Glucocorticoids can be classified into two main groups: endogenous and exogenous. Cortisone and hydrocortisone belong to the former. Exogenous glucocorticoids are synthetic, such as prednisone, prednisolone, betamethasone, and dexamethasone, to name a few. When some people hear of hormones, they are disgusted and think of side effects; however, the “cortisones” are actually secreted by the body, and it turns out that they are actually our most familiar strangers. For decades, glucocorticoids have played the role of a treasure hunter in medicine, and have also taken the blame and criticism, so to speak, with mixed reputations. But for most people, it is still as difficult to see as a flower in the mist or a moon in the water. Should we love our body or hate it? Is there a reason to give the body this “pine” or that “dragon”? Let’s start our “excitement” journey today. The “American Elixir”? The body needs to consume calories for all its activities, and to be precise, it needs to maintain a certain level of blood sugar. The body is no less dependent on glucose than the U.S. government is on oil. When the body’s machine begins to function, the brain, the central command, immediately issues a directive. In the body, hydrocortisone is a hard-working courier. It carries these instructions to the muscle cells, to the liver cells and immune cells, and with the blood to every corner of the body. The central instructions are clear: to mobilize all available substances, like glycogen, proteins, fats, whatever, and convert them into glucose by all means. In the liver, the liver cells are immediately busy. Some of them are busy converting proteins, fats and so on into glucose, a process called glycogen xenobiogenesis. Some are busy promoting hepatic glycogen synthesis. In addition to open source, they also have to cut back. Slowing down the oxidative breakdown of glucose is also a proven way to do this. Muscle cells are the most dedicated movers and shakers of the year. They go out of their way to stop protein synthesis. The muscle cells stop transporting everything related to proteins and peptides, amino acids and other substances are excluded from the outside of the cell. In short, priority is given to ensuring the supply of raw materials for glycogen xenobiogenesis. When the immune cells received the order, they immediately embarked on a vigorous disarmament of T-lymphocytes, monocytes, eosinophils, and all the bloated cell divisions of the army, land, and sea. This not only eliminated the need for central funding, but also allowed them to concentrate on the central task of glucose synthesis. Physiological doses of glucocorticoids are necessary to sustain life. When the body is given more hormones, i.e., pharmacological doses, glucocorticoids will take on a more important mission. In the immune department, more immune cells are ordered to lay off. The result: relief of symptoms of allergic reactions and autoimmune diseases, which can fight rejection of allogeneic organ transplants. The more immune cells are killed in battle, the less they naturally fight with external antigens. The inflammation of DD, a by-product of the reaction, is then reduced. Capillaries constrict, secretion of inflammatory substances ceases, swelling subsides, and pain is reduced. Pharmacological doses of glucocorticoids do not stop themselves from running around after they have done their job. They can also dilate spasmodically constricted blood vessels, enhance myocardial contractility, and improve the state of shock; and improve the tolerance of the muscle to bacterial endotoxin. When you see this, readers can’t help but heartily exclaim: “Glucocorticoids, you are simply an angel floating down to earth. What’s more, decades ago, glucocorticoids were once hailed as the “American elixir”. The body says, “If you love me, give me glucocorticoids, because it is an angel. If you hate me, give me glucocorticoids because it’s the devil.” Our body is a sophisticated scale. There are glucocorticoid receptors in the brain, which is a feedback signal channel. When it receives the signal, it reduces the secretion of glucocorticoids, or even stops it. In this way, the adrenal glands, without a source of signal, will reduce and stop the secretion of glucocorticoids. Those hormones secreted by the adrenal glands are very useful to the body when they are just right. But if glucocorticoids are applied for a long time, or if they are abused, glucocorticoids can become the devil. In the immune system, bacteria, viruses and fungi are allowed to run rampant in the body and eat away at our muscles because of the large number of immune cells dying. Bones and muscles are sacrificed in excess, muscle atrophy, delayed wound healing, and even osteoporosis and osteonecrosis will ensue. After fat and protein are consumed excessively, centripetal obesity, full-moon face and and steroidal diabetes are also inevitable. Digestive tract, cardiovascular, eyes and central nervous system may say “no” to you! A special note of caution: long-term application in children can affect growth and lead to growth arrest. Use glucocorticoids and give a reason first. Clinically, doctors and pharmacists should carefully weigh the pros and cons and correctly select hormonal drugs according to different diseases. Take a look at a few commonly used in clinical practice: Inhaled glucocorticoids are the drug of choice for the long-term treatment of asthma. The vast majority of patients with chronic persistent asthma can be better controlled with a small inhaled dose of glucocorticoids (equivalent to 400 micrograms of budesonide per day). Topical topical glucocorticosteroids are probably experienced by many people. In terms of dosage form selection, creams are indicated for moist or minimally exuding skin, ointments for dry or mossy lesions, and lotions for the scalp. Hard creams are suitable for leathery hypertrophic lesions. Infant diaper dermatitis should be used with caution. Topical glucocorticoids in the eye are an important measure to control ocular inflammation (including surgically induced inflammation). A comparison of the anti-inflammatory efficacy of commonly used glucocorticoids is attached. The anti-inflammatory effect of hydrocortisone is 1.0, cortisone 0.8, prednisone 3.5, prednisolone 4.0, methylprednisolone 5.0, trenbolone 5.0, dexamethasone 3.0, betamethasone 25.0-30.0. It is a great honor to think that Hench was awarded the Nobel Prize for the use of cortisone for arthritis. But the joy was always short-lived. It soon discovered that cortisone only relieved the symptoms, and could not cure it completely. Once the patient stopped taking it, the symptoms returned. In the end, glucocorticoids play more of a firefighter’s role to put out the fire. The dosage and duration of glucocorticosteroid use should be minimized while ensuring efficacy. While the body is enjoying the comfort of hormones, side effects and adverse reactions are often waiting around the corner. If a parting word is given to glucocorticosteroids at the end of the journey. I think Shakespeare’s phrase “A sharp sword with two edges can kill the enemy as well as hurt oneself” would be the most appropriate.