裘昌林辨治妊娠合并重症肌无力经验

Qiu Changlin's Experience of Syndrome Differentiation and Treatment on Pregnancy Complicating Myasthenia Gravis

[目的]总结裘昌林老师诊疗妊娠合并重症肌无力(MG)的学术观点和临床经验。[方法]通过复习相关中医文献、跟师临证、整理医案等方式,系统挖掘整理裘昌林老师在治疗妊娠合并MG的病因病机、辨证分型、治疗思路、用药特色、药物禁忌以及中西医结合治疗方面的学术观点和临床经验。[结果]裘师认为,妊娠合并MG的病位涉及脾肾,而脾肾亏虚又是妊娠的生理过程和MG的病理过程;临床辨证分为脾气亏虚、脾肾两虚、气阴两虚3型;确立益气健脾、温补脾肾、益气养阴的治疗法则,分别以补中益气汤合泰山磐石散,补中益气汤合附子理中丸、泰山磐石散,补中益气汤合生脉散、泰山磐石散加减辨证治疗;益气健脾、补肾安胎是本病的治疗大法,补中益气汤合泰山磐石散加减是本病治疗基本方,方中特别重用黄芪、白术、党参、仙灵脾意在加强益气健脾补肾;中西药并用时,中药可以减少西药的使用量,从而减少西药的不良反应。[结论]裘昌林老师辨证论治妊娠合并MG临床经验丰富,疗效满意,副反应少,充分说明中医药治疗妊娠合并MG具有一定优势,值得传承推广。

[Objective] To conclude the teacher Qiu＇s clinical experience and academic points on diagnosing and treating pregnancy with myasthenia gravis（MG）. [Method] By reviewing relevant literature of traditional Chinese medicine, studying in clinic with teacher and tidying medical records, systematic mining and constructing teacher Qiu＇s clinical experience and academic points on etiology and pathogenesis, syndrome differentiation, medication thinking, drug characteristics, the taboo of drugs and combining traditional Chinese and western medicines treatment of pregnancy with myasthenia gravis（MG）.[Results]Teacher Qiu thinks, pregnancy with MG involving spleen and kidney deficiency is the pathological pracess of pregnancy and physio-logical process of MG; Clinical syndrome differentiations can be divided into three types like temper deficiency, spleen and kidney deficiency, qi and Yin deficiency; establish the therapeutic rules of nourishing qi to invigorate spleen, tonifying the spleen and kidney and tonifying qi and yin. Respoetively adding and subtracting Buzhong Yiqi Decoction with Taishan Panshi San, Buzhong Yiqi Decoction with aconitum lizhong pill and Taishan Panshi San, Buzhong Yiqi Decoction with sengmai san and Taishan Panshi San for syndrome differentiation treating the disease, nourishing qi to invigorate spleen and fetal irritability are the main treatments of the disease. Buzhong Yiqi Decoction and Taishan Panshi San are the basic prescriptions. Large dose of the astragalus membranaceus, atractylodes macrocephala koidz, Codonopsis pilosula,epimedium gradiflorum morr to tonify kidney strengthening spleen and supporting Qi in the prescription, combining traditional Chinese medicine with western medicine can reduce the use of western medicine and reduce the adverse reaction of western medicine.[Conclusion]The teacher Qiu＇s experience of syndrome differentiation and treatment on pregnancy complicating myasthenia gravis is rich, efficacy is got and has less side effect. It states that Chinese medicine treatment of pregnancy with MG has certain advantages and is worth being popularized and inheriting.