血瘀证和活血化瘀治疗临床研究.ppt

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1、血瘀证和活血化瘀治疗临床研究血瘀证和活血化瘀治疗临床研究Clinical Research on Blood-stasis Syndrome(BSS)and Activating-blood-circulation(ABC)Treatment 血瘀证 BSS,Xue Yu Zheng Oketsu Syndrome Eohyul(血流不畅，血液淤滞的血流不畅，血液淤滞的一种证候）一种证候）n具有中国传统医学特色的一种综合征诊断n国际传统医学界认同n涉及病种多,临床实践指导意义大多种病可归入血瘀证范畴多种病可归入血瘀证范畴(1)(1)Many kinds of modern diseases a

2、nd/or their clinical manifestations could be diagnosed within BSS category n心血管系统心血管系统：冠心病：冠心病心绞痛心绞痛，急性，急性心肌梗死心肌梗死，风湿风湿性心脏病，心力衰竭性心脏病，心力衰竭，各类脉管炎等，各类脉管炎等n神经精神系统神经精神系统：脑中风，脑外伤脑中风，脑外伤，慢性头痛，震颤，慢性头痛，震颤麻痹，周围神经疾病，精神分裂症麻痹，周围神经疾病，精神分裂症n血液系统疾病血液系统疾病：真性红细胞增多症真性红细胞增多症，紫癜，再障，紫癜，再障，弥漫性血管内凝血，弥漫性血管内凝血，高粘血症高粘血症等等n消化系

3、统消化系统：溃疡病，胃炎，消化道出血，：溃疡病，胃炎，消化道出血，慢性肝炎，慢性肝炎，肝纤维化肝纤维化n呼吸系统呼吸系统：慢性阻塞性肺疾病，：慢性阻塞性肺疾病，高原反应高原反应等等n泌尿系统泌尿系统：急慢性肾炎，血尿等：急慢性肾炎，血尿等n免疫系统免疫系统：硬皮病硬皮病，红斑狼疮，类风湿性关节炎，红斑狼疮，类风湿性关节炎，荨麻疹，血管神经性水肿等荨麻疹，血管神经性水肿等多种病可归入血瘀证范畴多种病可归入血瘀证范畴(2)(2)Many kinds of modern diseases and/or their clinical manifestations could be diagnosed

4、within BSS category n代谢系统代谢系统：高脂血症，糖尿病神经血管并发症等：高脂血症，糖尿病神经血管并发症等n结缔组织系统结缔组织系统：灼伤及外伤性皮肤瘢痕，角膜瘢痕等：灼伤及外伤性皮肤瘢痕，角膜瘢痕等n妇产科妇产科：功能性子宫出血，痛经，子宫内膜异位症，：功能性子宫出血，痛经，子宫内膜异位症，宫外孕宫外孕，盆腔炎，子宫肌瘤等，盆腔炎，子宫肌瘤等n儿科儿科：新生儿硬肿症，肝炎及：新生儿硬肿症，肝炎及紫癜紫癜等等n皮肤科皮肤科：红斑结节类病，色素沉着性病，酒糟鼻：红斑结节类病，色素沉着性病，酒糟鼻n眼科眼科：视网膜血管阻塞病视网膜血管阻塞病，眼部免疫病及退行性病，眼部免疫病及退

5、行性病n口腔及耳鼻喉科口腔及耳鼻喉科：三叉神经痛，突发性聋等：三叉神经痛，突发性聋等n骨科骨科：骨折骨折等等n外科外科：部分急腹症等：部分急腹症等n肿瘤科肿瘤科：血管瘤血管瘤，肝癌等，肝癌等n器官移植器官移植：排异反应等：排异反应等中国传统医学特色诊断：血瘀证Chinese Medicine Features Diagnosis-BSSn久病多瘀（久病多瘀（慢瘀慢瘀）n温热病重症必瘀（热瘀）温热病重症必瘀（热瘀）n创伤外症多瘀（创伤外症多瘀（伤瘀伤瘀）n急症多瘀（急症多瘀（急瘀急瘀）n老年多瘀（老瘀）老年多瘀（老瘀）n寒凝致瘀（寒瘀）寒凝致瘀（寒瘀）n紫舌无症状（紫舌无症状（潜瘀潜瘀,前瘀前瘀

6、）主要依据 生物流变学特点（血管流生物流变学特点（血管流变学及血液流变学所见）变学及血液流变学所见）宏观生物流变学宏观生物流变学（血液粘度，（血液粘度，血浆粘度，血管壁应力，微血血浆粘度，血管壁应力，微血管应力）管应力）微观生物流变学微观生物流变学（红细胞聚集（红细胞聚集性及变形能力，红细胞血小板性及变形能力，红细胞血小板表面电荷水平；血细胞性状、表面电荷水平；血细胞性状、粘附性及变形性；血浆蛋白含粘附性及变形性；血浆蛋白含量，凝血因子，细胞膜功能，量，凝血因子，细胞膜功能，神经介质，免疫因子，血栓素神经介质，免疫因子，血栓素等水平）等水平）真性红细胞增多症、肺心病、真性红细胞增多症、肺心病、

7、心衰、高原反应、脑梗塞、心衰、高原反应、脑梗塞、心肌梗塞、周围血管阻塞、心肌梗塞、周围血管阻塞、休克、高脂血症、高血压、休克、高脂血症、高血压、原发性骨髓瘤、多数肿瘤、原发性骨髓瘤、多数肿瘤、烧伤、创伤、脱水、增龄改烧伤、创伤、脱水、增龄改变、变、DICDIC、甲亢、经期妇女、甲亢、经期妇女、妊娠、红斑狼疮、视网膜静妊娠、红斑狼疮、视网膜静脉阻塞、脉阻塞、ARDSARDS、部分感染等部分感染等 失血、贫血、晚期肿瘤、失血、贫血、晚期肿瘤、尿毒症、肝硬变腹水、酒尿毒症、肝硬变腹水、酒精中毒、部分白血病、部精中毒、部分白血病、部分月经病、红细胞膜损伤分月经病、红细胞膜损伤等等 血瘀证的现代分类血瘀

8、证的现代分类BSS modern classificationnBlood and vessels stasis 血脉凝泣血脉凝泣Evil blood 恶血恶血Retained blood 留血留血Vascular obstruction 脉不通脉不通Injured blood stasis 损伤瘀血损伤瘀血Blood-stasis due to accumulated cold 寒寒凝瘀血凝瘀血Blood-stasis due to anger 大怒瘀血大怒瘀血血瘀证的经典概念(1)Classical Concepts of BSSQuoted from“Inner Classic of t

9、he Yellow Emperor”(West Han Dynasty,100 B.C.)（选引自黄帝内经黄帝内经）血瘀证的经典概念血瘀证的经典概念(2)Classical Concepts of BSS Blood-stasis due to chronic disorders 病久入深瘀血病久入深瘀血Blood-stasis with sudden pain of organs 瘀血瘀血“五藏卒痛五藏卒痛”Blood-stasis with arthralgia 瘀血痹证瘀血痹证Syncope due to blood-stasis 瘀血厥证瘀血厥证Carbuncle due to blo

10、od-stasis 瘀血成痈瘀血成痈Blood-stasis with blood exhaustion 瘀血血枯瘀血血枯Quoted from“Inner Classic of the Yellow Emperor”(West Han Dynasty,100 B.C.)（选引自黄帝内经黄帝内经）“Stagnation blood accumulated in certain channel or organ”Extracted from Dr.Zhang Zhong-jings “Golden Chamber”and“On Febrile”(East Han Dynasty,142220A.

11、D.)（选引自张仲景伤寒论伤寒论、金匮要略金匮要略)）“瘀血病脉证治”专论“Many chronic diseases could have blood-collateral disturbances”(“久病久病入络入络”)Quoted from Dr.Ye Tian-shis“Clinical Guidance with Case Studies”(Qing Dynasty,16671746 A.D.)（选引自叶天士临证指南医案临证指南医案）慢性疾病血瘀证慢性疾病血瘀证“Although there were many causes of diseases,they fell mainly

12、 into two groups:disturbances Qi and Xue(blood).There were strong and weak Qi,and there were the anemic and congealed blood(stasis)”.Dr.Wang listed fifty more diseases due to BSS in his book.（“治病之要决在于明气血，气有虚实，血治病之要决在于明气血，气有虚实，血有亏瘀有亏瘀”）Adopted from Dr.Wang Ching-rens “Corrections in Chinese Medicine”

13、(Qing Dynasty,17681831A.D.)（引自王清任医林改错医林改错）临床重视血瘀证的治疗临床重视血瘀证的治疗十纲十纲辨证辨证(Diferentiation with ten principle syndromes)+气血辨证气血辨证气虚、气陷、气滞、气逆血虚、血瘀、血热气滞血瘀、气虚血瘀、气血两虚气虚失血、气随血脱、痰瘀互结阴阳、寒热、表里、虚实阴阳、寒热、表里、虚实Principle Syndromesfrom eight to ten血瘀证基本诊断条件血瘀证基本诊断条件(1)Fundamental conditions for BSS diagnosis Purple of

14、 the tongue,or purple dots or scars on the tongue 舌质紫黯或有瘀斑、瘀点舌质紫黯或有瘀斑、瘀点 Hesitant pulse,or slow and uneven pulse,and intermittent pulse,or lack of pulse 涩脉、间歇脉、或无脉 Constant prickly pain or colic pain with resistance of pressing 痛有定处，不喜按痛有定处，不喜按Pathological mass including organic enlargement,newly ma

15、ss,inflammatory mass,histological hyperplasia or degeneration 瘀积肿块瘀积肿块 血瘀证基本诊断条件血瘀证基本诊断条件(2)Fundamental conditions for BSS diagnosis Abnormal blood vessels including varicosity of undertongue or other parts,capillary dilation,spasm,cyanosis of lips or extremeties,obstruction 舌下或他处瘀阻，唇或四肢青紫，梗阻舌下或他处瘀阻

16、，唇或四肢青紫，梗阻 Bleeding and its consequence as blood-stool,subcutaneous purple scars 出血及其后遗证如出血及其后遗证如黑便及皮下瘀斑黑便及皮下瘀斑血瘀证其他诊断条件血瘀证其他诊断条件Other conditions(manifestation due to blood-stasis)for BSS diagnosis Rough skin,skin hypertrophy or alligator skin-crumps 肌肤甲错肌肤甲错 Menstruation disorder 月经失调月经失调 Numbness of extremeties or hemiplegia 肢体麻木或肢体麻木或偏瘫偏瘫 Mania with emotional excitement or amnesia(forgetfulness)情志记忆失常情志记忆失常 Periodical mental dysfunction 周期性精神失常周期性精神失常 Ascites 腹水腹水血瘀证实验室所见Laboratory findings f