A Case Study of MG
By Michael Tierra on Sunday, February 10, 2008 - 04:34 pm:
Woman age 18, single, chief complaint: weakness of the extremities and alternate ptosis (drooping eyelid) of both eyelids for five months, difficulty in swallowing for two weeks. History of present illness: five months prior to consultation she experienced weakness in all extremities and was unable to sustain or repeat muscular contractions. Soon afterwards alternate ptosis of the eyelids occurred with narrowing the the eyelids (palpabral). Less evident in the morning or after rest but aggravated at night or when tired. She reported occasional diplopia (double vision) and cold extremities. Tongue: tongue is pinkish with fur Pulse: deep and small Can you determine a possible Western medical diagnosis for this condition? TCM diagnosis: Treatment Principle: Treatment: If at all possible please suggest dietary, lifestyle and/or possible ayurvedic and western herbal approaches. Do your best with this one and I do hope more people get involved other than my 'stars' -- its an opportunity to learn.
By Anne Salazar-Dunbar on Sunday, February 10, 2008 - 07:30 pm:
Could this be Myasthenia Gravis? Diagnosis:Yang-deficiency in the spleen and kidneys Treatment:To warm and tonify the spleen and kidneys Herbs: eleuthro, gingko, st. John’s Wort, gotu kola, black cohosh, yellow dock, licorice,ginger Tea of red clover and skullcap Evening primrose oil or fish oil, foods high in potassium/magnesium (whole grains,leafy greens) Avoid night-shade plants (tomatoes, eggplants, white potatoes, green peppers, etc), Eat a diet that is nourishing to the spleen, kidney, and liver, especially with essence-tonifying foods (this would include various beans and seeds, meats, seafoods, and mildly astringent fruits). Avoid excessive amounts of sour, spicy, and salty foods. Ginger/cayenne compresses on cold, affected areas Mild exercise everyday for fresh air and for lung and muscle tone. Massage and shiatsu (increasing oxygen to nerves and muscles) Anne
By Katrina May on Monday, February 11, 2008 - 10:35 am:
I am thinking Myasthenia Gravis also for Western Diagnosis TCM Diagnosis: Internal Wind and Kidney Yang Def Treatment Strategy: calm internal wind & warm/tonify kidney,nourish liver Herbs: Big Pearl for internal wind and Rehmannia Eight for KYang DEf Eat diet of foods with warming energy Whole grains, legumes (make sure to soak before eating) Cooked Greens (Especially kale & mustsard with garlic and onion) Avoid all raw and cold food and drinks and stimulants such as caffeine, alcohol, and sugar
Yes, it is myasthenia Gravis. -- good work. Now you still have to work out a TCM diagnosis and treatment protocol. Do whatever you think, if all you know is a Western approach, submit that. Tell how you arrived at your decisions.
Michael Tierra on Tuesday, February 19, 2008 - 11:32 pm:
TCM diagnosis: Spleen-Kidney Yang deficiency Therapeutic Principles: Strengthen the Spleen and reinforce the Qi, replenish the Kidney and strengthen the yang. Prescription used: Bu Zhong yi Qi tang (Ginseng and Astragalus combination) used to tonify qi, subdue yin-fire and Fu Zi Li Zhong Decoction (Aconite and ginseng combination) Doses are as follows: codonopsis (alternate for ginseng) - 30 gms; astragalus - 30 gms; cimicifuga - 9 gms, white atractylodes 30 gms; bupleurum 9 gms; prepared aconite - 36 gms!! citrus reticulatae,- 9gms; dang gui - 12 gms; licorice 6 gms; lumbricus (earthworm) - 9 gms, ephedra 6 gms; puerariae 30 gms. All the herbs were boiled in an amount of water at least one hour, the dregs are removed and cooked again. It is strained and the two liquors are combined and everything cooked down to 250 ml of decoction. half this amount is taken twice daily. --------------------------------------------------------------------------------
Michael Tierra on Tuesday, February 19, 2008 - 11:42 pm:
Discussion: This is a case history from China. the doctor reported 73 cases of myasthenia gravis treated combining western and traditional medicine. Note the unusually high doses of prepared aconite and astragalus. High doses of these herbs are indicated as the chief prescription for restoring the Spleen, nourishing the Kidney and enhancing Yang. It is of utmost important that even prepared aconite be boiled for at least an hour to neutralize any residual toxicity -- even though in the prepared form it is considered safe.
The author reported that of 67 cases treated with herbal medication, 15 (22.39%) were cured, 27 cases (40-30%) were significantly improved and 20 cases (29.85%) improved, 4 cases were unresponsive and one died due to another disease that occurred during treatment period. Of the 15 cases followed up from 2 to 4 years later, 14 remain in complete remission without any relapse, one died from myasthenic crisis.
By the 4th consultation the patient had taken 24 doses since the first consultation. Weakness of the extremities were significantly relieved. Degree of ptosis was lessened but still occurred alternately with occasional diplopia. A mild warm sensation was felt after taking the prescription. Some of her meds were reduced. occasional loss of appetite. Tongue and pulse condition remained the same. The original prescription was modified by increasing the dosage of both prepared aconite and astragalus to 60 gms. Administration was the same. The 8th consultation the patient had taken the prescription successively for 2 months since the 4th visit. There was significant alleviation of symptoms. The meds (Neostigmine bromide) was discontinued. Swallowing seemed normal, though the was still weakness of the extremities and ptosis. Eyeball movement was normal. The prescription was modified by decreasing the dose of prepared aconite to 36 gms and astragalus to 45 gms. Only two doses per week. By the 15th consultation there was a mild degree of weakness of the extremities when the patient was tired. Tongue and pulse did not change throughout the treatment period. The course of treatment began in 1978 through 1987. During that period she gave birth to a baby girl. In 1987 the patient had put on weight and upon medical examination she had no symptoms of myasthenia gravis.
Michael Tierra on Tuesday, February 19, 2008 - 11:55 pm:
About prepared aconite (Fu Zi) Pharmacological research of the boiled extract of prepared aconite indicates that it has an anti-curare effect in rabbits. Curare is used in Western medicine but in the jungles it is a deadly poison that kills by paralyzing the nerves. Aconite was administered as a load swimming test in mice and the results showed the antifatigue properties of the herb. Subsequent studies have found that prepared aconite enhances both the voluntary and involuntary muscles. clinically, there were no toxicity or side effects even when large doses were applied. Its believed that the effective element of aconite is not the toxic aconitine but other low-toxicity elements. There have been occasional allergic reactions to it. Poisoning from aconite occurs when the prepared aconite is improperly prepared or when it is not boiled long enough. IN ALL CASES EVEN PREPARED ACONITE SHOULD BE BOILED FOR AT LEAST ONE HOUR. Regarding a lengthy discussion about the uses and toxicity of aconite I would refer you to the following: http://www.henriettesherbal.com/archives/best/1995/aconite.html
By Michael Tierra on Wednesday, February 20, 2008 - 12:25 am:
Further considerations regarding this case. First I want to congratulate Anne Salazar for getting the TCM diagnosis correctly. I appreciate all of you for participating in this case. It the way to learn. It is unusual for lots of reasons. First of all myasthenia gravis is considered an incurable illness in Western medicine. It is described as "Myasthenia gravis is a neuromuscular disorder characterized by variable weakness of voluntary muscles, which often improves with rest and worsens with activity. The condition is caused by an abnormal immune response." read http://www.healthline.com/adamcontent/myasthenia-gravis?utm_medium=ask&utm_sourc e=smart&utm_campaign=article&utm_term=Myasthenia+Gravis&ask_return=Myasthenia+gr avisI don't consider that you may ever have the opportunity to treat this condition and I have seldom treated it clinically. You should refer any patient to proper medical care. Notice that it is a combined western medicine and herbal treatment. The extraordinarily high doses of herbs that are used. The high dose of prepared aconite which you will seldom see advocated in any school. My experience with teachers that use it is to warn a lot about the use of it, telling the standard dose which usually doesn't exceed 9 grams and then start telling the remarkable cures they have had with high doses. I find homeopathic aconite very powerful for quickly mobilizing the immune system. I use 3 to 30X potency taken as often as every 15 minutes under the tongue to ward off an impending cold or flu. Homeopathic aconite is very safe. However, in this treatment it would not have worked. Imagine all those herbs cooked down to 250 ml which is a half a pint. This is divided in two doses and taken daily. That's a huge amount of herb -- such high doses are needed for serious diseases. It requires time to prepare as you can see as well. It gives you an idea of how high a dose might be needed to treat serious diseases. It also must be decocted in water as the amounts go far beyond either a dried extract of alcoholic extract. Then the length of time for treatment to achieve noticeable results. The patient was first seen in mid february of 1978 the 4th visit when the first prescription change occurred was in mid march -- the 8th consultation was the beginning of august and the 15th consultation was on July 5, 1978. Notice also that the tongue and pulse never changed. This points out the limitations of depending on only one or two diagnostic parameters to measure progress. Patient's report and symptoms evaluation is always the best barometer of progress. Finally, notice how simply the two primary formulas used were. Lumbricus (earthworm), pueraria and ephedra were added to the formula. Lumbricus is a very important substance used for channel blockage conditions including arthritis and rheumatic conditions. It also stops spasms and convulsions. It can be used for both hot or cold painful obstructions. I would recommend purchasing this in dried extract and having patients take in in capsule form. Ephedra is often combined with prepared aconite for wind-cold obstruction which is a component of this condition. It should also be cooked a long time with the foam skimmed off. Pueraria (Ge Gen) -- I do recommend your learning both the latin and Chinese names for the herbs as someday you may find yourself in a Chinese medicine class and they only use the Chinese names. I recommend that they also learn the Latin binomials because many herbs are substituted for the Chinese. Pueraria releases the muscles and clears heat. So there was much to learn from this case.
Some more information from another site:
Wellness.com
INTEGRATIVE THERAPIES
Traditional or theoretical uses lacking sufficient evidence :
Astragalus: In traditional Chinese medicine (TCM), astragalus is commonly found in mixtures with other herbs. In the 1980s, astragalus became highly popular in the United States as an immune system stimulant, and it is one of the most widely purchased herbal remedies today. Although it has been suggested that astragalus may help treat myasthenia gravis, scientific evidence is lacking in this area.
Avoid if allergic to Astragalus membranceous or other members of the Fabaceae family. Use cautiously with weakened immune systems, autoimmune disorders, or if taking immunosuppressants, as astragalus may decrease the effectiveness of immunosuppressants. Use cautiously if taking antivirals. Use cautiously with diabetes or if taking agents that affect blood sugar levels. Use cautiously with high blood pressure or it taking blood pressure-lowering agents. Use cautiously if taking anticoagulants. Use cautiously with kidney or lipid disorders. Avoid if pregnant or breastfeeding due to a lack of safety evidence.
Ephedra: Ephedrine, a constituent of ephedra, has been suggested as a possible treatment for myasthenia gravis. However, because there is a lack of scientific evidence supporting its use, recommendations cannot be made at this time.
Even though ephedra has been suggested as a possible treatment for myasthenia gravis, it is unsafe for humans. Serious reactions, including heart attack, stroke, seizure, and death, have occurred. The U.S. Food and Drug Administration (FDA) banned sales of ephedra dietary supplements in all states except for Utah. Patients should not take ephedrine-containing agents unless recommended by their doctors.
Hypnotherapy, hypnosis: Hypnosis is a trance-like state in which a person becomes more aware and focused and is more open to suggestion. Hypnotherapy has been used to treat health conditions and to change behaviors. It has been suggested, but not scientifically proven, that hypnotherapy may help treat symptoms of myasthenia gravis. Studies are needed to determine if (and how) hypnotherapy can be a useful treatment for these patients.
Use cautiously with mental illnesses (e.g., psychosis/schizophrenia, manic depression, multiple personality disorder, or dissociative disorders) or seizure disorders.
Nux vomica: Nux vomica is the dried, ripe seed of Strychnos nux-vomica, L., a native tree of Burma, China, eastern India, Thailand, and northern Australia. Traditional Asian medicine includes nux vomica as a remedy. Although it has been suggested that nux vomica may help treat symptoms of myasthenia gravis, studies are currently lacking. Until research is performed in humans, it remains unknown if nux vomica is indeed beneficial for this condition.
Avoid if allergic to Strychnos nux-vomica or other members of the Loganiaceae family. Use cautiously as a traditional Asian remedy due to potential toxicity from strychnine in nux vomica. There are reports of poisonous outcomes with traditional use of the seeds or fruit of Strychnos nux-vomica, L. Use cautiously with seizure disorders. Avoid oral doses of nux vomica seeds because the seeds may contain toxic amounts of strychnine. Avoid if pregnant or breastfeeding.
Reishi mushroom: Reishi mushroom (Ganoderma lucidum), also known as ling zhi in China, grows on decaying logs and tree stumps. Reishi occurs in six different colors, but the red variety is most commonly used and commercially cultivated in East Asia and North America. It has been suggested, but not scientifically proven, that reishi mushroom may help treat myasthenia gravis.
Avoid if allergic to reishi mushroom, any of its constituents, or any other member of its family. Use cautiously with diabetes or if taking blood sugar-lowering agents. Avoid with hemophilia. Use cautiously with bleeding disorders or if taking anticoagulants. Use cautiously with hypotension or if taking blood pressure-lowering agents. Use cautiously with gastrointestinal bleeding. Avoid if pregnant or breastfeeding due to a lack of safety evidence.
Woman age 18, single, chief complaint: weakness of the extremities and alternate ptosis (drooping eyelid) of both eyelids for five months, difficulty in swallowing for two weeks. History of present illness: five months prior to consultation she experienced weakness in all extremities and was unable to sustain or repeat muscular contractions. Soon afterwards alternate ptosis of the eyelids occurred with narrowing the the eyelids (palpabral). Less evident in the morning or after rest but aggravated at night or when tired. She reported occasional diplopia (double vision) and cold extremities. Tongue: tongue is pinkish with fur Pulse: deep and small Can you determine a possible Western medical diagnosis for this condition? TCM diagnosis: Treatment Principle: Treatment: If at all possible please suggest dietary, lifestyle and/or possible ayurvedic and western herbal approaches. Do your best with this one and I do hope more people get involved other than my 'stars' -- its an opportunity to learn.
By Anne Salazar-Dunbar on Sunday, February 10, 2008 - 07:30 pm:
Could this be Myasthenia Gravis? Diagnosis:Yang-deficiency in the spleen and kidneys Treatment:To warm and tonify the spleen and kidneys Herbs: eleuthro, gingko, st. John’s Wort, gotu kola, black cohosh, yellow dock, licorice,ginger Tea of red clover and skullcap Evening primrose oil or fish oil, foods high in potassium/magnesium (whole grains,leafy greens) Avoid night-shade plants (tomatoes, eggplants, white potatoes, green peppers, etc), Eat a diet that is nourishing to the spleen, kidney, and liver, especially with essence-tonifying foods (this would include various beans and seeds, meats, seafoods, and mildly astringent fruits). Avoid excessive amounts of sour, spicy, and salty foods. Ginger/cayenne compresses on cold, affected areas Mild exercise everyday for fresh air and for lung and muscle tone. Massage and shiatsu (increasing oxygen to nerves and muscles) Anne
By Katrina May on Monday, February 11, 2008 - 10:35 am:
I am thinking Myasthenia Gravis also for Western Diagnosis TCM Diagnosis: Internal Wind and Kidney Yang Def Treatment Strategy: calm internal wind & warm/tonify kidney,nourish liver Herbs: Big Pearl for internal wind and Rehmannia Eight for KYang DEf Eat diet of foods with warming energy Whole grains, legumes (make sure to soak before eating) Cooked Greens (Especially kale & mustsard with garlic and onion) Avoid all raw and cold food and drinks and stimulants such as caffeine, alcohol, and sugar
Yes, it is myasthenia Gravis. -- good work. Now you still have to work out a TCM diagnosis and treatment protocol. Do whatever you think, if all you know is a Western approach, submit that. Tell how you arrived at your decisions.
Michael Tierra on Tuesday, February 19, 2008 - 11:32 pm:
TCM diagnosis: Spleen-Kidney Yang deficiency Therapeutic Principles: Strengthen the Spleen and reinforce the Qi, replenish the Kidney and strengthen the yang. Prescription used: Bu Zhong yi Qi tang (Ginseng and Astragalus combination) used to tonify qi, subdue yin-fire and Fu Zi Li Zhong Decoction (Aconite and ginseng combination) Doses are as follows: codonopsis (alternate for ginseng) - 30 gms; astragalus - 30 gms; cimicifuga - 9 gms, white atractylodes 30 gms; bupleurum 9 gms; prepared aconite - 36 gms!! citrus reticulatae,- 9gms; dang gui - 12 gms; licorice 6 gms; lumbricus (earthworm) - 9 gms, ephedra 6 gms; puerariae 30 gms. All the herbs were boiled in an amount of water at least one hour, the dregs are removed and cooked again. It is strained and the two liquors are combined and everything cooked down to 250 ml of decoction. half this amount is taken twice daily. --------------------------------------------------------------------------------
Michael Tierra on Tuesday, February 19, 2008 - 11:42 pm:
Discussion: This is a case history from China. the doctor reported 73 cases of myasthenia gravis treated combining western and traditional medicine. Note the unusually high doses of prepared aconite and astragalus. High doses of these herbs are indicated as the chief prescription for restoring the Spleen, nourishing the Kidney and enhancing Yang. It is of utmost important that even prepared aconite be boiled for at least an hour to neutralize any residual toxicity -- even though in the prepared form it is considered safe.
The author reported that of 67 cases treated with herbal medication, 15 (22.39%) were cured, 27 cases (40-30%) were significantly improved and 20 cases (29.85%) improved, 4 cases were unresponsive and one died due to another disease that occurred during treatment period. Of the 15 cases followed up from 2 to 4 years later, 14 remain in complete remission without any relapse, one died from myasthenic crisis.
By the 4th consultation the patient had taken 24 doses since the first consultation. Weakness of the extremities were significantly relieved. Degree of ptosis was lessened but still occurred alternately with occasional diplopia. A mild warm sensation was felt after taking the prescription. Some of her meds were reduced. occasional loss of appetite. Tongue and pulse condition remained the same. The original prescription was modified by increasing the dosage of both prepared aconite and astragalus to 60 gms. Administration was the same. The 8th consultation the patient had taken the prescription successively for 2 months since the 4th visit. There was significant alleviation of symptoms. The meds (Neostigmine bromide) was discontinued. Swallowing seemed normal, though the was still weakness of the extremities and ptosis. Eyeball movement was normal. The prescription was modified by decreasing the dose of prepared aconite to 36 gms and astragalus to 45 gms. Only two doses per week. By the 15th consultation there was a mild degree of weakness of the extremities when the patient was tired. Tongue and pulse did not change throughout the treatment period. The course of treatment began in 1978 through 1987. During that period she gave birth to a baby girl. In 1987 the patient had put on weight and upon medical examination she had no symptoms of myasthenia gravis.
Michael Tierra on Tuesday, February 19, 2008 - 11:55 pm:
About prepared aconite (Fu Zi) Pharmacological research of the boiled extract of prepared aconite indicates that it has an anti-curare effect in rabbits. Curare is used in Western medicine but in the jungles it is a deadly poison that kills by paralyzing the nerves. Aconite was administered as a load swimming test in mice and the results showed the antifatigue properties of the herb. Subsequent studies have found that prepared aconite enhances both the voluntary and involuntary muscles. clinically, there were no toxicity or side effects even when large doses were applied. Its believed that the effective element of aconite is not the toxic aconitine but other low-toxicity elements. There have been occasional allergic reactions to it. Poisoning from aconite occurs when the prepared aconite is improperly prepared or when it is not boiled long enough. IN ALL CASES EVEN PREPARED ACONITE SHOULD BE BOILED FOR AT LEAST ONE HOUR. Regarding a lengthy discussion about the uses and toxicity of aconite I would refer you to the following: http://www.henriettesherbal.com/archives/best/1995/aconite.html
By Michael Tierra on Wednesday, February 20, 2008 - 12:25 am:
Further considerations regarding this case. First I want to congratulate Anne Salazar for getting the TCM diagnosis correctly. I appreciate all of you for participating in this case. It the way to learn. It is unusual for lots of reasons. First of all myasthenia gravis is considered an incurable illness in Western medicine. It is described as "Myasthenia gravis is a neuromuscular disorder characterized by variable weakness of voluntary muscles, which often improves with rest and worsens with activity. The condition is caused by an abnormal immune response." read http://www.healthline.com/adamcontent/myasthenia-gravis?utm_medium=ask&utm_sourc e=smart&utm_campaign=article&utm_term=Myasthenia+Gravis&ask_return=Myasthenia+gr avisI don't consider that you may ever have the opportunity to treat this condition and I have seldom treated it clinically. You should refer any patient to proper medical care. Notice that it is a combined western medicine and herbal treatment. The extraordinarily high doses of herbs that are used. The high dose of prepared aconite which you will seldom see advocated in any school. My experience with teachers that use it is to warn a lot about the use of it, telling the standard dose which usually doesn't exceed 9 grams and then start telling the remarkable cures they have had with high doses. I find homeopathic aconite very powerful for quickly mobilizing the immune system. I use 3 to 30X potency taken as often as every 15 minutes under the tongue to ward off an impending cold or flu. Homeopathic aconite is very safe. However, in this treatment it would not have worked. Imagine all those herbs cooked down to 250 ml which is a half a pint. This is divided in two doses and taken daily. That's a huge amount of herb -- such high doses are needed for serious diseases. It requires time to prepare as you can see as well. It gives you an idea of how high a dose might be needed to treat serious diseases. It also must be decocted in water as the amounts go far beyond either a dried extract of alcoholic extract. Then the length of time for treatment to achieve noticeable results. The patient was first seen in mid february of 1978 the 4th visit when the first prescription change occurred was in mid march -- the 8th consultation was the beginning of august and the 15th consultation was on July 5, 1978. Notice also that the tongue and pulse never changed. This points out the limitations of depending on only one or two diagnostic parameters to measure progress. Patient's report and symptoms evaluation is always the best barometer of progress. Finally, notice how simply the two primary formulas used were. Lumbricus (earthworm), pueraria and ephedra were added to the formula. Lumbricus is a very important substance used for channel blockage conditions including arthritis and rheumatic conditions. It also stops spasms and convulsions. It can be used for both hot or cold painful obstructions. I would recommend purchasing this in dried extract and having patients take in in capsule form. Ephedra is often combined with prepared aconite for wind-cold obstruction which is a component of this condition. It should also be cooked a long time with the foam skimmed off. Pueraria (Ge Gen) -- I do recommend your learning both the latin and Chinese names for the herbs as someday you may find yourself in a Chinese medicine class and they only use the Chinese names. I recommend that they also learn the Latin binomials because many herbs are substituted for the Chinese. Pueraria releases the muscles and clears heat. So there was much to learn from this case.
Some more information from another site:
Wellness.com
INTEGRATIVE THERAPIES
Traditional or theoretical uses lacking sufficient evidence :
Astragalus: In traditional Chinese medicine (TCM), astragalus is commonly found in mixtures with other herbs. In the 1980s, astragalus became highly popular in the United States as an immune system stimulant, and it is one of the most widely purchased herbal remedies today. Although it has been suggested that astragalus may help treat myasthenia gravis, scientific evidence is lacking in this area.
Avoid if allergic to Astragalus membranceous or other members of the Fabaceae family. Use cautiously with weakened immune systems, autoimmune disorders, or if taking immunosuppressants, as astragalus may decrease the effectiveness of immunosuppressants. Use cautiously if taking antivirals. Use cautiously with diabetes or if taking agents that affect blood sugar levels. Use cautiously with high blood pressure or it taking blood pressure-lowering agents. Use cautiously if taking anticoagulants. Use cautiously with kidney or lipid disorders. Avoid if pregnant or breastfeeding due to a lack of safety evidence.
Ephedra: Ephedrine, a constituent of ephedra, has been suggested as a possible treatment for myasthenia gravis. However, because there is a lack of scientific evidence supporting its use, recommendations cannot be made at this time.
Even though ephedra has been suggested as a possible treatment for myasthenia gravis, it is unsafe for humans. Serious reactions, including heart attack, stroke, seizure, and death, have occurred. The U.S. Food and Drug Administration (FDA) banned sales of ephedra dietary supplements in all states except for Utah. Patients should not take ephedrine-containing agents unless recommended by their doctors.
Hypnotherapy, hypnosis: Hypnosis is a trance-like state in which a person becomes more aware and focused and is more open to suggestion. Hypnotherapy has been used to treat health conditions and to change behaviors. It has been suggested, but not scientifically proven, that hypnotherapy may help treat symptoms of myasthenia gravis. Studies are needed to determine if (and how) hypnotherapy can be a useful treatment for these patients.
Use cautiously with mental illnesses (e.g., psychosis/schizophrenia, manic depression, multiple personality disorder, or dissociative disorders) or seizure disorders.
Nux vomica: Nux vomica is the dried, ripe seed of Strychnos nux-vomica, L., a native tree of Burma, China, eastern India, Thailand, and northern Australia. Traditional Asian medicine includes nux vomica as a remedy. Although it has been suggested that nux vomica may help treat symptoms of myasthenia gravis, studies are currently lacking. Until research is performed in humans, it remains unknown if nux vomica is indeed beneficial for this condition.
Avoid if allergic to Strychnos nux-vomica or other members of the Loganiaceae family. Use cautiously as a traditional Asian remedy due to potential toxicity from strychnine in nux vomica. There are reports of poisonous outcomes with traditional use of the seeds or fruit of Strychnos nux-vomica, L. Use cautiously with seizure disorders. Avoid oral doses of nux vomica seeds because the seeds may contain toxic amounts of strychnine. Avoid if pregnant or breastfeeding.
Reishi mushroom: Reishi mushroom (Ganoderma lucidum), also known as ling zhi in China, grows on decaying logs and tree stumps. Reishi occurs in six different colors, but the red variety is most commonly used and commercially cultivated in East Asia and North America. It has been suggested, but not scientifically proven, that reishi mushroom may help treat myasthenia gravis.
Avoid if allergic to reishi mushroom, any of its constituents, or any other member of its family. Use cautiously with diabetes or if taking blood sugar-lowering agents. Avoid with hemophilia. Use cautiously with bleeding disorders or if taking anticoagulants. Use cautiously with hypotension or if taking blood pressure-lowering agents. Use cautiously with gastrointestinal bleeding. Avoid if pregnant or breastfeeding due to a lack of safety evidence.
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