Traditional Chinese Medicine Interventions for Post-Stroke Emotional Disorders: A Protocol for Network Meta-Analysis of Randomized Controlled Trials

Yuqiao Chao¹Bai Li¹Zhaozhan Xie¹Hongling Jia^2*Yongchen Zhang^1*

• ¹Shandong University of Traditional Chinese Medicine, Jinan, China
• ²Shandong University of Traditional Chinese Medicine Second Affiliated Hospital, Jinan, China

Background: Post-stroke emotional disorders (PSED—depression, anxiety, comorbidity) are prevalent, debilitating complications hindering recovery and increasing mortality risk. Conventional treatments face limitations like slow onset and side effects. Traditional Chinese Medicine (TCM) offers multi-target potential, but evidence comparing its diverse therapies is lacking.Methods: This registered network meta-analysis (NMA) will systematically search major databases (PubMed, Embase, CENTRAL, Web of Science, CNKI, CBM, VIP, Wanfang, ClinicalTrials) for RCTs (since 2000) comparing TCM therapies against Western medicine or placebo in adult PSED. Primary outcomes are clinical effective rate and scale score changes. Two researchers will independently screen studies, extract data, and assess bias. A Bayesian random-effects NMA model will quantify efficacy differences and rank probabilities among TCM interventions. Subgroup analyses by PSED type and TCM syndrome pattern will explore heterogeneity. Transitivity, heterogeneity, inconsistency, and evidence certainty (GRADE) will be evaluated. PRISMA-P/NMA guidelines are followed.Results: The NMA will synthesize direct/indirect evidence to provide: 1) Pairwise comparisons (TCM interventions vs. each other/controls); 2) Efficacy rankings for PSED symptom improvement; 3) Subgroup treatment effects; 4) GRADE evidence ratings for all estimates.Conclusion: This study will be the first NMA under the TCM framework to systematically compare and rank the efficacy of multiple TCM interventions for PSED, quantifying effect sizes and optimal probabilities. Results aim to provide clinicians with an evidence-based hierarchy for selecting "acupuncture-herbal medicine-integrated therapy," addressing current decision-making gaps. Emphasis on syndrome/subtype subgroups seeks to establish a foundation for precise, individualized integrated treatment. Preregistration enhances transparency and credibility, promoting high-quality TCM evidence for optimizing PSED management and prognosis.