[Research progress in oxidative stress-mediated multilink pathological cascade in ischemic stroke and synergistic...

Ischemic stroke(IS) is a globally prevalent neurological emergency, with its core pathology featuring oxidative stress-driven cascade injury induced by ischemia-reperfusion(I/R). This pathology involves the synergistic amplification of reactive oxygen species(ROS) burst, inflammation activation, and multiple types of cellular damage. Existing therapeutic approaches struggle to achieve simultaneous blocking of multiple targets. TCM, centering on the holistic concept and syndrome differentiation and treatment, exerts therapeutic effects via multiple components and pathways, which are highly compatible with the complex pathological network of IS. Accordingly, TCM has evolved into a key strategy for IS intervention. This article systematically summarizes the initiating and amplifying mechanisms of oxidative stress in the IS pathological cascade, and focuses on reviewing the multi-target intervention systems of TCM. The active components of single herbs precisely target key nodes of the cascade through mechanisms such as antioxidation, anti-inflammation, inhibition of abnormal cell death, protection of the blood-brain barrier(BBB), and metabolic microenvironment regulation. Classic TCM formulae achieve holistic blocking of the cascade loop by virtue of cross-system regulation, multi-link coverage, and clinical scenario adaptability. Novel intelligent drug delivery systems effectively address intracerebral delivery challenges and significantly enhance intervention efficacy. Meanwhile, this article highlights the current core research gaps: inadequate elaboration on the molecular mechanisms underlying the multicomponent synergistic intervention of TCM, insufficient standardization of clinical studies, and delayed translation of drug delivery systems into clinical applications. In the future, it is necessary to rely on interdisciplinary technologies such as systems biology and nanomedicine to deeply decipher the synergistic intervention mechanisms of TCM, and improve the basic-clinical medical translation system. In summary, TCM, through a synergistic blocking model supported by multicomponent empowerment, multi-targeting, and multistage intervention, offers a unique and feasible solution for breaking through the bottlenecks in the clinical treatment for IS and is expected to become a core intervention method for the integrated traditional Chinese and western medicine treatment of IS.