Perimenopausal women are more susceptible to fire pathogen disturbances,often resulting in the restlessness of the mind owing to the deficiency and decline of the thoroughfare and conception vessels,as well as the insufficiency of the essence and blood of the viscera.CHENG Zhongling's theory of thief and child fire in Medical Insights proposes that thief fire primarily arises from exogenous pathogen invasion and improper diet,leading to syndromes such as food retention in the stomach or phlegm-fire stagnation.In contrast,child fire is generated endogenously,often owing to liver and kidney deficiency,resulting in an imbalance of water and fire and liver dysfunction,leading to excessive fire transformation.This theory provides a novel perspective for understanding the pathogenesis of perimenopausal insomnia.An in-depth exploration of the role of thief fire and child fire in perimenopausal insomnia is presented,along with a detailed discussion of corresponding treatment strategies.For the invasion of thief fire,therapeutic approaches include ascending and dispersing stagnant fire,clearing and moistening to remove interior heat,purging the heat accumulation to unblock the bowels,and subduing the fire and nourishing yin to eliminate depression.When child fire disturbs the spirit,treatment methods involve smoothing and relieving the liver qi to clear the stagnant heat,nourishing the true yin to restrain the yang,warming and nurturing the primordial qi and harmonizing the nutrient and defensive qi,and guiding and reducing the deficient heat to remove the floating fire.Clinical practice necessitates precise identification of thief and child fire,thorough investigation of exogenous pathogens and internal damage,and careful differentiation between deficiency and excess,as well as the superficial and internal aspects.Strict adherence to the treatment principle of"nourishing the child fire can drive out the thief fire,but driving out the thief fire should not harm the child fire"ensures a balanced approach.By harmonizing the yin and yang of the viscera and allowing the mind to be at ease,this strategy effectively alleviates perimenopausal insomnia.The application of these principles provides a practical and feasible theoretical foundation and practical guidance for the treatment of perimenopausal insomnia using traditional Chinese medicine.

Perimenopausal anxiety and depression state fall under the categories of"visceral agitation"and"perimenopausal syndrome"in traditional Chinese medicine(TCM).Grounded in the theory of"Yang transforms qi,yin shapes form",this study posits that the pathogenesis of this condition is complex,often presenting with concurrent deficiency and excess syndromes,and is closely associated with yang deficiency-induced stagnation and qi stagnation leading to mental decline.The pathological mechanism is summarized as yang deficiency being the root and qi stagnation the manifestation.This article proposes a"yang-oriented treatment"approach for perimenopausal anxiety-depression disorders,employing a stepwise integrated acupuncture protocol termed"One Needling,Two Moxibustion,Three Consolidation":"One Needling"prioritizes regulating qi flow via acupuncture to soothe the liver and harmonize the spirit;"Two Moxibustion"utilizes refined moxibustion to warm yang,resolve stagnation,and activate yang circulation;"Three Consolidation"combines bloodletting therapy to remove stasis and regenerate tissues with intradermal needle embedding to stimulate yang and regulate visceral functions.This synergistic protocol aims to nourish the heart-mind,awaken the orifices of consciousness,alleviate perimenopausal anxiety and depressive symptoms,and consolidate therapeutic efficacy.

The phrase"wood element characterized by spreading harmony"from the Huangdi Neijing five-phase theory summarizes the fundamental nature and functions of the wood element,emphasizing the crucial significance of the harmonious virtue of wood in promoting the generation and transformation of all things.In human physiology,"wood element characterized by spreading harmony"corresponds to the harmonious spreading of liver-gallbladder qi,ensuring smooth liver qi regulation and proper functioning of the ascending-descending movement mechanisms.Bipolar disorder,categorized in traditional Chinese medicine as"depression"or"manic depressive psychosis,"primarily arises from hepatic wood dysfunction.Insufficient wood qi dispersion typically manifests as a depressive phase,whereas excessive dispersion leads to a manic phase,with alternating manic-depressive phase indicating qi movement disorder.By integrating wood qi characteristics,disease pathogenesis of bipolar disorder,and our team's clinical experience in treating emotional disorders,this study developed an integrated acupuncture and moxibustion diagnosis and treatment approach for bipolar disorder,focusing on soothing the liver and regulating spirit,structured as"acupuncture-moxibustion-consolidation."Based on the physiological characteristics of"wood element characterized by spreading harmony,"from liver failing to controll conveyance and dispersion:depressive phase should apply warm-nourishing growth method,manic phase should suppress hyperactive liver for tranquillizing mind method,and alternating manic-depressive phase should apply harmonized rigidity-flexibility method.These methods aim to regulate the spirit of the heart and brain,harmonize the qi movement of the spleen and stomach,and replenish the essence and blood of the liver and kidney.Clinical application through syndrome differentiation has demonstrated satisfactory therapeutic outcomes.

The phrase"wood element characterized by spreading harmony"from the Huangdi Neijing five-phase theory summarizes the fundamental nature and functions of the wood element,emphasizing the crucial significance of the harmonious virtue of wood in promoting the generation and transformation of all things.In human physiology,"wood element characterized by spreading harmony"corresponds to the harmonious spreading of liver-gallbladder qi,ensuring smooth liver qi regulation and proper functioning of the ascending-descending movement mechanisms.Bipolar disorder,categorized in traditional Chinese medicine as"depression"or"manic depressive psychosis,"primarily arises from hepatic wood dysfunction.Insufficient wood qi dispersion typically manifests as a depressive phase,whereas excessive dispersion leads to a manic phase,with alternating manic-depressive phase indicating qi movement disorder.By integrating wood qi characteristics,disease pathogenesis of bipolar disorder,and our team's clinical experience in treating emotional disorders,this study developed an integrated acupuncture and moxibustion diagnosis and treatment approach for bipolar disorder,focusing on soothing the liver and regulating spirit,structured as"acupuncture-moxibustion-consolidation."Based on the physiological characteristics of"wood element characterized by spreading harmony,"from liver failing to controll conveyance and dispersion:depressive phase should apply warm-nourishing growth method,manic phase should suppress hyperactive liver for tranquillizing mind method,and alternating manic-depressive phase should apply harmonized rigidity-flexibility method.These methods aim to regulate the spirit of the heart and brain,harmonize the qi movement of the spleen and stomach,and replenish the essence and blood of the liver and kidney.Clinical application through syndrome differentiation has demonstrated satisfactory therapeutic outcomes.

Perimenopausal women are more susceptible to fire pathogen disturbances,often resulting in the restlessness of the mind owing to the deficiency and decline of the thoroughfare and conception vessels,as well as the insufficiency of the essence and blood of the viscera.CHENG Zhongling's theory of thief and child fire in Medical Insights proposes that thief fire primarily arises from exogenous pathogen invasion and improper diet,leading to syndromes such as food retention in the stomach or phlegm-fire stagnation.In contrast,child fire is generated endogenously,often owing to liver and kidney deficiency,resulting in an imbalance of water and fire and liver dysfunction,leading to excessive fire transformation.This theory provides a novel perspective for understanding the pathogenesis of perimenopausal insomnia.An in-depth exploration of the role of thief fire and child fire in perimenopausal insomnia is presented,along with a detailed discussion of corresponding treatment strategies.For the invasion of thief fire,therapeutic approaches include ascending and dispersing stagnant fire,clearing and moistening to remove interior heat,purging the heat accumulation to unblock the bowels,and subduing the fire and nourishing yin to eliminate depression.When child fire disturbs the spirit,treatment methods involve smoothing and relieving the liver qi to clear the stagnant heat,nourishing the true yin to restrain the yang,warming and nurturing the primordial qi and harmonizing the nutrient and defensive qi,and guiding and reducing the deficient heat to remove the floating fire.Clinical practice necessitates precise identification of thief and child fire,thorough investigation of exogenous pathogens and internal damage,and careful differentiation between deficiency and excess,as well as the superficial and internal aspects.Strict adherence to the treatment principle of"nourishing the child fire can drive out the thief fire,but driving out the thief fire should not harm the child fire"ensures a balanced approach.By harmonizing the yin and yang of the viscera and allowing the mind to be at ease,this strategy effectively alleviates perimenopausal insomnia.The application of these principles provides a practical and feasible theoretical foundation and practical guidance for the treatment of perimenopausal insomnia using traditional Chinese medicine.

Objective To analyze the clinical manifestations and possible gene mutation sites of Chinese patients in order to improve the clinician's understanding of CHARGE syndrome. Methods Clinical data were collected and blood samples were obtained from the proband of CHARGE syndrome and their relatives. The peripheral blood DNA was extracted and sequenced by PCR amplification. Mutation sites were verified by Sanger sequencing. Results For the first proband, a heterozygous mutation was detected in the intron 10 of CHD7 gene. His parents and brother did not have mutation. For the second proband, total repeat sequence in exon 7 of CHD7 gene was detected. His father carried the same mutation and his mother did not have mutation. Conclusion For the patients who are diagnosed with CHARGE syndrome based on the clinical manifestations, genetic mutation detection should be proceeded. It is useful for studying possible genetic pathogenesis and enhancing the awareness of clinicians.

Objective: To analyze the electrocardiographic (ECG) characteristics in patients with primary hyperparathyroidism (PHPT) and meanwhile, to explore the relationship between ECG abnormality and serum calcium level in relevant patients. Methods: Our study included 2 groups: Observation group,n=84 PHPT patients treated in our hospital from 2010-01 to 2014-04 and Control group,n=80 normal subjects from regular physical examination at the same period. The ECG manifestation was compared between 2 groups. Meanwhile, according to tertile levels of serum calcium, PHPT patients were further divided into 3 subgroups:①Ca2+ level (2.0-2.8) mmol/L,②Ca2+ level (2.8-3.1) mmol/L,③Ca2+ level >3.1 mmol/L andn=28 in each subgroup. The ECG abnormalities were compared among 3 subgroups and the relationship between ECG changes and serum calcium levels were studied. Results: The ECG abnormality rates in Observation group and Control group were as 83.3% vs 18.8%, P<0.001. Compared with Control group, Observation group presented more frequent ST-T changes, QRS duration widening, high left ventricular pressure and QT interval shortening,P<0.001 orP<0.05. In observation group, with the rising of serum calcium, the incidences of ST-T changes and high left ventricular pressure were increased accordingly, the ST-T changes among 3 subgroups were significant,P<0.05; while with the rising of serum calcium, the QT interval was shortened and QRS duration was widened accordingly, the differences were obvious among 3 subgroups, allP<0.05.Conclusion: PHPT patients have the higher incidence with abnormal ECG, while ECG abnormality has beenrelated to serum calcium level in relevant patients.