Traditional Chinese herbal medicines for the treatment of ischemic stroke in China

Ischemic stroke (IS) is a devastating disease with high disability and mortality rates worldwide. Despite advances in medical treatment, managing IS remains a significant challenge. In China, traditional Chinese herbal medicines (TCHMs) are often sought as alternative pharmacotherapies for both prevention and rehabilitation because of their proven efficacy and relatively low incidence of adverse reactions. While TCHMs do have certain limitations, their value cannot be overlooked. Centuries of clinical experience in China have established TCHMs as promising approaches for improving clinical outcomes and accelerating drug discovery in the treatment of IS. In this review, we summarize the potential mechanisms and clinical evidence of TCHMs in the treatment of IS in China. These findings suggest that TCHMs can treat IS through various pharmacological mechanisms, mainly anti-inflammatory, antiapoptotic, antioxidative stress, and mitochondrial regulatory mechanisms. Additionally, TCHMs provide protection to the blood brain barrier, inhibit excitotoxicity, promote angiogenesis, reduce ferroptosis, modulate the gut brain axis, prevent thrombosis, improve blood rheology, and regulate neural stem cells. These effects contribute to improved therapeutic outcomes at various stages of IS and poststroke complications, especially when combined with Western medicine, while also offering a favorable safety profile. In conclusion, TCHMs represent a promising strategy for managing IS and advancing related drug development. We hope that this review will inspire further exploration into the mechanisms underlying the anti-IS effects of TCHMs, thereby enhancing the scientific understanding of traditional Chinese medicine. • Traditional Chinese herbal medicines show promise in managing ischemic stroke. • These medicines act through various pharmacological mechanisms. • Combining Traditional Chinese herbal medicine and Western medicine improves outcomes. • Traditional Chinese herbal medicines provide a favorable safety profile. • Traditional Chinese herbal medicines offer potential for drug development in IS.