Traditional Chinese Medicine in the Management of Anxiety Disorders: A Narrative Review of Theoretical Foundations, Clinical Applications, and Modern Integrative Approaches

Abstract

Anxiety disorders are highly prevalent psychiatric conditions that impair quality of life and daily functioning. Despite the availability of pharmacological and psychotherapeutic treatments, limitations such as suboptimal efficacy, adverse effects, and high relapse rates remain unresolved. Traditional Chinese Medicine (TCM) has emerged as a complementary approach, yet its theoretical complexity and lack of standardized evidence hinder broader clinical integration. This review provides a comprehensive synthesis of the role of TCM in the management of anxiety disorders, covering classical theories, epidemiological features, diagnostic principles, therapeutic strategies, and modern innovations. It outlines the pathogenesis of anxiety from a TCM perspective, including syndrome types such as liver Qi stagnation and heart-spleen deficiency, and discusses personalized treatment modalities such as herbal prescriptions, acupuncture, and five-element music therapy. Importantly, it highlights advances in TCM standardization through data mining, integration with metabolomics and neuroimaging, and emerging tools for objective evaluation, such as fNIRS. Clinical trials suggest that TCM interventions may achieve comparable or superior symptom control with fewer adverse effects than conventional treatments. This review offers a structured reference for clinicians and researchers aiming to understand the evolving role of TCM in anxiety management and its potential contribution to future integrative care models.

Keywords: 5-HT; DSM-5; ICD-11; TCM; anxiety disorder.

Figure 1

Traditional Chinese Medicine (TCM) Perspectives on the Etiology, Classification, and Treatment Principles of Anxiety Disorders. This figure summarizes key TCM theoretical constructs used to understand and manage anxiety disorders. The etiological section outlines common mechanisms such as insufficient heart blood impairing mental stability, liver Qi stagnation disrupting emotional regulation, and spleen deficiency leading to phlegm accumulation that interferes with mental clarity. Corresponding syndrome types include liver depression with Qi stagnation, heart and spleen deficiency, and phlegm-heat disturbing the heart. Treatment strategies emphasize harmonizing liver function, strengthening the spleen, nourishing the heart, clearing excess heat, resolving phlegm, and calming the mind to restore emotional balance.

Figure 2

Integration of Traditional Chinese Medicine (TCM) Diagnosis with Modern Assistive Technologies in the Evaluation of Anxiety Disorders. This figure illustrates the complementary relationship between Traditional Chinese Medicine (TCM) diagnostic methods, including inspection, auscultation, inquiry, palpation, tongue and pulse analysis, and syndrome differentiation, and modern assistive technologies such as functional magnetic resonance imaging (fMRI), metabolomics analysis, and AI-assisted diagnostic tools. The integration of these approaches supports the development of more standardized and objective diagnostic frameworks, offering a direction for future research aimed at enhancing diagnostic precision in the clinical evaluation of anxiety disorders.

Figure 3

Multimodal Traditional Chinese Medicine (TCM) Intervention Strategy for Anxiety Disorders. This figure presents a framework for TCM-based intervention in anxiety disorders, highlighting acupuncture and moxibustion, herbal treatment, and five-element music therapy as primary treatment modalities. These interventions are supported by adjunctive therapies such as combined Western medicine and psychosocial interventions. The integration of these approaches is intended to reduce anxiety symptoms by modulating both physiological and emotional dimensions, reflecting the personalized and multi-component treatment philosophy of TCM.

Figure 4

Challenges and Future Directions in the Application of Traditional Chinese Medicine (TCM) for Anxiety Disorders. This figure shows the major challenges in the clinical application of TCM for anxiety, including the lack of standardized efficacy criteria, insufficient clinical safety data, and unclear mechanisms of action. In contrast, future research directions emphasize the need to establish multidomain evaluation frameworks, implement large-scale longitudinal studies, and apply multi-omics technologies to investigate the mechanisms of TCM interventions. These strategies aim to improve scientific rigor and support the modernization of TCM-based treatments for anxiety disorders.