Although symptomatic treatment is widely applied in clinical practice， it is often regarded as a relatively low-level therapeutic method. Based on Traditional Chinese Medicine （TCM） state theory， the macroscopic， mesoscopic， and microscopic characterization parameters of TCM symptomatology are horizontally integrated， the full life cycle of states （pre-disease， incipient disease， manifest disease， post-disease） is vertically covered， and the cognitive system of "symptoms" is reconstructed from multiple dimensions. Accordingly， the application approach of symptomatic treatment at different state stages is proposed： implementing preventive intervention in the pre-disease state， strengthening the interception of disease progression in the incipient disease state， regulating dynamic development and treatment in the manifest disease state， and formulating a staged diagnosis and treatment strategy which focuses on functional rehabilitation in the post-disease state.

The essence of asymptomatic syndrome differenciation is that the disease is in a special stage or state. To perform traditional Chinese medicine （TCM） diagnosis when there was no symptoms for differentiation is a key scientific issue in current TCM diagnosis and treatment. The reasons include limitations in doctor-patient behaviors and relationships， as well as limitations in cognitive thinking. To address such situations， the following strategies can be adopted from a thinking perspective，i.e. grasping the occurrence and development of diseases based on a holistic concept， using dialectical thinking to summarize the laws of diseases， integrating clinical practice with experiential thinking， and introducing new thinking modes through interdisciplinary collaboration. These strategies help TCM practitioners make accurate diagnoses in the absence of obvious symptoms， thereby providing better medical services for patients.

In the context of the complex and ever-changing spectrum of diseases, the traditional Chinese medicine compatibility of prescription and drugs is no longer able to fully meet the needs of clinical diagnosis and treatment. Therefore, this article is based on the diagnosis and treatment model of the combination of disease, syndrome, and symptom, combined with the development achievements of Western medicine, and explores the principles of formulating traditional prescriptions based on the combination of chief, deputy, assistant, and envoy. This article proposes a formulation principle of composing prescriptions with the diagnosis of syndrome as the chief, the diagnosis of disease as the deputy, the treatment of symptoms as the assistant, and the harmonization of medicine as the envoy. This forms a treatment plan with the core link of syndrome differentiation and treatment, disease differentiation and treatment, symptomatic treatment, detoxification, and efficacy enhancement. The purpose of this article is to address the current clinical challenges such as an increasing disease spectrum and the complexity of syndrome patterns and symptom clusters. It aims to provide new insights into traditional Chinese medicine clinical treatment plans and herbal formulation strategies, with the ultimate goal of improving the clinical effectiveness of traditional Chinese medicine.

Objective:Bacterial liver abscess is one of the common infectious diseases of the digestive system.Invasive Klebsiella pneumoniae liver abscess syndrome(IKLAS)refers to cases where,in addition to liver abscess,there are migratory infections foci or other invasive manifestations.The clinical characteristics and risk factors of IKLAS are not fully elucidated,and there is a lack of research on the effectiveness and cost-effectiveness of different treatment methods.This study aims to compare the clinical characteristics of patients with IKLAS and non-IKLAS,and explore effective and economical treatment methods. Methods:This retrospective study collected medical records of patients with Klebsiella pneumoniae liver abscess treated at Xiangya Hospital of Central South University from January 2010 to December 2023.A total of 201 patients were included,dividing into an IKLAS group(n=37)and a non-IKLAS group(n=164).Differences in demographics,symptoms and signs,laboratory indicators,imaging characteristics,comorbidities,treatment methods,treatment outcomes,and direct treatment costs between 2 groups were analyzed.The study also compared the effectiveness and costs of different treatment methods. Results:Compared with the non-IKLAS group,the proportion of patients with diabetes,Quick Sequential Organ Failure Assessment(qSOFA)≥2,immune deficiency,anemia,and thrombocytopenia in the IKLAS group was higher,and the level of procalcitonin at the onset in the IKLAS group was also higher(all P<0.05).In terms of symptoms and signs,the IKLAS group had a higher proportion of visual abnormalities and a lower proportion of complaints of abdominal pain(both P<0.05).In terms of complications,the incidence of combined pleural effusion,pulmonary infection,acute renal failure,respiratory failure,and multiple organ failure was higher in the IKLAS group(all P<0.05).The IKLAS group had a higher proportion of patients treated with antibiotics alone(24.32%vs 11.59%),while the non-IKLAS group had a higher proportion of patients treated with antibiotics combined with puncture and drainage(86.59%vs 64.86%,both P<0.05).The overall effective rate of the IKLAS group(83.78%)was lower than that of the non-IKLAS group(95.73%),and the treatment and drug costs were higher(all P<0.05).The treatment method of antibiotics combined with surgical resection of infectious foci showed a 100%improvement rate,antibiotics combined with abscess puncture and drainage had an 84.9%improvement rate,and in antibiotics alone had an 82.1%improvement rate,with statistical differences among the 3 treatment methods(P<0.05).In terms of treatment costs,antibiotics alone were the most expensive(P<0.05). Conclusion:Patients with IKLAS have poorer prognosis and higher direct medical costs.The combination of abscess puncture and drainage or surgery has a higher improvement rate and lower hospitalization costs compared to antibiotics alone,suggesting that surgical intervention may reduce antibiotic costs and save medical expenses.

Objective:To evaluate the efficacy and safety of dyclonine hydrochloride gel for patients unsuitable for antispasmodic agents during endoscopic retrograde cholangiopancreatography(ERCP).Methods:A total of 72 patients diagnosed as having biliary diseases who intended to receive ERCP but were unsuitable for spasmolytic use were selected from June 2022 to June 2023 at the Digestive Hospital of Heilongjiang Provincial Hospital. Thus dyclonine hydrochloride gel was locally sprayed during the process of ERCP due to frequent intestinal peristalsis. The amplitude and frequency of duodenal peristalsis, clarity of endoscopic view, the time of biliary cannulation and vital signs were compared before and after the administration to evaluate efficacy and safety of dyclonine hydrochloride gel. At the same time, 9 patients with suspected sphincter of Oddi dysfunstion (SOD) underwent sphincter of Oddi manometry (SOM) before and after the administration.Results:Among the 72 patients, 57 (79.2%) showed improvements in duodenal peristalsis after the administration ( t=22.524, P<0.05). Twelve cases with significantly obstructed views due to bubbles showed complete improvement after the medication. The time for successful biliary cannulation after the administration was 2.9±4.2 minutes in 63 patients with first ERCP. Among the 9 SOD patients, 7 showed a decrease in basal pressure and (or) contraction frequency of the sphincter muscles after the administration ( χ2=5.143, P<0.05). No drug-related complication occurred during the operation in any of the patients. The incidences of post-ERCP pancreatitis and hyperamylasemia were 4.2% (3/72) and 8.3% (6/72), respectively. Conclusion:Local spray of dyclonine hydrochloride jelly can effectively suppress duodenal peristalsis, reduce basal pressure and contraction frequency of the sphincter, improve operational conditions, and increase the success rate of biliary cannulation with satisfactory safety in ERCP procedures for those who experience frequent intestinal peristalsis that may affect the procedure and are not suitable for the use of antispasmodics.

In order to evaluate the efficacy and safety of submucosal tunneling endoscopic resection (STER) for the treatment of multiple submucosal tumors (SMT) in the upper gastrointestinal tract, data of 24 cases with upper gastrointestinal SMT (including 56 SMT lesions) treated at Taizhou Municipal Hospital and Shanghai East Hospital from January 2016 to June 2021 were collected for retrospective observation. The treatment effect, occurrence of major adverse events and follow-up results were analyzed. The results showed that 19 cases (79.2%) underwent tumor resection through one tunnel, and 5 cases (20.8%) underwent tumor resection through two tunnels. The length of the tunnel was 3-12 cm, with an average of 6.2 cm. The surgical time ranged from 19 to 130 minutes, with an average of 55.6 minutes. The overall resection rate was 89.29% (50/56). The hospitalization time was 2-7 days, with an average of 3.5 days. Major adverse events occurred in 2 cases (8.3%), all of which were mucosal injuries, and were cured with titanium clips and self expanding metal sealing stents. During a follow-up period of 6-64 months, with an average of 32.0 months, there was no residual tumor, tumor implantation tunnel, local recurrence, distant metastasis or death. To sum up, STER is safe and feasible for the treatment of multiple SMT in the upper gastrointestinal tract. The main resection method is single tunnel, and double tunnel is required for multiple SMT far apart.

From the perspective of cybernetics， this study investigated the fundamental principles of empirical thinking in traditional Chinese medicine， encompassing six stages： experience input and storage， experience extraction and activation， experience combination and reconstruction， judgment and decision-making based on experience， and experience evaluation and feedback. The potential limitations of empirical thinking in clinical applications were analyzed， mainly manifested as “individuality”， “superficiality”， “conservatism”， “prioritizing commonality over individuality”， and “cognitive inertia”. To overcome these limitations， this paper also explored strategies and methods for clinical error-correction from four points： the integration of rational and empirical thinking， the reinforcement of feedback mechanisms and transcendent correction， the integration of individualization and quantity-quality balance， and the management and transference of tacit knowledge under empirical thinking.

Irritable bowel syndrome is a common functional gastrointestinal disorder, among which diarrhea-type irritable bowel syndrome (IBS-D) is the main type in China, which is seriously affecting the quality of life for patients. The pathogenesis of IBS-D is still unclear. It has been found that Intestinal flora disorder is an important pathogenesis of IBS-D. There is a close relationship between intestinal flora and IBS-D TCM syndrome types, and there are differences in intestinal flora of different TCM syndrome types of IBS-D. However, TCM syndrome types are a complex and multi-factor combination. Therefore, based on the TCM theory of nature and location of disease, this article proposed the following conclusions through analyzing previous studies on intestinal flora of different TCM syndromes of IBS-D, including that the intestinal flora of different TCM syndromes have different characteristics and there are differences in the functions of flora, deficiency and excess of disease are associated with the diversity and abundance of intestinal flora, cold and heat of disease are related to the proportion of beneficial bacteria and opportunistic pathogens, and the characteristics of intestinal flora are the microcosmic manifestation of the disease position of TCM. In addition, this article also proposed the application of fecal bacteria transplantation based on the theory of nature and location of disease. Based on this theory, the study on intestinal flora of IBS-D can provide help for objectification of TCM syndrome types, and also provide TCM research ideas for revealing the pathogenesis of IBS-D.

Philadelphia chromosome-negative myeloproliferative neoplasms (MPN) is a group of chronic hematological tumors caused by clonal proliferation of hematopoietic stem cells, and hydroxyurea is the traditional first-line chemotherapy drug for it. In recent years, pegylated interferon has shown great advantages in the clinical treatment of MPN, and it has become the first-line preferred therapeutic regimen for special populations, especially for young patients and pregnant women.

Objective:To analyze the epidemic status and characteristics of human brucellosis in Ordos City, and to provide basis for formulating perfect prevention and control countermeasures of brucellosis.Methods:The data of reported human brucellosis cases in Ordos City from 2016 to 2020 were collected through the Chinese Disease Prevention and Control Information System. Descriptive epidemiological method was used to analyze the distributions of time, region and population.Results:Totally 2 861 cases of human brucellosis were reported in Ordos City from 2016 to 2020. The average annual incidence rate was 27.68/100 000 and no deaths. The incidence rate of human brucellosis decreased year by year from 2016 to 2018 (24.11/100 000, 20.82/100 000, 20.11/100 000). But the incidence rate began to pick up in 2019 (24.59/100 000) and rose to 48.53/100 000 in 2020. The incidence peak was from March to August (1 882 cases). The cases had been reported in all over 9 banners (districts) of the city. The cumulative number of reported cases from more to less was Hangjin Banner, Dalat Banner, Otog Front Banner, Jungar Banner, Otog Banner, Dongsheng District, Wushen County, Ejin Horo Banner and Kangbashi District. The cases were predominantly male, and the sex ratio of male to female was 2.23∶1.00 (1 974 ∶ 887). The onset was mainly young and middle-aged adults, and the age was mainly 30-69 years old (2 541 cases). Farmers accounted for 65.26% (1 867 cases) in all reported cases, followed by herdsmen, accounting for 18.98% (543 cases).Conclusions:There is an obvious upward trend of human brucellosis in Ordos City in recent years, mainly among young and middle-aged male farmers. Health education for key populations should be strengthened, as well as personal protection during high-risk operations.