Neural Remodeling After Ischemic Stroke From the Perspective of Qi-Blood-Neurovascular Unit Coupling: A Narrative Review

Abstract

Neurological recovery after ischemic stroke is closely associated with successful reperfusion and preservation of the neurovascular unit (NVU). Traditional Chinese medicine (TCM) concepts such as disharmony of qi and blood and intermingling of phlegm and blood stasis show conceptual parallels with blood-brain barrier disruption, glial dysregulation, inflammatory activation, and other pathological changes recognized in modern medicine. From the perspective of qi-blood-NVU coupling, this review summarizes NVU injury, neural remodeling, and the potential mechanisms of TCM interventions after ischemic stroke. It further discusses how therapeutic approaches that replenish qi, activate blood circulation, resolve blood stasis, and unblock the collaterals may influence neurotrophic factor expression, inflammatory microenvironments, microcirculation, and synaptic plasticity. Current evidence suggests that TCM may modulate post-stroke neural repair through multicomponent, multitarget, and multipathway actions. However, major limitations remain, including the lack of standardized disease-syndrome animal models, insufficient validation of key causal mechanisms, and limited high-quality clinical evidence. Future studies should integrate multi-omics, artificial intelligence-assisted analysis, advanced disease models, and rigorously designed clinical trials to clarify the modern biological basis of qi-blood-NVU coupling and to provide a stronger foundation for neural repair and integrative treatment after ischemic stroke.