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基于中医津液代谢与痰浊阻窍相关理论，结合脑脊液-间质液交换、类淋巴清除及细胞外基质调控等研究进展，从病机演变、症状表现及治疗启示等层面探讨“无形之痰”的生物学内涵。脑内液体交换受阻可引起清除功能下降及代谢废物、病理蛋白滞留；细胞外基质异常重塑可进一步影响物质交换和局部微环境稳态，形成“流动减慢-清除下降-异常滞留”的病理过程。该过程与津液输布失常、痰浊内生并阻滞清窍的病机具有一定功能相似性，也可能与头昏蒙、认知及情绪异常等临床表现相关。部分化痰类中药改善脑内清除功能和细胞外微环境稳态的潜在作用值得进一步研究。中医“无形之痰”在脑组织中可能表现为以液体交换受限、清除功能下降和细胞外微环境失衡为特征的病理滞留状态，可为从痰论治神经及精神类疾病提供思路。
Abstract：Based on the traditional Chinese medicine(TCM) theories of body fluid metabolism and turbid phlegm obstructing the orifices, and drawing on recent advances in cerebrospinal fluid-interstitial fluid(CSF-ISF) exchange, glymphatic clearance, and extracellular matrix(ECM) regulation, this article discusses the possible scientific connotation of "invisible phlegm" from the perspectives of pathogenesis, clinical manifestations, and therapeutic implications. Impaired brain fluid exchange may lead to reduced clearance, the retention of metabolic wastes and pathological proteins. Abnormal ECM remodeling may further disrupt molecular diffusion and local microenvironmental homeostasis, resulting in a pathological process characterized by slowed fluid movement, reduced clearance, and abnormal retention. This process bears a certain functional resemblance to the TCM pathogenesis of impaired distribution of body fluids, endogenous formation of turbid phlegm and obstruction of the brain orifices, and may also be associated with manifestations such as a clouded sensation in the head, cognitive abnormalities, and emotional disturbances. On this basis, the potential effects of certain phlegm-dissolving Chinese medicines in improving brain clearance function and extracellular microenvironmental homeostasis warrant further investigation. We therefore propose that, the "invisible phlegm" of TCM in brain tissue may manifest as a pathological retention state characterized by restricted fluid exchange, impaired clearance function, and extracellular microenvironmental imbalance. This perspective may provide a new avenue for investigating TCM treatment of neurological and psychiatric disorders from the perspective of phlegm.
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基本信息:
DOI：10.13288/j.11-2166/r.2026.15.002
中图分类号:R228
引用信息:
[1]任毅铭,陆悦阳,张国瑗,等.从脑内液体交换与细胞外微环境调控探讨“无形之痰”的生物学内涵[J].中医杂志,2026,67(15):1592-1598.DOI:10.13288/j.11-2166/r.2026.15.002.
基金信息:
中国中医科学院中药监管科学研究项目（ZYJGKX202401）; 西藏自治区科技计划（XZ202501JX0007）
2026-08-02
2026-08-02