ObjectiveTo establish preliminary diagnostic criteria for spleen and kidney deficiency syndrome in ischemic stroke patients and provide a basis for standardized diagnosis and treatment of ischemic stroke. MethodsRelevant literature on the diagnostic criteria for spleen and kidney deficiency syndrome in ischemic stroke patients was retrieved， and data were mined and extracted to form an item pool. Based on the formation of the item pool， this study used the Delphi method to initiate two rounds of questionnaire surveys with selected experts to complete the initial screening of items and the discrimination of symptom importance. A prospective clinical investigation method was adopted to collect clinical information from patients， and statistical analysis methods and data mining techniques were comprehensively used to determine their primary and secondary symptoms. Based on the clear main and secondary symptoms identified， combined with expert group discussions， the study established preliminary diagnostic criteria for spleen and kidney deficiency syndrome in ischemic stroke patients. ResultsA total of 25 relevant syndrome differentiation standards were included. After splitting， standardizing， and screening the items， the study established a pool of 48 items. The first round of questionnaire survey consulted 30 experts， with both the positive coefficient of experts and the effectiveness rate of the questionnaire reaching 100%. The Kendall's coefficient of concordance was 0.359. According to the item screening criteria， 26 items were retained in this round of questionnaire survey. A total of 176 cases were collected through clinical information investigation， including 94 cases with spleen and kidney deficiency syndrome and 82 cases without spleen and kidney deficiency syndrome. The statistical results were as follows： ① Descriptive statistics： The main symptoms with a frequency of ≥ 30% included mental fatigue and lack of strength， weakness of the lower back and knees， etc. The secondary symptoms with a frequency of ≥ 10% and ≤ 30% were lassitude and disinclination to talk， shortness of breath， etc. ② Binary logistic regression analysis： The main symptoms with an odds ratio （OR） value of ≥ 3 were mental fatigue and lack of strength， weakness of the lower back and knees， etc. The secondary symptoms with an OR value of ≥ 1 and ≤ 3 were lassitude and disinclination to talk， shortness of breath， etc. Artificial neural network： The main symptoms with a weight value（W_ij）of ≥ 0.5 and < 1 were mental fatigue and lack of strength， lassitude and disinclination to talk， etc. The secondary symptoms with W_ij of ≥ 0.3 and < 0.5 were shortness of breath， flaccid limbs， etc. In the second round of questionnaire survey， a total of 37 experts were consulted， with both the positive coefficient of experts and the effectiveness rate of the questionnaire reaching 100%. The Kendall's coefficient of concordance was 0.237. According to the criteria to determine primary and secondary symptoms based on the Delphi method， the main symptoms included in this round of the questionnaire were mental fatigue and lack of strength， lassitude and disinclination to talk， etc.， and the secondary symptoms were shortness of breath， dizziness， etc. ConclusionThe main symptoms of spleen and kidney deficiency syndrome in ischemic stroke patients are mental fatigue and lack of strength， weakness of the lower back and knees， loose stool， pale and edematous tongue texture possibly with tooth marks， and deep and thready pulse or weak pulse. The secondary symptoms include shortness of breath， dizziness， tinnitus and deafness， decreased appetite or postprandial abdominal distension， pale complexion， frequent micturition at night， dull tongue texture， and white and slippery tongue coating. The preliminarily established diagnostic criteria for spleen and kidney deficiency syndrome in ischemic stroke patients can provide a standardized and objective basis， thereby better guiding clinical diagnosis and treatment of ischemic stroke.

Minimally conscious state （MCS） is at the edge between closed and open consciousness， but it still belongs to the category of "wind-strike block" syndrome. The basic pathogenesis of MCS is the obstruction of pathogenic qi， orifices closed and spirit hidden， with pathological factors including phlegm， fire， and blood stasis. Wind movement and water retention may also be present， and often leading to deficiency syndrome due to the exhaustion of qi， blood， yin， and yang at later stages. Treatment chooses Shexiang （Moschus） as the chief medicinal， emphasizing combination of medicinals and urgency of medication administration； the key therapeutic method is to open the orifices， with focuses on expelling pathogens and reinforcing healthy qi. For patients with severe phlegm or fire， use Xiaochengqi Decoction （小承气汤） to open the lower orifices， discharge heat and unblock the bowels， combined with Shexiang （Moschus） and Niuhuang （Bovis Calculus） to open the upper orifices， awaken the spirit and guide qi. For patients with turbid phlegm as the predominant， temporarily replace Shexiang （Moschus） with Baizhi （Angelicae dahuricae radix）， using Ditan Decoction （涤痰汤） to eliminate phlegm to open the orifices， when turbid phlegm gradually subsided， Shexiang （Moschus） could be added. For patients with blood stasis as the predominant， Tongqiao Huoxue Decoction （通窍活血汤） will be used to activate blood and open orifice， if the blood circulates， the endogenous wind will be calmed， the water will be induced， the orifices will open and the consciousness will restore. For patients with closed orifices and body deficiency， the treatment should open the orifices and reinforce healthy qi， and consider the root and branch simultaneously； qi deficiency syndrome can be addressed with Buyang Huanwu Decoction （补阳还五汤） to boost qi and reinforce healthy qi； yin deficiency syndrome can be treated with Shaoyao Gancao Decoction （芍药甘草汤） combined with Fengsui Pill （封髓丹） to nourish yin， soften sinews， and secure kidney essence； yang deficiency can be managed by using Dihuang Yinzi Decoction （地黄饮子） to enrich yin， supplement yang， and open the orifices.

Objective To compare the efficacy and safety of stellate ganglion block(SGB)with those of conventional western medication in the treatment of insomnia.Methods A computerized retrieval of academic papers concerning the clinical randomized controlled trials of SGB versus conventional western medication in the treatment of insomnia from the databases of PubMed,Embase,Cochrane Library,CNKI,Wanfang Data knowledge service platform,VIP database and CBM database was conducted.The retrieval time period was from the establishment of the database to June 13,2023.NoteExpress v3.5 software was used to make literature screening,Stata17.0 software was used to perform meta-analysis of the obtained data,TSA0.9.5.10 beta software was used to make sequential analysis,and GRADEpro was used to perform the grade classification.Results A total of 11 articles including 875 patients with insomnia were included in this analysis.Compared with the conventional western medication,SGB showed certain advantages in the following aspects:improving total clinical effectiveness(RR total=1.24,95％CI:1.16-1.32,P＜0.01),increasing the proportion of patients who could sleep for more than 3 hours after treatment(RR total=1.24,95％CI:1.09-1.41,P=0.001),increasing total sleep time(SMD=1.53,95％CI:0.89-2.16,P＜0.01),reducing sleep latency(MD=-14.08,95％CI:-18.72--9.43,P＜0.01),decreasing PSQI score(MD=-3.54,95％CI:-4.31--2.78,P＜0.01),and reducing the recurrence rate within 6 months(RR=0.19,95％CI:0.10-0.37,P＜0.01).However,the difference in the proportion of patients who could sleep for more than 6 hours after treatment between the two groups was not statistically significant(RR=1.31,95％CI:0.97-1.76,P=0.078).The traditional SGB therapy had a certain risk of adverse events,ultrasound-guided SGB therapy was much safer.Trial sequential analysis showed that the cumulative sample size of the effective rate crossed the conventional threshold and TSA threshold,the positive results had been obtained in advance although it did not reach RIS.The quality of evidence evaluated by GRADE for the sleep latency,PSQI and recurrence rate within 6 months was medium grade,and the quality for the remaining indexes was low grade.Conclusion Compared with conventional western medication for the treatment of insomnia,the effect of SGB in increasing the total response rate,the proportion of patients who get sleeping for more than 3 hours after treatment and the total sleep duration,in reducing sleep latency,PSQI score and recurrence rate within 6 months has gained some certain evidence supports.The SGB and conventional western medication have similar efficacy in improving the proportion of patients who get sleeping for more than 6 hours after treatment.The results of this study are stable and reliable,but the current level of evidence grade is lower,therefore,large-sample randomized controlled trials need to be conducted before its clinical efficacy can get further evidence-based support.

The core of diagnosing and treating diseases in traditional Chinese medicine lies in syndrome differentiation. The eight principles of syndrome differentiation serve as guidance for syndrome differentiation. As one of the eight principles of syndrome differentiation， the differentiation of deficiency and excess is the basic and critical method. Ischemic stroke is currently the leading cause harming the health of Chinese residents. Although the hypotheses about the cause of ischemic stroke have evolved from external wind to the later internal wind and to the modern theory of toxin damaging the brain collaterals， they all believe that this disease is rooted in internal deficiency and external excess. According to available studies， although stroke is characterized by complex pathogenesis and rapid progression of syndromes， the key cause evolution has a regularity， that is， from excess to deficiency. This article analyzes the historical evolution of the etiology， pathogenesis， and syndrome differentiation schemes of stroke. There are diverse schemes for the syndrome differentiation of stroke， which make it difficult to choose in clinical practice. In view of this problem， this paper puts forward a new approach of staging sequential treatment of ischemic stroke based on the differentiation of deficiency and excess according to the evolution law of the key cause of stroke. Furthermore， we conducted a randomized controlled study on 100 patients with ischemic stroke to evaluate this new approach. The results showed that the staging sequential treatment of ischemic stroke based on the differentiation of deficiency and excess demonstrated definite clinical efficacy. In addition， this article reviews the previous research results of our team and the research achievements of other teams to preliminarily explore the relationship between stroke syndromes and biomarkers， aiming to provide an objective basis for unveiling the pathogenesis of stroke. In summary， according to the key cause evolution （from excess to deficiency）， the treatment of ischemic stroke by stages based on differentiation of deficiency and excess can facilitate the rapid intervention and improve the clinical efficacy on ischemic stroke.

Objective To explore the regulatory effect and mechanism of Zhongfeng Xinglou Tongfu Capsule on the brain inflammatory response of mice with cerebral hemorrhage through cholecystokinin octapeptide(CCK-8)mediated the interleukin 10(IL-10)/signal transduction and transcriptional activator 3(STAT3)signaling pathway.Methods A total of 110 C57BL/6 mice were divided into sham operation group,cerebral hemorrhage group,Zhongfeng Xinglou Tongfu Capsule low-,medium-,and high-dose groups according to the random number table method,with 22 mice in each group.The intracerebral hemorrhage model was established by collagenase method.At 2 hours after the establishment of the model,Zhongfeng Xinglou Tongfu Capsule suspension was intragastrically administered at a dose of 10 mL·kg-1.The sham operation group and the cerebral hemorrhage group were intragastrically administered with the same dose of normal saline.The neurofunctional score and left-turn rate of the mice were recorded.The dry and wet weight method was used to detect brain water content on the 72 h after surgery,and the Western Blot method was used to detect tumor necrosis factor-α(TNF-α),interleukin 1β(IL-1β),interleukin 6(IL-6),interleukin 10(IL-10),and the relative expression levels of JAK-1,STAT3,and p-STAT3 pathway proteins around the hematoma of mice at 72 h after surgery.On the 3rd and 5th day after surgery,Elisa method was used to detect the relative expression level of CCK-8,qPCR method was used to detect the expression levels of IL-10 and STAT3 mRNA.Results Compared with the cerebral hemorrhage group,the NDS scores of mice in the low-,medium-,and high-dose groups of Zhongfeng Xinglou Tongfu Capsules were significantly reduced on the 3rd and 5th days after intervention treatment(P＜0.01).And the left-turn rate in the low-dose group on the 3rd and 5th days after intervention treatment was reduced(P＜0.05),the left-turn rate in the medium-dose group was reduced on the 3rd day(P＜0.05)and the 5th day(P＜0.01).Furthermore,the left-turn rate was obviously reduced on the 3rd and 5th day in the high-dose group(P＜0.01).The brain water content of mice in the low-dose group was reduced(P＜0.05),and the brain water content of mice in the medium-and high-dose groups was significantly reduced(P＜0.01).In the low-dose group,the expressions of pro-inflammatory factors TNF-α,IL-6 and JAK-1,STAT3,and p-STAT3 pathway proteins were significantly reduced(P＜0.01),while the expression of IL-1β was reduced(P＜0.05),the expression of IL-10 increased significantly(P＜0.01).The expression of pro-inflammatory factors TNF-α,IL-1β,IL-6,as well as JAK-1,STAT3,and p-STAT3 pathway proteins in the medium-and high-dose groups was significantly reduced(P＜0.01),the expression of anti-inflammatory factor IL-10 increased significantly(P＜0.01).The content of CCK-8 in the low-dose group was increased on the 3rd day after treatment(P＜0.05),and the content increased significantly on the 5th day(P＜0.01).The content of CCK-8 in the medium-and high-dose groups obviously increased on the 3rd and the 5th day after treatment(P＜0.01).The relative expression level of IL-10 mRNA was significantly increased after treatment(P＜0.01),but the relative expression level of STAT3 mRNA was significantly decreased after treatment(P＜0.01).Conclusion Zhongfeng Xinglou Tongfu Capsule can target the content of brain-gut peptide CCK-8 and regulate the IL-10/STAT3 signaling pathway to reduce the secondary inflammatory reaction and cytotoxic brain edema after cerebral hemorrhage.

Objective To evaluate postoperative efficacy and safety of oral or nasal feeding Chinese patent medicine in the treatment of intracerebral haemorrhage(ICH)based on Bayesian network meta-analysis(BNMA).Methods The randomized controlled trial(RCT)study of Chinese patent medicine for intervening in post-operative patients of ICH was retrieved from CNKI,Wanfang,VIP,SinoMed,PubMed,Embase,Cochrane Library,and Web of Science.The retrieval time is from the establishment of databases to August 25,2023.ROB 2.0 was used for risk of bias assessments.BNMA was performed by using R 4.2.2 loaded with the BUGSnet 1.1.0 package.Results A total of 28 RCTs were included,with a total sample size of 2 530 cases,including 9 kinds of Chinese patent medicines[Angong Niuhuang Pills(AGNH),Suhexiang Pills(SHX),Naoxueshu Oral Liquid(NXS),Naoxintong Capsules(NXT),Naoxuekang Tablets(NXK),Xiaoyukang Capsules(XYK),Yangxue Qingnao Granules(YXQN),Tongtian Oral Liquid(TT),Sanqi Tongshu Capsules(SQTS)].All patients underwent surgical treatment and postoperative treatment of conventional western medicine(CWMT),the experimental group was additionally given Chinese patent medicine orally or by nasal feeding.The BNMA results showed that AGNH+CWMT group ranked first in reducing short-term mortality,NIHSS score,and perihematomal edema,with P＜0.05 compared to CWMT group.SHX+CWMT group ranked first in improving total effective efficiency,with P＜0.05 compared to CWMT group.TT+CWMT group ranked first in increasing GCS scores,with P＜0.05 compared to CWMT group.YXQN+CWMT group ranked first in improving BI index,with P＜0.05 compared to CWMT group.NXS+CWMT group ranked first in promoting the absorption of cerebral hematoma,with P＞0.05 compared to CWMT group.NXT+CWMT group ranked first in shortening the average length of hospital stay,with P＞0.05 compared to CWMT group.Conclusion Compared with CWMT group,the combined use of Chinese patent medicine and CWMT is effective in improving the total effective rate,reducing mortality and NIHSS score,increasing GCS score and BI after operation in patients with ICH.There is no significant difference in promoting hematoma absorption and shortening the average length of hospital stay.AGNH has good effect,which may be the best Chinese patent medicine in the post-operative treatment of ICH patients.However,due to limitations in quality and methodology of included research,the conclusions obtained still need further validation.

OBJECTIVE To explore the correlation between changes in intestinal toxicity and changes in component composition of the Mongolian medicine Euphorbiae pekinensis Radix(EPR)before and after processing with milk.METHODS Mice were given 95%ethanol extract of raw EPR,milk-processed EPR and water-processed EPR by gavage.The purgative effect and intestinal inflam-matory toxicity changes of EPR before and after milk processing were investigated using the fecal water content and the levels of inflam-matory factors TNF-α and IL-1β in each intestinal segment of mice as indicators;LC-MS/MS was used to analyze the composition changes of the 95%alcohol extract of EPR before and after milk processing.RESULTS Compared with the blank group,the raw and water processed products of EPR could significantly increase the water content of mouse feces and the levels of TNF-α and IL-1β in each intestinal segment(P＜0.05);compared with the raw product group,all indicators in the milk processing group were significantly reduced(P＜0.05),while there was no significant difference in the water processing group,indicating that water processing cannot at-tenuate toxicity,and the auxiliary material milk is the key auxiliary material to reduce the toxicity of EPR.Mass spectrometry analysis results showed that a total of 50 components were identified in EPR,including 38 terpenoid components,6 phenolic acid components,and 6 other components.The content of each component decreased to varying degrees after milk processing.Principal component analy-sis(PCA)and orthogonal partial least squares discriminant analysis(OPLS-DA)were performed on the mass spectrum data of raw ma-terials and products,and it was found that the components of raw materials and products can be obviously clustered into 2 categories.13 differential components of raw materials and products were screened through t test,and 11 of which were terpene compo-nents,indicating that the composition of terpene components changed significantly after milk processing.17 components derived from EPR were detected in the residual liquid of milk excipients after processing,of which 16 were terpenoids,indicating that the terpenoid components of EPR were transferred to the excipient milk during the soaking and processing processes.CONCLUSION The toxicity of EPR is reduced and the purgative effect is alleviated after milk processing.The attenuation mechanism may be that during the milk soaking and processing processes,terpenoid components are transferred to the milk,and the content of toxic components in the decoc-tion pieces is reduced,thereby reducing the toxicity.

This article summarizes the unique viewpoints and experience application of the famous and veteran Chinese medicine practitioner,Professor Wang Xinzhi,in treating emotional diseases from the perspective of gallbladder theory.Based on the physiologi-cal functions and characteristics of the gallbladder in Chinese medicine,it is proposed that the"heart mind-gallbladder-viscera"axis dominates the generation and changes of emotions,and it is believed that gallbladder failure is the key pathogenesis of emotional disor-ders.The treatment of clinical syndromes should be based on the type of gallbladder,and emotional diseases can be divided into types of insufficient gallbladder qi,unfavorable Shaoyang,gallbladder and heat excess,timidity-deficiency,and heart-gallbladder indeci-sion,according to clinical manifestations;based on the basic principle of adjusting the functions of the heart,spleen,liver,gallblad-der,kidney and other organs,treatment methods such as tonifying the spleen and kidneys,increasing gallbladder qi,resolving Shaoy-ang,clearing gallbladder heat,warming yang and replenishing qi,calming the mind,resolving phlegm and removing blood stasis should be used,highlighting the joint treatment of the heart and the gallbladder,and the simultaneous regulation of the liver and gall-bladder,so that the mind can be at ease,the gallbladder can be decisive,and the emotions can be harmonious.

Chaihu Guizhi Decoction is an excellent prescription of ZHANG Zhongjing;however,nowadays the application of Chaihu Guizhi Decoction is primarily derived from the text.The xiang thinking is the source of traditional Chinese medicine thinking.Understanding Chaihu Guizhi Decoction from the xiang thinking,it is easy to perceive the true meaning of ZHANG Zhongjing,and grasp the location of the disease and the patient's overall qi,so as to make better use of this formula.This article discusses the understanding of Chaihu Guizhi Decoction from five perspectives:firstly,it gives an overview of the xiang thinking,pointing out the source and essential value of the xiang thinking;secondly,it analyses the disease position and the patient's qi of Chaihu Guizhi Decoction under the perspective of the xiang thinking as a whole;thirdly,it discusses the disease position and the patient's qi of the original text of Chaihu Guizhi Decoction from the xiang thinking;fourthly,it discusses how to understand the principle of formula formation and the main and minor parts of Chaihu Guizhi Decoction by xiang thinking;finally,it analyses the primary medicines in Chaihu Guizhi Decoction by using xiang thinking based on the records of Shennong Bencao Jing.Based on these five points,we hope to reveal the traditional Chinese medicine thinking behind Chaihu Guizhi Decoction,and provide new ideas for the clinical application of Chaihu Guizhi Decoction.