Autoimmune disease: how an Ayurvedic treatment is planned

Autoimmune disease is not settled by herbs. The immune system has to be re-tuned by specialist medicine; our work is the layer around it, and the interactions.

In autoimmunity the immune system loses the ability to tell self from not-self and attacks the body's own tissue — the joint lining, the skin, the bowel, the kidney, the nerve covering, the platelets, the liver. It runs in flares and quiet phases, it is more common in women, and it is not caused by anything the patient ate, tolerated or failed to do. The treatments that change its course are immunosuppressants, immunomodulators and the newer targeted drugs, and none of them are optional in the diseases that damage organs.

The conditions this conversation applies to

• Rheumatoid arthritis, lupus, psoriasis and psoriatic arthritis, ankylosing spondylitis, scleroderma and myositis.
• Inflammatory bowel disease, coeliac disease, autoimmune hepatitis and primary biliary disease.
• Immune thrombocytopenia, autoimmune haemolytic anaemia, vasculitis and antiphospholipid syndrome.
• Myasthenia gravis, multiple sclerosis, Guillain-Barre syndrome and the inflammatory neuropathies.
• Vitiligo, alopecia areata, Addison's disease and the thyroid autoimmunities. The last two sit on the adrenal and thyroid side of endocrinology, and they are not conditions we treat here; they are managed by an endocrinologist, and we say that plainly rather than taking the case.
• Type 1 diabetes, where the insulin is the treatment and nothing else substitutes for it.

What we do not claim

• That any herb cures autoimmunity, induces a permanent remission, or lets anyone stop an immunosuppressant. The claim is made constantly and it is the reason patients arrive with damaged kidneys, destroyed joints or in intensive care.
• That 'balancing immunity' is a thing a supplement does. In an autoimmune disease the immune system is already over-directed against self; a preparation whose traditional reputation is immune stimulation is exactly the wrong pharmacology. Ashwagandha, guduchi and guggulu all sit in that conversation and all of them have real interactions.
• That a diet replaces a drug. An anti-inflammatory diet can help the day; it does not alter the antibody.
• Steroids are never stopped by the patient, and never reduced on our advice. A sudden stop can cause an adrenal crisis, which is a medical emergency.

Where we genuinely help

• The steroid layer: sugar, blood pressure, weight, sleep, mood, gastritis, facial puffiness, cataract, thinning bone and the infections that follow long courses. These are the complaints an autoimmune patient actually arrives with, and they are treatable.
• Bone protection on long steroid use: calcium and vitamin D decided with the doctor, weight-bearing activity, and a bone-density conversation when the course is long.
• Gut comfort with methotrexate and NSAIDs, constipation with the drugs that cause it, and the nausea that makes people skip doses.
• Skin and hair in lupus and psoriasis, with the sun-protection rules stated as treatment rather than advice.
• Fatigue and sleep, which is the largest unaddressed complaint in this whole group and the one that responds least to tablets.
• Function: range of motion, strength, stair and grip work, joint protection and the small devices that let a hand keep working. This is where a chronic arthritis is won or lost.
• Mood and the family conversation, including sex, pregnancy planning and work, which nobody has time for in a fifteen-minute specialist appointment.

The calendar that keeps a patient safe

• Blood counts, liver and kidney tests on the schedule the drug demands, and no missed visit while a dose is being titrated.
• Hydroxychloroquine needs periodic eye examination; statins and methotrexate need the liver watched; cyclophosphamide and the biologics need infection vigilance.
• Vaccines before immunosuppression where possible, live vaccines avoided while on it, and a household told the same.
• Infection is the great decision point: a fever on an immunosuppressant is a call to the treating doctor, not a reason to start three powders.
• Pregnancy planned rather than discovered: methotrexate stopped well in advance, some drugs swapped, some continued because the disease flaring is more dangerous than the drug, and folate started. This conversation belongs to the specialist and it happens before conception.
• Surgery, dental work and travel arranged with the physician, including the steroid cover that some operations need.

Supplements that have real interactions

• Guduchi with liver enzymes already under pressure, and with diabetes tablets.
• Guggulu with cyclosporine and thyroid tablets, and its own liver questions.
• High-dose curcumin with blood thinners and with NSAIDs.
• Ashwagandha with sedatives, thyroid treatment and in pregnancy.
• St John's wort with a long list of immunosuppressants, where it can drop drug levels and trigger a flare.
• Unlabelled powders and syrups for 'autoimmune control', which have been found to contain corticosteroids. The dramatic improvement in a fortnight is the diagnosis.
• Anything that claims to detox or cleanse the immune system, and anything that tells a patient to stop their biologic to 'reset'.

Habits that change outcomes

• Not smoking. It worsens rheumatoid arthritis and lupus directly and reduces how well the drugs work; it is the single largest thing in this list.
• Sun protection in lupus and in the photosensitive rashes, including through car glass.
• Weight, because fat tissue is itself inflammatory and an arthritic knee with extra load is a worse knee.
• Activity that is kept through quiet phases, so the flare does not find an untrained body.
• Alcohol limited, and often stopped, with methotrexate and liver disease.
• Salt and sugar controlled while on steroids; dental and skin sources of infection cleared.
• Sleep, and the treatment of the low mood that comes with a chronic disease rather than being tolerated as part of it.

The same-day list

• Fever, breathlessness or a new chest pain while on immunosuppression.
• Sudden weakness, numbness, facial droop, double vision, a seizure or confusion.
• New widespread bruising, blood in stool or urine, or bleeding that will not stop — a platelet problem, not a diet problem.
• A swollen, painful calf, or sudden breathlessness after a long journey: a clot, and lupus and antiphospholipid syndrome make clots likely.
• A hot, swollen, exquisitely painful joint with fever: an infected joint on an immunosuppressed person.
• Vomiting with drowsiness and low blood pressure in someone who has just stopped steroids.
• In type 1 diabetes: vomiting, deep breathing and drowsiness with high sugar is ketoacidosis, and insulin is the treatment.

At our two centres

• Model Town and Burari, first consultation free. We read the reports and the drug list, keep every medicine the specialist has started, work on the steroid side-effects, the gut, the sleep, the weight, the skin, the fatigue and the joint function, and tell the family honestly which parts of this disease belong to a physician and which we can make easier. Nothing is stopped to make room for something herbal, and nothing is promised about remission.

Flare or infection — the question that decides the day

• A flare usually builds over days in the same places as before: more joint swelling, the rash in its usual pattern, fatigue rising, and no high fever.
• An infection arrives faster and differently: fever with chills, one hot swollen joint rather than both, burning urine, a cough with breathlessness, a wound that is red and spreading, or diarrhoea after antibiotics.
• On immunosuppression an infection can look mild and behave badly. A temperature that would be ignored in anyone else is a call to the rheumatologist or physician.
• The mistake that causes harm is treating a fever as a flare by raising the steroid dose at home, or treating a flare as an infection by stopping the immunosuppressant for weeks. Both decisions belong to the doctor who prescribed them.
• Methotrexate is often paused during a documented infection, and that pause is a decision with a date and a plan to restart — not an open-ended stop.

What to bring to the first visit

• Every report from the last two years in order, including the ones that were normal.
• The current drug list with doses, and what was tried before and why it was stopped.
• A note of the flares: month, what changed, what was given, how long it took to settle.
• Every packet, syrup and powder being taken from anywhere — including what a relative brought from another city.
• The vaccination record and the last blood pressure, sugar and kidney readings.
• And the honest question to ask us, and any doctor: what is this add-on for, how long will it take, and what number will tell us whether it worked?

Every individual is different. Before starting any new remedy or routine, please consult a qualified doctor, especially if you are pregnant, on regular medication for BP, sugar or thyroid, take blood thinners, or have liver or kidney problems.