Syndrome differentiation is a unique part of traditional Chinese medicine (TCM). Syndrome factors play an important role in the diagnosis and treatment of TCM syndromes. Thromboelastography (TEG) intuitively reflects the blood status of patients with acute ischemic stroke (AIS) and is important in the treatment and prognosis of AIS. To identify the relationship between TCM syndrome factors and TEG in AIS patients and standardize TCM syndrome differentiation and treatment objectives, we designed a prospective cohort study of 103 AIS patients.

We used the diagnostic criteria for AIS in the Chinese Guideline for Diagnosis and Management of Acute Ischemic Stroke 2010. Diagnosis of phlegm-heat and fu-organ excess syndrome was based on the TCM Scale for the Syndrome of Phlegm-heat and fu-organ Excess. The ischemic Stroke TCM Syndrome Factor Diagnostic Scale was used to identify and diagnose syndrome factors. General information, scores of syndrome factors and values of TEG parameters of all enrolled patients were recorded.

There were significant differences in internal fire and phlegm-dampness scores between patients with and without phlegm-heat and fu-organ excess syndrome (P < .05). In patients with phlegm-heat and fu-organ excess syndrome, internal fire was negatively correlated with TEG parameters R and K (P < .05) and positively correlated with alpha Angle and coagulation index (P < .01). There were no significant correlations between the two syndrome factors and MA (P = .058) and LY30 (P > .05) or between both syndrome factors and TEG parameters in patients without phlegm-heat and fu-organ excess syndrome.

The syndrome factor internal fire is a potential predictor of increased platelet function and fibrinogen activity in AIS patients with phlegm-heat and fu-organ excess, and a potentially important predictor of blood hypercoagulability in TCM.

Panax notoginseng saponins (PNS), extracted from rhizome of the herb Radix et Rhizoma Notoginseng (Panax notoginseng (Burk.) F.H. Chen), was recently discovered to have beneficial effects against neurological damage. This study investigated the effects of PNS on cerebral ischemia and elucidated the molecular mechanisms underlying these effects.

Middle cerebral artery occlusion rats were treated with PNS (3.6 mg/100 g or 7.2 mg/100 g per day) for 7 days, the gene of LINGO-1 was measured and the expression of protein synaptophysin, postsynaptic density protein 95, LINGO-1 and p-EGFR/p-PI3K/p-AKT were investigated. The weight and mNSS score of Sprague–Dawley rats in each group were recorded every day during the 7 days.

PNS promoted middle cerebral artery occlusion rats' weight and the recovery of neural function. PNS significantly decreased ischemia-induced LINGO-1 protein expression. PNS also elevated EGFR/PI3K/AKT phosphorylation levels.

PNS promoted cerebral recovery from ischemic injury by accelerating synapse reconstruction and inhibiting the neuron growth negative regulatory protein LINGO-1 and activating the epidermal growth factor receptor (EGFR)/PI3K/AKT signaling pathway in vivo.