卒中后抑郁（PSD） 是卒中后的常见并发症之一，严重影响着患者的生活质量和疾病的转归。中医将其归属于中风与 郁证共病。该文基于“心-血-脉”一体论探讨了PSD的发病机制和治疗原则，认为PSD之发病始于血脉之变，继而发展为 心体之变，而心、血、脉三者之变均可引起神之变；其核心病机为心气虚、脉道不利而血瘀神郁，干预原则当护脉调血、养心 安神。护脉包括生脉、复脉、通脉三法，可分别运用生脉散、炙甘草汤、通脉四逆汤。调血可分别采用活血、生血之法，活 血可选用丹参饮、血府逐瘀汤等，生血之法选用八珍汤、人参养荣汤、当归补血汤等。养心安神可运用加味甘麦大枣汤、归脾 汤等。 “心-血-脉”一体论弥补了脉络学说中的形神分离、结构与功能分离之不足，为PSD的中医治疗拓展了思路。

Post-stroke depression （PSD） is one of the commonly-seen complications after stroke，which seriously affects patients’ quality of life and outcome of disease. Traditional Chinese medicine （TCM） classifies PSD as the co-morbidity of stroke and depression. This paper explored the pathogenesis and therapeutic principles of PSD from the view of “heart-blood-vessels” integration. It is proposed that PSD originates from the lesions of blood and vessels，and then the heart-body is involved；the lesions of heart，blood and vessels can cause the disorders of spirit. The core pathogenesis is due to the deficiency of heart qi，unsmoothed circulation of the vessels，and blood stasis causing depression of spirit. The principle of intervention of PSD should be focused on protecting vessels and regulating blood， nourishing heart and tranquilizing. Protecting vessels can be achieved by generating vessels， soothing vessels，and unblocking vessels through the application of Shengmai San，Zhi Gancao Decoction，and Tongmai Sini Decoction respectively. Regulating blood can be achieved by activating blood and generating blood. For activating blood， Danshen Decoction and Xuefu Zhuyu Decoction can be employed； for generating blood， Bazhen Decoction，Renshen Yangrong Decoction and Danggui Buxue Decoction can be employed. For nourishing heart and tranquilizing，the modified Gan Mai Dazao Decoction and Guipi Decoction can be employed. The view of “heart-blood-vessels” integration makes up for the disadvantages in separating the physique from the spirit，and in separating the structure from the function in the theory of the vessels and collaterals，and expands the approach of TCM treatment for PSD.

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广东省中医药局科研项目（编号：202204282125375600）； 佛山市“十四五”中医重点专科、特色专科和专病建设项目（编号： ZDZKJS24）； 佛山市卫生健康局医学科研项目（编号：20220459）；广东省名中医传承工作室建设项目（粤中医办函 〔2023〕 108 号）