云华，男，1965年1月生人

原国家自由式空中技巧滑雪队队医，中国民族医药学会会员。第57届世界传统医学大会中国代表团成员，获金针奖和杰出名医奖。擅长筋骨损伤，风湿骨病的治疗，尤其对腰间盘突出，股骨头坏死，强直性脊柱炎等疑难病有着独特的理解和治疗方法。

刺血疗法对于血液循环障碍治疗的积极意义

Significance of Blood Pricking Therapy for Treatment of Blood Circulation Disturbance

云  华

Yun Hua

刺血疗法是针灸学领域里的一种传统针刺疗法，源远流长。早在史前时代，我们的祖先就用砭石刺破脓疡，放出恶血，可以说是刺血疗法的发端。迨至金属医针取代砭石以后，在九种类型的医针之中，有了专做刺血之用的锋针，后世又名之为三棱针，一直沿用至今。

Blood pricking therapy as a traditional acupuncture treatment of acup mox science has developed for a long history. As early as in prehistoric times, our ancestors have used stone needle to pierce the abscess and release the extravasated blood, which can be regarded as the origin of blood pricking therapy. After the stone needles were replaced by the metal ones, ensiform needle only for blood-pricking therapy among the nine types of medical needles was invented, which is also known as the three-edged needle and still be used today.

从历史角度来看，世界上不少民族在古代都有过放血治病的经历，我国的藏医、蒙医至今还盛行放血疗法。但是，这些放血疗法同针灸学所讲的刺血疗法是有所不同的。一是所用的工具不同，放血疗法常用刀形工具，而刺血疗法常用的工具是三棱针；二是施术部位不同，放血疗法的施术部位，或在病痛局部，或在静脉血管丰盈之处。而刺血疗法的施术部位，除了也在病痛局部施术以外，更多的是要按照经络主治来选取腧穴处“血络”进行治疗。

Historically, many ethnic groups in the world used bloodletting to treat diseases in ancient times. Moreover, bloodletting therapy is still popular in Tibetan and Mongolian medicine in China. Such bloodletting therapy, however, is different from blood pricking therapy of acup mox science. On the one hand, the tools used are different. The tools for bloodletting therapy are commonly in knife-shape, while that for blood pricking therapy is the three-edged needle; on the other hand, their operation parts are different. The former is operated on afflicted part or dense veins, while the latter most targets on blood network vessels of acupuncture points according to pathogenesis of channel disease besides the afflicted part.

针灸的基本作用，是疏通经络，调和气血，扶正祛邪。毫针的长处在于调气，三棱针的长处在于调血，二者兼备，相得益彰。据《灵枢》、《针灸甲乙经》等经典著作记载，锋针刺血最适于治疗“痼疾”。《灵枢·官针》篇更明确地指出：“病在五脏固居者，取以锋针。”这些记载表明，对于那些久治不愈的疾病，采取刺血疗法是最好的选择。可是半个多世纪以来，在针灸界有一种只重视毫针疗法而忽视其他针法的倾向，在国外甚至于把针刺出血视为临床大忌，因而干脆摒弃刺血疗法。这种倾向，既妨碍了针灸疗效的提高，对病人不利，又限制了针灸特色的发挥，对学术发展不利，不能不引起针灸界有识之士的深切关注。近年来，在北京、天津、南京等地，有些研究者专门立题研究刺血疗法，取得了成绩，就是为扭转上述倾向所采取的对应措施。

For acupuncture and moxibustion, it has the basic curative effect of dredging meridians and collaterals, regulating Qi and blood, and strengthening the body resistance to eliminate pathogenic factors, among which the filiform needle has the advantage of regulating Qi, and the three-edged needle can regulate blood. Therefore, only through combining the two can give full play to the role of acupuncture and moxibustion. What’s more, using ensiform needle for blood pricking therapy is most suitable for the treatment of aeipathia, according to the classic works Miraculous Pivot and Classic of Acupuncture and Moxibustion. Aeipathias in the five internal organs (heart, liver, spleen, lungs and kidneys) shall be treated by ensiform needle, written in the part Guanzhen of Miraculous Pivot. Therefore, blood pricking therapy is the best choice for treating chronic disease, according to the works mentioned above. Nevertheless, for more than half a century, the filiform needle treatment attracted the only attention in the field of acupuncture and moxibustion, even blood pricking therapy is regarded harmful in clinical and rejected in other countries. This tendency not only harms the patients’ health for hindering the improvement of acupuncture curative effect, but also is unfavorable to academic development for limiting the advantages of acupuncture and moxibustion, which draws the deep concern from intellectuals of acup mox science. In order to reverse such a tendency, some researchers in Beijing, Tianjin, Nanjing and other places have specifically studied the topic of blood pricking therapy and achieved some good results in recent years.

现代医学研究发现疾病的发生是一个极其复杂的过程，在病因和机体反应的相互作用下，患者机体有关部分的形态结构、代谢和功能都会发生种种改变。血液循环障碍是许多疾病过程的中间环节，亦是一些疾病的共同发病机理。

Modern medical research has found that the occurrence of disease is an extremely complicated process. Under the interaction of etiology and body response, the morphological structure, metabolism and function of the relevant parts of the patient's body will undergo various changes. Blood circulation disturbance is the intermediate link in many disease processes and is also the common pathogenesis of some diseases.

传统医学对瘀血致病很早以前就有这方面的论述，“气滞血瘀”就是现代医学血液循环障碍的表现。尽管由于致病的因素不同，但机体在防御各种疾病过程中，都离不开“气”、“血”参与的演变反应。中医《千金方》提出：“诸病皆因血气壅滞，不得宣通”，而《素问-调经论》指出：“血气不和百病乃变化而生”。能引起血液循环障碍的原因很多，现代病理学认为物理性损伤（如机械、高温、冷冻等），化学性损伤（如酸碱、药物等），以及生物性损伤（如病毒、细菌、立克次体等）都可以引起血液循环障碍，另外还有遗传、免疫反应等。而中医早就提出的外感六淫：风、寒、暑、湿、燥、火，内伤七情：喜、怒、忧、思、悲、恐、惊，以及疫疠、饮食、房劳、跌打损伤等致病因素，是更具体地认识到日常生活中所碰到的这些致病因素都可导致神经调控异常，引起血管运动的改变、血液成分的改变、血液流动的改变，以及血管壁的损伤、局部血管活性物质释放的改变，等等。比如人在焦虑、愤怒、怨恨之时，可使胃黏膜充血，胃液分泌增多，从而导致胃溃疡发生。人在发怒时，心脏的冠状动脉会痉挛，可引起动脉管腔狭窄，以致引起致命的心肌梗死。刺血疗法对于以下方面血液循环障碍治疗都极具积极意义。

Qi-stagnation and blood stasis written in early traditional medicine actually are the symptoms of blood circulation disturbance of modern medicine. Although pathogenic factors are various, Qi and blood always have roles to play in the process of defending diseases. Golden Prescriptions stated that all diseases are caused by blood stasis and Qi stagnation; Basic Questions--Theory of Regulating Meridians said that the disharmony of Qi and blood may cause various diseases. Modern pathology believes that causes of blood circulation disturbance are many, including physical damages （cause by machine, high temperature, freezing, etc.）, chemical damage （cause by acid, alkali, drugs, etc.）, biological damage （from viruses, bacteria, and rickettsia, etc.） as well as genetic and immune responses. Similar conclusions that the six exogenous pathogens (wind, coldness, hotness, wetness, dryness and heat), and seven emotions (happiness, anger, anxiety, longing, sorrow, panic and shock), as well as pestilence, diet, sexual strain and traumatic injury are all the causes of blood circulation disturbance, which was early proposed in the traditional Chinese medicine. Such discussions further indicate that these pathogenic factors in daily life can lead to abnormal neurological regulation, changes in vascular motion, components and flow, damages on blood vessel walls and changes in the release of vascular activator. For example, the stomach lining congestion and the increase of gastric juice leading to gastric ulcer can be caused when people are anxious, angry, and resentful. People’s anger may cause the heart coronary arteries spasm which will narrows the artery stenosis and even result in fatal myocardial infarction. Blood pricking therapy shows positive effect on the following treatment of blood circulation disturbance.

一、  刺血疗法能改变局部循环血量的异常。

I.  Blood pricking therapy can change the abnormal local blood circulation volume.

1.动脉性充血

1.  Arterial hyperemia

刺血疗法治疗动脉性充血时，能够迅速退热，去狂躁、安心神，能降血压，使炎症肿胀消退，并能迅速止痛。

Blood pricking therapy on arterial hyperemia can quickly allay a fever, calm the mind, lower blood pressure, so as to reduce inflammation and quickly relieve pain.

2.静脉性充血及淤血

2.  Venous hyperemia

刺血疗法对于无论是静脉腔阻塞、静脉回流受阻，还是动脉性充血引起的静脉性充血及淤血均能够迅速取得效果，使静脉压力回复正常。

The effect of blood pricking therapy, helping venous pressure return to normal, can be quickly seen in the treatment of vena cava obstruction, obstruction of venous reflux, and venous hyperemia and blood stasis caused by arterial hyperemia.

3.局部缺血

3.  Ischaemia

刺血疗法可用于急性缺血性的症状抢救，通过对血管的刺激，对血管容量的调整，对血液流速的改变，使血管痉挛状态解除，避免病情进一步恶化和遗留后遗症。

Blood pricking therapy can be used for rescue of patient who shows acute ischemic symptoms. By stimulating blood vessels, the blood vessel volume can be regulated and the blood flow rate can be promoted, so that the angiospastic symptom is reduced to avoid worse conditions and sequelae.

二、 刺血疗法能促使血管内血栓的转归

II.  Blood pricking therapy can accelerate the dissolution of thrombus.

在活体的心血管内血液成分互相聚集或发生凝固的过程称为血栓形成，这一过程所产生的凝块叫做血栓。当血管破裂时，血栓形成有止血作用，炎症时周围小血管内的血栓形成，有防止病原菌蔓延扩散的作用，但绝大部分血栓形成对人体极为不利。现在血栓引起的各种疾病已被广泛的引起了注意，并对其形成的机理有了更深入的研究，同时也在寻找抗栓、溶栓的各种手段和方法。而刺血疗法通过针刺、出血、拔火罐等手段，使人体在受到多种刺激后，对血管内容物施行自身调整和重组，对血栓的形成有着抗凝、溶栓、解聚和再通的强大作用。

The process that blood components accumulate or coagulate in the cardiovascular of a living body is called thrombosis, and the clot produced by this process is called a thrombus. A thrombus can prevent bleeding where the blood vessel ruptures and can prevent the spread of pathogens in the small blood vessels around the inflammation. However, most of thromboses are unfavorable to human body. Nowadays, various diseases caused by blood clots have been widely noticed, and the mechanism of their formation has been further studied. At the same time, various methods for anti-thrombosis and thrombolysis are also being developed. Blood pricking therapy is one of these methods, which has powerful effects including anticoagulant activity, thrombolysis, disaggregation and vascular recanalization on thrombus. It stimulates the body by acupuncturing, bleeding and cupping to adjust and regulate the vascular contents.

三、  刺血疗法能够改变血液的性状和流速。

III.  Blood pricking therapy can change blood traits and its flow rate.

通过穴位的刺激和血管的分布状况，可以有选择性的改变局部的血流状态，对血液流速起双相调整作用。通过静脉血流出和火罐的负压作用，增加了局部血管的压力梯度，促使血流流速加快，流量增多，使毛细血管及微小静脉血管中因流速缓慢而形成的血栓解聚。改善了微循环的流变状态，使营养通路血流量增加，氧分压增高，使细胞的生命活力增强。但是体表静脉的血容量、流速的改变是如何影响深层血液的流变状态，以及脏器的血液流动状况，这些都是需要阐明的临床医学课题，这其中一定包含有一些尚未揭示的生命科学现象。

It is possible to selectively promote the local blood flow in a biphasic manner on the basis of acupuncture stimulation and the distribution of blood vessels. The bleeding of venous and the pressure of the cupping can increase pressure gradient of the local blood vessels to accelerate the blood flow. Then the thrombi resulted from slow blood flow of the capillaries and the tiny veins are depolymerized. Furthermore, the improved microcirculation increases the blood flow of the nutrient pathway and the oxygen partial pressure, which can enhance the vitality of the cells. However, how the changes in blood volume and flow rate of body surface veins affect the rheological state of inside blood and the blood flow of organs are the clinical medical issues that need to be elucidated. There must be some undiscovered phenomenon about life science.

四、  刺血疗法能改善微循环障碍。

IV.  Blood pricking therapy can improve microcirculation disturbance.

刺血疗法可通过刺中、小静脉出血和拔罐形成的负压，使微静脉和小静脉形成压力梯度，促使微动脉血液流动，毛细血管前括约肌开放，使消失的微血管自律运动出现，并使自律运动的振幅和频率明显增大和加强，来自体循环的血流即可向缺血区冲击，并可带走和降解局部血管内皮细胞、平滑肌细胞、血细胞缺血后异常分泌在局部血管中的微量的影响血管舒缩活动的生化物质。而这些部位往往是单纯用药物治疗无法达到的闭塞区。

Blood pricking therapy can create a pressure gradient in venules through the pressure caused by blood pricking with cupping, which can improves arterioles blood circulation, open the anterior sphincter of the capillaries and regain the microvascular vasomotion with larger amplitude and higher frequency. The blood of the systemic circulation can flow to ischemic area, carrying away and degrading the local vascular endothelial cells, smooth muscle tissue cells, and biochemical compounds that affects vascular vasomotion from ischemic cells in the local blood vessels. Usually, medication treatment alone cannot target at such occluded areas.

五、   刺血疗法能很快的纠正体液循环障碍。

V.  Blood pricking therapy can quickly improve fluid circulation disturbance.

刺血疗法在改善血液瘀滞状态时，也就调整了体液的分布，因形成水肿的体液来自血液。人体大量的体液又维持着血容量，如少量失血后，所损失的血液水分和无机盐成分，在1—2小时内即可由组织间液渗入血管而完全得到补充，是中医一种极好的抢救手段，应该予以推广和使用。

When the blood pricking therapy improves blood stasis, it also adjusts the distribution of body fluids, because the body fluid that forms edema comes from the blood. Water and inorganic salt components lost caused by a small amount of blood loss can be completely replenished by interstitial fluid infiltration into the blood vessel within 1-2 hours because the body fluid can maintains blood volume. Therefore, blood pricking therapy, as an excellent rescue means developed by traditional Chinese medicine, deserves to be used and promoted.

正常的血液循环是保证机体的内环境稳定，各种器官新陈代谢和功能活动正常进行的基本条件。一旦血液循环发生改变，并且经过—神经一血管一体液所能调节的范围时，特别是影响了局部的神经、血管、血细胞的内分泌调控作用时，即可引起有关组织器官的代谢、功能和形态结构的改变，出现组织的萎缩、变性、坏死等改变，严重者甚至导致机体死亡。各个器官虽然在功能和结构上互不相同，但在各种致病因子的影响下，不同器官都可呈现同样的基本反应和结构改变，都具有局部血液循环障碍，以及细胞变性和组织的损伤。刺血疗法是一种最直接和快捷地改善血液循环障碍的医疗方法。

Normal blood circulation is the basic condition for ensuring homeostasis and the normal metabolism and function of various organs. Once blood circulation changes occur in the adjustable range of nerve-vessel-fluid circulation and especially affect the endocrine regulation of local nerves, blood vessels and blood cells, changes in metabolism, function and morphology of relevant tissues and organs including atrophy, degeneration, necrosis, etc. may occur as well, and the worst result is death. Under the influence of various pathogenic factors, organs with different functions and structures may shows the same basic responses and structural changes including local blood circulation disturbance, cell degeneration and tissue damage. Blood pricking therapy can most directly and rapidly improve blood circulation disturbance.

近二十年，通过大量的临床经验得出，刺血疗法对于风湿骨病、瘀血肿痛以及颈椎、腰椎、膝关节损伤，股骨头缺血性坏死等都具有良好的治疗效果。相信随着医疗技术的发展，刺血疗法会在更多方面发挥出更大的治疗作用，为更多的患者解除病痛。

Much clinical experience in the past two decades has indicated the eutherapeutic efficacy of blood pricking therapy on the treatment of rheumatism, congestion and swelling pain, injuries of cervical vertebrae, lumbar vertebrae and knee joint, and ischemic necrosis of femoral head. It is believed that with the development of medical technology, blood pricking therapy will play a greater therapeutic role in more aspects and relieve the pain for more patients.