Understanding of the concept and nature of blood stasis
Stasis: Shuowen Jiezi: “Stasis is also the accumulation of blood.” The term “stasis of blood” was first used in the Treatise on Typhoid and Miscellaneous Diseases.
Traditional Chinese medicine understanding: it refers to “blood flow loss of degree”, i.e. blood flowing in the veins loses its normal degree.
Modern research on blood circulation and stasis: It refers to the pathological changes in the form and function of body tissues resulting from the poor blood flow in the whole body or localized blood stagnation and the retention of blood away from the meridian in the body.
The nature of blood stasis from the perspective of modern medicine: it is related to blood circulation and microcirculation disorders, thrombosis, metabolic disorders, immune dysfunction, abnormal blood rheology, humoral regulation and endocrine disorders.
Traditional Chinese medicine understanding: It refers to various clinical syndromes caused by “blood flow disorder”.
Modern research on blood circulation and blood stasis: it refers to a series of clinical syndromes caused by internal obstruction of blood stasis. For those who lack clinical symptoms or signs, but exhibit hypercoagulability or hypercoagulability, the current tendency is that they belong to the precoagulable state.
The nature of blood stasis: 1. blood that is stagnant and internally caked; 2. blood that is free from the menstrual flow; 3. blood that is defiled.
1. Blood of internal stagnation: It refers to the slow running, blockage and coagulation of blood in the veins. Nei Jing: “Blood stagnation leads to obstruction”, “Blood coagulates and does not flow” Jin Kui: “Internal stagnation is blood stasis”
Modern research.
Abnormal blood rheology: abnormal rheology of red blood cells, abnormal rheology of white blood cells; it is believed that abnormal rheology of white blood cells is more sensitive and accurate to the viscous polycoagulation response of blood than to the rheology of red blood cells.
Hemodynamic changes: changes in cardiac output, volume per beat, cardiac index, blood flow to various organs, nail folds, bulbar conjunctiva, tongue and other microcirculation.
Thrombosis and arterial lumen narrowing: changes in platelet morphology and function, enhanced coagulation activity and reduced anticoagulation activity; arterial lumen narrowing caused by lipid deposition in the arterial wall, transitional proliferation of smooth muscle cells in the tubular junction and platelet aggregation.
2.Blood away from the meridian: refers to blood away from the meridian, can not be discharged from the body in time, loss of normal blood function, stay in the body to become pathological products of blood. The Blood Evidence: “The blood that leaves the menstrual vessels does not coincide with the good blood, which is called stasis blood. “
Modern research: all kinds of bleeding Endogenous coagulation system is activated, exogenous coagulation, system is activated (severe tissue destruction, a large number of tissue, tissue factors into the blood). Congenital cardiovascular diseases, vascular malformations of certain organs, blood supply of various neoplastic organisms, organ transplantation, vascular bypass recanalization, etc. Inadequate blood supply and hypoxia resulting in “non-hemorrhagic menstrual blood”. Endometriosis, ectopic pregnancy, uterine fibroids, gonorrhea, incomplete postpartum dew, etc.
Defiled blood: It is the blood that has lost its normal blood function and stagnates in the body, causing stasis. Nei Jing: “bad blood”, “blood”
The “Rules for the Treatment of Evidence”: “Defiled blood is stagnant blood” “All diseases are caused by defiled blood”
Modern research.
Exogenous “dirty blood”: blood “contaminated” by biological, physical and chemical factors, such as various pathogenic microorganisms and their endotoxins activate the endogenous coagulation system, fibrinolytic system, kinin and complement system; many inorganic or organic chemical substances, such as CO have a strong affinity for hemoglobin, forming carboxyhemoglobin; physical factors such as trauma, major surgery, and changes in atmospheric pressure activate the exogenous or endogenous coagulation system.
Endogenous “dirty blood”: The accumulation of self-metabolites in the blood caused by the failure of vital organs; for example, uremia, cirrhosis, hyperlipidemia, diabetes, etc.
Compound “dirty blood”: the above two coexist, commonly in allergic reactions and autoimmune diseases: such as nephritis, scleroderma, dermatomyositis, lupus erythematosus and other diseases. Antigenic substances stimulate the body to produce antibodies, antigen-antibody complexes, which are deposited in the tissues.
The pathophysiological essence of blood stasis is oxygen supply disorder
The availability of oxygen supply to tissue cells depends, first of all, on the good or bad blood circulation.
Diseases with a vascular severing nature (e.g. wounds) are the most serious blood stasis; organ dysfunction caused by blood transport disorders is stasis.
Myocardial infarction and thrombotic vasculitis directly affect the blood supply and are stasis; necrotic tissues have no blood supply and edematous tissues restrict the transport of oxygen from diffuse capillaries to tissue cells and are stasis; fibrous tissue hyperplasia and benign tumors have more stroma and fewer blood vessels and are stasis; malignant tumors are extremely rich in blood transport but still cannot meet the needs of overgrown tumor cells and are therefore stasis.
※ The appearance of cyanosis must be accompanied by an increase in the total venous blood volume of the skin (reduced hemoglobin) or a decrease in oxygen saturation. In cyanosis formation, the absolute value of reduced hemoglobin is more important than the relative value (cyanosis becomes apparent when the average reduced hemoglobin concentration in capillaries exceeds 50 g/L). In anemia, cyanosis may not be present despite a marked decrease in oxygen saturation; in erythrocytosis, cyanosis may be present despite the presence of high oxygen saturation; in peripheral cyanosis, it is due to slow blood flow and excessive tissue oxygen use; and in central cyanosis, it is due to a decrease in arterial oxygen saturation and the presence of abnormal hemoglobin.
Chinese standard (1986)
I. Main basis.
1. Purple and dark tongue or petechiae and petechiae on the tongue and stasis of sublingual varices. Slide
2. fixed pain, or colic, or abdominal pain refusing to be pressed.
3, Pathological masses, including visceral enlargement, neoplasia, inflammatory or non-inflammatory masses, tissue hyperplasia.
4.Vascular abnormalities, varicose veins in various parts of the body, capillary dilation, vascular spasm, lip and extremity cyanosis, thrombosis, and vascular obstruction.
5.Blood does not follow the menstruation and stagnation and bleeding caused by petechiae, black feces, subcutaneous petechiae, etc., or bloody ascites.
6.Menstrual disorders, abdominal pain during menstruation, black color with blood clots, urgent knots in the lesser abdomen, etc.
7.People with purple and black face, lips, gums and around the eyes. Slide
8.Pulse is astringent, or knotted or substituted, or no pulse.
Second, other basis.
1, skin nail error (rough skin, hypertrophy, increased scaling).
2, numbness or hemiplegia of the limbs.
3, mental mania.
4. Positive palatal mucosal sign (vascular varicosity, purple hue).
C. Laboratory basis.
1.Microcirculatory disorders.
2.Abnormal blood rheology.
3. Increased blood coagulability or decreased fibrinolytic activity.
4. Increased platelet aggregation or hyperfunction of platelet release.
5.Hemodynamic disorders.
6.Pathological section shows stasis of blood, etc.
7.Specific new technology shows vascular obstruction.
The diagnosis of blood stasis can be made if the following conditions are met.
1.With two or more major bases.
2.With one main basis, plus two laboratory bases or two other bases.
3.With two or more other bases, plus one laboratory basis.
Note]
Clinical evidence of blood stasis often has concurrent evidence, such as Qi deficiency and blood stasis, Qi stagnation and blood stasis, phlegm obstruction and blood stasis, or cold clotting and blood stasis, etc. Clinical diagnosis can be made according to the theory of traditional Chinese medicine and other relevant criteria.
1988.
1. Purple and dark tongue or petechiae and petechial spots.
2. Typical astringent pulse or no pulse.
3. Pain with a definite location (or prolonged pain, tapered pain or unpleasant pressure).
4, abdominal evidence of blood stasis.
5.Y accumulation.
6, Blood away from the menstrual flow (bleeding or stasis of blood from trauma).
7.Stasis of blood in the skin and mucous membrane, abnormal veins.
8, Dysmenorrhea with black color and blood clots or amenorrhea.
9, Skin nail error.
10.Hemiplegia and numbness.
11.Blood stasis mania.
12.Physical and chemical examination with blood circulation stasis.
Note]
1. Any one of the above can be diagnosed as blood stasis.
2.Diagnostic criteria for blood stasis in various disciplines are separately formulated.
3. Attention should be paid to the overall diagnosis and treatment of the relevant concurrent evidence.
Japanese criteria (Terasawa Jetnin et al.)
Judgment: below 20 points as non-stasis of blood evidence; above 21 points as stasis of blood evidence; above 40 points as severe stasis of blood evidence.
Chen Ke-Yi et al. Quantitative Blood Stasis Diagnostic Criteria Score Method
A score of 19 or less is considered non-stasis of blood; 20-49 is considered mild stasis of blood; 50 or more is considered severe stasis of blood.
Ear signs
Earlobe fold: The skin folds between the earlobes in a diagonal direction from the interpalpal cut to the edge of the earlobe.
Preauricular folds: two or more preauricular folds.
External ear canal hairs: one or more thick black ear hairs in the external ear canal.
Eye Signs Score
Dark red skin tone around the eyes 5 Cyanosis
Distorted or wavy deformity of the bulbar conjunctival microvessels >3 5 >6 10 or significant deformity
Microvessels in the bulbar conjunctiva are angular, varying in thickness or tumor-like >3 5 >6
Spherical conjunctival microvessels are reticulated to the extent that >1/8 of the spherical conjunctiva is deformed
Bulbar conjunctival vascular tone Dark red 5 Cyanotic
Bulbar conjunctival hemorrhagic spots
Hemorrhage, petechiae
Spherical conjunctiva reported injury points 1~2 5 >3
Score value: <19 points negative; >20 points positive (20~39 points mild, >40 points severe)
40 points or more for severe)
Palatal mucosal sign
0 degree: the small blood vessels are basically not visible on the palatal mucosa, and the mucosal surface is light red.
Soft palate mucosal signs.
Degree Ⅰ: the mucosa at the palatal arch is slightly red, and clearer small blood vessels are visible, this type basically belongs to the normal range.
Degree Ⅱ: there is the performance of degree Ⅰ, and small arteries or varicose veins can be seen.
Degree III: Small arteries on the mucosa of the soft palate are clearly dilated or small varicose veins are clearly stasis, or there is bleeding. Or a change in the mucosal surface color tone of deep red or dark purple is added to the change in degree II.
Hard palate mucosal signs.
Degree I: clear vessels are visible on the mucosa of the hard palate.
Degree II: small arteries on the mucosa are dilated and congested or small varicose veins are stasis.
Degree III: obvious small arterial congestion and dilatation or small venous stasis and varicose or bleeding, or a change in mucosal tone of deep red or dark purple on top of the degree II change.
Awareness of stasis of blood theory of treatment.
1. the treatment of stasis of blood with prescriptions.
2. the application of drug classification for stasis of blood.
3. clinical practice of the method of activating blood circulation and resolving blood stasis.
Jiangsu Zhou Zhongying’s nineteen methods for activating blood stasis and resolving stasis.
Seven methods for identifying pathological factors: the method of regulating Qi to eliminate stasis; the method of dispersing cold (warming the meridians) to eliminate stasis; the method of clearing heat (cooling the blood) to eliminate stasis; the method of tonifying Yang to eliminate stasis; the method of benefiting Qi to eliminate stasis; the method of nourishing blood to eliminate stasis; the method of nourishing Yin to eliminate stasis.
Characteristics of the application of Wang Qingren’s method of invigorating Blood and resolving stasis.
Tonifying the Blood and invigorating the Blood – invigorating the Blood and resolving stasis: peach kernel, red flowers, red peony, chuanxiong
Treating head, face and extremities Pungent and aromatic enlightenment: musk, onion, ginger, yellow wine
Blood stasis in the peripheral vessels
Blood Mansions and Blood Stasis Tang — Invigorating Blood stasis: Peach kernel, Red Flower, Red Peony, Chuanxiong
Treating blood stasis in the Blood Mansions of the chest :Angelica sinensis, Niubizi
Promoting Qi and broadening the chest: Chai Hu, Citrus aurantium, Radix Platycodon
Diaphragmatic Stasis Dissipation Tang — Promoting Blood circulation and resolving stasis: Peach kernel, Red Flower, Red Peony, Chuanxiong
Treating blood stasis in the abdomen; Angelica sinensis, Ganoderma lucidum, Dangpi
Promoting circulation of Qi and relieving pain: Aromatic Herb, Wu Yao, Yan Hu, Citrus Aurantium
① Selecting the remedy according to the site.
② Focus on moving Qi and reflect the intent of its divisions through the combination of Qi-activating drugs.
The basic drugs for promoting blood circulation and resolving blood stasis are: peach kernel, red flower, red peony, Chuanxiong, angelica
Shao Abdominal Stasis Removal Soup — Promoting Blood circulation and resolving blood stasis: Radix Paeoniae, Chuanxiong, Angelicae
For the treatment of painful accumulation of lumps in the lower abdomen: Pu Huang, Ling Li, Myrrh
Warming menstruation and promoting menstruation: cumin, cinnamon, ginger, etc.
Regulating Qi: Yan Hu
Body Pain and Removal of Blood Stasis: Peach kernel, Red Flower, Chuanxiong
For paralysis: Angelica sinensis, Ganoderma lucidum, Myrrh
Dispelling wind and removing dampness: Gentiana macrophylla, Qiangwu, Niu Knee
To promote menstruation and relieve pain: Di Long
Regulating Qi: Aromatic Herb
① Selecting and using medicines according to the type and nature of the disease.
② Focus on moving Qi and regulating Qi.
Guan Youbo’s 21 methods of treatment for blood stasis.
Treatment according to the pathological factors: benefit the qi and blood circulation method, promote qi and blood circulation method, nourish blood and blood circulation method, nourish yin and blood circulation method, stop bleeding and blood circulation method, warm yang and blood circulation method, dispel cold and blood circulation method, clear heat and blood circulation method
Treatment of Blood stasis with prescriptions.
Identification: nature of disease (Qi, Blood, Yin, Yang, Cold, Heat) type of disease (water, phlegm, accumulation, injury, swelling, bleeding, paralysis, etc.)
Identification of location: general division (trunk, limbs, skin and hair, etc.) division of internal organs (organs, viscera, meridians, etc.)
Current thinking on the use of blood activation and stasis removal.
Traditional.
1. to activate blood circulation and eliminate blood stasis – generally to move Qi and activate blood circulation; combined with location, disease nature, disease type, etc.; mainly treating obvious blood stasis.
2. To identify the evidence and seek for the main reason – on the basis of the conventional identification, add blood-activating and blood-stasis-eliminating drugs (according to the nature and flavor, generalization and main treatment, etc.).
Modern times: Combine with pharmacology to study the classification and application of blood stasis drugs
Classification according to the strength of blood-activating and stasis-removing drugs; classification according to the action of blood-activating and stasis-removing drugs.
Classification scheme of drugs for activating blood circulation and resolving stasis at Xiyuan Hospital of Beijing Institute of Traditional Chinese Medicine.
Blood-activating drugs, stasis-transforming drugs
Traditional range of drugs to invigorate blood circulation and resolve stasis (revised at the 1986 National Conference).
I. The concept of traditional blood-activating and stasis-transforming drugs.
Any drug whose main function is to unblock blood vessels, remove stagnation and make blood flow smoothly is called blood activating and stasis-transforming drug.
Second, the scope of traditional blood-stasis-activating drugs.
Traditionally, it is believed that all drugs that can “harmonize blood”, “activate blood”, “disperse blood”, “move blood”, “break blood” and “remove blood stasis” are called blood-stasis activators. All drugs that can “harmonize Blood”, “invigorate Blood”, “disperse Blood”, “move Blood”, “break Blood”, “expel Blood stasis”, and “main evil Blood” belong to the scope of blood activating and stasis removing drugs.
According to their degree of action, they are divided into three categories, namely, blood-healing, blood-invigorating and blood-breaking.
1, and the blood class of drugs: refers to the blood, and the role of blood vessels.
Including Angelica, Dampi, Salvia, Radix Rehmanniae, Radix Paeoniae, and Coriolus Versicolor.
2, blood-activating drugs: refers to those who have the effect of activating the blood, blood circulation and blood stasis.
Including Chuanxiong, Puhuang, safflower, Liu Yifan, Wu Lingliao, Yujin, Panax ginseng, rhubarb, turmeric, motherwort, panax notoginseng, Zelenia, Sumac, Oxalis, grubs, Yanhuosuo, ghost feather, frankincense, myrrh, Wang Buliu Xing, Ziwei twenty-one.
3, blood-breaking drugs: refers to those who have the effect of breaking blood and eliminating blood stasis and attacking hardness.
Including leeches, caddisfly, trigon, curcuma, blood, peach kernel, dry lacquer, turtle worms, stinging insects nine.
Drugs classified according to their action to invigorate blood and remove blood stasis.
Nourishing the Blood and invigorating the Blood – Angelica sinensis, Salvia miltiorrhiza, Cortex roxburghii, Panax ginseng.
Activating blood circulation and relieving pain – Chuanxiong, Yanhu, Yujin, Boswellia, Myrrh, Phellodendron, Linglip, Ginger, Salvia, Radix Paeoniae, Angelicae Sinensis, Curcuma longa
Activating blood circulation – Dan Shen, Angelica sinensis, Chuanxiong, Turmeric, Gynostemma, Frankincense, Myrrh, Peach kernel, Safflower, Di Long, Andrographis paniculata.
Activating blood circulation and stopping bleeding – Panax ginseng, Cyperus rotundus, Phellodendron, Radix et Rhizoma, Rhubarb
cooling the blood and dispersing blood stasis – Salvia miltiorrhiza, Salvia miltiorrhiza, Radix et Rhizoma Paeoniae, Yujin, Peach kernel, Comfrey
Invigorating the Blood to eliminate carbuncles – Salvia miltiorrhiza, Paeonia lactiflora, Red Vine, Zelenia, Boswellia, Myrrh, Peach kernel, Andrographis paniculata, Wang Bu Li Xing.
Invigorating the blood to heal wounds – Panax ginseng, Sumac, Safflower, Boswellia, Myrrh, Yanhu, Chuanxiong, Dangpi, Blood exhaustion, Lingliao, Liu Yao Nuo, Radix et Rhizoma, Tiger Balm, Natural Copper, Stinging Worm.
Activating blood circulation and regulating menstruation – Angelica sinensis, Chuanxiong, Radix Paeoniae Alba, Salviae Miltiorrhizae, Cortex Eucommiae, Peach kernel, Safflower, Lobelia, Yujin, Zelenia, Yimou, Radix Bupleurum, Zweiwei, Tiger Balm, Wang Bu Li Xing.
Activating blood circulation and eliminating blood stasis – Salvia miltiorrhiza, Rhizoma Chuanxiong, Radix Angelicae Sinensis, Peach kernel, Safflower, Radix Paeoniae Alba, Salviae Miltiorrhiza, Radix Achyranthes bidentatae, Rhizoma Rhei, Stinging worm
Breaking blood and expelling blood stasis – Salvia miltiorrhiza, Trigonella, Curcuma longa, Curcuma longa, Andrographis paniculata, leech, gadfly, stinging worm.