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OBJECTIVE:To evaluate the effectiveness of traditional Chinese herbal Xinglouchengqi (XLCQ) decoction for the treatment of constipation in acute ischemic stroke patients,and figure out the role that bowel movements play in the treatment of acute ischemic stroke.METHODS:A total of 317 eligible patients were recruited and randomized to the XLCQ group (211 patients) or the control group (106 patients).In addition to conventional standard medical care and rehabilitation,participants in the XLCQ group received XLCQ decoction,while the control group received clysis therapy using glycerin enemas or lactulose oral solution.Both groups were given treatment for 3 to 6 d,during which they received daily visits to record defecation features and accompanying symptoms.Neurological assessments using the National Institutes of Health Stroke Scale (NI-HSS) were conducted before and 1 month after treatment.RESULTS:Patients in the XLCQ group had lower aggregate constipation scores compared with the control group on days 3 and 5 (P ＜ 0.05).Spontaneous bowel movements tended to reappear more rapidly after taking the XLCQ decoction than after conventional laxative treatment.Both the average aggregate constipation score and the time taken to achieve spontaneous bowel movements showed positive correlations with NIHSS scores before and 1 month after treatment (P ＜ 0.01).CONCLUSION:Treatment with XLCQ decoction effectively alleviated the overall symptoms of constipation in acute ischemic stroke patients.The status of bowel movements in acute ischemic stroke can reflect the severity of neurological impairment and predict neurological outcomes at 1 month.