How to treat myasthenia gravis

TCM (traditional Chinese medicine) theory

According to the five-wheel theory of traditional Chinese medicine, eyelid belongs to spleen; According to the theory of viscera, spleen governs limbs and muscles. Therefore, the clinical syndromes of myasthenia gravis are mostly guided by the spleen-stomach theory of traditional Chinese medicine. At the same time, according to the relationship between the five internal organs, lung, spleen and kidney are closely related, so this disease is closely related to lung and kidney. The etiology of myasthenia is manifested as deficiency of lung, spleen and kidney, which leads to subsidence of qi deficiency, loss of transport due to spleen deficiency, inaccurate kidney deficiency, dystrophy of tendons and veins, dysfunction of viscera and muscle weakness. At the same time, due to kidney deficiency of lung and spleen, external dampness and unconsolidation, exogenous common cold, internal injury and phlegm turbidity, internal and external attack aggravated the condition. Therefore, attention should be paid to pathogenic factors (exogenous pathogen, wet phlegm) and positive factors (lung, spleen and kidney) in the treatment, and the specimens should be weighed. First of all, eliminate pathogenic factors in treatment and enhance the body's resistance.

Muscle weakness is called "flaccidity syndrome" in Chinese medicine, and the causes are divided into five categories, namely lung heat impairing body fluid, damp-heat immersion, spleen and stomach weakness, liver and kidney deficiency, blood deficiency and blood stasis. However, these pathogenesis are independent and interrelated. Traditional Chinese medicine has made a detailed syndrome differentiation in theory, and at the same time, it is treated with the guidance of clearing lung and nourishing yin, regulating liver and kidney, strengthening tendons and bones, regulating spleen and stomach, and regulating qi and blood.

Therapeutic mode

There are many ways to treat myasthenia, among which Chinese medicine can also treat myasthenia. Muscle weakness belongs to the category of eyelid, eye deficiency and flaccidity in traditional Chinese medicine. This kind of Chinese medicine attaches great importance to heat toxicity in the treatment of flaccidity syndrome such as myasthenia, and regards "heat injury to body fluid and nutrient loss of tendons and veins" as an important pathogenesis of this syndrome. It is of great clinical significance to summarize the main causes of flaccid spots in myasthenia gravis with heat toxin as the disease.

A basic concept is defined, that is, heat pathogen can cause damage to body fluid, and only when heat pathogen is removed, body fluid will not dry up, and a kind of flaccidity syndrome such as biochemical activity and myasthenia will appear. It gives the healer a basic solution. No matter whether the patient has a "fever" at present, the influence of heat has always existed, so we can't ignore it when treating.

In addition, "heat", as a whole body manifestation, inevitably involves all viscera. To treat flaccid diseases such as myasthenia, it is necessary to regulate dirty qi, restore healthy qi, develop old furuncle and help the weak.

Muscle weakness is called flaccidity syndrome in Chinese medicine. Flaccidity syndrome refers to a disease in which the muscles of limbs are sluggish, weak and unable to voluntary movement for a long time, which leads to muscle atrophy. Traditional Chinese medicine believes that the main causes of flaccidity are "heat" and "deficiency", congenital deficiency, acquired malnutrition, viscera deficiency and dysfunction.

Flaccidity is a disease characterized by flaccidity, weakness and inability to voluntary movement, which leads to muscle atrophy or long-term paralysis of limbs. Muscle weakness, myasthenia gravis, muscular atrophy, motor neuron disease and muscular dystrophy all belong to the category of flaccidity. According to China's medical classic "Jing Yue Quan Shu Wei Lun", the five internal organs make people weak. Heart, liver, spleen, lung and kidney are a whole and play a key role in the treatment of flaccidity syndrome. According to the idea of the integration of five zang-organs in Chinese medicine, according to the diagnosis and treatment standards of the World Health Organization (WHO), after decades of research and summarizing the previous medical experience and clinical experience, the chief expert group of Beijing Research and Treatment Center for Atrophic Diseases of Chinese Medicine has finally successfully developed the comprehensive therapy of strengthening muscles and promoting granulation and strengthening the body. This therapy breaks the bottleneck of refractory and easy recurrence of flaccidity syndrome, and it is the most advanced and effective technology to treat flaccidity syndrome in China at present. It has its remarkable characteristics in the scientific, accurate and normative aspects of diagnosis and treatment. Compared with traditional therapy, this therapy is more effective and the cure rate has been improved.

Syndrome differentiation treatment of traditional Chinese medicine

Through oral Chinese medicine and rehabilitation exercise.

1, lung heat injury body fluid: lung governs fur, announces hair, rises and falls. Warm pathogens will first invade the lungs, causing lung heat, burning leaves, insufficient body fluid, abnormal qi and blood operation, and malnutrition of limbs and five bodies, thus becoming a flaccidity syndrome.

The main symptoms are limb weakness, muscle atrophy, limb deformation, dull skin or fever, cough without phlegm, short and red urine and heat pain.

Treatment principle: clearing lung and moistening dryness, benefiting qi and nourishing yin.

2. Damp-heat soaking: Damp-heat pathogen damages the spleen and stomach of guanidine, which cannot be transported. Immersing in the tendons in the wet is unfavorable for walking, which affects the operation and nourishment of qi and blood and makes the muscles of the tendons weak.

Symptoms are abnormal sensation of limbs, weakness of hands and feet, and drooping of hands and feet, which is not suitable for employment. Numbness of limbs, red heat and astringent pain in urine.

Treatment principle: clearing heat and promoting diuresis, drying and warming and resolving phlegm.

3. Spleen and stomach weakness: Spleen is the acquired foundation, the source of qi and blood biochemistry, and mainly transports Shui Gu, qi and blood, muscles and limbs. Spleen and stomach weakness, incomplete transportation, insufficient biochemical sources of qi and blood, muscle dystrophy and flaccidity.

The clinical manifestations are: weakness of limbs, emaciation of muscles, mental fatigue, lack of food and loose stool, and vain complexion.

Treatment principle: invigorating spleen and promoting blood production, benefiting qi and promoting granulation.

4, liver and kidney deficiency: liver storing blood, main reinforcement, kidney storing essence, main bone, liver and kidney deficiency, deficiency of essence and blood, disharmony of bones, muscles and meridians.

Symptoms include: weakness of lower limbs, inability to stand for a long time, backache and backache. One or both sensory disorders or pain disappear. And dizziness, tinnitus, nocturnal emission, enuresis or irregular menstruation.

Treatment principle: tonify liver and kidney, nourish yin and clear heat.

5, blood deficiency and blood stasis: blood deficiency leads to limb dystrophy, and blood stasis leads to paralysis. Symptoms are weakness of limbs, numbness of hands and feet, dull complexion or purple lips.

Treatment principle: nourishing blood and activating blood, removing blood stasis and dredging collaterals.

Western medicine treatment

Anti-cholinesterase drugs and immunosuppressants are mainly used.

1. anticholinesterase drugs include neostigmine, pyridostigmine, enzyme inhibitor or mestamine. The side effects of these drugs include mydriasis, drooling, sweating, abdominal pain, diarrhea and so on. You can take atropine at the same time to fight it.

2. Immunosuppressants mainly include corticosteroids and cyclophosphamide.

3. Surgical treatment is suitable for thymoma patients.

Patients with myasthenia gravis should pay more attention to diet. For diseases with low incidence but seriously affecting people's quality of life, western medicine basically gives bromopyrimidine or hormones in clinic.

Treatment of myasthenia gravis crisis

1. To maintain and improve respiratory function, artificial respiration can be used, and oxygen can be inhaled continuously at low flow rate. Early tracheotomy can be performed when sputum is difficult to cough up.

2. Correct and rapid use of effective anti-crisis drugs:

(1) myasthenia crisis: intramuscular injection of neostigmine sulfate 1-2mg or intravenous injection of 0.5- 1.0mg. After improvement, it should be repeated every 2 hours according to the condition, with a daily total of 6mg, or 1-2mg should be added to 500 ml of 5% glucose saline for intravenous drip. If there are symptoms of drug overdose, use atropine 0.5mg intramuscular injection as appropriate. It can be swallowed and then taken orally.

(2) Cholinergic crisis: immediately stop using anticholinesterase drugs, and use: ① Atropine 0.5-2.0mg by intramuscular injection or intravenous injection, repeated for 15-30 minutes, and then use intermittently until toxic and alkaline symptoms are relieved. (2) Protamine, anti-nicotine, with 400-500mg added to 5% glucose or physiological saline, intravenous drip, until muscle relaxation, muscle strength recovery.

(3) Antagonistic crisis: Stop using all anticholinesterase drugs for at least 3 days. After that, the drug was given from half of the original dose, and hormones were used or combined.

Post-crisis treatment: anticholinesterase drugs should continue to be used in combination with other treatments.

3. Principles to be followed when choosing antibiotics for diseases with infection:

(1) Penicillins, cephalosporins and chloramphenicol are the first choice.

(2) Secondary selection of macrolide drugs, such as erythromycin, spiramycin and midecamycin. But we must pay attention to the heart and blood pressure, because both red and chloramphenicol have the side effects of inhibiting myocardium and lowering blood pressure.

(3) If the above antibiotics are ineffective, aminoglycoside antibiotics, neomycin, kana, Qingda and Pamycin can be used with caution. But it must be combined with neostigmine drugs, and the dose of the latter should be increased accordingly. Tetracyclines should be used with caution.

(4) It is best not to use polymyxobacteria. Do not use two antibiotics that block neuromuscular junction at the same time. Do not use muscle relaxants, anesthetics and sleep sedatives at the same time. Do not use mucosal and serosa administration methods.

(5) Patients with myasthenia gravis with kidney disease and renal insufficiency should not use antibiotics that block neuromuscular junction.

(6) Fluoroquinolones such as norfloxacin can also aggravate the symptoms of myasthenia, so use with caution.

Psychological care of patients with myasthenia gravis is an immune disease, which not only brings great pain to patients, but also brings great burden to families and society. The long etiology and difficult treatment also bring great psychological pressure to patients, thus affecting the improvement and rehabilitation of the disease. A good mental state will add incomparably strong disease resistance to patients. A firm belief in life can promote the early recovery of diseases. Therefore, psychological adjustment plays an important role in the treatment of diseases. All bad mental stimulation, bad mood, anxiety, sadness, depression and loneliness will cause immune body dysfunction, leading to the occurrence or deterioration of diseases. In addition, people around you don't understand patients and have a bad attitude, which will also cause heavy psychological pressure to patients. This kind of psychological pressure can not only affect the treatment effect and rehabilitation of patients, but also transform the psychological pressure of patients into physical symptoms, making the condition more complicated.