Parkinson's disease （PD） is a chronic progressive neurodegenerative disorder primarily characterized by motor dysfunction. The main pathological features include the loss of dopaminergic neurons in the substantia nigra， abnormal aggregation of alpha-Synuclein （α-Syn）， and the formation of Lewy bodies. However， the exact mechanisms remain unclear. In recent years， the PD incidence has gradually increased， while current treatment methods are limited to symptom alleviation， incapable of halting disease progression， and prone to adverse effects， thus making it urgent to search for medicines effective for PD. Modern research indicates that the Kelch-like ECH-associated protein 1 （Keap1）/nuclear factor E₂ related factor 2 （Nrf2）/antioxidant response element （ARE） signaling pathway is closely related to oxidative stress， neuroinflammation， apoptosis， ferroptosis， and mitochondrial dysfunction， playing a crucial role in the pathophysiological development of PD. A large number of studies have further confirmed that traditional Chinese medicine （TCM） can regulate diseases through a holistic view of Syndrome differentiation and microscopic molecular pathways. With unique advantages， such as multiple targets， multiple pathways， and fewer adverse reactions， TCM provides a new strategy for PD treatment. This article elucidates the mechanism of the Keap1/Nrf2/ARE signaling pathway in the occurrence and development of PD， while summarizing the latest research on PD intervention by TCM monomers， active ingredients， and compounds， as well as acupuncture via the precise targeted regulation of the Keap1/Nrf2/ARE pathway， aiming to provide a reference for clinical medicine development to prevent and treat PD.

Objective To compare the efficacy and safety of stellate ganglion block(SGB)with those of conventional western medication in the treatment of insomnia.Methods A computerized retrieval of academic papers concerning the clinical randomized controlled trials of SGB versus conventional western medication in the treatment of insomnia from the databases of PubMed,Embase,Cochrane Library,CNKI,Wanfang Data knowledge service platform,VIP database and CBM database was conducted.The retrieval time period was from the establishment of the database to June 13,2023.NoteExpress v3.5 software was used to make literature screening,Stata17.0 software was used to perform meta-analysis of the obtained data,TSA0.9.5.10 beta software was used to make sequential analysis,and GRADEpro was used to perform the grade classification.Results A total of 11 articles including 875 patients with insomnia were included in this analysis.Compared with the conventional western medication,SGB showed certain advantages in the following aspects:improving total clinical effectiveness(RR total=1.24,95％CI:1.16-1.32,P＜0.01),increasing the proportion of patients who could sleep for more than 3 hours after treatment(RR total=1.24,95％CI:1.09-1.41,P=0.001),increasing total sleep time(SMD=1.53,95％CI:0.89-2.16,P＜0.01),reducing sleep latency(MD=-14.08,95％CI:-18.72--9.43,P＜0.01),decreasing PSQI score(MD=-3.54,95％CI:-4.31--2.78,P＜0.01),and reducing the recurrence rate within 6 months(RR=0.19,95％CI:0.10-0.37,P＜0.01).However,the difference in the proportion of patients who could sleep for more than 6 hours after treatment between the two groups was not statistically significant(RR=1.31,95％CI:0.97-1.76,P=0.078).The traditional SGB therapy had a certain risk of adverse events,ultrasound-guided SGB therapy was much safer.Trial sequential analysis showed that the cumulative sample size of the effective rate crossed the conventional threshold and TSA threshold,the positive results had been obtained in advance although it did not reach RIS.The quality of evidence evaluated by GRADE for the sleep latency,PSQI and recurrence rate within 6 months was medium grade,and the quality for the remaining indexes was low grade.Conclusion Compared with conventional western medication for the treatment of insomnia,the effect of SGB in increasing the total response rate,the proportion of patients who get sleeping for more than 3 hours after treatment and the total sleep duration,in reducing sleep latency,PSQI score and recurrence rate within 6 months has gained some certain evidence supports.The SGB and conventional western medication have similar efficacy in improving the proportion of patients who get sleeping for more than 6 hours after treatment.The results of this study are stable and reliable,but the current level of evidence grade is lower,therefore,large-sample randomized controlled trials need to be conducted before its clinical efficacy can get further evidence-based support.

Minimally conscious state （MCS） is at the edge between closed and open consciousness， but it still belongs to the category of "wind-strike block" syndrome. The basic pathogenesis of MCS is the obstruction of pathogenic qi， orifices closed and spirit hidden， with pathological factors including phlegm， fire， and blood stasis. Wind movement and water retention may also be present， and often leading to deficiency syndrome due to the exhaustion of qi， blood， yin， and yang at later stages. Treatment chooses Shexiang （Moschus） as the chief medicinal， emphasizing combination of medicinals and urgency of medication administration； the key therapeutic method is to open the orifices， with focuses on expelling pathogens and reinforcing healthy qi. For patients with severe phlegm or fire， use Xiaochengqi Decoction （小承气汤） to open the lower orifices， discharge heat and unblock the bowels， combined with Shexiang （Moschus） and Niuhuang （Bovis Calculus） to open the upper orifices， awaken the spirit and guide qi. For patients with turbid phlegm as the predominant， temporarily replace Shexiang （Moschus） with Baizhi （Angelicae dahuricae radix）， using Ditan Decoction （涤痰汤） to eliminate phlegm to open the orifices， when turbid phlegm gradually subsided， Shexiang （Moschus） could be added. For patients with blood stasis as the predominant， Tongqiao Huoxue Decoction （通窍活血汤） will be used to activate blood and open orifice， if the blood circulates， the endogenous wind will be calmed， the water will be induced， the orifices will open and the consciousness will restore. For patients with closed orifices and body deficiency， the treatment should open the orifices and reinforce healthy qi， and consider the root and branch simultaneously； qi deficiency syndrome can be addressed with Buyang Huanwu Decoction （补阳还五汤） to boost qi and reinforce healthy qi； yin deficiency syndrome can be treated with Shaoyao Gancao Decoction （芍药甘草汤） combined with Fengsui Pill （封髓丹） to nourish yin， soften sinews， and secure kidney essence； yang deficiency can be managed by using Dihuang Yinzi Decoction （地黄饮子） to enrich yin， supplement yang， and open the orifices.

Neurodegenerative diseases are chronic and progressive diseases of the nervous system.Modern studies have shown that intestinal flora disorders,mitochondrial dysfunction and lipid metabolism abnormalities are closely related to the occurrence and development of neurodegenerative diseases,but the treatment methods are limited.Traditional Chinese medicine believes that spleen is the"the foundation of nurture"and the"the source of Qi and blood biochemistry",Qi deficiency leads to insufficient Qi,blood and body fluid metaplasia,brain dysplasia,leading to the occurrence of neurodegenerative diseases.This paper discusses the mechanism of treating neurodegenerative diseases by spleen from the perspective of"intestinal flora,mitochondria and lipids",and concludes that intestinal flora balance is the material basis of spleen function,mitochondrial homeostasis is an important mechanism of the function of"spleen governing transportation and transformation",and abnormal lipid metabolism is an important manifestation of spleen deficiency and phlegm stasis.Intestinal flora,mitochondria and lipid metabolism may be the potential biological basis for the treatment of neurodegenerative diseases by spleen in traditional Chinese medicine.In order to provide ideas for the clinical research and treatment of neurodegenerative diseases.

Post-stroke limb movement disorder is a common functional disorder after stroke.Xuming Decoction in Ancient and Modern Records of the Proven is an important prescription of Zhang Zhongjing for treating"stroke prickly heat,the body cannot hold it-self".It has been modified and recorded in many later generations,among which Xiaoxuming Decoction in Important Formulas Worth a Thousand Gold Pieces for Emergency is the most commonly used.With the development of the"internal wind theory"of stroke,the pre-scriptions of Xuming Decoction were gradually criticized and even abandoned because they often used"wind drugs"and were difficult to understand the medical theory of"internal wind".Based on the viewpoints of"wind prevailing and causing movement"and"internal wind being the change of yang qi in the body",the paper proposes the theory of"inducing wind to promote movement"of Xuming De-coction and believes that"wind is qi".At the beginning of stroke,wind-yang is violently hyperactive,and wind prevails and causes movement,resulting in stroke;after stroke,yang qi is weak,wind is defeated and static,and limbs are unable to use.However,"wind drugs"such as Ephedra sinica Stapf and Cinnamomum aromaticum Nees have the functions of generating wind and promoting movement,revitalizing the decadent and the useless,exciting yang qi,harmonizing the ying and wei,and raising and lowering qi.The Xuming Decoction is mainly composed of"wind drugs",which warms the yang and replenishes the qi,generates wind to excite yang qi,and revitalizes the weak;replenishes the yang to induce wind and promote movement,replenishes qi and generates blood;relieves muscles to harmonize the ying and wei,and dredges the limbs;restores the pivot to regulate the axis of the internal organs,unblocks the qi,and promotes the recovery of limb motor function after stroke,providing a theoretical basis for the clinical application of Xuming Decoction.

Objective To construct a quality evaluation index system for non-medical technical services in public hospitals,aiming to provide a more scientific and feasible basis for evaluating patient service quality.Methods Based on literature research,the SERVQUAL theory was used to preliminarily formulate a comprehensive and full-cycle evaluation index for patient service quality.The final evaluation index system was determined through expert consultation,and the Analytic Hierarchy Process was used to determine the weights of the evaluation indices.Results The questionnaire response rates for the two rounds of expert consultation were both 100％.The authority coefficients of the experts were 0.82 and 0.80,respectively,indicating a high level of expert authority.The Kendall's W coefficient increased from 0.088 to 0.107 between the two rounds,and the difference was statistically significant (P<0.001),indicating good consistency of expert opinions.The consistency results of each judgment matrix were less than 0.1,passing the consistency test.The final evaluation index system consisted of six primary indicators (tangibility,reliability,responsiveness,assurance,empathy,and continuity) and 33 secondary indicators.Conclusion The selection of evaluation indicators revolves around the core service processes of outpatient,inpatient,and other hospital services,focusing on key elements at various critical junctures that influence patient experience.The evaluation indicators aim to guide hospitals to improve not only essential needs but also desired improvements in service quality,thus promoting the continuous enhancement of hospital services.

Neurodegenerative diseases are chronic and progressive diseases of the nervous system.Modern studies have shown that intestinal flora disorders,mitochondrial dysfunction and lipid metabolism abnormalities are closely related to the occurrence and development of neurodegenerative diseases,but the treatment methods are limited.Traditional Chinese medicine believes that spleen is the"the foundation of nurture"and the"the source of Qi and blood biochemistry",Qi deficiency leads to insufficient Qi,blood and body fluid metaplasia,brain dysplasia,leading to the occurrence of neurodegenerative diseases.This paper discusses the mechanism of treating neurodegenerative diseases by spleen from the perspective of"intestinal flora,mitochondria and lipids",and concludes that intestinal flora balance is the material basis of spleen function,mitochondrial homeostasis is an important mechanism of the function of"spleen governing transportation and transformation",and abnormal lipid metabolism is an important manifestation of spleen deficiency and phlegm stasis.Intestinal flora,mitochondria and lipid metabolism may be the potential biological basis for the treatment of neurodegenerative diseases by spleen in traditional Chinese medicine.In order to provide ideas for the clinical research and treatment of neurodegenerative diseases.

OBJECTIVE To investigate the ameliorative effect of Pinelliae Rhizoma Praeparatum Cum Alumine and its effective components on inflammatory response in mice with acute lung injury(ALI).METHODS A mice model of acute lung injury induced by lipopolysaccharide(LPS)was used as the in vivo animal model.The levels of inflammatory factors TNF-α,IL-6,and IL-1β,the total protein concentration,the number of inflammatory cells in bronchoalveolar lavage fluid,the ratio of lung wet weight to dry weight,and the pathological damage of lung tissues were taken as the evaluation indexes.RAW264.7 macrophages induced by LPS were used as the in vitro experimental model,with the mRNA levels of intracellular inflammatory factors TNF-α,IL-1β,and IL-6 as indicators,systematic solvent extraction and silica gel column chromatography were used to separate and screen the effective parts and components of Pinelliae Rhizoma Praeparatum Cum Alumine for treating acute lung injury.The component composition of the effective fractions was analyzed by mass spectrometry,the content of cyclic dipeptide components in the effective fraction was determined,and the anti-in-flammatory activity of cyclic dipeptides was verified in vitro.RESULTS The ethyl acetate extraction fraction obtained by extracting the supernatant of water extraction and ethanol precipitation of Pinelliae Rhizoma Praeparatum Cum Alumine(referred to as the ethyl acetate fraction for short)significantly improved the inflammatory response in mice with acute lung injury and significantly reduced the mRNA levels of TNF-α,IL-1β,and IL-6 in RAW264.7 cells induced by LPS.The Fr.1 fraction isolated from the ethyl acetate frac-tion by silica gel column chromatography had anti-inflammatory effects in vitro.Mass spectrometry determined the content of two main cyclic dipeptide components,cyclo-(Pro-Phe)and cyclo-(Pro-Val),in the Fr.1 fraction.After mixing these two cyclic dipeptide components in the molar ratio in the Fr.1 fraction and administering them in vitro,the results showed that the combination of these two cyclic dipeptide components could significantly inhibit the mRNA expression levels of TNF-α,IL-1β,and IL-6 in RAW264.7 cells induced by LPS.CONCLUSION Cyclic dipeptide component is one of the main material basis categories for the anti-inflammatory effect of Pinelliae Rhizoma Praeparatum Cum Alumine.

ObjectiveTo establish preliminary diagnostic criteria for spleen and kidney deficiency syndrome in ischemic stroke patients and provide a basis for standardized diagnosis and treatment of ischemic stroke. MethodsRelevant literature on the diagnostic criteria for spleen and kidney deficiency syndrome in ischemic stroke patients was retrieved， and data were mined and extracted to form an item pool. Based on the formation of the item pool， this study used the Delphi method to initiate two rounds of questionnaire surveys with selected experts to complete the initial screening of items and the discrimination of symptom importance. A prospective clinical investigation method was adopted to collect clinical information from patients， and statistical analysis methods and data mining techniques were comprehensively used to determine their primary and secondary symptoms. Based on the clear main and secondary symptoms identified， combined with expert group discussions， the study established preliminary diagnostic criteria for spleen and kidney deficiency syndrome in ischemic stroke patients. ResultsA total of 25 relevant syndrome differentiation standards were included. After splitting， standardizing， and screening the items， the study established a pool of 48 items. The first round of questionnaire survey consulted 30 experts， with both the positive coefficient of experts and the effectiveness rate of the questionnaire reaching 100%. The Kendall's coefficient of concordance was 0.359. According to the item screening criteria， 26 items were retained in this round of questionnaire survey. A total of 176 cases were collected through clinical information investigation， including 94 cases with spleen and kidney deficiency syndrome and 82 cases without spleen and kidney deficiency syndrome. The statistical results were as follows： ① Descriptive statistics： The main symptoms with a frequency of ≥ 30% included mental fatigue and lack of strength， weakness of the lower back and knees， etc. The secondary symptoms with a frequency of ≥ 10% and ≤ 30% were lassitude and disinclination to talk， shortness of breath， etc. ② Binary logistic regression analysis： The main symptoms with an odds ratio （OR） value of ≥ 3 were mental fatigue and lack of strength， weakness of the lower back and knees， etc. The secondary symptoms with an OR value of ≥ 1 and ≤ 3 were lassitude and disinclination to talk， shortness of breath， etc. Artificial neural network： The main symptoms with a weight value（W_ij）of ≥ 0.5 and < 1 were mental fatigue and lack of strength， lassitude and disinclination to talk， etc. The secondary symptoms with W_ij of ≥ 0.3 and < 0.5 were shortness of breath， flaccid limbs， etc. In the second round of questionnaire survey， a total of 37 experts were consulted， with both the positive coefficient of experts and the effectiveness rate of the questionnaire reaching 100%. The Kendall's coefficient of concordance was 0.237. According to the criteria to determine primary and secondary symptoms based on the Delphi method， the main symptoms included in this round of the questionnaire were mental fatigue and lack of strength， lassitude and disinclination to talk， etc.， and the secondary symptoms were shortness of breath， dizziness， etc. ConclusionThe main symptoms of spleen and kidney deficiency syndrome in ischemic stroke patients are mental fatigue and lack of strength， weakness of the lower back and knees， loose stool， pale and edematous tongue texture possibly with tooth marks， and deep and thready pulse or weak pulse. The secondary symptoms include shortness of breath， dizziness， tinnitus and deafness， decreased appetite or postprandial abdominal distension， pale complexion， frequent micturition at night， dull tongue texture， and white and slippery tongue coating. The preliminarily established diagnostic criteria for spleen and kidney deficiency syndrome in ischemic stroke patients can provide a standardized and objective basis， thereby better guiding clinical diagnosis and treatment of ischemic stroke.