Xiyuan Hospital, China Academy of Chinese Medical Sciences, Shi Dazhuo and Zhao Lancai (Beijing, 100091)
Chinese Abstract: Tracing the literature on blood stasis, the connotation of the concept of blood stasis refers to blood that is separated from the meridian and blood that does not run smoothly. The clinical manifestations are complex and diverse. According to the severity of the blood stasis and the severity of the disease, it can be divided into blood stasis, blood accumulation, and dry blood. With the development of clinical and scientific research on blood stasis syndrome, the diagnostic criteria for blood stasis syndrome have also been revised several times. The current diagnostic criteria for blood stasis syndrome still have the characteristics of traditional Chinese medicine that are not prominent, the severity of the disease is small, the judgment method is more complicated, and the laboratory The indicators are not comprehensive, the primary and secondary basis is not standardized, etc.; it is proposed that the selection of the overall symptoms and signs of TCM should be emphasized, the micro-pathological indicators should reflect the advanced and multi-faceted, the standard and rigorous concepts, the quantitative diagnosis and the qualitative diagnosis, evidence-based medicine and the Several suggestions with equal emphasis on expert opinions; with a view to revising the advanced, universal and practical diagnostic criteria for blood stasis syndrome.
Derive of the documents about the blood stasis. Which include the extravasated blood and the blood moving sluggishly in circulation or congested in a viscus. From the clinical complicated expressions, It s devided into three stages: blood stasis, consumptive disease due to blood stasis and accumulation of stagnant blood according to the disease condition. Along with the blood stasis development of the clinical and research, the diagnosis standard, have several amends. However, there is still some disadvantages: our traditional Chinese medicine characteristic less prominent, the disease condition less qualitative. Methods of diagnosis less complicated, less lab index, less regulated basis, less micro-pathology index, and so on. In order to embody more advanced, qualitative analysis, quantitative analysis and take more epidemic medicine and medical experts advises into account, we hope to make out the adaptive, practicable the diagnosis standard.
Blood stasis syndrome can involve almost all clinical diseases or different links of diseases. Blood stasis syndrome research has always been the most active field in modern TCM syndrome research, and significant progress has been made in both macro and micro research. At present, the diagnosis of blood stasis syndrome still follows the standards established at the second meeting of the Chinese Society of Integrative Medicine for Promoting Blood Circulation and Removing Blood Stasis in 1986. It has not been revised for more than 20 years. It is difficult to cover the progress in the research field of blood stasis syndrome, and to a certain extent There are unlimited expansion, no disease, no blood stasis, blood stasis syndrome and other syndromes, and it is difficult to adapt to the needs of clinical, scientific research and international exchanges. Therefore, it is imperative to formulate diagnostic criteria for blood stasis syndrome that meets the modern clinical needs. I have some opinions on this for discussion.
1. The origin of the concept of blood stasis syndrome
"Blood stasis" can be traced back to "Internal Classics". Although there is no disease name of "blood stasis", it has titles such as "malignant blood" and "remaining blood". "Lingshu·Swelling Pian" says: "Malignant blood should not diarrhea when diarrhea , You can stop by staying." "Malignant blood" is the blood of stasis. "Lingshu·Tiefeng Pian" says: "If there is a fall, the evil blood will not go away." "Treatise on Febrile Diseases and Miscellaneous Diseases" is based on the blood stasis theory in the "Internal Classics", focusing on the difference between the severity of blood stasis and the old and new , Proposed "blood stasis", "blood storage", "dry blood" and other syndromes. Regarding the symptoms of blood stasis, there is such a record in the article "The Synopsis of the Golden Chamber · Blood stasis under the thorax with tremor and vomiting": "The chest is full, the lips are dark, the tongue is blue, and the mouth is dry, but if you want to rinse, you don't want to swallow, there is no cold or heat, the pulse is slightly big and late, and the abdomen is dissatisfied. The person said that I am full, because there is blood stasis." , Annoying, dry mouth and thirsty, but the pulse is not hot, this is Yin Fu, it is blood stasis, it is now". If the blood stasis stays for a long time and the condition worsens, the "blood accumulation" syndrome of Yangming blood accumulation and sun accumulation will appear. For example, the "Treatise on Febrile Diseases · Differentiation and Treatment of Yangming Disease and Pulse Syndrome" records: "Yangming disease is forgotten. , There must be blood accumulation, so those who have blood stasis for a long time, so the joy is forgotten, although the feces are hard, the stool is easy to turn, the color must be dark, and it should be used as a soup"; "Combination Treatment" says: "The sun is sick with yellow body, sinking pulse, full abdomen is hard, and the urination is not bloody, and the urination is self-interested, and the person is like a mad person, and the blood syndrome is the essence of the soup."; if stasis If the blood stays in the body for a long time, the condition aggravates, the qi and yin are consumed, and the dry blood syndrome can be formed. For example, "The Sixth Syndrome of Blood Stasis Deficiency of Blood", "Five-work Deficiency is extremely thin, and the abdomen cannot be full." Diet, food injuries, severe injuries, drinking injuries, room strains, starvation injuries, strains, meridian, camp, and air injuries, with dry blood inside, wrong skin, dark eyes..."Here points out that dry blood has five strains. The premise of extremely chronic internal injury and Yin Ying depletion. This syndrome is especially easy for women after childbirth. For example, "The Synopsis of the Golden Chamber·The 21st Therapy of Women’s Postpartum Disease" "This is because there is dried blood in the abdomen. "Under the umbilical cord" and "The Synopsis of the Golden Chamber · Women's Miscellaneous Diseases and Pulse Syndrome Treatment 22" "There is dried blood and white matter inside"; As for the change of blood stasis in the body, labor and syndrome are mentioned in the Treatise on Febrile Diseases. There are several kinds such as accumulation, black jaundice, malaria, liver disease and so on. "Theories of various disease sources" and "Qianjin Prescriptions" make it clear that "menstruation is astringent or not" and "postpartum malignant blood is not exhausted" are blood stasis syndrome. In the Qing Dynasty, Tang Rongchuan made clear the concept that the blood from the Lijing is blood stasis, and he believed that "spitting out the feces and leakage, the blood does not leave the meridian, and all the blood of the Lijing...Although the blood is clear, the blood is also blood stasis." The connotation of the concept of blood stasis mainly refers to the blood that leaves the meridian. There are various clinical manifestations. According to the severity of the blood stasis and the severity of the disease, it can be divided into three levels: blood stasis, blood accumulation, and dried blood. Symptoms, black jaundice, liver disease, etc.
Another connotation of the concept of blood stasis refers to blood that is stagnant in the meridians or viscera tissues and organs. The blood that stagnates due to poor circulation is called "blood weeping", "blood coagulation" in Neijing "Weeping", "coagulation", "blood"; in "The Synopsis of the Golden Chamber" it is called "blood numbness"; Zhu Danxi pioneered the theory of "six depressions" and called the stagnation of blood stagnation as "blood depression". Ye Tianshi believes that "the collateral is the place where the blood gathers", and the collateral disease that enters the collateral for a long time is also attributed to the blood stasis syndrome. Developed the theory of qi deficiency and blood stasis. It was believed that “the deficiency of vital energy must not reach the blood vessels, and the blood vessels have no qi, and it must remain as stasis”. Yanlibuyanghuanwutang treats hemiplegia due to stroke and lunatic Mengxingtang treats madness. Poor blood flow is not only the result of multiple pathogenic factors, but also the cause of multiple diseases. If it is classified into the category of blood stasis, the scope of blood stasis syndrome is very wide. Therefore, how to quantify and standardize the diagnosis of blood stasis syndrome is a very difficult problem in clinical practice.
2. The gradual development of diagnostic criteria for blood stasis syndrome
In 1982, the first national academic conference for promoting blood circulation and removing blood stasis by the China Association of Integrated Traditional Chinese and Western Medicine, formulated the "Trial Standards for the Diagnosis of Blood Stasis Syndrome" for the first time, ⑴Main basis: including tongue condition, pulse condition, pain, lumps, blood vessels, Abnormalities such as bleeding. (2) Other evidences: including abnormalities such as skin, menstruation, limbs, spirit, memory, ascites, etc., as well as laboratories such as microcirculation, hemorheology, hemodynamics, platelet aggregation, cerebral angiography or CT, ultrastructural changes, etc. in accordance with. ⑶ Although there is no such basis, it can be considered in combination with medical history and primary disease and blood stasis. ⑷ Blood stasis syndrome can also be considered for some diseases that are effective in the treatment of blood stasis. The standard points out that as long as there are 2 main basis, blood stasis syndrome can be diagnosed; if there are more than 1 other basis, and confirmed by laboratory evidence, it can be diagnosed as blood stasis syndrome. The formulation of this standard is a historic progress in the process of blood stasis syndrome research. Although there are many imperfections, it has established China's leading position in the research of blood stasis syndrome in the world, and revised its later diagnostic criteria for blood stasis syndrome. Foundation.
In 1986, the Second National Conference on Activating Blood and Removing Blood Stasis Research formulated the "Diagnostic Criteria for Blood Stasis Syndrome" in Guangzhou, which was improved on the basis of the 1982 diagnostic criteria: (1) The sublingual vein was added to the main basis. Items such as varicose, bloody ascites, menstruation, facial lip and gums and abnormalities around the eyes. (2) The positive palatal mucosal sign was included in other evidences. ⑶In the laboratory evidence, items such as increased blood coagulation or decreased fibrinolytic activity, and pathological slices showing blood stasis were added. ⑷ Judgment criteria are: the main basis is 1 item plus 2 items of laboratory basis or 2 items of other basis. It can also have more than 2 items plus 1 item of laboratory basis. ⑸According to the theory of Chinese medicine and other relevant standards, it can be diagnosed with concurrent syndromes. The advantage of this standard is that it involves many projects and highlights the objective indicators of the laboratory. However, there are the following problems: the standard of TCM diagnosis of blood stasis syndrome is not reflected enough, the judgment method is more complicated, the operability needs to be improved, and there is a lack of objective evidence for the distinction between the main basis and other basis.
In 1985, Ogawa of Japan proposed the "Trial Plan for the International Diagnostic Standards for Blood Stasis" . The content includes: ⑴ Necessary items, namely abdominal syndrome of blood stasis. ⑵General items, including skin, tongue, fixed pain, pathological masses, abnormal blood vessels, bleeding tendency, menstrual disorders or abnormal urination, autonomic disorders, mental disorders, dry mouth, and irritated hands and feet. ⑶ Laboratory examination, that is, microcirculation disorder, abnormal blood rheology, increased platelet aggregation, increased blood viscosity, cerebral and cardiovascular imaging or CT, myocardial scintigraphy showed vascular embolism, pelvic and lumbar X-ray abnormalities. Any of the above can be diagnosed as blood stasis syndrome. This standard highlights the syndrome of blood stasis and abdomen, which is more suitable for Japan and countries that attach importance to abdominal diagnosis. It only lists laboratory indicators and is not included in the diagnostic criteria. It does not achieve the purpose of standardization. It is biased to regard abdominal syndrome as a necessary item and overemphasizes Abdominal syndrome may restrict the popularization and development of blood stasis syndrome clinically. It is difficult to popularize because of the objectivity and operability of the diagnosis of abdominal syndrome.
In October 1988, the "Blood Stasis Syndrome Diagnostic Reference Standard" was formulated at the Beijing International Conference on Blood Stasis Syndrome: (1) Dark tongue or petechiae or petechiae; (2) Typical astringent pulse or no pulse (3) Pain has a fixed place; (4) Blood stasis abdominal syndrome; (5) Symptoms; (6) Blood from the menstruation; (7) Skin and mucous membrane ecchymosis, abnormal veins; (8) Dysmenorrhea with dark color There are blood clots or amenorrhea; (9) skin nails; (10) hemiplegia and numbness; (11) blood stasis mania; (12) physical and chemical examination with blood circulation stasis. Formulating methods: (1) Any one of the above can be diagnosed as blood stasis syndrome; (2) The standard diagnosis of blood stasis syndrome in each department shall be formulated separately; (3) The related syndromes should be treated as a whole. This standard is relatively simple and practical, highlighting the macro-indications of blood stasis syndrome in TCM. The shortcomings are the lack of hierarchical and quantitative diagnostic criteria, and the lack of microscopic syndrome differentiation indicators. Many pathophysiological and pathomorphological indicators related to thrombosis and stasis are not included , Such as vasoactive mediators, inflammatory mediators, platelet membrane granule protein, etc. The pathological changes observed by modern CT, angiography, and pathological morphology are also related to blood circulation, which can be used as an objective basis to incorporate blood stasis syndrome differentiation indicators. The diagnosis of blood stasis syndrome based on only one symptom (syndrome) is too broad and not precise enough. For example, zhengji is not necessarily all blood stasis syndrome, many are caused by phlegm obstruction.
Due to the diversity and complexity of the clinical manifestations of blood stasis syndrome, it is very difficult to formulate a complete, universal, and feasible diagnostic standard. Although there are several diagnostic standards, the research on blood stasis syndrome has achieved a lot in recent years. With great progress, the above-mentioned diagnostic criteria can no longer meet the needs of clinical research. Many domestic scholars of traditional Chinese medicine and integrated traditional Chinese and Western medicine continue to call for the development of new diagnostic criteria for blood stasis syndrome, expecting a combination of macro and micro syndromes, strong specificity of indicators, and quantification. The introduction of easy-to-operate diagnostic criteria for blood stasis syndrome.
3. Problems in the diagnostic criteria of blood stasis syndrome
1 Qualitative diagnosis
The qualitative diagnosis of blood stasis syndrome is to determine whether there is blood stasis syndrome. The blood stasis syndrome has two meanings, one is "the blood leaving the meridians stays in the body", and the other is "the blood does not run smoothly and stasis in the meridians or viscera "Within tissues and organs", there is no qualitative difference or absolute boundary between the two meanings, but there are differences in severity. The above-mentioned concept of blood stasis syndrome has been widely used at home and abroad, and it should not be changed. In order to make the concept clear and convenient In research and communication, the first meaning can be called blood stasis syndrome, and the second meaning is called blood stasis syndrome. The qualitative diagnostic criteria for blood stasis syndrome has always been the core content of the diagnostic criteria for blood stasis syndrome, and it is also the most difficult problem to form a gold standard. The Guangzhou Conference Standard in 1988 and the International Standard for Blood Stasis still exist in terms of specificity and operability. Insufficiency needs to be resolved in the future.
2 Quantitative diagnosis
Hierarchical quantification of blood stasis syndrome is based on the severity of the blood stasis syndrome, which is divided into light, moderate, severe or several levels represented by numbers, so as to facilitate mutual communication and judgment of the condition and the effect of judgment. The quantitative diagnosis of blood stasis syndrome has taken shape in "Treatise on Febrile Diseases", which distinguishes blood stasis diseases into blood stasis, blood accumulation, dried blood, dry blood labor, malaria, zhengji and so on. With the modernization of traditional Chinese medicine and the extensive development of research and exchanges with domestic and foreign research, the quantitative diagnosis of blood stasis syndrome has received increasing attention. In recent years, domestic and foreign scholars have carried out a large number of studies, such as the Japanese Terazawa  using multivariate analysis. Re-regression analysis, principal component analysis and discriminant analysis were performed on the subjective symptoms and signs of patients with blood stasis syndrome, and the scoring standard of blood stasis syndrome was proposed. Its items include: eye circles, black face, skin nails, dark red lips, dark red gums, dark purple tongue, thin collaterals, subcutaneous hemorrhage, palm erythema, umbilical and para-umbilical tenderness resistance, ileocecal area and season Tenderness in the ribs, resistance to hemorrhoids, menstrual disorders. According to the comprehensive judgment, a score of less than 20 is considered as non-blood stasis syndrome, a score of 21 or more is considered as blood stasis syndrome, and a score of more than 40 is considered severe blood stasis syndrome. The diagnostic standard method is simple and easy to master, but the disadvantage is that it pays too much attention to the diagnosis of abdominal syndrome. China Wang Jie et al.  proposed a scoring standard for the diagnosis of blood stasis syndrome, using multiple linear stepwise regression methods to quantitatively analyze 202 cases of blood stasis syndrome clinical symptoms, signs and hemorheological indicators, and the results showed that the occurrence rate was the largest Symptoms and signs are in order of dark purple tongue, low abdominal resistance to tenderness, subcutaneous blood stasis, astringent pulse, pathological mass, melena, etc. The blood rheology examination is based on whole blood viscosity, extracorporeal thrombosis, platelet aggregation, and thrombus elasticity. Figures and others have a high incidence of blood stasis diagnosis, and score the above clinical manifestations one by one, and put forward blood stasis syndrome scoring standards. The characteristics of this standard are: (1) There are many items; (2) Symptoms, signs, and physical and chemical examination indicators are included in the diagnostic criteria at the same time; (3) Hemorheology indicators can be specified. Later Wang Jie et al.  tested 170 cases of blood stasis syndrome and non-blood stasis syndrome patients with hemoglobin, triglycerides, total cholesterol, endothelin, nitric oxide, plasminogen activator, and explored its effects on blood stasis syndrome. Contribution degree, the order of the result contribution degree is: endothelin>hemoglobin>plasminogen activator>nitric oxide. It shows that endothelin, hemoglobin, nitric oxide, and plasminogen activator affect hemorheology and coagulation function. Standardized TCM syndromes should be composed of symptoms, signs, and objective indicators that have been standardized and quantitatively studied. Multi-center (4 to 5), prospective, randomized controlled large-scale clinical epidemiological investigations and clinical trials are effective in enriching and It is of great significance to improve the diagnosis of blood stasis syndrome. According to this idea, Beijing, Yunnan, and Fujian jointly conducted a study on the quantitative diagnostic criteria and degree grading standards of blood stasis syndrome . The method is based on epidemiological investigations, according to the five diseases in blood stasis syndrome. The difference in the condition between the group and the non-blood stasis syndrome group is assigned to the relevant factors, and the quantitative diagnostic criteria are established based on this, and then the quantitative diagnostic criteria are tested, and finally the degree grading standard is established. Results: The quantitative diagnostic standard of blood stasis syndrome is 15 points; the sensitivity and accuracy of the quantitative diagnostic standard retrospective and prospective tests are both above 80%. Compared with the various forms of blood stasis syndrome diagnostic standards established in the past, it is new The established quantitative standards for blood stasis syndrome have the following characteristics: (1) The results obtained through multi-center, large-sample clinical epidemiological investigations, the conclusions are more objective; (2) the statistics are rigorous; (3) the relevant factors are reasonable.
The research on the quantitative diagnosis of blood stasis syndrome has just started, and there are many problems, such as not distinguishing whether the blood stasis stays or the blood stasis in the pulse does not run smoothly. There are few multi-center and large-sample quantitative studies of symptoms, signs and laboratory indicators.
4. Pathological basis of objectification of blood stasis syndrome
TCM syndrome diagnosis is mainly obtained by analyzing and discriminating the information obtained from the four clinics. The focus is to grasp the functioning state of the human body as a whole. It belongs to "macro-diagnosis" and its objectivity is difficult to grasp. In order to explore the microscopic pathological basis of the objectification of blood stasis syndrome, and to find specific microscopic indicators of blood stasis syndrome, in recent years, people have clarified the structure and structure of blood stasis syndrome from multiple levels and levels (system, organ, cell, subcellular, molecule, etc.) The material basis of various aspects of metabolism and function has obtained many micro-indicators with diagnostic value. Compared with "macro-diagnosis", it is "micro-diagnosis". "Micro-differentiation" can develop, supplement and deepen "macro-differentiation", but "micro-differentiation" has its obvious specificity. In order to make "micro-differentiation" be used in clinical practice, it is necessary to emphasize the combination of multiple indicators. There is a non-linear relationship between microscopic indicators and syndromes. It is known that there are dozens of laboratory indicators that have abnormal changes in blood stasis syndrome, and more indicators will be discovered as research progresses. how to choose? From which level can I choose to have a good correspondence with blood stasis syndrome? Is the diagnosis of blood stasis syndrome relatively specific? How to organically combine the symptoms and signs of "macro-differentiation" with the indicators of "micro-differentiation" for quantitative and objective diagnosis? It is a subject worthy of in-depth study.
In recent years, the progress in the exploration and screening of microscopic pathological indicators of blood stasis syndrome can be summarized as follows:
1 Vascular endothelial injury and vasoconstriction related media: It is known that vascular endothelial cells can synthesize a variety of vasoactive substances, such as nitric oxide (NO), endothelin (ET), etc., which are indispensable to the vasomotor function and blood fluidity. Alternative regulation. The mediators related to endothelial injury and vasoconstriction mainly include ET, NO, calcitonin gene-related peptide (CGRP), angiotensin converting enzyme (ACE), and angiotensin 2 (AgII). Endothelial cell injury is the initiating factor of vascular disease, and ET, which is one of the specific markers reflecting vascular endothelial cell injury, is the strongest and longest-lasting vasoconstrictor found so far; AgII is a vasoconstrictor active substance that can Long-term or temporary spasm of blood vessels; CGRP is an important vasodilator with strong vasodilation and antagonism of ET; NO is the most important vasodilator produced by endothelial cells, bradykinin, histamine, etc. The effects are all mediated by NO. Studies have shown that plasma ET levels in patients with blood stasis cerebrovascular sclerosing dementia, hypertension and diabetes are significantly increased, while CGRP and NO levels are significantly reduced [8,9]; Hu Shiyun et al.  believe that hypertension has blood stasis syndrome The pathophysiological basis is mainly vasoconstriction and the "concentration, adhesion, aggregation and stagnation" of blood. Endothelin can be used as a specific indicator for the diagnosis of blood stasis syndrome. Studies have shown that AgII plays an important role in atherosclerotic endothelial damage and vasoconstriction , Huang Xianping  Studies have shown that coronary heart disease (CHD) heart blood stasis syndrome group ACE gene DD genotype and D alleles The gene frequency was significantly higher than the other three groups. The AgII activity of the three ACE genotypes in the heart-blood stasis syndrome group was significantly higher than that of the healthy control group. It is believed that the long-term abnormal increase of AgII caused by the ACE gene D allele caused CHD heart-blood stasis. One of the pathophysiological basis of the card.
2 Indicators affecting hemorheology: thromboxane A2 (TXA2), prostacyclin (PGI2), tissue-type plasminogen activator (tpA), tissue-type plasminogen activator inhibitor (PAI) and P selection Sustained elements are commonly used indicators that affect blood rheology in blood stasis syndrome. t-PA can activate plasminogen, exert fibrinolysis locally, and dissolve thrombus; while endothelial cells have the effect of plasminogen activation and release plasminogen inhibitors at the same time, the two maintain dynamic balance and prevent fibrin Excessive dissolution. Han Chongxu et al.  detected 130 cases of acute myocardial infarction, cerebral thrombosis, and 90 cases of angina pectoris, transient ischemic attack. The results showed that P-selectin and tPA content are sensitive to cardiovascular disease thrombosis. index. Lu Zhongzhong reported  The t-PA activity of peripheral blood mononuclear cells of coronary heart disease with blood stasis syndrome was significantly lower than that of the non-blood stasis syndrome group, while the activity of PAI-1 was significantly higher in both blood stasis syndrome and non-blood stasis syndrome, suggesting coronary heart disease The formation of blood stasis syndrome is related to changes in blood composition and decreased fibrinolytic activity at the level of monocytes.
3 The influence of blood components on the formation of blood stasis syndrome: recent studies have shown that the adhesion of white blood cells (WBC) in patients with blood stasis syndrome increases, and the expression of adhesion molecules increases, causing RBC and vascular endothelial damage, and WBC adhering to the surface of the vascular endothelium activates each other , Produces vasoactive substances, promotes vasoconstriction, and induces platelet aggregation, so the spontaneous activation rate of WBC, adhesion and adhesion molecule expression are the important pathological basis of blood stasis syndrome . It has been reported  that the expression of circulating blood monocytes and neutrophils CD11b and CD18 in CHD patients with blood stasis syndrome increased, indicating that their monocytes and neutrophils were activated and their adhesion increased. CD62P and TSP are specific indicators that reflect platelet activation. Activated platelets are involved in the occurrence of atherosclerosis, thrombosis, vasospasm and other links. CD62p, TSP and CDllb are closely related to the occurrence and development of blood stasis syndrome[ 17]. Jiang Zhaoshun et al.  used monoclonal antibodies as molecular probes and used flow cytometry to detect the expression of platelet membrane glycoprotein CD62p and CD63 in patients with blood stasis syndrome and non-blood stasis syndrome in type 2 diabetes, and healthy people, and found that type 2 The level of platelet activation in diabetic patients with blood stasis syndrome is elevated. It is believed that platelet membrane glycoprotein CD62p and CD63 are the important molecular basis for the occurrence of blood stasis syndrome. Platelet alpha-granule membrane protein (GMP-140) is a specific marker of platelet activation. It has been reported in recent years  blood stasis syndrome diabetes, cardiovascular disease, nephropathy, psoriasis, and plasma of patients with primary glomerular disease The concentration of GMP-140 is significantly higher than that of patients with non-blood stasis syndrome, indicating that the increase of GMP-140 reflects the pathological changes of blood stasis syndrome co-existing in different diseases, and also indicates that platelet activation is closely related to blood stasis syndrome, reflecting GM The sensitivity of P-140 as a microscopic index of blood stasis syndrome differentiation.
5. Necessity and suggestions for establishing new diagnostic criteria for blood stasis syndrome
As mentioned above, the diagnostic criteria for blood stasis syndrome formulated in 1986 and 1988 have many shortcomings, which can no longer meet the needs of modern clinics. It is urgently needed to be revised. How to revise it, the author briefly talks about some suggestions:
1 The selection of the overall macroscopic indicators and signs should be based on a review of ancient and modern literature, and a few symptoms, signs or symptom groups should be initially selected as the main basis for the diagnosis of blood stasis syndrome, and the main basis should be selected to contribute to blood stasis syndrome The choice of secondary basis for symptoms, signs, or syndromes with high severity and high specificity should also be based on this principle, and the formulation of provisions should be accurate, concise, and practical. The content should cover two aspects of blood stasis syndrome: bleeding and bleeding from menstruation.
2 In terms of microscopic indicators, it is necessary to take into account multiple aspects related to blood stasis syndrome, such as bleeding and thrombosis, high rheology and low rheology, blood flow retardation and blood coagulation, changes in blood components and changes in vascular function, blood vessels The mediators related to endothelial injury and vasoconstriction must have both pathophysiological indicators and pathomorphological and imaging indicators.
3 In the selection of indicators, it is necessary to absorb new results and discoveries, but also to take care of regional differences to make it both advanced, universal and practical.
4 For every symptom and sign involving blood stasis syndrome, a standardized definition of the concept is required to prevent the inconsistency of the connotation and extension of the concept from causing ambiguity.
5 The determination of the new standard requires a multi-center (4 to 5), prospective, randomized controlled large-scale clinical epidemiological investigation and clinical research, and then a national meeting is held after a preliminary feasible plan is discussed and finalized by experts . Pay attention to the research foundation of evidence-based medicine and epidemiology.
6 Emphasize on the basic connotation of blood stasis syndrome (blood from the menstruation and blood stagnation) to carry out the correlation analysis, optimization and combination of related indicators, symptoms and signs, and finally establish clinical diagnostic criteria.
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