Ayurvedic Management in Myasthenia Gravis – A case study

Monika Sheshrao Adhave, Vijaykumar U. Gawai

(PG scholar, Department of Kaumarbhritya, Government Ayurved College, Nanded)

 (Professor, HOD, Department of Kaumarbhritya, Government Ayurved College, Nanded)

*Corresponding author: monikaadhave4@gmail.com

Abstract

 Myasthenia Gravis is a long-term neuromuscular disease. Myasthenia Gravis presents with weakness and fatigability of skeletal muscles. It involves defects in the part of the nervous system that sends messages from your brain to your muscles telling them when to work. As a result, muscles fatigue easily and often weaken, leading to reduced physical function. The prevalence of Myasthenia Gravis is 50 to 200 per million people. There is still no cure for myasthenia Gravis in Modern Science other than symptomatic management. Ayurvedic therapies can give much better results. It can be understood on the basis of Srotorodha and Agnidushti.

Keywords:

Myasthenia Gravis, neuromuscular disease, Sarvanga snehana, til tail

Introduction

Myasthenia gravis is the most common autoimmune disorder that affects the neuromuscular junction^[1]. Myasthenia Gravis is a Greek word MYS means muscle and ASTHENEIA means weakness and the Latin word gravis means serious^[2]. Myasthenia results from dysfunction of the neuromuscular junction. It usually affects the extra-ocular muscles, but can also affect all skeletal muscles leading to generalized weakness and fatigability usually due to autoantibodies directed against acetylcholine receptors at neuromuscular junctions^[3]. This disease is caused by weakness, especially in the eyes, neck, face and skeletal muscles. Myasthenia Gravis is caused by an error in the transmission of nerve impulses to muscles. In Ayurveda, it is mainly due to Srotorodha and Agnidushti both in Kostha and Dhatu levels. Agnidushti leads to the formation of Ama, which leads to the Doshakopa mainly Vata and Kapha, and which affects the function of Rasadidhathu.

Aims and objectives:

To evaluate the effect of Ayurvedic treatment in a case of Myasthenia Gravis.

Case Details

Chief complaints

A 4 year old female child was brought by her parents to the kaumarbhritya OPD of Government Ayurveda College and Hospital Nanded, with the complaints of;

• Drooping of left eyelid
• Weakness in the left hand of the body

Birth history -

• A full-term Fch Delivery by LSCS.
• Birth weight 2.25 kg
• Cried immediately after birth

Neonatal history –

NICU management for 4 days For ? LBW

Drug history:

Tab gravitor (Pyridostigmine) 60 mg ½ BD

Tab Renodapt (mycophenolate mofetil) 200mg BD

Family history- 

History of hypothyroidism to patient’s mother in pregnancy.

H/O Consanguineous marriage of parents II⁰

General examination

Weight - 14kg

Height -105 cm

Pallor, cyanosis, and icterus were absent

Systemic examination

CVS -S1, S2 heard, No murmur

RS – normal vascular breathing

CNS –conscious and oriented

Coordination test – intact

Gait – normal

Muscular system examination

Intervention-

 Observation After Treatment:

Before Treatment

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After Treatment

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Assessment criteria :

 The assessment was done based on complaints of the patient and also using a gradation system developed by the Myasthenia Gravis foundation of America^[5]

Result-

After the course of Abhyanga and Swedana, Left hand weakness was reduced. Tarpana with Triphala ghrita to strengthen the muscles of the upper eyelids. It aids in reducing eye stress. Nasya therapy with Panchendriyavardhana Taila It helps balance the doshas and supports eye health^[6]. After the course of comprehensive management, there was relief in chewing and swallowing and muscle weakness.

Discussion-

In Ayurveda, Myasthenia Gravis is mainly due to Srotorodha and Agnidushti (both in Kosta and Dhatu). Agnidusti leads to the formation of Samavastha in the body. Which hamper the proper functioning of Dosha, mainly Vata along with Kapha. Since Vata dosha is mainly responsible for the proper functioning of neurotransmitters, here the functioning of Vata is obstructed by the Samadhathu. Dhatwagni is responsible for the formation of the Utarotaradhatu. Impaired Dhatwagni leads to Rasa-Raktadi dhatu dushti.

Discussion on treatment

In Myasthenia gravis, patient will have varying degree of weakness of skeletal muscles. Therefore, Sarvanga snehana with til tail was effective in nourishment of dhatus and increases their strength and helps in proper functioning of Vata Dosha.

Sarvanga Nadi swedana which helps in beneficial for reliving stambha, Gaurava and shula and also nourishing the body.

Vishtindukadi Vati^[7] is prepared from purified kuchala (StrichnusNux-vomica) along with Maricha, Chincha Phala and Supari which having properties like Vata-Kapha Shamana, and does Aamapachan^[8]. This medicine used for nerve disorders. Vishtinduk is a nerve tonic. It also acts on nerves, senses, and muscles. It stimulates the functions of these organs.

Brahmi capsules helps to enhance the Agni.

Conclusion

The analysis of Myasthenia gravis in Ayurveda concludes that it is a symptom complex and it is not correlated with specific Ayurveda term. So myasthenia gravis was treated according to Ardita vata^[9]. The treatment methods explained in the classics is helpful in giving Significant relief in signs and symptoms of disease. Proper nutrition, such as moistening solid foods to reduce fatigue from chewing.

Acknowledgement

I assert my gratituted to the various Acharya of Ayurveda, for giving us this wholesome knowledge, & an opportunity to explore it with the full extend. I thank my guide, HOD, all teachers of the Dept. of Kaumabhritya, my fellow friends & colleagues to help me whenever I was stack during this article work.

References

1. Editor Kligman, St Geme, Blum, shah, Taskar, Nelson Textbook of paediatrics Volume 2, Wilson. 21^st edition Page No. 3304
2. https://en.wikipedia.org/wiki/Myasthenia_gravi
3. Editor Kligman, St Geme, Blum, shah, Taskar, Nelson Textbook of paediatrics Volume 2, Wilson. 21^st edition Page No. 3306
4. Wolfe, GI, Herbelin L, Nations, SP, Foster, B, Bryan WW, Barohn RJ. Myasthenia gravis activities of daily living profile. Neurology. 1999;52:1487- 1489Agnivesha: Charak samhita of Agnivesha by Acharya Vidyadhar Shukla and and Ravidutta Tripathi, Chaukhambha Sanskrit Pratishthan, Sutrasthana, Chapter 5, sutra 63. 2011 page 97.
5. Vaidhyaraj, Datto Ballal Borkar, Sarth Rasachandeshu, Shree Gajanan book depo prakashan pune, Ajirna adhikar, Page no. 213.
6. Acharya Priyarta Sharama. Dravaya Guna Vighyan, Vol.2nd Publication choukhmbha orientaliya Varanasi, Madakari prakarana.Page 83,362,750.
7. Agnivesha : Charak Samhita of Agnivesha by Dr.Bramhanand Tripathi, Chikitsa sthana, Chapter 28, sutra 38. Varanasi, Chukhamba Surabharati Prakashana, 2009 page 942