Progress of Traditional Chinese Medicine in the Treatment of Post-stroke Depression

Shanbei ZHONG

Luchuan County Hospital of Traditional Chinese Medicine, Luchuan 537700, China

Abstract The patients with post-stroke depression often form a negative evaluation of themselves, and even have the idea of suicide in serious cases. Therefore, post-stroke depression has become one of the most common complications of mental illness after stroke, which seriously hinders the normal rehabilitation of the central nervous system, thus increasing the disability rate, early recurrence rate and mortality rate of patients. Therefore, the active treatment of post-stroke depression is very necessary. Western medicine uses antidepressant drugs for this kind of patients, but because the side effects of antidepressants are relatively large, the compliance of patients is not good, it is not easy to see the effect, while traditional Chinese medicine (TCM) has many ways to deal with post-stroke depression with obvious advantages, the side effects are relatively small, and there is more compliance in patients. This paper focuses on several TCM treatment methods, hoping to provide a reference for the treatment of post-stroke depression.

Key words Post-stroke depression, TCM treatment, Clinical progress

1 Introduction

Post-stroke depression (PSD) is a kind of clinical syndrome accompanied by low social emotion, lack of interests and hobbies, including sleep disorders, decreased appetite, decreased libido and other physical manifestations after brain death[1]. It is one of the most common complications in cerebrovascular diseases. The early clinical manifestations of patients mainly include abnormal anxiety, depressed mood, loss of appetite, decreased ability of speech communication, sleep disorder, mental retardation, low energy, early awakening, lack of concentration, lack of confidence in themselves, and so on. Serious cases can also form physical symptoms such as retardation, and even form a tendency to commit suicide or show weariness of the world[2]. Epidemiological studies have shown that the prevalence of depression five years after stroke is as high as 33.3%[3]. At present, the clinical treatment of post-stroke depression has made great progress, but a large quantity of clinical research data show that traditional Chinese medicine has advantages in the treatment of post-stroke depression, so this article reviews the progress of traditional Chinese medicine in the treatment of post-stroke depression.

2 Etiology and pathogenesis of post-stroke depression

The clinical name of post-stroke depression has never existed in the ancient literature of China, and it falls within the type of "depression disease" in traditional Chinese medicine. Some scholars believe that it is a combination of "stroke" and "depression syndrome"[4], which is caused by meridian stagnation, stagnation of qi and blood, loss of nourishment of heart and liver on the basis of apoplexy, resulting in depression-related low spirits. The location of the lesion is mainly in the brain, and it also involves the heart, liver, spleen and kidney. The imbalance of viscera, yin and yang, and the disorder of qi and blood in meridians, lead to failure of liver to convey and disperse. The loss of heart, spleen and kidney essence is the main pathogenesis of this kind of disease.

3 TCM treatment of post-stroke depression

3.1 Massage treatmentMassage treatment can also be called naprapathy, and it can play the effect of relaxing muscles and activating collaterals, awakening brain and opening orifices, broadening chest and regulating qi and relaxing body and mind. Jin Jinetal.[5]studied the massage treatment of post-stroke depression by introducing yang into yin. Massage method: before going to bed every night, the patient lies flat on the bed, and the operator sits on the side of the patient’s head. Massage therapy is carried out in the following order: massage on Tianmen point, push Kangong point, knead Dayang point, press Baihui point, push Fengchi point and press Anmian point, push Lianquan point and press Chengjiang point. The above steps are repeated for 3-4 cycles, and it is pushed for 30-50 times in each step. Once a night, 20-25 min each time. The curative effect was re-evaluated after four weeks, and the results showed that the method of introducing yang into yin for massage could improve the insomnia of patients after stroke, thus reducing the bad mood of anxiety and depression of patients. Tao Jimingetal.[6]conducted a control study of two groups. The control group was treated with routine medication and psychological support therapy, while the treatment group was treated with massage with ointment on the basis of routine treatment in the control group. The treatment period was two weeks. The scores of Hamilton Depression Scale (HAMD), Modified Barthe Index (MBI), Mini Mental Status Exam (MMSE) and Treatment Emergent Symptom Scale (TESS) were compared between the two groups before and after intervention treatment. The degree of depression, life and learning ability, cognitive ability and emotional stability of the two groups were evaluated. By comparison, it was concluded that massage with ointment could significantly reduce the depression score of PSD patients, improve the ability of daily activities, and the treatment safety was better, so it was a recommended method for PSD treatment.

3.2 Acupuncture treatmentAcupuncture is the most commonly used measure to treat diseases in traditional Chinese medicine. Acupuncture can dredge meridians and collaterals and reconcile yin and yang. Wang Xianetal.[7]found that Tongduzhiyu Acupuncture could reduce the damage to brain function, dilate cerebral vessels and increase cerebral blood flow in patients with stroke, and could significantly increase the levels of serum 5-HT, DA and BDNF and decrease the level of NSE in patients with post-stroke depression, and effectively change the state of depression and anxiety in patients with post-stroke depression, thus reducing the defect of cerebral nerves. Wang Jingxinetal.[8]compared paroxetine treatment group with paroxetine plus acupuncture treatment group. It was found that the level of 5-HT in paroxetine plus acupuncture treatment group was significantly higher than that in paroxetine treatment group, but the levels of II-1 and Hy were significantly lower than those in paroxetine treatment group. The difference was statistically significant. Therefore, it was concluded that paroxetine plus acupuncture could effectively improve the depression status of patients with depression after stroke, and could increase the level of 5-HT and significantly reduce the level of II-1. Acupuncture treatment of PSD has obvious effect, which can not only improve the symptoms of anxiety and depression, but also promote the recovery of nerve defect function, improve the ability of daily life, reduce the adverse reactions of antidepressants and improve the confidence and compliance of patients[9].

3.3 Traditional Chinese medicine treatmentIn traditional Chinese medicine, it is believed that the emergence of PSD is related to stagnation of liver fire, stagnation of qi and blood, emotional disorders, or loss of liver essence, wind-fire and phlegm stasis, resulting in brain nutrient loss. It is the combination of "depression syndrome" and "stroke". In prevention, we should not only pay attention to soothing the liver, relieving qi and relieving depression, but also pay attention to phlegm and blood stasis after stroke. On the basis of psychotherapy and SSRI therapy, Li Qinglietal.[11]administered Jieyu Tongluo decoction (composed ofBupleurum,R.PaeoniaeAlba,F.Aurantii,A.calamus,A.macrocephala, common turmeric,P.tenuifolia,A.cumBile,P.cocos,P.ternata, the root of herbaceous peony,L.wallichii, safflower, earthworm, peach kernel, lily, licorice,etc.) to PSD patients. This could further reduce the severity of depression, effectively alleviate the symptoms of depression, regulate the expression of neurotransmitters, promote the normal repair of brain nerve tissue, reduce the defect of central nervous system and improve the activities of daily life. Gu Cuiyingetal.[12]routinely treated stroke in all patients with PSD, and simultaneously carried out psychological counseling and functional exercises of language and limbs. The control group was given antidepressant paroxetine hydrochloride tablets, and the treatment group was basically given self-made traditional Chinese medicine decoction on the basis of the treatment in the control group. The prescription was composed of more than 20 kinds of traditional Chinese medicine, including ginkgo biloba, turmeric,R.PinellinaePraeparata,Bupleurum,R.Astragali,L.wallichiig,A.gramineus,S.miltiorrhiza,A.sinensis,A.senticosus,C.PolygoniMultiflori, seed of wild jujube, andP.cocos. Four weeks later, it was found that the depression state and daily activity ability of PSD patients treated with paroxetine hydrochloride were improved, the adverse reactions of paroxetine hydrochloride were reduced, and the effect was significantly higher than that of paroxetine hydrochloride alone. Liang Guolongetal.[13]used the method of soothing the liver and invigorating the spleen (Chaihu Shugan Powder and Guipi decoction) and amitriptyline tablets to treat patients with post-stroke depression, and compared it with the single amitriptyline group, with the observation period of 8 weeks. Through the comparison of the scores of HAMD before and after 8 weeks of treatment, it was found that the curative effect of the traditional Chinese medicine group was better than that of the amitriptyline group, and it was concluded that the method of soothing the liver and invigorating the spleen could effectively improve the depressive symptoms of the patients and reduce the side effects of amitriptyline tablets. Therefore, traditional Chinese medicine is effective in the treatment of post-stroke depression, and traditional decoction is also easy to accept.

3.4 Traditional exercisesThere are many traditional exercises methods in China, such as Taiji, Baduanjin, and Wuqinxi. Chinese traditional fitness methods can play the effect of regulating body and mind and health care. For example, Cheng Zhiqingetal.[14]found that Taijiquan exercise for middle-aged and elderly patients can adjust their bad emotions, so as to help improve the level of mental health and improve their thoughts and emotions, improve their own concept and self-confidence, especially for the regulation of the mental state, cardiopulmonary function and mental state of the middle-aged and elderly people. Zhao Binetal.[15]selected 60 patients with post-stroke depression for grouping. One group of patients received traditional rehabilitation treatment, the other group received simple Taijiquan exercise under the guidance of professional teachers. The results showed that compared with the control group, the symptoms of post-stroke depression were significantly improved for the patients who received Taijiquan exercise, and the motion balance function of patients could be improved at the same time. Liu Xiaoyuetal.[16]found that the eight patterns of Baduanjin corresponded to meridians and collaterals, which could regulate organs, meridians, qi, blood, yin and yang, and make the body and mind peaceful. Through the comparative study of the observation group and the control group, it was confirmed that Baduanjin could significantly improve the symptoms of post-stroke depression, and at the same time, it could improve the symptoms caused by cerebral nerve function damage, and could improve the ability of balanced movement. Through the comparative study of two groups, Du Jingetal.[17]concluded that the sitting-horizontal exercises method could improve the HAMD score of patients with post-stroke depression. The mechanism is that the sitting-horizontal traditional exercise can regulate the function of organs, relax qi, improve the condition of meridian qi and blood stasis, and improve cerebral ischemia and hypoxia. At the same time, it can calm the mind, soothe the liver and relieve depression, and improve patients’ negative emotions such as depression and anxiety. Therefore, the traditional exercises methods for stroke patients can not only improve the motion strength and limb function and then adjust the psychological conditions, but also help to adjust the autonomic nerves of the body and alleviate the clinical symptoms of patients with post-stroke depression.

3.5 Emotional interventionTraditional Chinese medicine attaches great importance to the intervention and adjustment of psychological state, especially pays special attention to the regulation and guidance of patients’ emotional state, often using psychological therapy, reasoning and guidance, psychological suggestion and calming mind and other ways for the diagnosis and treatment of various mental diseases. All the PSD patients selected by Wang Qi[18]in her research data had a history of cerebral infarction for one year and were hospitalized recently because of a new cerebral infarction. The patient’s mental state was good, occasionally showing signs of forced crying and laughter. After entering the hospital, on the basis of routine rehabilitation treatment combined with emotional intervention of traditional Chinese medicine, attention was paid to patients’ emotional changes and good communication with patients was maintained. When patients had mood swings, the medical staff provided them with language guidance in a timely manner. Health care workers helped patients play soothing music on time every day, and patients were in a good mood and stable after receiving emotional intervention for a period of time. Zheng Rongfangetal.[19]divided nearly 60 patients with PSD into two groups. The treatment group was given TCM psychological care, while the control group was given routine psychological care. Finally, the study found that the timely use of TCM psychological care intervention for patients with depression after stroke could effectively improve the depression status of patients, so as to improve the ability of daily life and quality. Therefore, for patients with post-stroke depression, TCM emotional intervention as early as possible can effectively improve the degree of depression.

3.6 Five-element music therapyThe traditional five-element music therapy is the combination of the five elements of traditional Chinese medicine and music. The five tones (Gong, Shang, Jiao, Zhi, Yu) correspond to the five internal organs (liver, heart, spleen, lung, kidney) and five minds (anger, joy, thought, sadness, fear). They can form a unified relationship to affect people’s mood, regulate the balance of yin and yang, and improve the function of internal organs and viscera, so as to achieve the effect of disease prevention and treatment[20]. Through the study of 90 patients with PSD, Sun Ruilietal.[21]found that the application of five-element music therapy combined with psychotherapy could improve the anxiety and depression of patients with post-stroke depression, so as to balance the patient’s body and psychology, improve the patient’s enthusiasm and activity, and enhance the patient’s physical ability. Lin Yi[22]divided 90 inpatients with ischemic post-stroke depression (all with liver-qi stagnation) into two groups for comparative observation. It was found that Jiao in five-element music could significantly improve the anxiety and depression state of patients with post-stroke depression (liver-qi stagnation type), effectively improve the quality of life of patients and promote the recovery of neurological impairment. Therefore, the five-element music therapy can not only improve the psychological and physical symptoms of patients with post-stroke depression, improve their activity and enthusiasm, but also make it easy for the operators to implement because they are free from the pain from acupuncture and medicine, so the patients have strong compliance, and it has a good prospect in the rehabilitation of physical and mental health of patients with post-stroke depression[23].

4 Conclusions

PSD has been the most important factor that hinders the normal survival ability and central nervous system rehabilitation of patients with stroke. The earlier the occurrence of depression, the greater the damage to the rehabilitation of the central nervous system, and the higher the mortality degree of the patients. After the occurrence of PSD, due to the lack of confidence in the rehabilitation process of the disease, patients form negative feelings of depression such as pessimism and negativity in daily life, and even can not participate in social activities normally. Therefore, in view of the repeatability, harmfulness and long-term characteristics of PSD, timely and reasonable treatment must be carried out for PSD patients in clinic. In particular, it is necessary to closely follow the patients psychologically. For PSD patients, not only drug treatment is necessary, but also doctors are advised to carry out comprehensive intervention for patients. Antidepressant therapy can effectively alleviate the clinical symptoms of PSD patients, and help to promote the recovery of neurological function and normal living ability of patients. After the normal living ability of patients is improved, their self-confidence will be improved, and their satisfaction with life will be improved, thus improving psychological symptoms such as depression. In the aspect of traditional Chinese medicine, the treatment of PSD is unique compared with Western medicine, because the cost of traditional Chinese medicine is relatively low, the toxic and side effects are relatively small, and the therapeutic effect is relatively good. It can also help patients recover the function of central nervous system on the basis of improving the degree of depressive symptoms. However, at present, there are still some problems in the prevention and treatment of PSD in traditional Chinese medicine, the TCM mechanism and syndrome differentiation of post-stroke depression are not very clear. At present, the traditional treatment of post-stroke depression is only limited to a small sample test, and we need to increase the sample data and do more research. Traditional Chinese medicine has the idea of preventive treatment of disease, so it is hoped that scholars can find a way of prevention and treatment, which will help to intervene in the emergence of post-stroke depression. To sum up, it is an irreplaceable medical measure for patients with post-stroke depression to receive traditional Chinese medicine treatment, and it must be used in clinical practice to help change the depression status of patients and improve the quality of life of patients with post-stroke depression, further improve the patients’ ability of work and life, and help the patients return to the family and society as soon as possible.