E-ISSN:2456-3110

Case Report

Herbomineral Drug

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 11 NOVEMBER
Publisherwww.maharshicharaka.in

Management of Myasthenia Gravis through Herbomineral Drug - A Case Study

Kumar A1*, Sapna2, Kumar S3, Kumar S4
DOI:10.21760/jaims.9.11.41

1* Amit Kumar, First Year Post Graduate Scholar, Department of Kayachikitsa, Govt Ayurvedic College, Patna, Bihar, India.

2 Sapna, First Year Post Graduate Scholar, Department of Kayachikitsa, Govt Ayurvedic College, Patna, Bihar, India.

3 Santosh Kumar, Second Year Post Graduate Scholar, Department of Kayachikitsa, Govt Ayurvedic College, Patna, Bihar, India.

4 Sujeet Kumar, Associate Professor and Guide, Department of Kayachikitsa, Govt Ayurvedic College, Patna, Bihar, India.

Ayurveda is an oldest traditional medicine system that believes on natural and holistic approach of treatment for various diseases. It is the science of healthy life. Myasthenia gravis is a chronic autoimmune neuromuscular disease that causes weakness in the skeletal muscles, which are responsible for breathing and moving parts of the body including the arms and legs. Myasthenia gravis affects approximately 2 out of every 100000 people and can occur at any age of 18 and 25 years. In Ayurveda, the symptoms of myasthenia gravis closely resemble with Vata Vyadhi. As per Ayurvedic perspective, dysregulation of the immune function occurs on account of either Ojovyapat or Ojovisramsa the dearrangement or displacement of Ojas resulting from inherent disposition, nutritional inadequacy, digestive or eliminative, vitiation of the Doshas by tissues destructions and metabolic disruption, unresolved psychological trauma or protected somatic stress, or environment or Karmic factors may lead to develop myasthenia gravis. Ojas disorders still they have no satisfactory management. Myasthenia gravis is mainly due to Srotorodha and Agnidusti. Agnidusti leads to formation of Samavastha in the body which provide hinderance in the functioning of body. A case study of Myasthenia gravis was studied and managed accordingly symptomatic improvement was noted after 21 days of treatment.

Keywords: Myasthenia Gravis, Ojovyapat, Ojovisramsa, Rasayana

Corresponding Author How to Cite this Article To Browse
Amit Kumar, First Year Post Graduate Scholar, Department of Kayachikitsa, Govt Ayurvedic College, Patna, Bihar, India.
Email: 		Kumar A, Sapna, Kumar S, Kumar S, Management of Myasthenia Gravis through Herbomineral Drug - A Case Study. J Ayu Int Med Sci. 2024;9(11):290-294.
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https://jaims.in/jaims/article/view/3725

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-10-14 2024-10-24 2024-11-04 2024-11-14 2024-11-22
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© 2024by Kumar A, Sapna, Kumar S, Kumar Sand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

J Ayu Int Med Sci 2024;9(11)290
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Amit K et al. Management of Myasthenia Gravis through Herbomineral Drug

Introduction

There are more than 100 types of immune disorders known today. Pathology of some of them is known and some are still puzzling for medical science. Myasthenia Gravis is chronic autoimmune neuromuscular disease that is characterized by antibodies directed against proteins of the neuromuscular junction. In most cases auto antibodies against the acetylcholine receptor can be found.[1] This is the most common cause of acutely evolving, fatigable weakness and commonly affects ocular, facial and bulbar muscles. It is usually present between the age of 15 and 50 years in which female predominance is seen in younger patients. In old age, males are more prone to myasthenia gravis. It seems to run a relapsing and remittent course.[2] The weakness of muscles increases during repetitive use and may improve following rest. Facial weakness produces a snarling expression while smiling and difficulty in swallowing with speech may occur due to weakness of palate, tongue and pharynx. If weakness of respiratory muscles becomes so severe then the patient condition is in crisis leads to difficulty in breathing and related symptoms. The limb weakness is often proximal and may be asymmetric.[3] Weakness of respiratory muscles represents severe MG crisis. The prevalence of MG was estimated 1 in 200,000 from 1915 to 1934, increased to 1 per 20,000 after the introduction of anticholinesterase drugs in 1934 and rises to 1 per 17000 populations. Prevalence rate ranges from 150 to 200 cases per million and they have increased slowly over past 50 years.[4] The factors that increases the risk of myasthenia gravis are fatigue, illness, infection, stress, pregnancy and menstruation. It is most commonly caused by antibodies to acetylcholine receptors in the post junctional membrane of the neuromuscular junction. The resultant blockage of neuromuscular transmission and inflammatory response reduces the number of acetylcholine receptors and damages the end plate. MG patients have more likely to have associated organ specific automimmune disease.[5] In Ayurveda, the exact correlation with Myasthenia gravis is not known yet. But as per signs and symptoms of myasthenia gravis, Acharya Charaka has mentioned the signs and symptoms in Indriya Sthana which are called Arista Lakhshana and can be correlated with neurological and muscular disorders.

These symptoms are similar to symptoms of myasthenia gravis as per modern science. Symptoms are like Ati Mukta Bandhana[6] which means drooping of upper eyelids that may be due to weakness and fatigability of upper eyelids muscle, “Naupaiti Kanthanaharo Jihva Kanthomepaiti[7] which means difficulty in swallowing that means oropharyngeal dysphagia, shallow breathing, change in voice & speech, wasting of muscles and a pattern of weakness, etc. These are some symptoms which are similar to myasthenia gravis as Ayurveda classics has mentioned a lot about signs and symptoms of various diseases including the neurological and neuromuscular disorders. Some research has mentioned that in Ayurveda, myasthenia gravis is caused by the vitiation of Vata and Kapha Dosha with Agni Dusti which leads to formation of Ama as per sign & symptoms of myasthenia gravis, it can be correlated with Mansagata Vata which is caused by vitiation of Vata Dosha in Mansa Dhatu. Vata Dosha in this condition is vitiated by Oja Kshaya. Oja is called as Sharira Bala which is present in heart and the Sara of all seven Dhatus. Oja Kshaya occurs due to Nidana Sevan like Abhigata, Shuda, Shoka, Ati Shram which are mentioned by Acharya Sushruta. Oja Kshaya leads to vitiation of Vata Dosha which further accumulates in Mansa Dhatu results in symptoms which are similar to Myasthenia gravis. Oja Kshaya occurs in three stages: Visransa, Vyapat and Kshaya in which first stage is Visransa causes looseness of joints, weakness of the body, displacement of Doshas and hinderance to all movements. The second stage Oja Vyapat show symptoms like stiffness & heaviness of body, oedema caused by Vata, discolouration, stupor, etc and the last Oja Kshaya leads to loss and decrease of muscles, delirium and death.[8]

Case History

A 60 years old male patient came to the OPD of Kayachikitsa in Government Ayurvedic College and Hospital with complaint of bipedal edema with difficulty in standing, severe difficulty in breathing, severe fatigue with tiredness, already diagnosed with Gullain Barre syndrome. During treatment patient has severe shortness of breath, unable to sleep & fatigue of limb muscles with bipedal edema not able to even stand came on wheel chair with mild difficulty in swallowing & speech, proximal muscle weakness, & incomplete eye closure.


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Amit K et al. Management of Myasthenia Gravis through Herbomineral Drug

Examination

On physical examination, the patient has drooping of eyelids, downward lip corners with depress face, extreme proximal limb muscles weakness, shallow breathing.

On laboratory examination, IgE was found increase to 1166 IU/mL and on lungs examination, limitation of diaphragmatic excursions and bilateral lower chest dullness with absent breath sounds are found.

Diagnosis

Diagnosis was done on the basis of classical symptoms of myasthenia gravis like drooping of eyelids, acute respiratory distress, difficulty in swallowing and extreme limb weakness with edema present bilaterally, unable to stand and complete symptoms of Oja Kshaya.

Assessment Criteria

Osserman classification system for myasthenia gravis[9]

ClassSymptoms
IOnly ocular involvement
IIaGeneralized muscle involvement without pulmonary involvement
IIbBulbar manifestation
IIIRapid progression of generalized bulbar disease and weakness in respiratory muscles
IVClass 1 or 2 patients presenting progressive symptoms within 2 years

Treatment Plan

FormulationsDays of treatment administrationTotal duration of treatment
Purnchandrodaya Rasa 65mg
Shwasakasachintamani Rasa 65mg
Sameerpannag Rasa 65mg
Sitopladi Churna 3gm BD (with honey)		14 days14 days
Satavari Churna 2gm
Ashwagandh Churna 2gm
BD (with milk)		14 days14 days
Balarishta 20ml + 20ml water BD14 days14 days
Jivantyadi Ghrita 15ml BD14 days14 days
Mashabaladi Khwath 20ml
Vidaryadi Khwath 20ml
BD		14 days14 days

Assessment of symptoms Before & After treatment

Before treatment, the patient came to OPD with Class III myasthenia gravis and after the treatment the Class Grade is reduced to Class IIa based on signs and symptoms according to Osserman classification system of myasthenia gravis.

Discussion

It is a well-known fact that MG is an autoimmune disorder and there is no established line of treatment available to cure patient fully. In this scenario, the role of Ayurveda becomes important.

Ayurveda has said that it is not essential to give name of each and every disease to treat them. Considering the state of Dosha and Dushya, treatment can be planned for any disease.

Purnchandrodya Rasa[10]

It is an Ayurvedic herbo mineral formulation contains Shudha Hartal, Lauh, Abhrak, Talispatra, Shunthi, Lavang, etc which act as a whole as best Rasayana.

It helps to boost the body's immune response and balances the Tridoshas- Vata, Pitta and Kapha. It is used to rejuvenate the body and used for convalescent therapy to get better immunity.

Shwasakasachintamani Rasa[11]

It is the best Ayurvedic Medicine for imparting strength to respiratory system. It contains Swarna Bhasma, Moti Bhasma, Lauh, Abhrak Bhasma, Shudh Parad and Gandhak which together act as a Good combination to correct chronic respiratory diseases. It should be taken with Pipli churna and honey that act as adjuvant and increase its effect.

Sameerpannag Rasa[12]

It is one of the most effective mineral formulation as it contains Parada, Gandhak, Hartala, Manashila, Gouripashan, and Trimalla is used which is very effective in Kaphavrita Vatavyadhi.

It has Ushna Virya and Sara Guna with Tulsi Swarasa as Bhavna Dravya act as Kaphahara. It is used in the management of Tamak shwasa, Sandhivata, Amavata, etc. It works over the channel of respiatory and musculoskeleton system.


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Sitopladi Churna[13]

It is the popular polyherbal formulation that is used as Anupana antitussive, analgesic and anti-pyretic. It contains Sitopladi, Vanshlochana, Pipli, Twak, Ela, etc which helps loosen and expel mucus, clear chest congestion. Its antitussive activity have ability to effect the Central nervous system and suppress the cough. It should be taken with honey as adjuvant.

Shatavari Churna[14]

It is the main Rasayana and used in nervine disorders and act as anti inflammatory churna. It has anti stress, antihepatotoxic, immunomodulator, anti-oxidant and anti-inflammatory activity. It helps to maintain immunity and prevent from further infection. Shatavari ismentioned as Balya means a strength promoter. It is described as Medhya, the plant which increases intelligence and promote learning ability.

Ashwagandha Churna[15]

It is a Rasayana Herbal formulation that has a real potent regenerative tonic having several properties like neuroprotective, anti-stress, anti-arthritic, anti-tumour, analgesic and anti-inflammatory. Ashwagandha act as a immunomodulator that helps to delay hypersensitivity reactions and protect the body against automimmune responses as well. It should be taken with milk as adjuvant.

Balarishta[16]

It is polyherbal Ayurvedic alcoholic preparation act as a prime tool to cure arthritis, rheumatism and other autoimmune disorders. As it contains Bala, Ashwagandha, Dhataki, Rasna, Ela, Prasarani, Devapuspa, etc together act as a restorative for gastric disorders. It provide relief from pain and stiffness due to its antioxidant properties and balance the Tridoshas- Vata, Pitta and Kapha.

Jivantyadi Ghrita[17]

It is a combination of Jivanti, Yashtimadhu, Kutaj, Kachora, Kantari, Gokhshur, Bala, Nilkamal, Dhamasa, Pipli, Ghee, etc having properties such as Agnideepana, Amapachan, Strotovishodan, Rasayanguna, Brimhana, Balya and Dhatuposhaka. It has anti inflammatory, anti-microbial and immune stimulating activity which reduces future recurrence of diseases.

Mashabaladi Khwath[18]

It is a multi herb decoction having Tridoshaghana action mainly Vata-Kaphasamaka, Nadibalya, Dhatuvardhaka Pustivardhaka, along with Rasayana Guna. As it is anti inflammatory provide relaxation to muscles stiffness and strength to body tissues and nerves. It is made up of Masha, Bala, Rasna, Ashwagandha, Urubaka, Saindhav, etc which in together act as a boon for neuromuscular disorders.

Vidaryadi Khwath[19]

It is a polyherbal Ayurvedic formulation contains Vidari, Eranda, Punarnava, Mashaparni, Mudagaparni, Abheeru, Jeevaka, Prishnaparni, Shalaparni, Kantakari, etc which provide strength and nourishment to muscles and bones. It provide support to respiratory system and helps in Vata Pitta Dosha balance. It has antioxidant and immunomodulator activity that protect the immune system from recurrent infections and helps in strengthening the muscles weakness.

Conclusion

Although, the management of Myasthenia gravis is done in above case was very effective and patient responded in three weeks treatment but above mentioned drug treatment can’t be applied in each and every case or myasthenia gravis on the basis of previous study.

A large scale study with larger sample is needed to establish this drug treatment as line of treatment. On this basis, concept can be concluded that Rasayana therapy can open new dimension of drug treatment in Myasthenia gravis.

References

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2. Ralston, S.H., Penman, I. D., Strachan, M. W. J., & Hobson, R. [Eds.]. [2018]. Davidson’s principles and practice of Medicine [23rd Ed.] Elsevier Health Sciences chapter 25 pp 1141.

3. Fauci. Kasper. Hauser. Longo. Localzo. [2018]. Harrison’s principle of internal medicine. McGraw Hill Education. Chapter Neurological diseases.


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4. Dresser, Soliven, Laura, Betty. (2021). Myasthenia Gravis: Epidemiology, Pathophysiology and Clinical Manifestations. MDPI, 10(11), 2235.

5. Ralston, S.H., Penman, I. D., Strachan, M. W. J., & Hobson, R. [Eds.]. [2018]. Davidson’s principles and practice of Medicine [23rd Ed.] Elsevier Health Sciences chapter 25 pp 1142.

6. Maharshi Agnivesha, Charaka Samhita, Indriya sthana, (3/6 ). In S.N. Shastri (eds), Vidyotini Hindi Commentary. Reprint 2018ed. Chaukhambha Bharati Academy; Varanasi: 2018, pp. 979.

7. Maharshi Agnivesha, Charaka Samhita, Indriya sthana, (8/25). In S.N. Shastri (eds), Vidyotini Hindi Commentary. Reprint 2018ed. Chaukhambha Bharati Academy; Varanasi: 2018, pp. 1002.

8. Acharya Sushruta, Sushrut Samhita, Sutra sthana (15/29 ) In Ambikadatta Shastri (eds), Hindi Commentary. Reprint 2014 ed. Chaukhambha Sanskrit Sansthan, Varanasi: 2014, page no. 80.

9. Damian, Maxwell & De Visser, Marianne. (2022). Emergencies in Neuromuscular Disorders. Springer Nature Switzerland. pp 39-75.

10. Shri Govind Das Sen, Bhaishajya Ratnawali, Atisar chikitsaprakaran (15/119)In Shri Kaviraj Ambikadatta Shastri(eds), Vidyotini Hindi Commentary analysis. Reprint 2014ed., Chaukhambha Sanskrit Sansthan, Varanasi. 2014, page no.264.

11. Shri Govind Das Sen, Bhaishajya Ratnawali, Hikka Shwasaroga chikitsaprakaran(16/57-60)In Shri Kaviraj Ambikadatta Shastri(eds), Vidyotini Hindi Commentary analysis. Reprint 2014ed., Chaukhambha Sanskrit Sansthan, Varanasi. 2014.

12. Kumar, Jadar, Shashi, Prashant. (2023). Critical Review of Sameerpannag Rasa: A Kupipakwa Rasayana Yoga. Journal of Ayurvedic Sciences, 11(1), 31-35.

13. Negi, Prashar, Jyoti, Bharat. (2019). Sitopaladi Churna As Anti-Tussive: A Review. International Journal of Health and Clinical Research, 2(6), 1-5.

14. Sakharam Bhokardanker, Prashant. (2019). AN OVERVIEW OF SHATAVARI (ASPARAGUS RACEMOSUS) AN AYURVEDIC DRUG. International Journal of Ayurveda and Pharma Research, 7(4), 60-65.

15. Gupta, Nath Bansal, Sonu, Ravinder. (2021). Ashwagandha (Withania somnifera) – a herb with versatile medicinal properties empowering human physical and mental health. Journal of Pre Clinical Research and Clinical Research, 15(3), 129-133.

16. Swapana, Nagaveni, E, P. (2015). Evaluation of Antioxidant activity of Marketed Ayurvedic Formulations- Balarishta. RJJP, 7(2), 107-110.

17. Nandkishor Bhaurao Kale. (2022). TO STUDY EFFICACY OF JIVANTYADI GHRIT AS ADD-ON TREATMENT IN PTB TREATING WITH AKT (DOTS) REGIMEN. Journal of Ayurvedic Herbal and Integrative Medicine, 2(1), 1-12.

18. Salah sulaiman. (2023). PHYTOCHEMICAL ANALYSIS OF MASHABALADI KWATHA CHURNA. International Journal Of Creative Research Thoughts, 11(4), 13-19.

19. Acharaya Vagbhatta, Astang hridyam, Sutra sthana (15/9-10) Hindi commentary, Chukhamba Krishandas Academy; Varanasi.2020.

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