中醫(yī)基礎(chǔ)理論：7-學(xué)生用氣血津液

1、第4講 氣血津液瘀血、痰飲氣血津液46億年40億年150萬年 無機(jī)物無機(jī)物 有機(jī)物有機(jī)物細(xì)胞細(xì)胞微生物微生物植物植物動(dòng)物動(dòng)物人人空氣空氣水水氣氣：構(gòu)成人體、維持人體生命活動(dòng)的精微物質(zhì)：構(gòu)成人體、維持人體生命活動(dòng)的精微物質(zhì)水谷精微水谷精微水谷精微糖、蛋白、脂肪 氧氣ATP線粒體NADH氧化酶琥珀酸-Q還原酶細(xì)胞色素還原酶電子傳遞鏈細(xì)胞色素C氧化酶ATP合酶(Papa S, Martion et al. Adv Exp Med Biol.2012. 942:3-37)碳?xì)滏I在氧化過程中斷裂-CO2、H2O能量50%轉(zhuǎn)化為熱能50高能磷酸鍵連接細(xì)胞骨架維持細(xì)胞形態(tài)和連接肌肉的收縮和舒張?jiān)黾影准?xì)胞的吞

2、噬功能離子和物質(zhì)的主動(dòng)轉(zhuǎn)運(yùn)細(xì)胞兩側(cè)的離子濃度差氣的生成先天之先天之氣-腎腎-元元?dú)馇迩鍤? 肺肺 -宗宗氣-衛(wèi)衛(wèi)氣水谷精微水谷精微脾脾營營氣oxygenlungsnutrition intestinesQiATPATPpromotes blood flow氣的作用推動(dòng)作用推動(dòng)作用：推動(dòng)臟腑功能 推動(dòng)液態(tài)物質(zhì)的流動(dòng)氣的作用推動(dòng)作用：推動(dòng)作用：推動(dòng)臟腑功能 推動(dòng)液態(tài)物質(zhì)的流動(dòng)溫煦作用溫煦作用：維持體溫 維持液態(tài)物質(zhì)流動(dòng)的環(huán)境氣的作用推動(dòng)作用推動(dòng)作用：推動(dòng)臟腑功能 推動(dòng)液態(tài)物質(zhì)的流動(dòng)溫煦作用溫煦作用：維持體溫 維持液態(tài)物質(zhì)流動(dòng)的環(huán)境防御作用防御作用：抵御外邪侵入 與入侵的外邪抗?fàn)帤獾淖饔猛苿?dòng)作用推動(dòng)

3、作用：推動(dòng)臟腑功能 推動(dòng)液態(tài)物質(zhì)的流動(dòng)溫煦作用溫煦作用：維持體溫 維持液態(tài)物質(zhì)流動(dòng)的環(huán)境防御作用防御作用：抵御外邪入侵 與入侵的外邪抗?fàn)幑虜z作用固攝作用：維持臟器的位置 防止液態(tài)物質(zhì)的流失oxygenlungsnutrition intestinesQiATPATP氣的作用推動(dòng)作用推動(dòng)作用：推動(dòng)臟腑功能 推動(dòng)液態(tài)物質(zhì)的流動(dòng)溫煦作用溫煦作用：維持體溫 維持液態(tài)物質(zhì)流動(dòng)的環(huán)境防御作用防御作用：抵御外邪入侵 與入侵的外邪抗?fàn)幑虜z作用固攝作用：維持臟器的位置 防止液態(tài)物質(zhì)的流失氣化作用氣化作用：由氣的運(yùn)動(dòng)引起的變化氣的流動(dòng)（運(yùn)動(dòng)）及其流動(dòng)形式氣機(jī)：氣的流動(dòng)（運(yùn)動(dòng)）氣的流動(dòng)形式：升降出入肺肺宣發(fā)宣發(fā)-升

4、、出升、出 肅降肅降-降、入降、入胃胃-脾脾-降降升升肺肺-降降肝肝-升升腎腎 升清、降濁升清、降濁宗氣形成部位：肺原料：水谷精微、清氣作用：行呼吸 行心血 與發(fā)聲、下肢溫度相關(guān)營氣行于脈內(nèi)的氣，沿血管巡行周身，發(fā)揮營養(yǎng)作用。 衛(wèi)氣行于脈外的氣，溫煦臟腑和肌表 調(diào)節(jié)腠理開合 抵御外邪水谷水谷 水谷之精微水谷之精微清氣清氣 脾脾肺肺宗氣宗氣脈內(nèi)脈內(nèi)營氣營氣脈外脈外衛(wèi)氣衛(wèi)氣維持體溫維持體溫調(diào)節(jié)腠理調(diào)節(jié)腠理抵御外邪抵御外邪血行、呼吸血行、呼吸語聲、下肢體溫語聲、下肢體溫 腠理腠理細(xì)胞間縫隙鏈接細(xì)胞間縫隙鏈接元?dú)庀忍熘畾庀忍熘畾?腎腎-元?dú)庠獨(dú)馍顒?dòng)的元?jiǎng)恿?，推?dòng)臟腑的功能活動(dòng)生命活動(dòng)的元?jiǎng)恿?，推?dòng)

5、臟腑的功能活動(dòng)清氣清氣- 肺肺 -宗氣宗氣-衛(wèi)氣衛(wèi)氣水谷精微水谷精微脾脾營氣營氣血：流動(dòng)于血管內(nèi)的具有營養(yǎng)作用的赤色液體。血：流動(dòng)于血管內(nèi)的具有營養(yǎng)作用的赤色液體。血血血的生成 無形成分 清氣-肺-宗氣- 營氣 水谷精微-脾- 水-脾- 津液有形成分先天之精- 后天之精精（腎）-肝血的作用濡養(yǎng)作用：血沿脈巡行周身，滋養(yǎng)各臟腑、 器官、組織和細(xì)胞。養(yǎng)神：血滋養(yǎng)腦，維持精神意識(shí)思維活動(dòng)。血的運(yùn)行血在脈內(nèi)巡行（脈為血之府） 血的運(yùn)行血在脈內(nèi)巡行（脈為血之府）。 離經(jīng)之血（溢于脈外之血）血的運(yùn)行血在脈內(nèi)巡行（脈為血之府）。 離經(jīng)之血（溢于脈外之血）。氣：推動(dòng)作用 （心氣） 固攝作用 （脈氣）血的運(yùn)行血

6、在脈內(nèi)巡行（脈為血之府）。 離經(jīng)之血（溢與脈外之血）氣：推動(dòng)作用 固攝作用心：推動(dòng)血行的動(dòng)力肝：疏泄、藏血、調(diào)血肺：宗氣、朝百脈脾：統(tǒng)血血虛血灌流量不足面色無華、唇爪淡白、舌小淡白、脈細(xì)、神的異常。血瘀血在脈內(nèi)巡行不暢，或溢于脈外（內(nèi)出血）血瘀血在脈內(nèi)巡行不暢，或溢于脈外（內(nèi)出血）血在脈內(nèi)巡行不暢，或溢于脈外（內(nèi)出血）引起血液在脈內(nèi)巡行不暢的原因引起血液在脈內(nèi)巡行不暢的原因 氣虛：不能推動(dòng)血行 氣滯：不能調(diào)節(jié)血行 血熱：消耗津液 血寒：脈管收縮引起血溢于脈外的原因引起血溢于脈外的原因 氣虛：不能攝血 血熱：損傷脈 外傷：損傷脈 瘀血血液在脈內(nèi)巡行不暢，或溢于脈外（內(nèi)出血血液在脈內(nèi)巡行不暢，或溢

7、于脈外（內(nèi)出血）的狀態(tài)。）的狀態(tài)。氣虛：不能推動(dòng)血行、不能攝血-氣虛血瘀 氣虛氣虛不行血不行血不固攝不固攝血瘀血瘀補(bǔ)氣行血補(bǔ)氣行血芪參益氣滴丸芪參益氣滴丸補(bǔ)氣固攝補(bǔ)氣固攝痰飲、出血痰飲、出血結(jié)語結(jié)語瘀血血液在脈內(nèi)巡行不暢，或溢于脈外（內(nèi)出血） 氣虛：不能推動(dòng)血行、不能攝血?dú)馓撗?氣滯：不能調(diào)節(jié)血行-氣滯血瘀 喜、怒、憂、思、悲、恐、驚喜、怒、憂、思、悲、恐、驚正常刺激量正常刺激量情情志刺激志刺激 肝肝疏泄功能疏泄功能喜、怒、憂、思、悲、恐、驚喜、怒、憂、思、悲、恐、驚正常刺激量正常刺激量情情志刺激志刺激 肝肝疏泄功能疏泄功能瘀血血液在脈內(nèi)巡行不暢，或溢于脈外（內(nèi)出血）引起血液在脈內(nèi)巡行不暢的

8、原因 氣虛：不能推動(dòng)血行、不能攝血?dú)馓撗?氣滯：不能調(diào)節(jié)血行-氣滯血瘀 血熱：消耗津液、損傷脈絡(luò)-血熱血瘀 膿毒血癥及其發(fā)展而成的重癥膿毒血癥和膿毒性休克發(fā)病率和死亡率居高不下，目前尚缺乏真正有效的降低其發(fā)病率和目前尚缺乏真正有效的降低其發(fā)病率和死亡率的臨床藥物死亡率的臨床藥物。背背 景景The Lancet Infectious Diseases, 2012, 12, 89.Proinflammatory cytokineAdhesion molecule血熱血瘀（溫?。┬l(wèi)分衛(wèi)分氣分氣分營分營分血分血分migrationICAM-1-CD18/11bXOO2-O2H2O2O2-O2NADH

9、 oxidaseH2O2sticking血漿白蛋白血漿白蛋白出出血血血栓血栓辛涼解表辛涼解表清熱解毒清熱解毒清營涼血清營涼血活血化瘀活血化瘀Latin name (Chinese name)Major effective phytochemical compoundEphedra sinica Stapf (麻黃麻黃)EphedrineAmygdalus Communis Vas. (杏仁杏仁)NitrilosidesGypsum Fibrosuum (石膏石膏)Calcium sulfateGlycyrrhiza uralensis Fisch.(甘草甘草)Liquiritin麻杏石甘湯麻杏

10、石甘湯(Ma-Xing-Shi-Gan-Tang, MXSGT）37Li-Qian Ma et al. Microcirculation. 2014 May 8. doi: 6 h (NS 6h, LPS6h)0 hi.p. injected LPS in 7.5mg/kgOral gavage with MXSGT in 2.6075 g/kg MBP, HR, temperatureGas analysisMicrocirculation observationImmunohistochemistryELISAWesterblot72 hMethods (Post-treatment wi

11、th MXSGT)Animals: male SD rats (180-220 g)12 h (NS 12h, MXSGT, LPS 12h, MXSGT+LPS)Survival rate38NS: Normal SalineRat lungLi-Qian Ma et al. Microcirculation. 2014 May 8. doi: 2030405060708090100NS 12hMXSGT5LPS 12hMXSGT5+LPSMXSGT1+LPS6121824364872Time (h)Survival (%)MXSGT Post-treatment Improves the

12、Rat Survival Rate Reduced by LPS39Li-Qian Ma et al. Microcirculation. 2014 May 8. doi: 0246810128090100110120#&Time (h)Mean Blood pressure (mmHg)024681012390400410420430#&Heart Rate (/min)Time (h)0246810123536373839#*&Temperature ()Time (h)9596979899100*&#SO2 (%)80859095#*&PaO2 (

13、mmHg)35404550#&PaCO2 (mmHg)MXSGTMXSGT+LPSNS 12hLPS 12hMXSGT+LPSNS 6hLPS 6hNS 12hMXSGT LPS 12hMXSGT Post-treatment Relieves the Rat Vital Sign Depravation Induced by LPS40Li-Qian Ma et al. Microcirculation. 2014 May 8. doi: VVVV0.51.01.52.0*#&ICAM-1-actinICAM-1/-actin (normalized)Number of ad

14、herent leukocytes 01 02 03 04 0#*&VVMXSGT Post-treatment Attenuates LPS-elicited Enhancement of Leukocyte Adhesion and Reduces the Upregulation of ICAM-1MXSGT+LPSNS 6hLPS 6hNS 12hMXSGT LPS 12h41NS 6hLPS 6hNS 12hMXSGT LPS 12hMXSGT+LPS50 umLi-Qian Ma et al. Microcirculation. 2014 May 8. doi: 0246*

15、&#MPO activity (U/mg)MXSGT Post-treatment Reduces the Release of MPO in the induced by LPS42NS 6hLPS 6hNS 12hMXSGT LPS 12hMXSGT+LPS50 umMXSGT+LPSNS 6hLPS 6hNS 12hMXSGT LPS 12hLi-Qian Ma et al. Microcirculation. 2014 May 8. doi: MXSGT post-treatment suppresses the activation of Src，and inhibits t

16、he transfer of NF-B p65 and the overexpression of Toll Like receptor 4 induced by LPSSrcP-SrcTLR-4-actin0.00.51.01.52.02.5*&#TLR-4/-actin (normalized)Src/-actin (normalized)0.00.51.01.50 . 00 . 51 . 01 . 52 . 0*#&p-Src/-actin (normalized)Plasma0.00.81.01.2&#*p65-actinp65/-actin

17、(normalized)0.00.51.01.52.02.5*&#Nucleus H-3MXSGT+LPSNS 6hLPS 6hNS 12hMXSGT LPS 12h43p65p65/-actin (normalized)Li-Qian Ma et al. Microcirculation. 2014 May 8. doi: 200300400500600700*#&TNF in serum (pg/ml)0100200300400*#&TNFin BAL pg/ml0200400600*#&TNFin tissue (pg/ml)MXSGT Reduces t

18、he Release of TNF, IL-6, IL1- induced by LPS44MXSGT+LPSNS 6hLPS 6hNS 12hMXSGT LPS 12hLi-Qian Ma et al. Microcirculation. 2014 May 8. doi: 瘀血血液在脈內(nèi)巡行不暢，或溢于脈外（內(nèi)出血）引起血液在脈內(nèi)巡行不暢的原因 氣虛：不能推動(dòng)血行、不能攝血?dú)馓撗?氣滯：不能調(diào)節(jié)血行-氣滯血瘀 血熱：消耗津液、損傷脈絡(luò)-血熱血瘀 血寒：凝聚、收引-血寒血瘀 寒凝血瘀麻黃湯表寒理中湯-里寒溫經(jīng)湯-宮寒瘀血血液在脈內(nèi)巡行不暢，或溢于脈外（內(nèi)出血）引起血液在脈內(nèi)巡行不暢的原因 氣

19、虛：不能推動(dòng)血行、不能攝血?dú)馓撗?氣滯：不能調(diào)節(jié)血行-氣滯血瘀 血熱：消耗津液、損傷脈絡(luò)-血熱血瘀 血寒：凝聚、收引-血寒血瘀 外傷：損傷脈絡(luò)、缺血再灌注-外傷血瘀 Salvia miltiorrhiza Bunge.Panax notoginseng (Burk) F. H. ChenDihydroxylphenyl lactic acid (DLA)Salvianolic acid A(SAA)Salvianolic acid B(SAB)Ginsenoside Rb1(Rb1)Ginsenoside Rg1 (Rg1)Ginsenoside R1 (R1)Panax notoginse

20、ng saponins (PNS)Total Salvianolic acid (TSA) 復(fù)方丹參滴丸復(fù)方丹參滴丸Cardiotonic pills (CP)(Dantonic)Borneol The effect of CP pre-treatment on Diameter of and RBC velocity in coronary arteriole and venule in rat after I/R ShamIRCP0.1+IRCP0.4+IRCP0.8+IRP0.05 vs. Sham # P0.05 vs. I/R Baseline03060(min)IR60100120

21、#20*4080IRBaseline03060 (min)60100120204080(%)(%)#Baseline03060IR(min)#Baseline03060(min)IR2060100120*#*8040*(%)(%)RBC velocity Diameter Arterioles Arteriolesvenules venules N Zhao,et al., Am J Physiol Heart Circ Physiol. 2010 Apr;298(4):H1166-1176 The influence of pre-treatment with CP on the expre

22、ssion of ICAM-1on vascular endothelial cells in myocardium of rats after I/R 100 mShamI/RCP0.4+I/RCP0.8+I/RCP0.1+I/R0ShamI/RCP0.1+I/R CP0.4+I/R CP0.8+I/R*#*P0.05 vs Sham # P0.05 vs I/R N Zhao,et al., Am J Physiol Heart Circ Physiol. 2010 Apr;298(4):H1166-1176 Mean Density of ICAM-1 The effe

23、ct of pre-treatment with CP on capillary endothelium injury and FITC-albumin leakage from coronary venular wall after reperfusion. ShamI/RCP0.4+I/RCP0.8+I/RCP0.1+I/R60ShamI/RCP0.1+I/R304515CP0.4+I/RCP0.8+I/R*#Albumin Leakage(%)N Zhao,et al., Am J Physiol Heart Circ Physiol. 2010 Apr;298(4):H1166-117

24、6 The effect of CP pre-treatment on coronary blood flow of rats subjected to I/R. BaselineIR-0IR-30IR-60CP 0.1+IRShamIRCP 0.4+IRCP 0.8+IRShamIRCP0.1+IRCP0.4+IRCP0.8+IR#*206080120Baseline60510(min)IR03040100* P0.05 vs Sham # P0.05 vs I/R N Zhao,et al., Am J Physiol Heart Circ Physiol. 2010 Apr;298(4)

25、:H1166-176 Coronary blood flow (%) ShamIRCP 0.8+IRP0.05 vs Sham # P0.05 vs I/R *#*ShamI/RCP0.1+I/R CP0.4+I/R CP0.8+I/R05151020The effect of pre-treatment with CP on myocardial damage and infarct size of rats after I/R ShamI/RCP 0.4+I/RCP 0.8+I/RCP 0.1+I/RInfarct size（%）N Zhao,et al., Am J Physiol He

26、art Circ Physiol. 2010 Apr;298(4):H1166-176 N Zhao,et al., Am J Physiol Heart Circ Physiol. 2010 Apr;298(4):H1166-176100 mShamI/RCP 0.4+I/RCP 0.8+I/RCP 0.1+I/REffect of pretreatment with CP on histology of myocardial tissue of rats after I/R.Myocadium fibrosis after I/RMonocyte MacrophageInjured myo

27、cardial cellMonocyteC5aS19CD68TGF-1The expression of chemokines S19 , C5a , TGF1 and CD68 positive cells 6 days after reperfusionSham I/R 3hI/R 6dI/R 6d+ CP0.8Xiao-Hong Wei et al. Microcirculation. 2013 Jan;20(1):17-29.0 05050100100150150ShamIR3hIR6dIR+CP0.8IR+CP0.4Optical density of TGF-1 (% sham)T

28、GF-1Tubulin*#P-Smad3TubulinSmad4Tubulin0 05050100100150150200200ShamIR3hIR6dIR+CP0.8IR+CP0.4Optical density of Smad4 (% Sham)*#0 05050100100150150200200250250ShamIR3hIR6dIR+CP0.8IR+CP0.4Optical density of P-Smad3 (% Sham)*#Xiao-Hong Wei et al. Microcirculation. 2013 Jan;20(1):17-29.0246810ShamI/R3hI

29、/R6dI/R+CP0.1 I/R+CP0.4 I/R+CP0.8Ratio of Mallory staining myocardium (%)ShamIR3hIR6d+CP0.1IR6dIR6d+CP0.4IR6d+CP0.8Xiao-Hong Wei et al. Microcirculation. 2013 Jan;20(1):17-29.Total Salvianolic acid (TSA)Salvia miltiorrhiza Bunge.Panax notoginseng (Burk) F. H. ChenDihydroxylphenyl lactic acid (DLA)Sa

30、lvianolic acid A(SAA)Salvianolic acid B(SAB)Ginsenoside Rb1(Rb1)Ginsenoside Rg1 (Rg1)Ginsenoside R1 (R1)Panax notoginseng saponins (PNS) 復(fù)方丹參滴丸復(fù)方丹參滴丸Cardiotonic pills (CP)(Dantonic)Borneol 科學(xué)問題五復(fù)方丹參滴丸的主要入血和標(biāo)定成分DLA、R1的發(fā)揮了何作用及其作用機(jī)理？Xiao-Yuan Yang, et al. Scientific Reports, 2015丹參素的作用Xiao-Yuan Yang, e

31、t al. Scientific Reports, 2015NDUFA10 I/RSIRT-1NDUFA9 ATP5DSDHAXiao-Yuan Yang, et al. Scientific Reports, 2015NDUFA10 I/RSIRT-1NDUFA9 ATP5DSDHAXiao-Yuan Yang, et al. Scientific Reports, 2015Xiao-Yuan Yang, et al. Scientific Reports, 2015Xiao-Yuan Yang, et al. Scientific Reports, 2015NDUFA 10I/RSIRT-

32、1DLAATP5DCASIRT-3NDUFA 9 NDUFA 10I/RSIRT-1DLA ATP5DCASIRT-3NDUFA 9R1RockAJP-HC，2014Scientific Reports2015Free Rad Bio Med 2015oxygenlungsnutrition intestinesQiHypoxanthineOHONOO- H2O2 NOMDAApoptosisO2 O2- O2NADPH oxidaseNF- B TNF-、 IL-1 IL-6、IL-10Energy Metabolic DisordersOccludin/claudin-5/JAM/ ZO-

33、1ATP Synthase MPO+Cellular DamegeMitochondrial respiratory chainATPADPAMPXanthine dehydrogenaseXanthine OxidaseSrcATP5DDLASit1-NDUFA10-Complex 1R1Rock小結(jié)五復(fù)方丹參滴丸2008年4月-2009年12月 124 例穩(wěn)定性心絞痛患者Phase II study in FDA of USITT,ITT, Trough Trough (n=39-44) (n=39-44) P0.0P0.00505N=39-44ITT,ITT, TroughTrough心

34、絞痛發(fā)作次數(shù) 復(fù)方丹參滴丸復(fù)方丹參滴丸Cardiotonic pills (CP)P0.05N=39-44P0.010.00%5.00%10.00%15.00%20.00%25.00%CHDPain FatigueHeadacheDizzinessIndigestionSafety: AE/SAEs Occurred High DoseLow DosePlacebo2010年7月23日-24日FDA通過2期臨床試驗(yàn)，批準(zhǔn)啟動(dòng)3期臨床試驗(yàn)。使用硝酸甘油的次數(shù)臨床問題高血壓：小動(dòng)脈攣縮-擴(kuò)血管藥物再灌注 腦微循環(huán)障礙和神經(jīng)元損傷腦血栓：溶栓-再灌注腦微循環(huán)障礙和神經(jīng)元損傷 溶栓治療時(shí)間窗外焦慮：

35、小動(dòng)脈攣縮輕度認(rèn)知障礙：腦灌流不足 養(yǎng)血清腦顆粒養(yǎng)血清腦顆粒（Cerebralcare Granule , CG）Latin name (Chinese name)Major effective phytochemical compoundAngelica sinensis (Oliv.) Diels (當(dāng)歸當(dāng)歸)ferulic acidLigusticum chuanxiong Hort. (川芎川芎)ligustrazinePaeonia lactiflora Pall (白芍白芍)paeoniflorinUncaria sinensis (Oliv.) Havil. (勾藤勾藤)rhyn

36、chophyllineSpatholobus suberectus Dunn (雞血藤雞血藤)genisteinPrunella vulgaris L. (夏枯草夏枯草)ursolic acidHyriopsis cumingii (Lea) (珍珠母珍珠母)water-soluble polysaccharideRehmannia glutinosa Libosch. (地黃地黃)rehmanniosideCassia tora L. (決明子決明子)naphthopyrone glucosidesCorydalis yanhusuo W.T.Wang (延胡索延胡索)tetrahydrop

37、almatineAsarum sieboldii Miquel (細(xì)辛細(xì)辛)methyleugenolMale Mongolian gerbils weighing 65-90 g IR0 min60 min -30 min-120 minCG (0.4g/kg, 0.8g/kg)Microcirculation observation Infarct size Ultrastructural alterations TUNEL Western blotting The role of pre-treatment with CG in attenuating global cerebral m

38、icrocirculatory disturbance and neuron injury in hippocampus CA1Baseline 0 10 30 60 (min)IR02468Number of adherent leukocytes(per 200m venule)ShamI/RCG 0.4+I/RCG 0.8+I/RXS Xu, et al., Shock. 2009,32(2):201-209 IR010203040DHR fluorescence ratioBaseline 0 10 30 60 (min) abcdAShamI/RCG 0.4+I/RCG 0.8+I/

39、RB50mXS Xu, et al., Shock. 2009,32(2):201-209 IRBaseline 0 10 30 60 (min) 0246Albumin leakage (%) 50mabcdefAShamI/RCG 0.4+I/RCG 0.8+I/RBXS Xu, et al., Shock. 2009,32(2):201-209ABCXS Xu, et al., Shock. 2009,32(2):201-209ShamI/RCG 0.4+I/RCG 0.8+I/R IR050100150Ratio of CBF (%) Baseline 0 10 20 30 40 50

40、 60 (min)XS Xu, et al., Shock. 2009,32(2):201-2092mm2mm2mmShamI/RI/R養(yǎng)血清脳顆粒養(yǎng)血清脳顆粒Sham3HIR6DI/R6D+CG0.86D3H6D3H6DI/R6D+CG0.43H6D0100200300400500I/R6DI/R6D+CG0.8ShamI/R6D+CG0.4Hemisphere Intensity (%)I/R3HI/R6D#*#Ping Huang et al., Experimental Neurology.2013ABCShamI/R3HI/R6DI/R6D+CG0.4I/R6D+CG0.8Evans

41、 Blue Leakage (ug/g)024681012141618ShamI/R3HI/R6DI/R6D+CG0.4I/R6D+CG0.8*#*#74767880828486ShamI/R3HI/R6DI/R6D+CG0.4I/R6D+CG0.8Brain Water Content (%)*#Ping Huang et al., Experimental Neurology.2013AShamI/R3HI/R6DI/R6D+CG0.4I/R6D+CG0.8a1a2a3a4a5v iAlbumin Leakage (%)0204060ShamI/R6DI/R6D+CG0.4I/R6D+CG

42、0.880I/R3H#*BPing Huang et al., Experimental Neurology 2012,237:453-464b1b2b3b4b5a1a2a3a4a5EEEEOCVOCOCVOCVc1c2c3c4c5iVEVOCEVOCEVEVVOCVOCd1d2d3d4d5ShamI/R3hI/R6DI/R6D+CG0.4I/R6D+CG0.8NSVPing Huang et al., Experimental Neurology.2013BClaudin-5-actinJAM-1-actinCijklmnopJAM-1ShamI/R3HI/R6D I/R6D+CG0.8AC

43、laudin-5abcdefgh Claudin-5 Change (100%)ShamI/R3HI/R6DI/R6D+CG0.8I/R6D+CG0.4*#*#020406080100120020406080100120JAM-1 Change (100%)ShamI/R3HI/R6DI/R6D+0.8CGI/R6D+CG0.4#*#Ping Huang et al., Experimental Neurology.2013Occludin-actin-actinZO-1CBabcdefghijklmnopOccludinZO-1AShamI/R3HI/R6D I/R6D+CG0.8Occlu

44、din Change (100%)020406080100120ShamI/R3HI/R6DI/R6D+CG0.8I/R6D+CG0.4#*# ZO-1 Change (100%)020406080100120ShamI/R3HI/R6DI/R6D+CG0.8I/R6D+CG0.4*#Ping Huang et al., Experimental Neurology.2013cabdeCaveolin-1-actin22KD43KDBAI/R6D+CG0.8I/R6D+CG0.4 Caveolin-1 Change (100 %)04080120ShamI/R3HI/R6D*#*#160Pin

45、g Huang et al., Experimental Neurology.2013ShamI/R3HI/R6D I/R6D+CG0.4I/R6D+CG0.8Aa1a2a3a4a5B0200400600*#ShamI/R6DI/R6D+CG0.4I/R6D+CG0.8I/R3HPerfusion UnitPing Huang et al., Experimental Neurology.2013Neurological Score00.511.52ShamI/R6DI/R6D+CG0.4I/R6D+CG0.8I/R3H*#*#*ShamI/R3HI/R6D I/R6D+CG0.4I/R6D+

46、CG0.8ABCI/R6D+CG0.8#Sham010203040* Infarct Size (%)50I/R6D+CG0.4I/R3HI/R6D*#* &Ping Huang et al., Experimental Neurology.2013血瘀的種類氣虛血瘀氣滯血瘀血熱血瘀血寒血瘀外傷血瘀瘀血致病的特點(diǎn)疼痛疼痛: : 針刺樣、部位固定。針刺樣、部位固定。腫塊：可以觸及的體內(nèi)包塊，血液的凝固。腫塊：可以觸及的體內(nèi)包塊，血液的凝固。青紫色：皮膚、粘膜、口唇，舌（點(diǎn)、癍）青紫色：皮膚、粘膜、口唇，舌（點(diǎn)、癍）結(jié)、代、促脈：結(jié)、代、促脈： 結(jié)脈：脈緩，不規(guī)則的間歇結(jié)脈：脈緩，不規(guī)則的

47、間歇 代脈：脈緩，有規(guī)則的間歇代脈：脈緩，有規(guī)則的間歇 促脈：脈數(shù)，有規(guī)則的間歇促脈：脈數(shù)，有規(guī)則的間歇瘀血的危害造成靶器官的損傷造成靶器官的損傷 心脈瘀血：心肌梗死心脈瘀血：心肌梗死 腦脈瘀血：腦梗塞、腦出血腦脈瘀血：腦梗塞、腦出血 肝脈瘀血：肝損傷肝脈瘀血：肝損傷 腎脈瘀血：腎損傷腎脈瘀血：腎損傷 皮脈瘀血：紫癍皮脈瘀血：紫癍 粘膜脈瘀血：潰瘍粘膜脈瘀血：潰瘍活血化瘀方藥（1）氣虛血瘀補(bǔ)氣活血：補(bǔ)陽還五湯 芪參益氣滴丸 歸脾湯（2）氣滯血瘀行氣活血：血府逐瘀湯（3）血熱血瘀清熱涼血：犀角地黃丸（4）血寒血瘀溫經(jīng)活血：溫經(jīng)湯（5）外傷血瘀活血化瘀：復(fù)元活血湯 復(fù)方丹參滴丸中西醫(yī)結(jié)合教研室中西

48、醫(yī)結(jié)合教研室微循環(huán)三級(jí)實(shí)驗(yàn)室微循環(huán)三級(jí)實(shí)驗(yàn)室氣虛血瘀氣虛血瘀氣滯血瘀氣滯血瘀外傷血瘀血熱血瘀血熱血瘀血寒血瘀補(bǔ)氣活血行氣活血清熱涼血溫經(jīng)活血活血化瘀血瘀氣滯胃痛氣滯腹瀉氣滯頭痛月經(jīng)不調(diào)心氣虛膿毒血癥休克、多臟器衰竭風(fēng)寒感冒胃寒腹痛經(jīng)寒月經(jīng)痛介入損傷外科損傷擠壓損傷候選新藥補(bǔ)氣攝血休克津津 液液體內(nèi)正常水液的總稱。津：清稀，滲入肌膚、腠理、孔竅液：濃稠，灌注于臟腑、腦、髓、關(guān)節(jié)津液的生成、輸布和排泄肺肺水水液液津津宣發(fā)宣發(fā)皮膚，頭面皮膚，頭面脾脾腎腎膀胱膀胱尿尿便便汗汗肅降肅降升清：再吸收機(jī)體有用者升清：再吸收機(jī)體有用者降濁：排除代謝廢物降濁：排除代謝廢物開：令膀胱排尿開：令膀胱排尿合：令膀胱儲(chǔ)

49、尿合：令膀胱儲(chǔ)尿溫煦溫煦溫煦溫煦津液的功能滋養(yǎng)作用：肌膚、孔竅、臟腑、腦髓補(bǔ)充血容量、調(diào)節(jié)血液濃度：細(xì)動(dòng)脈細(xì)動(dòng)脈細(xì)靜脈細(xì)靜脈血管內(nèi)壓血管內(nèi)壓組織壓組織壓血管內(nèi)滲透壓組織滲透壓組織滲透壓津液血管內(nèi)壓血管內(nèi)壓組織壓血管內(nèi)滲透壓血管內(nèi)滲透壓組織滲透壓津液毛細(xì)血管津液膜上焦中焦下焦津液微血管膜血管周圍組織的細(xì)胞膜微血管膜淋巴管膜氣水通道脂膜微囊縫隙連接 （蛋白、津液）津液膜上焦中焦下焦飲痰微血管膜血管周圍組織的細(xì)胞膜微血管膜淋巴管膜 氣虛ATP少水通道脂膜微囊縫隙連接 （蛋白、津液）脫證津液膜上焦中焦下焦飲痰微血管膜血管周圍組織的細(xì)胞膜微血管膜淋巴管膜內(nèi)源性ATP合成增多水通道脂膜微囊縫隙連接 （蛋白、津液脫證補(bǔ)氣治療Xing-Sun Xu et al. Shock. 2009, 32(2):201-209. 痰飲津液代謝異常形成的病理產(chǎn)物 （停留于血管內(nèi)外的水） 痰：稠濁 飲：清稀 可見的痰飲： 有形之痰 不可見的痰飲：無形之痰 痰飲停留的部位相異所致。痰飲產(chǎn)生的原因肺虛肺虛水水液液津津宣發(fā)宣發(fā)皮膚，頭面皮膚，頭面腎虛腎虛膀胱膀胱尿尿便便汗汗肅降肅降升清：再吸收機(jī)體有用者升清：再吸收機(jī)體有用者降濁：排除代謝廢物降濁：排除