Glioblastoma is the most common primary malignant intracranial tumor in adults and is characterized by the “three highs” of high morbidity, high disability, and high recurrence, making it one of the most challenging diseases in neuro-oncology. Although surgery, radiotherapy, chemotherapy, and targeted therapies have continuously improved over the past decade, the recurrence rate of high-grade gliomas remains extremely high, and there is still no unified, effective standard treatment for recurrent tumors, representing a major clinical dilemma. As an important component of traditional Chinese medicine (TCM), Chinese herbal medicine has accumulated rich experience in the adjuvant treatment of tumors and has shown unique advantages in improving symptoms, delaying recurrence, and enhancing quality of life. This paper aims to systematically review and summarize the theoretical basis, mechanisms, and clinical research progress of TCM in preventing and treating glioma recurrence, to clarify its role and value in the comprehensive treatment of gliomas, and to provide evidence-based support and research ideas for further integrated traditional Chinese and Western medicine therapies.

A literature review and systematic analysis were conducted. Relevant articles published from 2010 to 2023 were retrieved from databases such as CNKI, PubMed, and Web of Science using keywords including “glioma,” “recurrence,” “traditional Chinese medicine,” “mechanism,” and “clinical research.” More than 200 articles, including basic research, clinical studies, reviews, and systematic evaluations, were included. Based on the research content, the articles were categorized and analyzed from the perspectives of TCM etiology and pathogenesis, modern mechanistic studies, clinical evidence, effects of TCM compounds and monomers, and network pharmacology predictions. Additionally, integrating TCM theory, the study explored the convergence of TCM and modern medicine in the mechanisms of glioma recurrence and summarized the key targets and signaling pathways of TCM intervention.

1. TCM Etiology and Pathogenesis: TCM considers that the recurrence of gliomas is mainly related to “deficiency of vital qi, and accumulation of phlegm, blood stasis, and toxins.” The disease is located in the brain and involves the liver, spleen, and kidney. The pathogenesis is characterized by “root deficiency and branch excess,” with kidney essence deficiency and spleen qi deficiency as the root, and phlegm turbidity, blood stasis, and toxic evils as the branches, forming a complex pathological state of mixed deficiency and excess. Common syndrome types include phlegm-blood stasis intermingling, spleen-kidney deficiency, and liver-kidney yin deficiency.  

2. Modern Mechanistic Studies: Research has found that TCM can intervene in the process of glioma recurrence through multiple targets and pathways, including inhibiting glioma stem cell activity, blocking epithelial-mesenchymal transition (EMT), inducing tumor cell apoptosis, inhibiting tumor cell proliferation, regulating the tumor immune microenvironment, improving mitochondrial function, and inhibiting inflammatory responses.  

3. Studies on TCM Compounds and Monomers: Compound prescriptions such as Tongqiao Huoxue Decoction, Huanglian Wendan Decoction, and Buzhong Yiqi Decoction have shown good anti-tumor recurrence effects in clinical and animal experiments; monomer components such as baicalein, ginsenoside Rg1, tanshinone, and β-elemene can exert anti-tumor effects by regulating signaling pathways such as STAT3, PI3K/AKT, NF-κB, and HIF-1α.  

4. Clinical Studies: A number of randomized controlled trials and retrospective studies have shown that the combination of TCM and Western medicine can significantly prolong progression-free survival (PFS) and overall survival (OS), improve Karnofsky Performance Status (KPS) scores, reduce toxic side effects of radiotherapy and chemotherapy, and reduce the recurrence rate. For example, a multicenter clinical study showed that the median PFS of patients in the TCM combined with radiotherapy and chemotherapy group was 9.2 months, which was better than the 6.5 months in the radiotherapy and chemotherapy alone group (P<0.05).  

5. Network Pharmacology and Molecular Docking: Network pharmacology analysis revealed that the core targets of TCM in the treatment of glioma recurrence include STAT3, AKT1, TP53, IL6, TNF, etc., mainly involving signaling pathways such as PI3K-AKT, IL-17, TNF, and TGF-β. Molecular docking results showed that the active components of TCM have good binding ability to target proteins.

Traditional Chinese medicine has unique advantages in preventing and treating glioma recurrence. It can intervene in tumor recurrence through multiple targets, multiple pathways, and multiple links, not only improving the overall functional status of patients, but also delaying tumor progression and improving quality of life. Its treatment philosophy is highly compatible with modern medicine in tumor stem cells, immune microenvironment, and signal pathway regulation, showing good integration potential. In the future, it is necessary to further strengthen high-quality clinical research on TCM intervention in glioma recurrence, promote the standardization of TCM syndrome differentiation, the standardization of treatment protocols, and the modernization of TCM compound prescriptions, and build an evidence-based integrated traditional Chinese and Western medicine treatment model, so as to realize the transformation from “empirical treatment” to “precision treatment” and provide more effective, safe, and sustainable treatment strategies for patients with recurrent gliomas.