In the early morning, a ray of sunlight comes into the house and the body wakes up from its sleep. The crescent-shaped area above the kidneys called the adrenal glands, after lying dormant overnight, receives instructions from the pituitary gland and begins to work. Some of these cells, called fasciculi, begin to secrete a substance scientifically known as cortisol. These cortisols, also known as cortisone and hydrocortisone. They are one of the main characters of this article, DD glucocorticoids. Glucocorticoids, as the name suggests, have a physiological role in regulating the metabolism of three major substances (sugar, protein and fat) in the body, and in 1950, the British pharmacologists Hench and Kendall were awarded the Nobel Prize in Medicine for their discovery of glucocorticoids and the conclusive proof of their effectiveness in the treatment of rheumatic diseases. In fact, glucocorticoids can be divided into two main groups: endogenous and exogenous. Cortisone and hydrocortisone belong to the former category. Exogenous glucocorticoids are synthetic, such as prednisone, prednisolone, betamethasone and dexamethasone, to name a few. When some people hear about hormones, they are disgusted and think of side effects; however, corticosteroids are actually secreted by the body, and they turn out to be our most familiar strangers. Over the decades, glucocorticoids have played the role of a treasure trooper in medicine, and they have also taken the blame and criticism, so to speak, with a mixed reputation. 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 should we hate it? Is there a reason to give the body this “pine” or that “dragon”? Come with me, our “exciting” journey today, thus officially begins. The “American Elixir”? The body needs to consume calories for all 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 undertook a vigorous disarmament. t-lymphocytes, monocytes, eosinophils, all bloated cell divisions of the army, navy and air force were immediately abolished. This way they not only did not require central funding of the military, but also could concentrate on the central task of synthesizing glucose. 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 shock; and improve the tolerance of the muscle to bacterial endotoxin. Seeing this, readers can’t help but heartily exclaim: “Glucocorticoids, you are simply an angel floating down on 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 is 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 glucocorticoid hormone 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. The digestive tract, cardiovascular, eyes and central nervous system may all say “no!” to you. A special note of caution: long-term application in children can affect growth and lead to growth arrest. Give a reason for using glucocorticosteroids. Clinically, doctors and pharmacists should weigh the pros and cons carefully and choose the right 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 inhaled small doses of glucocorticoids (equivalent to 400 micrograms of budesonide per day). Topical topical glucocorticosteroids applied topically to the skin are probably experienced by many people. In terms of dosage form selection, creams are indicated for moist or minimally exuding skin, ointments for dry skin or lesions with mossy changes, 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 happy time is always short. It soon discovered that cortisone only relieved the symptoms, and could not completely cure it. 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 there is a parting word for glucocorticoids at the end of the journey. I think Shakespeare’s phrase “A sword with two edges can kill the enemy as well as hurt oneself” would be the most appropriate.