Chapter 11 - Angong Niuhuang pill could be an effective medicinal agent for stroke treatment

Abstract

Angong Niuhuang pill (ANP) is a classical medicinal formula in Traditional Chinese Medicine (TCM) and approved by the State Food and Drug Administration of China for stroke treatment. This review aims to provide the up-to-date research progress about the efficacy and safety of ANP in acute stroke treatment. Pharmacological studies indicate that ANP reduces infarction volume, attenuates brain edema, protects the blood–brain barrier integrity, improves neurological functions, and decreases mortality rates in both experimental ischemic stroke and intracerebral hemorrhage (ICH) animal models. The neuroprotective mechanisms of ANP could be attributed to the properties of antioxidant and antiinflammation. ANP contains cinnabar (>96% mercury sulfide) and realgar (>90% arsenic sulfide), raising the safety and toxic concerns. Nevertheless, oral administration of ANP at regular dosage for 1week should be safe for treating ischemic stroke with neuroprotective effects. Cinnabar and realgar have antioxidant and antiinflammation capacity contributing to the ANP neuroprotective effects against cerebral ischemia-reperfusion injury. Clinical trials indicate that ANP could be an adjunct therapeutic agent with conventional drugs to attenuate brain damage and improve neurologic deficit scores for acute cerebral infarction and acute ICH patients. Taken together, ANP could be a promising therapeutic medicinal product for attenuating neurological dysfunctions in stroke treatment. Further studies to explore the efficacies of ANP as adjuvant reagent with thrombolytic drug would create new opportunity to extending therapeutic window of thrombolytic treatment and improving therapeutic outcome for stroke patients.