##Criteria for Inclusion and Exclusion
Studies that met the following criteria were included. (1) study design was limited to a randomized controlled trial of SXNS combined with edaravone for cerebral infarction; (2) all subjects were diagnosed with cerebral infarction by computed tomography (CT) or magnetic resonance imaging (MRI); (3) edaravone alone was applied in the control group and SXNS combined with edaravone in the experimental group on top of conventional treatment
Studies involving the following criteria were excluded. (1) participants with other cerebrovascular diseases or with severe cardiac, hepatic, or renal diseases; (2) duplicate studies; (3) inappropriate interventions, such as other herbal medicines in the intervention group; (4) incomplete data; and (5) irrelevant to the outcome measures.
##Literature Search Strategy
From inception to April 4, 2022, we searched the following relevant databases: PubMed, EMBASE, Cochrane Library, China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Database and China Science Journal Database (VIP database). We combine grid words with text words in search for retrieval research. "Cerebral Infarction" is considered a net word. All policies come from different databases.
The search strategy used in PubMed is as follows:
#1 "Cerebral Infarction" [MeSH]
#2 "Cerebral Infarctions"[Title/Abstract] OR "Infarctions, Cerebral"[Title/Abstract] OR "Infarction, Cerebral"[Title/Abstract] OR "Cerebral Infarct"[Title/Abstract] OR "Cerebral Infarcts"[Title/Abstract] OR "Infarct, Cerebral"[Title/Abstract] OR "Infarcts, Cerebral"[Title/Abstract] OR "Cerebral Infarction, Left Hemisphere"[Title/Abstract] OR "Left Hemisphere, Infarction, Cerebral"[Title/Abstract] OR "Infarction, Left Hemisphere, Cerebral"[Title/Abstract] OR "Left Hemisphere, Cerebral Infarction"[Title/Abstract] OR "Cerebral, Left Hemisphere, Infarction"[Title/Abstract] OR "Infarction, Cerebral, Left Hemisphere"[Title/Abstract] OR "Subcortical Infarction"[Title/Abstract] OR "Infarction, Subcortical"[Title/Abstract] OR "Infarctions, Subcortical"[Title/Abstract] OR "Subcortical Infarctions"[Title/Abstract] OR "Posterior Choroidal Artery Infarction"[Title/Abstract] OR "Anterior Choroidal Artery Infarction"[Title/Abstract] OR "Cerebral Infarction, Right Hemisphere"[Title/Abstract] OR "Right Hemisphere, Cerebral Infarction"[Title/Abstract] OR "Infarction, Right Hemisphere, Cerebral"[Title/Abstract] OR "Right Hemisphere, Infarction, Cerebral"[Title/Abstract] OR "Cerebral, Right Hemisphere, Infarction"[Title/Abstract] OR "Infarction, Cerebral, Right Hemisphere"[Title/Abstract]
#3 #1 OR #2
#4 "shuxuening" [Title/Abstract] OR "Soothing tablets" [Title/Abstract] OR "Shuxuening"[Title/Abstract] OR "Shu Xue Ning" [Title/Abstract] OR" Shuxuening injection" [Title/Abstract] OR "shuxuening"[Title/Abstract]
#5 #3 AND #4
##Outcomes of Interest
The primary outcome was the neurologic deficit measured by National Institutes of Health Stroke Scale (NIHSS). The secondary outcomes were: (1) quality of life measured by Barthel Index (BI), ADL scores and Fibrinogen (FIB); (2) response rates (proportion of patients improved): cure (neurologic deficit scores reduced rate from 91–100%), significantly effective (neurologic deficit scores reduced rate more from 46–90%), effective (neurologic deficit scores reduced rate from 18–46%), and ineffective (neurologic deficit scores scores reduced rate less than 18%).
##Study Selection
We imported the search results into EndNote. Duplicates were first removed from all search results, and the remaining studies were filtered by title and abstract. Studies were then screened by browsing the full text to identify studies that met the inclusion criteria. The entire screening process was performed by two researchers.
##Data Extraction and Quality Assessment
All data were extracted independently by two investigators, and any differeces between reviewers were solved by a middleman until common understanding was reached. Data extracted from each study included the name of the first author, year of publication, country of publication, number of patients, mean age, gender, dose, course of treatment, and clinical outcomes.
On quality assessment, we assessed the quality of the included studies using Review Manager 5.4,which is a program for the production and maintenance of Cochrane systematic reviews by the International Cochrane Collaborative Network, and is the most commonly used software for systematic review and analysis in evidence-based medicine. Literatures were evaluated as low risk, high risk, and unclear risk according to the following quality items: randomization method, allocation concealment, subject blinding, completeness of outcome data, selective outcome reporting, and other biases. The quality assessment was done jointly by two investigators, and any disagreements between the evaluators were resolved by an intermediary until consensus was reached.
##Statistical Analysis
Quantitative synthesis of results reported in multiple homogeneous RCTs. System evaluation was performed using Stata 16.0 software. Heterogeneity between randomized controlled trials was analyzed using the chi-square test and estimated using I2, depending on the analysis of heterogeneity, a random-effects or fixed-effects model was chosen. Lack of significant heterogeneity was considered by P ≥ 0.1 or I2 ≤ 50%, so a fixed-effects model was used; otherwise, a random-effects model was used. Risk ratio (RR) was used to evaluate dichotomous outcomes, while mean difference (MD) was used to evaluate continuous variables. Each result value is expressed as a 95% confidence interval. P < 0.05 was considered significant. The results of the sensitivity analysis are also reported.