基于“肝-肾-脑”轴理论探讨针刺治疗卒中后抑郁  

Exploration of Acupuncture Treatment for Post-Stroke Depression Based on the“Liver-Kidney-Brain”Axis Theory

作　　者：季武 王震[2] 欧茜茜 胡忠萍 伍思嘉 JI Wu;WANG Zhen;OU Xixi;HU Zhongping;WU Sijia(Anhui University of Traditional Chinese Medicine,Hefei 230012,Anhui,China;The Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine,Hefei 230061,Anhui,China)

机构地区：[1]安徽中医药大学,安徽合肥230012 [2]安徽中医药大学第二附属医院,安徽合肥230061

出　　处：《辽宁中医药大学学报》2025年第5期181-185,共5页Journal of Liaoning University of Traditional Chinese Medicine

基　　金：安徽省高等学校科学研究自然科学类项目(2023AH050769);安徽省高等学校省级质量工程项目(2021jyxm0826);安徽省重点研究与开发计划项目(1704a0802169);安徽省第十三批115产业创新团队项目(皖人才办[2020]4号);长三角名中医工作室项目(皖中医药发展秘[2023]16号)。

摘　　要：卒中后抑郁(post-stroke depression,PSD)是一种卒中后出现的综合征,表现为多种抑郁症状和身体症状,其症状种类繁多,持续时间久,严重影响患者康复过程及预后。“肝-肾-脑”轴理论基于中医藏象学说,指的是肝、肾、脑以血、精、髓为物质基础,互相转化;通过督脉紧密联系,经气互通互用。该文基于“肝-肾-脑”轴理论,认为肾藏精,精生髓,髓聚为脑,肾精虚损则见情志失调、精神委顿,是PSD的根本病机,肝主疏泄,具有调畅气机、调畅情志、促进血液与津液运行输布的功用,肝木郁结则气血运行不畅,精神无处安定,抑郁乃生,是PSD重要病因,最终脑脉受损,督脉失养而致脉气痹阻发为PSD,并提出穴选太溪益肾精之本源、三阴交理三阴充髓海、足三里充后天脏腑之源而补先天之本,合谷、太冲“开四关”同调脏腑气血阴阳而散肝气郁滞之标,经选督脉,穴取百会、风府、神庭、大椎、命门和神道奏通督、调神、开郁、神形共调之功,通督而治郁。为临床针刺治疗PSD提供了新的思路。Post-stroke depression(PSD)is a syndrome that occurs after stroke,characterized by a variety of depressive symptoms and physical symptoms.It has a wide range of symptoms and a long duration,which severely affects the rehabilitation process and prognosis of patients.The“liver-kidney-brain”axis theory is based on the theory of viscera and meridians in traditional Chinese medicine,which refers to the interconnection of the liver,kidney,and brain through blood,essence,and marrow as the material basis,and their mutual transformation.They are closely linked through the Du meridian and share the flow of vital energy.This paper,based on the“liver-kidney-brain”axis theory,posits that the kidney stores essence,which generates marrow,and the marrow converges to form the brain.When kidney essence is deficient,it leads to emotional disorders and mental fatigue,which are the fundamental pathogenesis of PSD.The liver is responsible for regulating emotions and distributing blood and Qi.When the liver function is impaired,it becomes an important cause of PSD.If the liver is constrained,the circulation of blood and Qi will be disrupted,the flow of meridian energy will be impeded,and the spirit will have nowhere to settle,leading to depression,which is another important cause of PSD.Ultimately,the brain vessels are damaged,and the governing vessel is not nourished,resulting in the obstruction of pulse energy and the manifestation of PSD.The paper further proposes the selection of acupoints such as Taixi(KI3)to nourish the kidney essence,Sanyinjiao(SP6)to regulate the three yin meridians and replenish the marrow,and Zusanli(ST36)to replenish the source of the viscera and support the innate foundation.Hegu(LI4)and Taichong(LR3)are used to“open the four gates”and regulate the yin and yang of the viscera and blood and Qi,thereby dispersing the stagnation of liver Qi.The Du meridian is selected,and acupoints such as Baihui(GV20),Fengfu(GV16),Shenting(GV24),Dazhui(GV14),Mingmen(GV4),and Shendao(GV11)are used to unblock the Du

关 键 词：“肝-肾-脑”轴 卒中后抑郁 针刺疗法 肝肾同治 督脉 

分 类 号：R246.6[医药卫生—针灸推拿学]