The connotation of the "four-dimensional pivot-earth" qi transformation mode is a dialectical system of the ascending and descending of yin-yang qi movement， which presented as "the middle Jiao showing earth qi mediating， the left wheel showing water and wood ascending， and the right wheel showing fire and metal converting and descending". Based on this dialectical thinking， it is believed that the core pathogenesis of myasthenia gravis is deficiency of center qi and transportation failure to pivot-earth； the middle-stage characteristics of the disease progression are the loss of mediation of the central qi， resulting in water coldness and wood constraint， and clear yang failing to ascend； the final outcome of this disease is the loss of astringeing of lung metal and qi sinking. The treatment should be based on the rule of qi movement， so for the start-stage， Buzhong Yiqi Decoction （补中益气汤） should be used as the basis to nourish the earth and consolidate the root， and restrengthen the middle qi； for the middle-stage， herbs like Yingyanghuo （Epimedium brevicornu Maxim.）， Bajitian （Morinda officinalis How） could be combined to warm the water and soothe the wood， raise yang and boost qi； for the final stage， plus Sini Decoction （四逆汤） to astringe metal to stop collapse， and powerfully supplement original qi. All these medicinals can promote pivot-earth re-transportation， four-dimensional transformation， and regular circulation of qi movement， so as to provide thoughts for improving the clinical effectiveness of myasthenia gravis.

ObjectiveTo characterize the evidence distribution and methodological quality of randomized controlled trials （RCTs） on oral Chinese herbal medicine （CHM） for atopic dermatitis （AD） based on evidence mapping. MethodsSeven databases （CNKI， Wanfang Data， VIP， CBM， Cochrane Library， PubMed， and Embase） and the Chinese Clinical Trial Registry were searched for the RCTs in Chinese and English. Evidence distribution was presented graphically and textually， and methodological quality was assessed via the Cochrane Risk of Bias tool （ROB 1.0）. ResultsA total of 168 RCTs were included. The number of annual publications showing an increasing trend， and 72.6% RCTs had sample sizes of 51-100 participants. The studies evaluated 108 distinct CHM interventions categorized as decoctions， granules， Chinese patent medicines， and extracts. Compound Glycyrrhizin was the most frequently used， followed by Xiaofengsan and Chushi Weiling decoction. Among the RCTs， 57.1% had the treatment courses of 4-8 weeks. Outcome measures predominantly focused on clinical response rate， skin lesion severity scores， and adverse events， with less attention to TCM symptom scores， skin barrier function， and relapse rates. The overall risk of bias was generally high. ConclusionWhile CHM for AD is a research hotspot and demonstrates clinical advantages， the related studies have problems such as unclear clinical positioning， poor research standardization and methodological quality， and insufficient prominence of TCM clinical advantages. Large-sample， methodologically rigorous， and high-quality studies are needed to enhance the evidence base for CHM in treating AD.

ObjectiveTo characterize the evidence distribution and methodological quality of randomized controlled trials （RCTs） on oral Chinese herbal medicine （CHM） for atopic dermatitis （AD） based on evidence mapping. MethodsSeven databases （CNKI， Wanfang Data， VIP， CBM， Cochrane Library， PubMed， and Embase） and the Chinese Clinical Trial Registry were searched for the RCTs in Chinese and English. Evidence distribution was presented graphically and textually， and methodological quality was assessed via the Cochrane Risk of Bias tool （ROB 1.0）. ResultsA total of 168 RCTs were included. The number of annual publications showing an increasing trend， and 72.6% RCTs had sample sizes of 51-100 participants. The studies evaluated 108 distinct CHM interventions categorized as decoctions， granules， Chinese patent medicines， and extracts. Compound Glycyrrhizin was the most frequently used， followed by Xiaofengsan and Chushi Weiling decoction. Among the RCTs， 57.1% had the treatment courses of 4-8 weeks. Outcome measures predominantly focused on clinical response rate， skin lesion severity scores， and adverse events， with less attention to TCM symptom scores， skin barrier function， and relapse rates. The overall risk of bias was generally high. ConclusionWhile CHM for AD is a research hotspot and demonstrates clinical advantages， the related studies have problems such as unclear clinical positioning， poor research standardization and methodological quality， and insufficient prominence of TCM clinical advantages. Large-sample， methodologically rigorous， and high-quality studies are needed to enhance the evidence base for CHM in treating AD.

[Objective]Using CiteSpace software to visualize and analyse the literature related to acupuncture treatment of post-stroke dysphagia in China,to reveal the dynamics of frontiers and the evolution of hotspots in this field,as well as provide suggestions and references for future research.[Methods]By searching the three major Chinese databases,China National Knowledge Internet(CNKI),Wanfang Data and China Science and Technology Journal Database(VIP),the literature related to acupuncture treatment of post-stroke dysphagia was retrieved between the establishment of these databases and June 2023.Then the data issuance,authors,institutions,keywords clustering and keywords emergence were analyzed and presented in a visualization map or chart with CiteSpace 6.1.R6 software.[Results]After searching and screening,a total of 1 585 relevant literatures were included,and the overall trend of the number of studies within the field showed a steady increase in terms of the number of publications.However,links among study authors are scattered and mostly intra-institutional.At the same time,the connection among institutions for cross-regional collaboration is not close enough.Keywords clustering analysis showed that the type of research in the literature mainly consists overviews and clinical randomized controlled trial(RCT).In terms of treatment approaches,the use of combination of multiple therapies is common.The time zone map reflects the continuous process of refinement of acupuncture therapies,from which the creation of a series of new types of acupuncture therapies could be observed.[Conclusion]The field of acupuncture for the treatment of post-stroke dysphagia is becoming increasingly sophisticated.It is predicted that the combination of acupuncture with other common therapies for the treatment of post-stroke dysphagia will remain a hot research topic in the coming years.Meanwhile,there will be a new trend towards integrating resources and conducting high-quality clinical studies with multi-centre collaboration.

Propensity score can improve the efficiency and accuracy of clinical trials， and has been widely used in many fields such as comparison of efficacy evaluation， exploration of disease occurrence factors， and monitoring of adverse drug reactions. At present， the propensity scoe has application prospects in traditional Chinese medicine （TCM） monotherapy intervention， complex intervention and integrated Chinese and Western medicine intervention research， and it is a good auxiliary tool for real-world study. By analysing the cha-racteristics of clinical research in TCM， the authors believed that， firstly， the application of propensity score can acce-lerate the progress of clinical efficacy evaluation research in TCM， contribute to the collection of high-level clinical evidence， and promote the development and promotion of TCM therapies； Secondly， under the background of big data resources， propensity score has good application prospects in assisting TCM prescription analysis， drug safety and adverse reaction monitoring， and large-scale cohort studies in TCM； thirdly， in the process of clinical practice， propensity scoring method may face problems such as inappropriate method selection， incorrect judgement or measurement of confounding factors， and unreasonable interpretation or extrapolation of results.

[Objective]To summarize the clinical experience of Professor MA Ruijie in the treatment of insomnia by using Hewei-acupuncture,with a view to illustrating the theoretical basis and clinical application of Hewei-acupuncture in the treatment of insomnia.[Methods]Through the clinical study with the teacher,combined with the review of Chinese medical textbooks and modern medical clinical research literature on insomnia.Professor MA's understanding of the etiology and pathogenesis of insomnia,the composition and basis of the acupuncture points of Hewei-acupuncture,and the theoretical and mechanistic study of Hewei-acupuncture for the treatment of insomnia were elaborated,and Professor MA's ideas of identification and treatment of this disease were analyzed.[Results]Professor MA believes that the sleep and wakefulness of human beings are controlled by the heart and spirit,and regulated by the Yin and Yang of Ying and Wei,which are related to the functions of internal organs,among which the malfunctioning of the spleen and stomach is closely related to the occurrence of insomnia.Professor MA's treatment of this disease is characterized by the importance of the theory of meridian and collateral disease and the Qi of the spleen and stomach in the middle-Jiao,and she believes that the foot Yangming stomach meridian Qi reversal,Ying and Wei are out of harmony;the spleen and stomach deficiency,the heart and spirit of the loss of nourishment;and elevation disorders,misdirection of the good offices are important reasons for the occurrence of insomnia.Hewei-acupuncture is a summary of Professor MA's clinical experience in treating insomnia and other neurological disorders by taking"Tianshu"(ST25),"Zusanli"(ST36),"Neiguan"(PC6)and"Gongsun"(SP4)as the main acupoints.This method relieves insomnia by regulating Qi of the spleen and stomach,strengthening the function of the spleen and stomach,and balancing Yin and Yang of the organism.[Conclusion]Hewei-acupuncture in the clinical treatment of insomnia is characterized by streamlining of acupoints,light pain,and good long-term efficacy,which is of practical significance in guiding the clinical treatment of insomnia.

Objective To evaluate the clinical efficacy of dragon-tiger contending needling at Xi-cleft points plus electroacupuncture in treating postherpetic neuralgia (PHN).Method Seventy PHN patients were randomized into a treatment group of 36 cases and a control group of 34 cases. The treatment group was intervened by dragon-tiger contending needling at Xi-cleft points plus electroacupuncture, while the control group was treated with electroacupuncture alone. In the 4-week treatment, the Visual Analogue Scale (VAS) scores right before and after the 1st, 2nd, 6th, 9th and 12th treatment sessions were recorded, “the maximum pain intensity since the last treatment session” and “real-time analgesic effect” were observed, and the total therapeutic efficacy was also evaluated.Result The real-time analgesic effects right after the 1st, 2nd and 6th treatments in the treatment group were significantly better than those in the control group (P<0.05). The “maximum pain intensities since the last treatment session” prior to the 2nd, 6th, 9th, and 12th treatment sessions were significantly different from the pain intensity before the intervention in the two groups (P<0.05). The “maximum pain intensities since the last treatment session” prior to the 6th, 9th, and 12th treatment sessions were significantly different from those in the control group (P<0.05). The total effective rate and recovery plus markedly-effective rate were respectively 97.2% and 77.8% in the treatment group, versus 91.2% and 59.2% in the control group. There was a statistically significant difference in the recovery plus markedly-effective rate between the two groups (P<0.05).Conclusion Dragon-tiger contending needling at Xi-cleft points plus electro- acupuncture is an effective approach in treating PHN; it acts efficiently and can produce a satisfactory real-time analgesic effect.

Objective To observe the clinical efficacy of bloodletting cupping plus Chinese medication in treating acne vulgaris due to wind-heat invading Lung Meridian.Method Sixty-six patients with acne vulgaris due to wind-heat invading Lung Meridian were randomized into a treatment group and a control group, 33 cases in each group. The treatment group was intervened by bloodletting cupping at Dazhui (GV 14) and Feishu (BL 13) plus Chinese medication; the control group was intervened by Chinese medication alone. The treatment was given 4 weeks sessions as a treatment course, for a total of 3 courses. The clinical efficacy and relapse rate were compared between the two groups.Result The total effective rate was 74.2% in the treatment group versus 96.9% in the control group, and the between-group difference was statistically significant (P<0.05). Three months after the intervention, the relapse rate was 3.1% in the treatment group versus 16.1% in the control group, and the between-group difference was statistically insignificant (P>0.05); 6 months after the intervention, the relapse rate was 18.8% in the treatment group versus 45.2% in the control group, and the between-group difference was statistically significant (P<0.05).Conclusion Bloodletting cupping plus Chinese medication can produce a more significant efficacy than Chinese medication alone in treating acne vulgaris, with a low long-term relapse rate and fewer adverse effects.

[ Abstract] Objective To investigate the clinical efficacy of preoperative three-dimensional radiotherapy (3DRT) with or without concurrent chemotherapy for esophageal carcinoma.Methods We retrospectively analyzed 103 esophageal carcinoma patients who received preoperative 3DRT with or without concurrent chemotherapy from 2004 to 2014 in Cancer Hospital CAMS.The median radiation dose was 40 Gy, and the TP or PF regimen was adopted for concurrent chemotherapy if needed.The overall survival (OS) and disease-free survival ( DFS) were calculated by the Kaplan-Meier method, and the survival difference and univariate prognostic analyses were performed by the log-rank test.The Cox proportional hazards model was used for multivariate prognostic analysis.Results The number of patients followed at 3-years was 54.The 3-year OS and DFS rates were 61.1% and 54.9%, respectively, for all patients.There were no significant differences between the 3DRT and concurrent chemoradiotherapy (CCRT) groups as to OS (P=0.876) and DFS (P=0.521).The rates of complete, partial, and minimal pathologic responses of the primary tumor were 48.0%, 40.2%, and 11.8%, respectively.There were significant differences in OS and DFS between the complete, partial, and minimal pathologic response groups (P=0.037 and 0.003). No significant difference in pathologic response rate was found between the 3DRT and CCRT groups (P=0.953).The lymph node metastasis rate was 26.5%, and this rate for the complete, partial, and minimal pathologic response groups was 14%, 30%, and 67%, respectively, with a significant difference between the three groups (P=0.001).The OS and DFS were significantly higher in patients without lymph node metastasis than in those with lymph node metastasis (P=0.034 and 0.020).The surgery-related mortality was 7.8% in all patients.Compared with the 3DRT group, the CCRT group had significantly higher incidence rates of leukopenia (P=0.002), neutropenia (P=0.023), radiation esophagitis (P=0.008), and radiation esophagitis ( P=0.023).Pathologic response of the primary tumor and weight loss before treatment were independent prognostic factors for OS and DFS (P=0.030,0.024 and P=0.003,0.042). Conclusions Preoperative 3DRT alone or with concurrent chemotherapy can result in a relatively high complete pathologic response rate, hence increasing the survival rate.Further randomized clinical trials are needed to confirm whether preoperative CCRT is better than 3DRT in improving survival without increasing the incidence of adverse reactions.

Objective To analyze the clinical value of postoperative radiotherapy for node-positive middle thoracic esophageal squamous cell carcinoma ( TESCC ) and to modify the target volume .Methods A total of 286 patients with node-positive middle TESCC underwent radical surgery in Cancer Hospital, Chinese Academy of Medical Sciences, from 2004 to 2009.In addition, 90 of these patients received postoperative intensity-modulated radiotherapy.The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used for survival difference analysis.The Cox model was used for multivariate prognostic analysis.The chi-square test was used for comparing the recurrence between patients receiving different treatment modalities.Results The 5-year overall survival ( OS) rates of the surgery alone ( S) group and surgery plus postoperative radiotherapy ( S+R) group were 22.9%and 37.8%, respectively, and the median OS times were 23.2 and 34.7 months, respectively ( P=0.003) .For patients with 1 or 2 lymph
node metastases (LNMs), the 5-year OS rates of the S group and S+R group were 27.3%and 44.8%, respectively ( P=0.017);for patients with more than 2 LNMs, the 5-year OS rates of the S group and S+R group were 16.7%and 25.0%, respectively (P=0.043).The peritoneal lymph node metastasis rates of N1 , N2 , and N3 patients in the S group were 2.9%, 10.9%, and 20.0%, respectively ( P=0.024) .The S+R group had a significantly lower mediastinal lymph node metastasis rate than the S group ( for patients with 1 or 2 LMNs:8.0%vs.35.3%, P=0.003;for patients with more than 2 LNMs, 10.0%vs.42.3%, P=0.001) , and had a prolonged recurrence time compared with the S group ( 25.1 vs.10.7 months, P=0.000) .However, for patients with more than 2 LNMs, the S+R group had a significantly higher hematogenous metastasis rate than the S group (46.7%vs.26.1%, P=0.039).Conclusions Patients with node-positive middle TESCC could benefit from postoperative radiotherapy.The target volume can be reduced for patients with 1 or 2 LNMs.Prospective studies are needed to examine whether it is more appropriate to reduce the radiotherapy dose than to reduce the target volume for patients with more than 2 LNMs.A high hematogenous metastasis rate warrants chemotherapy as an additional regimen.