Myasthenia gravis is a chronic autoimmune disease with dysfunctional transmission at the nerve and muscle junction, mainly characterized by fatigue of the affected skeletal muscles, which can be partially recovered after rest and anticholinesterase drugs. The disease can be clinically classified into simple ophthalmic, myelomeningocele, spinal cord, generalized and myasthenia gravis types. The symptoms of the disease are complex, and the clinical course can be both acute and chronic with repeated fluctuations. Modern Chinese medicine classifies this disease as “lid wasting”, “visual disorder” and “impotence”. According to traditional Chinese medicine, the basic etiology of this disease is internal injury and deficiency, which may be aggravated by overwork, internal injury, menstruation, childbirth, or trauma. In terms of the location of the disease, it is mainly attributed to the spleen and kidneys, with emphasis on the spleen, either due to deficiency of the spleen and middle energy, or deficiency of the kidney energy, or both. Du Xiubo, Department of Pediatrics, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
1 Insufficient consolidation of the external guard
This symptom is seen as droopy eyelids. The “Spiritual Pivot: A Treatise on Confusion” states: “The essence of the five viscera and six bowels is injected into the eyes as essence”, “The areoles of essence are the eyes, the areoles of bone are the pupils, the areoles of tendons are the black eyes, the essence of blood is the lobe, the areoles of qi are the white eyes, and the essence of muscle is the restraint…”. … “Later medical practitioners developed the doctrine of the “five chakras”, which points out the intrinsic connection between the eyes and the internal organs, of which the “flesh chakra” – -The “Source of Diseases” states that “the eye is the essence of the blood of the viscera, outside the liver, but the blood of the five viscera and six internal organs are all glorified in the eye, if the blood is deficient, then the coup is open, and the outer guard is not solid and affected by the wind, the wind is between the skin of the lids, so the skin is slow and vertical, hanging back on the eye, it can not open. The skin is slow and long, and the eyes can’t be opened.” The most common symptom of myasthenia gravis is drooping eyelids, which is similar to the “lid wasting” in “The Great Formation of the Eye Classic” and the “Sucking Eye” and “Invasion of Wind” in “The Treatise on the Origin of Diseases”. Therefore, modern Chinese medicine classifies myasthenia gravis as “lid wasting”. The clinical treatment can be done with Yi Qi Smart Tang and Yu Ping Feng San.
2 Liver and kidney essence deficiency
The symptoms are diplopia and loss of vision. According to Chinese medicine, the pupil is the water wheel, which is dominated by the kidney, and the liver opens the orifice of the eyes. In the Nei Jing, it is said that “when the essence is lost, the vision is divergent, and when the vision is divergent, two things are seen”. The “Taiping Sheng Hui Fang” also pointed out that “Yang Qi loss is the eyes closed, Yin Qi is extinct, the eyes blind,” the symptoms of myasthenia gravis in diplopia, vision loss can be included in the category of Chinese medicine, diplopia and blurred vision and the loss of liver and kidney essence and blood have a direct causal relationship. The clinical treatment can be done by adding and subtracting Qiju Dihuang Tang.
3 Spleen deficiency, dampness and stagnation
The symptoms include weakness of the limbs, difficulty in swallowing, soft neck and head tilting, which is worse after exertion, and shortage of breath, low voice, dullness, loose stools, yellowish face and weak pulse.
The symptoms include shortness of breath, low voice, sluggishness, loose stools, yellowing of the face, and weak pulse. This belongs to the category of “impotence” in Chinese medicine.
(1) External dampness The dampness invades the body and stagnates in the internal organs and meridians, most easily suppressing the qi flow, causing irregularities in the elevation of the qi flow and obstruction of the meridians. Dampness is heavy and sticky, so it is difficult to heal. Treatment should be Huopu Xia Ling Tang, San Ren Tang, etc.
(2) Phlegm and dampness trapping the spleen “all diseases are caused by phlegm”, external sensation of six mirths or diet, seven internal injuries, so that the lungs, spleen, kidneys and three jiao gasification
The phlegm and dampness in the internal organs can affect the malfunction of the qi flow, and if the phlegm and dampness trap the spleen, the spleen yang is not invigorated and the spleen qi is insufficient. The spleen is the master of clearing, spleen deficiency is qi trapped, lifting incompetent, so the neck is soft and head tilted. If the spleen is deficient, the stomach is weak, and if the stomach is weak, there is no right to receive and swallowing difficulties. “The patient with phlegm drink should be treated with warm medicine and “can be treated with the addition and subtraction of Radix Rizhong Tang and Ling Gui Zhu Gan Tang.
4 Qi subsidence
The evidence of shortness of breath, dyspnea, human respiration, the lungs are the division, all rely on the zong qi, Zhang Xichen called “atmosphere”, and that “the atmosphere, full of chest, to the division of the lungs breathing qi. …… Originally to the yuan qi as the basis, to the water and grain of the gas nourishment, to the chest for the residence of the cave also, all are gas, to the chest of the gas alone for the atmosphere, sincere to its ability to support the whole body for the program of the gas, outside the lungs, the pivot of breathing.” And pointed out that: “the atmosphere in the chest is trapped, short of breath is not enough to rest, or efforts to breathe, there seems to be wheezing, or breath will be exhausted in a moment of danger.” Zhang Jinyue thinks: “deficiency and more phlegm …… this water floods for phlegm, spleen deficiency can not control water.” The spleen is the source of phlegm, the lungs are the storage of phlegm, spleen deficiency is the production of phlegm, lung deficiency is the right to open phlegm, will certainly lead to phlegm and saliva congestion, breath is not smooth, until death by suffocation. Clinical use can be added and subtracted by Sheng shen tang and tonifying zhong yi qi tang.
5 Spleen and kidney Yang deficiency
Symptoms of myasthenia gravis are accompanied by white complexion, cold fear and cold extremities, pale fat tongue, white smooth coating and sunken pulse. The Sixteen Difficulties of the Spleen Classic says: “Laziness, restlessness, and lack of collection of the limbs are also spleen diseases. The main cause of this disease is weakness of the spleen and stomach. The spleen and stomach transport water and grain, the source of biochemical energy and blood, to moisten the organs and limbs, the spleen in the body for the flesh, open the mouth, eyelids in the meat wheel also belongs to the spleen. Myasthenia gravis is characterized by muscle disease and weakness, which coincides with the physiological scope of the spleen. The spleen yang deficiency often leads to the spleen yang deficiency, the spleen yang deficiency can not be warmed externally four end, in the Yang is not invigorated, the main transport and transformation, distribution of essence, transformation of water and dampness, depends on the warmth of the vital gate, the kidney is the essence of the latter, warming the internal organs tissue, gasification and water and liquid, must rely on the spleen essence supply, so any deficiency of the yang of the organs, can lead to the spleen and kidney yang deficiency. Treatment should be based on the Kidney Qi Pill as the main formula.
6 Deficiency of both Qi and Yin
This may manifest as various symptoms of myasthenia gravis, but with red tongue, little coating and fine pulse. The spleen is located in the middle jiao, which transports water and grain essence and produces middle qi, and the spleen is healthy by ascending. If the spleen is not healthy, there is a lack of qi and the yang does not rise, so the eyelids droop, the muscles are not solid, the lifting is weak, the voice is low, and the speech is lazy. If the spleen is deficient, it cannot transport fluid, and if fluid is deficient, the tongue is red and less coated; if the spleen is deficient, the stomach is also deficient; if the spleen is deficient in qi and yin, it cannot transport and transform properly; if the spleen is deficient in qi and yang, the limbs are tired and weak; if the lung is deficient in qi, it is not solid outside the body, the couples are loose and susceptible to sensation, and external sensation is an important factor in the initiation and aggravation of myasthenia gravis. It can be treated clinically with Zuo Gui Wan plus or minus.
7 Blood stasis blocking the ligaments
The symptoms include weakness of the limbs, bruising of the limbs and skin, purple tongue with petechiae, and thin and astringent pulse or junction. This symptom is seen in myasthenia gravis
This disease has a long duration, and there are many stasis symptoms. If the blood stasis blocks the veins and ligaments, the limbs and muscles lose their moistening, so we see weakness of the limbs and blue skin. The treatment should be Yang Yang Returning Five Soup plus or minus.
8 Loss of Yin and Yang
The manifestations are dyspnea, open mouth and shoulders, shortness of breath, inability to lie down, cold feet and head sweating, sweating like pearls of oil, red face and agitation, loose stools with direct vision, and a large, rapid and rootless pulse. Any type of myasthenia gravis can develop to this stage. This type of patient is due to the deficiency of liver and kidney yin too fast, damage to the kidney yang, the kidney yin and yang deficiency in the kidney, resulting in the kidney does not accept qi, qi does not return to the original and float on the top, then there is difficulty in breathing and other critical signs. If the disease develops further, the deficiency of yin and yang in the kidney will lead to the extinction of yin and yang, which will not only lead to difficulty in breathing, but also to dripping sweat, cold hands and feet, thirst and irritability, weak pulse and other critical symptoms. In this case, we should use Sheng Wei Wei Tang and Ginseng and Radix Soup.
In addition, internal injuries, external injuries can lead to the onset of the disease, “Suwen – Yin and Yang should be the elephant in the room” said “people have five organs into five qi, to produce happiness, anger, sadness and fear, so happiness and anger hurt the qi, the cold department hurt the shape; violent anger hurts the liver, violent happiness hurts the yang”. Anger hurts the liver, happiness hurts the heart, thinking hurts the spleen, worry hurts the lungs, and fear hurts the kidneys. The seven internal injuries can injure the five internal organs and the six internal organs, which can develop into the above pathologies over time. Trauma can also trigger myasthenia gravis.