Endocrine psychiatric comorbidity in metabolic disorders: Integrative mechanisms and traditional Chinese medicine

Table 3 Traditional Chinese medicine intervention evidence matrix for metabolic-psychiatric comorbidity, prioritising dual endpoints (Figures 1 and 2)

TCM modality	Target clinical context (metabolic-psychiatric focus)	Intervention use (typical delivery)	Outcomes commonly captured	Dual-endpoint capture1	Evidence maturity and key limitations
Chinese herbal medicine	Depressive symptoms in patients with cardiometabolic comorbidity; adjunctive care when tolerability/acceptability is a concern	Pattern-informed prescriptions; monotherapy or adjunct to antidepressants	Mental health: Depressive symptoms, anxiety, sleep-related complaints; metabolic: Often absent or secondary	Inconsistent (mental-health-dominant in many trials)	Evidence base includes syntheses and condition-specific reviews; limitations: Formulation heterogeneity, variable standardisation, limited integrated metabolic endpoints
Acupuncture/EA (PCOS-focused)	PCOS with negative emotions plus metabolic features (weight/insulin resistance concerns)	Protocol-based acupuncture/EA; often alongside lifestyle/usual care	Mental health: Depression/anxiety; metabolic/PCOS: Weight-related and PCOS clinical features commonly reported	More consistent (mood + metabolic/PCOS features often co-reported)	Recent synthesis suggests potential benefit for negative emotions; limitations: Trial quality and heterogeneity; psychiatric endpoints not always primary[106]
Acupuncture for insomnia (sleep as a mechanistic amplifier)	Insomnia (often coexisting with metabolic disorders), targeting the sleep-stress-metabolic loop	Manual acupuncture; protocol-driven courses; sometimes adjunct to CBT-I/usual care	Sleep: PSQI/ISI and daytime function; mental health: Mood may be secondary; metabolic: Seldom captured	Partial (sleep-centric; metabolic endpoints uncommon)	Systematic reviews support insomnia improvement; limitation: Integrated metabolic-psychiatric cohorts and dual-endpoint designs remain limited[107]
Mind-body therapies (Tai Chi/Qigong)	Adults at risk of MetS/obesity-related risk with psychological distress or reduced self-efficacy	Group-based, adherence-friendly programmes; combined physical + meditative components	Psychosocial: Depressive mood/anxiety, self-efficacy, quality of life; metabolic: Cardiometabolic risk indicators often assessed	Often yes (psychosocial + metabolic outcomes co-reported)	Systematic reviews in MetS-risk populations support multidomain benefits; limitations: Programme heterogeneity, comparator variability, adherence reporting[107]
EA for anxiety/depression (general psychiatric target with metabolic relevance via stress axis)	Anxiety/depressive symptoms where stress biology and autonomic dysregulation are prominent (metabolic impact often indirect)	EA protocols; adjunct to standard care	Mental health: Anxiety/depression; metabolic: Typically not collected	Rare (psychiatric endpoint-dominant)	Evidence from systematic reviews exists; limitation: Metabolic outcomes and psychotropic–metabolic stewardship endpoints are rarely incorporated
TCM-integrated lifestyle counselling (TCM-informed diet/exercise guidance)	Prediabetes/metabolic risk states where behavior change is central and psychological burden may affect adherence	Individualised counselling aligned with constitution/pattern concepts; pragmatic delivery	Metabolic: Lifestyle adherence and metabolic risk markers; mental health: Usually under-measured	Usually no	Evidence supports metabolic prevention approaches, but dual-endpoint capture and standardized mental-health assessment are uncommon (gap aligns with Figure 2)[108]

¹Dual-endpoint capture: Concurrent assessment of metabolic endpoints (e.g., glycaemic/adiposity/cardiometabolic risk measures) and mental health endpoints (e.g., validated mood/anxiety/sleep scales), consistent with the integrated pathway (Figure 2).

TCM: Traditional Chinese medicine; PCOS: Polycystic ovary syndrome; EA: Electroacupuncture; ISI: Insomnia Severity Index; PSQI: Pittsburgh Sleep Quality Index; ISI: Insomnia Severity Index; MetS: Metabolic syndrome.