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卒中后抑郁（PSD）是脑卒中后常见的精神系统并发症，其发生发展深刻体现了中医“因病致郁”与“因郁致病”理论的交互作用。本文基于该理论，提出“气血失和”是贯穿PSD“病-郁-病”恶性循环的核心病机。卒中（病）导致气血逆乱、脑神失养，继而引发郁证（郁）；而持续存在的抑郁状态（郁）加剧气机郁滞与血脉瘀阻，反致卒中复发或加重（病）。针对此循环，本文以气血为纲，构建了PSD的分期辨治框架：初期以肝气郁结或瘀血阻络为主，治疗重在疏肝理气、活血通络以调畅气机；中期以气郁化火或痰瘀互结为主，治疗侧重清热化痰、祛瘀开郁以化其胶结；后期气血共病，可见气滞血瘀、气虚血瘀、气血两虚，治疗注重益气养血、调和气血以扶正固本。通过分期辨治、气血同治，旨在为打破PSD的恶性循环、完善其中医诊疗方案提供理论依据与系统思路。
Abstract：Post-stroke depression(PSD) as a common mental complication following stroke, whose occurrence and progression of which profoundly reflect the interaction between the traditional Chinese medicine(TCM) theories of "Yu due to illness" and "illness caused by Yu". Based on the theories, this illustrative case report proposes that the disharmony of Qi and blood is the core pathogenesis central to the vicious cycle of "diseasedepression-disease" in PSD. Stroke(disease) leads to reversed flow of Qi and blood and malnourishment of the mental faculty, thereby inducing depression(Yu), whereas the persistent depressive state(Yu) aggravates the stagnation of Qi movement and obstruction of blood vessels, consequently leading to the recurrence or worsening of stroke(disease). To address this cycle, this illustrative case report constructs a staged diagnosis and treatment framework for PSD guided by the principle of regulating Qi and blood: In the early stage, characterized mainly by liver Qi stagnation or static blood blocking collaterals, treatment focuses on soothing the liver to regulate Qi, and promoting blood circulation to remove obstruction in collaterals, so as to regulate the Qi movement. In the middle stage, dominated by Qi depression transforming into fire or intermingled phlegm and blood stasis, the emphasis shifts to clearing heat and resolving phlegm, eliminating stasis and relieving depression to resolve the congelation. In the late stage, where Qi and blood are both affected, manifesting as stagnation of Qi and blood stasis, blood stasis due to Qi deficiency, or deficiency of both Qi and blood, the therapeutic principle prioritizes tonifying Qi and nourishing blood, harmonizing Qi and blood to reinforce healthy Qi. Through staged treatment based on syndrome differentiation and simultaneous regulation of Qi and blood, this illustrative case report aims to provide a theoretical basis and a systematic approach for breaking the vicious cycle of PSD and improving its TCM diagnosis and treatment strategies.
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基本信息:
DOI：10.26946/j.cnki.1000-3649.sczy.2508180001
中图分类号:R277.7
引用信息:
[1]黎婕,张晓乐,曹永丹,等.基于“因病致郁、因郁致病”理论探讨气血要素下卒中后抑郁的辨治[J].四川中医,2025,43(12):38-44.DOI:10.26946/j.cnki.1000-3649.sczy.2508180001.
基金信息:
国家中医药管理局韩祖成全国名老中医药专家传承工作室项目（国中医药人教函[2022]75号）; 西安市科技计划项目（24YXYJ0151）; 铜川市中医药传承创新发展示范试点项目（SXM20241116-01）; 陕西省中医药管理局项目（SZY-KJCYC-2025-LC-013）
2025-12-15
2025-12-15