Xingnaojing for Moderate-to-severe Acute Ischemic Stroke (XMAS)

Inclusion Criteria: * Acute ischemic stroke within 24 hours of symptom onset. * National Institutes of Health Stroke Scale score ≥ 5 and ≤ 20. * Age ≥ 35 and ≤ 80 years. * Patient or legally authorized representative has signed informed consent. Exclusion Criteria: * Planned or already received endovascular treatment. * Suspected secondary stroke caused by tumor, brain trauma, or hematologic diseases. * Already dependent in activities of daily living before the present acute stroke (defined as modified Rankin Scare score ≥2 ). * Other conditions that lead to motor dysfunction (e.g. severe osteoarthrosis, rheumatoid arthritis). * Significant renal or hepatic insufficiency (defined as a serum creatinine concentration, alanine aminotransferase, or aspartate aminotransferase value that is twice greater than the upper limit of normal). * Life expectancy of 90 days or less due to other life threatening illness (e.g. advanced cancer). * Other conditions that render outcomes or follow-up unlikely to be assessed.. * Known to be pregnant or breastfeeding. * Currently receiving an investigational drug.