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
