Ayurveda & Myasthenia Gravis

Myasthenia Gravis (MG) is a neuromuscular disease characterized by increasingly severe fluctuating muscle weakness and fatiguability. This weakness is brought about by an over-active immune response by the body against its own tissues; hence, it is termed an autoimmune diseases.

Myasthenia Gravis is caused by a defect in the transmission of nerve impulses to muscles. It occurs when normal communication between the nerve and muscle is interrupted at the neuromuscular junction - the place where nerve cells connect with the muscles they control. Normally when impulses travel down the nerve, the nerve endings release a neurotransmitter substance called acetylcholine. Acetylcholine travels through the neuromuscular junction and binds to acetylcholine receptors which are activated and generate a muscle contraction.

In Myasthenia Gravis, antibodies block, alter, or destroy the receptors for acetylcholine which prevents the muscle contraction from occurring. These antibodies are produced by the body's own immune system. Muscles become progressively weaker following ever-briefer periods of activity and improve after ever-lengthening periods of rest, and muscles that control eye and eyelid movement, facial expressions, chewing, talking, and swallowing are especially susceptible, although as the disease progresses muscles that control breathing and limb movements can also become affected. The initiating event leading to antibody production is not known.

The condition is more common in women under 40 years of age and in men over 60. Pregnant women with MG can pass the disease on to their children, and neonatal myasthenia occurs in 12 percent of infants born to MG mothers.

From an Ayurvedic perspective, dysregulation of the immune function occurs on account of either Ojovyapat or Ojovisramsa, the derangement or displacement of Ojas resulting from inherent disposition, nutritional inadequacy, digestive or eliminative inefficiency, vitiation of the doshas with resulting tissue damage and metabolic disruption, unresolved psychological trauma or protracted somatic stress, or environmental or karmic factors, leading in the case of MG to Ojovruddhi, a quantitative increase in systemic Ojas of impaired quality. This process coincides with vitiation of one or more of the doshas (tridoshic vitiation is ordinarily encountered in MG), with the vitiated doshas admixing with deficient Ojas and Aam when present in one or more of the pranavaha, mamsavaha, meddavaha orajjavaha srotamsi, occluding the same and resulting in the malnourishment of their dependent tissues.

The potentiated state of the immunity fomented by the surplus of deficient Ojas, and the radical loss of somatic "intelligence" on the cellular level brought about by the admixtures of vitiated doshas (likely to include tarpak kapha, sadhak pitta, and vyan and pran vayu, inter alia), aam and tissues at the site of reception (khavaigunya) give rise to the syndrome categorized by Western biomedicine as Myasthenia Gravis (MG), which essentially is an autoimmune attack on the postsynaptic acetylcholine receptors of the neuromuscular junction.

Symptoms include fluctuating weakness and fatigability of skeletal muscles, especially the ones innervated by the cranial nerves, and diplopia and muscle fatigability after exercise. Ocular muscles are affected at the onset in 40 percent of patients and will eventually be affected in 85 percent. Dysarthria, dysphagia, and proximal limb weakness are common. Changes in speech, nasal regurgitation with choking, and respiratory failure may be present. Symptoms flux in intensity over the course of hours or days. It is important to ascertain that MG is differentiated from certain forms of Celiac Disease, which can have neurological symptoms, as can long-term treatment with penicillamine.

The Ayurvedic treatment of myasthenia gravis is aimed at three goals: detoxifying the patient, reducing the symptoms, and correcting immune dysfunction.

To treat the basic condition, ayurvedic medications which have neuromuscular activity are used, including Yograj-Guggulu, Trayodashang-Guggulu, Kaishor-Guggulu, Sinhanaad-Guggulu, Ekangveer-Ras, Vat-Gajankush-Ras, Agnitundi-Vati, Vish-Tinduk-Vati and Tapyadi-Loh. Drugs which act on the mamsa and medda dhatus are useful for this condition and include Patol (Tricosanthe dioica), Musta (Cyperus rotundus), Nimba (Azadirachta indica), Triphala (Three fruits), Guduchi (Tinospora cordifolia), Chirayta (Swertia chirata), Chandan (Santalum album), Sunthi (Zinziber officinalis) and Kutaj (Holarrhina antidysentrica). In addition, medicated oils like Mahanarayan oil, Mahamash oil and Mahasaindhav oil are used for topical application, followed by a medicated steam fomentation of Dashmool Qadha (decoction) and Nirgundi Qadha.

To treat immune dysregulation, Bruhat-Vat-Chintamani, Suvarna-Malini-Vasant, Maha-Yograj-Guggulu, Suvarna-Sameerpannag-Ras, Trivanga-Bhasma, Abhrak-Bhasma, Ashwagandha (Withania somnifera), Shatavari (Asparagus racemosus), Bala (Sida cordifolia) and Nagbala (Grewia hirsuta) are used. When used on a long term basis, these medicines have been known to prevent recurrence of this disease. Nutritional supplementation with calcium, glycine, lecithin, manganese, pantothenic acid, and vitamin B complex, C and E have proven useful.

People who suffer from this condition need to make adequate life style changes to adjust to this problem. Psychological counseling is also central to helping the patient deal with this troubling disorder.

Article provided by William Courson, BVSA, D.Ayur., CH, an Ayurvedic Practitioner, faculty member and the College Dean of Institutional Development at Sai Ayurvedic College & Ayurvedic Wellness Center in Miami, FL.

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