Nuanjian Jian(Decoction for Warming Liver Meridian),originating from Jing Yue Quan Shu(Jingyue's Complete Works)written by Zhang Jingyue,is composed of Angelicae Sinensis Radix(Danggui),Lycii Fructus(Gouqizi),Poria(Fuling),Fructus Foeniculi(Xiaohuixiang),Cinnamomi Cortex(Rougui),Linderae Radix(Wuyao),and Aquilariae Lignum Resinatumd(Chenxiang)or Aucklandiae Radix(Muxiang).Nuanjian Jian is a widely-used classical formula for warming the liver and kidneys,promoting qi circulation and alleviating pain.It was included in the Ancient Classical Formulas Catalog(First Batch)published by the National Administration of Traditional Chinese Medicine in 2018,and was primarily used to treat lower abdominal pain,hernia,and other disorders differentiated as the syndrome of cold stagnation in the liver and kidneys.Based on the principles of key information verification for classical formulas,this article systematically reviewed the ancient and modern literature on Nuangan Jian,and conducted a comprehensive textual research and analysis of its origin,composition,dosage,method of making a decoction and taking medicines,processing,modifications,historical and modern applications,and experimental studies.The study concluded that the composition and dosage of this formula are relatively clear.The contemporary single-dose equivalents are calculated as Danggui 9.33 g,Gouqizi 11.19 g,Fuling 7.46 g,Xiaohuixiang 7.46 g,Rougui 5.60 g,Wuyao 7.46 g,and Chenxiang 3.73 g.The decoction is prepared by adding 300 mL of water and 4 g of ginger,boiling until reduced to 140 mL,and taken 2-3 times daily,2 hours after meals.Modern practitioners have expanded the indications of this formula,extending its use from hernia and lower abdominal pain to various disorders in andrology,gynecology,and gastroenterology.The indications have the core pathogenesis of cold stagnation in the liver meridian,and usually affect the liver while also involve the spleen,kidneys,and lower energizer.Diseases of the lower abdomen,genitals,and breasts belonging to the region of the liver-meridian route,are also commonly treated with Nuangan Jian.The findings of this study provide a reference for the further development of this classical formula.

Background Aluminum and fluoride are neurotoxic, and aluminum exposure alone is closely related to the overall cognitive function of operational workers. It is unclear about the effect of aluminum and fluoride interactions on cognitive function. Objective To evaluate a potential interaction effect of blood aluminum and urinary fluoride on the overall cognitive function of workers working in an aluminum plant. Methods Using cluster sampling, 230 workers in the electrolysis workshop of an aluminum group company in Shanxi Province were selected, and plasma aluminum concentrations were determined by inductively coupled plasma mass spectrometry (ICP-MS) and urinary fluoride by ion-selective electrode. The study participants were divided into a low blood aluminum group and a high blood aluminum group according to the median (M) of blood aluminum concentration, and a low urinary fluoride group and a high urinary fluoride group by a predetermined cutoff point (2.160 mg·L⁻¹). The Montreal Cognitive Assessment-Beijing (MoCA-BJ) was used to assess overall cognitive function of the workers. Logistic regression model was used to analyze the relationship between blood aluminum, urinary fluoride, and mild cognitive impairment (MCI), including multiplicative interaction analysis and correlation analysis; R language was used to fit an additive interaction model of blood aluminum and urinary fluoride on MCI and to calculate synergy index (S), relative excess risk due to interaction (RERI), and attributable proportion due to interaction (API). Results Among the 230 operational workers, the median blood aluminum concentration (P₂₅, P₇₅) was 40.11 (25.16, 58.89) µg·L⁻¹, and there were 104 cases of abnormal urinary fluoride, with an abnormality rate of 45.2%. There was a multiplicative interaction (OR=7.783, 95%CI: 1.377, 43.991) and no additive interaction (RERI=0.030, 95%CI: −0.498, 0.559; API=0.018, 95%CI: −0.279, 0.316; S=1.049, 95%CI: 0.519, 2.118) for the effect between blood aluminum and urinary fluoride on overall cognitive function of the workers. The logistic regression analysis showed that the risk of MCI was 12.105 (95%CI: 2.802, 52.287) times higher in workers with both high blood aluminum and high urinary fluoride than in those with low blood aluminum and low urinary fluoride, after adjusting for selected influencing factors. Conclusion Occupational exposure related high blood aluminum and high urinary fluoride are risk factors for cognitive dysfunction, and the coexistence of both indicators increases the risk of MCI in workers with occupational aluminum exposure, with a multiplicative interaction.