The term"heat stroke"originates from the integration of modern traditional Chinese and Western medicine.In clinical practice,the complementary advantages of the two medical systems can significantly enhance the clinical diagnosis and treatment level of heat stroke.Through comprehensively analyzes the traditional Chinese medicine(TCM)nomenclature for heat stroke,proposing that heat stroke is a type of sunstroke characterized by intense and pure yang nature,specifically referring to symptoms caused directly or indirectly by hot weather.It can be referenced under the categories of Zhongye,Shuwen,Yinshu/Yangshu,Shujue,and Shufeng for treatment.The article reviews the TCM diagnostic and therapeutic thinking for heat stroke,summarizing its etiology and pathogenesis,including summerheat directly entering the Yangming,heat entering the heart and nutrient-blood aspects,evil combined with water(post-emergency),dual injury of qi and fluid(post-mild recovery),and phlegm-stasis obstructing collaterals(post-severe recovery).Based on years of clinical experience and combining the different clinical manifestations of heat stroke with TCM's four diagnostic methods,the article proposes a treatment plan that integrates Chinese and Western medicine,combining disease differentiation with syndrome differentiation.The main syndromes summarized include high fever with spasms(Yangming heat excess syndrome),diarrhea(Yangming fu syndrome-intestinal sweating),high fever with coma(heat entering the heart-nutrient syndrome),high fever with convulsions(extreme heat generating wind syndrome),heat stroke-induced coagulopathy(heat entering the blood aspect syndrome),edema after fluid resuscitation(Taiyang water retention syndrome),recovery phase(dual injury of qi and fluid syndrome),and sequelae(phlegm-stasis obstructing collaterals syndrome).For treatment,Baihu Jia Renshen decotion combined with Zengye Chengqi decotion is used for nourishing yin and increasing fluids,relaxing tendons,and stopping spasms for Yangming heat excess syndrome;Baihu decotion combined with Zengye decotion for clearing summerheat and nourishing yin for Yangming fu syndrome-intestinal sweating;Qingying decotion for clearing the nutrient aspect and cooling blood,penetrating heat,and nourishing yin for heat entering the heart-nutrient syndrome;Lingjiao Gouteng decotion for clearing heat and cooling the liver,extinguishing wind,and calming spasms for extreme heat generating wind syndrome;Wuling powder for draining and eliminating water retention for Taiyang water retention syndrome;Wang's Qing Shu Yiqi decotion for clearing summerheat and reducing fever,benefiting qi,and generating fluids for dual injury of qi and fluid syndrome;and Sanjia powder for clearing residual heat,resolving phlegm,and removing stasis from collaterals for phlegm-stasis obstructing collaterals syndrome.Starting from TCM theory and linking it with practice,the article combines Western disease differentiation with TCM syndrome differentiation,aiming to provide new ideas for the clinical treatment of heat stroke.

The term"heat stroke"originates from the integration of modern traditional Chinese and Western medicine.In clinical practice,the complementary advantages of the two medical systems can significantly enhance the clinical diagnosis and treatment level of heat stroke.Through comprehensively analyzes the traditional Chinese medicine(TCM)nomenclature for heat stroke,proposing that heat stroke is a type of sunstroke characterized by intense and pure yang nature,specifically referring to symptoms caused directly or indirectly by hot weather.It can be referenced under the categories of Zhongye,Shuwen,Yinshu/Yangshu,Shujue,and Shufeng for treatment.The article reviews the TCM diagnostic and therapeutic thinking for heat stroke,summarizing its etiology and pathogenesis,including summerheat directly entering the Yangming,heat entering the heart and nutrient-blood aspects,evil combined with water(post-emergency),dual injury of qi and fluid(post-mild recovery),and phlegm-stasis obstructing collaterals(post-severe recovery).Based on years of clinical experience and combining the different clinical manifestations of heat stroke with TCM's four diagnostic methods,the article proposes a treatment plan that integrates Chinese and Western medicine,combining disease differentiation with syndrome differentiation.The main syndromes summarized include high fever with spasms(Yangming heat excess syndrome),diarrhea(Yangming fu syndrome-intestinal sweating),high fever with coma(heat entering the heart-nutrient syndrome),high fever with convulsions(extreme heat generating wind syndrome),heat stroke-induced coagulopathy(heat entering the blood aspect syndrome),edema after fluid resuscitation(Taiyang water retention syndrome),recovery phase(dual injury of qi and fluid syndrome),and sequelae(phlegm-stasis obstructing collaterals syndrome).For treatment,Baihu Jia Renshen decotion combined with Zengye Chengqi decotion is used for nourishing yin and increasing fluids,relaxing tendons,and stopping spasms for Yangming heat excess syndrome;Baihu decotion combined with Zengye decotion for clearing summerheat and nourishing yin for Yangming fu syndrome-intestinal sweating;Qingying decotion for clearing the nutrient aspect and cooling blood,penetrating heat,and nourishing yin for heat entering the heart-nutrient syndrome;Lingjiao Gouteng decotion for clearing heat and cooling the liver,extinguishing wind,and calming spasms for extreme heat generating wind syndrome;Wuling powder for draining and eliminating water retention for Taiyang water retention syndrome;Wang's Qing Shu Yiqi decotion for clearing summerheat and reducing fever,benefiting qi,and generating fluids for dual injury of qi and fluid syndrome;and Sanjia powder for clearing residual heat,resolving phlegm,and removing stasis from collaterals for phlegm-stasis obstructing collaterals syndrome.Starting from TCM theory and linking it with practice,the article combines Western disease differentiation with TCM syndrome differentiation,aiming to provide new ideas for the clinical treatment of heat stroke.

BACKGROUND:Autophagy may be involved in the pathological process of steroid-induced necrosis of the femoral head(SINFH).Some studies have confirmed that circular RNAs(circRNAs)have a regulatory mechanism in SINFH;however,whether circCDR1as affects autophagy in SINFH has not been investigated. OBJECTIVE:To explore the level of autophagy and the regulatory mechanism of circCDR1as in SINFH. METHODS:Gene expression profiles of SINFH and control rats were extracted from the GSE26316 dataset and differential expression analysis was performed.Subsequently,the biological functions of differentially expressed genes were analyzed.Then,the target miRNAs of circCDR1as and the target genes of target miRNAs were predicted.Further,the target genes were compared with the differentially expressed genes to construct the regulatory network of circCDR1as.In addition,femoral head samples from patients with SINFH and healthy control individuals were collected.Bone marrow mesenchymal stem cells were also applied for cellular experiments and randomly divided into bone marrow mesenchymal stem cell group,model group(methylprednisolone-treated),model+si-NC group,and model+si-CDR1as group.RT-qPCR was used to detect the expression of circCDR1as and target genes in cells and tissue samples.Western blot was used to examine the expression of autophagy proteins.The luciferase reporter gene vectors,pmirGLO-CDR1as(WT),pmirGLO-RAF1(WT),pmirGLO-CDR1as(MUT),and pmirGLO-RAF1(MUT),were constructed and transfected into the cells.miR-7-5p mimic and mimic NC groups were established.The target-regulatory relationship of the circCDR1as network was detected. RESULTS AND CONCLUSION:A total of 1 283 differentially expressed genes were identified between the SINFH and control groups,which were mainly involved in apoptotic and autophagic signaling pathways.Prediction analysis revealed that circCDR1as targeted 6 miRNAs,which in turn regulated 305 target genes.Among these target genes,31 showed differential expression in SINFH.Among the differentially expressed target genes,RAF1,involved in autophagy,was selected as a key gene,leading to the construction of the circCDR1as/miR-7-5p/RAF1 regulatory network.Compared with the control group,circCDR1as,RAF1,and autophagy levels were upregulated in patients with SINFH and in hormone-induced bone marrow mesenchymal stem cells(P<0.05),while miR-7-5p expression was downregulated(P<0.05).Knockdown of circCDR1as significantly decreased cellular autophagy levels(P<0.05).Dual-luciferase reporter assays confirmed the targeting relationships between circCDR1as and miR-7-5p,as well as between miR-7-5p and RAF1.To conclude,the CircCDR1as/miR-7-5p/RAF1 may potentially promote SINFH through autophagy.Targeting circCDR1as is a potential strategy for partial autophagic repair in the treatment of SINFH.