To systematically review the efficacy and safety of acupuncture combined with minimally invasive surgery or basic the-rapy in treating hypertensive intracerebral hemorrhage(HICH) patients compared with minimally invasive surgery or basic treatment. In this study, the four Chinese databases, the four English databases, Chinese Clinical Trial Registry and ClinicalTrail.gov, all above were systematically and comprehensively retrieved from the time of database establishment to September 10, 2020. Rando-mized controlled trials(RCTs) were screened out according to inclusion criteria and exclusion criteria established in advanced. The methodological quality of included studies was evaluated by the tool named "Cochrane bias risk assessment 6.1". Meta-analysis of the included studies was performed using RevMan 5.4, and the quality of outcome indicators was evaluated by the GRADE system. Finally, 17 studies were included, involving 1 852 patients with HICH, and the overall quality of the included studies was not high. According to Meta-analysis,(1)CSS score of the group of acupuncture combined with minimally invasive surgery or basic therapy was superior to the group of minimally invasive surgery or basic therapy(MD=-3.50,95%CI[-4.39,-2.61],P<0.000 01);(2)NIHSS score of the group of acupuncture combined with minimally invasive surgery or basic therapy was superior to the group of minimally invasive surgery or basic therapy(MD=-4.78,95%CI[-5.55,-4.00],P<0.000 01);(3)the cerebral hematoma volume of the group of acupuncture combined with minimally invasive surgery or basic therapy was superior to the group of minimally invasive surgery or basic therapy(MD=-4.44,95%CI[-5.83,-3.04],P<0.000 01);(4)ADL score of the group of acupuncture combined with minimally invasive surgery or basic therapy was superior to the group of minimally invasive surgery or basic therapy(MD=20.81,95%CI[17.25,24.37],P<0.000 01);(5)the GCS score of the group of acupuncture combined with minimally invasive surgery or basic therapy was superior to the group of minimally invasive surgery or basic therapy(MD=2.41,95%CI[1.90,2.91],P<0.000 01). The GRADE system showed an extremely low level of evidence for the above outcome indicators. Adverse reactions were mentioned only in two literatures, with no adverse reactions reported. The available evidence showed that acupuncture combined with minimally invasive surgery or basic therapy had a certain efficacy in patients of HICH compared with minimally invasive surgery or basic therapy. However, due to the high risk of bias in the included studies, its true efficacy needs to be verified by more high-quality studies in the future.
Acupuncture Therapy ; Humans ; Intracranial Hemorrhage, Hypertensive/therapy* ; Treatment Outcome

To systematically review the efficacy and safety of Naoxueshu Oral Liquid in treatment of hypertensive intracerebral hemorrhage, four Chinese databases, four English databases, clinical trials registration center(ClinicalTrials.gov) and Chinese clinical trial registry were retrieved. The retrieval time was from the establishment of each database to September 9, 2020. According to the set criteria, the randomized controlled trial(RCT) of Naoxueshu Oral Liquid combined with conventional Western medicine was selected. The "Cochrane bias risk assessment" tool was used to evaluate the quality of the included studies. RevMan 5.4.1 was used to conduct Meta-analysis of the included studies and GRADE system was used to evaluate the evidence quality of the outcome indicators. Eleven studies were finally included, with a total sample size of 1 221 cases, 612 cases in the treatment group and 609 cases in the control group. Meta-analysis showed that Naoxueshu Oral Liquid combined with conventional Western medicine had no significant difference compare with conventional Western medicine in reducing National Institute of health stroke scale(NIHSS) after 2 weeks of treatment for hypertensive intracerebral hemorrhage(MD=-1.59,95%CI[-3.46,0.29],P=0.10), but was superior to conventional Western medicine after 30 d of treatment(MD=-1.16,95%CI [-1.39,-0.94],P<0.000 01). Naoxueshu Oral Liquid combined with conventional Western medicine was superior to conventional Western medicine in improving Glasgow coma scale(MD=1.00,95%CI[0,2.00],P=0.05) and reducing the incidence of secondary brain insults(RR=0.38,95%CI[0.24,0.59],P<0.000 1), but there was no significant difference in increasing Barthel index(MD=1.00,95%CI[-0.30,2.30],P=0.13). In terms of effective rate, studies using Guideline for clinical trials of new patent Chinese medicines, NHISS or Glasgow outcome scale(GOS) had shown that Naoxueshu Oral Liquid combined with conventional Western medicine was superior to conventional Western medicine(RR_(Guideline for clinical trials of new patent Chinese medicines)=1.27,95%CI[1.10,1.46],P=0.001;RR_(NHISS)=1.26,95%CI[1.13,1.40],P<0.000 1;RR_(GOS)=1.54,95%CI[1.22,1.93],P=0.000 2). In reduction of hematoma volume, Naoxueshu Oral Liquid combined with conventional Western medicine was superior to conventional Western medicine after 2 and 4 weeks of treatment(MD_(2 week)=-2.31,95%CI[-3.12,-1.49],P<0.000 01;MD_(4 week)=-2.04,95%CI[-2.41,-1.68],P<0.000 01). GRADE system showed that the evidence level of the above outcome indicators was low and extremely low. In terms of adverse reactions, two of the included studies reported mild adverse reactions, and the rest of studies were not mentioned, so this study was not able to make a positive evaluation of the safety of Naoxueshu Oral Liquid. This study showed that compared with conventional Western medicine, combined Naoxueshu Oral Liquid may be better for hypertensive intracerebral hemorrhage. However, due to the high bias risk in the included studies, more large-sample and high-quality RCTs are still needed in the future.
Drugs, Chinese Herbal/adverse effects* ; Humans ; Intracranial Hemorrhage, Hypertensive/drug therapy* ; Nonprescription Drugs ; Stroke

The study aims to analyze the outcome indicators of randomized controlled trial(RCT) of traditional Chinese medicine(TCM) in the treatment of hypertensive intracerebral hemorrhage(HICH) in recent three years, and thus provide suggestions for the future studies in this field. Four English databases, four Chinese databases and two online registration websites of clinical trials were searched. The RCTs published between January 2018 and September 2020 were screened. The risk of bias was assessed and outcome measures were classified. A total of 151 839 articles were retrieved, of which 44 RCTs were included for analysis after screening. The outcome measures of the included RCTs were classified into 7 categories, among which the symptoms/signs category showed the highest reporting rate. National Institute of Health stroke scale(72.73%) was the most frequently reported outcome indicator, while the vo-lume of intracerebral hemorrhage determined by computerized tomography(36.36%) was the most frequently reported lab test outcome. Most studies collect the outcomes at the end of treatment, while 9 studies reported long-term outcomes 3 months or more after onset. Compared with those of international clinical trials, the application of some of the outcomes was reasonable, focusing on patients' symptoms, quality of life and objective outcomes. However, there were still several problems: unclear primary and secondary outcome measures, insufficient attention to long-term prognosis, insufficient attention to social function, few TCM outcomes, lack of measurement blindness and the use of unreasonable composite outcomes. It is recommended that researchers should rationally design the outcome indicators of clinical trials and develop the core outcome set.
Drugs, Chinese Herbal/therapeutic use* ; Humans ; Intracranial Hemorrhage, Hypertensive/drug therapy* ; Medicine, Chinese Traditional ; Quality of Life ; Randomized Controlled Trials as Topic

OBJECTIVETo probe the best therapy for the patient after operation of hypertensive cerebral hemorrhage.

METHODSOne hundred cases were randomly divided into a treatment group and a control group, 50 cases in each group. The control group were treated by routine western medicine (Mannitol, Nifedipine and Caftriaxone sodium and so On), and the treatment group by the medication of the control group plus acupuncture 9 days after operation. Acupuncture was given at Neiguan (PC 6), Shuigou (GV 26), Sanyinjiso (SP 6), Jiquan (HT 1) and Weizhong (BL 40) and so on, combined with scalp acupuncture, with "restoring consciousness and inducing consciousness" needling method, for 10 days. The nervous function defect was assessed by Chinese Stroke Scale and the criteria for assessment of therapeutic effects.

RESULTSAcupuncture could improve significantly nervous function defect. The total effective rate was 86.000 in the treatment group and 14.0% in the control group with a significant difference between the two groups (P < 0.01).

CONCLUSIONThe therapeutic effect of the treatment group is better than that of the control group. Acupuncture combined with western medicine has cooperation for treatment of hypertensive intracerebral hemorrhage with a better therapeutic effect.

Acupuncture Therapy ; Adult ; Aged ; Aged, 80 and over ; Combined Modality Therapy ; Female ; Humans ; Intracranial Hemorrhage, Hypertensive ; physiopathology ; therapy ; Male ; Middle Aged ; Nervous System ; physiopathology

Adult ; Aged ; Basal Ganglia ; Combined Modality Therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Intracranial Hemorrhage, Hypertensive ; drug therapy ; etiology ; Male ; Middle Aged ; Phytotherapy

OBJECT: It is reported that spontaneous subcortical intracerebral hemorrhage consists about 10 to 44% of spontaneous intracerebral hemorrhage. Recently, spontaneous subcortical intracerebral hemorrhage due to the complication of the systemic disease has been increasing, and the selection of management strategy according to the cause of hemorrhage closely affected the management outcome. This study was designed to analyze the cause of spontaneous subcortical intracerebral hemorrhage and the outcome in order to establish the appropriate management strategy. SUBJECT: One hundred and seventy-nine cases of spontaneous subcortical intracerebral hemorrhage managed at Yonsei University Hospital from January 1998 to December 2000 were included in this study. Patients who suffered from subcortical intracerebral hemorrhage due to the ruptured intracranial aneurysm were excluded. The patient's sex, age, mental state on admission, neurologic condition, past history, systemic disease related to hemorrhage, location of hemorrhage, the diagnosis of intracranial or systemic disease, treatment methods, and clinical outcome were analyzed. Consciousness on admission was evaluated and scored based on Glasgow Coma Eye Motor Scale (GCEMS), which was the sum of eye response score and motor response score of the Glasgow Coma Scale. Patients were categorized into 4 groups according to GCEMS: Group 1 (10 points), Group 2 (8, 9 points), Group 3 (5-7 points), and Group 4 (2-4 points). The clinical outcome of the patient was evaluated based on Glasgow outcome scale (GOS). Differences in diagnostic procedure were present depending on the condition of the patients, thus the final diagnostic procedure was used to diagnose the reason behind bleeding. When accurate diagnosis was difficult to perform, the reasons with the highest likelihood were chosen. RESULTS: The patients corresponding to each group were as follow: 79 (44.1%) in Group 1, 35 (19.6%) in Group 2, 27 (15.1%) in Group 3, and 38 (21.2%) in Group 4. Fifty-five patients (30.7%) were hypertensive intracerebral hemorrhage, 45 patients (25.1%) had anticoagulant therapy and thrombocytopenia due to the systemic disease and bleeding diathesis after anticancer drug therapy, 23 patients (12.8%) had brain tumor including the metastatic tumor, 19 patients (10.6%) had arteriovenous malformation, 18 patients (10.1%) had postinfarct hemorrhages, 5 patients (2.8%) had infective endocarditis, 2 patients (1.1%) had cerebral vasculitis. Conservative treatment was done in 115 patients (64.2%), open craniotomy in 31 patients (17.3%), and catheter insertion in 33 patients (18.4%). Group 1 mainly had conservative treatment (58 patients, 73.4%), Group 2 and 3 had 12 patients (37.1%) and 16 patients (59.3%) each underwent open craniotomy respectively. In Group 4, conservative treatment was done for 24 patients (63.2%), and open craniotomy was done for only one patients among 14 patients treated surgically. Overall clinical outcome was: 77 patients (43.0%) in GOS 5, 21 (11.7%) in GOS 4, 14 (7.8%) in GOS 3, 11 (6.1%) in GOS 2, and 56 patients (31.3%) died. Poor neurological state (low GCEMS) on admission was closely related to mortality (Group 1, 7.6%; Group 2, 22.8%; Group 3, 45.0%; Group 4, 78.9%). CONCLUSION: The major causes of spontaneous subcortical intracerebral hemorrhage were hypertension, metastatic brain tumor, vascular malformation, and the bleeding tendency due to the systemic disease, complication of the anticancer drug, anticoagulant, and thrombolytics therapy. Conservative treatment could be considered for the patients with GCEMS 10, removal of hematoma by open craniotomy or catheter insertion for the patients with GCEMS 5-9, and the catheter insertion or deferring the active treatment could be considered for the patients with GCEMS 2-4.
Arteriovenous Malformations ; Brain Neoplasms ; Catheters ; Cerebral Hemorrhage* ; Coma ; Consciousness ; Craniotomy ; Diagnosis ; Disease Susceptibility ; Drug Therapy ; Endocarditis ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hematoma ; Hemorrhage ; Humans ; Hypertension ; Intracranial Aneurysm ; Intracranial Hemorrhage, Hypertensive ; Mortality ; Thrombocytopenia ; Vascular Malformations ; Vasculitis, Central Nervous System

OBJECTIVETo investigate the efficacy and safety of the Chinese herbal therapeutic regimen of activating blood circulation (TRABC) in treatment of hypertensive intracerebral hemorrhage (HICH).

METHODSThis was a multi-center prospective randomized open-label blinded-endpoint (PROBE) trial with HICH admitted to 12 hospitals. Totally 240 participants were randomized to the treatment group treated with TRABC in addition to conventional Western treatment or the control group with conventional Western treatment equally for 3 months. Primary outcome was degree of disability as measured by modified Rankin Scale (mRS). Secondary outcomes were the absorption of hematoma and edema, National Institutes of Health Stroke Scale (NIHSS) scores and patient-reported outcome measures for stroke and Barthel activities of daily living index. Adverse events and mortality were also recorded.

RESULTSAfter 3 months of treatment, the rate of mRS 0-1 and mRS 0-2 in the treatment group was 72.5% and 80.4%, respectively, and in the control group 48.1% and 63.9%, respectively, with a significant difference between groups (P<0.01). Hematoma volume decreased significantly at day 7 of treatment in the treatment group than the control group (P=0.038). Average Barthel scores in the treatment group after treatment was 89.11±19.93, and in the control group 82.18±24.02 (P=0.003). NIHSS scores of the two groups after treatment decreased significantly compared with before treatment (P=0.001). Patient-reported outcomes in the treatment group were lower than the control group at day 21 and 3 months of treatment (P<0.05). There were 4 deaths, 2 in each group, and 11 adverse events, 6 in the treatment group and 5 in the control group.

CONCLUSIONThe integrative therapy combined TRABC with conventional Western treatment for HICH could promote hematoma absorption thus minimize neurologic impairment, without increasing intracerebral hematoma expansion and re-bleeding.

Blood Circulation ; Drugs, Chinese Herbal ; adverse effects ; therapeutic use ; Endpoint Determination ; Female ; Hematoma ; blood ; complications ; drug therapy ; Humans ; Intracranial Hemorrhage, Hypertensive ; blood ; drug therapy ; Male ; Middle Aged ; Prospective Studies ; Stroke ; blood ; drug therapy ; Treatment Outcome

OBJECTIVETo observe the clinical efficacy and mechanism of Zhuyu Tongfu (ZYTF) Serial Recipe combined with acupuncture and massotherapy in treating hypertensive cerebral hemorrhage (HCH).

METHODSOne hundred and eighteen patients with hypertensive cerebral hemorrhage, on the basis of conventional Western medicine treatment, were randomly divided into ZYTF combined with acupuncture and massotherapy group (treated group) and simple Western medicine group (control group); the clinical efficacy, neurofunction deficit scoring (NDS) alterations and hematoma absorption rate of both groups were observed, and also the plasma superoxide dismutase (SOD) activity, plasma lipid peroxidase (LPO) content, erythrocyte glutathion peroxidase (GSH-Px) activity, hematocrit (Ht) and the whole blood viscosity (Va) change were also observed.

RESULTSIn the treated group, the clinical efficacy, NDS improvement and hematoma absorption rate were superior to that of the control group; comparison between the two groups after treatment showed that plasma SOD activity and GSH-Px activity got more elevated and plasma LPO content, Ht and Va more lowered in the the treated group than those in the control group.

CONCLUSIONZYTF combined with acupuncture and massotherapy has better effect, its therapeutic mechanism was possibly correlated to the elevation of plasma SOD activity, GSH-Px activity and lowering of plasma LPO content, Ht and Va.

Acupuncture Therapy ; methods ; Adult ; Aged ; Aged, 80 and over ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Intracranial Hemorrhage, Hypertensive ; therapy ; Male ; Massage ; methods ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Treatment Outcome