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基于“脑-脏腑相通”理论，从中西医融合的视角解析卒中后抑郁（post-stroke depression,PSD）的发病机制与干预策略。现代医学研究表明，PSD与神经递质（如5-羟色胺、去甲肾上腺素、多巴胺）失衡、下丘脑-垂体-肾上腺轴过度激活、神经可塑性改变、促炎因子（如白细胞介素-1β、白细胞介素-6、肿瘤坏死因子-α）释放、脑源性神经营养因子（brain-derived neurotrophic factor,BDNF）水平下降、5-羟色胺转运体与多巴胺受体等基因多态性，以及额叶、颞叶、海马等情绪相关脑区的结构与功能异常密切相关。中医学认为，脑与脏腑通过经络系统相互联系、相互影响。卒中导致脑髓损伤、神机失序，其病邪可通过经络传导，引发心、肝、脾、肺、肾等脏腑功能失调；反之，脏腑功能失调又会上扰于脑，进一步损伤脑神，从而形成PSD“脑病及脏-脏病损脑”的双轴联动病理循环。这一理论框架揭示了PSD进程中，脑与肝、心、脾、胃肠、肺、肾等多脏腑轴系，通过神经-内分泌-免疫-代谢（如肠道菌群）网络进行双向交互的致病机制。基于此理论，疏肝、健脾、养心类中药（如柴胡类方剂、归脾汤及疏肝解郁胶囊等）、情志疗法、针灸等干预手段，能够多靶点调节神经递质、稳定下丘脑-垂体-肾上腺轴功能、提升BDNF水平、抑制炎症反应、改善神经可塑性及调节肠道菌群，从而有效缓解PSD。这一融合机制获得了“神主导气”系统针法临床随机试验的进一步支持。综上揭示PSD“脑病及脏-脏病损脑”的循环病理本质及其多系统网络交互致病机制，为破解单一靶点治疗的困局提供了新思路。据此提出的整合干预策略，通过“调神-和脏-通络”实现多靶点协同增效，为PSD的中西医融合诊疗开辟了新路径。
Abstract：The pathogenesis and intervention strategies for post-stroke depression(PSD) can be elucidated through an integrative perspective grounded in the theory of "Brain-Viscera Interconnection". Modern medical research indicates that PSD is closely associated with an imbalance of neurotransmitters(such as 5-HT, NE, DA), overactivation of the hypothalamic-pituitary-adrenal(HPA) axis, impaired neuroplasticity, release of pro-inflammatory cytokines(e.g., IL-1β, IL-6, TNF-α), decreased levels of brain-derived neurotrophic factor(BDNF), genetic polymorphisms(e.g., in the serotonin transporter gene and dopamine receptor genes), as well as structural and functional abnormalities in emotion-related brain regions including the frontal lobe, temporal lobe, and hippocampus. Traditional Chinese Medicine(TCM) posits that the brain and visceral organs are interconnected and mutually influential through the meridian system. A stroke causes brain injury and disrupts mental activity, which can transmit pathogenic factors via the meridians, leading to functional disorders of the heart, liver, spleen, lungs, kidneys, and other viscera. Conversely, visceral dysfunction can further disturb the brain, aggravating mental impairment. This forms the "brain affecting viscera-viscera impairing brain" bidirectional pathological cycle in PSD. This theoretical framework reveals the multi-system network interactions-through the neuro-endocrine-immune-metabolic(e.g., gut microbiota) network-between the brain and visceral axes(such as liver, heart, spleen, gastrointestinal tract, lungs, kidneys) in the pathogenesis of PSD. Based on this theory, interventions such as Chinese herbal medicine for soothing the liver, strengthening the spleen, and nourishing the heart(e.g., Chaihu-class formulas, Guipi Tang, and Shugan Jieyu Capsule), emotion-regulating therapies, and acupuncture can multi-targetedly modulate neurotransmitters, stabilize the HPA axis, elevate BDNF levels, inhibit inflammatory responses, improve neuroplasticity, and regulate gut microbiota, thereby effectively alleviating PSD. This integrative mechanism is further supported by a clinical randomized trial of the "Shen Dominating Qi" systematic acupuncture technique.In summary, these findings illuminate the cyclical pathological nature of PSD-"brain disease involving viscera and visceral disease damaging the brain"-and its multi-system network interactive pathogenesis, offering novel insights to overcome the limitations of single-target therapies. The proposed integrated intervention strategy, achieved through "regulating the spirit, harmonizing the viscera, and unblocking the meridians", enables multi-target synergistic effects, paving a new path for the integrative diagnosis and treatment of PSD.
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基本信息:
DOI：10.26950/j.issn.2097-5031.2026.01.001
中图分类号:R277.7
引用信息:
[1]程永.基于“脑-脏腑相通”理论深入探讨卒中后抑郁发病机制[J].中西医结合慢性病杂志,2026,3(01):1-8.DOI:10.26950/j.issn.2097-5031.2026.01.001.
基金信息:
国家中医药管理局第五批全国中医临床优秀人才研修项目（国中医药人教函[2022]1号）; 重庆市科卫联合医学科研项目（2022MSXM178）
2025-11-21
2025-11-21
2025-11-21