Objective: To develop QingNangTCM, a specialized large language model (LLM) tailored for expert-level traditional Chinese medicine (TCM) question-answering and clinical reasoning, addressing the scarcity of domain-specific corpora and specialized alignment. Methods: We constructed QnTCM_Dataset, a corpus of 100 000 entries, by integrating data from ShenNong_TCM_Dataset and SymMap v2.0, and synthesizing additional samples via retrieval-augmented generation (RAG) and persona-driven generation. The dataset comprehensively covers diagnostic inquiries, prescriptions, and herbal knowledge. Utilizing P-Tuning v2, we fine-tuned the GLM-4-9B-Chat backbone to develop QingNangTCM. A multi-dimensional evaluation framework, assessing accuracy, coverage, consistency, safety, professionalism, and fluency, was established using metrics such as bilingual evaluation understudy (BLEU), recall-oriented understudy for gisting evaluation (ROUGE), metric for evaluation of translation with explicit ordering (METEOR), and LLM-as-a-Judge with expert review. Qualitative analysis was conducted across four simulated clinical scenarios: symptom analysis, disease treatment, herb inquiry, and failure cases. Baseline models included GLM-4-9B-Chat, DeepSeek-V2, HuatuoGPT-II (7B), and GLM-4-9B-Chat (freeze-tuning). Results: QingNangTCM achieved the highest scores in BLEU-1/2/3/4 (0.425/0.298/0.137/0.064), ROUGE-1/2 (0.368/0.157), and METEOR (0.218), demonstrating a balanced and superior normalized performance profile of 0.900 across the dimensions of accuracy, coverage, and consistency. Although its ROUGE-L score (0.299) was lower than that of HuatuoGPT-II (7B) (0.351), it significantly outperformed domain-specific models in expert-validated win rates for professionalism (86%) and safety (73%). Qualitative analysis confirmed that the model strictly adheres to the “symptom-syndrome-pathogenesis-treatment” reasoning chain, though occasional misclassifications and hallucinations persisted when dealing with rare medicinal materials and uncommon syndromes. Conclusion Combining domain-specific corpus construction with parameter-efficient prompt tuning enhances the reasoning behavior and domain adaptation of LLMs for TCM-related tasks. This work provides a technical framework for the digital organization and intelligent utilization of TCM knowledge, with potential value for supporting diagnostic reasoning and medical education.

Objective: To explore the association between meat consumption and anxiety symptoms in first year junior high school students in Yunnan Province, and to provide theoretical support for preventing and relieving anxiety symptoms in junior high school students. Methods: From October to December 2022, a random cluster sampling method was used to select 8 500 first year junior high school students from 11 counties in Yunnan Province as the survey subjects for a questionnaire survey. The study used Food Frequency Questionnaire and the Chinese version of the Depression Anxiety Stress Scale-21 (DASS-21) to assess the meat consumption and anxiety symptoms of junior high school students.The distribution differences in anxiety symptoms among first year junior high school students with different demographic characteristics were analyzed statistically by using the Chi-square test,and the association between meat consumption and anxiety symptoms in students was analyzed by using a generalized linear model. Results: The detection rate of anxiety symptoms was 48.47%. After controlling for demographic variables and confounding factors, the consumption of livestock meat, poultry meat, processed meat, cured meat, barbecued meat and raw skin meat was statistically significant with anxiety symptoms ( β =-0.05, 0.04, 0.04, 0.08, 0.14, 0.17, all P <0.05). Stratified by ethnicity, The consumption of livestock meat, cured meat and barbecue was statistically correlated with anxiety symptoms in Han adolescents ( β =-0.07, 0.14, 0.22 ); the consumption of processed meat and raw skin meat was statistically correlated with anxiety symptoms in ethnic minority adolescents ( β =0.08, 0.18) (all P <0.05). Conclusions There is a statistical association between meat comsumption and the risk of anxiety symptoms in first year junior high school students in Yunnan Province. Guidance on meat consumption should be strengthened to prevent the occurrence of anxiety symptoms.

ObjectiveThis study aims to investigate the effectiveness and mechanisms of Polygonati Rhizoma polysaccharides （PRP） on improving cognitive and emotional functions in the ovariectomy （OVX）-Alzheimer's disease （AD） model rats. MethodsAfter being randomly divided into blank group， model group， estradiol group （0.18 mg·kg^-1·d^-1）， low-PRP group （200 mg·kg^-1）， medium-PRP group （400 mg·kg^-1）， and high-PRP group （800 mg·kg^-1）， 60 SPF female Sprague-Dawley （SD） rats were subjected to OVX. One week later， vaginal smear examination as well as D-galactose intraperitoneal injection （150 mg·kg^-1·d^-1， once daily， for eight weeks） were adopted to establish the OVX-AD model， and drug intervention was initiated nine weeks after surgery. Upon completion of the treatment course， cognitive and emotional functions， as well as hippocampal CA3 region damage were assessed in all rats by open-field test， new object recognition test， Morris water maze test， and transmission electron microscopy. Indicators of inflammation ［interleukin-6 （IL-6）， tumor-necrosis-factor-α （TNF-α）， interleukin-1β （IL-1β））， oxidative-stress （superoxide-dismutase （SOD）， glutathione-peroxidase （GSH-Px）］ were measured by enzyme-linked immunosorbent assay （ELISA） and biochemical methods. The mRNA and protein expression levels of estrogen-receptor α （ERα）/phosphoinositide 3kinase （PI3K）/protein-kinase-B （Akt） signaling pathway， apoptosis ［Bcl-2 associated X protein （Bax）， B-cell lymphoma/leukemia-2 （Bcl-2）］ and the indicators of pathological sedimentary proteins ［amyloid β-protein_1-42 （Aβ_1-42）， microtubule-associated protein Tau， phosphorylated site 404 of microtubule-associated protein Tau ［p-Tau （Ser404）］ were detected by using real-time polymerase chain reaction （Real-time PCR） and western blot analysis. ResultsCompared with those in blank group， the rats in model group exhibited marked ultra-structural damage to hippocampal CA3 neurons， along with the reduction of activity time and shuttle frequency in central area， the index and exploration frequency of new object recognition， and the platform crossings and time spent in target quadrant， as well as the prolonged latency （P<0.05， P<0.01）. Furthermore， the contents and expression levels of IL-6， TNF-α， IL-1β， Bax， Aβ_1-42， Tau， and p-Tau （Ser404） were significantly increased， and the activity and expression of SOD， GSH-Px， ERα， PI3K， Akt， and Bcl-2 were significantly decreased （P<0.05， P<0.01）. Compared to those in model group， the rats in estradiol group and groups with different doses of PRP noticeably presented with amelioration of neuronal damage， along with increased activity time and shuttle frequency in the central zone， elevated new object recognition index and exploration frequency， shortened latency， prolonged activity time， and increased platform crossings in the target quadrant （P<0.05， P<0.01）. What is more， the contents and expression levels of IL-6， TNF-α， IL-1β， Bax， Aβ_1-42， Tau， and p-Tau （Ser404） were significantly reduced， whereas the activity and expression levels of SOD， GSH-Px， ERα， PI3K， Akt， and Bcl-2 were markedly elevated （P<0.05， P<0.01）. ConclusionPRP can improve the cognitive and emotional functions of AD model rats， and its mechanisms are probably related to modulating the ERα/PI3K/Akt pathway as well as inhibiting Aβ， Tau， neuro-inflammation， oxidative stress， and apoptosis， resulting in alleviation of neuronal damage.

Chronic heart failure （CHF） is a clinical syndrome characterized by impaired ventricular ejection function due to cardiac abnormalities， representing the terminal stage of most cardiovascular diseases. With its rising prevalence and significant impact on patients' quality of life， CHF has emerged as a major global public health concern. Current Western medicine treatments mainly involve the oral administration of the "new quadruple therapy" drugs and diuretics. Despite substantial progress in pathological research and clinical treatment， challenges persist， including considerable side effects， drug resistance， and marked interindividual variability in therapeutic response. Therefore， exploring and leveraging the advantages of traditional Chinese medicine （TCM） in treating CHF has become an urgent research priority. TCM has a millennia-long history in the prevention and treatment of heart failure， accumulating extensive clinical experience. Characterized by its multi-component and multi-target properties， TCM enables holistic regulation of multiple systemic functions and intervention in the progression of heart failure， demonstrating significant clinical relevance in its management. By employing therapeutic strategies such as warming Yang， promoting diuresis， replenishing Qi， nourishing Yin， and activating blood circulation， TCM effectively improves myocardial fibrosis， inhibits oxidative stress responses， enhances myocardial contractility， and ameliorates ventricular remodeling. Modern proprietary Chinese medicines derived from classic formulas， based on the theoretical foundation of traditional prescriptions， not only exhibit favorable clinical efficacy but also offer notable advantages in convenience， stability， and safety. This review systematically examined the significant therapeutic effects and underlying mechanisms of classical TCM formulas in the treatment of CHF， and provided an overview of the clinical application of modern proprietary Chinese medicines. It aims to provide new strategies for the clinical diagnosis and treatment of CHF.

ObjectiveTo decipher the mechanism by which Zuoguiwan （ZGW） treat hyperthyroidism in rats with kidney-Yin deficiency based on the dopamine receptor D4 （DRD4）/nicotinamide adenine dinucleotide phosphate （NADPH） oxidase 4 （NOX4） signaling pathway. MethodsThe rat model of kidney-Yin deficiency was induced by unilateral intramuscular injection of dexamethasone （0.35 mg·kg^-1）. After successful modeling， the rats were randomized into model， methimazole （positive control， 5 mg·kg^-1）， low-， medium-， and high-dose （1.85， 3.70， 7.40 g·kg^-1， respectively） ZGW， and normal control groups. After 21 days of continuous gavage， the behavioral indexes and body weight changes of rats were evaluated. The pathological changes of the renal tissue were observed by hematoxylin-eosin staining. The serum levels of thyroid hormones ［triiodothyronine （T₃）， thyroxine （T₄）， thyroid-stimulating hormone （TSH）］， renal function indexes ［serum creatine （Scr） and blood urea nitrogen （BUN）］， energy metabolism markers ［cyclic adenosine monophosphate （cAMP） and cyclic guanosine monophosphate （cGMP）］， and oxidative stress-related factors ［superoxide dismutase （SOD）， malondialdehyde （MDA）， and NADPH）］ were measured by enzyme-linked immunosorbent assay （ELISA）. Western blot was employed to analyze the expression of DRD4， NOX4， mitochondrial respiratory chain complex proteins ［NADH：ubiquinone oxidoreductase subunit S4 （NDUFS4） and cytochrome C oxidase subunit 4 （COX4）］， and inflammation-related protein ［tumor necrosis factor-alpha （TNF-α）， interleukin-6 （IL-6）， p38 mitogen-activated protein kinase （MAPK）］ pathway in the renal tissue. ResultsCompared with the normal group， the model group showed mental malaise， body weight decreases （P<0.01）， inflammatory cell infiltration in the renal tissue， a few residual parotid glands in the thyroid， elevations in serum levels of T₃， T₄， Scr， BUN， cAMP， cAMP/cGMP， MDA， and NADPH （P<0.01）， down-regulation in protein levels of TSH， SOD， and DRD4 （P<0.05， P<0.01）， and up-regulation in expression of NOX4， p-p38 MAPK/p38 MAPK， and inflammatory factors （P<0.01）. Compared with the model group， ZGW increased the body weight （P<0.05， P<0.01）， reduced the infiltration of renal interstitial inflammatory cells， restored the thyroid structure and follicle size， lowered the serum levels of T₃， T₄， Scr， BUN， cAMP， cAMP/cGMP， MDA and NADPH （P<0.05， P<0.01）， up-regulated the expression of TSH， SOD and DRD4 （P<0.05， P<0.01）， and down-regulated the expression of NOX4， p-p38 MAPK/p38 MAPK， and inflammatory factors （P<0.05， P<0.01）. Moreover， high-dose ZGW outperformed methimazole （P<0.05）. ConclusionBy activating DRD4， ZGW can inhibit the expression of NOX4 mediated by the p38 MAPK pathway， reduce oxidative stress and inflammatory response， thereby ameliorating the pathological state of hyperthyroidism due to kidney-Yin deficiency. This study provides new molecular mechanism support for the clinical application of ZGW.

Diseases of the central nervous system have become a growing global health concern. At present， there are many adverse reactions in the treatment with Western medicine. In contrast， traditional Chinese medicine has shown unique efficacy and rich clinical practice accumulation in diseases of the central nervous system. As a traditional Chinese medicine， Bupleuri Radix has played an important role in the treatment of neurological diseases through multi-target regulation， multi-pathway intervention， and multi-pathway mechanism of action. In recent years， with the in-depth study of the pharmacological effects of Bupleuri Radix， it has been found that the active ingredients such as saikosaponin， baicalin， quercetin， and kaempferol in Bupleuri Radix can be used as the main material basis for the treatment of neurological diseases. The results of this study showed that in neurodegenerative diseases， active ingredients of Bupleuri Radix can inhibit β-amyloid （Aβ） deposition and abnormal phosphorylation of microtubule-associated protein （Tau protein） in Alzheimer's disease， regulate the nuclear factor-κB/nuclear factor E₂ related factor 2 （NF-κB/Nrf2） pathway to play the anti-inflammatory role， and alleviate α-Synuclein （α-Syn） aggregation and mitochondrial damage in Parkinson's disease. In epilepsy， depression， and cerebral ischemia， they can improve symptoms by regulating neurotransmitters， oxidative stress， and apoptosis pathways， and inhibit brain glioma proliferation. However， the mechanism of action has not been fully elucidated， and the complexity of compound components and poor blood-brain barrier penetration limit their clinical application. In the future， it is necessary to integrate multi-omics， network pharmacology， and nano-delivery technologies， focus on the optimization of active ingredient group compounds and the precise guidance of biomarkers， accelerate the development of innovative therapies for Alzheimer's disease， Parkinson's disease， and other diseases for laying a solid theoretical foundation for further development and application and inspiring new research ideas.

Attention deficit hyperactivity disorder （ADHD） is often accompanied by tic disorder. The core pathogenesis is considered to be ministerial fire scorching yin and internal stirring of deficient wind， which leads to disharmony between the body and spirit， resulting in clinical manifestations. The treatment principles emphasize nourishing yin fluids， calming ministerial fire， and extinguishing endogenous wind （内风）. The method of nourishing yin fluids is applied throughout the entire treatment process， commonly using ingredients such as Shudihuang （Rehmanniae Radix Praeparata）， Shanzhuyu （Corni Fructus）， Gouqizi （Lycii Fructus）， Wuweizi （Schisandrae Chinensis Fructus）， and Tusizi （Cuscutae Semen）. These are combined with approaches to harmonize the zang-fu organs， primarily including extinguishing liver wind， clearing heart fire， nourishing kidney water， and strengthening spleen earth， thereby stabilizing ministerial fire and extinguishing endogenous wind. Additionally， emotional regulation and smoothing emotional constraint are essential to improve clinical symptoms in children with ADHD comorbid with tic disorder.

OBJECTIVE To construct specialized file management and risk warning system for narcotic drugs， and promote the refined management of narcotic drugs in medical institutions. METHODS Through the rational medication management system， patient-indexed narcotic drug medication record information was integrated， pain assessment and rapid dose titration modules were constructed， and a prescription pre-review risk warning model was established. Statistical analysis was conducted on the number of drugs returned by patients， interventions for adverse events related to narcotic drug abuse， patient and physician satisfaction， and patient medication adherence before the system was constructed （January-July 2023） and after its stable operation （January-July 2024）. RESULTS After the construction of the system， the number of narcotic drugs returned by patients decreased， except for Morphine tablets. The number of interventions for adverse events related to narcotic drug abuse increased from 0 to 5 cases. The patients’ satisfaction with pain control increased from 46.25% to 67.50%， the proportion of patients with poor adherence decreased from 23.75% to 7.50%， and the overall satisfaction of physicians was 72.41%. CONCLUSIONS The construction of a specialized file management and risk warning system for narcotic drugs enables refined management of narcotic drugs， provides alerts for abnormal prescriptions， reduces patient stockpiling of narcotic drugs， allows timely detection and intervention of adverse events related to narcotic drug abuse， improves physician treatment efficiency and precision， and enhances patient pain control satisfaction and medication adherence.

OBJECTIVE To construct a predictive model for evaluating the efficacy of a triple antiemetic regimen （neurokinin- 1 receptor antagonist+5-hydroxytryptamine 3 receptor antagonist+dexamethasone） for preventing nausea and vomiting induced by highly emetogenic chemotherapy （HEC） based on interpretable deep learning algorithms. METHODS Clinical data of cancer patients who received HEC and were treated with the standard triple antiemetic regimen in the oncology department of Tianjin Medical University General Hospital from January 2018 to December 2022 were collected retrospectively. Demographic， clinical and metabolism-related variables were integrated. After data pre-processing， two deep learning algorithms （deep random forest and dense neural network） and four machine learning algorithms （support vector machine， categorical boosting， random forest and decision tree） were used to build predictive models. Subsequently， model performance evaluation and model interpretability analysis were conducted. RESULTS Among the six candidate models， the deep random forest model demonstrated the best predictive performance on the test set， with an area under the receiver operating characteristic curve of 0.850， an accuracy of 0.911， a precision of 0.805， a recall of 0.783， an F1 score of 0.793， and a Brier score of 0.075. Interpretability analysis revealed that creatinine clearance rate （Ccr） was the key predictive factor， and low Ccr levels， female gender， younger age， highly emetogenic drugs （particularly cisplatin-containing chemotherapy regimens）， and anticipatory nausea and vomiting were positively correlated with the risk of HEC-related nausea and vomiting. CONCLUSIONS The deep random forest model exhibits the best performance in predicting the efficacy of triple antiemetic regimen for preventing HEC-related nausea and vomiting. The key predictors in this model primarily include Ccr，anticipatory nausea and vomiting， gender， age， and highly emetogenic drugs.

ObjectiveTo investigate the mechanisms by which Renshentang treats atherosclerosis （AS） in mice， focusing on the regulation of endothelial inflammatory responses mediated by transient receptor potential vanilloid subtype 1 （TRPV1）. MethodsAn AS model was established in apolipoprotein E knockout （ApoE^-/-） mice fed a high-fat diet. The mice were randomly divided into a simvastatin group （0.02 g·kg^-1·d^-1） and low-， medium-， and high-dose Renshentang groups （1.77， 3.54， 7.08 g·kg^-1·d^-1）， with 12 mice in each group. ApoE^-/- mice were fed a high-fat diet and treated simultaneously. C57BL/6J mice fed a normal diet served as the normal group （n=9）. After continuous administration for 12 weeks， mice were anesthetized and the aortas were collected. Oil Red O staining was used to observe lipid plaque formation in the aorta. Hematoxylin-eosin （HE） staining was performed to examine pathological changes in the aortic root. Immunohistochemistry was used to analyze the levels of pro-inflammatory factors tumor necrosis factor-α （TNF-α） and interleukin-1β （IL-1β）， as well as the expression of TRPV1， phosphorylated phosphoinositide 3-kinase （p-PI3K）， and phosphorylated protein kinase B （p-Akt） in the aortic root. Real-time quantitative polymerase chain reaction （Real-time PCR） was used to detect endothelial nitric oxide synthase （eNOS） mRNA expression in the aorta， and Western blot was used to detect TRPV1 protein expression. ResultsCompared with the normal group， the model group showed a significant increase in aortic plaque formation （P<0.01） and significantly elevated levels of TNF-α and IL-1β in the aortic root （P<0.01）. The expression levels of TRPV1， p-PI3K， and p-Akt were decreased （P<0.05， P<0.01）， and eNOS mRNA expression was reduced （P<0.05， P<0.01）. Compared with the model group， all Renshentang groups significantly reduced aortic plaque formation （P<0.01）， significantly decreased TNF-α and IL-1β levels （P<0.01）， and markedly increased the expression levels of TRPV1， p-PI3K， p-Akt， and eNOS mRNA （P<0.05， P<0.01）. ConclusionRenshentang may inhibit endothelial inflammation and suppress the formation of AS by increasing TRPV1 protein expression and up-regulating the PI3K/Akt/eNOS signaling pathway， which may be one of the molecular mechanisms underlying its therapeutic effect against AS.