CN102406798A - Chinese medicinal composition for treating myasthenia gravis - Google Patents

Chinese medicinal composition for treating myasthenia gravis Download PDF

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CN102406798A
CN102406798A CN2011103814099A CN201110381409A CN102406798A CN 102406798 A CN102406798 A CN 102406798A CN 2011103814099 A CN2011103814099 A CN 2011103814099A CN 201110381409 A CN201110381409 A CN 201110381409A CN 102406798 A CN102406798 A CN 102406798A
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radix
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myasthenia gravis
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CN102406798B (en
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鲍颖
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Abstract

The invention relates to a Chinese medicinal composition for treating myasthenia gravis, which is prepared from 55 to 75 grams of earthworm, 45 to 55 grams of centipede, 25 to 45 grams of polygonum multiflorum, 30 to 50 grams of bighead atractylodes rhizome, 70 to 80 grams of astragalus, 5 to 8 grams of tortoise plastron, 3 to 6 grams of ginseng, 15 to 30 grams of cimicifuga foetida, 25 to 45 grams of medlar and 60 to 80 grams of yam. Therefore, the myasthenia gravis treatment effect of the Chinese medicinal composition is better.

Description

Be used to treat the Chinese medicine composition of myasthenia gravis
One, technical field
The present invention relates to a kind of Chinese medicine composition that is used to treat myasthenia gravis.
Two, background technology
Myasthenia gravis is one of intractable disease of nervous system; Its disease shows as: one-sided or bilateral blepharoptosis, tetraparesis are unable, dysphagia and asaphia; In doctor trained in Western medicine, use cholinesterase inhibitor, hormone medicine and immunosuppressant to treat usually, have very strong side effect regulating liver-QI nephrotoxicity; But also bounce-back easily, therapeutic effect is bad.
Three, summary of the invention
The purpose of this invention is to provide a kind of Chinese medicine composition that is used to treat myasthenia gravis, the better effects if of treatment myasthenia gravis.
For achieving the above object; The technical scheme of taking of the present invention is: medicine of the present invention is formed, and is made up of Pheretima 55-75 gram, Scolopendra 45-55 gram, Radix Polygoni Multiflori 25-45 gram, Rhizoma Atractylodis Macrocephalae 30-50 gram, Radix Astragali 70-80 gram, Carapax et Plastrum Testudinis 5-8 gram, Radix Ginseng 3-6 gram, Rhizoma Cimicifugae 15-30 gram, Fructus Lycii 25-45 gram and Rhizoma Dioscoreae 60-80 gram.
In we, be monarch with Pheretima and Scolopendra, be minister with Radix Polygoni Multiflori, the Rhizoma Atractylodis Macrocephalae, the Radix Astragali, Carapax et Plastrum Testudinis, Radix Ginseng, Rhizoma Cimicifugae, Fructus Lycii and Rhizoma Dioscoreae, through the function of building body, lifting yang-energy, the side of making has the effect of invigorating spleen and kidney, the strong power of strong flesh.
The Pheretima effect is: Pheretima is cold in nature, salty in the mouth.Function: heat clearing away, suppressing the hyperactive liver, Zhichuan, collateral dredging.Return liver, stomach, lung, urinary bladder channel.Function heat clearing away suppressing the hyperactive liver, relieving spasm by subduing liver-wind, relieving asthma, diuresis, collateral dredging eliminating impediment.Cure mainly hyperpyrexia agitation, infantile convulsion tic, dyspnea and cough due to lung-heat, accumulation of heat urine retention, arthralgia pain limb fiber crops, hemiplegia, and card such as sore swollen toxin.It is fanatical dry to cure mainly height, convulsion with spasms, headache due to pathogenic wind-heat, conjunctival congestion, hemiplegia etc.Pheretima provides gets liquid the good effect that cloperastine is breathed heavily of deciding is arranged.The Lumbricus ash is knitted alopecia with the Oleum Rosae Rugosae mixing energy.Heat clearing away, endogenous wind stopping, collateral dredging is relievingd asthma, diuresis.The endogenous wind stopping relieving convulsion acts on not strong.Heat clearing away is made good use of, and removing heat from the liver can also obviously move back high fever, the fever body-temp. reducing.Intense heat bringing about wind syndrome and epidemic febrile disease or infantile convulsion there be the available of high fever.But be of little use,, and fresh move back high fever and the effect of endogenous wind stopping relieving convulsion is more obvious because a little less than its endogenous wind stopping relieving convulsion effect; It is just not obvious to have done the decoction effect; It is maximum that dry product is used is collateral dredging or relaxing muscles and tendons and activating QI and blood in the collateral, and stimulating the menstrual flow is exactly relaxing muscles and tendons and activating QI and blood in the collateral, and joint contracture, joint stuffiness are alleviated.Active, promotion of blood circulation or meridians improve numb hemiplegia, facial hemiparalysis is all used always.The compatibility of hemiplegia and benefiting qi and nourishing blood, blood circulation promoting and blood stasis dispelling such as the Radix Astragali, Flos Carthami, Rhizoma Chuanxiong are relievingd asthma.The asthma that can be used for lung-heat.Inducing diuresis to remove edema.Be used for damp and hot edema.Usefulness maximum are collateral dredging and relieving asthma.Relieving asthma and to alleviate the spasm of bronchial smooth muscle exactly.Clearing heat for calming endogenous wind is used for hyperpyrexia infantile convulsion, demented.Salty-cold the falling of Pheretima let out, and property is walked to scurry, can the endogenous wind stopping relieving convulsion, and kind again removing summer-heat hyperpyrexia is so be applicable to manic due to the hyperpyrexia, convulsion with spasms, diseases such as epilepsy.Treatment epidemic febrile disease extreme heat causing wind syndrome unconsciousness and delirium, spasm are twitched, and can singly get effect with the decoction of these article, or use together with endogenous wind stopping relieving convulsion medicines such as Ramulus Uncariae Cum Uncis, Calculus Bovis, Bombyx Batryticatus.Treatment infantile convulsion, hyperpyrexia, frightened taking out can these article be ground mashedly, obey for ball altogether with Cinnabaris.Manic or the epilepsy of treatment hyperpyrexia, the bright article of Chang Danyong turn to water with salt, drink-service.Dredge the meridian passage is used for arthromyodynia and hemiplegia.Pheretima is longer than current meridians, is used for the blockage of meridian that multiple reason causes, blood vessels are not smooth, the card that podomere is unfavorable.Because of its cold in nature can heat clearing away, so the pyretic arthralgia of suitable treatment joint congestion and swelling pain, joint stuffiness, normal and Radix Stephaniae Tetrandrae, Radix Gentianae Macrophyllae, Caulis Lonicerae etc. are except that damp and hot, the meridian dredging compatibility of drugs.Also with controlling anemofrigid-damp arthralgia, diseases such as limbs joint numbness, pain, joint stuffiness, can with compatibilities such as Radix Aconiti, Rhizoma Arisaematis, Olibanum, like XIAOHUOLUO DAN.The treatment blood stagnancy due to deficiency of QI, diseases such as unfavorable, the hemiplegia of meridians, facial hemiparalysis after the apoplexy, compatibilities such as the normal and Radix Astragali, Radix Angelicae Sinensis, Rhizoma Chuanxiong are like BUYANG HUANWU TANG.Clearing lung, relieving asthma is used for lung-heat asthma.These article clearing away lung-heat are again relievingd asthma.With controlling accumulatiorn of pathogenic heat in the lung, the gasping for breath of impairment of purifying and descending function of the lung, the whistling sound in the throat person, single with grinding i.e. effect for oral administration into powder, also can be equal to usefulness with Herba Ephedrae, Gypsum Fibrosum, Semen Armeniacae Amarum.Clearing away heat and promoting diuresis is used for accumulation of heat in the urinary bladder, and dysuria or urine retention are obstructed.These article are salty-cold walks to be lowered to kidney, can the heat clearing away knot, dredging water passages, with controlling dysuria or urine retention is obstructed, available bright article are mashed, immersion, leaching extract clothes, also can with damp-clearing drugs such as Semen Plantaginis, Caulis Akebiae, Rhizoma Alismatis usefulness together.
The effect of Scolopendra: antitumor action: Scolopendra extract has certain effect to animal transplanting tumor.Antibacterial action: these article infusion has inhibitory action in various degree to the various skin fungus.External test tube method shows, these article infusion, ethanol, ether extracted liquid are to staphylococcus, and eight folded bacillus, bacillus pyocyaneus, Candida albicans do not show direct inhibitory action.Promote immunologic function: the recurrent oral ulceration patient, serum IgG and the rare garland formation rate of E Flos Rosae Rugosae are respectively 0.034 ± 0.025mg/L and 0.213 ± 0.022mg/L before taking medicine.Behind the clothes Scolopendra, serum IgG and E rosette forming rate obviously raise, and IgG, IgA all are higher than normal person P < 0.05,0.01 in the saliva sooner or later.
The effect of Radix Polygoni Multiflori is: detoxifcation, eliminating carbuncle, loosening bowel to relieve constipation.Be used for the scrofula carbuncle sore, rubella pruritus, dryness of the intestine constipation; Hyperlipidemia.Bone light air disease (lumbocrural pain, pruritus all over, row step difficulty).With each one jin of Radix Polygoni Multiflori, Radix Achyranthis Bidentatae, to steep for seven nights in the wine that coexisted, taking-up is dried, and mashes, and adds jujube pulp and becomes a ball, and is big like WUZI.Every clothes 30 to 50 balls.Hollow clothes, wine send down.Flesh side have a pain (do not know pain wherein).With Radix Polygoni Multiflori end, Sucus Zingberis furnishing cream is coated with to be put on the skin, put the back on the skin and encase with cloth, with fire baking sole press by.From apogee sweating.With the Radix Polygoni Multiflori end, transfer saliva, on the envelope umbilicus.Discharging fresh blood stool.With two liang of what road crows, grind and be the end.Every clothes two money, taking medicine before meal, rice water send down.Broken blood trouble goes out.Apply promptly with the Radix Polygoni Multiflori end and to end.Specially good effect is arranged.Scrofula tuberculosis (or broken or broken, the former all can control down to breast) is cleaned with the Radix Polygoni Multiflori root, and every day, life was chewed, and gets leaf and mash and be coated with the affected part.The carbuncle skin infection.Quantity-unlimiting with Radix Polygoni Multiflori, on mild and heavy respiration, torture, with wine equivalent, fry in shallow oil again open several times after, deposit wine, drink at any time; The slag of getting it filled dries, and grinds to be the end, boils a face furnishing ball with wine, and is big like WUZI.Every clothes 30 balls, hollow clothes, heat wine send down.After recovering, but the medicine informal dress.Big scrofula caused by pathogenic wind disease.With one jin of Radix Polygoni Multiflori (with the big and person that has the decorative pattern for well), in the bubble washing water of rice seven days, steam repeatedly, shine for several times, add four liang of linum, steam solarization more again, grind and be the end, every clothes two money, wine send down, obey secondary in one day.Scabies.With Radix Polygoni Multiflori, district's leaf five equilibrium, the bathing of decocting thick soup can be alleviated pain, granulation promoting meat.Fry in shallow oil the soup bathing with Caulis Polygoni Multiflori, leaf, also effective. 
The effect of the Rhizoma Atractylodis Macrocephalae: invigorating the spleen and benefiting QI, the dampness diuretic, hidroschesis, antiabortive.Be used for insufficiency of the spleen lack of appetite, abdominal distention is had loose bowels, phlegm retention vertigo and palpitation, edema, spontaneous perspiration, frequent fetal movement.
The effect of Huang Shi is: benefiting QI for strengthening the superficies, arresting sweating takes off admittedly, holder skin ulcer granulation promoting, inducing diuresis to remove edema.Adopt Huang Shi to increase because of the mechanism that protects the liver in the pharmacological action is to make hepatic glycogen among the we, the total serum protein and the albumin reduction that cause for liver injury have the rise effect, can increase 3The H-leucine mixes liver, and protein promotes its renewal, recovers the normal immunologic function of body, improves the ability of removing virus or suppressing the virus diffusion.
The effect of Carapax et Plastrum Testudinis is: control deficiency of kidney yin, the hectic fever due to YIN-deficiency consumptive fever is spitted blood, epistaxis, chronic cough, seminal emission, metrorrhagia, leukorrhagia, lumbago, the atrophic debility of bones, stirring of wind due to deficiency of YIN, chronic dysentery, chronic malaria, hemorrhoid, non-closure of fontanels jin infants.
The effect of Radix Ginseng is: strongly invigorating primordial QI, promote the production of body fluid admittedly take off, and calm the nerves.It is deficient to control impairment caused by overstrain, lack of appetite, and asthenia, food is told in regurgitation, the stool lingering diarrhea, empty cough with asthma is short, the spontaneous perspiration sudden collapse, palpitation with fear, forgetful, dizziness and headache, sexual impotence, frequent micturition is quenched one's thirst, woman uterine bleeding, children's's intermittent infantile convulsion, and prolonged deficiency is not multiple, the card of all qi-blood-body fluid deficiencies.
The effect of Rhizoma Cimicifugae is: deliver rash, heat-clearing and toxic substances removing, elevate a turnable ladder yang-energy.Be used for headache due to pathogenic wind-heat, toothache, aphtha, laryngopharynx swelling and pain, measles without adequate eruption, YANG toxin syndrome is sent out speckle; Proctoptosis, uterine prolapse.
The effect of Fructus Lycii is: the kidney invigorating and essence nourishing, nourishing the liver to improve visual acuity, blood-enriching tranquillizing, promoting the production of body fluid to quench thirst, nourishing the lung to arrest cough.The treating the liver kidney yin is lost, soreness of the waist and knees, and dizziness, dizzy, the many tears of blurred vision, cough due to consumptive disease is quenched one's thirst, seminal emission.
The effect of Rhizoma Dioscoreae is: heat clearing away, detoxifcation.Control the epidemic febrile disease heating, toxic-heat and blood stasis, carbuncle and ulcer, toxic swelling, scrofula, anal fistula." the southern regions of the Yunnan Province book on Chinese herbal medicine ": heat clearing away, separate all skin ulcers, carbuncle carbuncle on the back, red stream scrofula." the SHENGCAO property of medicine is wanted fully "; Ability eliminating carbuncle cellulitis furunculosis, the dysentery relieving disease is washed chancre, peeling skin heat in blood.Essentials of Matea Medica: nourish blood and quench the thirst.Control scabies." Chongqing hall random notes ": wind-fire is damp and hot in the clear network, separates the dirty filthy heresy of pestilence, and the floating wind more of breath liver and gall sun is controlled all diseases of convulsion syncope and insanity epilepsy.Guangzhou army " Chinese herbal medicine handbook commonly used: heat-clearing and toxic substances removing.Control the fever caused by exogenous pathogens cough, enteritis, bacillary dysentery, measles, parotitis, septicemia, furuncle toxic swelling, appendicitis, trauma infection contamination, children's's hidradenitis suppurativa.Process herbal tea, can prevent heatstroke, flu and infectious intestinal disease.
The present invention has designed, and is made up of Pheretima 55 grams, Scolopendra 45 grams, Radix Polygoni Multiflori 25 grams, the Rhizoma Atractylodis Macrocephalae 30 grams, the Radix Astragali 70 grams, Carapax et Plastrum Testudinis 5 grams, Radix Ginseng 3 grams, Rhizoma Cimicifugae 15 grams, Fructus Lycii 25 grams and Rhizoma Dioscoreae 60 grams.
The present invention has designed, and is made up of Pheretima 75 grams, Scolopendra 55 grams, Radix Polygoni Multiflori 45 grams, the Rhizoma Atractylodis Macrocephalae 50 grams, the Radix Astragali 80 grams, Carapax et Plastrum Testudinis 8 grams, Radix Ginseng 6 grams, Rhizoma Cimicifugae 30 grams, Fructus Lycii 45 grams and Rhizoma Dioscoreae 80 grams.
The present invention has designed, and is made up of Pheretima 62 grams, Scolopendra 52 grams, Radix Polygoni Multiflori 37 grams, the Rhizoma Atractylodis Macrocephalae 45 grams, the Radix Astragali 76 grams, Carapax et Plastrum Testudinis 6 grams, Radix Ginseng 4 grams, Rhizoma Cimicifugae 22 grams, Fructus Lycii 33 grams and Rhizoma Dioscoreae 78 grams.
Four, the specific embodiment
The medicine of first embodiment of the present invention is formed, and is made up of Pheretima 55-75 gram, Scolopendra 45-55 gram, Radix Polygoni Multiflori 25-45 gram, Rhizoma Atractylodis Macrocephalae 30-50 gram, Radix Astragali 70-80 gram, Carapax et Plastrum Testudinis 5-8 gram, Radix Ginseng 3-6 gram, Rhizoma Cimicifugae 15-30 gram, Fructus Lycii 25-45 gram and Rhizoma Dioscoreae 60-80 gram.
The fried one-tenth Chinese medicine of these several kinds of Chinese medicines soup, divide every day take three times morning, noon and afternoon, seven days is a course of treatment, after the course of treatment, drug withdrawal 3-5 days, carries out next one course of treatment again.
Carried out the clinical observation of blepharoptosis myasthenia gravis in The Central Hospital of Taian:
Accept patient 30 people for medical treatment, wherein male 10 people, women 20 people, wherein 15-25 year 12 examples, 35-50 year 8 examples, 10 examples more than 50 years old.
The tcm diagnosis standard: according to the picture of the tongue and the pulse condition of traditional Chinese medical science the four methods of diagnosis and eight key links, light evening of blepharoptosis diplopia and morning is heavy, and taste are deficient, the weak myasthenia gravis that is of yang deficiency.
The Western medicine diagnose standard: the eyes muscular fatigue test is positive, the long 3mm that surpasses of eyelid, and the ocular movemeut sluggishness is myasthenia gravis.
Use present embodiment, divide every day take three times morning, noon and afternoon, seven days is a course of treatment, after the course of treatment, and drug withdrawal 3-5 days, carry out next one course of treatment again, carry out getting final product 3-5 the course of treatment rehabilitation.Through observing: disease disappears, eyes can be normally and open automatically and close and do not recur promptly complete more person 28 people in three months, and cure rate is 93.33%, and eyes can be normal but can not open that to close be responder 30 people freely, and total effective rate is 100%.
The routine patient man of typical trouble, 12 years old, 2008 check in the provincial hospital, Shandong Province was blepharoptosis myasthenia gravis patient, behind the reception western medical treatment, effect is bad, has carried out the treatment of five courses of treatment according to present embodiment, heals entirely, does not have recurrence so far.
The typical case suffers from routine patient woman, and 60 years old, 2009 was blepharoptosis myasthenia gravis patient in The Central Hospital of Taian's inspection, has directly carried out the treatment of four courses of treatment according to present embodiment, healed entirely, so far not recurrence.
Second embodiment of the present invention is made up of Pheretima 55 grams, Scolopendra 45 grams, Radix Polygoni Multiflori 25 grams, the Rhizoma Atractylodis Macrocephalae 30 grams, the Radix Astragali 70 grams, Carapax et Plastrum Testudinis 5 grams, Radix Ginseng 3 grams, Rhizoma Cimicifugae 15 grams, Fructus Lycii 25 grams and Rhizoma Dioscoreae 60 grams.
The 3rd embodiment of the present invention is made up of Pheretima 75 grams, Scolopendra 55 grams, Radix Polygoni Multiflori 45 grams, the Rhizoma Atractylodis Macrocephalae 50 grams, the Radix Astragali 80 grams, Carapax et Plastrum Testudinis 8 grams, Radix Ginseng 6 grams, Rhizoma Cimicifugae 30 grams, Fructus Lycii 45 grams and Rhizoma Dioscoreae 80 grams.
The 4th embodiment of the present invention is made up of Pheretima 62 grams, Scolopendra 52 grams, Radix Polygoni Multiflori 37 grams, the Rhizoma Atractylodis Macrocephalae 45 grams, the Radix Astragali 76 grams, Carapax et Plastrum Testudinis 6 grams, Radix Ginseng 4 grams, Rhizoma Cimicifugae 22 grams, Fructus Lycii 33 grams and Rhizoma Dioscoreae 78 grams.
Therefore the present invention is theoretical according to traditional Chinese medical science traditional theory and modern treatment, and is theoretical in conjunction with traditional Chinese medical science traditional theory and modern treatment, the better effects if of treatment myasthenia gravis.
In the technical field of the Chinese medicine composition that is used to treat myasthenia gravis, every technology contents of being made up of Pheretima 55-75 gram, Scolopendra 45-55 gram, Radix Polygoni Multiflori 25-45 gram, Rhizoma Atractylodis Macrocephalae 30-50 gram, Radix Astragali 70-80 gram, Carapax et Plastrum Testudinis 5-8 gram, Radix Ginseng 3-6 gram, Rhizoma Cimicifugae 15-30 gram, Fructus Lycii 25-45 gram and Rhizoma Dioscoreae 60-80 gram is all in protection scope of the present invention.

Claims (4)

1. Chinese medicine composition that is used to treat myasthenia gravis; It is characterized in that medicine forms, form by Pheretima 55-75 gram, Scolopendra 45-55 gram, Radix Polygoni Multiflori 25-45 gram, Rhizoma Atractylodis Macrocephalae 30-50 gram, Radix Astragali 70-80 gram, Carapax et Plastrum Testudinis 5-8 gram, Radix Ginseng 3-6 gram, Rhizoma Cimicifugae 15-30 gram, Fructus Lycii 25-45 gram and Rhizoma Dioscoreae 60-80 gram.
2. the Chinese medicine composition that is used to treat myasthenia gravis according to claim 1; It is characterized in that: form by Pheretima 55 grams, Scolopendra 45 grams, Radix Polygoni Multiflori 25 grams, the Rhizoma Atractylodis Macrocephalae 30 grams, the Radix Astragali 70 grams, Carapax et Plastrum Testudinis 5 grams, Radix Ginseng 3 grams, Rhizoma Cimicifugae 15 grams, Fructus Lycii 25 grams and Rhizoma Dioscoreae 60 grams.
3. the Chinese medicine composition that is used to treat myasthenia gravis according to claim 1; Form by Pheretima 75 grams, Scolopendra 55 grams, Radix Polygoni Multiflori 45 grams, the Rhizoma Atractylodis Macrocephalae 50 grams, the Radix Astragali 80 grams, Carapax et Plastrum Testudinis 8 grams, Radix Ginseng 6 grams, Rhizoma Cimicifugae 30 grams, Fructus Lycii 45 grams and Rhizoma Dioscoreae 80 grams.
4. the Chinese medicine composition that is used to treat myasthenia gravis according to claim 1; Form by Pheretima 62 grams, Scolopendra 52 grams, Radix Polygoni Multiflori 37 grams, the Rhizoma Atractylodis Macrocephalae 45 grams, the Radix Astragali 76 grams, Carapax et Plastrum Testudinis 6 grams, Radix Ginseng 4 grams, Rhizoma Cimicifugae 22 grams, Fructus Lycii 33 grams and Rhizoma Dioscoreae 78 grams.
CN2011103814099A 2011-11-27 2011-11-27 Chinese medicinal composition for treating myasthenia gravis Expired - Fee Related CN102406798B (en)

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Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN104474353A (en) * 2014-12-19 2015-04-01 李爱花 Medicine for treating myasthenia gravis and preparation method of medicine
CN105288561A (en) * 2015-11-30 2016-02-03 吕翠云 Traditional Chinese medicine composition for treating eye myasthenia gravis
CN105497334A (en) * 2015-12-31 2016-04-20 张鹏 Chinese patent medicine for treating myasthenia gravis and preparation method thereof
CN106138615A (en) * 2016-08-13 2016-11-23 包莉丽 A kind of medicine for treating myasthenia gravis

Families Citing this family (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN105853586A (en) * 2015-07-07 2016-08-17 常洪德 Medicine for treating myasthenia gravis and preparation method thereof

Non-Patent Citations (2)

* Cited by examiner, † Cited by third party
Title
杨颖: "中医对重症肌无力的理论认识及临床治疗", 《河北中医》 *
高俊彦: "起痿丸治小儿痿证", 《新中医》 *

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN104474353A (en) * 2014-12-19 2015-04-01 李爱花 Medicine for treating myasthenia gravis and preparation method of medicine
CN105288561A (en) * 2015-11-30 2016-02-03 吕翠云 Traditional Chinese medicine composition for treating eye myasthenia gravis
CN105497334A (en) * 2015-12-31 2016-04-20 张鹏 Chinese patent medicine for treating myasthenia gravis and preparation method thereof
CN106138615A (en) * 2016-08-13 2016-11-23 包莉丽 A kind of medicine for treating myasthenia gravis

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