Central mast cells are one type of important immune cells in the brain together with central cells such as microglia cells and neurons. Central mast cells participate in a variety of physiological and pathological processes and play a two‑way role in nervous system diseases. This article summarizes the possible mechanism by which central mast cells are involved in neurogenesis and nerve protection under the physiological conditions, and its unusual activation causes blood brain barrier damage, nerve inflammation, stress, and neuropathological pain, so as to provide new thoughts for the treatment of nervous system diseases.