Research in the Treatment of Myasthenia Gravis with Traditional Chinese Medicine: A Review

Myasthenia Gravis and Conventional Treatments

Myasthenia gravis (MG) is an autoimmune neuromuscular disease caused by circulating autoantibodies that impair neuromuscular transmission by blocking or destroying nicotinic acetylcholine receptors at the neuromuscular junction (NMJ). Common symptoms include weakness and easy fatigability of ocular, bulbar, respiratory muscles and limb skeletal muscles.

The incidence of MG is approximately 15 cases per million people per year. Women tend to be affected more than men in a 2:1 ratio. Symptom onset is often between 20 to 40 years of age (Mendell et al., 2017). Conventional treatments include immunosuppressants, acetylcholinesterase inhibitors and thymectomy surgery. However, long-term drug use often leads to systemic toxicity and recurrence. The pathogenesis and optimal treatment regimen of MG remain elusive. Thus, effective and safer adjuvant therapies are urgently needed.

In recent years, studies have shown that traditional Chinese medicine (TCM) holds promise for MG management through its multi-target holistic approach. This review summarizes the advancements in applying four main TCM modalities - herbal medicine, acupuncture, tuina and dietary therapy - based on syndrome differentiation and individualized treatment principles.

Herbal Medicine for MG Treatment

Herbal formulae catering to different TCM diagnostic patterns have been commonly prescribed for MG. For instance, Sijunzi decoction aims to invigorate Qi and nourish Yin based on a spleen-kidney Yang deficiency pattern (Yang et al., 2017). Tongqiaohuoxuening synergizes blood circulation enhancement with dampness dissipation for MG with phlegm-dampness stasis (Wu et al., 2015). Randomized controlled trials (RCTs) of standardized herbal extracts have demonstrated efficacy.

Kushen injection has shown positive effects on improving MG quantitative myasthenia gravis score (QMGS) and activities of daily living (ADL) in both short and long-term treatment (Xu et al., 2018). An RCT found Siler extract could enhance acetylcholinesterase activity and muscle strength, with lower recurrence than conventional drugs (Li et al., 2021). A systematic review revealed Borneol combined with immunosuppressants achieved better outcomes than immunosuppressants alone in ADL, muscle strength and incidence of adverse reactions (Li et al., 2017).

Other herbs including Astragalus membranaceus, Glossy privet fruit (Ligustrum lucidum Ait.) and Notoginseng also demonstrated potential either alone or as formula components based on their anti-inflammatory and immunity-regulating properties (Wang et al., 2016; Zhao et al., 2018). These studies validate the multi-target effect of herbs in modulating MG pathogenesis from TCM perspectives.

Acupuncture Treatment for MG

Acupuncture regulates meridian-collateral circulation by stimulating specific acupoints. It has benefits including activating neuroendocrine-immune pathways, improving circulation and producing analgesic and anti-inflammatory responses (Zhao et al., 2018). A meta-analysis of 8 RCTs compared acupuncture added to routine Western medicine versus routine treatment alone in MG. Significant differences were found in favor of acupuncture for muscle strength, fatigue score, ADL and life quality (Pan et al., 2019).

Some RCTs directly compared acupuncture and anticholinesterase drugs. Electroacupuncture at Jiaoxin (KI8) and Zusanli (ST36) shown comparable outcomes to pyridostigmine in improving muscle force, while acupuncture lowered adverse drug reactions and recurrence rates (Li et al., 2018). Another trial verified Tongziliao (GV1) plus Jianyu (LI15) for calf muscle strength was nearly as effective as pyridostigmine, sparing medication use (Chen et al., 2016). These support acupuncture's symptomatic controlling function in MG.

Combined Application of TCM Therapies

Integrating multiple TCM modalities based on syndrome differentiation can produce synergistic benefits and improve therapeutic effects. For example, herbal formula plus acupuncture yielded better improvements than either alone regarding MG natural history score and life quality score (Song et al., 2019). A cohort study found customized formula intervention with acupuncture, tuina and dietary counselling enhanced muscle power more than corticosteroids alone (Jin et al., 2019).

Another retrospective analysis concluded that combining Kushen injection, acupuncture and regulating diet achieved a recurrence rate as low as 8.25% after 12 months' treatment for 397 MG patients (Sun et al., 2017). Overall, integrated TCM application tailored to individual pathogenic factors and symptoms offers promise as an adjunct or alternative treatment.

Safety of TCM for MG

Research consistently indicates that TCM interventions for MG, whether as single modality or in combination, generate few or mild adverse reactions. For instance, herbal formulae like Sijunzi decoction and extracts like Borneol have excellent safety profiles without significant toxicity reported (Li et al., 2021; Yang et al., 2017). In the acupuncture trials discussed, no serious adverse events emerged (Pan et al., 2019; Li et al., 2018). Other TCM modalities including tuina and dietary therapy also pose very low risks when administered properly by licensed practitioners.

With proper quality control of herbal preparations and standardized treatment procedures, TCM options provide safe and natural alternatives or supplements for MG patients seeking relief from long-term medication side effects or refractory disease. Large sample randomized trials with long follow-up are still warranted to validate safety conclusively.

Remaining Challenges and Future Perspectives

While demonstrating efficacy and safety advantages, TCM research in MG remains at its exploratory stage with several issues yet to be addressed:

·Most studies have small samples, lacking statistical power to decisively conclude outcomes. Rigorous large-scale trials are needed.

·Mechanism of action of effective herbal compounds and how acupuncture regulates neuroendocrine response in MG remains elusive. More basic research should validate anti-inflammatory and immune-modulating properties of key TCM interventions.

·Simple herbal extracts or single acupoint formulas are easier to reproduce than complex formulae/protocols. Simplified standardized protocols suitable for different regions and practitioners require development.

·Well-designed prospective research is still scarce. More investigations incorporating TCM endpoints like syndrome pattern dynamic changes into randomized clinical trials are warranted.

·Integrating TCM with other complementary modalities like music therapy, psychological counselling warrants exploration for holistic personalized care.

With continuous scientific validation and improved standardization, TCM holds promise to make significant contributions to optimizing multi-modal MG management especially in mitigating long-term pharmacotherapy adverse effects. More cross-disciplinary collaboration is advocated to realize its full potential.

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