目的：探究柴温桂苓汤对缺血性脑卒中后抑郁痰瘀阻络证下丘脑-垂体-肾上腺素轴功能的影响。方法：选取2022年6月至2024年7月我院收治的缺血性脑卒中后抑郁患者96例，根据随机数字表法分组，对照组48例采用常规治疗，研究组48例在对照组基础上采用柴温桂苓汤治疗。治疗4周后比较两组临床疗效、中医证候积分、汉密尔顿抑郁量表24项评分、下丘脑-垂体-肾上腺素轴功能指标、下丘脑-垂体-性腺轴功能指标、脑CT参数、皮质醇、甲状腺功能指标、褪黑素水平、美国国立卫生研究院卒中量表评分、日常生活活动能力评分、不良反应发生情况。结果：研究组总有效率93.75%，高于对照组77.08%（P<0.05）。治疗4周后，研究组中医证候积分低于对照组（P<0.05）；研究组汉密尔顿抑郁量表24项评分低于对照组（P<0.05）；研究组皮质醇（Cor）、促肾上腺皮质激素释放激素（CRH）及促肾上腺皮质激素（ACTH）水平均低于对照组（P<0.05）；研究组卵泡刺激素（FSH）、黄体生成素（LH）、睾酮（T）、雌二醇（E2）高于对照组（P<0.05）；研究组脑血流量高于对照组，梗死灶体积及水肿带宽度小于对照组（P<0.05）；研究组皮质醇、促甲状腺激素（TSH）低于对照组，游离甲状腺素（FT4）、褪黑素高于对照组（P<0.05）；研究组美国国立卫生研究院卒中量表得分低于对照组，日常生活活动能力评分高于对照组（P<0.05）。两组治疗过程中均无心电图、血常规、肝肾功能异常发生，且未发生严重不良事件。结论：柴温桂苓汤治疗缺血性脑卒中后抑郁痰瘀阻络证疗效明显，能够减轻临床症状，改善抑郁情况、下丘脑-垂体-肾上腺素轴及性腺轴功能、脑血流、甲状腺功能、睡眠-觉醒节律，减轻应激反应，加快神经功能及日常生活活动能力恢复，且安全可靠。

Objective： To investigate the effect of Chaiwen Guiling decoction on the function of the hypothalamic-pituitary-adrenergic axis in post-ischemic stroke depression patients with phlegm stasis obstruction syndrome.Methods： 96 patients with post-ischemic stroke depression admitted to our hospital from June 2022 to July 2024 were selected and grouped according to the random number table method. 48 cases in the control group were treated with conventional therapy， while 48 cases in the study group were treated with Chaiwen Guiling Decoction on the basis of the control group. After 4 weeks of treatment， the clinical efficacy， TCM syndrome score， Hamilton Depression Scale 24 item score， hypothalamic-pituitary-adrenergic axis fnnction indictors， hypothalamic-pituitary-gonadal axis function indictors， brain CT parameters， cortisol， thyroid function， melatonin levels， National Institutes of Health Stroke Scale， Activities of Daily Living score， and the occurrence of adverse reactions were compared between the two groups.Results： The total effective rate of the research group was 93.75%， which was higher than the control group's 77.08% （P<0.05）. After 4 weeks of treatment， the TCM syndrome scores in the study group were lower than those in the control group （P<0.05）. The Hamilton Depression Scale scores for 24 items in the study group were lower than those in the control group （P<0.05）. The levels of cortisol （Cor）， corticotropin releasing hormone （CRH）， and adrenocorticotropic hormone （ACTH） in the study group were all lower than those in the control group （P<0.05）. The levels of follicle stimulating hormone （FSH）， luteinizing hormone （LH）， testosterone （T）， and estradiol （E2） in the study group were higher than those in the control group （P<0.05）. The cerebral blood flow in the study group was higher than that in the control group， while the infarct volume and edema zone width were smaller than those in the control group （P<0.05）. The cortisol and thyroid stimulating hormone （TSH） levels in the study group were lower than those in the control group， while free thyroxine （FT4） and melatonin levels were higher than those in the control group （P<0.05）. The study group had lower scores on the National Institutes of Health Stroke Scale and higher scores on Activities of Daily Living than the control group （P<0.05）. There were no abnormalities in electrocardiogram， blood routine， liver and kidney function during the treatment of both groups， and no serious adverse events occurred.Conclusion： Chaiwen Guiling decoction has significant therapeutic effects on post-ischemic stroke depression patients with phlegm stasis obstruction syndrome. It can alleviate clinical symptoms， improve depression， hypothalamic pituitary adrenal axis and gonadal axis function， cerebral blood flow， thyroid function， sleep wake rhythm， alleviate stress response， accelerate the recovery of neurological function and daily living activities， and is safe and reliable.