannot be cleared, the subtle distribution of Mizutani is abnormal, the brain is lost in nourishment, and mental fatigue and dizziness appear.Spleen movement is abnormal, Mizutani subtlety cannot normalize the vitality of qi and blood essence, qi and blood biochemical is insufficient, cannot normally nourish the body organs, manifested as loss of appetite, weight loss, limb weakness and other symptoms.The spleen loses good luck, abnormal water infusion, easy to stop agglomerating to generate wet phlegm drinking, hinder the operation of the qi machine, and manifestations such as heavy limbs, fatigue and lack of food, and low mood.The Four Sacred Hearts [17] says: "Yin rises and the sun descends, power is in the middle qi, the middle qi decays, the rise and fall dereliction of duty, the gold and water waste its collection, and the wood fire depresses its growth, so this spirit is separated and sick."The spleen is thinking, and thinking too much will also lead to qi blockade and abnormal qi machine in the five internal organs.As Li Jiao mentioned in "The Theory of Spleen and Stomach": "All diseases are born from the failure of the spleen and stomach."Ma Lieguang [18] believes that the pathogenesis of depression is related to insufficient temper, and the treatment of patients in the early stage of depression should be mainly used to loosen the liver and strengthen the spleen.Liu Tai [19] believes that temper deficiency is the pathological basis of depression, and pays attention to the care of the spleen and stomach in treatment.Yang Ke [20] believes that spleen deficiency runs through the entire course of senile depression, and the cause of the disease is closely related to the spleen, and attention is paid to strengthening the spleen and benefiting the spleen in the treatment process.Deng Tietao [21] believes that although the location of anxiety and depression after PCI surgery for coronary heart disease is in the heart, the root of the deficiency lies in the spleen.Yu Yao et al. [22] found that the treatment of depression from the spleen theory was better than that of antidepressant treatment alone, with higher efficacy and no obvious adverse drug reactions.

Treat depression from the perspective of the lungs
The lungs govern the generation and movement of Qi throughout the body, and play an important role in regulating the rise, fall, entry and exit of Qi throughout the body.The lungs have the function of regulating Qi, blood and water throughout the body.Abnormal regulation function of the lungs can lead to qi blockage, poor blood circulation, metabolic disorders in body fluid distribution, and the formation of pathological products such as congestion, phlegm and dampness."Su Wen Zhi Zhen Yao Da Lun" says: "All qi that are depressed and depressed belong to the lungs.""Yi Shu• Yu" says: "The lung qi is blocked and stagnated, the chest is full and the chest is full, and the chest is full and the breath is raised.Non-stimulating lung qi is not enough to clear it."The onset of depression syndrome is mainly caused by stagnation of lung qi [23].Clinically, it can be seen that the speech of patients with depression is often full of sadness and negative emotions.If the lung qi is weak or blocked, the heart and blood will not flow smoothly, and stagnant blood will be blocked for a long time, causing chest tightness, palpitations, purple lips, and discomfort when holding breath.There are two sayings in the "Nei Jing": "One says that the ambition of the lungs is sadness, and the other says that the ambition of the lungs is sorrow."Medical Chunshengyi• Strain" says: "Sorrow will lead to adverse qi, depression and discomfort, and long-term accumulation will damage the lungs."Excessive sadness or sadness can easily consume lung qi and lung essence, leading to abnormal lung qi function, mental fatigue, lack of breath and laziness, and easy crying when sad. Modern research has found that the most common complication in patients diagnosed with chronic obstructive pulmonary disease (COPD) is depression.Adult patients with COPD are four times more likely to suffer from depression than adults without COPD [24].It can be seen that there is a clear correlation between lung disease and the onset of depression.Wu Haoxin [25] believes that the physiological dysfunction of the lungs is the main factor in depression syndrome.Depression syndrome can be treated by regulating the lungs and smoothing the qi throughout the body.Zhu Qiaoxia [26] believes that the treatment of menopausal depression should be to open up lung qi and believe that the lungs play an important role in maintaining the movement of human qi.Abnormality of the lungs will lead to imbalance of qi, which will lead to depression syndrome.Hu Yueqiang [27] used the "warming yang and suppressing the lung method" to treat depression, believing that insufficient lung yang caused Rongwei's yin and yang to be depressed and resulted in depression syndrome.

Treating depression from the kidney
In the early stage of depression, most of them are yang deficiency or yang qi is suppressed, and long-term illness causes yang damage and yin [28]."Jing Yue Quanshu" said: "The yang qi of the five internal organs, unless it is here, it cannot be sent."The yang of the kidney yang lord and the yang of the five internal organs all depend on the warmth of the kidney yang.The kidneys are full of yang, and the functions and physiological activities of the human organs can operate normally.Kidney yang deficiency, kidney qi promotion weakness, kidney essence metaplasia, medullary sea empty, brain loss of nourishment."Lingshu Sea Theory" said: "The brain is the sea of pith"."Quasi-Evidence Treatment" said: "The brain is the house of the Yuan God, the sea of essence, and the real memory is also based."The brain is the hub of mental consciousness activities, and people's emotional activities are psychological emotions produced in response to external stimuli.The filling of the cerebral pulp is inseparable from the nourishment of kidney qi and kidney essence.If the kidney is deficient, it cannot be used to nourish the brain, and a series of emotional changes such as mental restlessness and lack of understanding appear.It can be seen that the kidney and brain are closely related and affect each other.Kidney yang is the root of determining the prosperity and decline of human yang, and kidney yang deficiency or kidney yang deficiency is the basis of the pathogenesis of depression.Wang Peijuan [29] believes that the gradual decline of kidney qi is the physiological and pathological characteristics of premenopausal and premenopausal diseases, and the deficiency of kidney yin and yang is the main physiological and pathological basis, so in the treatment, attention is paid to the method of regulating kidney yin and kidney yang and communicating heart and kidney.Li Peiwen [30] believes that the key to the pathogenesis of breast cancer-related depression is insufficient kidney qi, insufficient kidney qi, no water and wood, and liver depression and stagnation, which aggravates the patient's own anxiety and depression.Tang Qisheng [31] believes that renal deficiency is the basis of menopausal depression, and cerebral and renal deficiency is the key to the pathogenesis.Qin Zhu [32] believes that menopausal depression is mainly based on kidney yin deficiency, and uses six flavor dihuang pills to combine two to pills to nourish yin and tonify the kidneys.

Traditional Chinese medicine
Xie Xiaohua et al. [33] divided 102 patients with depression diagnosed with cardiorenal nondelivery depression into a control group and an observation group, the observation group was treated with nourishing kidney and anyu decoction (eleuthero, He Shou Wu, Bajingtian, Chaihu, Yujin, etc.), and the control group was treated with fluoxetine hydrochloride capsules, and found that the clinical efficacy of the observation group was better than that of the control group, and the HAMD-17, SCL-90 scores and TCM syndrome scores in the observation group were lower than those in the control group (P<0.05).Li Xiaojie et al. [34] found that Qingxin nourishing kidney soup with flavor has a definite effect on the treatment of perimenopausal depression patients with cardiorenal incompatibility and liver depression.Chen Shaoyun et al. [35] divided 92 patients diagnosed with depression with liver depression and spleen deficiency into control group and observation group, the control group used Xiaoyaoshan, and the observation group used sweet wheat jujube soup combined with four reverse soup, and found that the clinical efficiency and depression scores of the observation group were higher than those of the control group, which showed that the combination of sweet wheat jujube soup and four reverse decoction could improve the treatment effect, improve the clinical symptoms of depressed patients, and further restore a healthy and positive attitude.

Acupuncture
Pu Hongchun et al. [36] randomly divided 60 patients with hepatic depression and stagnation into treatment group and control group, the treatment group used the eight methods of the spirit turtle combined with Baihui, Hegu, Taichong, Yintang, Sanyin intercourse, Neiguan, Shenmen acupuncture treatment, the control group used oral haloperthioxine melitraxine tablets, the results showed that the total effective rate of the treatment group (90.00%) was higher than the total effective rate of the control group (66.67%), the SAS points, HAMD-24 points.The scores and total points of TCM symptoms were lower than those of the control group, and the efficacy of improving depression was quite good.Cao Shuang et al. [37] used five-element acupuncture (Tianshu, Futu, Xiexi, Lung Yu, Liver Yu, Pericardial Yu, etc.) as the treatment mode for the acupuncture treatment group, and the Western medicine treatment group used St. John's wort extract tablets or venlafaxine hydrochloride sustained-release tablets for treatment, and found that the total effective rate and HAMD score of the acupuncture group were better than those in the Western medicine group (P<0.05).Sun Yunting [38] found that the use of meridian acupoint retention and acupuncture method has a definite effect on the treatment of patients with depression.

Injection-drug combination
Yang Ruijun et al. [39] selected 90 cases of infertility depression patients admitted to the treatment group into 30 cases in the treatment group and 30 cases in the control group, the control group was treated with oral Prozac, the treatment group was treated with pulse cutting acupuncture on the basis of the control group, and it was found that the clinical efficacy of the treatment group was better than that of the control group, and the HDAM score of the two groups decreased after the 4th and 8th weeks of treatment compared with before treatment, but the score of the treatment group was significantly lower than that of the control group.The WHOQOL-BREF (World Health Organization Quality of Life Measurement Scale Simplified Scale) score domains were higher in the treatment group than in the control group, and the difference was statistically significant (P<0.05).Dong Chunxiu et al. [40] divided 80 patients with type 2 diabetes mellitus and depression into a treatment group and a control group of 40 cases, and the control group was given conventional drug treatment, and the treatment group was combined with acupuncture treatment (Neiguan, Renzhong, Sishencong, Hegu, Taichong, etc.) on the basis of drug treatment, and the study found that the comprehensive efficacy and score of the treatment group were significantly better than those of the control group.

Conclusion
To sum up, TCM treats depression through various methods such as traditional Chinese medicine, acupuncture, tuina, and has found that the efficacy is quite good.Based on the overall concept and the theoretical system of dialectical treatment, TCM adheres to the three factors, rational use of medicine, and adopts different treatment methods to alleviate the bad emotions of patients with depression.Compared with Western medicine, it is more safe and practical, and provides more ways and references for modern clinical treatment of depression.However, the efficacy of TCM in the treatment of depression still lacks objective indicators and a large number of data support, which cannot ensure that all treatment methods can get 100% efficacy, so more clinical observations and indicators are needed to support and provide better evidence for TCM treatment of depression.