ArticlePDF Available

Trends of Tuina Therapy on Depression and Its Efficacy -based on CNKI-

Authors:

Abstract and Figures

Objectives: The purpose of this study is to investigate the research about using tuina therapy for depression and to determine its efficacy. Methods: All relevant articles were searched in the China National Knowledge Infrastructure using the terms `tuina` and `depression`. Results: Forty-one studies were selected, 34 randomized controlled trials (RCTs) and 7 prospective studies. The Chinese Classification of Mental Disorders and Hamilton Depression Rating Scale were used most frequently as diagnostic criteria and an assessment tool, respectively. Conduction exercise therapy was used in all studies; in contrast, Zheng Xing exercise therapy was used in only 1 study of depression patients with neck vertebrae disease. In 9 RCTs that showed scores of more than 2 points on a modified Jadad scale, tuina therapy had significant antidepressant efficacy compared with conventional treatment. However, more high-quality studies are required. Conclusions: Tuina therapy has a valid therapeutic effect on depression according to studies published in China; if evidence accumulates from high-quality studies, it can be considered a non-pharmacologic treatment for depression in Korean medicine, as well.
Content may be subject to copyright.
ORIGINAL ARTICLE
pISSN 1226-6396, eISSN 2234-4942
J of Oriental Neuropsychiatry 2015;26(3):251-266
http://dx.doi.org/10.7231/jon.2015.26.3.251
Trends of Tuina Therapy on Depression and Its Efficacy
-based on CNKI-
Chan-Young Kwon, Eun-Ji Choi, Jong-Woo Kim, Sun-Young Chung
Department of Neuropsychiatry, College of Korean Medicine, KyungHee University
Received: August 25, 2015
Revised: August 27, 2015
Accepted: September 11, 2015
Objectives: The purpose of this study is to investigate the research about using tuina therapy for de-
pression and to determine its efficacy.
Methods: All relevant articles were searched in the China National Knowledge Infrastructure using the
terms 'tuina' and 'depression'.
Results: Forty-one studies were selected, 34 randomized controlled trials (RCTs) and 7 prospective
studies. The Chinese Classification of Mental Disorders and Hamilton Depression Rating Scale were
used most frequently as diagnostic criteria and an assessment tool, respectively. Conduction exercise
therapy was used in all studies; in contrast, Zheng Xing exercise therapy was used in only 1 study of
depression patients with neck vertebrae disease. In 9 RCTs that showed scores of more than 2 points
on a modified Jadad scale, tuina therapy had significant antidepressant efficacy compared with con-
ventional treatment. However, more high-quality studies are required.
Conclusions: Tuina therapy has a valid therapeutic effect on depression according to studies published
in China; if evidence accumulates from high-quality studies, it can be considered a non-pharmaco-
logic treatment for depression in Korean medicine, as well.
Key Words: Massage, Tuina, Depression, Korean medicine, Traditional Chinese medicine.
Correspondence to
Sun-Young Chung
Department of Korean
Neuropsychiatry, Gangdong
KyungHee University Hospital, 149,
Sangil-dong, Gangdong-gu, Seoul,
Korea.
Tel: +82-2-440-7134
Fax: +82-2-440-7143
E-mail: lovepwr@khu.ac.kr
Acknowledgement
The study was supported by the Korea
Institute of Oriental Medicine
(K15080).
Copyright © 2015 by The Korean Society of Oriental Neuropsychiatry. All rights reserved.
CC
This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creati vecommons.org/licenses/ by-nc/4.0) which
permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
252 Trends of Tuina Therapy on Depression and Its Efficacy -based on CNKI-
I. INTRODUCTION
Massage therapy, so-called ‘tuina’ (推拿), is one of
the therapeutic technique in Traditional Chinese
Medicine (TCM) to treat and prevent diseases, by rub-
bing, kneading, or percussion of the soft tissues and
joints of the body with the hands, usually performed
by one person on another, esp. to relieve tension or
pain1). In general, tuina therapy which is a typical ma-
nipulative therapy in TCM has been used for muscu-
loskeletal disorders, pain disorders, body modification,
and rehabilitation. And its application range is ex-
panding increasingly. Globally manipulation is used to
improve various medical system diseases such as eye
disease, cardiovascular disease, and otolaryngology
disease as well as musculoskeletal disorders and pain
disorders2). Also manipulation therapy is even used for
psychiatric disorders like anxiety3) , depression4), and
insomnia5) to treat or relief their symptoms.
Among them, depression which is one of the major
psychiatric disorders generally known to use anti-
depressants like selective serotonin reuptake inhibitor
(SSRI), but because of considerable side effects and its
limits of treatment, nonpharmacological treatments are
often used as complementary6). Nonpharmacological
treatment is not only applicable effectively to a patient
refusing drug treatment, but also known to have syner-
gistic effect when it used with medication
7). Therefore
its importance in the clinical field could be considered
high.
In TCM, since ancient times, nonpharmacological
treatments such as acupuncture, moxibustion, cup-
ping, and massage therapy has been applied to treat
various diseases as well as traditional herb medicine.
They are not just simple treatment technique, and has
been used as object-oriented treatments according to
the state of patient’s condition and neuropathy based
on the theory of TCM. Thus in depression, which is
important to care with nonpharmacological inter-
vention, traditional nonpharmacological treatment can
be used more efficiently by providing a comprehensive
care according to the condition of patient as well as
state of the disease.
Until now, depressive effect of acupuncture8) and
moxibustion9) has been reported in Korea, but there
is no research about the impact of tuina therapy on
depression yet. In this study, we are purposed to in-
vestigate trend of the researches and to identify the ef-
fectiveness of tuina on depression by searching rele-
vant articles through the Chinese database ‘China
National Knowledge Infrastructure (CNKI). And it ex-
pected to be used in the progress of developing clin-
ical guidelines related with depression as a data for
determine the effectiveness of tuina therapy and as a
reference for design of clinical research.
II. METHODS
1. Study selection
Studies included in this review were clinical trials
or prospective studies that examined participants with
depression using tuina therapy. Studies that not asso-
ciated with depression, review articles, and not speci-
fied diagnostic criteria or screening tool in inclusion
criteria were excluded. In order to identify the effects
of tuina therapy, studies using same massage inter-
vention for treatment group and control group were
excluded. Intradermal acupuncture, acupoint sticking
therapy, self-acupressure, and manipulation which is
not applied theory of TCM were considered to be not
included in tuina therapy. Master's thesis and doctoral
thesis were included.
2. Search strategy
Chinese database (CNKI, 中國知識基礎施設工程) were
searched until up July 2015, using terms 'tuina' and
‘depression’ (‘OR 抑郁[] AND 推拿[],
OR 抑郁[] AND ‘按摩[], ‘OR 抑郁
CY Kwon, EJ Choi, JW Kim, SY Chung 253
[] AND ‘’ [], ‘depression’ [subject] AND
‘tuina’ OR ‘massage’ [subject])
3. Assessment of RCTs
In order to evaluate the quality of the study design,
we used modified Jadad scale to assess RCTs. Modified
Jadad scale is a modification of the existing evaluation
methods of Jadad scale to reflect the difficulty of set-
ting study design, especially blind study, in Traditional
Chinese Medicine10). In this study, according to the
modified Jadad scale, we graded scores in the follow-
ing order:
1) 1 point was added if research was conducted
randomly assigned (randomization)
2) 1 point was added if the randomization method
is described and appropriate
3) 1 point was added if research was conducted as
subject blinded
4) 1 point was added if research was conducted as
evaluator blinded
5) 1 point was added if withdrawals and dropouts
are described
4. Classification of Tuina therapy
In accordance with the method and purpose, tuina
therapy has a very broad and individual features. To
investigate the effect of tuina therapy more in detail,
we classified tuina into two ways
11).
1) Conduction exercise (導引推拿)
Tuina therapy to control qi () and blood () by
the application of hand techniques to the patient's skin
surface, meridians and acupoints.
2) Zheng Xing exercise (正形推拿)
Tuina therapy to improve the activity by stretching
the meridian sinew (經筋推拿) or to restore the dis-
location or fracture by using orthodontic techniques to
the anatomical imbalance (整骨推拿).
We classified tuina of simple physical stimulus on
surface of the skin, meridians or acupoints as con-
duction exercise on the other hand massage of ortho-
dontic therapy on muscles or skeleton to correct the
local tensions or deviation as Zheng Xing exercise.
III. RESULTS
1. Study selection
Total 509 studies were screened and 107 duplicated
studies were excluded. 341 studies not related with
depression or review articles, and 8 studies not related
with tuina therapy were excluded by title and abstract
screening. After 1st screening, by full text screening,
4 studies not describing certain diagnostic criteria or
screening tool for depression, 3 studies using same tui-
na therapy for treatment and control group, 3 studies
not using definite tuina therapy (intradermal acu-
puncture, self-acupressure, and not using TCM theory),
1 studies overlapping publication, and 1 studies un-
available to get full text. Lastly 41 studies were re-
mained and examined tuina therapy for depression
(Fig. 1).
2. Type of study
The 41 studies included conclusively in this review
contain 34 RCTs (82.93%), and 7 prospective studies
(17.07%). In RCTs, there were 5 masters thesis.
3. Content of study
1) Classification by research topic
According to the content of diseases type, they were
divided into 2 categories, studies of depression alone
and studies of depression comorbid with other condi-
tions. The former include 11 RCTs, and 2 prospective
studies while the latter include 23 RCTs and 5 pro-
spective studies.
254 Trends of Tuina Therapy on Depression and Its Efficacy -based on CNKI-
Fig. 1. Flowchart of study selection.
2) Subject
In case of 23 RCTs of depression comorbid with
other conditions, post stroke depression was the most
frequent subject as 7 pieces (30.43%), and 6 pieces
(21.74%) about postpartum depression followed. And
in 5 prospective studies, postpartum depression was
the most frequent subject as 3 pieces (60.00%).
Throughout the studies included in this review,
there were 7 studies (17.07%) using pattern identi-
fication as a screening tool.
3) Diagnostic criteria/Screening tool
Of the total 41 studies, studies describing depressive
disorder diagnostic criteria were 32 pieces (78.05%).
Among them Chinese Classification of Mental
Disorders (CCMD) was the most commonly used as 16
pieces (68.75%), Diagnostic and Statistical Manual of
Mental Disorders (DSM) as 4 pieces (12.50%), and
International Classification of Disease (ICD) as 3 pieces
(9.38%) followed.
Of the total 41 studies, studies describing depressive
disorder screening tool were 24 pieces (57.14%). Among
them Hamilton Depression Rating Scale (HAMD) was
CY Kwon, EJ Choi, JW Kim, SY Chung 255
the most commonly used as 15 pieces (62.50%), and
Self-Rating Depression Scale (SDS) as 5 pieces (20.83%)
followed.
Other than, in case of senile depression or post-
partum depression, Geriatric Depression Scale (GDS)
or Edinburgh Postnatal Depression Scale (EPDS) were
used respectively.
4) Assessment tool
Of the total 41 studies, most of studies (95.12%) de-
scribing the assessment tool except for 2 prospective
study. Among them, for depression symptom, HAMD
was the most commonly used as 27 pieces (69.23%),
SDS as 11 pieces (28.21%), and EPDS as 5 pieces
(12.82%) followed. For other symptoms, Pittsburgh
Sleep Quality Index (PSQI) was the most commonly
used as 5 pieces (12.82%).
Other than, in case of depression with diabetes or
postpartum depression, fasting blood glucose (FBG)
and glycated hemoglobin (HbA1c) or estradiol (E2) and
follicle stimulating hormone (FSH) were used respec-
tively
5) Treatment period
Of the total 41 studies, most of studies (97.56%) de-
scribed the treatment period except for 1 prospective
studies. Among them, the period ofmore than 4
weeks, under 8 weeks’ was the most commonly used
as 24 pieces (60.00%), ‘more than 8 weeks, under 12
weeks’ as 9 pieces (22.50%), ‘more than 12 weeks’ as
6 pieces (15.00%), and ‘under 4 weeks’ as 1 pieces
(2.50%) followed.
6) Intervention
Of the total 41 studies, studies describing the meth-
od of tuina therapy were 39 pieces (95.12%), the fre-
quency of tuina therapy were 35 pieces (85.37%), and
the total time required to perform tuina therapy at one
time were 19 pieces (46.34%).
Among the studies describing the method of tuina
therapy, conduction exercise was used in all studies
(100.00%), and Zheng Xing exercise was used in only
1 study (2.56%) of depression patients with neck verte-
brae disease.
Among the studies describing the frequency of tuina
therapy, performing ‘once per day’ was the most com-
monly used as 25 pieces (71.43%), ‘3 times a week’
oronce per 2 days as 7 pieces (20.00%) followed.
Among the studies describing the total time required
to perform tuina therapy at one time,more than 30
minutes, under 1 hour’ was the most commonly used
as 15 pieces (78.95%), ‘under 30 minutes’ as remaining
4 pieces (21.05%) followed.
4. Structure of study
1) Randomized controlled trial
Of the total 34 RCTs, 33 studies were conducted as
a structure of two arm-parallel group, and 1 study as
a structure of three-arm parallel group, traditional
herbal medicine and tuina therapy for treatment group,
traditional herbal medicine or tuina therapy for 2 con-
trol group each.
In the 33 two-arm parallel group studies, 24 studies
(72.73%) performed common intervention for both
group and additional intervention for treatment group.
Among them, as a additional intervention, ‘tuina ther-
apy combination with other interventions like acu-
puncture, traditional herbal medicine, and psycho-
logical intervention’ was used as 14 pieces (58.33%),
andtuina therapy alone as 10 pieces (41.67%).
In the 33 two-arm parallel group studies, 9 studies
(27.27%) performed separate intervention for each
group without common intervention. Among them, as
a intervention for treatment group,tuina therapy
combination with other interventions’ was used as 2
pieces (22.22%), and ‘tuina therapy alone’ as 6 pieces
(66.67%). And in remaining 1 study (11.11%),tuina
256 Trends of Tuina Therapy on Depression and Its Efficacy -based on CNKI-
Ta b l e 1 . Assessment of RCTs with Modified Jadad Scale
No. 1st author (year) Modified Jad ad scale Score
1 Zhai (2014) 1/0/0/0/0 1
2 Jiang (2014) 1/0/0/0/0 1
3 Cuo (2009) 1/0/0/0/0 1
4 Zhang (2010) 1/0/0/0/0 1
5 Tan (2013) 1/0/0/0/0 1
6 Xi (2006) 1/0/0/0/0 1
7 Zhuang (2004) 1/1/0/0/0 2
8 Xiao (2008) 1/1/0/0/0 2
9 Zhao (2010) 1/0/0/0/0 1
10 Meng (2013) 1/1/0/0/0 2
11 Xiao (2013) 1/0/0/0/0 1
12 Liang (2013) 1/0/0/0/0 1
13 Du (2015) 1/0/0/0/0 1
14 Huang (2011) 1/0/0/0/0 1
15 Yang (2012) 1/0/0/0/0 1
16 Liao (2012) 1/0/0/0/0 1
17 Ren (2013) 1/0/0/0/0 1
18 Qiu (2015) 1/1/0/0/0 2
19 Zheng (2010) 1/0/0/0/0 1
20 Xu (2012) 1/0/0/0/0 1
21 Fang (2013) 1/0/0/0/0 1
22 Wang (2012) 1/0/0/0/0 1
23 Zhu (2014) 1/1/0/0/0 2
24 Yuan (2007) 1/0/0/0/0 1
25 Zhang (2009) 1/0/0/0/0 1
26 Wang (2009) 1/0/0/0/0 1
27 Tan (2011) 1/1/0/0/0 2
28 Tan (2012) 1/1/1/0/0 3
29 Yang (2012) 1/0/0/0/0 1
30 Gu (2013) 1/1/0/0/0 2
31 Guo (2014) 1/0/0/0/0 1
32 Xing (2014) 1/0/0/0/0 1
33 Yao (2014) 1/0/0/0/0 1
34 Zheng (2015) 1/1/0/0/0 2
therapy alone’ was used for control group, while treat-
ment group received acupuncture intervention.
2) Prospective study
Of the total 7 prospective clinical researches, ‘tuina
therapy combination with other interventions’ was
used as a intervention.
5. Assessment of RCTs
In order to evaluate the quality of RCTs, modified
Jadad scale was performed for 34 RCTs included in this
review. Among them, 8 studies using randomized allo-
cation methods on the basis of consultation hours or
hospitalization time, 2 studies describing blind with
uncertain methods, and 2 studies describing with-
drawals and dropouts with poor description did not
receive a score.
After assessment of RCTs with modified Jadad scale,
25 pieces (73.53%) were for 1 point, 8 pieces (23.53%)
were for 2 point, 1 piece (2.94%) was for 3 point, and
no piece was for 4 point (Table 1).
6. Result of study (based on RCTs)
By assessing RCTs scored more than 2 points of
modified Jadad scale, 4 RCTs of depression alone, and
5 RCTs of depression comorbid with other conditions
were remained.
In case of 4 RCTs of depression alone, HAMD was
used in all studies for evaluating therapeutic effect of
the intervention. Tan (, 2011) performed repeti-
tive transcranial magnetic stimulator (rTMS) 3 times
per week for both group, and additional tuina therapy
for treatment group, for 6 weeks to 51 depression pa-
tients diagnosed by CCMD, corresponding to 24
HAMD18, and classified as liver depression and
spleen deficiency (肝鬱脾). As a result, treatment
group was reported to have significantly lower levels
of HAMD than control group at 1st, 2nd, 4th, and 6th
week after treatment. Also they reported that addi-
tional tuina therapy was particularly effective for the
initial 1 month. Tan (譚濤, 2012) and Gu (穀建雲, 2013)
performed tuina therapy combination with acu-
puncture, traditional herbal medicine or cupping for
treatment group, and drug therapy for control group,
respectively for 4 and 12 weeks and to 56 and 60 de-
pression patients diagnosed by CCMD. As a result,
treatment group was reported to have significantly
lower levels of HAMD than control group. Moreover
Ta n ( 譚濤, 2012) reported that in the treatment group
compared to the control group, side effects occurred
less and lightly based on Treatment Emergent Sym-
CY Kwon, EJ Choi, JW Kim, SY Chung 257
ptom Scale (TESS). Zheng (鄭碧琴, 2015) performed
routine psychiatric nursing, drug therapy, and health
education for both group, and additional tuina therapy
for treatment group, for 2 weeks to 83 depression pa-
tients diagnosed by ICD-10 and corresponding to
HAMD18. As a result, treatment group was reported
to have significantly lower levels of HAMD and heart
rate than control group, so they reported that addi-
tional tuina therapy has a significant effect to reduce
depression and anxiety.
In case of 5 RCTs of depression comorbid with other
conditions, studies about post stroke depression were
3 pieces, postpartum depression as 1 piece, and de-
pression with peritoneal dialysis for chronic kidney
disease uremia stage as 1 pieced followed. Zhuang (
子齊, 2004) performed acupuncture and tuina therapy
once per 2 days for treatment group, and drug therapy
for control group, for 1 month, to 62 post stroke de-
pression patients diagnosed by CCMD and correspond-
ing to HAMD8. As a result, treatment group was re-
ported to have significantly lower levels of HAMD and
1 year relapse rate than control group. Xiao (蕭蕙,
2008) performed rehabilitation care for both group,
additional routine counseling for control group, and
additional psychological care based on TCM and tuina
therapy everyday for treatment group, for 1 month, to
150 post stroke depression patients diagnosed by
CCMD and DSM, and corresponding to 35HAMD8.
As a result, treatment group was reported to have sig-
nificantly lower levels of HAMD, Activity of Daily
Living Scale (ADL) and Short Form Health Survey
(SF-36) than control group. Meng (孟慶芳, 2013) per-
formed routine rehabilitation care and drug therapy for
both group, and additional hyperbaric oxygen and tui-
na therapy everyday for treatment group, for 28 days,
to 100 post stroke depression patients corresponding
to HAMD17, NIHSS12. As a result, treatment
group was reported to have significantly lower levels
of HAMD, NIHSS, and Modified Barthel Index (MBI)
than control group, so they reported that additional
hyperbaric oxygen and tuina therapy have a significant
effect not only to reduce depression but also to recov-
er neurological disturbance. Qiu (, 2015) per-
formed routine care for both group, and additional
psychiatric nursing and tuina therapy once a day on
hospitalization period and then 1 time per week, for
42 days, to 60 postpartum depression patients corre-
sponding to EPDS10. As a result, treatment group
was reported to have significantly lower levels of EPDS
and PSQI and significantly higher levels of Quality of
Life (QOL) and nursing satisfaction score than control
group. Zhu (, 2014) performed routine care for
chronic kidney disease for both group, and additional
steam therapy on foot, eyepatch, and tuina therapy ev-
eryday for treatment group, for 40 days, to 107 de-
pression patients with peritoneal dialysis for chronic
kidney disease uremia stage corresponding to SDS
50, and classified as kidney deficiency and liver de-
pression (腎虛肝鬱) and dual deficiency of the heart
and spleen (心脾兩虛). As a result, there was no sig-
nificant difference between two group until 20th day
after treatment in PSQI and SDS, but at 40th day after
treatment, treatment group was reported to have sig-
nificantly lower levels of PSQI and SDS than control
group (Tables 24).
7. Example of performing tuina in a clinical
field
For instance, one study, conducted by Tan (譚濤,
2012) and gained 3 points in modified Jadad scale,
suggested the use of conduction exercise therapy as
follows.
“For tuina therapy, a patient lies down in supine
position and a doctor sits at the beside of the patient.
At first, the doctor draw a straight line from Yin Tang
(印堂, EX-HN3) to Bai Hui (百會, GV20) using qi-con-
centrated single-finger pushing manipulation (一指
) for one minute. Then he rubs Yin Tang, Bai Hui,
258 Trends of Tuina Therapy on Depression and Its Efficacy -based on CNKI-
Ta b l e 2. RC Ts of Depression
No. 1st Author (year) Subjects Modified Jadad
Score
Diagnostic
criteria
Sample
size
Treatmen t intervention
(period)
Control
interve ntion
Outcome measures
(clinical efficacy reported)
1 Zhai (2014)
14)
Senile DEP 1/0/0/0/0 CCM D-3 TG:30
CG:30
ACU (60 days) CE Symptoms (TG
CG)
2 Jiang (2014)
15)
Senile DEP 1/0/0/0/0 25
GDS
10 TG:60
CG:60
PSY+CE (12 weeks) PSY GDS (TG
CG)
3 Cuo (2009)
16)
DEP with diabetes 1/0/0/0/0 CCMD-3
HAMD
20
TG:50
CG:50
ROC+PSY+CE (3 months) ROC SDS, SAS, FBG, 2hPG,
HbA1c (TG
>>
CG)
4 Zhang (2010)
17)
DEP with end-stage renal
disease
1/0/0/0/0 CCMD-3
HAMD>17
TG:34
CG:34
ROC+CE (4 weeks) ROC HAMD (TG
>>
CG)
5 Tan (2013)
18)
DEP with neck vertebrae
disease
1/0/0/0/0 SCM
HAMD
24
SDS
50
TG:75
CG1:75
CG2:75
THM+CE+ZXE (4 weeks) CG1:THM
CG2:CE+ZXE
HAMD, SDS (TG
CG1= CG2)
Symptoms (TG
>>
CG1= CG2)
6 Xi (2006)
19)
DEP with sleep disorder 1/0/0/0/0 SCM
CCMD-3
TG:30
CG:30
CE (1 month) THM PSQI, HAMD (TG
CG)
7 Wang (2012)
20)
DEP with sleep disorder 1/0/0/0/0 CCMD-3 (insomnia)
PSQI>7
SDS>50
TG:30
CG:30
CE (4 weeks) MED PSQI, SDS, SERS (TG=CG)
8 Zhuang (2004)
21)
PSD 1/1/0/0/0 CCM D-R
HAMD>8
TG:32
CG:30
ACU+CE (1 month) MED HAMD (TG
CG)
SDS (TG
>>
CG)
9 Xiao (2008)
22)
PSD 1/1/0/0/0 CCMD-2-R
DSM-IV
35>HAMD>8
TG:75
CG:75
ROC+PSY+CE (1 month) ROC+PSY HAMD (TG
CG)
ADL, SF-36 (TG
CG or
TG=CG by subcategory)
10 Zhao (2010)
23)
PSD 1/0/0/0/0 CCM D-3
ICD -10
SDS>50
HAMD>17
TG:51
CG:51
MED+ROC+PSY+hyperbaric
oxygenation+ear-ACU+
THM+CE (180 days)
MED SDS, HAMD (TG
>>
CG)
11 Meng (2013)
24)
PSD 1/1/0/0/0 HAMD
17
NIHSS
12
TG:50
CG:50
ROC+MED+hyperbaric
oxygenation+CE (28 days)
ROC+MED NIHSS, HAMD, MBI (TG
>>
CG)
12 Xiao (2013)
25)
PSD 1/0/0/0/0 35
HAMD
8TG:30
CG:30
ROC+PSY+CE (4 weeks) ROC HAM D (no statistical analysis)
13 Liang (2013)
26)
PSD 1/0/0/0/0 CCM D-3
24
HAMD
8
35
NIHSS
16
TG:40
CG:40
ROC+PSY+CE (8 weeks) ROC NIHSS, HAMD (TG
CG)
CY Kwon, EJ Choi, JW Kim, SY Chung 259
Ta b l e 2. Continued 1
No. 1st Author (year) Subjects Mod ified Jadad
Score
Diagnostic
criteria
Sample
size
Treatmen t intervention
(period)
Control
interve ntion
Outcome measures
(clinical efficacy reported)
14 Du (2015)
27)
PSD 1/0/0/0/0 SCM TG:36
CG:36
ROC+PSY+CE (4 weeks) ROC SDS, SF-36 (TG
CG)
15 Huang (2011)
28)
PPD 1/0/0/0/0 19
EPDS
10
Apgar
10
TG:75
CG:74
ROC+CE (42 days) ROC EPDS, PSQI (TG
>>
CG)
16 Yang (2012)
29)
PPD 1/0/0/0/0 SCM
HAMD
20
TG:32
CG:32
MED+ear-ACU+CE (8 weeks) MED HAMD (TG
CG)
17 Liao (2012)
30)
PPD 1/0/0/0/0 DSM-4 TG:84
CG:84
ROC+CE (42 days) ROC EPDS (TG
CG)
18 Ren (2013)
31)
PPD 1/0/0/0/0 DSM-4 TG:35
CG:35
PSY+CE (4 weeks) PSY EPDS, PSQI, Nursing
Satisfaction (TG
CG)
19 Qiu (2015)
32)
PPD 1/1/0/0/0 EPDS
10 TG:30
CG:30
ROC+PSY+CE (42 days) ROC EPDS, PSQI, SF-36, Nursing
Satisfaction (TG
CG)
20 Zheng (2010)
33)
PPD 1/0/0/0/0 CCMD-3
KMI
17
HAMD
16
TG:38
CG:37
MED+CE (3 months) MED HAMD (TG
CG)
KMI, FSH, E
2
(TG
>>
CG)
LH (TG=CG)
21 Xu (2012)
34)
DEP with acute myocardial
infarction
1/0/0/0/0 SAS
50
SDS
50
TG:31
CG:32
ROC+PSY+CE (30 days) ROC SAS, SDS (TG
CG)
SAQ (TG
CG or TG=CG by
subcategory))
22 Fang (2013)
35)
DEP with cirrhosis ascites 1/0/0/0/0 CC MD-3 TG:30
CG:30
ROC+PSY+ear-ACU+CE
(1 month)
ROC HAMD (TG
CG)
23 Zhu (2014)
36)
DEP with peritoneal dialysis for
chronic kidney disease
uremia stage
1/1/0/0/0 SDS>50 TG:54
CG:53
ROC+steam therapy+
eyepatch+CE (40 days)
ROC PSQI, SDS (TG
>>
CG)
24 Yuan (2007)
37)
DEP 1/0/0/0/0 CCM D-3
HAMD
17
TG:50
CG:50
MED+CE (6 weeks) MED HAMD (TG
CG)
25 Zhang (2009)
38)
DEP 1/0/0/0/0 CCM D-3
25
HAMD
14
TG:40
CG:40
CE (6 weeks) MED HAMD (TG=CG)
26 Wang (2009)
39)
DEP 1/0/0/0/0 CCM D-3
HAMD
20
TG:40
CG:40
electro-ACU+CE (4 weeks) Electro-ACU HAMD (TG
CG)
27 Tan (2011)
40)
DEP 1/1/0/0/0 CCM D-3
24
HAMD
18
TG:30
CG:21
rTMS+CE (6 weeks) rTMS HAMD (TG
CG)
28 Tan (2012)
41)
DEP 1/1/1/0/0 CCM D-3
HAMD
18
TG:30
CG:26
MED+ACU+MOX+CE
(4 weeks)
MED HAMD, HAMA (TG=CG)
CGI (NR)
29 Yang (2012)
42)
DEP 1/0/0/0/0 SCM TG:36
CG:36
ACU+CE (40 days) MED HAMD (TG=CG)
SDS (TG
CG)
30 Gu (2013)
43)
DEP 1/1/0/0/0 CCM D-3
SCM
TG:30
CG:30
MED+CUP+CE (12 weeks) MED HAMD (TG
CG)
260 Trends of Tuina Therapy on Depression and Its Efficacy -based on CNKI-
To u We i ( 頭維, ST8) and Feng Chi (風池, GB20) for one
minute to get obtaining qi (得氣). And then he rubs
from Cuan Zhu (, BL2) along the eyebrows and
forehead to both temples, and applies acupressure Tai
Ya ng ( 太陽, EX-HN5) and Yu Yao (魚腰, EX-HN4), using
his both thenar eminence (大魚際) about nine times.
After that, the doctor changes the position to the left
of the patient, and rubs the patient’s abdomen clock-
wise for five minutes, placing his right palm on the
patient’s Shen Que (神闕, CV8). Then again, rubbing
in a counterclockwise for three minutes, he press gen-
tly the patient’s Quan Yuan (關元, CV4) until the pa-
tient feel warm on the abdomen and his both legs.
Finally, the doctor acupress the patient’s San Yin Jiao
(三陰交, SP6) and Jian Jing (肩井, GB21) for one minute,
and press the patient's foot strongly with his thumb
at Tai Chong (太衝, LR3) and his middle finger at Yong
Quan (涌泉, KI1) about 9 times. After the therapy, the
patient usually feels a warm feeling in the abdomen,
and perceives a feeling of drowsiness.”
IV. DISCUSSION
In this review, to investigate the researches about
using tuina therapy for depression and to understand
the efficacy, we searched clinical studies related with
tuina therapy on depression at CNKI, Chinese data-
base, selected and analyzed them. According to our
criteria, by 1st screening with title and abstract and
by full text screening, lastly 41 studies remained and
examined tuina therapy for depression. As study types,
they classified into RCTs and prospective studies, and
we analyzed their contents and structure.
In contents of study, according to the content of
diseases type, they were divided into 2 categories,
studies of depression alone and studies of depression
comorbid with other conditions, and in case of the lat-
ter type, post stroke depression and postpartum de-
pression accounted a high percentage of subject. As
Ta b l e 2. Continued 2
No. 1st Author (year) Subjects Modified Jadad
Score
Diagnostic
criteria
Sample
size
Treatmen t intervention
(period)
Control
interve ntion
Outcome measures
(clinical efficacy reported)
31 Guo (2014)
44)
DEP 1/0/0/0/0 CCM D-3
ICD -10
TG:30
CG:30
CE (30 days) MED HAMD, SDS (TG
CG)
32 Xing (2014)
45)
DEP 1/0/0/0/0 CCM D-3
HAMD>20
TG:120
CG:120
CE (6 weeks) MED HAM D (TG=CG )
33 Yao (2014)
46)
DEP 1/0/0/0/0 CCM D-3
HAMD
18
TG:36
CG:36
ACU+CE (40 days) MED HAMD (TG
CG)
34 Zheng (2015)
47)
DEP 1/1/0/0/0 ICD-10
HAMD
18
TG:42
CG:41
MED+PSY+CE (2 weeks) MED+PSY HAMD (TG
CG or TG
>>
CG
by subcategory)
Heart rate (TG
>>
CG)
ACU: acupuncture, ADL: Activity of Daily Living, CCMD: Chinese Classification of Mental Disorders, CE: Conduction exercise (
導引推拿
), CG: control group, CGI: Clinical Global Impression, CUP: cupping, DEP: depression, DSM:
Diagnostic and Statistical Manual of Mental Disorders, E2: estradiol, EPDS: Edinburgh Postnatal Depression Scale, FBG: fasting blood glucose, F SH: follicle stimulating horm one, G DS: Geriatric De pression Scale, HAM D: Ham ilton
Depression Rating Scale, ICD: International Classification of Disease, LH: luteinizing hormone, KMI: Kupperman Menopausal Index, MBI : Modified Barthel Index, MED: medication, MOX: moxibustion, NIHSS: National Institutes of
Health Stroke Scale, NR: not recorded, PPD: postpartum depression, PSD: post stroke depression, PSQI: Pittsburgh Sleep Quality Index, PSY: psychotherapy, ROC: routine care, rTMS: repetitive Transcranial M agnetic Stimulation, SAS:
Self-Rating Anxiety Sca le, SAQ : Seatle Angina Questionnaire, SCM : sepa rate crite ria from medical text, SDS: Self-Rating D epres sion Scale, SERS: Rating Scale for Side Effects, SF-36: Short-Form Health Survey, TES S: Treatment
Emergent Symptom Scale, TG: treatment group, THM: traditional herbal medicine, ZXE: Zheng Xing exercise (
正形推拿
), A
B: A has significant clinical efficac y than B (p
0.05), A
>>
B: A has significant clinical efficacy than B (p
0.01), A=B: A has not s ignificant clinical effica cy than B.
CY Kwon, EJ Choi, JW Kim, SY Chung 261
Ta b l e 3. Prospective Studies of Depression Comorbid with Other Conditions
No. 1st Author (year) Subjects Diagnostic
criteria
Sample
size
Treatmen t intervention
(period)
Outcome measures
(clinical efficacy reported)
1 Fu (2009)
48)
PPD DSM-4 50 PSY+CE (1 month) HAMD, ADL (AF
>>
BE)
SF-36 (AT
BT or AT
>>
BT by
subcategory)
2 Jing (2012)
49)
PPD SCM
EPDS
13
31 ACU+ear-ACU+THM+
PSY+CE (4 weeks)
EPDS (no statistical analysis)
3 Cheng (2015)
50)
PPD SCM 50 ROC+PSY+CE (1 month) HAMD, ADL (AT
>>
BT)
4 Yu (2014)
51)
DEP with Parkinson's
disease
CCMD-3
HAMD
8
24 ROC+PSY+CE (1 month) HAMD (AT
BT)
5 Ren (2008)
52)
PSD CCMD-3 50 THM+CE (NR) NR
ACU: acupuncture, ADL: Activity of Daily Living, AT: after treatment, BT: before treatment, CCMD: Chinese Classification of Mental Disorders, CE: Conduction exercise (
引推拿
), DEP: depression, DSM: Diagnostic and Statistical Manual of Mental Disorders, EPDS: Edinburgh Postnatal Depression Scale, HAMD: Hamilton Depression
Rating Scale, NR: not recorded, PPD: postpartum depression, PSD: post stroke depression, PSY: psychotherapy, ROC: routine care, SCM: separate criteria from med ical
text, SDS: Self-Rating Depression Scale, SF-36: Short-Form Health Survey, THM: traditional herbal medicine, A
B: A has significant clinical efficacy tha n B (p
0.05),
A
>>
B: A has significant clinica l efficacy th an B (p
0.01), A =B: A has not significant clinical efficacy than B.
Ta b l e 4. Prospective Studies of Depression Comorbid with Other Conditions
No. 1st Author (year) Subjects Diagnostic
criteria
Sample
size
Treatment intervention
(period)
Outcome measures
(clinical efficacy reported)
1 Zhang (2012)
53)
DEP HAMD
18 60 PSY+exercise+CE (4 weeks) HAMD, SDS, Social fitness (AT
>>
BT)
2 Zheng (2004)
54)
Affective disorder CC MD -2-R 77 ACU+CE (6 mo nths) Symptoms (no statistic al analysis)
ACU: acupuncture, AT: after treatment, BT: before treatm ent, CCMD: Chinese Classification of Mental Disorders, CE: Conduction exercise (
導引推拿
), DEP: depression,
HAMD: Hamilton Depression Rating Scale, PSD: post stroke depression, PSY: psychotherapy, SDS: Self-Rating Depression Scale, A
B: A has significant clinical efficacy
than B (p
0.05), A
>>
B: A has significant clinical efficacy than B (p
0.01), A=B: A has not significant clinical efficacy than B.
a diagnostic criteria, most of studies used CCMD or
DSM to diagnose depressive disorder, and as a screen-
ing tool, HAMD was the most commonly used. HAMD
was also the most commonly used as a assessment tool
to assess depression symptom, whereas EPDS and PSQI
were used according to other conditions comorbid
with depression to assess other symptoms.
To investigate the effect of tuina therapy more in
detail, we classified tuina into two ways, conduction
exercise and Zheng Xing exercise. All of 39 studies de-
scribing the method of tuina therapy used conduction
exercise. Zheng Xing exercise was used in only 1 study
of depression patients with neck vertebrae disease, but
considering its subject, the method of tuina therapy on
depression is mostly conduction exercise in fact. In
case of the treatment period, frequency, and total time
required to perform tuina therapy at one time, ‘more
than 4 weeks, under 8 weeks’, ‘once per day’, and
‘more than 30minutes, under 1 hour’ were the most
commonly used, respectively.
In structure of study, many of included RCTs per-
formed common intervention for both group and addi-
tional intervention for treatment group. Among them,
as a additional intervention,tuina therapy combina-
tion with other interventions like acupuncture, tradi-
tional herbal medicine, and psychological intervention’
was the most commonly used. In case of prospective
studies, ‘tuina therapy combination with other inter-
ventions’ was used totally as a intervention.
In result of study, in order to evaluate the quality
of RCTs, modified Jadad scale was performed for 34
RCTs included in this review. And by assessing RCTs
scored more than 2 points of modified Jadad scale, 4
RCTs of depression alone, and 5 RCTs of depression
comorbid with other conditions were remained. In
case of 4 RCTs of depression alone, HAMD was used
for evaluating therapeutic effect of the intervention,
and CCMD or ICD were used for diagnosing depressive
262 Trends of Tuina Therapy on Depression and Its Efficacy -based on CNKI-
disorder in all studies. And then the combination cares
between ‘tuina therapy’ and ‘conventional treatment’
or ‘TCM therapy including tuina’ and ‘conventional
treatment’, like rTMS, drug therapy, routine psychiatric
nursing, and health education, were reported to have
a significantly better effect for depression to reduce
depressive symptoms and side effects. Among them,
Tan ( , 2001) reported that additional tuina ther-
apy on rTMS 3 times per week seems to significantly
increase the antidepressant effect of rTMS, and addi-
tional tuina therapy was particularly effective for the
initial 1 month, which can be said to have meaning
in clinical use.
In case of 5 RCTs of depression comorbid with other
conditions, Zhuang (莊子齊, 2004) reported that addi-
tional acupuncture and tuina therapy on routine drug
therapy seems to significantly reduce HAMD score and
1 year relapse rate than routine drug therapy alone.
And in other studies also, additional tuina therapy on
routine care such as counseling and rehabilitation re-
ported to significantly reduce depressive symptom
than routine care alone, when it applied to post stroke
depression, postpartum depression, and depression
with chronic kidney disease. Among them, Meng (孟慶
, 2013) reported that additional hyperbaric oxygen
and tuina therapy on routine rehabilitation care and
drug therapy seems to have significant effect on neu-
rological disturbance than routine care alone, when it
applied to post stroke depression.
Depression, by its nature, has aspects that patients
are reluctant to receive drug therapy, so nonphar-
macological treatments are often used as comple-
mentary, and they are also known to have synergtic
effect when they used with medication. Therefore its
importance in the clinical field could be considered
high. And in this respect, the clinical effects of manip-
ulative therapies through physical contact like ‘thera-
peutic touch’12), massage therapy’13) on depression
have been reported.
In particular conduction exercise therapy used in all
studies included in this review, can be used as the
form of meridian massage or acupressure in clinical
practice. These treatments, unlike typical massage ther-
apy, have an advantage to provide patient-centered
treatment based on TCM theory such as meridian and
acupoint. As described above, tuina therapy has been
recognized to be effective on depression in TCM, and
it can be applied without difficulty in the clinical field.
Therefore if the evidences supplementing the deficient
quality of these studies are accumulated through high-
quality studies, it can be considered as nonpharma-
cologic therapy for depression in Korean medicine, too.
The limitations of this study are as follows. Limita-
tion of searching method limited to CNKI, limitation
of composing detailed search strategy in Chinese, limi-
tation of Chinese clinical trials laking ethics system like
Institutional Review Board (IRB), limitation of high
quality researches scored more than 4 points of modi-
fied Jadad scale, and limitation of selecting articles in-
cluding depression patients by screening tool not diag-
nostic criteria.
However this study has meaning in terms of dealing
with the effectiveness of tuina therapy on depression
domestically for the first time. And it has a point that
we investigated the study trend, and identified the ef-
fectiveness of tuina therapy on depression by assessing
quality of RCTs. So it can be expected to be used in
the progress of developing clinical guidelines related
with depression as a data for determine the effective-
ness of tuina therapy and as a reference for design of
clinical research.
V. C O N C LU S I ON
We investigated the study trend and identified the
effectiveness of tuina on depression by searching rele-
vant articles through the Chinese database CNKI.
According to our inclusion criteria, 41 studies remained
CY Kwon, EJ Choi, JW Kim, SY Chung 263
and examined tuina therapy for depression lastly, and
the following conclusions were obtained.
1. RCTs occupied a high percentage (82.93%) among
a total of 41 articles included in this review.
2. In case of 23 RCTs of depression comorbid with
other conditions, post stroke depression was the most
frequent subject (30.43%), and postpartum depression
(21.74%) followed. And in 5 prospective studies, post-
partum depression was the most frequent subject
(60.00%).
3. Among the studies describing depressive disorder
screening tool (57.14%), HAMD was the most com-
monly used (62.50%). Among the studies describing the
assessment tool for depression symptom (95.12%),
HAMD was the most commonly used (69.23%).
4. Among the studies describing the treatment peri-
od (97.56%), ‘more than 4 weeks, under 8 weeks’ was
the most commonly used (60.00%). Among the studies
describing the frequency of tuina therapy (85.37%),
performingonce per day was the most commonly
used (71.43%). Among the studies describing the total
time required to perform tuina therapy (46.34%), ‘more
than 30 minutes, under 1 hour was the most com-
monly used (78.95%).
5. Among the studies describing the method of mas-
sage therapy (95.12%), conduction exercise was used
in all studies (100.00%), and Zheng Xing exercise was
used in only 1 study (2.56%).
6. By assessing RCTs scored more than 2 points of
modified Jadad scale, tuina therapy was reported to
have a significantly better effect for depression to re-
duce depressive symptoms than conventional treatment.
Moreover it was reported to increase the antidepres-
sant effect when tuina therapy combined with con-
ventional treatment additionally.
REFERENCES
1. World Health Organization Western Pacific Region. WHO
international standard terminologies on traditional medi-
cine in the Western pacific region. 2007:230.
2. Kwon OB, Song YK, Lim HH, Lee JS. A Review of Journals
on the spinal manipulation treatment applied to internal
disease. The Journal of Korea massage Manual Medi-
cine for Spine & Nerves. 2006;1(2):61-72.
3. Sherman KJ, Ludman EJ, Cook AJ, Hawkes RJ, Roy-
Byrne PP, Bentley S, Brooks MZ, Cherkin DC. Effective -
ness of therapeutic massage for generalized anxiety dis-
order: a randomized controlled trial. Depress Anxiety.
2010;27(5):441-50.
4. Coelho HF, Boddy K, Ernst E. Massage therapy for the
treatment of depression: a systematic review. Int J Clin
Pract. 2008;62(2):325-33.
5. Oliveira DS, Hachul H, Goto V, Tufik S, Bittencourt LR.
Effect of therapeutic massage on insomnia and climac-
teric symptoms in postmenopausal women. Climacteric.
2012;15(1):21-9.
6. Lim SW, Shin EH. Non-Pharmacological Treatm ent for
Depression in Primary Care. Korean J Fam Pract. 2012;
2:30-5.
7. Karp JF, Buysse DJ, Houck PR, Cherry C, Kupfer DJ,
Frank E. Relationship of variability in residual symptoms
with recurrence of major depressive disorder during
maintenance treatment. Am J Psychiatry. 2004;161:
1877-84.
8. Kang HC, Lee SG. The Trends in Clinical Trials about
Effects of Acupuncture on Anxiety, Depression and Mental
Stress - In Medline, Pubmedcentral & Oriental Medicine
Journal since 2004 -. J. of Oriental Neuropsychiatry.
2009;20(4):137-48.
9. Park BG. Effects of an Acupuncture Program on Activities
of Daily Living, Depression, and Life Satisfaction in the
Institutionalized Elderly People. J. of Welfare for the Aged.
2008;40:249-86.
10. White AR, Ernst E. A systematic review of randomized
controlled trials of acupuncture for neck pain. Rheuma-
tology (Oxford). 1999;38(2):143-7.
11. Dept. of Rehabilitation Medicine in College of Korean Me-
dicine in Nation. Oriental Rehabilitation medicine. Seoul:
Seowondang. 1995:273.
12. Marta IE , Baldan S S, Berton AF, Pavam M, da Silva MJ.
The effectiveness of therapeutic touch on pain, depres-
sion and sleep in patients with chronic pain: clinical trial.
Rev Esc Enferm USP. 2010;44(4):1100-6.
13. Poland RE, Gertsik L, Favreau JT, Smith SI, Mirocha JM,
Rao U, Daar ES. Open-label, randomized, parallel-group
controlled clinical trial of massage for treatment of de-
pression in HIV-infected subjects. J Altern Complement
Med. 2013;19(4):334-40.
14. Zhai H, X ian g B, H an C. T he meridians a cupun ctu re in th e
treatment of senile depression. Journal of Changchun
University of Traditional C hinese Medicine. 2014;30(6):
1118-9.
264 Trends of Tuina Therapy on Depression and Its Efficacy -based on CNKI-
15. Jiang N, Hu HF, Jiang Y. Clinical study of reminiscence
therapy combined with acupoints massage for commun-
ity of empty nest elderly with depressive symptom. Chinese
Journal of Gerontology. 2014;10(34):5893-4. (the title
was translated from '
懷舊治療配合穴位按摩對社區空巢老
人抑鬱症狀的影響
')
16. Cuo QF, Li CP, Zhang YH. Clinical study of comprehensive
treatment for diabetic patients with depression and
anxiety. Journal of Practical Traditional Chinese Medicine.
2009;25(11):723-4. (the title was translated from '
綜合治
療糖尿病伴抑鬱焦慮療效觀察
')
17. Zhang YH. 34 cases of acupoints massage nursing for
end stage renal disease with depressive disorder. Jour-
nal of Bengbu Medical College. 2010;35(9):968-9. (the ti-
tle was translated from '
穴位按摩改善終末期腎病合
抑鬱
34
例護理觀察
')
18. Tan J, Pei YH, Wu YF. Clinical study of Chinese medicine
combined internal and external treatment for depression
with neck vertebrae disease. Shanxi Medical University,
Master's thesis of Integrated Traditional and Western
Medicine. 2013. (the title was translated from '
中醫內外結
合治療抑鬱發作伴頸椎病臨床療效觀察
')
19. Xi XD. The Clinical Study about the Effect of Massage with
Ointment on Curing Depression Sleep Disorder. Shan-
dong University of Traditional Chinese Medicine, Master's
thesis of Acupuncture and Moxibustion and Tuina of
Chinese medicine. 2006.
20. Wang XD. The Effect of Soothing the Liver Stagnation in
the Treatment to Insomnia. ChangChun University of
Chinese Medicine, Master's thesis of Acupuncture and
Moxibustion and Tuina of Chinese medicine. 2012.
21. Zhuang ZJ, Wang CR. Treatment of poststroke depres-
sion by “Zhisanzhen” combined with digital point pres -
sure and massage. Chinese Acupuncture & Moxibustion.
2004;24(11):800-2.
22. Xiao H, Zhang GQ, Wang L, Bao QH. Clinical study of
emotional nursing combined with acupoints massage for
stroke patients with depression. Chinese Journal of
Nursing. 2008;43(1):77-9.
23. Zhao JW, Xu F, Zhao HJ. A study on combined reha-
bilitation in treating cerebral stroke complicated with de-
pression in elderly patients. Chinese Journal of Conva-
lescent Medicine. 2010;19(8):691-2.
24. Meng QF, Chen QH, Liang T, Sun SS. Curative effect of hy-
perbaric oxygen with massage and Citalopram to treat
post-stroke depression. Chinese Journal of Convales-
cent Medicine. 2013;22(4):393-4.
25. Xaio BY, Cai XY. Clinical study of relaxation therapy com -
bined with acupoints massage for post stroke depres-
sion. Chinese Journal of Integrative M edicine on Cardio-/
Cerebrovascular Disease. 2013;11(5):639-40. (the title
was translated from '
穴位按摩及放松療法對腦卒中抑鬱患
者的治療作用
')
26. Liang CN, Pan LP. Clinical study of nursing with psycho -
therapy based on traditional Chinese medicine for post
stroke depression. Hainan Medical Journal. 2013;24(17):
2637-8. (the title was translated from '
傳統心理療法在中風
後抑鬱患者護理中應用的效果觀察
')
27. Du F, Liao XM. The effects of traditional Chinese medicine
mental nursing on the quality of life for post stroke
depression. Hebei Journal of Traditional Chinese Medi-
cine. 2015;37(5):773-4. (the title was translated from '
中醫
情志護理對卒中後抑鬱患者生活質量的影響
')
28. Huang L , Chen Y, Luo Z, He H, Liu W, Liao S, Yu F, Zhao
Hn, Cai L . Effect of aromatherapy m assage during puer-
perium on postpartum depression. Journal of Nursing
Science. 2011;26(12):40-1.
29. Yang YQ. Clinical study of burying seeds on ear points
combined with acupoints massage for postpartum de-
pression. The Journal of M edical Theory and Practice.
2012;25(18):2284. (the title was translated from '
耳穴埋
加穴位按摩輔助治療
後抑鬱症的臨床觀察
')
30. Liao SL, Huang LY, Luo Z, Zhao HL, Lu HN, Peng DS.
Clinical study of aromatherapy massage for postpartum
depression. Heilongjiang Medical Journal. 2012;36(6):
462-3. (the title was translated from '
香薰按摩減輕
後抑
鬱症的臨床應用
')
31. Ren FF, Liu M, Wang Y. Evaluation of effect of massage
therapy on patients with postpartum depression. Mater-
nal and Child Health Care of China. 2013;28:2692.
32. Qiu YL . The influence of psychological nursing interven -
tion combined with massage on postpartum depression
of patients. Journal of Clinical Medicine in Practice. 2015;
19(2):77-8.
33. Zheng SH, Qu YJ, Jiao JK, Wei LL, Ren R, Cui X. Obser-
vation of depression in peri-menopausal period treated
by combination of manipulative therapy and medication.
Hebei Journal of Traditional Chinese Medicine. 2010;
32(8):1208-9.
34. Xu JM, Wang W, Zhu SM, Zhou UY, Lian ZM . Application
of silence method com bined with massage in co-morbid
anxiety and depression for patients with acute myocar-
dial infarctio Nursing and Rehabilitation Journal. 2012;
11(7):607-9.
35. Fang GZ. Influence of acupoint massage, auricular-plas-
ter therapy combined with emotional nursing on depres-
sion in patients with cirrhosis ascites. China Modern
Medicine. 2013;20(29):123-6.
36. Zhu W, Yang YY, Jiang ZY, Song FY, Wang LE, Ji B. Effects
of Sedative Care on Maintenance Hemodialysis Patients
with Depressive Insomnia Status. Nurs J Chin PLA.
2014:31(9):39-42.
37. Yuan MH, Li GS. Curative effect of acupoints massage for
depression. Medical Journal of Chinese People’s Health.
2007;19(3):226-8. (the title was translated from '
穴位按摩
對抑鬱症患者康複療效的觀察
')
38. Zhang J, Chen Z. Controlled Clinical Trials on Treatment
of Depression with Tuina or Deanxit. J. Acupunct. Tuina.
CY Kwon, EJ Choi, JW Kim, SY Chung 265
Sci. 2009;7:207-9.
39. Wang SH, Yang LX, Cui X. The effects of electro-acu -
puncture combined with facial massage for depression.
Journal of Emergency in Traditional Chinese Medicine.
2009;18(1):41-2, 48. (the title was translated from '
電針結
合頭面部圍剿按摩對抑鬱症細胞因子的影響
')
40. Tan YF. Clinical study of therapeutic manipulation for
soothing the liver, fortifying the spleen and making free
the collateral vessels for mild depression. Beijing Univer-
sity of Chinese Medicine, Master's thesis of Acupuncture
and Moxibustion and Tuina of Chinese medicine. 2011.
(the title was translated from '
疏肝健脾通絡手法治療輕度
抑鬱症的臨床療效觀察
')
41. Tan T, Wang JG, Sun Q. Clinical Observation of Therapy of
Integrated Traditional Chinese and Western Medicine on
Depressive Disorder. Shanxi Journal of Traditional Chinese
Medicine. 2012;28(9):16-8.
42. Yang DH, Tan YF, Cheng YZ. 36 cases of acupuncture
combined with facial massage for depression with the
pattern of liver depression and qi stagnation. Journal of
Changchun University of Traditional C hinese M edicine.
2012;28(6):1074. (the title was translated from '
針刺配合
頭面部推拿治療肝鬱氣滯型抑鬱症
36
')
43. Gu JY, Cheng JP. 30 cases of supportive traditional Chinese
life nurturing for depression. Journal of Traditional Chinese
Medicine. 2013;54(14):1235-6. (the title was translated
from '
中醫養生療法輔助治療抑鬱症
30
')
44. Guo ZM, Wang DY, Li YH, Xiao YQ, Guo SD. Efficacy of the
Three Part Massage on Depression: A Clinical Observa-
tion of 30 Cases. Guiding Journal of Traditional Chinese
Medicine and Pharmacy. 2014;20(8):100-2.
45. Xing K, Ai M. 120 cases of massage for nourishing the
heart to tranquilize and soothing the liver for depression.
China Journal of Pharmaceutical Economics. 2014;87-8.
(the title was translated from '
養心安神疏肝推拿法治療抑
鬱症
120
例療效觀察
')
46. Yao CL. Clinical study on acupuncture with head and fa-
cial massage on the treatment of Liver depression and qi
stagnation type depression. Changchun University of
Traditional Chinese Medicine, Master's thesis of Acu-
puncture and Moxibustion and Tuina of Chinese medi-
cine. 2014.
47. Zheng BQ, Zhu XY, Jin BB, Lv HF. Effect of point massage
on rehabilitation of inpatients with depression. Nursing
and Rehabilitation Journal. 2015;14(6):506-8.
48. Fu YZ. Effect of emotional nursing com bined with point
massage on rehabilitation of patients with postpartum
depression. Nursing and Rehabilitation Journal. 2009;
8(6):463-5.
49. Jing LJ. Empirical study of comprehensive therapy in tra -
ditional Chinese medicine for postpartum depression.
Clinical Journal of Chinese Medicine. 2012;4(12):75. (the
title was translated from '
中醫綜合療法治療
後抑鬱體會
')
50. Cheng SM, Ai CQ. Clinical study of massage nursing
combined with psychotherapy for postpartum depression.
Guiding Journal of Traditional Chinese Medicine and
Pharmacy. 2015;7:100-2. (the title was translated from '
摩護理和心理療法治療
褥期抑鬱症患者的臨床觀察
')
51. Yu LJ. Clinical study of traditional Chinese m edicine nurs-
ing for Parkinson's diseases with depression. Guang-
ming Journal of Chinese Medicine. 2014;29(4):823-4.
(the title was translated from '
金森病伴抑鬱的中醫護理
觀察
')
52. Ren XY, Jia Q. Clinical study of traditional herbal medicine
combined with massage for post stroke depression.
Shanxi Journal of Traditional C hinese M edicine. 2008;
24:37-8. (the title was translated from '
中藥配合推拿治療
中風後抑鬱療效觀察
')
53. Zhang WG, Shan SQ, Zheng SF, Hou FQ, Xue BL, Zhou
XF, Yu L . Study on combining traditional Chinese mas -
sage with exercise and psychological intervention to in-
crease the social fitness among patients with depressive
disorder. Chinese Journal of Convalescent Medicine.
2012;21(1):1-3.
54. Zheng MF. Curative effect of integrated shallow insertion
and Chinese massage in treating affective disorders:
analysis of the effect on 77 cases. Chinese Journal of
Clinical Rehabilitation. 2004;8(30):6674-5.
ResearchGate has not been able to resolve any citations for this publication.
Article
Full-text available
This research aimed to check the effectiveness of Therapeutic Touch on decreased pain intensity, depression self-assessment scores and improved sleep quality. A clinical before-after trial is presented. The study was carried out at a Basic Health Unit in Fernandópolis, SP-Brazil, involving 30 elderly patients with chronic non-oncologic pain who received 8 sessions of Therapeutic Touch in accordance with the Krieger-Kunz method. The Visual Analogue Scale for pain was applied before and after each session, and Beck Depression Inventory and the Pittsburgh Sleep Quality Index before the first and after the last session. Data analysis showed a significant decrease (p < 0.05) in pain intensity, depression self-assessment scores and the sleep quality index. It is concluded that the Therapeutic Touch was effective to decrease pain intensity and depressive attitudes and symptoms, as well as to improve sleep quality.
Article
Full-text available
To establish whether there is evidence for or against the efficacy of acupuncture in the treatment of neck pain. A systematic literature review was undertaken of studies that compared needle or laser acupuncture with a control procedure for the treatment of neck pain. Two reviewers independently extracted data concerning study methods, quality and outcome. Overall, the outcomes of 14 randomized controlled trials were equally balanced between positive and negative. Acupuncture was superior to waiting-list in one study, and either equal or superior to physiotherapy in three studies. Needle acupuncture was not superior to indistinguishable sham control in four out of five studies. Of the eight high-quality trials, five were negative. In conclusion, the hypothesis that acupuncture is efficacious in the treatment of neck pain is not based on the available evidence from sound clinical trials. Further studies are justified.
Article
Objectives: The study objectives were to determine whether massage therapy reduces symptoms of depression in subjects with human immunodeficiency virus (HIV) disease. Design: Subjects were randomized non-blinded into one of three parallel groups to receive Swedish massage or to one of two control groups, touch or no intervention for eight weeks. Settings/location: The study was conducted at the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai Medical Center in Los Angeles, California, which provided primary clinical care in an institutional setting. Subjects: Study inclusion required being at least 16 years of age, HIV-seropositive, with a diagnosis of major depressive disorder. Subjects had to be on a stable neuropsychiatric, analgesic, and antiretroviral regimen for >30 days with no plans to modify therapy for the duration of the study. Approximately 40% of the subjects were currently taking antidepressants. All subjects were medically stable. Fifty-four (54) subjects were randomized, 50 completed at least 1 week (intent-to-treat; ITT), and 37 completed the study (completers). Interventions: Swedish massage and touch subjects visited the massage therapist for 1 hour twice per week. The touch group had a massage therapist place both hands on the subject with slight pressure, but no massage, in a uniform distribution in the same pattern used for the massage subjects. Outcome measures: The primary outcome measure was the Hamilton Rating Scale for Depression score, with the secondary outcome measure being the Beck Depression Inventory. Results: For both the ITT and completers analyses, massage significantly reduced the severity of depression beginning at week 4 (p ≤ 0.04) and continuing at weeks 6 (p ≤ 0.03) and 8 (p ≤ 0.005) compared to no intervention and/or touch. Conclusions: The results indicate that massage therapy can reduce symptoms of depression in subjects with HIV disease. The durability of the response, optimal "dose" of massage, and mechanisms by which massage exerts its antidepressant effects remain to be determined.
Article
Objective To observe the clinical efficacy of tuina in treating depression. Method Eighty depression cases that conformed to the inclusive criteria were randomized into tuina and Deanxit group, with 40 cases in each group. Tuina manipulations were adopted for cases in the tuina group, 30 min for each treatment. While 2 Deanxit tablets were adopted for cases in the Deanxit group, twice a day. The clinical efficacy of the two groups was evaluated by using Hamilton Rating Scale for Depression (HAMD) before treatment and the 2nd, 4th and 6th weeks after. In addition, the Treatment Emergent Symptom Scale (TESS) was adopted to evaluate the adverse reactions in the two groups. Result Both tuina and Deanxit can help to relieve the symptoms of depression patients. The effective rate of tuina and Deanxit were 72.5% and 70.0% respectively. However, there were no adverse reactions in tuina group, while 12.5% of adverse reaction rate occurred in the Deanxit group. Conclusion Tuina can definitely benefit patients with depression and cause no adverse reactions.
Article
Physiological and psychological alterations in the climacteric period frequently influence women's quality of life. Hot flushes, nocturia, mood alterations, respiratory disturbances, insomnia and restless leg syndrome all affect sleep, and the altered hormonal state in this period impacts the aging process. As hormonal therapy is not indicated in some cases, the search for complementary therapies, such as massage therapy, to improve insomnia in the climacteric period is increasing. To evaluate the effect of therapeutic massage on insomnia and climacteric symptoms in postmenopausal women. Forty-four volunteers were randomly distributed into three groups: therapeutic massage (TM), passive movement (PM) and control (CTL). The women received 32 therapeutic massage sessions and passive movement twice a week. Questionnaires were given in the pre-trial and the 16th and 32nd sessions. The Insomnia Severity Index (ISI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Menopause Quality of Life questionnaire (MENQOL), Kupperman Menopausal Index and Lipp Symptoms of Stress Inventory were assessed. In addition, the women underwent polysomnography at baseline and post-treatment. Statistical analyses were calculated using Friedman and Wilcoxon non-parametric tests. The level of significance was fixed at p ≤ 0.05. There was an improvement in ISI in the TM group (p = 0.000) and in the PM group (p = 0.001). A decrease in the BDI occurred in the TM group (p = 0.004), and the MENQOL improved in the TM group (p = 0.015). Furthermore, there were no significant differences in polysomnography parameters in the TM group, with only an increase in minimal saturation (p = 0.053). The TM group exhibited improved subjective data considering the changes in symptoms according to the ISI and the MENQOL and a decrease in symptoms according to the BDI.
Article
Although massage is one of the most popular complementary and alternative medical (CAM) treatments for anxiety, its effectiveness has never been rigorously evaluated for a diagnosed anxiety disorder. This study evaluates the effectiveness of therapeutic massage for persons with generalized anxiety disorder (GAD). Sixty-eight persons with GAD were randomized to therapeutic massage (n=23), thermotherapy (n=22), or relaxing room therapy (n=23) for a total of 10 sessions over 12 weeks. Mean reduction in anxiety was measured by the Hamilton Anxiety Rating Scale (HARS). Secondary outcomes included 50% reduction in HARS and symptom resolution of GAD, changes in depressive symptoms (Patient Health Questionnaire (PHQ-8)), worry and GAD-related disability. We compared changes in these outcomes in the massage and control groups posttreatment and at 6 months using generalized estimating equation (GEE) regression. All groups had improved by the end of treatment (adjusted mean change scores for the HARS ranged from -10.0 to -13.0; P<.001) and maintained their gains at the 26-week followup. No differences were seen between groups (P=.39). Symptom reduction and resolution of GAD, depressive symptoms, worry and disability showed similar patterns. Massage was not superior to the control treatments, and all showed some clinically important improvements, likely due to some beneficial but generalized relaxation response. Because the relaxing room treatment is substantially less expensive than the other treatments, a similar treatment packaged in a clinically credible manner might be the most cost effective option for persons with GAD who want to try relaxation-oriented CAM therapies.
Article
To investigate how residual symptoms from an index episode of major depressive disorder may be associated with recurrence, the authors conducted a trial involving four maintenance treatment approaches and examined 1) whether the level and variability of residual symptoms differed among the maintenance treatment conditions and 2) whether greater symptom variability is associated with a higher likelihood of recurrence and more rapid recurrence. Patients enrolled in a maintenance treatment study (N=114) were randomly assigned to one of four maintenance treatment conditions: imipramine plus interpersonal psychotherapy, imipramine alone, interpersonal psychotherapy alone, or no active treatment. Residual symptoms were characterized both as continuous variables (mean values and coefficients of variation for Hamilton Depression Rating Scale and Global Assessment Scale [GAS] scores) and as a categorical variable, the percentage of maintenance evaluations with a Hamilton depression scale score > or =8 (e.g., with a symptom peak). Analysis of variance revealed no differences among the four treatment conditions in patients' levels of residual symptoms or symptom variability assessed as a continuous variable, but patients in the combined treatment group had fewer symptom peaks, compared to those in the placebo and interpersonal psychotherapy groups. Cox proportional hazards modeling showed that higher coefficients of variation for both the Hamilton depression scale and the GAS scores and a greater percentage of evaluations with symptom peaks were associated with shorter survival times. A higher level of symptom variability during maintenance treatment is associated with higher risk for recurrence of depression and may provide a specific target for maintenance treatments.
Article
People with depressive disorders or subsyndromal symptoms of depression (SSD) often use complementary and alternative therapies, including massage therapy (MT). This systematic review evaluates the evidence, from randomised clinical trials (RCTs), for the effectiveness of multiple sessions of classical European (Swedish) MT for the treatment of depression. Eligible RCTs were identified via eight electronic databases and manual searches of references. Two reviewers independently selected trials, assessed trial quality and extracted data. Four RCTs met our inclusion criteria. Three of these RCTs compared MT with relaxation therapies, but provided insufficient data and analyses to contribute meaningfully to the evaluation of MT for depression. The fourth included RCT used MT as a control condition to evaluate a depression-specific acupuncture treatment. This trial provided limited evidence that, in the early stages of treatment, MT is less effective than acupuncture for treating depression, a treatment which itself is not accepted for this condition. Despite previous research suggesting that MT may be an effective treatment for depression, there is currently a lack of evidence to support this assertion from RCTs that have selected participants for depression or SSD.
Non-Pharmacological Treatment for Depression in Primary Care
  • S W Lim
  • E H Shin
Lim SW, Shin EH. Non-Pharmacological Treatment for Depression in Primary Care. Korean J Fam Pract. 2012; 2:30-5.