Based on the theory of "shaoyang（少阳） resembling the pivot" and collateral diseases， this article proposes that pulmonary fibrosis （PF） can be divided into three stages including wind bi （痹）， constraint bi， and atrophy bi. The core pathogenesis of PF is the obstruction of the pivot and pulmonary collateral obstruction. In terms of treatment， the basic principles are to harmonize and regulate the pivot， and to promote the circulation of the lung collaterals. Depending on the different characteristics of the "essence-attribute-function"， treatment methods such as harmonizing and regulating the pivot， resolving phlegm and removing stasis， supplementing deficiency and harmonizing collaterals are suggested. This approach ensures the regulation of the pivot， smooth circulation of qi and blood， unblocking of the lung collaterals and nourishing the lung body， achieving the goals of balancing the ascending and descending of qi， removing phlegm and stasis， and relieving cough and wheezing.

The Expert Consensus on Clinical Application of Qinbaohong Zhike Oral Liquid in Treatment of Acute Bronchitis and Acute Attack of Chronic Bronchitis （GS/CACM 337-2023） was released by the China Association of Chinese Medicine on December 13^th， 2023. This expert consensus was developed by experts in methodology， pharmacy， and Chinese medicine in strict accordance with the development requirements of the China Association of Chinese Medicine （CACM） and based on the latest medical evidence and the clinical medication experience of well-known experts in the fields of respiratory medicine （pulmonary diseases） and pediatrics. This expert consensus defines the application of Qinbaohong Zhike oral liquid in the treatment of cough and excessive sputum caused by phlegm-heat obstructing lung， acute bronchitis， and acute attack of chronic bronchitis from the aspects of applicable populations， efficacy evaluation， usage， dosage， drug combination， and safety. It is expected to guide the rational drug use in medical and health institutions， give full play to the unique value of Qinbaohong Zhike oral liquid， and vigorously promote the inheritance and innovation of Chinese patent medicines.

ObjectiveTo observe the efficacy of Sangmei Pingfeng granules combined with western medicine in the treatment of patients with allergic asthma in the chronic persistent stage， diagnosed with lung-spleen Qi deficiency syndrome in traditional Chinese medicine （TCM）. MethodsA retrospective analysis was conducted on 420 patients with allergic asthma in the chronic persistent stage and TCM-diagnosed lung-spleen Qi deficiency syndrome， treated at the Third Affiliated Hospital of Beijing University of Chinese Medicine from January 2017 to September 2024. Patients were divided into an exposed group （320 cases） and a non-exposed group （100 cases） based on whether they used Sangmei Pingfeng granules. The non-exposed group received conventional western medicine treatment， while the exposed group took Sangmei Pingfeng Granules in addition to conventional western medicine. The following indicators were observed： recurrence rate per 100 patients per year， pulmonary function tests， fractional exhaled nitric oxide （FeNO） and fractional nasal nitric oxide （FnNO） tests， serum total IgE （TIgE） detection， TCM syndrome score， and changes in asthma control test （ACT） scores between the two groups. ResultsThe annual recurrence rate per 100 people was 8.4 times/100 person-years in the exposed group， lower than the 13 times/100 person-years in the unexposed group. After treatment， the exposed group showed increases in forced vital capacity percentage predicted （FVC%pred）， forced expiratory volume in one second percentage predicted （FEV₁%pred）， the ratio of forced expiratory volume in one second to forced vital capacity （FEV₁/FVC）， and peak expiratory flow percentage predicted （PEF%pred） （P0.05）. Lung function indicators in the non-exposed group showed no statistically significant differences after treatment. Residual volume as a percentage of total lung capacity （RV%TLC） showed no statistically significant difference after treatment in either group. Compared with the non-exposed group， the exposed group had increased FVC%pred， FEV₁%pred， FEV₁/FVC， and PEF%pred， without statistically significant differences. After treatment， fractional exhaled nitric oxide （FeNO）， fractional nasal nitric oxide （FnNO）， and total immunoglobulin E （TIgE） decreased in the exposed group. FeNO decreased in the non-exposed group （P0.05）. FnNO decreased， and TIgE increased in the non-exposed group， without statistically significant differences. After treatment， compared with the non-exposed group， the treatment group had decreased FeNO （P0.05）. After treatment， traditional Chinese medicine （TCM） syndrome scores decreased， and asthma control test （ACT） scores increased in both groups （P0.01）. After treatment， compared with the non-exposed group， the exposed group had decreased TCM syndrome scores and increased ACT scores （P0.01）. ConclusionCombining Sangmei Pingfeng granules with Western medicine significantly reduces recurrence rates， enhances clinical efficacy， improves lung function， lowers serum TIgE and FeNO levels， and reduces reliance on Western medications in patients with allergic asthma. This integrated approach is worthy of clinical promotion and application.

ObjectiveTo analyze the correlation between the clinical symptoms， signs， syndrome characteristics and laboratory indicators of cough variant asthma （CVA） and deepen the understanding of the treatment of this disease based on the theory of "Fu Feng". MethodsAn observational study was conducted. A total of 207 CVA patients who visited the respiratory department of the Third Affiliated Hospital of Beijing University of Chinese Medicine from September 2022 to November 2023 were included. The information from the four diagnostic methods and the laboratory test results of patients were collected. Factor analysis was conducted on the information obtained through the four diagnostic methods in TCM， and the nature and location of CVA were extracted. Sample cluster analysis （Q clustering） and the K-means method were used for data clustering analysis to determine the syndrome types of CVA and analyze the syndrome characteristics and differences in laboratory indicators among different syndrome types. ResultsThe main symptom of CVA patients was cough， accompanied by symptoms such as itchy throat， foreign body sensation in the throat， dry throat， shortness of breath， dry mouth， chest tightness， hoarseness， bitter mouth， poor appetite， and skin itching. Factor analysis showed that the disease was located in the lung， involving the liver， spleen， and kidney. The pathological factors involved Yin deficiency， Yang deficiency， wind factor， dampness factor， Yin factor， and Qi stagnation. Cluster analysis revealed four syndrome types： Fengfu Yinshang syndrome， Shixie Neiyun syndrome， Tanyin Zufei syndrome， and Ganhuo Fanfei syndrome. Fengfu Yinshang syndrome accounted for the highest proportion， followed by Tanyin Zufei syndrome. There were no significant differences in eosinophil count and percentage， fractional nasal nitric oxide （FnNO） level， and pulmonary function indexes among the four syndromes. The levels of serum total IgE and fractional exhaled nitric oxide （FeNO） in patients with Fengfu Yinshang syndrome were significantly higher than those in patients with Shixie Neiyun syndrome and Tanyin Zufeisyndrome. ConclusionCough is the main symptom of CVA， accompanied by pharyngeal itching， foreign body sensation in the throat， dry throat， shortness of breath， dry mouth， and allergic manifestations. The disease involves the lung， liver， spleen， and kidneys. The essence of the pathogenesis lies in a latent dormant pathogen and a disorder of the pivot mechanism. The four common syndrome types are Fengfu Yinshang syndrome， Shixie Neiyun syndrome， Tanyin Zufei syndrome， and Ganhuo Fanfei syndrome. The TCM syndrome types are correlated with laboratory indexes. The serum total IgE and FeNO of patients with Fengfu Yinshang syndrome are worse.

ObjectiveTo observe the regulation effect of Sangmei Zhike granules on airway inflammation and cyclic adenosine monophosphate （cAMP）-protein kinase A （PKA）-cAMP response element binding protein （CREB） pathway in cough variant asthma （CVA） rats with Fengfu Yinshang syndrome. MethodsEight-week-old male rats were randomly divided into a blank group， model group， western medicine group， and traditional Chinese medicine （TCM） group. Except for the blank group， Fengfu Yinshang models of CVA were established in the other groups. On the 16th day of the experiment， the western medicine group was treated with budesonide aerosol inhalation （dosage of 0.5 g·L^-1）， and the TCM group was given Sangmei Zhike granules by gavage （dosage of 4.19 g·kg^-1·d^-1）， with each group treated once daily for 14 days. On the 30^th day of the experiment， lung function parameters were determined. Whole blood inflammatory cell detection， hematoxylin-eosin （HE） staining of lung tissue， and immunohistochemistry were used to detect the expression of CREB， phosphorylated CREB （pCREB）， and phosphorylated vasodilator-stimulated phosphoprotein （pVASP） proteins in rat lung tissue， and Reverse transcription quantitative polymerase chain reaction （Real-time PCR） was used to determine the protein expressions of cAMP， CREB， and PKA in rat lung tissue. Western blot （WB） was used to detect the expression of PKA， VASP， p-VASP， CREB， and p-CREB proteins. ResultsCompared with the model group， the average dynamic lung compliance （CDyn_average） in the TCM group increased （P0.05）. Compared with the model group， the TCM group showed a decrease in absolute and percentage values of neutrophils （NEUT%）， absolute values of lymphocytes （LYMPH）， absolute and percentage values of basophils （BASO%）， absolute values of monocytes （MONO）， absolute and percentage values of eosinophils （EOS%）， and white blood cells （WBC） （P0.05）. Compared with the western medicine group， the TCM group showed a decrease in MONO， EOS%， and LYMPH% and an increase in MONO% （P0.05）. ELISA results showed that compared with the model group， the TCM group had increased interferon-gamma （IFN-γ） and decreased interleukins （IL）-4， IL-5， IL-13， and total serum IgE， while the Western medicine group had increased IFN-γ and decreased IL-5， IL-13， and total serum IgE （P0.05）. Compared with the western medicine group， the TCM group had decreased IL-5 （P0.05）. HE staining results of rat lung tissue showed that the ciliated epithelium of the D bronchi in the TCM group recovered well. Mucous edema secretion decreased， and a small number of bronchiolar epithelial cells were shed， with reduced infiltration of inflammatory cells and the degree of epithelial injury. Immunohistochemical （IHC） results showed that compared with the model group， positive expressions of CREB， pCREB， and pVASP （brownish-yellow） were significantly increased in the TCM and western medicine groups. Real-time PCR results showed that compared with the model group， the relative expression levels of cAMP， CREB， and PKA in the TCM group were significantly increased （P0.05）， and compared with the western medicine group， the TCM group also showed significantly increased relative expression levels of cAMP， CREB， and PKA （P0.05）. WB results showed that compared with the model group， the expressions of PKA， VASP， p-VASP， CREB， p-CREB， and p-CREB/CREB proteins were increased in the TCM group， while p-VASP/VASP protein expression decreased （P0.05）. Compared with the western medicine group， the TCM group had increased expressions of PKA， VASP， and p-CREB proteins and decreased p-VASP/VASP expression （P0.05）. ConclusionSangmei Zhike granules have the effect of improving lung function and inhibiting airway inflammation in rats with CVA due to Fengfu Yinshang syndrome， possibly related to the activation of the cAMP/PKA/CREB pathway.

Cough variant asthma （CVA） is a special type of asthma and the most common cause of chronic cough in China. It has a relatively high incidence， seriously affects patients' quality of life， and in some cases may even progress to typical asthma， posing an important challenge in the field of health economics. At present， first-line treatment in Western medicine mainly consists of inhaled corticosteroids combined with bronchodilators. However， there remain many problems such as poor efficacy in some patients， frequent relapse after drug withdrawal， and poor compliance， making it urgent to improve treatment strategies. In-depth research on the pathogenesis is helpful for a comprehensive understanding and prevention of CVA. The pathogenesis of CVA is complex and involves multiple pathophysiological links. While similar to typical asthma， it still presents some differences. Traditional Chinese medicine （TCM） has unique advantages in the treatment of CVA. Guided by the theory of syndrome differentiation and treatment， TCM can not only improve the clinical symptoms of CVA but also prevent recurrence. In recent years， with the continuous deepening of research on the pathogenesis of CVA and on its treatment with TCM based on syndrome differentiation， related academic achievements have been updated year by year. A review of literature in China and abroad shows that the current pathogenesis of CVA can be summarized into six aspects： airway inflammation， airway remodeling， airway hyperresponsiveness， cough hypersensitivity， genetic factors， and imbalance of intestinal flora. TCM often differentiates and treats CVA from four perspectives： cause， disease location， disease nature， and disease tendency. This paper systematically summarizes the progress in the study of CVA pathogenesis， comprehensively collates the experience and clinical research evidence on its treatment with TCM based on syndrome differentiation， and discusses the problems existing in current research. On this basis， it puts forward suggestions and prospects for future research and development of TCM in the treatment of CVA， with a view to providing a theoretical basis and therapeutic approaches for its prevention and treatment.

Mycophenolic acid (MPA), the active moiety of both mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS), serves as a primary immunosuppressant for maintaining solid organ transplants. Therapeutic drug monitoring (TDM) enhances treatment outcomes through tailored approaches. This study aimed to develop an evidence-based guideline for MPA TDM, facilitating its rational application in clinical settings. The guideline plan was drawn from the Institute of Medicine and World Health Organization (WHO) guidelines. Using the Delphi method, clinical questions and outcome indicators were generated. Systematic reviews, Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence quality evaluations, expert opinions, and patient values guided evidence-based suggestions for the guideline. External reviews further refined the recommendations. The guideline for the TDM of MPA (IPGRP-2020CN099) consists of four sections and 16 recommendations encompassing target populations, monitoring strategies, dosage regimens, and influencing factors. High-risk populations, timing of TDM, area under the curve (AUC) versus trough concentration (C₀), target concentration ranges, monitoring frequency, and analytical methods are addressed. Formulation-specific recommendations, initial dosage regimens, populations with unique considerations, pharmacokinetic-informed dosing, body weight factors, pharmacogenetics, and drug‍-‍drug interactions are covered. The evidence-based guideline offers a comprehensive recommendation for solid organ transplant recipients undergoing MPA therapy, promoting standardization of MPA TDM, and enhancing treatment efficacy and safety.
Mycophenolic Acid/administration & dosage* ; Drug Monitoring/methods* ; Humans ; Organ Transplantation ; Immunosuppressive Agents/administration & dosage* ; Delphi Technique

Objective:To explore the efficacy of Qingjin Huatan Decoction combined with conventional Western medicine for the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with phlegm-heat obstructing lung syndrome.Methods:A randomized controlled trial was conducted. Totally 90 hospitalized patients with AECOPD phlegm-heat obstructing lung syndrome in the respiratory department of Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital from January 2023 to June 2024 were selected as the observation subjects. According to the simplified randomization method (single-double number method), the patients were divided into two groups, with 45 cases in each group. The conventional Western medicine group was given conventional Western medicine treatment, and the combined Chinese materia medica group was given Qingjin Huatan Decoction on the basis of the conventional Western medicine group. The treatment for both groups lasted for 7 d. TCM symptoms were scored before and after treatment; FEV 1 and FVC were detected by pulmonary function analyzer, PaO 2, PaCO 2, PaO 2/FiO 2 were detected by blood gas biochemical analyzer, CRP and PCT were detected by ELISA, and white blood cell count (WBC) was detected by automatic blood cell analyzer. Adverse reactions were recorded, and the clinical efficacy was evaluated. Results:The total effective rate was 93.33% (42/45) in the combined Chinese materia medica group and 77.78% (35/45) in the conventional Western medicine group, with statistical significance ( χ2=4.41, P=0.036). After treatment, the scores of cough, wheezing, chest tightness and shortness of breath and fever and the total score in the combined Chinese materia medica group were lower than those in the conventional Western medicine group ( t=4.83, 2.26, 5.36, 10.43, 5.27,respectively, P<0.01 or P<0.05); the levels of FEV 1 and FVC in the combined Chinese materia medica group were higher than those in the conventional Western medicine group ( t=3.03, 2.64, respectively, P<0.01); the levels of PaO 2 and PaO 2/FiO 2 in the combined Chinese materia medica group were higher than those in the conventional Western medicine group ( t=4.83, 5.36, P<0.01), while the level of PaCO 2 in the combined Chinese materia medica group was lower than that in the conventional Western medicine group ( t=2.26, P<0.05); the levels of CRP, PCT and WBC in the combined Chinese materia medica group were lower than those in the conventional western medicine group ( t=10.53, 11.29 and 2.59, respectively, P<0.01 or P<0.05). During the treatment, the incidence of adverse reactions was 6.67% (3/45) in the combined Chinese materia medica and 8.89% (4/45) in the conventional Western medicine group, without statistical significance ( χ2=0.16, P=0.694). Conclusion:Qingjin Huatan Decoction can effectively improve the lung function and blood gas indicators of AECOPD with phlegm-heat obstructing lung syndrome, and relieve the inflammation, with safety and effectiveness.

OBJECTIVE Based on the G protein-coupled bile acid receptor(TGR5)/nucleotide binding oligomerization domain-like receptor 3(NLRP3) signaling pathway, to explore the mechanism of Huoxue Qingjieling in improving the inflammatory response of rats with nonalcoholic steatohepatitis(NASH). METHODS A total of 70 male SD rats were randomly divided into 5 groups, 20 rats in the control group, 20 rats in the model group, 10 rats in each of the atorvastatin positive drug group, the high-dose and low-dose groups of Huoxue Qingjieling. The control group was given normal feed, and the rest of the groups were given high-fat diet. Through model evaluation, it was determined that the NASH rat model was successfully established at the end of the 20th week. After successful modeling, the control group and the model group were given with normal saline by intragastric administration, the atorvastatin positive drug group, and the high and low dose groups of Huoxue Qingjieling were given corresponding drugs once a day for 4 weeks. At the end of the 24th week, the rats were killed, and the changes of body weight, wet liver weight and liver index was calculated. The serum was taken to test the triglyceride(TG), total cholesterol(TC), alanine aminotransferase(ALT), and aspartic acid aminotransferase(AST) levels by automatic biochemical analyzer. Pathological changes of liver tissues were observed by HE staining and oil red O staining. The expression levels of TGR5 and NLRP3 proteins were detected by Western blotting and immunofluorescence staining. ELISA detected the content of interleukin-18(IL-18) and interleukin-1β(IL-1β) in liver tissue. RESULTS Huoxue Qingjieling could significantly improve the general state of NASH rats. Every dose group could significantly reduce the body weight, liver wet weight and liver index of rats(P<0.01), and TG, TC content and ALT, AST activity levels of serum significantly decreased(P<0.01). The pathological results showed that Huoxue Qingjieling could significantly improve liver steatosis, inflammation and balloon-like. The expression of TGR5 protein was significantly increased(P<0.01), the expression of NLRP3 protein and the content of IL-18, IL-1β were significantly decreased(P<0.01, P<0.05). CONCLUSION Huoxue Qingjieling can significantly improve the state of NASH rats, inhibit liver steatosis and inflammation, and its mechanism may be closely related to the inhibition of TGR5/NLRP3 signaling pathway.

This paper summarized the characteristics of constitution， disease， and syndrome of five different phenotypes of bronchial asthma including allergic asthma， cough variant asthma， chest tightness variant asthma， psychological stress asthma， and hormone-dependent asthma， and systematically expounds the application of three-dimensional diagnosis and treatment pattern， that is differentiation of constitution， disease and syndromes in the five phenotypes of bronchial asthma. It is considered that the allergic constitution is the main one of bronchial asthma， which is usually combined with the constitutions of qi-deficiency， yin-deficiency， yang-deficiency， qi-stagnation and others. In the treatment of bronchial asthma， constitution， disease and syndromes should all be taken into account but applied flexibly according to the order of the urgency and priority. The three-dimensional diagnosis and treatment pattern can reflect the essential characteristics and clinical panorama of bronchial asthma more comprehensively and objectively and provide effective intervention measures and management programs for the prevention and treatment by traditional Chinese medicine.