| Background Acute ischemic stroke has led to significant burden of human society, with high rate of mortality and dependency. Currently very few drugs are supported by Evidence-Based Medicine to be used as a routine treatment for this disease. Sanchi is one of the most widely used medicinal herbs in China for acute ischemic stroke. However, the effectiveness and safety have not been confirmed yet.Objectives This review aims to assess the effectiveness and safety of sanchi preparations (extraction from sanchi plant) in the treatment of acute ischemic stroke.Materials and Methods We searched for studies according to the search strategy of Cochrane Stroke Group. The following databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library issue 1, 2007), MEDLINE (1966 to Feb. 2007), EMBASE (1980 to Feb. 2007), China Biological Medicine Database (CBM-disc 1979 to Feb. 2007), the Chinese VIP database (1989- Feb. 2007), the CNKI China full-text database (1979 to Feb. 2007), the Chinese Stroke Trials Register (2003 to Feb. 2007) , the CNKI Chinese Proceedings of Conference Full-text Database and China Doctor and Master Dissertation Full-text Database(1999 to Feb. 2007). Reference lists of all relevant papers were searched for further studies. Randomized and quasi randomized controlled clinical trials comparing sanchi preparations with placebo or no treatment for treating patients of acute ischemic stroke within 14 days of onset were retrieved. When the report of methodology or result was unclear, we tried to telephone interview the primary authors to obtain further information and excluded those not fulfilling our inclusion criteria. Two reviewers extracted data and assessed trial quality independently. Disagreement were resolved by discussion or with a third party. The RevMan 4.2.10 software provided by Cochrane collaboration was used for statistical analyses.Results Fourteen trials involving 1119 participants were included. All the included trials were of inferior methodology quality. 4 studies reported number of patients who were dependent at the end of the trial; 1 study reported mean value of degree of dependency; all the studies focused on improvement of neurological deficit; 3 studies mentioned slight adverse reaction in sanchi group which disappeared after sanchi discontinued; 1 study mentioned deaths; 1 study mentioned stroke recurrence; none of the studies measured quality of life. Data for proportion of patients who were dead or dependent at the end of trial were pooled for analysis, indicating that sanchi can significantly decrease number of patients who were dead or dependent patients with improvement of neurological deficit from 12 studies were pooled for analysis, which indicated that using Sanchi for acute ischemic stroke was statistically more effective than control in achieving both general improvement [ (RR 1.16, 95%C1(1. 06,1. 28) ] and marked improvement [(RR 1.79, 95%C1(1.45-2. 20) ] in neurological function deficit.Conclusions Current evidence in our review indicated that sanchi might be efficacious in improving activities of daily living and neurological function deficit. But due to the inferior quality of all the included trials with high risk of bias, no definite conclusions were allowed to confirm the effectiveness and safety to support routine use of sanchi for acute ischemic stroke. There is a requirement for well-designed, large-scale randomized controlled trials. Methodology report should be clear. Follow-up should be longer and outcome measures should focus on activities of daily living.
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