目的：观察耳尖放血治疗肝阳上亢型后循环缺血性眩晕（PCIV）的临床疗效及对患者血栓前状态的影响。方法：将124例患者按随机数字表法分为对照组与观察组各62例（两组各终止2例）。对照组口服甲磺酸倍他司汀片；观察组在对照组的基础上增加耳尖放血疗法。疗程30 d。治疗前后进行肝阳上亢证证候积分量表和眩晕障碍调查表（DHI）评分，并进行经颅多普勒超声检查，记录左椎动脉（LVA）、右椎动脉（RVA）、基底动脉（BA）平均流速与血管搏动指数（PI）；检测治疗前后血栓前状态指标血浆纤维蛋白原（FIB）、D-二聚体（D-D）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）并进行安全性评价。结果：治疗后，两组患者DHI评分和肝阳上亢证证候积分量表评分显著降低，LVA、RVA与BA的平均流速增加，PI、FIB、D-D显著降低（P<0.01）,APTT、PT显著升高（P<0.01）；组间比较，以上指标差异均有统计学意义（P<0.01）。观察组疗效优于对照组（P<0.01）。结论：耳尖放血治疗肝阳上亢型PCIV患者可以改善其血栓前状态与脑部血流异常状况，增加脑供血量，从而减轻PCIV的相关症状，提高其生活质量，且安全性高。

Objective:To observe the clinical efficacy of blood letting at ear apex in the treatment of posterior circulation ischemic vertigo(PCIV) of hyperactivity of liver yang type and its effect on prethrombotic state in patients. Methods:Totally,124 patients were randomly divided into control group and observation group,62 patients in each group(two cases terminated in earch group). Betastine mesylate tablets were taken orally in the control group,and blood letting at ear apex therapy was further administered in the observation group. The treatment course was 30 days. The syndrome score of hyperactivity of liver yang type,score of dizziness handicap inventory(DHI) were recorded and transcranial Doppler ultrasonography were performed before and after treatment to recorded the average flow velocity and pulsatility index(PI) of left vertebral artery(LVA),right vertebral artery(RVA) and basilar artery(BA). Pre thrombotic status indicators such as plasma fibrinogen(FIB),D-dimer(D-D),prothrombin time(PT),and activated partial thromboplastin time(APTT) before and after treatment were measured,and safety was evaluated. Results:After treatment,the DHI scores and the syndrome scores were significantly decreased,the average flow velocity of LVA,RVA and BA increased,PI,FIB and D-D decreased significantly( P < 0.01), and APTT and PT increased significantly in both groups( P < 0.01). The differences in the above indicalors between groups were statistically significant(P<0.05). Comparison between groups showed that the efficacy in the observation group was better than that in the control group(P<0.01). Conclusions:Blood letting at ear apex can improve the prethrombotic state and abnormal cerebral blood flow in PCIV patients of hyperactivity of liver yang type,increase the cerebral blood supply,so as to reduce the related symptoms of PCIV and improve life quality of patients,and with high security.