Migraine is a highly prevalent and disabling neurological disorder with multiple hypotheses regarding its pathogenesis. G protein-coupled receptor 30 (GPR30), a member of the G protein-coupled receptor family, was once considered a membrane estrogen receptor. GPR30 is highly expressed in migraine-associated core tissues such as the trigeminal ganglion and exerts an indirect regulatory effect on the pathophysiological processes of migraine, yet there remain controversies over its specific molecular mechanisms and whether it is involved in estrogen-mediated regulation. This review systematically summarizes the latest research advances in the effects of GPR30 on the pathogenesis of migraine, with a focus on the molecular structure, ligand profile, distribution characteristics in the nervous system, related signal transduction pathways of GPR30, as well as its regulatory effects on migraine-associated neural functions. Existing studies have mainly reported the impacts of GPR30 on migraine-related signal pathways and neural functions in neurological diseases, but only verified the correlation between GPR30 and these signal pathways, with contradictory conclusions regarding its regulation of neurovascular functions. In clinical research, there is a lack of evidence from migraine-specific therapeutic clinical trials targeting GPR30, and no estrogen-related evidence chain has been established. Overall, GPR30 may serve as a potential novel target for the prevention and treatment of migraine, and the existing challenges also provide new research perspectives for the development of GPR30-targeted migraine-specific therapies.

Background Hypoperfusion-induced cerebral infarction remains a significant therapeutic challenge due to limited treatment options. Yiqi Fumai (YQFM), a traditional Chinese medicine formula, has shown promise in treating cerebrovascular disorders, but its mechanisms in cerebral infarction remain unclear. Purpose To investigate the therapeutic effects and underlying mechanisms of YQFM in hypoperfusion-induced cerebral infarction. Study design This study combines machine learning analysis, animal experiments, and cellular mechanistic investigations. Methods Using an integrated approach combining machine learning analysis of clinical data, transcriptomics of rat brain tissue, computational fluid dynamics, microfluidics, in vivo experiments, and in vitro experiments, we investigated YQFM's effects on hypoperfusion-induced cerebral infarction. Cerebral blood flow, infarct volume, and neurological outcomes were assessed using multiple imaging modalities and behavioral tests. Single-cell transcriptomic analysis and transcriptomic analysis were performed to identify potential therapeutic targets. The mechanism was validated through in vitro experiments. Results Machine learning analysis identified that cerebral blood flow was closely associated with the severity of neurological deficits in patients with hypoperfusion-induced cerebral infarction. In vivo experiments demonstrated that YQFM significantly promoted collateral vessel formation, improved cerebral blood flow by 35.26-44.42%, reduced infarct volume by 2.35-4.65mm3, and enhanced neurological outcomes without toxicity. Mechanistically, we found that phospholipase B domain containing 1 (PLBD1) was downregulated after hypoperfusion-induced cerebral infarction and restored by YQFM treatment, in vitro experiments demonstrated that YQFM enhanced endothelial mechanotransduction in response to shear stress by upregulating PLBD1, leading to increased glycolysis and improved endothelial proliferation. We identified a potential “shear stress-PLBD1-glycolysis-angiogenesis” axis that mediates YQFM’s therapeutic effects. This multidimensional approach not only advances the existing knowledge of endothelial function but also highlights PLBD1 as a promising therapeutic target for ischemic stroke. Furthermore, the integration of advanced methodologies, such as single-cell transcriptomics and computational fluid dynamics, provides a more comprehensive understanding of YQFM’s therapeutic effects. Conclusion YQFM treats hypoperfusion-induced cerebral infarction by modulating endothelial mechanotransduction and glycolysis to enhance collateral vessel formation and cerebral perfusion. This study provides mechanistic insights into YQFM’s therapeutic action and highlights the potential of targeting the “shear stress-PLBD1-glycolysis-angiogenesis” axis for developing strategies to improve collateral circulation in hypoperfusion-induced cerebral infarction.

BACKGROUND:Migraine is a major cause of disability globally, yet its epidemiological impact on postmenopausal women (aged ≥55 years) is not well understood. This study aims to fill this knowledge gap by analyzing long-term trends in migraine burden from 1990 to 2021. METHODS:Data from the Global Burden of Disease (GBD) 2021 study were utilized to estimate prevalence, incidence, and disability-adjusted life years (DALYs), stratified by age group, Socio-demographic Index (SDI), and geographical region. Temporal trends were assessed using the estimated annual percentage change (EAPC), while socioeconomic inequalities were evaluated through the Slope Index of Inequality (SII) and Concentration Index (CIX). RESULTS:The number of prevalent cases of migraine among postmenopausal women increased by 118.3% globally, rising from 55.29 million to 120.68 million between 1990 and 2021. Age-standardized rates (ASRs) in this population displayed contrasting trends: while age-standardized prevalence and incidence rates experienced slight increases (EAPC: 0.07-0.17), the age-standardized DALY rate (ASDR) remained stable. Middle-SDI regions faced the highest absolute burden of migraine in postmenopausal women and showed the most rapid growth in ASRs. Inequality analyses highlighted persistent socioeconomic disparities, revealing significant efficiency gaps in health resource utilization in high-SDI countries. CONCLUSIONS:This study highlights the increasing absolute burden of migraine among postmenopausal women, despite stable age-standardized rates. This underscores the need for context-specific interventions across SDI strata to reduce health inequities and optimize resource allocation in migraine care.

OBJECTIVE:To evaluate the efficacy and safety of two doses of Dingluo nasal drops compared to placebo in the acute treatment of migraine. METHODS:This randomized, parallel-treatment, placebo-controlled, double-blind trial was conducted at Dongzhimen hospital, Beijing University of Chinese Medicine. Eligible participants were randomly assigned (1∶1∶1) to receive either full-dose Dingluo nasal drops, half-dose Dingluo nasal drops, or a placebo for three migraine attacks. The primary endpoint was the proportion of participants achieving pain freedom at 2 h postdose, assessed in all randomly assigned participants who received study medication. RESULTS:A total of 91 participants with 257 attacks were included in the statistical analysis. At 2 h postdose, Dingluo nasal drops were superior to placebo for freedom from pain [high dose vsplacebo: 14.61% vs1.20%, P = 0.001, risk difference 13.40, 95% CI(5.70, 21.11); low dose vsplacebo: 17.65% vs1.20%, P <0.001, risk difference: 16.44, 95% CI (8.00, 24.88)]. The high dose and the low dose effected similarly for freedom from pain [14.61% vs17.65%, P = 0.585, risk difference: －3.04, 95% CI(－13.97, 7.89)]. It showed a good efficacy in pain relief. The most common adverse events were nasal burning and nasal itchiness. All adverse events are transient and dissipate within a relatively short time frame. CONCLUSIONS:Dingluo nasal drops demonstrated superior efficacy to placebo in achieving pain freedom for acute migraine treatment. Mild nasal reactions were observed, with a trend toward reduced discomfort at the half-dose concentration.

BACKGROUND AND PURPOSE:Siguan points, comprising bilateral Hegu (LI4) and Taichong (LR3), have shown good therapeutic potential in migraine management. We aimed to systematically evaluate the clinical efficacy and neurovascular regulatory mechanisms of Siguan points-based acupuncture treatment (SPBAT) for migraine. METHODS:A comprehensive literature search was conducted across 15 databases through January 1st, 2025. Randomized controlled trials (RCTs) comparing SPBAT with conventional pharmacotherapy or sham acupuncture were included. Primary outcomes encompassed the clinical effective rate and the headache intensity measured by the visual analogue scale (VAS). Secondary outcomes included attack frequency, migraine days, doses of analgesics, adverse events (AEs), and other relevant measures. Dichotomous variables were reported as risk ratios (RR) or risk differences (RD), and continuous variables as mean differences (MD) or standardized mean differences (SMD); all estimates were presented with 95 % confidence intervals (CIs). Trial sequential analysis (TSA) and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) were employed to assess evidence reliability and certainty. The neurovascular regulatory mechanisms of Siguan points for migraine were systematically reviewed. RESULTS:Analysis of 19 RCTs (1312 participants) demonstrated significant improvements with SPBAT in clinical effective rate (RR 1.22 [1.14, 1.31]), VAS for headache intensity (MD -1.11 [-1.50, -0.73]), attack frequency (SMD -0.81 [-1.49, -0.14]), and other outcomes. TSA confirmed the robustness of primary outcome findings. GRADE assessment indicated moderate to low evidence certainty across outcomes. No significant differences in AEs were observed between groups (RD -0.04 [-0.11, 0.04]). Mechanistic investigations revealed that Siguan points exerted therapeutic effects through integrated modulation of central pain processing networks and peripheral neurovascular pathways. CONCLUSION:SPBAT demonstrates significant efficacy in reducing migraine severity, duration, and frequency while maintaining a safety profile comparable to standard treatments. Its neurovascular regulatory effects and clinical benefits position SPBAT as a viable alternative for migraine management, though further high-quality research is warranted to strengthen the evidence base.

PurposeMigraine, a leading global cause of disability, affects over 1.1 billion individuals worldwide. Current acute pharmacotherapy is limited by contraindications and adverse events (AEs), underscoring the need for safer, more effective alternatives. The Sishun Formula (SSF), a traditional Chinese medicine (TCM) formulation targeting “Ying-Wei disharmony,” demonstrated promising preclinical and preliminary clinical results. This trial aims to rigorously evaluate SSF’s efficacy and safety for acute migraine attacks.Patients and methodsThis multicenter, randomized, double-blind, placebo-controlled trial will enroll 144 participants with acute migraine and “Ying-Wei disharmony” syndrome, randomized 1:1 to SSF or placebo. A single dose of SSF or a matched placebo is administered within 0.5 h of migraine onset. The primary outcome is the proportion achieving headache freedom at 2 h post-dose. Secondary outcomes include the proportion achieving headache relief at 2 h post-dose, absence of most bothersome associated symptoms, sustained relief/freedom at 24/48 h, the Visual Analogue Scale (VAS) score changes, time to efficacy onset, recurrence rates, and TCM syndrome improvement. Biomarkers [e.g., calcitonin gene-related peptide (CGRP)] and safety parameters (vital signs, laboratory tests, AEs) are monitored. Data analysis will employ SPSS 25.0 and R 4.3.1.ConclusionThe findings are anticipated to deliver high-quality evidence validating SSF’s efficacy and safety, offering a promising therapeutic alternative for acute migraine attacks.Clinical trial registrationhttp://itmctr.ccebtcm.org.cn/, identifier ITMCTR2025000187.

Background:Acupuncture has long been used for migraine treatment as it is convenient for use and has remarkable efficacy. The acupuncture-based comprehensive treatment plan has been widely recognized for migraine prevention and treatment. However, the mechanism underlying acupuncture efficacy in migraine treatment is not yet completely understood. Our goal is to systematically analyze and evaluate this efficacy mechanism in migraine treatment-related basic research. Methods:To retrieve animal experiments investigating the action mechanism of acupuncture in migraine treatment, We conducted a literature search in major databases, the search period was the inception of each database to April 1, 2024. Literature was screened and data were extracted independently based on predefined inclusion and exclusion criteria. The animal models, acupuncture points, and acupuncture methods specified in the included studies were statistically analyzed and summarized. Furthermore, the potential action mechanisms of acupuncture were discussed. Results:In total, 20 animal experimental studies were included in the present analysis, and all of these studies used rats. In the order of frequency of use, the migraine animal models employed in the searched studies were the dural stimulation model, the nitroglycerin model, and the cortical spreading depression model. The primary acupuncture points selected were Fengchi (GB20) and Yanglingquan (GB34), and electroacupuncture was the most frequently used acupuncture method. The action mechanism of acupuncture underlying migraine treatment primarily involves regulating the descending pain modulatory system and inhibiting neurotransmitters such as CGRP, SP, and 5-HT, as well as microglial cell activation. It also reduces the levels of inflammatory cytokines, thereby mitigating neurogenic inflammation and improving central sensitization. Conclusion:Acupuncture exerts its therapeutic effect on migraine by regulating neurotransmitter release, inhibiting inflammatory responses, modulating central analgesic mechanisms, and suppressing glial cell activation. However, further in-depth exploration is needed in the study of the mechanisms underlying acupuncture treatment for migraine.

BackgroundSuhexiang (SHX) pill is widely used for treating acute ischemic stroke (AIS). Experimental and randomized controlled trials suggested that SHX pill was beneficial for patients with AIS. However, the effectiveness of SHX pill in real-world practice setting remains unclear. It is of great importance to investigate the effectiveness and safety of SHX pill in patients with acute ischemic stroke in real-world clinical practice with long-term follow-up.MethodsThe Suhexiang pill for acute ischemic stroke in Real-world Practice Setting (SUNRISE) is a multicenter, prospective, product-specific, observational study designed to provide insight into the administration of SHX pill for patients with AIS in the real-world clinical practice setting, with an initial sample size of 1000. Eligible patients treated with SHX pill within seven days of AIS onset will be consecutively included in this registry. The primary outcome is the proportion of patients independent at 3 months after stroke onset defined by an mRS score of 0, 1, or 2.ConclusionThe findings of the SUNRISE registry will not only provide insights into the characteristics of patients who may benefit from SHX treatment, but also may enable the individualized treatment decision-making of SHX pill in real-world practice setting.Study registrationThis study was registered with the ClinicalTrials.gov (URL: https://clinicaltrials.gov/, Unique identifier: NCT05833932).

Low blood pressure at acute ischemic stroke onset is associated with both short- and long-term adverse outcomes. Studies have shown that YQFM (YiQiFuMai lyophilized injection) can ameliorate neurological deficits in ischemic stroke.However, all of these studies are all small-sample clinical observations lacking rigorous study design for AIS with inappropriate blood pressure. To describe the design of the YQFM aimed at reducing the disability rate in AIS patients with inappropriate blood pressure. This trial is a prospective, multicenter, randomized, double-blind, placebo-controlled, superiority trial aimed at evaluating the efficacy and safety of YQFM in reducing the disability rate in patients with acute hypoperfusion stroke within 90 days. We will recruit 480 patients with AIS within 48 h of symptom onset from 24 hospitals, who have large atherosclerosis, systolic pressure ≤ 155 mmHg, and an NIHSS score of 4–18. Eligible patients will be randomly assigned to receive either YQFM or 0.9 https://www.chictr.org.cn/showproj.html?Proj=200686 .

Background:Elevated blood pressure (BP) in acute ischemic stroke (AIS) significantly impacts clinical outcomes, yet optimal BP management remains contentious due to patient heterogeneity. Traditional Chinese medicine (TCM) constitution theory categorizes individuals into distinct physiological patterns, offering a novel framework to address this variability. This study integrates TCM constitutional theory into modern AIS care to propose a personalized BP management ‌hypothesis. Methods:A systematic review and meta-analysis were conducted across nine databases, including PubMed, Web of Science, Scopus, the Cochrane Library, ScienceDirect, the Chinese National Knowledge Infrastructure, Wanfang Data, VIP Database, and China Biology Medicine, covering publications up to January 2025. We analyzed TCM constitution distributions in AIS, hypertension, hypotension, AIS with hypertension, ischemic stroke (IS) with hypertension, and ischemic cerebrovascular disease with hypoperfusion, correlating constitutional types with clinical outcomes. We employed the Agency for Healthcare Research and Quality (AHRQ) checklist to evaluate the methodological quality of cross-sectional studies and utilized the Newcastle-Ottawa Scale (NOS) for quality assessment of cohort and case-control studies. Subgroup and sensitivity analyses were performed, and publication bias was assessed. A constitution-guided framework for BP management was developed through evidence synthesis. Results:Fifty-four studies were included in the study, with the majority being of moderate-to-high quality. The findings demonstrated that Phlegm-dampness, Qi-deficiency, Yin-deficiency, and Blood-stasis constitutions predominated in AIS patients with hypertension. Subgroup and sensitivity analyses confirmed the robustness of the results. Most analyses demonstrated no evidence of publication bias. Although several analyses indicated potential publication bias, the primary conclusions withstood the trim-and-fill adjustment and remained robust. A TCM constitution-based BP management hypothesis was proposed: patients with Phlegm-dampness or Blood-stasis constitutions may benefit from intensive BP control, whereas Qi-deficiency and Yin-deficiency types may require conservative strategies to mitigate hypoperfusion risks. Conclusion:This integration of TCM constitutional theory into AIS BP management provides a potential framework for advancing precision care to improve clinical outcomes in AIS patients. Further validation in multicenter cohorts and mechanistic exploration is warranted to enhance clinical applicability (Registration information: https://www.crd.york.ac.uk/PROSPERO2/view/CRD420250655689).

BackgroundMigraine represents a chronic neurological disorder characterized by high prevalence, substantial disability rates, and significant economic burden. Its pathogenesis is complex, and there is currently no cure. The rapid progress in multi-omics technologies has provided new tools to uncover the intricate pathological mechanisms underlying migraine. This systematic review aims to synthesize the findings of multi-omics studies on migraine to further elucidate the complex mechanisms of disease onset, thereby laying a scientific foundation for identifying new therapeutic targets.MethodsWe conducted a comprehensive systematic review, specifically focusing on clinical observational studies that investigate various aspects of migraine through the integration of genomics, transcriptomics, proteomics, and metabolomics. Our search encompassed multiple databases including PubMed, EMBASE, the Web of Science Core Collection, the Cochrane Library, China National Knowledge Infrastructure, the Chinese Science and Technology Periodical Database, the Wanfang database, and the China Biology Medicine Database to cover studies from database inception until 20 March 2024., The scope of our review included various aspects of migraine such as ictal and interictal phases; episodic or chronic migraine; menstrual-related migraine; and migraine with or without aura (PROSPERO registration number: CRD42024470268).ResultsA total of 38 studies were ultimately included, highlighting a range of genetic variations, transcriptional abnormalities, protein function alterations, and disruptions in metabolic pathways associated with migraine.These multi-omics findings underscore the pivotal roles played by mitochondrial dysfunction, inflammatory responses, and oxidative stress in the pathophysiology of migraine.ConclusionMulti-omics approaches provide novel perspectives and tools for comprehending the intricate pathophysiology of migraine, facilitating the identification of potential biomarkers and therapeutic targets.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=470268, identifier CRD42024470268.

ObjectivesNeurodegenerative changes are key manifestations of Wilson disease (WD), causing neurological symptoms including parkinsonism, tremors, and dystonia. However, the neuroimaging correlates of specific neurological manifestations (especially dystonia) in WD remain poorly characterized.Methods37 WD patients and 37 healthy controls (HC) were recruited. All subjects underwent structural magnetic resonance scanning, muscle biomechanical measurements, and the Unified Wilson Disease Rating Scale for Neurology (UWDRS-N) assessment. Neurodegenerative changes, identified as gray matter volume (GV) changes, were analyzed via voxel-based morphometry (VBM) in WD compared to HC. Clinical symptoms were linked to GV changes in WD patients’ brains.ResultsCompared with HC, WD patients had GV loss in the bilateral caudate nucleus, putamen, cerebellum (Crus1), left amygdala, right posterior insular lobe, and right parahippocampal gyrus and increased GV in the bilateral anterior insular lobes. In cortical areas, UWDRS-N significantly negatively correlated with GV in the bilateral posterior insula lobes, part of temporal lobe, optic cortex, frontal lobe, and cingulate cortex, while positively correlated with that in bilateral anterior insular lobes and putamen. Moreover, the GV from the left parahippocampal gyrus, bilateral hippocampus, and bilateral caudate nucleus showed a strong positive correlation with the F value of the right gastrocnemius medial head.ConclusionIn WD patients with neurological symptoms, obvious abnormal GV values in the cortico-striatal-thalamo-cortical (CSTC) circuit were noted. These GV changes were linked to UWDRS-N and correlated with muscle tension. The study mapped UWDRS-N and muscle biomechanics in GV-impaired areas, suggesting altered GV (especially in basal ganglia) as a key imaging sign of WD severity. This indicates that the CSTC circuit could act as a biomarker for WD neurological symptoms and affect WD dystonia mechanisms. Additionally, it shows that muscle-related biological parameters can assess WD dystonia severity and neurological damage.Clinical trial registrationclinicaltrials.gov, identifier NCT05305872.

ObjectiveThe primary objective of this network meta-analysis (NMA) was to compare and rank the relative efficacy and safety of seven distinct Fuzheng traditional Chinese medicine injections (TCMIs) combined with conventional treatment (CT), against CT, for the management of acute ischemic stroke (AIS). The overarching hypothesis was that although TCMIs + CT as a class provides benefit over CT alone, their therapeutic profiles differ.MethodsThe Cochrane Library, Embase, PubMed, Web of science, CNKI, Wanfang, VIP, and SinoMed were comprehensively searched from their inception to 11 January 2025, for randomized controlled trials (RCTs) focusing on the use of Fuzheng TCMIs + CT to treat AIS. The quality of the included RCTs was assessed using the risk-of-bias 2 (RoB2) tool. NMA in the frequentist framework was designed to access the efficacy of different Fuzheng TCMIs.ResultsA total of 70 RCTs involving 6,227 patients were enrolled. The study showed that Mailuoning injection (MLN), Huangqi injection (HQ), Shengmai injection (SHM), Ciwujia injection (CWJ), Shenfu injection (SF), and Shenmai injection (SM) combined with CT significantly improved performance compared with CT alone in treating AIS. In terms of the increase in the clinical efficacy rate, MLN + CT was most likely to be the best course of action, as was CWJ + CT in terms of the National Institute of Health Stroke Scale Score (NIHSS), Barthel Index (BI), blood lipids, the low-cut viscosity of whole blood (LCV), and interleukin-6 (IL-6). CWJ + CT was associated with the lowest rate of adverse reactions (ADRs) although the evidence base for safety comparisons remains limited. Additionally, MLN + CT was most likely to be the best treatment in terms of plasma viscosity (PV), fibrinogen (FIB) and modified Rankin Scale (mRS). Given that SF + CT ameliorated the activities of daily living (ADL) rating and C-reactive protein (CRP) level, it was most likely to be the best course of action. The treatment that was most likely to be the best in terms of the high-cut viscosity of whole blood (HCV) was SHM + CT. Considering the decrease in the tumor necrosis factor-α (TNF-α) level, SM + CT had the best chance of being the best treatment.ConclusionThe combination of CT and TCMIs had a more beneficial impact on the treatment of AIS. Both CWJ + CT and MLN + CT performed best. However, these findings should be interpreted with caution due to the methodological limitations of the included trials. Therefore, to substantiate the findings, more excellent research is required.Systematic Review RegistrationCRD42025614168.

BACKGROUND:The relationship between lifestyle and migraine is complex, as it remains uncertain which specific lifestyle factors play the most prominent role in the development of migraine, or which modifiable metabolic traits serve as mediators in establishing causality. METHODS:Independent genetic variants strongly associated with 20 lifestyle factors were selected as instrumental variables from corresponding genome-wide association studies (GWASs). Summary-level data for migraine were obtained from the FinnGen consortium (18,477 cases and 287,837 controls) as a discovery set and the GWAS meta-analysis data (26,052 cases and 487,214 controls) as a replication set. Estimates derived from the two datasets were combined using fixed-effects meta-analysis. Two-step univariable MR (UVMR) and multivariable Mendelian randomization (MVMR) analyses were conducted to evaluate 19 potential mediators of association and determine the proportions of these mediators. RESULTS:The combined effect of inverse variance weighted revealed that a one standard deviation (SD) increase in genetically predicted Leisure screen time (LST) was associated with a 27.7% increase (95% CI: 1.14-1.44) in migraine risk, while Moderate or/and vigorous physical activity (MVPA) was associated with a 26.9% decrease (95% CI: 0.61-0.87) in migraine risk. The results of the mediation analysis indicated that out of the 19 modifiable metabolic risk factors examined, hypertension explains 24.81% of the relationship between LST and the risk of experiencing migraine. Furthermore, hypertension and diastolic blood pressure (DBP) partially weaken the association between MVPA and migraines, mediating 4.86% and 4.66% respectively. CONCLUSION:Our research findings indicated that both LST and MVPA in lifestyle have independent causal effects on migraine. Additionally, we have identified that hypertension and DBP play a mediating role in the causal pathway between these two factors and migraine.

OBJECTIVE: To summarize the evidence from Traditional Chinese Medicine(TCM) practice in the treatment of acute primary headache and provide clinical practice guidance. METHODS: The guidelines were developed in accordance with the World Health Organization guideline development manual. After the establishment of steering committee, panel and the registration and protocol formulation, the evidence on TCM for acute primary headache from published guidelines, clinical evidence, and expert experience and consensus were collected. The grading of recommendations assessment, development and evaluation method was used to grade the evidence and make the recommendations. RESULTS: Based on the available evidence, the guidelines recommended three TCM herbal decoctions, six Chinese patent medicines, and two kinds of external application of Chinese herbal medicines. Diagnostic recommendations based on the expert experience and consensus were also included in the guidelines. CONCLUSION: TCM diagnosis and treatment of decoction, Chinese patent medicine and external application for treating acute primary headache were recommended. We hope these guidelines will be helpful in standardize the TCM acute treatment of primary headache.

BACKGROUND:Yangxue Qingnao Granules (YXQN) is a Chinese patent medicine that has been commonly used in the clinical treatment of migraine. AIM:To assess the efficacy and safety of YXQN alone for the treatment of migraine. METHODS:We searched 10 databases to identify relevant randomized controlled trials (RCTs) published before September 2022. Two review authors independently searched and screened the literature, extracted the data, and assessed the methodological quality of the studies using criteria from ROB 2.0, and analyzed the data using Review Manager 5.4 software. RESULTS:A total of 12 RCTs including 767 participants with migraine met the selection criteria. We divided these studies into comparisons of YXQN with placebo, routine treatment drugs, and other Chinese patent medicines. The meta-analysis showed the following: (1) Efficacy: The YXQN group outperformed the placebo group [relative risk (RR) = 0.29, 95% confidence interval (95%CI): 0.15-0.43, P < 0.00001], routine treatment group (RR = 0.18, 95%CI: 0.09-0.27, P < 0.0001), and Chinese patent medicine group (RR = 0.27, 95%CI: 0.13-0.41, P < 0.001); (2) frequency of headache: There was a significant difference between YXQN vs placebo [mean difference (MD) = -1.25, 95%CI: -1.60 to -0.90, P < 0.00001], routine treatment drugs (MD = -0.85, 95%CI: -1.15 to -0.56, P < 0.00001), and Chinese patent medicine (MD = -0.91, 95%CI: -1.35 to -0.46, P < 0.0001); (3) headache duration: We found great heterogeneity between studies, with no differences between YXQN and placebo (MD = -0.61, 95%CI: -1.53 to -0.31, P = 0.19) and routine treatment drugs (MD = -0.22, 95%CI: -0.89 to 0.46, P < 0.53). YXQN was more effective than other Chinese patent medicines in reducing headache duration (MD = -1.24, 95%CI: -1.70 to -0.77, P < 0.00001); and (4) headache severity: There was no significant difference between YXQN vs placebo (MD = -1.67, 95%CI: -3.52 to 0.19, P = 0.08), routine treatment drugs (MD = -0.53, 95%CI: -2.02 to 0.96, P = 0.68), and other Chinese patent medicines (MD = -0.49, 95%CI: -2.83 to 1.85, P = 0.68). Mild gastrointestinal adverse reactions were reported in three cases. CONCLUSION:This study revealed that YXQN is effective and safe for treatment of migraine.

Objective:To derive the Chinese medicine(CM)syndrome classification and subgroup syndrome characteristics of ischemic stroke patients.Methods:By extracting the CM clinical electronic medical records(EMRs)of 7,170 hospitalized patients with ischemic stroke from 2016 to 2018 at Weifang Hospital of Traditional Chinese Medicine,Shandong Province,China,a patient similarity network(PSN)was constructed based on the symptomatic phenotype of the patients.Thereafter the efficient community detection method BGLL was used to identify subgroups of patients.Finally,subgroups with a large number of cases were selected to analyze the specific manifestations of clinical symptoms and CM syndromes in each subgroup.Results:Seven main subgroups of patients with specific symptom characteristics were identified,including M3,M2,M1,M5,M0,M29 and M4.M3 and M0 subgroups had prominent posterior circulatory symptoms,while M3 was associated with autonomic disorders,and M4 manifested as anxiety;M2 and M4 had motor and motor coordination disorders;M1 had sensory disorders;M5 had more obvious lung infections;M29 had a disorder of consciousness.The specificity of CM syndromes of each subgroup was as follows.M3,M2,M1,M0,M29 and M4 all had the same syndrome as wind phlegm pattern;M3 and M0 both showed hyperactivity of Gan(Liver)yang pattern;M2 and M29 had similar syndromes,which corresponded to intertwined phlegm and blood stasis pattern and phlegm-stasis obstructing meridians pattern,respectively.The manifestations of CM syndromes often appeared in a combination of 2 or more syndrome elements.The most common combination of these 7 subgroups was wind-phlegm.The 7 subgroups of CM syndrome elements were specifically manifested as pathogenic wind,pathogenic phlegm,and deficiency pathogens.Conclusions:There were 7 main symptom similarity-based subgroups in ischemic stroke patients,and their specific characteristics were obvious.The main syndromes were wind phlegm pattern and hyperactivity of Gan yang pattern.

To further improve clinical workers' Traditional Chinese Medicine (TCM) treatment level for headache attack, the TCM Guidelines for Acute Primary Headache has been developed based on the development methodology of the World Health Organization Standard Version guide. The grading of recommendations assessment, development and evaluation (GRADE) method was adopted for the development of evidence, evidence classification, and recommendations that can be systematically evaluated. For evidence lacking clinical research support, the quality of evidence was evaluated and recommended based on the evidence level standard of ancient books of traditional Chinese medicine, and The Appraisal of Guidelines for Research and Evaluation II (AGREE II) and The Reporting Items for Practice Guidelines in Healthcare (RIGHT) were referred to. This guideline plan mainly introduces the guideline formulation process of constructing clinical questions and selecting outcome indicators, evidence retrieval, generation of recommendations, etc.

目的 报道《伤寒论》苦酒汤治疗难治咽部溃疡1例,学习苦酒汤治疗咽部溃疡的适应证候以及临床应用的具体方法.方法 回顾、总结1例苦酒汤治疗难治咽部溃疡的诊疗过程,通过数据库检索、著作阅读的方式,从苦酒汤方证、煎服法及相关现代研究方面进行文献复习.结果 苦酒汤多用于治疗少阴虚火灼咽所致咽痛、溃疡、失音.其中可以醋可代苦酒,用以解毒敛疮,鸡子白止痛润咽,半夏豁痰开痹.煎服法上多改良仲景之法,通过后下鸡子白的方法存其凉润之性.在临床上,苦酒汤可应用于急慢性咽喉炎、失音、喉源性咳嗽、梅核气以及放疗后口腔溃疡等疾病的治疗.结论 苦酒汤对治疗咽部溃疡等咽部疾病具有确切临床疗效,但其药物选用、煎服法考证及改良、机制探索均有待进一步研究.