The pathological mechanism of "brain orifices confused by phlegm" in ischemic stroke from the perspective of lipid metabolism disorder in the brain

In traditional Chinese medicine (TCM), ischemic stroke belongs to the category of "apoplexy". Brain orifices confused by phlegm is one of the core pathogeneses of apoplexy, and phlegm is an essential pathological factor; however, its modern biological basis remains unclear. As the most lipid-rich organ in the human body, lipids play a pivotal role in maintaining its structure and function. Intracerebral lipid metabolism disorders, such as dysregulation of cholesteraol and phospholipids, may occur in the acute phase of ischemic stroke and can further induce neuroinflammation. From the perspective of TCM, post-stroke phlegm obstructs the clear orifices, leading to obstruction of the clear orifices and dysfunction of the mind. Although these two perspectives differ, they share an intrinsic connection. Our team believes that after stroke, the three pathological factors of phlegm, heat, and blood stasis interact with each other: phlegm can aggravate heat and promote blood stasi; phlegm, heat, and blood stasis block the cerebral collaterals and cloud the clear orifices, which jointly drive the occurrence and development of the spirit orifices confused by phlegm. The disorder of lipid metabolism in the brain induces the formation of lipid droplets in the brain, and the abnormal lipid metabolism drives neuroinflammation, lipid accumulation and inflammatory chemotaxis to stimulate the formation of microthrombosis. Therefore, this paper proposes the pathological mechanism of the spirit orifices confused by phlegm in ischemic stroke, which includes not only lipid metabolism disorder in the brain after ischemic stroke, but also neuroinflammation and microthrombosis driven by such cerebral lipid metabolic disturbance. The purpose of this article is to provide a modern perspective for brain orifices confused by phlegm, and lay a foundation for clinical practice and theoretical innovation of ischemic stroke from the perspective of clearing heat and resolving phlegm.