通讯作者: 伍大华

DOI：10.12201/bmr.202610.00013

Pathogenesis and Treatment of Depression Comorbid with Cerebral Small Vessel Disease Based on the Concept of “Disharmony of the Three Collaterals and Collateral Damage Impairing Mental Activity”

• 摘要：脑小血管病（cerebral small vessel disease, CSVD）伴抑郁涉及脑微血管损伤、白质网络联络异常及情绪调控失衡等环节。基于络病理论，本文将脑络的经气布散、血液运行和津液转输相关功能概括为脑气络、脑血络和脑津络三个维度，提出“三络失和、络损神伤”的病机认识。治疗以通络养髓为总则，横向辨三络受累主次，纵向察络用失调、络脉闭阻及络体受损层次，随证权衡宣通、化通、荣通之法，并将解郁调神贯穿始终。结合伍大华教授诊疗经验，阐明三络同调、形神并治的临证应用，为本病辨证论治提供理论参考。

  关键词： 脑小血管病; 抑郁; 络病理论; 气络; 血络; 津络; 络损神伤

   

  Abstract: Depression comorbid with cerebral small vessel disease (CSVD) involves cerebral microvascular injury, disrupted white-matter connectivity, and dysfunction of emotion-regulation networks. Previous traditional Chinese medicine studies have mainly interpreted this condition in terms of kidney deficiency and brain-marrow insufficiency, qi deficiency and blood stasis, phlegm-stasis obstruction, and pathogenic factors damaging the brain collaterals. However, the coordinated dysfunction of collateral transmission and regulation, circulation and nourishment, and fluid distribution and clearance requires further integration. Based on collateral disease theory, this article conceptualizes the brain qi, blood, and fluid collaterals as three interrelated functional dimensions of a single brain collateral network. The disease is considered to be rooted in depletion of kidney essence, impaired spleen function, and insufficiency of qi, blood, essence, and fluids. Disharmony of the three collaterals constitutes the core pathological change, collateral damage with brain-marrow injury represents the key link, and dysfunction of mental activity is the functional manifestation. The pathogenesis may be summarized as deficiency and stagnation of the qi collaterals, concurrent disorders of the blood and fluid collaterals, and collateral damage with brain-marrow injury. These patterns may overlap and transform dynamically rather than constituting fixed stages. Treatment should focus on unblocking the collaterals and nourishing the brain marrow. The predominant collateral involvement and the severity of collateral dysfunction, obstruction, and damage should be assessed to determine the relative application of dispersing, resolving, and nourishing methods, while relieving depression and regulating mental activity throughout treatment.

  Key words: cerebral small vessel disease; depression; collateral disease theory; qi collateral; blood collateral; fluid collateral; collateral damage impairing mental activity

  提交时间：2026-10-09

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
• html

• 图表

• 耿艺娜, 邱伟文, 王华强. 脑小血管病影像学总负荷与中医络病证型分布的相关性. 2026. doi: 10.12201/bmr.202606.00079

  占剑虎, 邱伟文, 蓝海源, 王华强. 脑白质高信号严重程度与络病学证型分布研究. 2024. doi: 10.12201/bmr.202411.00015

  黄勇斌, 邓鑫. 基于络病理论探析肝纤维化“痰瘀互结”的病机演变及论治. 2026. doi: 10.12201/bmr.202610.00009

  张二利, 何兰兰, 李丹阳, 沈立, 吴钟华, 张军, 叶永强. 基于脑小血管病影像学总负荷的急性脑梗死患者住院时间延长列线图模型构建与验证. 2025. doi: 10.12201/bmr.202501.00008

  鲁彩菊, 何欣, 麻甜甜, 袁岳鹏, 朱元恒, 许益国, 王伟龙. 基于心脑同治理论治疗血管性抑郁症的病机探讨. 2025. doi: 10.12201/bmr.202507.00080

  吴瑞麟, 段建辉. 基于“寒热同调、内外兼治”理论治疗膝骨关节炎合并内侧副韧带慢性损伤经验. 2026. doi: 10.12201/bmr.202608.00044

  罗周青, 兰玲燕, 舒琦瑾. 从“络虚毒结”分期辨治肺癌治疗相关心悸经验. 2026. doi: 10.12201/bmr.202601.00067

  朱施吉, 古英. 基于络以通为用理论探讨自拟蠲痹散外敷在治疗寒湿痹阻型膝骨关节炎中的运用. 2025. doi: 10.12201/bmr.202507.00051

  闫秀丽, 于小雨, 王宏伟. 基于“风湿热瘀蕴肠、肠络受损”认识辨治发作期溃疡性结肠炎. 2026. doi: 10.12201/bmr.202605.00058

  周铭岐, 林乐乙△. 从浊邪损络论治糖尿病肾病. 2026. doi: 10.12201/bmr.202603.00128

• 序号	提交日期	编号	操作
  1	2026-08-14	10.12201/bmr.202610.00013V1	下载

• 公开评论  匿名评论  仅发给作者 提交评论