The connotation of the "four-dimensional pivot-earth"

qi

transformation mode is a dialectical system of the ascending and descending of

yin

-

yang qi

movement， which presented as "the middle Jiao showing earth

qi

mediating， the left wheel showing water and wood ascending， and the right wheel showing fire and metal converting and descending". Based on this dialectical thinking， it is believed that the core pathogenesis of myasthenia gravis is deficiency of center

qi

and transportation failure to pivot-earth； the middle-stage characteristics of the disease progression are the loss of mediation of the central

qi

， resulting in water coldness and wood constraint， and clear

yang

failing to ascend； the final outcome of this disease is the loss of astringeing of lung metal and

qi

sinking. The treatment should be based on the rule of

qi

movement， so for the start-stage，

Buzhong Yiqi Decoction

（补中益气汤） should be used as the basis to nourish the earth and consolidate the root， and restrengthen the middle

qi

； for the middle-stage， herbs like Yingyanghuo （

Epimedium brevicornu

Maxim.）， Bajitian （

Morinda officinalis

How） could be combined to warm the water and soothe the wood， raise

yang

and boost

qi

； for the final stage， plus

Sini Decoction

（四逆汤） to astringe metal to stop collapse， and powerfully supplement original

qi

. All these medicinals can promote pivot-earth re-transportation， four-dimensional transformation， and regular circulation of

qi

movement， so as to provide thoughts for improving the clinical effectiveness of myasthenia gravis.