Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China.
Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China.
Phytomedicine. 2023 Jan;109:154609. doi: 10.1016/j.phymed.2022.154609. Epub 2022 Dec 17.
Ischemic stroke (IS) is a leading cause of death and severe long-term disability worldwide. Over the past few decades, considerable progress has been made in anti-ischemic therapies. However, IS remains a tremendous challenge, with favourable clinical outcomes being generally difficult to achieve from candidate drugs in preclinical phase testing. Traditional herbal medicine (THM) has been used to treat stroke for over 2,000 years in China. In modern times, THM as an alternative and complementary therapy have been prescribed in other Asian countries and have gained increasing attention for their therapeutic effects. These millennia of clinical experience allow THM to be a promising avenue for improving clinical efficacy and accelerating drug discovery.
To summarise the clinical evidence and potential mechanisms of THMs in IS.
A comprehensive literature search was conducted in seven electronic databases, including PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, the Chinese National Knowledge Infrastructure, the VIP Information Database, the Chinese Biomedical Literature Database, and the Wanfang Database, from inception to 17 June 2022 to examine the efficacy and safety of THM for IS, and to investigate experimental studies regarding potential mechanisms.
THM is widely prescribed for IS alone or as adjuvant therapy. In clinical trials, THM is generally administered within 72 h of stroke onset and are continuously prescribed for over 3 months. Compared with Western medicine (WM), THM combined with routine WM can significantly improve neurological function defect scores, promote clinical total effective rate, and accelerate the recovery time of stroke with fewer adverse effects (AEs). These effects can be attributed to multiple mechanisms, mainly anti-inflammation, antioxidative stress, anti-apoptosis, brain blood barrier (BBB) modulation, inhibition of platelet activation and thrombus formation, and promotion of neurogenesis and angiogenesis.
THM may be a promising candidate for IS management to guide clinical applications and as a reference for drug development.
缺血性脑卒中（IS）是全球范围内导致死亡和严重长期残疾的主要原因。在过去几十年中，抗缺血治疗取得了相当大的进展。然而，IS 仍然是一个巨大的挑战，在临床前阶段测试的候选药物中，通常很难获得有利的临床结果。传统草药（THM）在中国已被用于治疗中风超过 2000 年。在现代，THM 作为一种替代和补充疗法，在其他亚洲国家也有应用，并因其治疗效果而受到越来越多的关注。这些千年的临床经验使 THM 成为提高临床疗效和加速药物发现的有前途的途径。
总结 THM 在 IS 中的临床证据和潜在机制。
从七个电子数据库（包括 PubMed、EMBASE、Cochrane 中央对照试验注册库、中国国家知识基础设施、维普信息数据库、中国生物医学文献数据库和万方数据库）中进行了全面的文献检索，检索时间截至 2022 年 6 月 17 日，以评估 THM 治疗 IS 的疗效和安全性，并研究潜在机制的实验研究。
THM 广泛用于 IS 的单独治疗或辅助治疗。在临床试验中，THM 通常在中风发作后 72 小时内给药，并持续给药超过 3 个月。与西药（WM）相比，THM 联合常规 WM 可显著改善神经功能缺损评分，提高临床总有效率，加快中风恢复时间，且不良反应（AE）较少。这些作用可能归因于多种机制，主要包括抗炎、抗氧化应激、抗细胞凋亡、血脑屏障（BBB）调节、抑制血小板激活和血栓形成，以及促进神经发生和血管生成。
THM 可能是 IS 管理的有前途的候选药物，可指导临床应用，并为药物开发提供参考。
