基于"脑-脏腑相通"理论深入探讨卒中后抑郁发病机制OA

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.