从脑内液体交换与细胞外微环境调控探讨"无形之痰"的生物学内涵OA

Based on the traditional Chinese medicine(TCM)theories of body fluid metabolism and turbid phlegm obstructing the orifices,and drawing on recent advances in cerebrospinal fluid-interstitial fluid(CSF-ISF)exchange,glymphatic clearance,and extracellular matrix(ECM)regulation,this article discusses the possible scien-tific connotation of"invisible phlegm"from the perspectives of pathogenesis,clinical manifestations,and therapeutic implications.Impaired brain fluid exchange may lead to reduced clearance,the retention of metabolic wastes and pathological proteins.Abnormal ECM remodeling may further disrupt molecular diffusion and local microenvironmental homeostasis,resulting in a pathological process characterized by slowed fluid movement,reduced clearance,and abnormal retention.This process bears a certain functional resemblance to the TCM pathogenesis of impaired distribu-tion of body fluids,endogenous formation of turbid phlegm and obstruction of the brain orifices,and may also be asso-ciated with manifestations such as a clouded sensation in the head,cognitive abnormalities,and emotional disturbances.On this basis,the potential effects of certain phlegm-dissolving Chinese medicines in improving brain clearance func-tion and extracellular microenvironmental homeostasis warrant further investigation.We therefore propose that,the"invisible phlegm"of TCM in brain tissue may manifest as a pathological retention state characterized by restricted fluid exchange,impaired clearance function,and extracellular microenvironmental imbalance.This perspective may provide a new avenue for investigating TCM treatment of neurological and psychiatric disorders from the perspective of phlegm.