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Chinese herbal medicine and acupuncture reduce mortality after intracerebral hemorrhage
Dai-Ying Lin1,2,3, Ming-Jen Wang4,5, Ying-Hsiu Shih6,7
1Division of Chinese Internal Medicine, Department of Chinese Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan, ROC.
Background:
Intracerebral hemorrhage (ICH) is the second most common stroke worldwide and is associated with high mortality rates. Despite established guidelines for ICH treatment, the prognosis of ICH remains poor. Traditional Chinese Medicine (TCM), including Chinese herbal medicine (CHM) and acupuncture, has been used as a complementary therapy; however, its long-term survival benefits remain uncertain.
Methods:
This study aimed to evaluate the effectiveness of TCM, including CHM and acupuncture, in reducing mortality among patients with ICH, using data from Taiwan's National Health Insurance Research Database. This retrospective cohort study analyzed patients with ICH (ICD-9-CM: 430-432; ICD-10-CM: I60-I62) between 2000 and 2018. Patients who received TCM or acupuncture (≥2 outpatient or ≥1 inpatient visits) were matched 1:1 with non-TCM patients based on age, sex, urbanization, and income. Mortality was the primary outcome, analyzed using Cox proportional hazards models.
Results:
Among 6450 patients (3225 TCM; 3225 control), TCM, including CHM and acupuncture, was significantly associated with reduced all-cause mortality in patients with ICH (adjusted hazard ratio [aHR] = 0.42; 95% CI, 0.39-0.46; p < 0.001), with CHM alone showing aHR = 0.40 (95% CI, 0.35-0.45; p < 0.001) and CHM combined with acupuncture showing aHR = 0.43 (95% CI, 0.39-0.47; p < 0.001) compared with non-TCM users. Among the top 10 single herbs used, Di-Long exhibited the greatest reduction in mortality risk (aHR = 0.36; 95% CI, 0.28-0.47; p < 0.001). Among formulas, Xue-Fu-Zhu-Yu-Tang and Chai-Hu-Jia-Long-Gu-Mu-Li-Tang demonstrated the strongest protective associations with mortality (aHR = 0.35; p < 0.001). Network core pattern analysis identified the key components of treatment, including Bu-Yang-Huan-Wu-Tang, Yuan-Zhi, Shi-Chang-Pu, Tian-Ma, and Gou-Teng. Acupuncture exhibited a similar dose-response effect, with mortality risk decreasing progressively with more sessions (aHR: for ≥18 sessions: 0.45; 95% CI, 0.40-0.49; p < 0.001).
Conclusion:
CHM and acupuncture are associated with lower mortality in patients with ICH. Further research is needed to confirm these findings and explore the underlying mechanisms.
