Therapeutic Potential of Traditional Chinese Herbal Medicines in Intracerebral Haemorrhage: A Narrative Review.

Intracerebral haemorrhage (ICH) remains a devastating stroke subtype with limited therapeutic options, creating an urgent need for complementary strategies that target secondary brain injury and recovery. Traditional Chinese herbal medicines (TCHMs) have attracted interest because of their potential multitarget actions on neuroinflammation, oxidative stress, apoptosis, ferroptosis, blood-brain barrier dysfunction, haematoma resolution, gut microbiota dysbiosis and neurovascular repair. Relevant preclinical, clinical and translational studies were identified through a structured search of international and Chinese bibliographic databases. Preclinical studies suggest that selected TCHM-derived bioactive compounds and multicomponent formulae may modulate key pathological processes after ICH, although compound-level mechanisms should not be directly extrapolated to formula-level effects without further validation. Clinically, several small-scale randomized trials, observational studies and meta-analyses have reported potential benefits of selected TCHM preparations, including improved neurological scores, haematoma absorption, oedema reduction and functional recovery when used as adjuncts to conventional care. However, the clinical evidence remains heterogeneous. Larger and more rigorously designed multicentre trials, including CHAIN and CRRICH, have either failed to confirm clear functional benefit or raised safety concerns under specific conditions, particularly regarding ultra-early use of potent blood-activating formulations. Translation into mainstream ICH management is further hindered by variable study quality, insufficient risk-of-bias control, uncertainty regarding active material basis, potential synergistic or antagonistic interactions within multicomponent formulae and limited standardisation of herbal preparations. Future research should focus on formulation-specific, stage-specific and patient-stratified evaluation using rigorous randomized controlled trials, transparent pharmacological characterization, standardised quality control and careful safety monitoring. This review synthesises current evidence from bench to bedside and highlights a cautious pathway toward evidence-based integration of selected TCHMs into ICH management.