眼型重症肌無力的中西醫結合治療病例報告

Treatment of Ocular Myasthenia Gravis with Combined Chinese and Western Medicine-Case Report

許堯欽(Yao-Chin Hsu) ； 曾啟育(Chi-Yue Chen) ； 蔡弦霖(Shen-Lin Tsai)

《中西整合醫學雜誌》 8卷1期 (2006/12) Pp. 33-41

https://doi.org/10.29613/JICWM.200612.0004

摘要

這位四十一歲的女性病患，主訴發生右側眼球疼痛、眩暈與全身酸痛，同時右側上眼皮嚴重下垂已一週。南部某醫學中心神經內科診斷為眼型重症肌無力，口服抗膽鹼脂酶類藥物(Mestinon)後，二小時內眼部症狀可以緩解但隨後又發，所以至本院中醫部求診。
來診時病患神情疲倦，面色泛紅，右側眼皮明顯下垂。自述頭暈眩、眼球疼痛與法對焦、視物模糊乃因工作勞累與失眠所誘發，但可在口服Mestinon後緩解。舌苔薄白，舌質淡紅，脈沉弱。中醫辨證屬脾氣虛陷，兼見肝腎陰血虧虛、陰火上亢，處方以補中益氣湯與四物湯加減滋陰清熱藥物。服藥七帖後回診時，自覺頭暈、眼球疼痛與全身酸痛均見改善，但上班時偶而仍需服用原劑量一半的抗膽鹼脂酶類藥物才能維持右上眼皮終日正常開合。續服五帖後眼球疼痛無法對焦已減輕大半，西藥用量減至四分之一，可保持右眼皮正常開合。再服十二帖後已可停用西藥而維持眼皮正常開合，眼球轉動正常。病患的眼部疾患與全身症狀均獲得明顯改善。中醫辨證論治配合小劑量抗膽鹼脂酶類藥物有效的控制這個眼型重症肌無力的案例。

關鍵字

眼型重症肌無力 ； 脾氣虛陷 ； 補中益氣湯 ； 陰火上亢

並列摘要

The 41-year-old female visited our department with the complaint of paroxysmal vertigo, right eyeball pain, and severe ptosis of the right upper eyelid for 1 week. The illness had been evaluated by the neurological department of a medical center in southern Taiwan, and was diagnosed of Myasthenia Gravis, Ocular type. Mestinon, an oral anti-cholinesterase agent was prescribed. Symptoms were alleviated within 2 hours but recurred soon. Thus, she visited our Chinese Medical department for further management.
On the first visit, she had a tired looking, reddish cheek, sunken right eyelid, thin and white fur, pink tongue property, sunken and slow pulse. Recurred ptosis, vertigo, eyeball pain and blurred vision were aggravated by work and relieved by oral Mestinon. The ”Spleen Qi Vacuity and Fall” was impressed by the Chinese medical pattern Identification, and the combined symptoms were ”Yin vacuity of Liver and Kidney” and ”Ascending hyperactivity of yin fire”. Central Supplementing Qi-Boosting Decoction, the Four-Agents Decoction and the drugs for nourishing yin, and clearing heat were given. After the 7 medicine packs, the vertigo and eyeball pain were improved. However, a half dosage of Mestinon was required for maintaining freely movement of the eyelids all day. Subsequently, the 5 more medicine packs reduced over 50% of the residual pain and the dosage of Mestinon. Then, the added 12 medicines packs made the Mestinon no longer necessary. The ocular disease and general illness of the patient were improved. We controlled the ocular Myasthenia Gravis patient effectively with a small dosage of Mestinon and the combination of Chinese Pattern Identification and Treatment.

並列關鍵字

Ocular Myasthenia Gravis ； Spleen Qi Vacuity and Fall ； Central Supplementing Qi-Boosting Decoction ； Ascending hyperactivity of yin fire