浙江中医药大学学报
浙江中醫藥大學學報
절강중의약대학학보
JOURNAL OF ZHEJIANG UNIVERSITY OF TRADITIONAL CHINESE MEDICINE
2015年
6期
436-440
,共5页
妊娠%重症肌无力%裘昌林%脾肾亏虚%补中益气汤%泰山磐石散%名医经验
妊娠%重癥肌無力%裘昌林%脾腎虧虛%補中益氣湯%泰山磐石散%名醫經驗
임신%중증기무력%구창림%비신우허%보중익기탕%태산반석산%명의경험
pregnancy%myasthenia gravis%Qiu Changlin%spleen and kidney deficiency%Buzhong Yiqi Decoction%Taishan Panshi Powder%famous doctor's experience
[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。
[目的]總結裘昌林老師診療妊娠閤併重癥肌無力（MG）的學術觀點和臨床經驗。[方法]通過複習相關中醫文獻、跟師臨證、整理醫案等方式，繫統挖掘整理裘昌林老師在治療妊娠閤併MG的病因病機、辨證分型、治療思路、用藥特色、藥物禁忌以及中西醫結閤治療方麵的學術觀點和臨床經驗。[結果]裘師認為，妊娠閤併MG的病位涉及脾腎，而脾腎虧虛又是妊娠的生理過程和MG的病理過程；臨床辨證分為脾氣虧虛、脾腎兩虛、氣陰兩虛3型；確立益氣健脾、溫補脾腎、益氣養陰的治療法則，分彆以補中益氣湯閤泰山磐石散，補中益氣湯閤附子理中汍、泰山磐石散，補中益氣湯閤生脈散、泰山磐石散加減辨證治療；益氣健脾、補腎安胎是本病的治療大法，補中益氣湯閤泰山磐石散加減是本病治療基本方，方中特彆重用黃芪、白術、黨參、仙靈脾意在加彊益氣健脾補腎；中西藥併用時，中藥可以減少西藥的使用量，從而減少西藥的不良反應。[結論]裘昌林老師辨證論治妊娠閤併MG臨床經驗豐富，療效滿意，副反應少，充分說明中醫藥治療妊娠閤併MG具有一定優勢，值得傳承推廣。
[목적]총결구창림로사진료임신합병중증기무력（MG）적학술관점화림상경험。[방법]통과복습상관중의문헌、근사림증、정리의안등방식，계통알굴정리구창림로사재치료임신합병MG적병인병궤、변증분형、치료사로、용약특색、약물금기이급중서의결합치료방면적학술관점화림상경험。[결과]구사인위，임신합병MG적병위섭급비신，이비신우허우시임신적생리과정화MG적병리과정；림상변증분위비기우허、비신량허、기음량허3형；학립익기건비、온보비신、익기양음적치요법칙，분별이보중익기탕합태산반석산，보중익기탕합부자리중환、태산반석산，보중익기탕합생맥산、태산반석산가감변증치료；익기건비、보신안태시본병적치료대법，보중익기탕합태산반석산가감시본병치료기본방，방중특별중용황기、백술、당삼、선령비의재가강익기건비보신；중서약병용시，중약가이감소서약적사용량，종이감소서약적불량반응。[결론]구창림로사변증론치임신합병MG림상경험봉부，료효만의，부반응소，충분설명중의약치료임신합병MG구유일정우세，치득전승추엄。
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 process 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. Respectively 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.
