SYSTEMATIC REVIEW article
Front. Pharmacol.
Sec. Ethnopharmacology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1635090
Systematic Review and Meta-Analysis of Specific External Chinese Herbal Medicine for Post-Stroke Dysphagia: Efficacy and Clinical Implications
Provisionally accepted
- 1Heilongjiang University of Chinese Medicine, Harbin, China
- 2The second affiliated hospital of Heilongjiang University of Traditional Chinese medicine, Harbin, China
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Objective: To systematically evaluate the efficacy and safety of Specific External Traditional Chinese Medicine Therapies (SETCM Therapies) versus conventional non-SETCM Therapies interventions for improving swallowing function, nutritional status, and reducing complications in adult patients with PSD, based on RCTs. Methods: A comprehensive search was conducted from inception to present across Chinese (CNKI, VIP, Wanfang, CBM) and international databases (PubMed, Embase, Web of Science, Cochrane Library). RCTs investigating validated SETCM Therapies modalities (e.g., herbal patches, iontophoresis, compresses, fumigation) for PSD were included. All herbal components were taxonomically validated using the Kew Medicinal Plant Names Service (MPNS). The control group received conventional therapy (rehabilitation, nursing, medication). The experimental group received SETCM Therapies or combined with conventional care. The risk of bias in eligible studies was assessed using the Cochrane risk-of-bias tool. Meta-analysis was performed using RevMan 5.4. Stratified subgroup analyses were conducted based on stroke lesion location (supratentorial vs. brainstem) and intervention type. Results: Twenty-five RCTs (n=2,159 patients; SETCM Therapies group=1,152, control group=1,007) were included. Meta-analysis demonstrated significantly greater benefits in the SETCM Therapies group for: overall response rate (OR=3.28, 95% CI [2.49, 4.31]); overall cure rate (OR=2.36, 95% CI [1.84, 3.02]); Water Swallowing Test (WST) score (MD=-0.65, 95% CI [-1.23, -0.06]); and SWAL-Quality of Life (SWAL-QOL) score (MD=25.61, 95% CI [20.54, 30.67]). The SETCM Therapies group also demonstrated superior results in Videofluoroscopic Swallow Study (VFSS) scores, Modified Barthel Index (MBI), serum albumin (ALB), prealbumin (PA), Gugging Swallowing Screen (GUSS), Activities of Daily Living (ADL) and Functional Dysphagia Scale (FDS) scores, nasogastric tube removal success rate, as well as lower Nutritional Risk Screening 2002 (NRS2002) scores, reduced aspiration incidence, and shorter nasogastric tube indwelling time. Safety analysis (3 studies) reported mild skin irritation (erythema and pruritus) in 2.1% of cases. Conclusion: SETCM Therapies significantly improved swallowing function, nutritional status, and clinical outcomes in patients with PSD. Efficacy exhibited neuroanatomical specificity: Acupoints are preferred for cerebral hemisphere lesions, while herbal iontophoresis is the best choice for brainstem involvement. These findings support the integration of targeted SETCM Therapies into PSD rehabilitation. However, the evidence is limited by methodological biases, necessitating high-quality RCTs for confirmation.
Keywords: Deglutition Disorders, External Traditional Chinese Medicine Therapies, Stroke, therapeutic efficacy, Systematic review
Received: 27 May 2025; Accepted: 14 Jul 2025.
Copyright: © 2025 Zhang, Kang, 赵, Niu, Chen and Shi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Shuai Shi, The second affiliated hospital of Heilongjiang University of Traditional Chinese medicine, Harbin, China
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