The Pathological Complexity of Stroke and Rational Treatment Principles of Chinese Herbal Medicine

Abstract

This paper first analyzes the complexity of pathological processes involved in acute hemorrhagic or ischemic stroke, including primary and secondary brain injury manifestations and mechanisms, potential transformations between hemorrhage and infarction, and the impact of postbrain injury inflammation on disease progression. Based on decades of extensive clinical and pharmacological research on the usage of Chinese herbal medicine (CHM) monomers or formulas that promote blood circulation and remove blood stasis (such as Angong Niuhuang Wan, Buyang Huanwu Tang, Dahuoluo Wan, and Dushen Tang) for stroke treatment, it proposes that tonifying qi, promoting blood circulation, removing blood stasis, and detoxifying are rational treatment principles of CHM. These principles correspond to the following Western medical implications: tonifying qi corresponds to neuroprotection effects, promoting blood circulation corresponds to anticoagulation and thrombolysis, removing blood stasis addresses hematoma absorption and cerebral edema reduction, and detoxifying corresponds to anti-inflammatory actions. This paper further proposes from a systems medicine perspective that acute stroke is a complex disease requiring individualized CHM treatment with timely modifications rather than a one-size-fits-all approach. CHM monomers or formulas for promoting blood circulation and removing blood stasis, which have various effects such as lowering blood pressure, hemostasis, anticoagulation, antiplatelet, anti-inflammatory, promoting fibrinolysis, and edema reduction, must align with disease progression and be applied within appropriate therapeutic time windows to ensure efficacy and safety. Finally, this paper suggests that a combined use of acupuncture and CHM can potentially synergistically leverage their respective therapeutic strengths. Additionally, acupuncture shows clear benefits in the acute phase of intracerebral hemorrhage (ICH), such as stimulating the vagus nerve to enhance cerebral blood flow, reducing inflammation, as well as triggering hemostatic effects. By applying these rational treatment principles in an integrated approach, better CHM treatment outcomes and higher efficacy of stroke management may be attained.

Keywords

stroke - chinese herbal medicine - tonifying qi - promoting blood circulation - removing blood stasis - detoxifying - anti-inflammatory - therapeutic time windows - treatment with timely modification

CRediT Authorship Contribution Statement

Guanyuan Jin: Conceptualization, software and methodology, formal analysis, data curation, supervision, investigation, writing—original draft, review, and editing. Louis Lei Jin: Data curation, software and methodology, visualization, supervision, investigation, writing—review and editing. Belinda Jie He: Writing—review and editing.

Publikationsverlauf

Eingereicht: 02. November 2024

Angenommen: 28. Dezember 2024

Artikel online veröffentlicht:
08. April 2025

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