Banxia-Baizhu-Tianma Decoction Combined with Acupuncture for Cerebral Ischemic Stroke: A Narrative Review

Abstract: Cerebral ischemic stroke (CIS) is a devastating cerebrovascular disease with high global morbidity, mortality, and disability rates, posing a severe burden on public health and socioeconomic development. Conventional Western medical interventions, while effective in the acute phase, are limited in mitigating long-term neurological sequelae and improving functional outcomes. Traditional Chinese medicine (TCM) has accumulated rich experience in CIS treatment over millennia, with Banxia-Baizhu-Tianma Decoction (BBTD) and acupuncture as pivotal evidence-based therapies. This review synthesizes the latest advances in CIS pathophysiological mechanisms and elaborates the therapeutic effects and molecular mechanisms of BBTD, acupuncture, and their combination. BBTD, a classical TCM formula for resolving phlegm, calming wind, invigorating the spleen and eliminating dampness, exerts neuroprotective, anti-inflammatory, antioxidant, and vascular-protective effects via multi-targeted regulation, with its constituent herbs acting synergistically. Acupuncture, a WHO-endorsed TCM component, alleviates CIS by inhibiting glutamate excitotoxicity, calcium overload and inflammatory cascades, promoting angiogenesis, neurogenesis and synaptic plasticity, mediated by regulating neurotransmitters, cytokines, growth factors and key signaling pathways. Preliminary clinical studies suggest that combined BBTD and acupuncture may be superior to monotherapy, showing potential in improving cerebral perfusion, reducing inflammatory markers and blood lipids, enhancing motor function and daily activities, and lowering disability rates. Despite limitations, preclinical and clinical evidence supports this integrative TCM strategy. This review concludes that BBTD and acupuncture may exert synergistic effects by targeting overlapping CIS pathophysiological pathways, and highlights the need for large-scale, high-quality RCTs and in-depth mechanistic studies to validate efficacy and promote clinical translation. Keywords: Banxia-Baizhu-Tianma decoction, acupuncture, cerebral ischemic stroke, neuroprotection, inflammatory response, synergistic mechanism