Pathogenesis and treatment of "turbid-toxin disturbing the spleen" in post-stroke cognitive impairment

Post-stroke cognitive impairment (PSCI) is a common complication of stroke, and specific therapeutic methods are lacking. A thorough understanding of its pathogenesis is crucial for effective clinical prevention and treatment. This article proposes that "turbid-toxin disturbing the spleen" is a crucial link in PSCI pathogenesis. Qi movement disorder after stroke leads to bowel obstruction and the accumulation of waste products, which then stagnate and turn into turbid and toxin, which are sticky and collateral-damaging. They accumulate in the middle jiao (intestinal tract), thereby suppressing the spleen yang and blocking qi movement. Consequently, clear yang fails to rise, and the turbid-toxin enters the blood via the meridians and ascends to cloud the orifices of the clear senses, causing damage to the spleen′s functions of storing ideas and governing thinking, and leading to impairments in higher cognitive activities such as memory, reasoning, and executive function. Accordingly, the therapeutic principle of "resolving turbidity and detoxifying, awakening and tonifying the spleen" was established: purgative medicinals such as Dahuang (rhubarb) and Mangxiao (crystallized sodium sulfate) are used to unblock the fu-organs, drain heat, and detoxify; aromatic medicinals such as Shichangpu(grassleaf sweetflag rhizome) and Sharen (amomum fruit) are used to resolve turbidity and awaken the spleen; blood-activating medicinals such as Chuanxiong (Sichuan lovage rhizome) and Danshen (danshen root) are used to detoxify and dispel stasis; and sweet-natured medicinals such as Huangqi (milkvetch root) and Danggui (Chinese angelica) strengthen the spleen and nourish the spirit. This study aims to provide a theoretical basis and practical approach for the clinical treatment of PSCI by deriving the therapeutic principle and herbal prescription from the pathogenesis of turbid toxin disturbing the spleen.