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) Treatment2005-05-26，北京血瘀证BSS, Xue Yu ZhengOketsu SyndromeEohyul (血流不畅，血液淤滞的 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(1) Many kinds of modern diseases and/or their clinical manifestations could be diagnosed within BSS category n心血管系统：冠心病心绞痛，急性心肌梗死，风湿 性心脏病，心力衰竭，各类脉管炎等n神经精神系统：脑中风，脑外伤，慢性头痛，震颤 麻痹，周围神经疾病，精神分裂症n血液系统疾病：真性红细胞增多症，紫癜，再障， 弥漫性血管内凝血，高粘血症等n消化系统：溃疡病，胃炎，消化道出血，慢性肝炎 ，肝纤维化n呼吸系统：慢性阻塞性肺疾病，高原反应等n泌尿系统：急慢性肾炎，血尿等n免疫系统：硬皮病，红斑狼疮，类风湿性关节炎， 荨麻疹，血管神经性水肿等多种病可归入血瘀证范畴(2) Many kinds of modern diseases and/or their clinical manifestations could be diagnosed within BSS category n代谢系统：高脂血症，糖尿病神经血管并发症等n结缔组织系统：灼伤及外伤性皮肤瘢痕，角膜瘢痕等n妇产科：功能性子宫出血，痛经，子宫内膜异位症， 宫外孕，盆腔炎，子宫肌瘤等n儿科：新生儿硬肿症，肝炎及紫癜等n皮肤科：红斑结节类病，色素沉着性病，酒糟鼻n眼科：视网膜血管阻塞病，眼部免疫病及退行性病n口腔及耳鼻喉科：三叉神经痛，突发性聋等n骨科：骨折等n外科：部分急腹症等n肿瘤科：血管瘤，肝癌等n器官移植：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（慢瘀）n温热病重症必瘀（热瘀）n创伤外症多瘀（伤瘀）n急症多瘀（急瘀）n老年多瘀（老瘀）n寒凝致瘀（寒瘀）n紫舌无症状（潜瘀,前瘀）主要依据生物流变学特点（血管流 变学及血液流变学所见）宏观生物流变学（血液粘度， 血浆粘度，血管壁应力，微血 管应力）微观生物流变学（红细胞聚集 性及变形能力，红细胞血小板 表面电荷水平；血细胞性状、 粘附性及变形性；血浆蛋白含 量，凝血因子，细胞膜功能， 神经介质，免疫因子，血栓素 等水平）真性红细胞增多症、肺心病 、心衰、高原反应、脑梗塞 、心肌梗塞、周围血管阻塞 、休克、高脂血症、高血压 、原发性骨髓瘤、多数肿瘤 、烧伤、创伤、脱水、增龄 改变、DIC、甲亢、经期妇 女、妊娠、红斑狼疮、视网 膜静脉阻塞、ARDS、部分感 染等 失血、贫血、晚期肿瘤、 尿毒症、肝硬变腹水、酒 精中毒、部分白血病、部 分月经病、红细胞膜损伤 等 血瘀证的现代分类 BSS modern classificationnBlood and vessels stasis 血脉凝泣 Evil blood 恶血 Retained blood 留血 Vascular obstruction 脉不通 Injured blood stasis 损伤瘀血 Blood-stasis due to accumulated cold 寒 凝瘀血 Blood-stasis due to anger 大怒瘀血血瘀证的经典概念(1)Classical Concepts of BSSQuoted from “Inner Classic of the Yellow Emperor” (West Han Dynasty, 100 B.C.)（选引自黄帝内经）血瘀证的经典概念(2)Classical Concepts of BSSBlood-stasis due to chronic disorders 病久入深瘀血 Blood-stasis with sudden pain of organs 瘀血“五藏卒痛” Blood-stasis with arthralgia 瘀血痹证 Syncope due to blood-stasis 瘀血厥证 Carbuncle due to blood-stasis 瘀血成痈 Blood-stasis with blood exhaustion 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）“Stagnation blood accumulated in certain channel or organ” Extracted from Dr. Zhang Zhong-jings “Golden Chamber” and “On Febrile”(East Han Dynasty, 142220A.D.) （选引自张仲景伤寒论、金匮要略)）“瘀血病脉证治”专论“Many chronic diseases could have blood-collateral disturbances” (“久病 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）慢性疾病血瘀证“Although there were many causes of diseases, they fell mainly 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 有亏瘀”） Adopted from Dr. Wang Ching-rens “Corrections in Chinese Medicine”(Qing Dynasty, 17681831A.D.)（引自王清任医林改错）临床重视血瘀证的治疗十纲辨证(Diferentiation with ten principle syndromes)+ 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Principle Syndromesfrom eight to ten血瘀证基本诊断条件(1) Fundamental conditions for BSS diagnosis Purple of the tongue, or purple dots or scars on the tongue 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 Pathological mass including organic enlargement, newly mass, inflammatory mass, histological hyperplasia or degeneration 瘀积肿块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 Bleeding and its consequence as blood-stool, subcutaneous purple scars 出血及其后遗证如黑便及皮下瘀斑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 Menstruation disorder 月经失调 Numbness of extremeties or hemiplegia 肢体麻木或偏瘫 Mania with emotional excitement or amnesia (forgetfulness) 情志记忆失常 Periodical mental dysfunction 周期性精神失常 Ascites 腹水血瘀证实验室所见 Laboratory findings for BSS diagnosis Microcirculation disturbance 微循环失调 Abnormal hemorheology 血流变学异常 Hemodynamic changes 血流动力学异常 Platelet hyperaggregation 血小板聚集性增高 Cerebro-vascular thrombosis or embolism 脑血管梗塞 Ultrastructural blood-stasis by Echo, angiography or CT/MRI examination 超声、血管造影或CT/MRI所见超微结构血瘀征象临床研究用定量血瘀证诊断标准记分方法 The BSS scores for clinical diagnosis舌质紫暗少腹部抵抗压痛脉涩 黑便 病理性肿块 舌下脉曲张脉结代 无脉 腹壁静脉曲张 皮下瘀血斑月经色黑有块持续心绞痛 一般固定性疼痛 口唇齿龈暗红 细络 手足麻木（轻）8 （重）10 （轻）8 （重）10 10 10 10 （轻）8 （重）10 8 10 10 （轻）8 （重）10 （轻）8 （重）10 10 8 6 5 5手术史 腭粘膜征阳性肢体偏瘫精神异常皮肤粗糙全血粘度升高 血浆粘度升高 体外血栓干重增加 体外血栓湿重增加 血小板聚集性增高 血栓弹力图异常 微循环障碍 血液动力学障碍 纤溶活性降低 血小板释放功能亢进 病理切片示血瘀 新技术显示血管阻塞5 （轻）4 （重）5 （轻）5 （重）7 （烦躁）4 （狂躁）8 （轻）4 （重）5 10 5 10 8 10 8 10 10 10 10 10 10 注:判断标准以19分以下为非血瘀证;2049分为轻度血瘀证;50分以上为重度血瘀证 三类活血化瘀药物 Three Kinds of ABC Herbs1. 和血类药物 Blood-ha