Integration of Traditional Chinese Medicine and Psychotherapy in Mental Health: A Narrative Review of Mechanisms, Clinical Evidence, and Future Directions

Purpose: This narrative review critically evaluates the integration of Traditional Chinese Medicine (TCM) and Western psychotherapy in mental health care, identifying current evidence, methodological limitations, and future research priorities. Methods: We narratively synthesized peer-reviewed literature focusing on clinical studies that combined TCM interventions (acupuncture, herbal medicine, TCM exercises such as Baduanjin and Tai Chi) with psychological or psychiatric approaches for mental disorders. Evidence was organized into three levels: clinical efficacy (human RCTs and meta-analyses), mechanistic studies (animal and biomarker research), and exploratory investigations (neuroimaging, omics, observational surveys). Results: Key findings include: (1) TCM interventions combined with pharmacological or psychological treatments for depression showed a pooled standardized mean difference of − 2.05 (95% CI: − 2.74 to − 1.37) from 18 RCTs, indicating a large effect size but with high heterogeneity; (2) TCM exercises (Baduanjin, Tai Chi) improved attention and reduced mild anxiety (P=0.034), though evidence in clinical samples remains limited; (3) Mechanistic studies suggest potential regulation of the HPA axis, monoamine neurotransmitters, inflammation, and gut microbiota, but these findings are preliminary and derived mostly from animal models. Major barriers to integration include: lack of standardized TCM diagnostic criteria; few methodologically rigorous RCTs; high heterogeneity; insufficient cross-training of clinicians; and fundamental conceptual differences between TCM (holistic) and evidence-based psychotherapy (mechanistic). Conclusion: While TCM-psychotherapy integration holds conceptual promise, current evidence is limited by substantial methodological weaknesses. The most robust evidence exists for acupuncture and TCM exercises for depression and anxiety over short-term follow-up (4– 12 weeks). Evidence for PTSD, severe mental illness, and long-term outcomes (≥ 6 months) remains preliminary. Future research should prioritize large, well-blinded RCTs with prespecified TCM syndrome criteria and longer follow-up periods.