Deans' stroke musings: Effect of Buyang Huanwu decoction for the rehabilitation of ischemic stroke patients: a meta-analysis of randomized controlled trials

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, March 15, 2021

Effect of Buyang Huanwu decoction for the rehabilitation of ischemic stroke patients: a meta-analysis of randomized controlled trials

For your perusal, I have no comment.

Effect of Buyang Huanwu decoction for the rehabilitation of ischemic stroke patients: a meta-analysis of randomized controlled trials

Health and Quality of Life Outcomes volume 19, Article number: 79 (2021) Cite this article

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Abstract

Purpose

Buyang Huanwu decoction (BHD) is a widely used traditional Chinese medicine for the rehabilitation of ischemic stroke patients in China, but its clinical efficacy and safety have not been adequately assessed. In this paper, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of BHD.

Methods

We searched seven electronic databases from inception to 31 March 2019. The language was limited to Chinese and English. Randomized controlled trials evaluating the efficacy and safety of BHD for the rehabilitation of ischemic stroke patients were included in the meta-analysis. Reviewers independently performed the screening, data extraction, bias assessment, and data analysis. The treatment efficacy was pooled in a meta-analysis using RevMan 5.3 software with a random-effect model. Any disagreement was resolved by discussion among all reviewers. The PRISMA statement was used in the review process.

Results

A total of 11 studies with 1084 patients were included in the meta-analysis. The results suggested that BHD was superior to other treatments in terms of clinical efficacy in symptoms and daily activities (n = 684, RR = 1.12, 95% CI: 0.99 to 1.27), clinical efficacy in TCM symptoms (n = 280, RR = 1.45, 95% CI: 1.03 to 2.03), National Institute of Health stroke scale (n = 192, MD = 1.66, 95% CI: -1.08 to 4.40), and activities of daily living (n = 200, MD = 8.20, 95% CI: -3.95 to 20.35).

Conclusions

The results supported the clinical use of BHD for the rehabilitation of ischemic stroke patients. However, the methodological qualities of the included studies were relatively low, and there were limited reports on adverse events. The clinical efficacy and safety of BHD need to be further confirmed by more well-designed and high-quality randomized controlled trials to warrant the clinical recommendation of BHD for the rehabilitation of ischemic stroke patients.

Introduction

Ischemic stroke, accounting for approximately 80% of all strokes, is one of the major causes of disability [1, 2]. Even when stroke symptoms are stabilized, stroke survivors’ daily lives are still seriously affected [3]. The goal of stroke rehabilitation is to help patients restore physical and mental functions, and relearn the necessary skills to live everyday life.

There are several approaches to help ischemic stroke patients in rehabilitation, including physical activities (e.g., mobility training [4] and constraint-induced therapy [5]), cognitive and emotional activities (e.g., speech therapy [6]), biological therapies (e.g. stem cells [7]), and some alternative medicines (e.g. acupuncture [8], massage [9], and herbal medicines [10]). In China, traditional Chinese medicine (TCM) is commonly utilized by physicians as a complementary and alternative therapy for rehabilitation.

The commonly used TCM include Buchang Naoxintong, Shuxuetong, and Buyang Huanwu decoction (BHD). Many researchers have reported the therapeutic effect of TCM on ischemic stroke rehabilitation. Xu et al. [11] quantified 16 constituents of Buchang Naoxintong and verified the therapeutic effects of the constituents in ischemic stroke in mice. Han et al. [10] conducted a network meta-analysis to assess the effect of TCM on the recovery of stroke patients and found that Shuxuetong was effective, as it may reduce inflammation and inhibit thrombosis. Mu et al. [12] reported the neuroprotective effects of BHD on cerebral ischemia-induced neuronal damage. They concluded that BHD has a therapeutic effect primarily on facilitating blood circulation, attenuating the inflammatory response, and inhibiting neuronal apoptosis.

BHD was first created by Qingren Wang in the book Correction of Errors in Medical Classics (Yi Lin Gai Cuo). This decoction consists of seven herbs: milkvetch root (Huangqi), Chinese angelica (Danggui), red peony root (Chishao), earthworm (Dilong), Szechwan lovage rhizome (Chuanxiong), safflower (Honghua), and peach seed (Taoren). As reported, the main components of these seven herbs have therapeutic effects in promoting the recovery of ischemic stroke. Astragalus polysaccharide, a component of milkvetch roots, has anti-inflammatory effects [13] and resists oxidative stress [14]. Chinese angelica and its component ferulic acid ameliorate nerve injuries caused by cerebral ischemia [15] and augment angiogenesis [16]. Considering the combined effects of multiple herbs in BHD, Wang et al. [17] found that BHD had a neuroprotective effect in rats by decreasing apoptotic cells. Pan et al. [18] studied the mechanism of BHD on neuronal plasticity in cerebral ischemic rats. They found that BHD could facilitate the recovery of the nervous system by improving synaptic plasticity.

The therapeutic effects of BHD on stroke have been systematically reviewed by many researchers. Hao et al. [19] analyzed 19 randomized controlled trials for the clinical efficacy and safety of BHD and provided suggestive evidence for BHD in patients with acute ischemic stroke. Gou et al. [20] conducted a meta-analysis to assess the clinical efficacy of BHD combined with acupuncture in the treatment of stroke. The results showed that BHD could improve the daily activities of patients, and the clinical efficacy of BHD combined with acupuncture is better than that of BHD alone. Han et al. [21] conducted a systematic review and meta-analysis to assess herbal medicine treatments in patients with acute ischemic stroke and concluded that BHD was relatively safe and could improve neurological function. However, none of the systematic reviews or meta-analyses focused on the clinical efficacy and safety of BHD in the rehabilitation stage of ischemic stroke. Therefore, in this study, a meta-analysis was conducted to evaluate the clinical efficacy and safety of BHD on the rehabilitation of ischemic stroke patients.