title: Rhubarb root and rhizome-based Chinese herbal prescriptions for acute ischemic stroke: a systematic review and meta-analysis.
abstract: BACKGROUND
  Traditional Chinese Medicine has been using in stroke victims for thousands of years, and the rhubarb root and rhizome (RRR)-based Chinese herbal prescription is one of the principle treatments for stroke. The objective of this study is to systematically assess the clinical efficacy and safety of RRR-based prescriptions for acute ischemic stroke.
  
  
  METHODS
  A systematic literature search in six databases was performed to identify randomized controlled trials (RCTs), which compared RRR-based prescriptions with western conventional medicine (WCM) for acute ischemic stroke. The methodological quality of RCTs was assessed independently based on the 12 criteria recommended by the Cochrane Back Review Group.
  
  
  RESULTS
  A total of 968 participants were included in 12 eligible studies. All trials were deemed to have high a risk of bias. RRR-based prescriptions have a significant effect on the improvement of the clinical efficacy rate (n=10), Barthel Index scores (n=5), National Institutes of Health Stroke Scale scores (n=2), Glasgow Coma Scale scores (n=1), and neurological deficit scores (n=5) when compared with WCM controls (p<0.05 or p<0.01). Six trials reported that there were no adverse events, while no mention of adverse effect monitoring was reported in the other 6 studies.
  
  
  CONCLUSIONS
  Despite the apparently positive findings, it is premature to recommend the routine use of RRR-based prescriptions for acute ischemic stroke because methodological flaws undermine the strength of our findings. However, this work identifies an area, which is worthy of improvement and development for further research. Larger sample-sizes and rigorously designed RCTs are required in the future.
authors.affiliation: Department of Neurology, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical College, Wenzhou 325027, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Lu
authors.affiliation: Department of Neurology, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical College, Wenzhou 325027, China.
authors.forename: Hui-qin
authors.initials: HQ
authors.lastname: Li
authors.affiliation: Department of Neurology, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical College, Wenzhou 325027, China.
authors.forename: Deng-lei
authors.initials: DL
authors.lastname: Fu
authors.affiliation: Department of Neurology, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical College, Wenzhou 325027, China. Electronic address: gq_zheng@sohu.com.
authors.forename: Guo-qing
authors.initials: GQ
authors.lastname: Zheng
authors.affiliation: China Academy of Chinese Medical Sciences, Beijing 100091, China. Electronic address: fanjiping5218@vip.sina.com.
authors.forename: Ji-ping
authors.initials: JP
authors.lastname: Fan
mesh_terms: D000368:Aged; D004365:Drugs, Chinese Herbal / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008517:Phytotherapy / Q000379:methods*; D018517:Plant Roots / Q000737:chemistry; D016032:Randomized Controlled Trials as Topic; D012250:Rheum / Q000737:chemistry*; D027343:Rhizome / Q000737:chemistry; D020521:Stroke / Q000188:drug therapy*
chemical_list: D004365:Drugs, Chinese Herbal
keywords: Acute ischemic stroke; Chinese herbal medicine; Meta-analysis; Rhubarb root and rhizome; Systematic review