Prices are comparable to my herbalist, and maybe a little better. The packages always come in great condition and ontime. Great company to work with. Details How to Use Ingredients Size 1. Customer Reviews. Customer Photos. Reviews Questions. Title of Review. How was your overall experience?
Thank you for submitting a review! After blood is built it is under the control of the spleen and stored in liver. Once the liver qi is stagnated, it will thus cause qi stagnation and thus irregular menstruation; in the cases of long-term stagnation, it will be transformed into fire. And then Chong and Ren meridian will be injured by heat, which in turn results in Polymenorrhea, oligomenorrhea, vomiting blood or nosebleed during periods, uterine bleeding, and other syndromes.
As a commonly used prescription for reconciling the liver and spleen, clinically it is a very popular medication in treating women-only ailments, in particular those caused by liver depression and blood deficiency and transformed heat due to chronic stagnation.
Thanks to these amazing healing abilities, it is able to make a difference in the treatment of disorders associated with menstrual cycle if used properly. It can be also used to treat rounded nodules on both sides of the breast, which are usually of varying sizes, hard or cystic in texture, movable if pushed, aggravated before period starts but reduced or totally gone after menstrual period, and with no clear edges.
In addition, it is suitable for diagnosed mammary gland hyperplasia and cystic hyperplasia by Western medicine.
It is often stereotyped by some as a women medication, especially for regulating menstruation only. However, it is not true and in fact it works for both men and women.
First off, it must be made clear that this is not a supplement but a drug that is used to treat illness, from the perspective of Chinese herbal medicine.
To use it, the condition must fall into its indications — liver-qi depression, deficient spleen, and blood deficiency. And it is highly recommended for you to see a TCM doctor for a thorough exam and accurate diagnosis before taking it.
In addition, the matters needing attention are as follows:. In fact, nowadays diseases caused by emotions are quite common since the modern lifestyle is often characterized as overwhelming environmental and mental stresses. And that is exactly where Xiao Yao San Free and Easy Wanderer comes in as modern people are too easily influenced by emotions. However, you must accept that this formula can only give you a necessary boost when your bodies are newly defeated in a cruel battle and dying for help, just like any other medications.
However, after that you need to learn how to outgrow it and use defense system of your body. That being said, to totally recover and be happy again, sometimes you have to be on you own and trust your capacity for self-adjustment. And finally, wish you a happy life ahead! Continue reading here: Pyrrosia Lingua Shi Wei. The Xiaoyaosan XYS decoction containing eight commonly used herbs Bupleurum root, Chinese angelica root, white peony root, poria, bighead atractylodes rhizome, roasted ginger, prepared licorice root, menthol and peppermin been used for treatment of mental disorders such as depression for centuries in China.
The mechanism of the description maybe soothing the liver, invigorating the spleen, nourishing the blood to restore the normal menstruation, and clearing away the liver fire due to blood deficiency. Currently, xiaoyaosan used alone or integrated with antidepressants has been widely used as an alternative and effective method for the treatment of depression in China. Many clinical studies reported the effectiveness ranging from case reports and case series to controlled observational studies and randomized clinical trials, but the evidence for its effect is not clear.
The present paper aims to evaluate the beneficial and harmful effects of xiaoyaosan wan for treatment of depression in randomized trials.
All of those searches ended the end of November The bibliographies of included studies were searched for additional references. RCTs combined xiaoyansan with antidepressants compared with antidepressants and all the modified xiaoyaosan formula were included as well.
There were no restrictions on population characteristics, language and publication type. Duplicated publications reporting the same groups of participants were excluded. Two authors J. Liu and Y. Zhang extracted the data from the included trials independently. The methodological quality of trials was assessed using the 6 criteria 6 election bias study design, confounders, blinding, data collection methods, withdrawals and dropouts to following 3 categories: Category A strong quality : four strong ratings with no weak ratings above.
Category B moderate quality : less than four strong ratings and one weak rating. Category C weak quality : two or more weak ratings. Quality assessment of included randomized controlled trials: sequence generation, allocation concealment, blinding of participants personnel and outcome assessors, incomplete outcome data, selective outcome reporting, and other sources of bias. The statistical package RevMan 4. Meta-analysis was performed if the intervention, control, and outcome were the same or similar.
After primary search of 5 databases, trials were screen out from electronic and manual searches Figure 1 , and the majority were excluded due to obvious ineligibility which including irrelevant titles and abstract some papers being found from more than one database. The treatment for depressive neurosis, bipolar disorders, and depression in patients with psychological stress insomnia were excluded. In the end, 26 RCTs were reviewed. The characteristics of 26 randomized trials are summarized in Table 1.
The 26 RCTs involved patients with depression. There was a wide variation in the age of subjects 17—80 years. The controls included antidepressants alone or the combination of danzhiXiaoyaosan DXS placebo and antidepressants. The total treatment duration ranged from 30 days to 3 month.
The variable prescriptions are presented in Table 1. The different composition of formula Xiaoyaosan are presented in Table 2. Side effect was evaluated by asberg side effect scale and treatment-emergent symptom side effect TESS scale or described in details. Eleven 11 trials used four classes to evaluate treatment effects including cure, significant effective, effective, ineffective, while ten 10 trials used three classes except of cure according to the scores reducing rate.
The majority of the included trials were assessed to be moderate methodological quality. The sample size of including trials varied from 24 to patients. None of the 26 trials reported sample size calculation. Ten trials described the randomization procedure, six [ 10 , 12 , 15 , 16 , 23 , 26 ] trials used random number table, four trials [ 8 , 17 , 25 , 30 ] used visiting time to realize the randomization.
One trial [ 23 ] used opaque envelopes to allocate concealment. Only four [ 12 , 15 , 23 , 27 ] of the 26 trials employed a blinding procedure: three of them using patients blinding, doctors blinding, and assessors blinding, and the other one [ 27 ] mentioned single-blind without further details.
Three trials [ 13 , 16 , 26 ] mentioned follow-up, and neither of them used intention to treat method. The reporting quality of 26 trials according to quality assessment tool for quantitative studies varied among different trials Table 3. Eight [ 9 , 12 , 15 , 17 — 19 , 23 , 30 ] trials compared xiaoyaosan with antidepressants.
Seven of the eight trials used clinical comprehensive effect to evaluate the outcome. We put these two different kinds of measurements together to evaluate the general effectiveness. The meta-analysis showed no significant difference between xiaoyaosan and antidepressants on the Total effective rate RR: 1. Meanwhile four trials [ 12 , 15 , 18 , 30 ] reported there are no significant difference on the HAMD scores decrease nor on the HAMD scores reduced rate [ 15 ] after 6 weeks treatment. Meta-analysis of three trials showed the same result in the fixed effects model WMD: 0.
Four trails [ 15 , 17 , 19 , 30 ] reported the SDS scores decreasing. Seventeen trials [ 7 , 10 , 11 , 13 , 14 , 16 , 20 — 22 , 24 — 29 , 31 , 32 ] compared the combination of xiaoyaosan or modified xiaoyaosan plus antidepressants with antidepressants.
Meta-analysis of fourteen trials showed significant difference in favor of combination group on clinical comprehensive effect RR: 1. Fourteen trials reported the HAMD scores decrease. One trial [ 10 ] reported the outcome of CGI scores. It used modified DanzhiXiaoyao decoction plus fluoxetine versus fluoxetine showed better effect on the combination group MD: 0.
A funnel plot analysis of the 14 trials comparing xiaoyaosan plus antidepressants to antidepressants on Clinical Comprehensive Effect was generated, and it showed a significant asymmetry Figure 2. Twenty-four out of twenty-six trials mentioned the adverse effect except two trials [ 22 , 24 ]. Twenty- four trials reported the twenty-seven specific symptoms including diarrhea, dizziness and headache, somnolence, dry mouth, Bloating, constipation, tachycardia, blurred vision, insomnia, prolonged QT, naupathia, fatigue, anxiety, tremor, anorexia, palpitation, asthenia, oscitancy, sweat, akathisia, tetter, excitation, hypertension, bellyache, dysuria, transaminase increased, and sexual dysfunction Figure 3.
Amitriptyline showed main side effect including dry mouth, constipation, dizziness, blurred vision, tachycardia, somnolence and so forth, [ 8 , 9 , 14 , 18 , 22 , 25 , 32 ]. Imipramine, chlorimipramine, doxepin showed main side effect including dry mouth, constipation and other symptoms in alimentary canal [ 11 ]. Fluoxetine, paroxetine, citalopram showed main side effect including anxiety, insomnia, headache, naupathia, sexual dysfunction, and tremor, [ 8 , 13 , 16 , 19 — 21 , 23 , 26 — 28 , 30 ].
Venlafaxine showed main side effect including dry mouth, sweat, insomnia, headache, and anxiety, [ 17 , 31 ]. Four trials [ 9 , 17 , 19 , 23 ] reported no side effect in the herbal medicine group compared to the antidepressants group. Three trials reported side effect in xiaoyaosan group including headache, dizziness, and slightly diarrhea [ 15 , 18 , 30 ]. Fifteen out of eighteen trials reported the combination group has less side effect compare to the antidepressants group.
Twelve trials [ 7 , 15 — 19 , 21 , 25 , 29 — 31 ] mentioned the side effect are significant reduced in intervention group compared to control group. Seven trials [ 7 , 16 , 18 , 21 , 25 , 30 , 31 ] used treatment-emergent symptom side effect TESS scale scores, one trial [ 15 ] used asberg side effect scale scores, the rest three trials [ 17 , 19 , 29 ] did not mentioned the tools they used to evaluate the side effect.
The prescription xiaoyaosan may have the same effectiveness as antidepressants at the end point of the treatment with fewer side effects. The combination group may have significant beneficial effect compared to the antidepressants group variable on onset time with less side adverse events. Meanwhile the xiaoyaosan prescriptions [ 12 , 15 ] using alone may not as effective as antidepressants after 2 weeks treatment but after 4 or 6 weeks treatment the effectiveness tend to be no significant difference between two groups.
The SDS scores showed the xiaoyansan prescriptions are significantly more effective after 4 weeks [ 17 ] and 6 weeks [ 19 ] treatment compared to antidepressants. The combination of xiaoyaosan prescription plus antidepressants group may have significant beneficial effect compared to the antidepressants group.
The onset time are variable may depended on the form of prescription such as pills and decoctions. Two meta-analysis on HAMD scores showed significant heterogeneity. It may due to the different intervention and treatment time or the methodology quality. The significant heterogeneity on TESS scales may due to the dosage of the antidepressants.
According to the twenty-six trials the xiaoyansan prescription group and the combination of xiaoyaosan and antidepressants group have less adverse events compared to antidepressants group with significant differences which were showed by the TESS scales and Asberg side effect scales.
We should consider several limitations before accepting the findings of this paper. First, the quality of the included studies is generally moderate according to the quality assessment tool for quantitative Studies Effective Public Health Practice Project which was recommended on the Cochrane Handbook. It also indicated that there are moderate risk of bias in most of the trials. Due to inadequate reporting of the allocation sequence, allocation concealment, blinding, intention to treat analysis and drop outs account in the majority of trials, it was possible that there was performance bias and detection bias due to patients and researchers being aware of the therapeutic interventions for the subjective outcome measures.
Most of the trials provided limited descriptions of study design, randomization were mentioned but without further details after randomly assignment of patients which do not allow a proper judgment of the conduct of the trials.
Therefore, we canot draw a confident conclusion that there are significant beneficial effects in patients with depression on combined groups or xiaoyaosan prescriptions using alone comparing to antidepressants. The number of trials identified limits us to perform meaningful subgroup or sensitivity analyses to illuminate robustness of the results in the review. Sixteen out of twenty-seven trials didnot described the blinding in details, only two trials [ 12 , 15 ] used double-dummy in their study design.
Second, Liu et al. We cannot explore quantitatively the possibility of publication bias due to the small number of trials. Third, different modified xiaoyao prescriptions and different form of the prescriptions were used in the trials: eight trials [ 7 , 8 , 11 , 16 , 20 , 27 , 28 , 31 ] used fixed xiaoyaowan throughout the treatment, five trials used modified xiaoyaowan, and one trial used modified xiaoyansan based on menstruation period of young female [ 9 ].
The rest thirteen trials [ 10 , 13 , 14 , 18 , 19 , 21 — 24 , 29 , 32 ] used modified xiaoyao decoction according to syndrome differentiation based on Chinese medicine theory, the herbal compound varied from 7 to 17 herbs Table 2. The treatment duration varied from 30 days to 3 months.
Fourth, the use of composite outcome measures in 26 trials to evaluate overall improvement of symptoms limits the generalization of the findings. The classification of cure, significant effective, effective, or ineffective and the Total effective rate are not internationally recognized, and these outcome measurement are vague to interpret the effect.
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