Chinese herbal medicine and acupuncture reduce mortality after intracerebral hemorrhage

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 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 (NHIRD). 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 6,450 patients (3,225 TCM; 3,225 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% confidence interval [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 (Lumbricus rubellus) exhibited the greatest reduction in mortality risk, with an aHR of 0.36 (95%CI: 0.28-0.47; p<0.001), followed closely by Dan-Shan (Salvia miltiorrhiza), Tian-Ma (Gastrodia elata), Ji-Xue-Teng (Millettia dielsiana), and Gou-Teng (Uncaria rhynchophylla), each with an aHR of 0.37. For formula, 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), followed by Huang‑Qi‑Wu‑Wu‑Tang and Shao‑Yao‑Gan‑Cao‑Tang (both aHR: 0.35), suggesting consistent survival benefits associated with these core herbal formulas in the management of ICH. Network core pattern analysis identified the key components of treatment, including Bu-Yang-Huan-Wu-Tang, Yuan-Zhi (Polygala tenuifolia), Shi-Chang-Pu (Acorus tatarinowii), Tian-Ma (Gastrodia elata), and Gou-Teng (Uncaria rhynchophylla). 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: TCM, particularly with longer treatment and more acupuncture sessions, is associated with lower mortality in patients with ICH. Further research is needed to confirm these findings and explore the underlying mechanisms.