Efficacy and safety of traditional Chinese medicine for intracranial hemorrhage by promoting blood circulation and removing blood stasis: A systematic review and meta-analysis of randomized controlled trials

Systematic review and meta-analysis of 15 randomized controlled trials conducted in China in participants with intracranial hemorrhage. Across the pooled active arms, 784 participants received BACM plus Western medical treatment and 795 received Western medical treatment alone.

Blood-activating Chinese medicine (BACM) was used as an add-on to Western medical treatment in randomized trials of intracranial hemorrhage. The active regimens varied across studies and included oral decoctions and oral liquid or injectable Chinese medicine preparations; reported oral dosing was commonly one dose daily or three times daily, with some studies using multi-component formulations.

BACM combined with Western medical treatment was associated with better overall outcomes than Western medical treatment alone. Clinical effectiveness improved (RR=1.22, 95% CI [1.13 to 1.32], p<0.001), neurological deficit scores decreased (NIHSS MD=-2.75, 95% CI [-3.74 to -1.76], p<0.001), and functional status improved (Barthel index MD=5.95, 95% CI [3.92, 7.98], p<0.001). BACM also favored hematoma volume (MD=-2.94, 95% CI [-3.50 to -2.37], p<0.001) and cerebral edema (MD=-2.74, 95% CI [-3.01 to -2.48], p<0.001). Adverse events and mortality were not significantly different versus control, but the authors concluded the evidence should be interpreted cautiously.

The included trials had substantial heterogeneity and a high risk of bias, which weakens confidence in the pooled estimates. All studies were conducted in China, outcome timing varied across trials, and adverse event reporting was incomplete in some studies, limiting generalizability and safety interpretation.