《医学物理学》是医学类院校开设的一门基础课程,为了更好地开展以科学问题为导向的教学改革,提升本科教学质量,本文对中医活血化瘀疗法内涵的物理学进行探讨。心脑血管疾病多为气机运行不畅、寒热郁结体内不散、痰浊阻滞、瘀血肿块等因素导致,而活血化瘀法具有活血行血、消肿散结、调经止痛等功效。因此,活血化瘀法是心脑血管疾病治疗中一种十分有效的方法。传统文章着重探讨活血化瘀法的药效治疗,而本篇文章将活血化瘀作用机制通过血液与物理泊肃叶定律Q = πr4Δp/(8ηL),R = 8ηL/(πr4)联系起来,从物理学角度对活血化瘀内涵进行分析,并将物理学串并联理论延伸到毛细血管结构中,从而对血管各级分支的意义进行探讨,使活血化瘀法作用机制与物理学的联系更加深刻。以期由纳米级机器人进入人体血管治疗心血管疾病,为实现中医现代科学化做出进一步的贡献。 “Medical Physics” is a basic course offered by medical colleges and universities. In order to better carry out the teaching reform oriented by scientific problems and improve the quality of undergraduate teaching, this paper discusses the physics of the connotation of the TCM therapy of activating blood circulation and removing stasis. Most cardiovascular and cerebrovascular diseases are caused by such factors as poor qi circulation, stagnation of cold and heat stagnation in the body, block of phlegm and turbidness, blood stasis mass, etc., while activating blood circulation and removing blood stasis method has the functions of promoting blood circulation, reducing swelling and dispersing knot, regulating meridian and analgesia, etc. Therefore, activating blood circulation and removing blood stasis is a very effective method in the treatment of cardiovascular and cerebrovascular diseases. Traditional paper focuses on the pharmacodynamic treatment of activating blood circulation and removing blood stasis, and this article promotes blood circulation to remove blood stasis mechanism through blood and Poiseuille law of physics Q = πr4Δp/(8ηL), R = 8ηL/(πr4). From the perspective of physics, this paper analyzes the connotation of promoting blood circulation and removing blood stasis, and extends the theory of physics series and parallel to the capillary structure, so as to discuss the significance of the branches of blood vessels at all levels, which makes the connection between the mechanism of activating blood circulation and removing blood stasis more profound. It is expected that nanoscale robots will enter human blood vessels to treat cardiovascular diseases, making further contributions to the realization of modern science of traditional Chinese medicine.
《医学物理学》是医学类院校开设的一门基础课程,为了更好地开展以科学问题为导向的教学改革,提升本科教学质量,本文对中医活血化瘀疗法内涵的物理学进行探讨。心脑血管疾病多为气机运行不畅、寒热郁结体内不散、痰浊阻滞、瘀血肿块等因素导致,而活血化瘀法具有活血行血、消肿散结、调经止痛等功效。因此,活血化瘀法是心脑血管疾病治疗中一种十分有效的方法。传统文章着重探讨活血化瘀法的药效治疗,而本篇文章将活血化瘀作用机制通过血液与物理泊肃叶定律Q = πr4Δp/(8ηL),R = 8ηL/(πr4)联系起来,从物理学角度对活血化瘀内涵进行分析,并将物理学串并联理论延伸到毛细血管结构中,从而对血管各级分支的意义进行探讨,使活血化瘀法作用机制与物理学的联系更加深刻。以期由纳米级机器人进入人体血管治疗心血管疾病,为实现中医现代科学化做出进一步的贡献。
活血化瘀,血液,物理,泊肃叶定律
Benrong Mu*, Yu Fu*, Anyang Rao, Yi Yang, Wenwen Liu, Dongmei Wang#, Hai Wang#
Chengdu University of Traditional Chinese Medicine, Chengdu Sichuan
Received: Nov. 27th, 2020; accepted: Dec. 21st, 2020; published: Dec. 30th, 2020
“Medical Physics” is a basic course offered by medical colleges and universities. In order to better carry out the teaching reform oriented by scientific problems and improve the quality of undergraduate teaching, this paper discusses the physics of the connotation of the TCM therapy of activating blood circulation and removing stasis. Most cardiovascular and cerebrovascular diseases are caused by such factors as poor qi circulation, stagnation of cold and heat stagnation in the body, block of phlegm and turbidness, blood stasis mass, etc., while activating blood circulation and removing blood stasis method has the functions of promoting blood circulation, reducing swelling and dispersing knot, regulating meridian and analgesia, etc. Therefore, activating blood circulation and removing blood stasis is a very effective method in the treatment of cardiovascular and cerebrovascular diseases. Traditional paper focuses on the pharmacodynamic treatment of activating blood circulation and removing blood stasis, and this article promotes blood circulation to remove blood stasis mechanism through blood and Poiseuille law of physics Q = πr4Δp/(8ηL), R = 8ηL/(πr4). From the perspective of physics, this paper analyzes the connotation of promoting blood circulation and removing blood stasis, and extends the theory of physics series and parallel to the capillary structure, so as to discuss the significance of the branches of blood vessels at all levels, which makes the connection between the mechanism of activating blood circulation and removing blood stasis more profound. It is expected that nanoscale robots will enter human blood vessels to treat cardiovascular diseases, making further contributions to the realization of modern science of traditional Chinese medicine.
Keywords:Activating Blood and Removing Stasis, Blood, Physics, Poiseuille Law
Copyright © 2020 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
http://creativecommons.org/licenses/by/4.0/
随着人们生活水平的提高,生活作息不规律、人口老龄化等问题成为心血管疾病发生的重要因素。根据《中国心血管病报告2018》于2019年发布的报告可知,我国心血管疾病患病人数高达2.9亿,发病率及其死亡率仍在上升,且心血管疾病死亡率高于其他疾病,居于首位 [
活血化瘀法为中医特有的一种治疗方法,该法通过调通血液运行、消散瘀结、调经止痛来治疗瘀血内停导致的所引起的一系列疾病 [
活血化瘀法适用于血行不畅致使瘀血形成而引起的各种疼痛以及血证 [
在人体内,血液是流动在人的血管和心脏中的一种红色不透明的粘稠液体,是心血管循环系统的主要组成部分。血液由血细胞和血浆两部分组成,血细胞又包括红细胞、血小板、白细胞。而血浆的组成极其复杂,包括蛋白质、脂类、无机盐、糖、氨基酸、代谢废物以及大量的水。血液的组成赋予了血液基本特性:血液是黏性流体,具有屈服应力,触变性等。此外,红细胞具有运输O2和CO2的功能,血小板具有凝血止血的功能,白细胞具有防御功能。因此,血液的正常运行是维持人体正常生理功能的重要原因 [
因血瘀证多为瘀血郁结,体内血液停滞或血运行不畅而阻滞经脉脏腑之内的血液所引起 [
丹参有祛瘀止痛,活血通经,清心除烦等功效,临床常做活血化瘀药。以家兔作为实验对象,检测实验组和对照组实验前后血液流变方面指标,包括全血粘度(η1)、血浆粘度(η2)、血小板聚集性、血沉(ESR)、红细胞压积(HCT)、体外血栓形成 、纤维蛋白原(FG)、凝血酵元时间(PT)、自陶土凝血括酶时间(KPTT)。根据实验结果得出:丹参通过抑制血小板聚集性,减轻体外血栓干、湿重,降低低切变率γ下的全血黏度η1,延长KPTT(白陶土凝血活酶时间)值达到活血化瘀的疗效 [
项目 | 实验组 | 对照组 | |
---|---|---|---|
全血粘度 | 192 1 / s (mpa∙s) | 6.17 ± 0.70 | 6.59 ± 0.22 |
5.75 1 / s (mpa∙s) | 30.02 ± 13.61 | 51.1 ± 9.76 | |
血浆粘度 | 153.6 1 / s (mpa∙s) | 4.18 ± 0.28 | 3.96 ± 0.21 |
表1. 全血粘度、血浆粘度测定结果( X ¯ ± SD)
实验组 | 对照组 | |
---|---|---|
湿重(mg) | 58.2 ± 24.5 | 92.3 ± 47.9 |
干重(mg) | 17.4 ± 9.3 | 27.6 ± 16.8 |
表2. 体外血栓形成的测定结果( X ¯ ± SD)
项目 | 实验组 | 对照组 |
---|---|---|
PT (s) | 9.16 ± 0.75 | 9.0 ± 1.87 |
KPTT (s) | 24.60 ± 20.66 | 20.00 ± 2.68 |
Fg (mg%) | 455.30 ± 90.1 | 481.60 ± 58.80 |
ESR (mm/h) | 1.38 ± 0.82 | 2.35 ± 1.95 |
HCT (%) | 33.95 ± 4.79 | 34.08 ± 3.36 |
表3. 二组测定结果( X ¯ ± SD)
红花可通经活血、祛瘀止痛,试验以家兔作为研究对象,观察实验组与对照组实验过程中微血管径(d)、血管运动频率及振幅、血压(p)变化。据观测可知:在血管运动明显期,静注CTL (中草药红花提取液)后,血管运动的频率迅速减慢、振幅快速降低,并最终抑制于舒张状态,血液灌流量Q增加,且这种变化较注射NA (去甲肾上腺素)的对照组更明显。此外还发现红花具有“扩血管作用”,但并不是单纯的扩张血管,而是抑制由NA诱导出来的血管运动,从而导致血流量Q增加,且红花这种作用不通过内源性NO介导 [
根据劲动脉粥样硬化病理可知,劲动脉内膜增厚、斑块的形成导致血管狭窄,即该处血管半径R变小,血流量Q减少,脂质代谢异常使血液黏稠,即η值变大,从而引发心脑血管疾病。根据张文将等人收集的109篇文献及其对中药汤剂治疗CAS药物进行统计归类分析得知使用率最高的是丹参、川芎类活血药 [
对上述实验及疗法进行合理分析可知用于治疗心血管疾病的药物,如丹参、红花和川芎等药物主要是通过血液流变指数达到活血化瘀的目的。而根据由泊肃叶定律可知,血流量Q与r的四次方成正比,与η的一次方成反比。此外,r和η的大小还影响着流阻R的大小。由此可见,活血化瘀的根本解决途径与泊肃叶定律十分吻合。因此从物理学对中医活血化瘀疗法内涵进行科学探讨,对中医药理论现代化解释和现代化建设有着支持作用。
通过构建心血管系统物理模型,可以十分清楚地观测到血管各级分支变化:随着分支的增加,血管径r变小。由泊肃叶定律可知,流阻R与管径r的4次方成反比,当r变小时,R会明显增大。因此,血管分支到毛细血管处流阻R应最大。但是,流阻R过大显然与血液在毛细血管正常流动的情况不符。据观测心血管物理模型,可视全身毛细血管为“并联”电路。根据电路串并联规律可知,毛细血管“并联”将大为减少总流阻,因此毛细血管因半径小而造成流阻大的这一情况可相对忽视,也以此保障血液在毛细血管中的正常流通 [
临床关于活血化瘀法的研究大多都是单纯的对其活血化瘀功效,即活血行血、祛瘀通络、化旧生新进行研究,而很少有文章将活血化瘀的疗效机制与物理学进行联系。文章从物理学角度分析中医活血化瘀内涵,提出将活血化瘀的疗效内涵联系到物理泊肃叶定律上,并且将血管半径r与黏度η对血流量Q的影响进行对比分析。此外,通过合理推测,将物理电路串并联知识联系到毛细血管,从而深化活血化瘀与泊肃叶定律之间的联系。希望有更完善合理的实验设计将物理串并联知识应用到血管多级分支上,探究血液在各级分支流动情况并进行分析。在此可期待纳米级机器人进入人体血管 [
感谢成都中医药大学校级线上线下混合式示范课程《物理学》、成都中医药大学校级线课程思政示范课程《物理学》、成都中医药大学核心通识课程《物理思维与科研素养》、成都中医药大学青年骨干教师教学能力提升高级研修班等建设项目的支持。
成都中医药大学教学改革项目(JGYB201975, JGZX201812);四川省教育厅2018~2020年高等教育人才培养质量和教学改革项目(JG2018-611)。
木本荣,付 裕,饶安阳,杨 艺,刘文雯,王冬梅,王 海. 《医学物理学》课程中科学问题探索实践(一)——中医活血化瘀疗法内涵的物理学探讨Exploration and Practice of Science Problems in the Course of Medical Physics (I)—Physical Discussion on the Connotation of Traditional Chinese Medicine Therapy of Promoting Blood Circulation and Removing Blood Stasis[J]. 交叉科学快报, 2020, 04(04): 21-26. https://doi.org/10.12677/ISL.2020.44005