重症肌無力病例報告

A Case Report of Myasthenia Gravis

10.6516/TJTCM.201403_17(1).0007

沈炫樞(Hsuan-Shu Shen)；柯建新(Chien-Hsin Ko)

重症肌無力 ； 中醫藥 ； Myasthenia Gravis ； Chinese Herb

中醫藥研究論叢

17卷1期（2014 / 03 / 30）

77 - 88

繁體中文

本病例為三十一歲女性患者，罹患重症肌無力已五年多，經抽血檢查排除其他自體免疫疾病，且無胸腺增生。目前症狀為晨起及下午肌肉力量較小、眼皮下垂、複視、走路易跌倒，無法梳頭髮。患者長期使用乙醯膽鹼酶抑制劑（anticholinesterase）控制症狀。因患者不想長期服用西藥，故在102年2月26日至本院中醫部尋求協助。經中醫四診後，給予腎著湯加減，患者服藥頻率為1～2包／天，服藥後，肌肉無力、複視與眼皮下垂等症狀均有顯著改善，且全身肌力可維持2天半，故提出報告以供臨床參考。

This is a 31-year-old female who has suffered from myasthenia gravis for more than 5 years. There is no other autoimmune disease after serology tests and no thymus hyperplasia or thymoma. The symptoms of the patient are muscle weakness in the morning and in the afternoon, ptosis, diplopia, fall down easily when walking and can not comb the hair. So she takes anticholinesterase for symptoms control. Because of not willing to take the anticholinesterase, she visited our hospital for help on 102/2/26. We prescribed Shen-Zhuo-Tang after inspection, auscultation, olfaction, inquiry and palpation. She took 1-2 packs a day and the symptoms of muscle weakness, ptosis and diplopia were improved. The effects of Chinese herbs can last 2 and half days, so we presented this case for clinical reference.

1. Chan, KH,Lachance, DH,Harper, CM,Lennon, VA(2007).Frequency of seronegativity in adult-acquired generalized myasthenia gravis.Muscle Nerve.,36(5),651-658.
2. Chen, JL,Pan, C,Liu, YJ(2012).Sixty cases of ocular myasthenia gravis treated with acupuncture and moxibustion at extra-meridian and collateral.World Journal of Acupuncture-Moxibustion.,22(4),56-59.
3. Conti-Fine, BM,Milani, M,Kaminski, HJ(2006).Myasthenia gravis: past, present, and future.J Clin Invest.,116(11),2843-2854.
4. Gronseth, GS,Barohn, RJ(2000).Practice parameter: thymectomy for autoimmune myasthenia gravis (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.Neurology.,55(1),7-15.
5. Kohler, W,Bucka, C,Klingel, R(2011).A randomized and controlled study comparing immunoadsorption and plasma exchange in myasthenic crisis.J Clin Apher.,26(6),347-355.
6. Tu, LH,Huang, DR,Zhang, RQ,Shen, Q,Yu, YY,Hong, YF,Li, GH(1994).Regulatory action of Astragalus saponins and buzhong yiqi compound on synthesis of nicotinic acetylcholinereceptor antibody in vitro for myasthenia gravis.Chinese Medical Journal,107(4),300-303.
7. 王中琳(2010)。王新陸教授從肝脾腎論治重症肌無力經驗。中國中醫藥現代遠成教育，8(15)，4-5。
8. 王秀華、李文煒(2002)。腎著湯臨床應用舉隅。中醫藥學報，30(2)，52。
9. 王殿華、陳金(2008)。加味麻黃附子細辛湯治療頑固性重症肌無力31例。上海中醫藥雜誌，42(7)，39-40。
10. 李國學(2010)。腎著湯合附子餅灸治療寒濕腰痛58例。湖北中醫雜誌，32(12)，33。
11. 袁銀忠(2004)。腎著湯臨床新用。河南中醫，24(7)，14。
12. 高斌(2012)。王寶亮教授診治重症肌無力辨證遣藥經驗。中醫研究，25(11)，56-58。
13. 張紅豔、孫申(2012)。補中益氣湯合左歸丸、右歸丸化裁治療重症肌無力30例臨床觀察。北方藥學，9(6)，18。
14. 張倩、王耀光(2008)。腎著湯加味治療寒濕腰痛36例。中國中醫急症，17(11)，1621。
15. 鄧斌(2010)。鄧毓漳治療重症肌無力經驗。江西中醫藥，41(328)，22-23。
16. 鮑豔舉、石應軒、李清峰(2008)。經方治病有奇效—馮世綸教授應用腎著湯瑣談。中國民間療法，1，3-4。

1. 李月琴(2018)。照護一位重症肌無力患者之護理經驗。長庚護理，29(4)，591-601。