黄睿婷 张鹏横 阮璐薇 任秋萍

【摘要】 情志变化是围绝经期肝郁证的主要临床表现，亦是肝郁病理的外在表现，与“肝主疏泄，调节情志”密切相关。中医肝调节情志的调控因素复杂，其中以大脑的中枢调控为主，而神經环路又是中枢调控的基本单位。因此，本文以肝脑相维为切入点，从肝调节情志所涉及的神经环路角度，揭示围绝经期肝郁证的病理机制，旨在丰富“肝主疏泄，调节情志”的科学内涵，以期为相关研究提供新的方法与策略。

【关键词】 肝脑相关 情志 神经环路 围绝经期 肝郁证

[Abstract] Emotional change is the main clinical manifestation of liver stagnation in perimenopausal period， and also the external manifestation of liver depression pathology， which correlates with “liver controlling dispersion and regulating emotion”. Its complex that the factors of liver regulating emotion， among which the central regulation of brain is the main one， whats more neuronal circuit is the basic unit of central regulation. Therefore， in this paper， from the perspective of neuronal circuit involved in liver regulating emotion， the liver-brain correlation is used as the entry point， to reveal the pathological mechanism of liver stagnation in perimenopausal period. In order to enrich the scientific connotation of “liver controlling dispersion and regulating emotion”， as well as provide new methods and strategies for research.

[Key words] Liver-brain correlation Emotion Neuronal circuit Perimenopausal period Liver stagnation

肝气郁是肝脏病理变化中最为常见的一种病理变化，常以精神情志变化为其临床表现。有研究指出，从生理学基础角度，肝主疏泄的调控中枢主要涉及大脑，而神经环路是构成脑部神经系统的基本单元[1]。围绝经期肝郁证以情志精神变化为主要临床表现，主要包括抑郁和焦虑，两者常伴随出现，该病以肝为起病之源，脑为传病之所[2]。因此以肝脑相维为理论基础，从肝调节情志所涉及相关神经环路着手，进而对如何研究围绝经期肝郁证的病理机制展开讨论。

1 肝脑相维的理论渊源

1.1 肝脏象理论的现状 中医认为肝位于腹腔，横隔之下，右胁之内，与现代解剖学整体定位上大致相符。然西医之肝，为实质性的器官;中医之肝，脱离解剖范畴，为气化、气机的肝[3]。肝属木，木曰曲直，具生长、生发、条达之势。因此由木之特性，决定疏泄为肝之肝脏首要功能。肝主疏泄，气机调畅，流通全身自如;肝藏血，血得以藏，枢调周身血液。……