Abstract: Background　Wuyintiaoshen therapy（acupuncture combined with five-element music therapy）has proven to be effective in treating post-stroke depression（PSD），but there is a lack of studies on its clinical response and mechanism of action in PSD patients with liver qi stagnation and spleen deficiency syndrome. Objective　To investigate the clinical，gut flora，and serum serotonin responses to Wuyintiaoshen therapy in mild-to-moderate PSD patients with liver qi stagnation and spleen deficiency syndrome. Methods　Seventy-two mild-to-moderate PSD outpatients and inpatients with liver qi stagnation and spleen deficiency syndrome were recruited from the Rehabilitation Clinic and Ward of the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine，and equally randomized into control group（routine medical treatment with escitalopram）and experimental group（routine medical treatment with Wuyintiaoshen therapy）. Clinical response，pre- and post-treatment mean Hamilton Rating Scale for Depression（HAMD-17）scores，Gastrointestinal Symptom Rating Scale（GSRS）scores，number of strains of gut floras and serum serotonin levels were compared between the two groups. Results　After treatment，the experimental group had better clinical response，lower mean HAMD-17 and GSRS scores，higher mean number of strains of Bifidobacterium and Lactobacillus，lower mean number of strains of Escherichia coli and Enterococcus，and higher mean serum serotonin level than the control group（P<0.01）. Conclusion　Wuyintiaoshen therapy could effectively reduce the depression level，alleviate gastrointestinal symptoms，and regulate gut flora and serum serotonin level，indicating that the therapy could improve both physical and mental conditions in mild-to-moderate PSD patients with liver qi stagnation and spleen deficiency syndrome.

Key words: Depression, Stroke, Liver qi stagnation and spleen deficiency, Five-elements, Music therapy, Acupuncture, Gastrointestinal microbiome, Serotonin

摘要： 背景　“五音调神法”治疗卒中后抑郁（PSD）的临床疗效较好，但尚缺乏针对肝郁脾虚型PSD患者的临床疗效及其作用机制研究。目的　探讨“五音调神法”治疗轻中度肝郁脾虚型PSD患者的临床疗效及其对肠道菌群和血清5-羟色胺（5-HT）水平的影响。方法　选取2019年12月至2020年12月山东中医药大学第二附属医院康复医学科病房和门诊收治的轻中度肝郁脾虚型PSD患者72例，采用随机数字表法分为对照组和试验组，每组36例。在常规内科治疗基础上，对照组患者采用艾司西酞普兰治疗，试验组患者采用“五音调神”法治疗。比较两组患者临床疗效及治疗前后汉密尔顿抑郁量表17项版（HAMD-17）评分、胃肠道症状评定量表（GSRS）评分、肠道菌群数量、血清5-HT水平。结果　试验组患者临床疗效优于对照组，治疗后HAMD-17评分、GSRS评分低于对照组，双歧杆菌、乳酸杆菌数量多于对照组，大肠埃希菌、肠球菌数量少于对照组，血清5-HT水平高于对照组（P<0.01）。结论　“五音调神法”能够达到身心同治的目的，可在有效减轻轻中度肝郁脾虚型PSD患者抑郁程度与胃肠道症状的同时调节肠道菌群、血清5-HT水平。

关键词: 抑郁, 卒中, 肝郁脾虚, 五行, 音乐疗法, 针刺, 胃肠道微生物组, 血清素