Herbal Medicine Treating Myasthenia Gravis (MG)

The Generals

Patients with myasthenia gravis (MG), neuromuscular disease, typically show up with symptoms of variable ocular fatigue and weakness all over the body. This disease is caused by defunction of the certain nerve receptors to function properly. A reduction in the number of acetylcholine (ACh) receptors results in a special situation of progressively reduced muscle strength with repeated use of the muscle and recovery of muscle strength following a period of rest.

The common ocular syndrome includes ptosis, orbicularis weakness, droopy eyelids that appear worse at the end of the day, paradoxical lid retraction, limitation of ocular motility, Cogan’s lid twitch, exposure keratitis and intermittent diplopia.

Some percentage of patients possess a form of the disease known as ocular myasthenia. Here, the symptoms remain strictly confined to the extraocular muscles.

Systemic symptoms include intermittent fatigue of the limbs, weakness of the facial muscles and difficulty talking, breathing, swallowing and chewing. In a small percentage of patients, dysthyroidism may also be present, resulting in the mixture of ptosis and exophthalmos. Thymic thymoma is an associated finding signs in patients over 65. Associated disorders such as diabetes mellitus, lupus erythematosus and rheumatoid arthritis occur in 1/5 percent of MG patients.

The Mechanism

Autoantibodies develop against ACh acetylcholine (ACh) receptors for unknown reasons. Cholinergic nerve conduction to striated muscle is impaired by a mechanical blockage of the binding site by antibodies and, ultimately, by destruction of the binding site.

Patients become symptomatic once the number of ACh receptors is reduced to approximately 30% of normal. The cholinergic receptors of smooth and cardiac muscle have a different antigenicity than skeletal muscle does.

The role of the thymus in the pathogenesis of MG is not entirely clear, but three quarter of patients with MG have some degree of thymus abnormality. Given the immunologic function of the thymus and the improvement in the clinical condition of patients following thymectomy, the thymus is considered to be the site of autoantibody formation. However, the stimulus that initiates the autoimmune process has not been identified.

Clinical Attention

• MG should always become a consideration in cases of non-restrictive, pupil sparing CN III, IV and VI nerve palsy as well as unilateral and bilateral internuclear ophthalmoplegia.
• Laboratory testing is important for patients diagnosed with MG because of its association with other systemic autoimmune diseases. Pertinent studies include fasting blood sugar, thyroid function tests (ASH, T3, T4), antinuclear antibody (ANA: lupus), rheumatoid factor (RF: arthritis) and in suspicious cases, radiological testing of the thymus gland. A purified protein derivative (PPD: tuberculosis) should be completed because steroid regimens, used to treat MG have the potential to activate or worsen dormant disease.
• Patients should always be educated to report difficulties with breathing or swallowing.

The Symptoms of Myasthenia Gravis

The onset of MG may be sudden, with generalised and severe muscle weakness, but more often the symptoms in the early stages are variable and subtle, making it difficult to diagnose correctly.

The noticeable symptom frequently is weakness of the eye muscles. The disease may remain localised there, or progress to muscles involved in swallowing, chewing, talking, or in moving the limbs. Symptoms vary from patient, but can include a drooping of one or both the eyelids (ptosis), blurred or double vision, weakness of the muscles that move the eyeballs, and unstable or waddling gait, weakness in arms, hands, and fingers, difficulty in swallowing, and difficulty in breathing. These last two represent a significant danger to the patient.

Muscle weakness may develop over a few days or weeks, or remain at the same level for long periods of time. The severity of weakness varies from patient to patient, and even in the same patient at different times of the day. Weakness tends to worsen with exercise and at the end of the day, and is usually particularly alleviated by rest.

Effective Chinese Herbal Medicine

The following are main diagnosis points summed up by TCM

1. Modified Central-Burner Nourishment and Qi Refilling Formula
   Indication:
   Myasthenia Gravis
   Composition:
   Radix Codonopsis Pilosulae 12g, Rhizoma Atractylodis Macrocephalae 10g, Radix Angelicae Sinensis 10g, Radix Astragali 30g, Rhizoma Dioscorea Batatis 30g, Caulis Spatholobi 30g, Rhizoma Cimicifugae 8g, Radix Bupleuri 8g, Zaocys dhumnades 12g, Poria Cocos 15g
   Variation:
   1. For Yin vacuity with heat in blood:
   Radix Astragali preparata 24g, Rhizoma Dioscorea Batatis 30g, Caulis Spatholobi 30g, Radix Rehmanniae preparata 10g, Radix Angelicae Sinensis 10g, Rhizoma Cnidii 8g, Carapax Et Plastrum Testudinis Preparata 12g, Ramulus Mori 10g, Radix Paeoniae Alba 15g, Fructus Tribuli 12g, Jiang Huang 10g, Radix Codonopsis Pilosulae 12g, Zaocys dhumnades 12g
   2. For Insufficiency of Both Liver and Kidney:
   Radix Astragali 24g, Rhizoma Dioscorea Batatis 30g, Radix Rehmanniae preparata 10g, Fructus Corni 12g, Cortex Moutan Radicis 10g, Radix Pseudostellariae 12g, Zaocys dhumnades 12g, Caulis Spatholobi 30g, Radix Achyranthis 10g
   Administration:
   Decocted with water. On time daily.
   Clinical Fact Sheet
   31 received the treatment. Among them 28 gained recovery, 2 gained improvement and one gained nothing.
   Formula Source:
   Guangxi Chinese Medicine, Jan. 1991
2. Decoction for Fortifying Spleen and Refilling Qi and Strengthening Muscle
   Indication:
   Myasthenia Gravis
   Composition:
   Radix Astragali preparata 50g, Rhizoma Homalomenae 30g, Radix Codonopsis Pilosulae 30g, Niu Da Li 30g, Rhizoma Atractylodis 20g, Herba Epimedii 20g, Rhizoma Cimicifugae 8g, Radix Bupleuri 8g, Radix Glycyrrhizae 5g, Prepared Ma Qian Zi 0.5g
   Administration:
   Decocted with water. On time daily.
   Formula Source:
   Combination Between Western and Eastern Medicine, Jul. 1992
3. Formula for Activating Paralysis
   Indication:
   Myasthenia Gravis
   Composition:
   Radix Rehmanniae preparata 20g, Semen Cuscutae 30g, Hydrocotyle sibthorpioides 40g, Herba Epimedii 15g, Radix Angelicae Sinensis 15g, Radix Codonopsis Pilosulae 15g, Radix Aconiti Lateralis Preparata 20g, Radix Astragali 50g, Rhizoma Atractylodis Macrocephalae 12g, Rhizoma Gastrodiae 10g.
   Administration:
   Decocted with water. On time daily.
   Clinical Fact Sheet
   12 received the treatment. Among them 9 gained recovery, 2 gained improvement and one gained nothing.
   Formula Source:
   Shandong TCM Medicine, Jul. 1996
4. Formula for Myasthenia Gravis
   Indication:
   Infantile Myasthenia Gravis, ocular type
   Composition:
   1. For Central Qi downfall:
   Poria Cocos 10g, Radix Paeoniae Alba 10g, Radix Puerariae 10g, Ma Qian Zi 0.5g, Rhizoma Zingiberis 2 slips, Fructus Zizyphi 2 pieces.
   2. For Spleen Vacuity and Swampness Prevailing:
   Radix Ginseng 10g, Poria Cocos 10g, Rhizoma Atractylodis 10g, Radix Glycyrrhizae 6g, Pericarpium Citri Reticulatae preparata 6g, Rhizoma Pinelliae Preparata 10g, Radix Puerariae 10g, Radix Bupleuri 10g, Radix Saussureae 3g, Rhizoma Cimicifugae 5g, Ma Qian Zi 0.5g.
   3. For Cases with Liver and Kidney Involved:
   Fructus Lycii 10g, Flos Chrysanthemi 10g, Radix Rehmanniae preparata 10g, Rhizoma Dioscorea Batatis 10g, Fructus Corni 10g, Poria Cocos 10g, Bai Fu Zi 10g, Bombyx Cum Batryte 10g, Ramulus Uncariae Cum Uncis 10g, Scorpio 2g, Ma Qian Zi 0.5g.
   Administration:
   Decocted with water. On time daily.
   Clinical Fact Sheet
   21 received the treatment. Among them 7 gained recovery, 12 gained improvement and 2 gained nothing.
   Formula Source:
   TCM Medicine, Oct. 1985

Chinese Herbal Medicine Treatment Amyotrophy Convalescence Pill Series

Amyotrophy Convalescence Pill Series have been verified to be very effective in treating MG. Almost 83% of patients can gain an improvement within 35 days to five months. Patients with MG can use 1) series # 1 and series # 4 or 2) series # 1 and series 3 for the treatment of MG. For more information regarding Amyotrophy Convalescence Pill Series please CLICK HERE.