马芳　房定亚

摘要 瘀血分经脉内瘀血和离经之血2种情况，活血化瘀法的应用不局限在治疗“脉内瘀血”的范畴，对于出血性疾病亦须重视活血化瘀，这是因为出血会开启机体自身的凝血机制，从而导致血瘀证的产生，瘀血既是病理产物又可成为新的致病因素，对于出血性疾病，不可见血止血，应区分病因，尤其对于那些不是由于凝血机制障碍导致的新近出血患者，应抓住血瘀证的病理实质，大胆应用活血祛瘀法，并根据根据患者体质状况、出血量多少、病位不同而施药。

关键词 出血性疾病;血瘀证;调和气血;临床经验

Experience in Treating Hemorrhagic Diseases from Blood Stasis

MA Fang，FANG Dingya

（Department of Rheumatism，Xiyuan Hospital，China Academy of Traditional Chinese Medicine，Beijing 100091，China）

Abstract There are 2 types of blood stasis：intra-pulse blood stasis and outer-pulse blood stasis.The application of the activating blood circulation to dissipate blood stasis method is not limited to the treatment of “intra-pulse blood stasis” category.For hemorrhagic diseases，attention must also be paid to the activating blood circulation to dissipate blood stasis.This is because hemorrhagic diseases will turn on the body′s own blood coagulation mechanism，leading to the production of blood stasis syndrome.Blood stasis is both a pathological product and a new pathogenic factor.For hemorrhagic diseases diseases，hemostasis cannot used once we see blood.The cause should be distinguished，especially for those patients with recent hemorrhage.The pathological essence of blood stasis syndrome should be grasped，and the method of activating blood and removing blood stasis should be boldly applied.And we should administer medicine according to the patient′s physical condition，amount of hemorrhage，and disease position.

Keywords Hemorrhagic disease; Blood stasis syndrome; Harmonizing qi and blood; Clinical experience

中圖分类号：R249.2/.7文献标识码：Bdoi：10.3969/j.issn.1673-7202.2020.15.021

“瘀血”是由于血液流通不畅，阻滞于脉道之中，或溢出脉道之外，凝聚于局部而形成的一种病理产物。《黄帝内经》即记载了“血泣”“恶血”“脉不通”等有关瘀血证的内容，张仲景在《金匮要略》中首次提出“瘀血”之名称，并将其作为专病论治，后经历代医家不断演进，瘀血理论日臻完善，血瘀证和活血化瘀法已成为中医学中具有重要理论价值和实践意义的组成部分，尤其是20世纪80年代以来，瘀血理论空前发展，对血瘀证的认识不断深化，活血化瘀法的应用范围日益广泛，其科学性和实用性已被大量临床和实验研究证实。

瘀血分经脉内瘀血和离经之血2种情况，前者是由于气虚、寒凝、气滞、阴虚等因素导致脉内血行涩滞，后者是由于内外伤因素造成血不循经，血溢脉络之外，停留于脏腑、胞宫、腠理之间。目前血瘀证的研究多集中在“脉内瘀血”的范畴，对于出血性疾病导致的血瘀证尚缺乏足够认识。……