许博文 朱晓晨

摘要 血瘀是中风病的关键致病因素及重要病机，活血化瘀法在缺血性中风病的临床应用十分广泛，作为其治疗的基本治则，对改善脑梗死部位的血流灌注、影响侧支循环重建具有重要临床意义。但在临床上却不易把握活血化瘀法的应用时期，再则如何正确权衡活血化瘀法的用药轻重成为诊治一大阻碍。对此，通过临证发现，辨证的同时亦需灵活分期辨病治疗，即在疾病不同阶段运用不同程度的治则治法，以活血化瘀法分期辨治缺血性中风病，在疾病诊治中具有临床意义，且能促进诊疗效果。

关键词  分期论治;缺血性中风病;血瘀证;瘀阻脑络;活血化瘀;扶正化瘀;破血逐瘀;临床辨治

Progress in Research of Clinical Differentiation and Treatment of Ischemic Apoplexy by Promoting Blood Circulation and Removing Blood Stasis

XU Bowen¹，ZHU Xiaocheng²

（1 Graduate School of Beijing University of Traditional Chinese Medicine，Beijing 100029，China; 2 Oriental Hospital of Beijing University of Traditional Chinese Medicine，Beijing 100102，China）

Abstract Blood stasis is the key pathogenic factor and important pathogenesis of stroke.As the basic therapeutic principle，the method of activating blood circulation to dissipate blood stasis is widely used in the treatment of ischemic stroke.It has important clinical significance for improving blood perfusion in cerebral infarction and affecting collateral circulation reconstruction.However，it is difficult to grasp the application period of promoting blood circulation by removing blood stasis in clinical practice，and how to correctly weigh the drug use of activating blood circulation by removing blood stasis has become a major obstacle to diagnosis and treatment.In this regard，through clinical syndrome discovery，syndrome differentiation at the same time also need flexible stage disease differentiation treatment，that is，in the different stages of the disease，using different degrees of treatment rule，with the method of promoting blood circulation to treat ischemic stroke in stages，in the diagnosis and treatment of the disease has clinical significance，and can promote diagnosis and treatment effects.

Keywords Staging treatment; Ischemic stroke; Blood stasis syndrome; Stasis blocking brain collaterals; Promoting blood circulation to remove blood stasis; Righting and dissipating blood stasis; Breaking and dissipating blood stasis; Clinical differentiation and treatment

中圖分类号：R249;R277.7 文献标识码：A doi：10.3969/j.issn.1673-7202.2020.08.030

随着现代医学的发展，缺血性中风病的治疗方式也各种多样，静脉溶栓治疗，早期血管内治疗，如接触性溶栓、动脉机械取栓等，但中风病的高发病率、高致残率及高死亡率，仍是危害中老年人身体健康和生命的主要疾病之一，它与缺血性心脏病、恶性肿瘤构成多数国家的三大致死原因[1]。其与现代治疗方式在病程某方面的疗效存疑，或是因适应证受限或是不良反应偏大，抑或是并发症较多相关[2]。进而在大部分情况下，患者延误甚至错失治疗时机，留有后遗症，甚至出现再梗。西医论治脑梗死以疾病分期对症治疗，中医则是以辨证论治为主，辅以宏观观念。中医学认为中风病的核心病理要素为“瘀”，故在治疗时应抓住疾病的主要矛盾，结合现代医学优势，实行分期论治，中西医治疗优势互补，以活血化瘀法论治缺血性中风病，在临床实践中显得尤为重要。……