Toxic and adverse reactions associated with molecularly targeted anti-tumor drugs are highly prevalent and seriously affect the patients' quality of life. Drawing upon TCM meridian-collateral theory, this paper elucidated the essentials of TCM pathogenesis of toxic and adverse reactions associated with molecularly targeted anti-tumor drugs. It postulated a core pathological theory defined as " drug pathogens invade the meridians, resulting in disharmony of Qi and blood". The toxic and adverse reactions of molecularly targeted anti-tumor drugs are not isolated or disordered local injuries but display a well-defined and intrinsically interconnected pattern. Their dynamic progression follows a sequential transmission pattern of " skin and pores-collaterals-meridians-Zang-fu organs ". Pathologically, this manifests as an evolutionary process of wind-heat accumulation in the skin, heat-toxin congestion in the collaterals, Qi stagnation and blood stasis in the meridians, and imbalance of Yin and Yang, which is highly consistent with the pathogen transmission theory described in Miraculous Pivot: Treatise on Contralateral Puncture(Lingshu: Miuci Lun). Toxic and adverse reactions of different classes of molecularly targeted anti-tumor drugs also exhibit distinct affinity for meridians and collaterals. For example, anti-angiogenic drugs primarily affect the Shaoyin meridian system and are prone to inducing hand-foot syndrome, hypertension, and hypothyroidism. Epidermal growth factor receptor tyrosine kinase inhibitors predominantly involve the Yangming and Taiyang meridian systems, commonly leading to cutaneous rash, diarrhea, and interstitial pneumonia. Human epidermal growth factor receptor-2 inhibitors preferentially affect the heart and spleen meridian systems, with cardiac toxicity and anemia being the most frequently observed manifestations. Meridian-collateral theory offers a novel perspective for understanding the TCM pathogenesis of toxic and adverse reactions associated with molecularly targeted anti-tumor drugs, providing a theoretical basis for the clinical implementation of early intervention, meridian-based syndrome differentiation, and stage-specific treatment.

Erythema ab igne (EAI) is a reticulated, erythematous rash resulting from repeated exposure to low-grade heat, commonly from heating devices. Although historically more common in adults, EAI is increasingly recognised in children due to the growing use of electronic devices.We describe a boy in mid-childhood presenting with an abdominal rash, initially suspected of having a liver injury following minor trauma. Blood tests and abdominal imaging were unremarkable. On re-presentation with rash progression and skin breakdown, targeted history identified prolonged laptop-to-skin contact, leading to a diagnosis of EAI.This case emphasises the importance of considering laptop-induced EAI in children presenting with reticulated rashes, as early recognition can prevent misdiagnosis, unnecessary investigations and avoidable radiation exposure.

Neonatal jaundice is one of the most frequently occurring conditions in newborns. This protocol describes the clinical implementation of two common care interventions, including standard phototherapy and clear water bathing or a Traditional Chinese Medicine (TCM)-integrated nursing care, on the serum and inflammatory indicators in neonates with damp-heat type jaundice. This protocol was demonstrated using anonymized medical records of 120 neonates who received treatment between 2022 and 2023. Clinical outcome measures included total bilirubin (TBIL), indirect bilirubin (IBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (γ-GT), lactate dehydrogenase (LDH), and C-reactive protein (CRP). Significant reductions in these serum and inflammatory markers were observed in both treatment groups (p < 0.001). The effect sizes on total bilirubin are large: Cohen d = 5.31 (clear water) and 5.37 (TCM-integrated). Similarly, marked reductions were observed in indirect bilirubin with d = 4.41 and d = 4.07, respectively. Improvements were also observed in ALT, AST, γ-GT, LDH, and CRP levels (AST: d = 3.31-3.73). CRP reductions were observed in both groups (d = 2.72 versus 2.24). Mixed ANOVA demonstrated significant main effects of time across all markers (TBIL F = 3427.51, p < 0.001). Multivariate regression analysis showed that ΔCRP was significantly associated with treatment effectiveness, suggesting a possible association between reduced systemic inflammation and clinical improvement (β = -1.771, p = 0.010). The adverse events are comparable between groups (incidence of rash: 10% vs. 15%, p = 0.581). Integrated TCM nursing interventions combined with standard phototherapy demonstrated treatment outcomes comparable to clear water bathing combined with phototherapy in improving clinical and biochemical parameters associated with neonatal jaundice.

Miliaria profunda is due to duct obstruction and rupture below the epidermis, with dermal sweat leakage associated and a variable inflammatory reaction. A rare but distinct presentation of miliaria profunda in infants is named giant centrifugal miliaria profunda (GCMP), showing centrifugal expansion of large, annular plaques. On histology, GCMP shows hyperkeratosis with ortho- and parakeratosis, and acanthosis with foci of intercellular edema. Acrosyringia are distended with obstruction by eosinophilic plugs of ortho-parakeratotic material. Dermal ducts appear dilated and show squamous metaplasia. A periductal and peri-eccrine variable inflammatory infiltrate contains neutrophils and often granulomatous inflammation is identified. We report two cases of GCMP, one of them associated with an MAP2K1 germinal RASopathy.

Chikungunya fever (CHIKF) is an emerging global health threat caused by the chikungunya virus (CHIKV), whose main symptoms include fever, rash and severe joint pain. The disease is characterized by acute febrile illness and chronic arthralgia, resulting in significant morbidity and economic burden, and posing a significant and growing global public health challenge. CHIKV has spread to over 119 countries, with recent outbreaks in the Americas and Asia. Two vaccines, VLA1553 (live-attenuated) and PXVX0317 (virus-like, particle-based), have been approved and have shown high immunogenicity, although their accessibility remains limited. Pathogenesis involves matrix remodeling-associated protein 8-mediated viral entry and immune dysregulation contributing to chronic arthritis. Traditional Chinese medicine approaches emphasize the removal of dampness and heat as well as the activation of collaterals, which have a potential adjunctive value in chronic phase management of CHIKF. Despite advances in vaccine development for CHIKF, challenges remain in terms of global coverage, research on chronic disease pathways and comprehensive treatment. Multidisciplinary collaboration will be needed to curb the public health impact of CHIKF in the future. Please cite this article as: Yu XL, Zhou RY, Xie XY, Zhang Y, Jia J. Chikungunya fever-What we know and have done in the face of a new global public health threat. J Integr Med. 2026; 24(5):634-644.

Heat-related illnesses encompass a spectrum of disorders resulting from exposure to high temperatures and the body's inability to efficiently dissipate heat. These syndromes range from mild illnesses, such as heat edema, heat rash, and heat cramps, to more concerning manifestations such as exercise-associated collapse, heat exhaustion, and exertional rhabdomyolysis. The most severe and potentially life-threatening heat-related illnesses include exercise collapse associated with sickle cell trait, severe exercise-associated hyponatremia, and heat stroke. Common risk factors of heat-related illness are physical activity in high ambient temperatures, behavioral factors, lack of acclimatization, deconditioning, recent illness, inadequate hydration, predisposing medical conditions, use of certain drugs and supplements, and excessive clothing or equipment. Treatment of mild heat-related illness includes cessation of activity, removal of the patient from high temperatures, and oral hydration. Symptoms of heat exhaustion are nonspecific and may include the inability to continue physical activity, weakness, fatigue, headache, nausea, and vomiting. Management includes rest, hydration, and basic cooling measures. Heat stroke is a medical emergency requiring immersion in ice-cold water within 30 minutes to prevent significant morbidity and mortality. Diagnosis of severe exercise-associated hyponatremia and exercise collapse associated with sickle cell trait require a high index of suspicion because they can mimic heat stroke but require different treatments. Heat-related illnesses are largely preventable with proper acclimatization, adequate hydration, avoidance of physical activity in extreme temperatures, and promotion of population-based intervention programs, particularly during anticipated heat waves.

Global warming is escalating occupational health risks worldwide, with outdoor workers in hot and humid regions facing disproportionate exposure to extreme heat. In such climates, the synergistic effects of high temperature and humidity critically impair thermoregulation, increasing susceptibility to heat stress-related disorders (HSRDs) a growing concern in low- and middle-income countries where adaptive capacity is limited. This study analyzed the six-year trend (2018-2023) in the HSRDs among outdoor workers in a hot, humid petrochemical industry in southern Iran. This retrospective longitudinal study collected health data on HSRDs alongside concurrent Wet-Bulb Globe Temperature (WBGT) index values. Additive time-series decomposition was used to analyze trends. Analyses were conducted using R and SPSS (p < 0.05). The mean WBGT index showed a significant, consistent increasing trend over the 6-year period (from 27.73 to 29.75 °C, p < 0.001). Exposure for site workers was highest, and summer critical (Sweltering) heat stress levels increased markedly from near zero to approximately 55% of the recorded time. General heat-related disorders showed the strongest association with elevated WBGT. A major challenge was identified in predictive modeling: only the model for general heat-related disorders showed relative accuracy (R[2] = 0.692). Other specific disorders (e.g., headache, cramp, rash) exhibited unpredictable patterns with high error rates (44% to 147% MAPE). Heat stress exposure is intensifying continuously in these work environments. While the WBGT index trend is predictable, the incidence of specific HSRDs follows complex, unpredictable patterns, making prediction based solely on WBGT challenging. The results underscore the necessity for robust, continuous preventive interventions considering all individual and environmental factors.

We present the case of a 25-year-old male who attended a dermatological online consultation due to a whiplash-shaped, pruritic rash. The lesions in the form of well-demarcated linear erythematous papules, located mainly on the trunk and arms, had first appeared four days prior to the consultation. Chronic disease history was negative and similar symptoms never appeared previously. After reviewing the clinical images and excluding dermatographism, flagellate dermatitis was suspected. The diagnosis was subsequently confirmed when the patient reported having consumed undercooked shiitake mushrooms two days prior to the onset of the lesions. Topical corticosteroids and oral antihistamines were recommended, and the patient was informed about the necessity of high-temperature preparation of shiitake mushrooms in the future. Flagellate dermatitis is a rare entity speculated to be a hypersensitivity reaction to lentinan, a heat-labile polysaccharide found in shiitake mushrooms (Lentinus edodes). Symptoms include characteristic papular or vesicular lesions erupting in a linear pattern resembling whiplash marks, usually on the trunk and extremities. While the condition is self-limiting, the awareness of its manifestation is important in order to prevent unnecessary biopsies. Patients should be educated to avoid further exposure to lentinan, as instances of severe reactions following repeated contact have been described.