This article systematically reviews the current research status as well as diagnosis and treatment strategies of traditional Chinese medicine （TCM） for gastroesophageal reflux disease （GERD）. Studies demonstrate that TCM， based on the "disease-syndrome combination" approach， exhibits multi-target advantages in alleviating symptoms of various GERD subtypes， promoting mucosal repair， regulating emotions， and facilitating the reduction of western medication. To address clinical challenges such as symptom overlap and limited therapeutic efficacy， strategies have been proposed including "treating different diseases with the same method" and integrated regulation based on viscera correlation. Future efforts should focus on elucidating the mechanisms of compound prescriptions， promoting TCM drug development under the "three-combination" evaluation framework that integrates TCM theory， human experience and clinical trial evidence， and optimizing integrated traditional and western medicine models to enhance GERD management.

Based on the theoretical framework of "grease-turbidity-heat toxin"， this paper elucidates the patholo-gical evolution pattern underlying the alternation between active and remission phases of inflammatory bowel disease （IBD）. It is proposed that the active phase of IBD represents a progressive and explosive process characterized by internal accumulation of grease turbidity， constraint transforming into heat， and exuberant heat generating toxin. During the remission phase， the pathogenic process manifests as subsidence of heat toxin， depletion of qi and yin， latent retention of residual turbidity， and a state of coexistence between deficiency of healthy qi and lingering pathogenic factors. Accordingly， a staged therapeutic strategy with dynamic intervention and targeted modulation has been established. During the active phase， treatment follows the sequential principle of unblocking， clearing， and resolving pathogenic factors. In the early stage， the therapeutic approach focuses on regulating qi movement， fortifying the spleen， and resolving turbidity， using Tongxie Essential Formula （痛泻要方） and Shenling Baizhu Powder （参苓白术散） to regulate qi and fortify spleen. In the middle stage， the strategy emphasizes clearing heat， eliminating dampness， and dispersing pathogenic accumulation through downward and outward pathways， and Gegen Qinlian Decoction （葛根芩连汤） combined with Banxia Xiexin Decoction （半夏泻心汤） is used to clear and resolve damp-heat. In the late stage， treatment aims to resolve toxin， restrain sore， cool blood， and stabilize collaterals， using Baitouweng Decoction （白头翁汤）， Shaoyao Decoction （芍药汤）， and Xijiao Dihuang Decoction （犀角地黄汤） to eliminate toxins and cool blood. During the remission phase， the principle of reinforcing， consolidating， and penetrating is adopted to restore internal balance and clear the source， using Sishen Pills （四神丸） and Sijunzi Decoction （四君子汤） to reinforce healthy qi and venting pathogens.

Based on the theory of Zi Wu Liu Zhu （子午流注， the ebb and flow of midnight and midday） and the clinical characteristics of diarrhea-predominant irritable bowel syndrome （IBS-D） that its symptoms mainly occur during chou （丑） period （01：00—03：00）， mao （卯） period （5：00—7：00）， and si （巳） period （9：00—11：00）， this paper proposes a temporal pathogenesis chain of "liver constraint during chou period， intestinal stagnation during mao period， and spleen deficiency during si period". Within this chain， liver constraint serves as the initiating factor， and intestinal stagnation manifests as the branch， while spleen deficiency constitutes the root of the disease. Accordingly， a chronotherapeutic principle of "soothing the liver， regulating the intestines， and fortifying the spleen" is proposed， establishing a corresponding time-based syndrome differentiation and treatment system. During chou period， the treatment should focus on soothing the liver to relieve constraint and calming the mind to tranquilize the spirit， thereby blocking the mechanism of liver constraint overacting on the spleen. During mao period， the focus is regulating qi to resolve dampness and harmonizing the intestine to alleviate the branch symptoms of morning abdominal pain and diarrhea. During si period， the suggested method is fortifying the spleen and supplementing qi to drain dampness and stop diarrhea， thereby restoring the pivot of spleen-stomach transportation and transformation. These methods are complemented by strategies to optimize medication compliance， thereby providing a new chronotherapeutic approach for clinical diagnosis and treatment of IBS-D.

Based on the theoretical framework of "grease-turbidity-heat toxin"， this paper elucidates the patholo-gical evolution pattern underlying the alternation between active and remission phases of inflammatory bowel disease （IBD）. It is proposed that the active phase of IBD represents a progressive and explosive process characterized by internal accumulation of grease turbidity， constraint transforming into heat， and exuberant heat generating toxin. During the remission phase， the pathogenic process manifests as subsidence of heat toxin， depletion of qi and yin， latent retention of residual turbidity， and a state of coexistence between deficiency of healthy qi and lingering pathogenic factors. Accordingly， a staged therapeutic strategy with dynamic intervention and targeted modulation has been established. During the active phase， treatment follows the sequential principle of unblocking， clearing， and resolving pathogenic factors. In the early stage， the therapeutic approach focuses on regulating qi movement， fortifying the spleen， and resolving turbidity， using Tongxie Essential Formula （痛泻要方） and Shenling Baizhu Powder （参苓白术散） to regulate qi and fortify spleen. In the middle stage， the strategy emphasizes clearing heat， eliminating dampness， and dispersing pathogenic accumulation through downward and outward pathways， and Gegen Qinlian Decoction （葛根芩连汤） combined with Banxia Xiexin Decoction （半夏泻心汤） is used to clear and resolve damp-heat. In the late stage， treatment aims to resolve toxin， restrain sore， cool blood， and stabilize collaterals， using Baitouweng Decoction （白头翁汤）， Shaoyao Decoction （芍药汤）， and Xijiao Dihuang Decoction （犀角地黄汤） to eliminate toxins and cool blood. During the remission phase， the principle of reinforcing， consolidating， and penetrating is adopted to restore internal balance and clear the source， using Sishen Pills （四神丸） and Sijunzi Decoction （四君子汤） to reinforce healthy qi and venting pathogens.

ObjectiveTo collate and compare the characteristics and differences in the methods for constructing animal models of different subtypes of gastroesophageal reflux disease （GERD） based on literature， providing a reference for researchers in this field regarding animal model construction. MethodsExperimental studies related to GERD including reflux esophagitis （RE）， nonerosive reflux disease （NERD） and Barrett's esophagus （BE） model construction from January 1， 2014 to January 27， 2024， were retrieved from databases such as CNKI， Wanfang， VIP， Web of Science， and Pubmed. Information on animal strains， genders， modeling methods including disease-syndrome combination models， modeling cycles were extracted； for studies with model evaluation， the methods of model evaluation were also extracted； then analyzing all those information. ResultsA total of 182 articles were included. SD rats were most frequently selected when inducing animal models of RE （88/148， 59.46%） and NERD （9/14， 64.29%）. For BE， C57BL/6 mice were most commonly used （11/20， 55.00%）. Male animals （RE： 111/135， 82.22%； NERD： 11/14， 78.57%； BE： 10/12， 83.33%） were the most common gender among the three subtypes. The key to constructing RE animal models lies in structural damage to the esophageal mucosal layer， gastric content reflux， or mixed reflux， among which forestomach ligation + incomplete pylorus ligation （42/158， 26.58%） was the most common modeling method； the key to constructing NERD animal models lies in micro-inflammation of the esophageal mucosa， visceral hypersensitivity， and emotional problems， and intraperitoneal injection of a mixed suspension of ovalbumin and aluminum hydroxide combined with acid perfusion in the lower esophagus （8/14， 57.14%） was the most common modeling method； the key to constructing BE animal models lies in long-term inflammatory stimulation of the esophageal mucosa and bile acid reflux， and constructing interleukin 2-interleukin 1β transgenic mice （7/25， 28.00%） was the most common modeling method. Adverse psychological stress was the most common method for inducing liver depression. ConclusionsThe construction key principles and methodologies for RE， NERD， and BE animal models exhibit significant differences. Researchers should select appropriate models based on subtype characteristics （e.g.， RE focusing on structural damage， NERD emphasizing visceral hypersensitivity）. Current studies show insufficient exploration of traditional Chinese medicine disease-syndrome combination models. Future research needs to optimize syndrome modeling approaches （e.g.， composite etiology simulation） and establish integrated Chinese-Western medicine evaluation systems to better support mechanistic investigations of traditional Chinese medicine.

Objective To investigate the effect of Siwu Wuzi Decoction in the treatment of wet age-related macular degeneration(wAMD)on the levels of vascular endothelial growth factor(VEGF),transforming growth factor-β1(TGF-β1),and inflammatory factors in patients.Methods A total of 216 patients with wAMD were randomly divided into western medicine group(n=108)and integrated Chinese and western medicine group(n=108).The western medicine group received conbercept plus photodynamic therapy(PDT),while the integrated Chinese and western medicine group received con-bercept,PDT,and Siwu Wuzi Decoction.Both groups were treated for 3 months.The traditional Chi-nese medicine syndrome scores,best-corrected visual acuity(BCVA),intraocular pressure,VEGF,TGF-β1,inflammatory factor levels[interleukin(IL)-6,IL-13],quality of life[Chinese Low Vision Quality of Life Scale(CLVQOL)],and clinical efficacy were observed in both groups.Results After treatment,the traditional Chinese medicine syndrome scores decreased in both groups,with the scores in the integrated Chinese and western medicine group being lower than those in the western medicine group(P＜0.05).After treatment,BCVA decreased in both groups,with the BCVA in the integrated Chinese and western medicine group being lower than that in the western medicine group(P＜0.05).After treatment,intraocular pressure increased in both groups,but the intraocu-lar pressure in the integrated Chinese and western medicine group was lower than that in the western medicine group(P＜0.05).After treatment,VEGF and TGF-β1 levels decreased in both groups,with the levels in the integrated Chinese and western medicine group being lower than those in the western medicine group(P＜0.05).After treatment,IL-6 and IL-13 levels decreased in both groups,with the levels in the integrated Chinese and western medicine group being lower than those in the western medicine group(P＜0.05).After treatment,CLVQOL scores increased in both groups,with the scores in the integrated Chinese and western medicine group being higher than those in the western medicine group(P＜0.05).The total effective rate of treatment in the integrat-ed Chinese and western medicine group was 97.22％,which was higher than 85.19％in the west-ern medicine group(P＜0.05).Conclusion Siwu Wuzi Decoction has a good therapeutic effect on wAMD,which can alleviate symptoms,restore vision,reduce intraocular pressure,regulate VEGF,TGF-β1,and inflammatory factor levels,and improve quality of life.

Objective To investigate the therapeutic mechanism of Wendan Decoction for phlegm syndrome in rats with metabolic syndrome(MS).Methods Forty Wistar rats were randomly divided into normal control group(n=8)and 3 phlegm syndrome model groups(induced by high-fat,high-sugar,and high-salt feeding and a single-dose intraperitoneal STZ injection;n=24)treated with daily gavage of saline,Wendan Decoction(3.6 g/kg),or metformin(0.1 g/kg)for 4 weeks.General conditions and glucose and lipid metabolism parameters of the rats were monitored,and serum LPS,liver histopathology,hepatic expressions of FXR,CYP7A1 and FGFR4 and ileal expressions of FXR and FGF15 were examined.Gut microbiota structure was analyzed using 16S rDNA sequencing,and serum bile acids were quantified with UHPLC-MS/MS.Results The rat models of phlegm syndrome exhibited severe hepatic steatosis and necrosis,increased body weight,abdominal circumference,Lee's index,FBG,FINS,HOMA-IR,TG,TC,LDL and LPS,and decreased HDL level.The abundance of Bacteroidetes,Megamonas,and Bacteroides in gut microbiota increased while Firmicutes,Lachnospiraceae_NK4A136_group,isohyodeoxycholic acid,and glycohyodeoxycholic acid decreased significantly;hepatic FXR and FGFR4 expressions and ileal FXR and FGF15 expressions decreased while hepatic CYP7A1 expression increased significantly in the rat models.Treatment with Wendan Decoction effectively alleviated hepatic pathology,reduced body weight and abdominal circumference,improved glucose and lipid metabolic profiles and gut microbiota structure,and reversed the changes in hepatic and ileal protein expressions.Correlation analysis revealed that Firmicutes and Lachnospiraceae_NK4A136_group were positively correlated while Bacteroidetes,Megamonas and Bacteroides were negative correlated with the levels of isohyodeoxycholic acid and hyodeoxycholic acid.Conclusion Wendan Decoction can significantly improve metabolic profiles in rats with phlegm syndrome of MS possibly by regulating the intestinal flora-bile acid axis to modulate the intestinal flora structure and maintain bile acid homeostasis via the FXR signaling pathway.

OBJECTIVES: To investigate the therapeutic mechanism of Wendan Decoction for phlegm syndrome in rats with metabolic syndrome (MS). METHODS: Forty Wistar rats were randomly divided into normal control group (n=8) and 3 phlegm syndrome model groups (induced by high-fat, high-sugar, and high-salt feeding and a single-dose intraperitoneal STZ injection; n=24) treated with daily gavage of saline, Wendan Decoction (3.6 g/kg), or metformin (0.1 g/kg) for 4 weeks. General conditions and glucose and lipid metabolism parameters of the rats were monitored, and serum LPS, liver histopathology, hepatic expressions of FXR, CYP7A1 and FGFR4 and ileal expressions of FXR and FGF15 were examined. Gut microbiota structure was analyzed using 16S rDNA sequencing, and serum bile acids were quantified with UHPLC-MS/MS. RESULTS: The rat models of phlegm syndrome exhibited severe hepatic steatosis and necrosis, increased body weight, abdominal circumference, Lee's index, FBG, FINS, HOMA-IR, TG, TC, LDL and LPS, and decreased HDL level. The abundance of Bacteroidetes, Megamonas, and Bacteroides in gut microbiota increased while Firmicutes, Lachnospiraceae_NK4A136_group, isohyodeoxycholic acid, and glycohyodeoxycholic acid decreased significantly; hepatic FXR and FGFR4 expressions and ileal FXR and FGF15 expressions decreased while hepatic CYP7A1 expression increased significantly in the rat models. Treatment with Wendan Decoction effectively alleviated hepatic pathology, reduced body weight and abdominal circumference, improved glucose and lipid metabolic profiles and gut microbiota structure, and reversed the changes in hepatic and ileal protein expressions. Correlation analysis revealed that Firmicutes and Lachnospiraceae_NK4A136_group were positively correlated while Bacteroidetes, Megamonas and Bacteroides were negative correlated with the levels of isohyodeoxycholic acid and hyodeoxycholic acid. CONCLUSIONS Wendan Decoction can significantly improve metabolic profiles in rats with phlegm syndrome of MS possibly by regulating the intestinal flora-bile acid axis to modulate the intestinal flora structure and maintain bile acid homeostasis via the FXR signaling pathway.
Animals ; Gastrointestinal Microbiome/drug effects* ; Metabolic Syndrome/microbiology* ; Bile Acids and Salts/metabolism* ; Rats, Wistar ; Drugs, Chinese Herbal/therapeutic use* ; Rats ; Male ; Fibroblast Growth Factors/metabolism* ; Liver/metabolism* ; Cholesterol 7-alpha-Hydroxylase/metabolism* ; Receptors, Cytoplasmic and Nuclear/metabolism*

Eimeria labbeana is a major pathogen of pigeon coccidiosis,causing damage to the intes-tinal epithelial cells of pigeons,which leads to gut injury,diarrhea,decreased production perform-ance,and even death.There have been no research on the pathogen characteristics of isolated strains in China.In this study,1 008 fecal samples were collected from nine cities in Zhejiang Prov-ince,including Hangzhou,Ningbo,Wenzhou,Shaoxing,Huzhou,Jinhua,Quzhou,Taizhou and Lishui.The samples were examined using the McMaster counting method to quantify oocysts per gram of feces,and coccidia species in positive samples were identified through microscopy.Patho-gens were isolated and purified with methods of single oocyst pickout under the microscopy and passage in coccidia-free pigeon,followed by a detailed study of their characteristics.Our findings demonstrated an overall infection rate of 55.8％(562/1 008)for pigeon coccidia in the surveyed ar-eas,with E.labbeana present across all farms.A strain of E.labbeana isolated from Zhejiang was successfully obtained and designated E.labbeana-ZJ.PCR identification and sequence alignment showed that this Zhejiang isolate shared a 99.67％similarity in the 18S rRNA gene sequence with the Australian strain(KT305927.1)and clustered into a small subgroup.Pathogenicity and oocyst shedding patterns were assessed through animal infection experiments,revealing a 4 days latent period,with peak infection occurring on the 8th day.Following infection,notable clinical symptoms emerged,with significant intestinal damage,and changes in body weight,indicating moderate path-ogenicity.The results enriched the epidemiological survey data of pigeon coccidiosis in China,and provide a new basis for further research and effective control measures against pigeon coccidiosis.

Eimeria labbeana is a major pathogen of pigeon coccidiosis,causing damage to the intes-tinal epithelial cells of pigeons,which leads to gut injury,diarrhea,decreased production perform-ance,and even death.There have been no research on the pathogen characteristics of isolated strains in China.In this study,1 008 fecal samples were collected from nine cities in Zhejiang Prov-ince,including Hangzhou,Ningbo,Wenzhou,Shaoxing,Huzhou,Jinhua,Quzhou,Taizhou and Lishui.The samples were examined using the McMaster counting method to quantify oocysts per gram of feces,and coccidia species in positive samples were identified through microscopy.Patho-gens were isolated and purified with methods of single oocyst pickout under the microscopy and passage in coccidia-free pigeon,followed by a detailed study of their characteristics.Our findings demonstrated an overall infection rate of 55.8％(562/1 008)for pigeon coccidia in the surveyed ar-eas,with E.labbeana present across all farms.A strain of E.labbeana isolated from Zhejiang was successfully obtained and designated E.labbeana-ZJ.PCR identification and sequence alignment showed that this Zhejiang isolate shared a 99.67％similarity in the 18S rRNA gene sequence with the Australian strain(KT305927.1)and clustered into a small subgroup.Pathogenicity and oocyst shedding patterns were assessed through animal infection experiments,revealing a 4 days latent period,with peak infection occurring on the 8th day.Following infection,notable clinical symptoms emerged,with significant intestinal damage,and changes in body weight,indicating moderate path-ogenicity.The results enriched the epidemiological survey data of pigeon coccidiosis in China,and provide a new basis for further research and effective control measures against pigeon coccidiosis.