Acupuncture and Evidence-Based Traditional Chinese Medicine Approaches for Mental Health

Journal of Complementary Therapies in Health ISSN 2975-9323 |eISSN 2975-9552 Journal of Complementary Therapies in Health 2025:3(3). doi:10.5281/zenodo.17257364 institutoptc.com/journal-complementary-therapies Review Acupuncture and Evidence-Based Traditional Chinese Medicine Approaches for Mental Health. Alexandre Penelas Constantino1*, Tânia Martins Ferreira2, Ermelinda Leitão1, Paula Silva1, and Eva Vieira2. 1 Independent researcher; 2 ABS – Health Level, Atlântico Business School, Vila Nova de Gaia, Porto, Portugal; * Correspondence: [email protected] Abstract Background: Mental health is a complex topic with physical, emotional, and social implications. Traditional Chinese Medicine is a therapeutic option for various pathologies, with relevant applications for public health. Objective: To analyse the effectiveness of Traditional Chinese Medicine (TCM), with a focus on acupuncture, as a complementary therapy for mental health. Methods: Review of the scientific literature on the application of Traditional Chinese Medicine, especially acupuncture, based on studies of systematic reviews with meta-analyses. Results: Acupuncture has demonstrated effectiveness in the treatment of various mental health conditions, with significant improvements observed in symptoms of depression, schizophrenia, cognitive impairment and insomnia. The combination of acupuncture with conventional treatments potentiated the clinical results. The mechanisms of action of acupuncture involve the regulation of neurotransmitters, the modulation of the hypothalamic-pituitary-adrenal (HPA) axis and the promotion of neuroplasticity. Other Traditional Chinese Medicine techniques, such as Taichi Chuan, Qigong and herbal medicine, have also shown relevant benefits. Conclusion: Traditional Chinese Medicine, with a focus on acupuncture, represents a promising complementary approach to mental health, offering personalized and effective treatments. Its integration into mental health care can enhance clinical outcomes. Ongoing research is essential to deepen knowledge and optimize the application of these techniques. Keywords: Mental health; Depression; Schizophrenia; Parkinson's Disease; Cognitive impairment; Insomnia; Traditional Chinese Medicine; Acupuncture. 1. Mental Health Mental health is a broad domain encompassing cognitive, emotional, social, and behavioural functioning 1. According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition), a mental disorder corresponds to a clinically significant alteration of cognitive processes, emotional regulation, or behaviour, reflecting psychological, biological, or developmental dysfunction 2. Mental health problems represent a significant burden at the individual, social, and economic levels. They are often associated with work incapacity 3, reflected both in loss of productivity and increased costs with medical care, therapies, and support services. In addition, they manifest in physical consequences, such as sleep disturbances, chronic fatigue, and worsening of other health conditions. These repercussions also extend to families and support networks, who face considerable emotional and financial burdens, while the social stigma associated with mental disorders may exacerbate exclusion and discrimination 4. Citation: Constantino A.P., Ferreira T.M., Leitão E., Silva P., Vieira E. Acupuncture and Evidence-Based Traditional Chinese Medicine Approaches for Mental Health. Journal of Complementary Therapies in Health. 2025;3(3) 10.5281/zenodo.17257364 Academic Editor: Jorge Rodrigues Received: 17 July 2025 Reviewed: 17 August 2025 Revised: 27 August 2025 Revised: 29 September 2025 Accepted: 1 October 2025 Published: 3 October 2025 Publisher’s Note: IPTC stays neutral concerning jurisdictional claims in published maps and institutional affiliations. Copyright: ©2025 by the authors. Submitted for open access publication under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Journal of Complementary Therapies in Health 2025: 3(3). 2 of 18 Constantino A.P., Ferreira T.M., Leitão E., Silva P., Vieira E. Acupuncture and Evidence-Based Traditional Chinese Medicine Approaches for Mental Health. doi:10.5281/zenodo.17257364 Mental disorders are also among the main direct and indirect causes of hospitalization 5-7, and according to Garcia-Ceja et al. 4, the deficit in access to treatment remains a global problem, both in developed and developing countries. Contributing factors include the shortage of qualified professionals, the high cost of treatments, and the insufficiency of quality mental health services. In many cases, people with mental disorders end up seeking emergency services or being hospitalized due to acute crises or health complications. Several factors influence mental health, interacting with one another and placing mental disorders on a spectrum that integrates both biological and psychosocial components 8. The relationship between mental health and physiological parameters has been documented: elevated inflammatory levels are associated with depressive symptoms, platelet distribution width may represent a risk marker, and the neutrophil-to-lymphocyte ratio negatively correlates with psychological well-being 9. This interdependence helps explain the high comorbidity between mental disorders and cardiovascular, oncological, and metabolic diseases 10-13. Despite this complexity, risk factors for mental health can be grouped into three major categories: biological, psychological, and social 14. Among biological factors, physical health and clinical conditions stand out, often associated with anxiety, depression 15-18, and increased risk of suicide19. Sleep disorders represent an additional physiological vulnerability 20,21, and genetic factors play a significant role in this domain 22,23. Regarding psychological factors, several can be identified, namely personality traits, self-esteem, coping mechanisms, and life experiences 14,24,25. Patients with treatment-resistant depression tend to present personality traits of high harm avoidance and low reward-seeking, which may hinder recovery 26. Likewise, Orth et al. 27 indicate that low selfesteem is associated with an increased risk of depression throughout adulthood. Similarly, crises such as natural disasters and nuclear accidents have demonstrated a substantial impact on the psychological suffering of populations, likely intensified by the perception of risk 28. As for social factors, these include social support, interpersonal relationships, work context, socioeconomic conditions, and culture 24,29,30. A longitudinal study with Latino youth in the USA showed that length of stay in the USA was associated with certain challenges and school engagement, while parental involvement in American culture appeared protective against social and behavioural problems. Interestingly, adolescents’ involvement with their culture of origin proved beneficial for self-esteem and was associated with less hopelessness and aggression over time 31. Romito et al. 32 also indicate that past and present experiences of physical violence or relational abuse are strongly related to worse mental health outcomes. In this scenario, the exploration of complementary interventions has gained relevance, offering new perspectives for mental health promotion. Among these, TCM, particularly acupuncture, stands out, whose integration with conventional treatments may contribute to more holistic, personalized, and potentially effective approaches. 1.1. Most Common Mental Disorders Mental health, understood as a state of well-being in which the individual recognizes and develops their abilities, copes with daily stress, works productively, and contributes to their community, is fundamental for individual and social functioning 33. However, mental disorders, characterized by alterations in thinking, mood, and/or behaviour, are prevalent and have a substantial personal, familial, and social impact. Journal of Complementary Therapies in Health 2025: 3(3). 3 of 18 Constantino A.P., Ferreira T.M., Leitão E., Silva P., Vieira E. Acupuncture and Evidence-Based Traditional Chinese Medicine Approaches for Mental Health. doi:10.5281/zenodo.17257364 Depression It is one of the most frequent disorders, characterized by persistently depressed mood, anhedonia, changes in sleep and appetite, fatigue, feelings of guilt or worthlessness, concentration deficits, and, in severe cases, suicidal ideation 34. Epidemiological studies demonstrate high lifetime prevalence 35,36. Its impact is vast, reflected in reduced quality of life, increased risk of physical comorbidities, and premature mortality. It compromises the ability to maintain healthy interpersonal relationships, affecting family life, friendships, and marital stability. It is also associated with work absenteeism, reduced productivity, and increased healthcare costs 37,38. Anxiety Disorders The prevalence of anxiety disorders are high 39-41, with repercussions on interpersonal relationships, academic and work performance, and an increased risk of other mental and physical disorders 42. They include generalized anxiety disorder, panic disorder, specific phobias, social anxiety disorder, and post-traumatic stress disorder 43,44. • Generalized anxiety disorder is characterized by excessive and persistent worry about various aspects of life; • Panic disorder involves sudden attacks of intense fear accompanied by physical symptoms; • Specific phobias are irrational fears of particular objects or situations; • Social anxiety disorder involves fear of social or performance situations; • Post-traumatic stress disorder occurs after traumatic events, manifesting as flashbacks, hypervigilance, avoidance, and negative mood and cognitive changes 34. Bipolar Disorder This condition involves alternating episodes of mania/hypomania and depressive episodes, characterized by extreme fluctuations in mood, energy, cognition, and behaviour 34. Its prevalence is significant 45, with important consequences: occupational and social dysfunction, high suicide risk, and comorbidities with other mental and physical disorders 46. Schizophrenia It is a chronic mental disorder that affects thinking, emotions, and behaviour. It manifests through positive symptoms (delusions, hallucinations, disorganized speech), negative symptoms (lack of affect, motivation deficits, poverty of speech), and cognitive symptoms (memory and attention deficits) 34. The prevalence is around 1% of the global population, typically appearing in late adolescence or early adulthood 47. The impact is severe, compromising social and occupational functioning and significantly increasing suicide risk 48. Its treatment is multimodal, combining pharmacotherapy (antipsychotics) and psychosocial interventions (cognitive-behavioural therapy, social rehabilitation), with early intervention being crucial for prognosis 49-52. Parkinson’s Disease Although it is a progressive neurodegenerative disorder caused by the loss of dopamine-producing neurons in the brain, primarily affecting movement through resting tremor, muscle rigidity, bradykinesia (slowness of movement), and postural instability 53,54, it has a strong impact on mental health. In addition to motor symptoms, depression, anxiety, loss of smell, cognitive deficits, and sleep disturbances are common 55-57. Its prevalence increases with age, leading to growing disability and dependence, affecting about 1% of individuals over 60 years 58. Treatment primarily aims to control symptoms through Journal of Complementary Therapies in Health 2025: 3(3). 4 of 18 Constantino A.P., Ferreira T.M., Leitão E., Silva P., Vieira E. Acupuncture and Evidence-Based Traditional Chinese Medicine Approaches for Mental Health. doi:10.5281/zenodo.17257364 medication that increases dopamine levels (such as levodopa) and other pharmacological therapies 59. Physiotherapy, occupational therapy, and speech therapy are also essential to maintain mobility and function 60. It should be noted that these disorders often coexist, complicating diagnosis and treatment and exacerbating clinical and social impact 61. Risk factors such as family history, traumatic experiences, substance use, and chronic diseases contribute to increased vulnerability 33. 2. Traditional Chinese Medicine TCM is a holistic healthcare system with more than 2,500 years of history in ancient China 62-64. It is deeply rooted in the belief that the human body is an interconnected system of physical, emotional, and spiritual aspects, whose balance is essential for maintaining health 65. In contrast to Western medicine, often oriented toward treating specific diseases or symptoms, TCM seeks to maintain and restore overall harmony in the body through natural methods, including both preventive strategies and therapeutic interventions, always individualized according to the patient’s needs 66-70. Its origins trace back to ancient China, where early medical knowledge was orally transmitted by shamans, herbalists, and healers. These teachings were shaped by philosophical traditions such as Taoism, Confucianism, and Buddhism, emphasizing harmony, balance, and interdependence among all things 71,72. Early written records date from the Shang Dynasty (1600–1046 BCE), but it was primarily during the Han Dynasty (206 BCE– 220 CE) that TCM’s theoretical foundations were consolidated 72. Among the most influential classical works, the Huangdi Neijing (The Inner Canon of the Yellow Emperor), written around the 3rd century BCE and attributed to the legendary Yellow Emperor, Huangdi, is considered the foundation of TCM theory. It addresses the principles of Qi, Yin-Yang, the Five Elements, and the relationship between the human body and the natural world, forming TCM’s conceptual core 73,74. The Shennong Bencao Jing (Divine Farmer’s Materia Medica) of the 1st century CE is another foundational work, cataloguing over 365 substances of plant, mineral, and animal origin, serving as a guide for herbal medicine practice to this day 75. With the development of Chinese civilization, TCM evolved alongside other scientific and philosophical advancements. During the Tang and Song Dynasties (618–1279 CE), it flourished and became more systematized, expanding its influence to neighbouring regions such as Korea, Japan, and Vietnam 76-79. During the Qing Dynasty (1644–1912 CE), it reached a high degree of consolidation, with well-established schools of thought and a wide network of practitioners throughout China. These legacies continue to underpin contemporary TCM practice, maintaining its relevance both in traditional contexts and in dialogue with modern medicine. 2.1. Traditional Concepts in Chinese Medicine The concept of Qi holds a central position in TCM. It refers to the vital force or energy that flows through all living beings. From the TCM perspective, health results from the harmonious and continuous flow of Qi along the meridians (energy channels), while disease arises when this flow is blocked, deficient, or excessive. The goal is to maintain or restore balanced Qi circulation, ensuring proper body and mind function. Importantly, Qi is not only defined as physical energy but also as a force influencing mental, emotional, and spiritual levels, directly affecting emotions and consciousness 80,81. Another fundamental principle is the Yin-Yang theory, describing the dynamic polarity present in all natural and bodily phenomena. Yin and Yang are opposite but complementary and interdependent forces, constantly transforming. Yin represents passive aspects (cold, dark, nourishing), whereas Yang corresponds to active qualities (warm, Journal of Complementary Therapies in Health 2025: 3(3). 5 of 18 Constantino A.P., Ferreira T.M., Leitão E., Silva P., Vieira E. Acupuncture and Evidence-Based Traditional Chinese Medicine Approaches for Mental Health. doi:10.5281/zenodo.17257364 bright, stimulating). Health is understood as the dynamic balance between Yin and Yang. Relative Yang predominance may manifest as fever, inflammation, or mental agitation, while relative Yin excess may result in fatigue, feeling cold, or lethargy 65,81. The Five Elements theory (Wood, Fire, Earth, Metal, and Water) complements these principles, explaining interactions between different aspects of the human body and the natural environment. Each element is associated with a specific organ, season, emotion, colour, and sound, forming a system of correspondences guiding both diagnosis and clinical treatment. For example, Wood corresponds to the Liver and is linked to anger, while Fire is associated with the Heart and relates to joy. Figure 1 illustrates how the Five Elements relate to the physiological and emotional dimensions of the body, organized into two essential cycles: generation and control. In the generation cycle, each element nourishes or promotes the next: Wood feeds Fire, Fire generates Earth, Earth produces Metal, Metal condenses and collects Water, and Water nourishes Wood. In the control cycle, each element keeps another in check, preventing excess: Wood controls Earth, Earth contains Water, Water dominates Fire, Fire melts Metal, and Metal cuts Wood. Figure 1. The Five Elements theory: Organs, Seasons, Emotion, and Sounds. Fundamentally, TCM seeks to maintain a state of dynamic balance between the internal and external environment. The concept of balance permeates all aspects of TCM, from Qi flow to the regulation of bodily fluids, emotions, and the balance of heat and cold. The body is viewed as a constantly adapting system seeking homeostasis and integration with its surroundings. Journal of Complementary Therapies in Health 2025: 3(3). 6 of 18 Constantino A.P., Ferreira T.M., Leitão E., Silva P., Vieira E. Acupuncture and Evidence-Based Traditional Chinese Medicine Approaches for Mental Health. doi:10.5281/zenodo.17257364 2.2. Traditional Chinese Medicine and Mental Health TCM is a holistic medicine that considers health as the cooperative functioning of various biological systems, which may interact negatively when disturbed. Mental health has emerged as a global priority in recent decades, leading to interest in complementary and integrative therapeutic approaches. TCM, with its holistic vision of the human being, understands health as a harmonious and cooperative state among different biological systems, which can interact negatively when there is imbalance or dysfunction 82. In the West, researchers have sought to interpret TCM’s philosophical and theoretical foundations and relate them to modern biomedical language 65,83-86. With scientific advances supporting the efficacy of some TCM techniques, its role in integrative medicine is increasingly recognized, considered a promising complement to conventional Western medicine 87-93. Specifically regarding mental health, TCM has been observed to play a complementary and beneficial role, helping to provide more accessible, cost-effective, and feasible mental healthcare 85,94-98. Several core concepts and principles of TCM are important to understand regarding this topic. Shen In TCM, the concept of Shen plays a crucial role, representing the mental, emotional, and spiritual dimension of the human being. Shen is considered the subtlest manifestation of life, reflecting consciousness, emotions, and spirit 99. It is described as the “spiritual essence” that resides in the body and coordinates mental, cognitive, and emotional faculties. Together with Jing, the vital essence, and Qi, the vital energy, it constitutes the socalled Three Treasures (San Bao), which sustain human existence in all dimensions 100. Shen is closely associated with the Heart, considered its residence in TCM. The Huangdi Neijing states that “the Heart is the sovereign of the organs and houses the Shen”, emphasizing the Heart’s central role in governing the mind and emotions. Thus, the harmonious circulation of Qi and Xue of the Heart is essential to nourish Shen and ensure mental clarity and emotional stability 100,101. Balanced Shen manifests as a clear, calm, and focused mind, restful sleep, appropriate emotional expression, bright eyes, and coherent communication. Conversely, when Shen is disturbed, signs such as anxiety, insomnia, excessive dreaming, palpitations, memory loss, depression, agitation, or even manic states may appear, depending on the severity of the imbalance 49-52. Understanding and nurturing Shen is therefore essential for preventing mental disorders and promoting a balanced and fulfilling life 99. Mental Processes in Traditional Chinese Medicine In TCM, mental and emotional processes are intrinsically linked to physiological functions. Excessive or poorly regulated emotions can affect the balance of Qi, Xue (blood), and internal organs, leading to disharmonies reflected in both body and mind 84. According to the Five Elements theory, each Zang-Fu organ is associated with a specific emotion or mental process, so psychological and spiritual health depends directly on the harmony among these systems. When an organ is balanced, the corresponding emotion manifests healthily; in imbalance, physical and psychological symptoms emerge. Table 1 presents these associations between elements, organs, and mental processes according to classical TCM. Thus, the importance of emotions in physiological systems is clear. In TCM’s bidirectional view, mental and physiological processes mutually influence each other, not as isolated entities but as expressions of internal organ activity. Each emotion is linked not only to an organ but also to its energetic function. Anger, for example, relates to the Liver and may manifest as Qi stagnation, headaches, muscle tension, or menstrual disturbances. Emotions are not inherently negative unless excessive or disharmonious. Joy, for instance, Journal of Complementary Therapies in Health 2025: 3(3). 7 of 18 Constantino A.P., Ferreira T.M., Leitão E., Silva P., Vieira E. Acupuncture and Evidence-Based Traditional Chinese Medicine Approaches for Mental Health. doi:10.5281/zenodo.17257364 is positive but when excessive may “agitate the Heart,” causing insomnia and mental agitation. Repetitive thinking, linked to the Spleen-Pancreas, impairs digestion and mental clarity, while prolonged sadness weakens the Lung, predisposing to isolation and physical vulnerability. Table 1. Associations between Elements, Organs, and Their Emotions according to Traditional Chinese Medicine. Element Organs (Zang-Fu) Emotions and Mental Processes Excess Deficiency Wood Liver - Gallbladder Excessive anger, irritability, frustration Shyness, indecision, lack of motivation Fire Heart - Small Intestine Joy/euphoria, insomnia, agitation Apathy, depression, lack of vitality Earth Spleen-Pancreas - Stomach Rumination, obsessiveness Mental fatigue, concentration difficulties Metal Lung - Large Intestine Sadness, melancholy, excessive attachment, excessive worry Inability to feel sadness or process loss, emotional detachment Water Kidney - Bladder Intense fear, panic, shock Recklessness, loss of willpower In diagnosis, the practitioner observes not only physical signs but also emotional aspects, such as eye brightness, facial colour, and tone of voice. Conversely, physiological imbalances can generate emotional states. For example, Kidney imbalance may cause fear or insecurity, and prolonged Lung deficiency may increase vulnerability to sadness or social withdrawal. This integrated view expands therapeutic possibilities, allowing treatment of emotional imbalances by harmonizing the corresponding organs through acupuncture, herbal therapy, Qigong, or dietotherapy, highlighting TCM’s preventive and therapeutic value in promoting mental and emotional health. 2.3. Acupuncture for Mental Health Acupuncture consists of the insertion of fine needles at specific points along the meridians, aiming to regulate the flow of Qi and promote the body’s homeostasis 82,102. The selection of points is individualized, considering the patient’s symptoms and energetic diagnosis. Studies show that acupuncture can be effective in treating chronic pain, stress, and conditions such as migraines, insomnia, and nausea, suggesting mechanisms of action related to neurotransmitter modulation and autonomic nervous system activity 103-110. A recent systematic review 82 concluded that TCM techniques, including acupuncture, may be useful in treating mental disorders and improving quality of life in patients with physical conditions associated with psychological distress. The following sections present scientific studies using acupuncture specifically in various areas of mental health. Depression Analyzing seven clinical trials, Wang et al. 111 suggest that acupuncture can significantly reduce the severity of major depression and depressive neurosis compared to placebo control. More recently, Smith et al. 112 analysed 64 clinical trials using acupuncture as an intervention for depression. They concluded that acupuncture may have positive effects on Journal of Complementary Therapies in Health 2025: 3(3). 8 of 18 Constantino A.P., Ferreira T.M., Leitão E., Silva P., Vieira E. Acupuncture and Evidence-Based Traditional Chinese Medicine Approaches for Mental Health. doi:10.5281/zenodo.17257364 depression, emphasizing the benefits of combining acupuncture with medication. In the 12 studies comparing acupuncture plus medication with medication alone, the combined approach was statistically superior. When compared with psychological therapy, acupuncture tended to produce more positive outcomes with fewer side effects. These meta-analytic studies suggest that acupuncture can be a valuable tool in treating depression, especially when used alongside conventional medication. Schizophrenia Shen et al. 113 analyzed the use of acupuncture in combination with conventional antipsychotic treatment in schizophrenia. Among the 30 studies included, they observed that adding acupuncture to standard-dose antipsychotics led to shortand medium-term improvements in psychiatric symptom severity compared to medication alone. Shortterm improvements in psychotic symptoms were also noted. For negative symptom severity, acupuncture showed value as an adjunct to conventional medication in both shortand medium-term follow-up. Relapse rates were also reduced when acupuncture was used alongside a low dose of antipsychotics compared to a standard dose, with the additional benefit of reducing medication-related side effects. These findings suggest that acupuncture may have therapeutic value in schizophrenia, particularly as a complement to antipsychotic medication. Parkinson’s Disease and Cognitive Deficit Liu et al. 114 analyzed 11 clinical trials regarding acupuncture’s effect on Parkinson’s disease. They concluded that acupuncture combined with the conventional drug Madopar improved clinical efficacy compared to the drug alone. Additionally, the combination produced significantly fewer adverse effects, including gastrointestinal reactions, “on-off” phenomena, and mental disturbances. Regarding cognitive improvement, Kim et al. 115 analysed acupuncture’s potential compared to conventional medication. Results suggested that acupuncture could effectively enhance cognitive function in patients with mild cognitive impairment. These findings indicate that acupuncture may be a useful complementary therapy in Parkinson’s disease, potentially providing advantages in cases of cognitive decline. Insomnia Kim et al. 116 analysed 19 clinical trials, suggesting that in a personalized approach according to TCM principles, acupuncture may be more effective than medication for insomnia, both in response rates and sleep quality. 2.4. Mechanisms of Acupuncture in Mental Health In general, acupuncture aims to regulate the nervous, circulatory, endocrine, and exocrine systems and promote well-being 102. Regarding its specific action in mental disorders, various mechanisms are proposed in the scientific literature. Yang et al. 117 state that acupuncture may alleviate depression by promoting hippocampal neuroplasticity, enhancing neural network function, and reducing brain inflammation. By regulating neurotransmitter levels and modulating the neuroendocrine axis, acupuncture contributes to improved emotional state and exhibits an antidepressant effect 118. Tu et al. 119, suggest that acupuncture can modulate glutamate receptors and excitatory amino acid transporters, potentially serving as complementary therapy for certain neuropsychiatric disorders. In addition, Zhao et al. 120 propose that acupuncture can protect dopaminergic neurons from degeneration via antioxidant, anti-inflammatory, and anti-apoptotic pathways, and modulate neurotransmitter balance in the basal ganglia circuits. As well, acupuncture has been shown to regulate hormonal levels associated with the HPA axis 121,122, which has implications for treating anxiety, depression, stress management, and sleep disorders. Journal of Complementary Therapies in Health 2025: 3(3). 9 of 18 Constantino A.P., Ferreira T.M., Leitão E., Silva P., Vieira E. Acupuncture and Evidence-Based Traditional Chinese Medicine Approaches for Mental Health. doi:10.5281/zenodo.17257364 2.5. Other TCM Techniques for Mental Health TCM integrates various therapeutic practices beyond acupuncture, many of which are relevant to mental health. Taichi Chuan and Qigong These are ancient practices involving slow, deliberate movements combined with controlled breathing and meditation to cultivate and balance Qi 123,124. They are believed to improve health by harmonizing internal energy, reducing stress, and increasing physical flexibility and strength. Qigong is often used as preventive medicine, while Taichi is practiced as a low-impact exercise 85. A meta-analysis 125 suggests that Taichi Chuan significantly improves depressive symptoms. Similarly, Qigong showed superiority over active and passive controls in reducing depression 126. For anxiety, both practices appear to provide symptomatic improvement 125,127. Regarding mild cognitive impairment, Lin et al. 128 reported gains in global function, memory, learning, visuospatial ability, and executive function. Yang et al. 129 also reported benefits in attention, abstraction, and mental flexibility. Additionally, Wu et al. 130 demonstrated positive effects on sleep quality. Chinese Herbal Medicine This is a major branch of TCM, using plants, minerals, and animal products to restore health 131,132. Over 500 substances are frequently used, generally combined in balanced formulas targeting both the underlying cause and symptoms. These may be administered as decoctions, powders, capsules, or topical preparations. Well-known herbs include Ginseng, Licorice, Angelica Sinensis (Dong Quai), and Reishi mushroom 133-136. Despite being an ancient practice, herbal medicine continues to be widely applied and studied across multiple clinical areas 131,132,137-141, including mental health 139,142,143. Table 2 summarizes various herbal applications for mental health. Table 2. Classic Chinese Herbal Formulas Applied to Mental Health Disorders. Pathology Actions Evidence Depression Chai Hu Shu Gan San Harmonizes Liver Qi, relieves stagnation, regulates emotions Sun et al. 144: superior efficacy to fluoxetine Bupleurum Frees Liver, regulates Qi, stabilizes emotions Yang et al. 145: superior to selective serotonin reuptake inhibitors Schizophrenia Wendan Tang Resolves phlegm-heat, harmonizes Stomach and Gallbladder, calms Shen Deng et al. 146: enhances antipsychotic effects, reduces adverse effects Insomnia Long Dan Xie Gan Tang Drains Liver Fire, calms Shen, improves sleep Fan et al. 147: slightly superior to conventional medication, with fewer side effects Shumian Nourishes Heart and Spleen, calms Shen, regulates sleep Wang et al. 148: efficacy equivalent to pharmacological medication 3. Final Considerations Mental health is a complex topic with physical, emotional, and social implications. This work shows that TCM offers a holistic approach, considering health as a result of balance among biological systems, and may play a complementary role in mental health. Journal of Complementary Therapies in Health 2025: 3(3). 16 of 18 Constantino A.P., Ferreira T.M., Leitão E., Silva P., Vieira E. Acupuncture and Evidence-Based Traditional Chinese Medicine Approaches for Mental Health. doi:10.5281/zenodo.17257364 106. Shi Y, Yao S, Shen Z, She L, Xu Y, Liu B, et al. Effect of Electroacupuncture on Pain Perception and Pain-Related Affection: Dissociation or Interaction Based on the Anterior Cingulate Cortex and S1. Neural Plast. 2020;2020:8865096. doi: https://doi.org/10.1155/2020/8865096 107. Amorim D, Amado J, Brito I, Fiuza SM, Amorim N, Costeira C, et al. Acupuncture and electroacupuncture for anxiety disorders: A systematic review of the clinical research. Complement Ther Clin Pract. 2018;31:31-7. doi: https://doi.org/10.1016/j.ctcp.2018.01.008 108. Rodrigues JM, Simões K, Moreira O, Cruz G, Soares PB, Machado JP. Auricle reflex system: A practical approach to diagnosis and treatment. Revista Internacional de Acupuntura. 2024;18(1):100287. doi: https://doi.org/10.1016/j.acu.2024.100287 109. Rodrigues JM, Ventura C, Abreu M, Santos C, Monte J, Machado JP, et al. Electro-Acupuncture Effects Measured by Functional Magnetic Resonance Imaging—A Systematic Review of Randomized Clinical Trials. Healthcare. 2023;12(1). doi: https://doi.org/10.3390/healthcare12010002 110. Silva H, Santos A, Monteiro A, Sousa IR, Rodrigues JM. Acupuncture for the Management of Breast Cancer: A Review of its Efficacy and Mechanisms. Revista Internacional de Acupuntura. 2024. 111. Wang H, Qi H, Wang B-s, Cui Y-y, Zhu L, Rong Z-x, et al. Is acupuncture beneficial in depression: a meta-analysis of 8 randomized controlled trials? Journal of affective disorders. 2008;111(2-3):125-34. 112. Smith CA, Armour M, Lee MS, Wang LQ, Hay PJ. Acupuncture for depression. Cochrane Database Syst Rev. 2018;3(3):CD004046. doi: https://doi.org/10.1002/14651858.CD004046.pub4 113. Shen X, Xia J, Adams CE. Acupuncture for schizophrenia. Cochrane Database of Systematic Reviews. 2014(10). 114. Liu H, Chen L, Zhang Z, Geng G, Chen W, Dong H, et al. Effectiveness and safety of acupuncture combined with madopar for parkinson—s disease: a systematic review with meta-analysis. Acupuncture in Medicine. 2017;35(6):404-12. 115. Kim H, Kim HK, Kim SY, Kim YI, Yoo HR, Jung IC. Cognitive improvement effects of electro-acupuncture for the treatment of MCI compared with Western medications: a systematic review and Meta-analysis. BMC complementary and alternative medicine. 2019;19(1):13. doi: https://doi.org/10.1186/s12906-018-2407-2 116. Kim SH, Jeong JH, Lim JH, Kim BK. Acupuncture using pattern-identification for the treatment of insomnia disorder: a systematic review and meta-analysis of randomized controlled trials. Integr Med Res. 2019;8(3):216-26. doi: https://doi.org/10.1016/j.imr.2019.08.002 117. Yang NN, Lin LL, Li YJ, Li HP, Cao Y, Tan CX, et al. Potential Mechanisms and Clinical Effectiveness of Acupuncture in Depression. Curr Neuropharmacol. 2022;20(4):738-50. doi: https://doi.org/10.2174/1570159X19666210609162809 118. Sun B, Cao X, Xin M, Guan R. Treatment of Depression with Acupuncture Based on Pathophysiological Mechanism. Int J Gen Med. 2024;17:347-57. doi: https://doi.org/10.2147/IJGM.S448031 119. Tu CH, MacDonald I, Chen YH. The Effects of Acupuncture on Glutamatergic Neurotransmission in Depression, Anxiety, Schizophrenia, and Alzheimer's Disease: A Review of the Literature. Front Psychiatry. 2019;10:14. doi: https://doi.org/10.3389/fpsyt.2019.00014 120. Zhao Y, Zhang Z, Qin S, Fan W, Li W, Liu J, et al. Acupuncture for Parkinson's Disease: Efficacy Evaluation and Mechanisms in the Dopaminergic Neural Circuit. Neural Plast. 2021;2021:9926445. doi: https://doi.org/10.1155/2021/9926445 121. Jia B, Li Z, Shi Y, Fei Y, Zhang H, Tu Y. Effect of electroacupuncture on changes of behavior and some related hormones of hypothalamus-pituitary-adrenal axis in chronic stress model rats. Acupuncture Research. 2004;29(4):252-6. 122. Xiao X, Wei J, LI W, Ceng X, Shen X, Leng J, et al. Mechanism analysis of the antidepressant effect of acupuncture by regulating the HPA axis. Shanghai Journal of Acupuncture and Moxibustion. 2016:758-60. 123. Rodrigues JM, Matos LC, Francisco N, Dias A, Azevedo J, Machado J. Assessment of Qigong Effects on Anxiety of High-school Students: A Randomized Controlled Trial. Adv Mind Body Med. 2021;35(3):10-9. 124. Howes SG. Can an online Tai Chi Qigong intervention reduce anxiety and promote self-actualisation in students with ADHD during lockdown? : University of Birmingham; 2021. Journal of Complementary Therapies in Health 2025: 3(3). 17 of 18 Constantino A.P., Ferreira T.M., Leitão E., Silva P., Vieira E. Acupuncture and Evidence-Based Traditional Chinese Medicine Approaches for Mental Health. doi:10.5281/zenodo.17257364 125. Wang F, Lee EK, Wu T, Benson H, Fricchione G, Wang W, et al. The effects of tai chi on depression, anxiety, and psychological well-being: a systematic review and meta-analysis. Int J Behav Med. 2014;21(4):605-17. doi: https://doi.org/10.1007/s12529-0139351-9 126. Guo L, Kong Z, Zhang Y. Qigong-Based Therapy for Treating Adults with Major Depressive Disorder: A Meta-Analysis of Randomized Controlled Trials. Int J Environ Res Public Health. 2019;16(5):826. doi: https://doi.org/10.3390/ijerph16050826 127. Chang PS, Knobf T, Oh B, Funk M. Physical and Psychological Health Outcomes of Qigong Exercise in Older Adults: A Systematic Review and Meta-Analysis. Am J Chin Med. 2019;47(2):301-22. doi: https://doi.org/10.1142/S0192415X19500149 128. Lin R, Cui S, Yang J, Yang H, Feng Z, Wahner-Roedler DL, et al. Effects of Tai Chi on Patients with Mild Cognitive Impairment: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Biomed Res Int. 2021;2021:5530149. doi: https://doi.org/10.1155/2021/5530149 129. Yang J, Zhang L, Tang Q, Wang F, Li Y, Peng H, et al. Tai Chi is Effective in Delaying Cognitive Decline in Older Adults with Mild Cognitive Impairment: Evidence from a Systematic Review and Meta-Analysis. Evidence-based complementary and alternative medicine : eCAM. 2020;2020:3620534. doi: https://doi.org/10.1155/2020/3620534 130. Wu YH, He WB, Gao YY, Han XM. Effects of traditional Chinese exercises and general aerobic exercises on older adults with sleep disorders: A systematic review and meta-analysis. J Integr Med. 2021;19(6):493-502. doi: https://doi.org/10.1016/j.joim.2021.09.007 131. Rodrigues JM, Santos C, Ribeiro V, Alvarenga A, Santos RV. Chinese Phytopharmacology in dermatology - A Systematic Review. Pharmacological Research - Modern Chinese Medicine. 2023;7:100255. doi: https://doi.org/10.1016/j.prmcm.2023.100255 132. Aguiar R, Gehlen S, Oliveira R, Rodrigues JM. Recent advances in Chinese phytopharmacology for female infertility: A systematic review of high-quality randomized controlled trials. Pharmacological Research - Modern Chinese Medicine. 2024;13:100539. doi: https://doi.org/10.1016/j.prmcm.2024.100539 133. Silva R, Lima da Fonseca M. Medicinal Mushrooms in Mental Health: A Review of TCM and Naturopathy. 2024. doi: https://doi.org/10.5281/zenodo.13353840 134. Xiang YZ, Shang HC, Gao XM, Zhang BL. A comparison of the ancient use of ginseng in traditional Chinese medicine with modern pharmacological experiments and clinical trials. Phytotherapy research : PTR. 2008;22(7):851-8. doi: https://doi.org/10.1002/ptr.2384 135. Wei WL, Zeng R, Gu CM, Qu Y, Huang LF. Angelica sinensis in China-A review of botanical profile, ethnopharmacology, phytochemistry and chemical analysis. Journal of ethnopharmacology. 2016;190:116-41. doi: https://doi.org/10.1016/j.jep.2016.05.023 136. Li N, Zhou T, Wu F, Wang R, Zhao Q, Zhang JQ, et al. Pharmacokinetic mechanisms underlying the detoxification effect of Glycyrrhizae Radix et Rhizoma (Gancao): drug metabolizing enzymes, transporters, and beyond. Expert Opin Drug Metab Toxicol. 2019;15(2):167-77. doi: https://doi.org/10.1080/17425255.2019.1563595 137. Gao Q, Shen L, Jiang B, Luan YF, Lin LN, Meng FC, et al. Salvia miltiorrhiza-Containing Chinese Herbal Medicine Combined With GnRH Agonist for Postoperative Treatment of Endometriosis: A Systematic Review and meta-Analysis. Frontiers in pharmacology. 2022;13:831850. doi: https://doi.org/10.3389/fphar.2022.831850 138. Ried K. Chinese herbal medicine for female infertility: an updated meta-analysis. Complement Ther Med. 2015;23(1):116-28. doi: https://doi.org/10.1016/j.ctim.2014.12.004 139. Yang S, Xu Y, Peng W, Han D, Feng F, Wang Z, et al. Chinese herbal medicine for symptoms of depression and anxiety in chronic obstructive pulmonary disease: A systematic review and meta-analysis. Complement Ther Clin Pract. 2021;45:101470. doi: https://doi.org/10.1016/j.ctcp.2021.101470 140. Ho VW, Tan HY, Guo W, Li S, Wang N, Meng W, et al. Efficacy and Safety of Chinese Herbal Medicine on Treatment of Breast Cancer: A Meta-analysis of Randomized Controlled Trials. Am J Chin Med. 2021;49(7):1557-75. doi: https://doi.org/10.1142/S0192415X21500737 Journal of Complementary Therapies in Health 2025: 3(3). 18 of 18 Constantino A.P., Ferreira T.M., Leitão E., Silva P., Vieira E. Acupuncture and Evidence-Based Traditional Chinese Medicine Approaches for Mental Health. doi:10.5281/zenodo.17257364 141. Zhang XW, Liu W, Jiang HL, Mao B. Chinese Herbal Medicine for Advanced Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis. Am J Chin Med. 2018;46(5):923-52. doi: https://doi.org/10.1142/S0192415X18500490 142. Wang Y, Shi YH, Xu Z, Fu H, Zeng H, Zheng GQ. Efficacy and safety of Chinese herbal medicine for depression: A systematic review and meta-analysis of randomized controlled trials. J Psychiatr Res. 2019;117:74-91. doi: https://doi.org/10.1016/j.jpsychires.2019.07.003 143. Wang J, Liu J, Ni X, Nie G, Zeng Y, Cao X, et al. Adjuvant Therapy of Oral Chinese Herbal Medicine for Menopausal Depression: A Systematic Review and Meta-Analysis. Evidence-based complementary and alternative medicine : eCAM. 2018;2018:7420394. doi: https://doi.org/10.1155/2018/7420394 144. Sun Y, Xu X, Zhang J, Chen Y. Treatment of depression with Chai Hu Shu Gan San: a systematic review and meta-analysis of 42 randomized controlled trials. BMC complementary and alternative medicine. 2018;18(1):66. doi: https://doi.org/10.1186/s12906-018-2130-z 145. Yang L, Shergis JL, Di YM, Zhang AL, Lu C, Guo X, et al. Managing Depression with Bupleurum chinense Herbal Formula: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Altern Complement Med. 2020;26(1):8-24. doi: https://doi.org/10.1089/acm.2019.0105 146. Deng H, Xu J. Wendan decoction (Traditional Chinese medicine) for schizophrenia. Cochrane Database Syst Rev. 2017;6(6):CD012217. doi: https://doi.org/10.1002/14651858.CD012217.pub2 147. Fan X, Su Z, Nie S, Yang J, Zhang X, Tan D, et al. Efficacy and safety of Chinese herbal medicine Long Dan Xie Gan Tang in insomnia: A systematic review and meta-analysis. Medicine (Baltimore). 2020;99(11):e19410. doi: https://doi.org/10.1097/MD.0000000000019410 148. Wang C, Yang Y, Ding X, Li J, Zhou X, Teng J, et al. Efficacy and safety of Shumian capsules in treating insomnia: A systematic review and meta-analysis. Medicine (Baltimore). 2021;100(50):e28194. doi: https://doi.org/10.1097/MD.0000000000028194