Myasthenia+Gravis


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Definition:
An acquired autoimmune disorder recognized by easy muscle fatiguability and weakness, especially in the muscles innervated by the cranial nerves, that improves with the administration of cholinesterase-inhibiting medications.

Etiology:
The incidence of myasthenia gravis is 2-5 per year per million. Although the disease may strike anyone at any age the two most affected patient groups are adolescent and young adults, especially females, and adults over 40, who also have a higher risk of associated thymoma. The MG problem seems to lie in a deficiency of the acetylcholine receptors at the motor endplate of the muscles: apparently the release of acetylcholine by the nerve is normal, but lack of receptors decreases the muscle response. The disease presents either specifically with external ocular muscle problems or with generalized cranial nerve involvement. In one standard classification of the disease there are three subtypes: • MG with thymoma: No association with sex or age of onset. The disease is usually severe. There is no HLA correlation. • No thymoma, onset before 40 years old: This presentation is associated with females, and there is HLA correlation to several antigens. • No thymoma, onset after 40 years old: This presentation is associated with males, and there are other specific HLA correlations.

The onset of the disease is purely ocular in 40% of patients, generalized in 40%, involves bulbar and/or ocular muscles in 10%, and affects only the extremities in 10% (proximal limbs are more severely affected than distal muscles). As the disease progresses, the weakness often spreads over the entire body. After the first year with MG, almost all patients have ocular involvement, and in the patients with whom the disease will become generalized, 90% have already done so. In only 16% of patients do the symptoms remain purely ocular. During the first three years the progression of the disease is rapid and most deaths occur during this time. Although remissions are seen (in about 25% of patients), they do not usually last long.

Only 10-15% of MG patients have a thymoma, however, two thirds of the patients have thymic hyperplasia. 10% of patients also exhibit the signs and symptoms of other autoimmune diseases such as SLE, RA, sarcoidosis, ulcerative colitis, pemphigus, etc.

Nutrition:
eating principles: • elimination/rotation diet, rotation diet, rotation diet expanded

therapeutic foods: • increase foods rich in Calcium, Phosphorus, Manganese, Sulfur, Iodine, tryptophan (Jensen, p. 63) • egg yolk, kale, celery, fish, raw goat's milk, veal joint broth, cod roe, rice polishings, brewer's yeast, nutritional yeast (Jensen, p. 63)

fresh juices: • celery, carrot, prune (Jensen, p. 63) • prune and rice polishings (Jensen, p. 63) • raw goat's milk and 1 tsp. sesame, sunflower or almond butter, 1 tsp. honey and sliver of avocado (Jensen, p. 63) • black cherry and egg yolk (Jensen, p. 63)

avoid: • food intolerances

Botanicals
• Ephedra spp. (Ma Huang): (British Herbal Pharmacopoeia, p. 83) • Physostigma venenosum (toxic): anticholinesterase activity (Brinker, Sherman)

Chinese Formulae
• Ginseng and Astragalus C. (Bu Zhong Yi Qi Wan) (available as patent): Spleen Qi Xu (Deficiency) with Spleen Qi Sinking (Ginseng: Hsu, 1980, p. 255; Yeung, p. 51; Dharmananda, 1986, p. 186; Bensky and Barolet, p. 241; patent: Zhu, p. 270) • Jian Bu Hu Qian Wan (Chen Pu Hu Chien Wen) (patent): Kidney Yin Xu (Deficiency) with Empty Fire Blazing: muscle atrophy, limbs without strength. (Naeser, p. 289) • Pueraria C. (Ge Gen Tang): Ptosis of eyelids (Hsu, 1980, p. 51; Yeung, p. 105; Dharmananda, 1986, p. 125; Bensky and Barolet, p. 51) • Ginseng and Tang Kuei Ten C. (Shi Quan Da Bu Tang): Qi Xu (Deficiency) with Xue Xu (Blood Deficiency): Heavy eyelids (Hsu, 1980, p. 262; Yeung, p. 209; Dharmananda, 1986, p. 107; Bensky and Barolet, p. 260) • Lithospermum 15 (patent): Xue Yu (Blood Stasis) with Fire Toxin: autoimmune disorders (Dharmananda, 1990, p. 85) • Ginseng and Longan C. (Gui Pi Tang): Spleen Qi Xu (Deficiency) with Heart Xue Xu (Blood Deficiency) (Hsu, 1980, p. 425; Yeung, p. 112; Dharmananda, 1986, p. 244; Bensky and Barolet, p. 255)

Acupuncture
after assessing the person and palpating, consider these patterns: Kidney Yin Xu (Deficiency), often with Empty Fire Blazing; Liver Wind; Spleen Qi Xu (Deficiency), possibly with Spleen Qi Sinking; Heart Xue Xu (Blood Deficiency); Xue Yu (Blood Stasis) with Fire Toxin; Shi (Excess) of the Du Mai (Governing Vessel); dysfunction of the Yin Qiao Mai (Yin Motility Vessel) and/or the Yang Qiao Mai (Yang Motility Vessel); Xu (Deficiency) of the Chong Mai (Penetrating Vessel)

» therapeutic note: The synchronous occurrence of dysarthria, acquired autoimmune activity, and a focus on muscles innervated by the cranial nerves suggests a parallelism with the Chinese concept of the Bones, Marrow and Brain (including the cranial nerves, cerebral spinal fluid and the immune function) as emanations of the Kidney orb. Like wise, Kidney would also for be connected with basic vitality and responsible for the pulling down of the Qi of the breath.

» illustrative combinations: • UB-18, UB-20, TW-17, St-6, TW-5, PC-6, LI-4, CV-12, CV-4, St-36 and Sp-6 for myasthenia gravis (Eisen) • GV-16, GV-1, GV-15, GV-17 and GV-28 are the Sea of Marrow points • GB-14, UB-2, LI-4, Kd-7 for diplopia (Shanghai, p. 146) • Kd-3 and Lu-5 for difficult inhalation; palpate and apply pressure to test for response before needling (Matsumoto) • CV-17 and CV-16 (ind. D with ginger): expand the chest; transform Phlegm; benefit the diaphragm; regulate Qi in the Upper Warmer; elevate Spleen Qi; suppress Stomach Qi • SI-3 and UB-62: open and regulate the Du Mai (Governing Vessel) • Kd-6 and Lu-7: open and regulate the Yin Qiao Mai (Yin Motility Vessel) which regulates muscular activity • UB-62 and SI-3: open and regulate the Yang Qiao Mai (Yang Motility Vessel) which regulates muscular activity • Sp-4 and PC-6: open and regulate the Chong Mai (Penetrating Vessel) for which Xue Xu (Blood Deficiency) is a Xu (Deficiency) sign • GV-16 and GV-20: treat brain disorders (Finkelstein, p. 81)

Homeopathy
• Causticum: great weakness, progressive and localized paralysis, esp. upper eyelids, hands (with cramps while writing), legs, bladder (enuresis at coughing, sneezing), intestine (constipation), optic nerve (decreasing vision), vocal cords (hoarseness < a.m.); weakness along with stiffness and contracted tendons; burning pains > dampness • Cocculus indicus: very weak; paresis of the extremities and cervical muscles; difficult to stand erect, to keep the head straight; numbness of extremities; shakiness; painful articular stiffness; late perception of nervous impressions • Conium maculatum: "worn-out" people; great weakness; muscular weakness starting in the legs and progressively moves upward, along with shaking, numbness; pins and needles in the extremities • Gelsemium: slow, weak people; sensation first of heaviness and great weakness in limbs with shaking (< emotions); slow, progressive paralysis; all muscles are susceptible but esp. the muscles of eyelids, eye, tongue, vocal cords, respiratory muscles, urinary bladder, genitals, anus, uterus • Manganum: lack of oxidation; increasing paralytic weakness in legs then arms; progressive atrophy of muscles; walks stooping forward; peculiar slapping gait • Physostigma venenosum: great weakness; locomotor troubles with tendency to paralysis; muscles contract with difficulty; progressive muscular atrophy • Plumbum metallicum: progressive sclerosis; medullary lesions esp. of the anterior horns; motor bi- or unilateral paresis or paralysis of extremities; paralysis starts with extensors (e.g. wrist drop); progressive atrophy, coldness of extremities; sudden constrictive and paroxysmal pains < evening and night, light touch > pressure, friction • Thallium: weakness of legs, shakiness and muscular atrophy; intense and spasmodic neuralgic pains

Subtle Support
musculoskeletal: • Sousa's marches • The Anvil Chorus • William Tell Overture • Brahm's Hungarian Dances • By the Waters of the Minnetonka (Heline, p. 18)

Mind/Body
• Several autoimmune diseases, such as myasthenia gravis, are the result of an immunopharmacological block of receptor sites. (Locke, 1983, p. 160)

• Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Zhi (Will); expresses ambition and focus; produces the Marrow which generates the spinal cord, "fills up" the brain, and possibly manifests through the immune system; nourishes the brain to sustain concentration, clear thinking, and memory; facilitates inspiration by grasping and pulling down the Qi of the breath; carries the constitutional endowment from the parents; and displays the effects of sexual dissipation, overwork, chronic degenerative processes, and extreme stress. » Healthy expressions are gentleness, groundedness, and endurance. » Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); fearfulness; apathy; chronic fatigue; discouragement; scatteredness; lack of will; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch. As always, chronic Yin Xu (Deficiency) predisposes to Empty Heat and/or acute inflammation. » Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency). » Mental signs of Kidney channel disorders include anxiety, fear in the pit of the stomach; sadness; mental and physical fatigue; antisocial tendencies; and laziness. (Seem, p. 28)
 * Chinese psychophysiology:**

• Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores and cleanses the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); controls the muscles, ligaments, and tendons, especially the contractility of the muscles and moistening of the sinews; expresses itself in the nervous system; and reflects emotional harmony and movement. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Xu (Deficiency) signs include impotence; frigidity; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry eyes, skin, and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down. Liver Yin Xu (Deficiency) predisposes to the Shi (Excess) conditions of Liver Wind, Liver Yang Rising, and Liver Fire Blazing. » Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216) » Liver Wind derives from Liver Yin Xu (Deficiency) and/or Liver Xue Xu (Blood Deficiency) and their subsequent inability to embrace the Yang, and can manifest as joint stiffness, dizziness, tremor, paralysis, convulsions, rashes, itching, and neurological problems.

• Spleen ~ Pi governs digestion and manifests in the muscle tissues; transforms food into Qi and Xue (Blood); governs the Xue (Blood); and relates to the ability to assimilate, stabilize, and feel centered and balanced. » Healthy expressions are fairness, openness, deep thinking, and reminiscence. » Spleen Xu (Deficiency) signs include slightness (deficient "form"); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; pale lips; loose stools; and muscular weakness. Unresolved Spleen » The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen and may lead to Xue Yu (Blood Stasis). This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise and excess consumption of sweet and Cold foods will also deplete the Spleen.