Traditional Chinese medicine combo shows therapeutic potential in disabling stroke

The Chinese medicinal combination chuanzhi tongluo, when added to standard medical therapy, helps improve the likelihood of achieving a good functional outcome without increasing the risk of intracranial haemorrhage in patients with disabling stroke without visible large or medium vessel occlusion, as shown in the CONCERN trial.

The percentage of patients who achieved a modified Rankin Scale (mRS) score of 0–1 at 90 days was higher by 8.1 percent with chuanzhi tongluo vs placebo (38.1 percent vs 30 percent; adjusted risk ratio, 1.25, 95 percent confidence interval [CI], 1.07–1.44; p=0.004), reported Dr Dahong Yang from Xinqiao Hospital and The Second Affiliated Hospital of Army Medical University in Chongqing, China. [ISC 2026, abstract LB034]

Additionally, 90-day mortality was significantly lower in the chuanzhi tongluo arm than in the placebo arm (1.9 percent vs 4.1 percent; p=0.03). Within 48 hours, one patient (0.2 percent) in the chuanzhi tongluo arm had asymptomatic intracranial haemorrhage, whereas five patients in the placebo arm had symptomatic (n=2; 0.3 percent) or asymptomatic (n=3; 0.5 percent) intracranial haemorrhage.

There were no significant between-group differences observed in the incidence of adverse events (AEs) (52.5 percent vs 51.8 percent; p=0.813), serious AEs (9.2 percent vs 11.4 percent; p=0.197), and gastrointestinal bleeding events (5.6 percent vs 5.5 percent; p=0.608), Yang noted.

Chuanzhi tongluo consists of the following compounds: 

   · Whitmania pigra Whitman (shuizhi), a medicinal leech with anticoagulation, antithrombotic, and anti-inflammatory effects; 

   · Ligusticum chuanxiong Hort (chuanxiong), which promotes blood circulation and reduces blood stasis;

   · Salvia miltiorrhiza bunge (danshen), which helps prevent neuronal apoptosis, inflammatory responses, and endothelial injury; and

   · Astragalus membranaceus (huangqi), which has potent antioxidant activity.

“This combination has been shown to exert neuroprotective effects through multiple targets and pathways,” Yang said. [Front Pharmacol 2022;13:1011333; Neuroscience 2023;537:21-31]

The results of CONCERN provide evidence on the efficacy and safety of chuanzhi tongluo in patients with disabling stroke without large or medium vessel occlusion, he added.

CONCERN enrolled adult patients with acute ischaemic stroke without large or medium vessel occlusion at 73 hospitals across China. Inclusion criteria were presentation within 24 h of onset or last known well plus ineligibility for intravenous thrombolysis (IVT) or endovascular treatment, presentation between >24 h and <96 h of time last known well but within 24 h of stroke progression, neurological deterioration within 24 h after IVT, and lack of neurological improvement after IVT.

A total of 1,268 patients (median age 68, 62 percent female) were randomly assigned to receive either chuanzhi tongluo (n=629) or placebo (n=639) capsules, in addition to standard medical therapy. Two capsules were administered three times daily for up to 90 days. 

The median NIHSS score at baseline was 7. The median time from last known well/stroke onset was 12 h, and time from last known well/onset to first treatment was 14 hours.

Yang acknowledged that the exclusively Asian population with a higher rate of intracranial artery stenosis may limit the generalizability of the study.