Background: Naoxueshu Oral Liquid (NXS) is the only traditional Chinese medicine approved for the treatment of intracerebral hemorrhage (ICH). While randomized controlled trials have demonstrated its ability to promote hematoma absorption improve neurological function prognosis, the efficacy and safety of NXS early use (within 72 hours) remain unclear. This study evaluate the efficacy and safety of early NXS administration (within 72 hours) in a real-world setting. Methods: Data were collected from 34 tertiary hospitals in China. Patients were enrolled from March 25, 2019 to December NXS administration was defined as the exposure. The primary outcome was hematoma volume at 14 days after onset. We the 1:1 propensity score matching (PSM) method to deal with confounding factors. Results: A total of 1602 patients were enrolled after PSM, including 872 NXS users (exposed group) and 730 non-NXS users group). At baseline, there was no significant difference in hematoma volumes between the two groups (21.46 +/- 19.47 +/- 14.26mL, P=0.55), the NXS group showed significantly less hematoma volume by day 14 (6.87 +/- 8.62 vs 5.43 +/- 5.35mL, There was no statistically significant difference in the incidence rate of serious adverse events between the two groups. analysis indicated that NXS might have a more pronounced effect on hematoma absorption in supratentorial hemorrhage patients, earlier administration potentially enhancing efficacy. Conclusion: This retrospective study explored the efficacy and safety of NXS in promoting hematoma absorption within real-world ICH patients, but its effect on short-term neurological improvement remains inconclusive. Further studies follow-up periods and more comprehensive functional assessments are warranted to explore the long-term neurological NXS in ICH patients.