裘昌林教授治疗重症肌无力危象的中医经验总结

To Study and Summarize Professor QIU Changlin’s TCM Clinical Experience in Treatment of Myasthenia Gravis Crisis

[目的]总结分析裘昌林教授救治重症肌无力危象的中医辨治思路。[方法]通过跟师学习、整理医案、复习相关中医文献,整理总结裘师临床抢救重症肌无力危象的中医辨治经验,分析重症肌无力危象的中医认识,中医治疗原则和用药方法,并列举医案分析。[结果]裘师认为,重症肌无力危象病情危重,属于中医大气下陷证,与脾肾密切相关,脾肾虚损为本,甚者脉微息弱、元气耗散而气脱,治疗重在急救脱陷、温肾敛阴,兼顾祛痰通腑,并且研用马钱子起沉疴。所举医案贯彻裘师辨治经验,遣方用药以健脾益气为主,补益肝肾为辅,佐以祛痰通腑,获得较好疗效。[结论]裘师基于中医病因病机,对重症肌无力危象进行辨证论治,遣方用药从虚出发,随证加减,配合西医治疗,能够提高疗效,减少不良反应,充分体现了中医药治疗重症肌无力危象的优势,其经验具有推广价值。

[Objective] To study and summarize Professor QIU Changlin’s thoughts on traditional Chinese medicine(TCM) syndrome differentiation and treatment of myasthenia gravis crisis(MGC). [Methods] By learning from the teacher, tidying medical records and reviewing relevant literature of TCM, this paper summarized Professor QIU’s experience of treating MGC based on syndrome differentiation of TCM, and analyzed the TCM pathomechanism, TCM treatment principles and medication methods of MGC with a medical case.[Results] Professor QIU thinks that MGC is critical and belongs to the syndrome of Qi depression in TCM. It is closely related to the spleen and kidney, the deficiency of the spleen and kidney is the root of the disease, what’s more, the pulse is weak, and the vitality is dissipated and Qi is removed. The treatment focuses on the first aid treatment of Qi depression, warming the kidney and astringent Yin,eliminating phlegm and freeing the bowels, and using the Strychnos nux-vomica L. to relieve the symptom. According to the medical case,the experience of Professor QIU in the syndrome differentiation and treatment was carried out, the prescription was mainly used for invigorating the spleen and Qi, combined with tonifying the liver and kidney, supplemented by removing phlegm and dredging the viscera,which had achieved good curative effect. And the satisfactory curative effect was obtained. [Conclusion] Based on the etiology and pathogenesis of TCM, Professor QIU treats MGC based on syndrome differentiation. His prescriptions start from deficiency, modified with the syndrome according to the change of the condition, and cooperate with western medicine treatment to improve the curative effect and reduce adverse reactions, which fully reflects the advantages of TCM in the treatment of MGC, and his experience has popularization value.