Can an ancient herbal pill improve outcomes after a bleeding stroke?

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria * In-Hospital Setting 1. Age ≥18 years. 2. Symptom onset or last known well ≤6 hours before randomization. Intracerebral hemorrhage (ICH) confirmed by brain imaging, with a hematoma volume ≥10 mL. 3. National Institutes of Health Stroke Scale (NIHSS) score ≥8. 4. Glasgow Coma Scale (GCS) score ≥8. 5. Traditional Chinese medicine (TCM) syndrome consistent with internal accumulation of heat-toxin, defined by the presence of at least 2 of the following: high fever, facial flushing, agitation, dry mouth, and rapid pulse. 6. No surgery performed at the time of randomization. 7. Written informed consent obtained from the participant or their legally authorized representative. * Prehospital (Ambulance) Setting 1. Age ≥18 years. 2. Symptom onset or last known well ≤6 hours before randomization. 3. Predicted to have ICH by an artificial intelligence-based model. 4. FAST score ≥2. 5. TCM syndrome consistent with internal accumulation of heat-toxin, defined by the presence of at least 2 of the following: high fever, facial flushing, agitation, dry mouth, and rapid pulse. 6. Written informed consent obtained from the participant or their legally authorized representative. Exclusion Criteria * In-Hospital Setting 1. Secondary ICH, including ICH associated with cerebrovascular malformations or other structural abnormalities, brain tumors, head trauma, hemorrhagic transformation of cerebral infarction, or bleeding following thrombolysis or thrombectomy. 2. Severe comorbidities that may interfere with study treatment, follow-up, or outcome assessment (e.g., severe heart failure, malignant tumors, chronic obstructive pulmonary disease, or severe pre-existing disability). 3. Known allergy to Angong Niuhuang Wan or any of its ingredients. 4. Pregnancy or breastfeeding. 5. History of severe chronic kidney disease or hepatic failure. 6. Very high likelihood of death within 7 days or poor anticipated adherence to study treatment or follow-up. * Prehospital (Ambulance) Setting 1. Blood glucose \<2.8 mmol/L. 2. History of head trauma within the previous 7 days. 3. History of seizures or seizure-like episodes. 4. Severe comorbidities that may interfere with study treatment, follow-up, or outcome assessment (e.g., severe heart failure, malignant tumors, chronic obstructive pulmonary disease, or severe pre-existing disability). 5. Known allergy to Angong Niuhuang Wan or any of its ingredients. 6. Pregnancy or breastfeeding. 7. History of severe chronic kidney disease or hepatic failure. 8. Very high likelihood of death within 7 days or poor anticipated adherence to study treatment or follow-up.