The reason for writing this article is also due to an inquiry from a patient, so I have gathered some information and put the results here. Myasthenia gravis is an autoimmune disease and the vast majority (over 90%) is associated with abnormal changes in the thymus gland. Antibodies are produced against neuromuscular transmission, which causes muscle weakness. The mechanism of tacrolimus in the treatment of myasthenia gravis lies in the inhibition of T cells, action on lanosterone receptors to enhance muscle strength, and action on glucocorticoid receptors, while acting as a treatment for myasthenia gravis, of which the first mechanism is the most important. Multiple studies have confirmed that tacrolimus has fewer side effects than prednisone, azathioprine, and cyclosporine, which were previously commonly applied. Regarding efficiency, for patients with more severe disease (most dependent on prednisone or cyclosporine), the vast majority (80-90% or more) of the studies were effective, with symptom improvement, and a small proportion of these could be tapered and discontinued. Most patients need to rely on medications to maintain symptom relief. Regarding the time of onset of action, it is generally considered to be effective within 1-2 months, with some patients having significant effects in 7-10 days, which is faster than azathioprine and cyclosporine. With regard to the duration of dosing, since after thymectomy, patients will have relatively good remission of symptoms for 3-5 years, after which there may also be milder exacerbations of symptoms, but overall it is also closely related to individual conditions. buckingham et al. reported that removal of the thymus early in the course of the disease (within 1 or 2 years) may eventually lead to complete remission in one-third of patients; about half may lead to improvement. Therefore, if symptoms gradually decrease over several years after surgery, you can try to taper tacrolimus to see if it can be discontinued, and some patients can stop using it. Many patients abroad have reported using it for 5 or 6 years with fewer significant side effects, but attention should still be paid to monitoring blood work, liver and kidney function, and the presence of secondary tumors, etc. Since the drug has been widely used in myasthenia gravis worldwide only in the last 5-10 years, follow-up data for too long is still scarce. As to the question of whether Chinese medicine can be taken at the same time, it is usually considered that Chinese medicine has a more moderate effect and can usually be taken at the same time, but it is better to check with the TCM physician when prescribing Chinese medicine and report the current medication taken, so that the TCM physician can assess whether the medication used therefore conflicts with the current immunosuppressant.