Traditional Chinese Medicine Interventions for Antipsychotic-Induced Extrapyramidal Symptoms: A Data Mining-Based Integrative Review of Prescription Patterns and Evidence

Why clinicians should know about it

• Picked for Complementary and Alternative Medicine (paper of the day, 27 July 2026): Integrative review of TCM for antipsychotic EPS

Abstract

BACKGROUND: Antipsychotic-induced extrapyramidal symptoms (EPS), including drug-induced parkinsonism, akathisia, dystonia, and tardive dyskinesia, remain major limitations of long-term antipsychotic therapy and negatively affect treatment adherence and quality of life. Traditional Chinese Medicine (TCM) has increasingly been explored as an adjunctive strategy for EPS management; however, evidence regarding prescription patterns, clinical effectiveness, and mechanistic rationale remains fragmented. OBJECTIVE: To conduct an integrative review of TCM interventions for antipsychotic-induced EPS through synthesis of clinical evidence and quantitative analysis of prescription patterns. METHODS: A systematic search of English- and Chinese-language databases identified 31 eligible studies, including randomized controlled trials, non-randomized studies, and cohort investigations. Clinical characteristics, EPS subtypes, outcome measures, safety data, and herbal prescription components were extracted. Narrative evidence synthesis was combined with frequency analysis, association rule mining, clustering, and network mapping to identify recurrent herbal combinations and therapeutic structures. RESULTS: Included studies involved patients with schizophrenia-spectrum disorders receiving first- or second-generation antipsychotics. Drug-induced parkinsonism and tardive dyskinesia were the most frequently evaluated EPS subtypes. Frequently prescribed herbs included Gastrodia elata, Uncaria rhynchophylla, Angelica sinensis, and Paeonia lactiflora. Data mining identified reproducible prescription patterns centered on wind-extinguishing, blood-nourishing, and phlegm-resolving therapeutic principles. Across comparative studies, adjunctive TCM interventions were associated with reductions in EPS severity scores and generally mild adverse events. Mechanistic findings suggested potential roles in dopaminergic modulation, neuroprotection, anti-inflammatory activity, and oxidative stress reduction. However, methodological heterogeneity, inconsistent reporting standards, limited blinding, and short follow-up durations reduced certainty of evidence. CONCLUSION: Current evidence suggests that adjunctive TCM interventions may provide symptomatic benefit for antipsychotic-induced EPS, particularly drug-induced parkinsonism and tardive dyskinesia. Nevertheless, existing evidence remains preliminary and geographically concentrated, and higher-quality multicenter studies with standardized reporting and long-term safety evaluation are required before broader clinical implementation can be recommended.

Abstract as published, via PubMed.