| 引用本文: |
吴俏兰, 孙扬, 伊树振, 于华芸.基于肾虚-痰瘀-气郁核心病机及分期辨治体系探析卒中后抑郁[J].湖南中医药大学学报,2026,46(4):772-776[点击复制] |
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| 基于肾虚-痰瘀-气郁核心病机及分期辨治体系探析卒中后抑郁 |
| 吴俏兰,孙扬,伊树振,于华芸 |
| (中国中医科学院广安门医院济南医院/济南市中医医院, 山东 济南 250101;山东中医药大学中医学院, 山东 济南 250355) |
| 摘要: |
| 卒中后抑郁（PSD）是卒中后常见并发症，属于中医学形神共病范畴。本文首次提出肾精亏虚为发病之根、痰瘀阻窍为病理之形、气郁不舒为情志之变三位一体的核心病机体系，三者相互关联，系统阐释了PSD因病致郁、因郁碍形的形神互损本质。基于此病机体系，本文构建了与之对应的分期辨治整合策略，明确PSD在急性期宜疏肝理气、恢复期宜化痰祛瘀、后遗症期宜补肾填精的核心治则与方药配伍规律，并对该治疗原则进行了深化和整合。同时，结合现代药理学证据，阐释了相关经典方药通过抑制神经炎症、抗氧化应激、促进神经发生与修复等多靶点途径实现形神同治的科学内涵，以期为PSD的中医临床方剂应用提供理论依据。 |
| 关键词: 卒中后抑郁|形神共病|肾精亏虚|痰瘀阻窍|气郁不舒|辨证论治 |
| DOI：10.3969/j.issn.1674-070X.2026.04.016 |
| 投稿时间：2026-01-12 |
| 基金项目:山东省自然科学基金资助项目(ZR2025MS1452);济南市市校融合发展战略工程项目(JNSX2024019) |
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| Analysis of post-stroke depression based on the core pathogenesis of kidney deficiency-phlegm and blood stasis-qi stagnation and the stage-based identification and treatment system |
| WU Qiaolan, SUN Yang, YI Shuzhen, YU Huayun |
| (Jinan Hospital of Guang'anmen Hospital, China Academy of Chinese Medical Sciences/Jinan Municipal Hospital of Chinese Medicine, Jinan, Shandong 250101, China;College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250355, China) |
| Abstract: |
| Post-stroke depression(PSD) is a common complication after stroke and falls into the category of body and spirit comorbidity in Chinese medicine. This paper proposes, for the first time, a core pathogenesis system comprising three interrelated components: kidney essence deficiency as the root cause, phlegm and blood stasis obstructing the orifices as the pathological manifestation, and qi stagnation with discomfort as the emotional alteration. This system systematically elucidates the essence of mutual impairment of body and spirit in PSD, characterized by disease leading to depression and depression hindering body. Based on this pathogenesis system, this paper establishes a corresponding integrated strategy of stage-based identification and treatment,clarifying the core therapeutic principles and formula compatibility rules: soothing the liver and regulating qi for the acute stage,transforming phlegm and eliminating stasis for the recovery stage, and to nifying the kidney and replenishing essence for the sequelae stage. These principles are further deepened and integrated. Additionally, drawing on modern pharmacological evidence,this paper explains the scientific connotation of classic TCM formulas achieving simultaneous treatment of body and spirit through multi-target pathways such as inhibiting neuroinflammation, counteracting oxidative stress, and promoting neurogenesis and repair,thereby providing a theoretical basis for the clinical application of TCM formulas in PSD. |
| Key words: post-stroke depression|body and spirit comorbidity|kidney essence deficiency|phlegm and blood stasis obstructing the orifices|qi stagnation with discomfort|treatment based on pattern identification |
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