Abstract
BACKGROUND: Hypertensive intracerebral hemorrhage (HICH) is a critical neurological emergency associated with high morbidity and mortality. Conventional Western medical therapies - such as antihypertensive treatment, intracranial pressure reduction, and supportive care - provide symptomatic relief but remain limited in promoting hematoma absorption, neurological recovery, and long-term functional outcomes. Traditional Chinese medicine (TCM) has shown clinical potential in enhancing neurological repair and improving prognosis. Given their complementary strengths, combined Chinese and Western medicine may represent a more comprehensive treatment strategy. However, the overall efficacy and safety of such integrative approaches remain uncertain due to inconsistent findings and lack of high-quality evidence. METHODS: A comprehensive search of CNKI, VIP, CBM, PubMed Embase, and Cochrane Library was conducted from 2010 to March 2024. Randomized controlled trials (RCTs) comparing combined therapy with Western medicine alone were included. The primary outcome was overall clinical effective rate. Secondary outcomes included National Institutes of Health Stroke Scale (NIHSS) score, Glasgow Coma Scale (GCS) score, hs-CRP level, adverse events and mortality. Data extraction, risk-of-bias assessment using the Cochrane tool and statistical analyses were independently performed by 2 reviewers. Meta-analysis was conducted with fixed- or random-effects models depending on heterogeneity, while sensitivity, subgroup, publication bias and trial sequential analyses (TSA) were also performed. RESULTS: Eighteen RCTs involving 1644 participants were analyzed. Compared with Western medicine alone, combined therapy significantly improved clinical effective rate (OR = 4.35, 95% CI [3.08-6.13], P < .00001), NIHSS score (MD = -2.95, 95% CI [-2.29 to -1.95], P < .00001), GCS score (MD = 1.95, 95% CI [1.61-2.28], P < .00001), and reduced hs-CRP levels (MD = -1.31, 95% CI [-1.44 to -1.19], P < .00001). No significant difference was observed in adverse events (OR = 0.81, P = .43). Mortality was reported in only one trial and showed no difference between groups (P > .05). TSA supported the sufficiency and robustness of evidence for the primary outcome. CONCLUSION: The therapeutic effect of combined traditional Chinese and Western medicine in treating HICH is better than that of Western medicine alone.