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Table of Contents
ORIGINAL ARTICLE
Year : 2018  |  Volume : 4  |  Issue : 3  |  Page : 85-95

Clinical study with randomized control on the therapy of integrated Chinese and Western medicine in treating neurological autoimmune diseases: A meta-analysis


Institute of Clinical Immunology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China

Date of Submission01-Aug-2018
Date of Acceptance14-Sep-2018
Date of Web Publication10-Oct-2018

Correspondence Address:
Xiao-Dong Cheng
Institute of Clinical Immunology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/wjtcm.wjtcm_17_18

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  Abstract 


Objective: The main objective of this study is to evaluate the effects of integrated Chinese and Western medicine in the treatment of neurological autoimmune diseases. Materials and Methods: The literature was comprehensively searched to collect the randomized controlled trials about integrated Chinese and Western medicine in the treatment of neurological autoimmune diseases. Neurological autoimmune diseases mainly occur in the central nervous system (CNS) and peripheral nervous system. Therefore, multiple sclerosis (MS) was chosen as the representative in the CNS, and Guillain–Barre syndrome (GBS) was chosen as the representative in the peripheral nervous system. Extended Disability Status Scale (EDSS) score, effective rate, clinical symptom score, neurological functional sign score, recurrence frequency, and incidence rate of adverse reactions were chosen as the markers of outcome variables of MS, and the effective rate and Hughes score were also chosen as the markers of outcome variables of GBS. Results: For MS, the results showed that there was a significant difference in statistical analysis between the experimental group and the control group in EDSS score, the effective rate, and the recurrence frequency. However, through the comparison of clinical symptom score, neurological functional sign score, and incidence rate of adverse reaction of both two groups, the results showed that there was no significant difference in the statistical analysis. For GBS, through the comparison of effective rate and Hughes score of both two groups, the results showed that there was a significant difference in statistical analysis. Conclusions: The study demonstrated that compared with Western medicine, the therapy of integrated Chinese and Western medicine was more effective in treating neurological autoimmune diseases.

Keywords: Guillain–Barre syndrome, integrated Chinese and Western medicine, meta-analysis, multiple sclerosis, randomized controlled trial


How to cite this article:
Peng XY, Ma JY, Cheng XD. Clinical study with randomized control on the therapy of integrated Chinese and Western medicine in treating neurological autoimmune diseases: A meta-analysis. World J Tradit Chin Med 2018;4:85-95

How to cite this URL:
Peng XY, Ma JY, Cheng XD. Clinical study with randomized control on the therapy of integrated Chinese and Western medicine in treating neurological autoimmune diseases: A meta-analysis. World J Tradit Chin Med [serial online] 2018 [cited 2018 Dec 15];4:85-95. Available from: http://www.wjtcm.net/text.asp?2018/4/3/85/243023




  Introduction Top


Neurological autoimmune diseases mainly occur in the central nervous system (CNS) as well as in the peripheral nervous system, and their pathogenesis is related to antineuron autoantibodies. Multiple sclerosis (MS) was chosen as the representative in the CNS and Guillain–Barre syndrome (GBS) was chosen as the representative in the peripheral nervous system. A meta-analysis was carried out so that the therapeutic effect of integrated Chinese and Western medicine on neurological autoimmune diseases was studied.

MS is an inflammatory demyelinating disease of the CNS, which affects more than two million people in the world.[1] Especially, it is the main cause of nontraumatic neurological dysfunction in young people in North America and Europe. Immune disorders of MS are considered to be multifactorial, involving genetic susceptibility, epigenetics and postgenomic events, and environmental factors.[2] GBS, also known as acute inflammatory demyelinating polyneuropathy, is the most common and severe acute paralytic neuropathy. In addition, it is a potential life-threatening postinfectious disease which is characterized by symmetrical flaccid paralysis of the extremities, cranial nerve damage, and “protein–cell separation” of the cerebrospinal fluid. About 25% of the patients have respiratory insufficiency and many patients have signs of autonomic dysfunction. There are about 100,000 people around the world suffering from this disease every year.[3],[4],[5],[6]

In the acute phase, MS is adopted with high-dose glucocorticoid pulse therapy. In the remission phase, the aim of drug therapy is to control or delay the progression of the disease. At present, researchers have designed a number of disease-modifying drugs for different biological signaling pathways, which can effectively prevent the recurrence or reduce the frequency of recurrence, such as interferon-beta, glatiramer acetate, fingolimod, and teriflunomide[7] Although disease-modifying drugs can reduce the frequency of recurrence, the occurrence of adverse reactions and the high price of drugs lead patients to bear great risks and heavy burdens. Treatments for GBS include plasma exchange, immunoglobulin, glucocorticoids, immunosuppressive agents, and symptomatic supportive therapy. However, take plasma exchange for an example, not only there are many side effects of plasma exchange, but also the relevant operation is complicated and risky. Compared with other treatments, although the therapy with immunoglobulin is relatively easy and safe to operate, it is still very expensive.[8] Therefore, it is imperative to find new drug therapies.

Although MS has no definitive nomenclature in the name of traditional Chinese medicine (TCM), according to its different clinical manifestations, it is called as “flaccidity syndrome,” “visual fainting,” “green blindness,” “vertigo,” and so on. Kidney deficiency is the root of the disease, while the evil excess is the tip of the disease. In other word, healthy qi deficiency-evil excess and deficiency-excess complex are the basic pathogeneses.[9] Long-term clinical practice of many doctors showed that TCM can improve patients' symptoms and signs, prolong remission, prevent recurrence, reduce side effects of glucocorticoid and immunosuppressive agents, and reduce disability.

GBS belongs to the category of “flaccidity syndrome” in TCM. Its pathogenesis is related to dampness in the external, while involving the deficiency of lung, spleen–stomach, liver, and kidney in the internal. At present, there is no unified standard for the syndrome differentiation of TCM in GBS. Wang[10] divided the disease into four types of TCM syndrome differentiation: qi and blood stasis stagnation type, spleen and kidney deficiency type, dampness-heat infiltration type, and nutrient-defense disorder type; Qiao et al.[11] divided the disease into Yang-Qi deficiency type, nutrient-blood deficiency type, and Sinew-vessel disharmony type; and Zhi and Li[12] divided the disease into spleen deficiency and qi-weak type, spleen and kidney in deficiency type, and spleen and kidney Yang deficiency. Wang et al.[13] believed that the TCM syndrome differentiation was not limited to the diagnosis of the name of the Western medicine. The application of TCM syndrome differentiation is flexible, and the efficacy of the treatment combining syndrome differentiation with disease differentiation is better than that of simple Western medicine.

A number of studies[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36],[37],[38] have shown that the therapy of integrated Chinese and Western medicine in treating neurological autoimmune diseases has achieved good results. However, these trials are mostly small-randomized controlled trials (RCTs). Here, we conducted a meta-analysis to assess the effectiveness of TCM on MS and GBS, providing more reliable evidence-based medical evidence for clinical practice.


  Materials and Methods Top


Search strategy

The scope of the search included the following databases: China National knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wan Fang Database, Chinese VIP database, PubMed and Cochrane Library. For MS, we chose “multiple sclerosis or MS” and “traditional Chinese medicine or herb or acupuncture or integrated Chinese and Western medicine” as the search terms. For GBS, the search strategy consisted with the following medical terms: “Guillain-Barre syndrome or GBS” and “traditional Chinese medicine or herb or acupuncture or integrated Chinese and Western medicine.” The time frame was ranged from January 1, 2000 to December 31, 2017 and the search language is not limited.

Inclusion criteria

  1. RCTs
  2. The test subjects: Participants with MS[39],[40],[41] and GBS[42],[43],[44] after definite diagnosis
  3. The intervention of the experimental group was treated with TCM or acupuncture on the basis of Western medicine, while the control group was treated with Western medicine solely
  4. The original literature is published literature.


Exclusion criteria

  1. The same data were published repeatedly, excluding multiple literature published for the same research population and select only the highest quality or the largest sample size
  2. The sample size is <10 or the sample size is unknown
  3. The data in the literature are incomplete or cannot be extracted
  4. Animal experiments.


Data extraction and analysis

Two researchers independently extracted and evaluated the quality of the literature according to the predefined inclusion criteria. Differences were resolved by a discussion. If the opinions are still not unified after discussion, the experts in this field who are engaged in neuroimmunology will make judgments. The contents of the literature extraction include: disease, author, sample size, experimental group treatment, control group treatment, treatment duration, follow-up period, the markers of outcome variables (MS: Extended Disability Status Scale [EDSS] score, effective rate, clinical symptom score, neurological functional sign score, recurrence frequency, incidence rate of adverse reactions; GBS: effective rate, Hughes score), random sequence generation, blind method, lost to follow-up and exit, and allocation concealment.

Methodology quality assessment

The quality of the included studies was assessed based on Jadad scale with a total score of 7 points. A score of 4–7 points denoted a high-quality study, while a score of <4 points denoted a low-quality study. The contents of the assessment mainly include whether to use random sequence generation, randomized allocation and concealment, blind method, lost to follow-up, and exit. Because of the low quality of the literature, a definition of 1 point or more could be entered into the meta-analysis.

Statistical analysis

Review Manager 5.3 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark) was used to estimate the pooled mean difference (MD) for continuous outcomes (such as EDSS score, clinical symptom score, neurological functional sign score, recurrence frequency, and Hughes score), and odds ratio (OR) risk for dichotomous outcome measures (such as effective rate and incidence rate of adverse reactions). Both data were statistically different at P < 0.05. A heterogeneity test was carried out by Chi-squared text (P = 0.10 was used as the test level) and the statistic I2. When I2< 50% and P > 0.10, the results were considered to be homogeneous and the fixed effect model was used; otherwise, the random effect model was used.


  Results Top


Search results

From January 1, 2000 to December 31, 2017, a total of 365 articles were retrieved, including 195 CNKI, 24 SinoMed, 93 Wan-Fang databases, 41 VIP, 5 PubMed, and 7 Cochrane Library [Figure 1]. After excluding the repetitive literature, nonRCT studies, animal experiments, the studies with too few data or incomplete data or unspecified diagnostic criteria, and finally, 25 articles were included in the literature, including 23 in Chinese and 2 in English.
Figure 1: Flow diagram showing the process of screening references

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Study description

A total of 16 articles were included in the study on MS. From 2004 to 2016, a total of 800 participants were included, including a minimum of 23 cases and a maximum of 73 cases. EDSS score was observed in ten studies, and the data could be extracted from nine studies; the effective rate was observed in ten studies, and the data could be extracted from ten studies; the clinical symptom score was observed in four studies, and the data could be extracted from four studies; the neurological functional sign score was observed in three studies, and the data could be extracted from three studies; the recurrence frequency was observed in three studies, and the data could be extracted from three studies; and the incidence rate of adverse reactions was observed in four studies, and the data could be extracted from three studies. A total of nine articles were included in the study on GBS. From 2003 to 2010, 599 participants were included, of which the sample size was at least 35 and the maximum was 100; effective rate was reported in nine studies, and the data could be extracted from nine studies and Hughes score was observed in three studies, and the data could be extracted from three studies. The basic characteristics of the included literature were showed in [Table 1].
Table 1: Characteristics of included studies

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Quality assessment

The description of quality assessment is shownin [Table 2].
Table 2: Quality assessment of included studies

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The Jadad scale was used to assess the quality of included studies. In the use of random methods, all the studies were reported a random grouping method; however, only six studies mentioned “randomization” with details. Only 3 of the 25 studies were adopted single-blind and the rest of the studies was not used blinding. The baseline comparison was conducted for both the experimental group and control group of included studies. The results showed that P > 0.05, which meant that both two groups were comparable. In addition, there was no case of shedding.

Meta-analysis results

Extended disability status scale score multiple sclerosis

From all the included studies, the EDSS score was observed in ten studies, the data could be extracted from nine studies. There was a heterogeneity in nine studies (χ2 = 69.01, P < 0.001, I2= 88%), so the random effect model was used. Through the comparison of EDSS score of both two groups, the results illustrated that the combined effect of quantity of MD and 95% confidence interval (CI) were −1.07, (−1.79, −0.36), P < 0.05, which had significant difference in statistical analysis (Z = 2.94, P < 0.05). It is indicated that the experimental group has an advantage over the control group in reducing the EDSS score [Figure 2].
Figure 2: Forest map of Extended Disability Status Scale score comparison in study group and control group multiple sclerosis

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Effective rate multiple sclerosis

Effective rate was observed in ten studies, and the data could be extracted from ten studies. There was no heterogeneity in ten studies (χ2 = 1.95, P = 0.99, I2= 0%), so the fixed effect model was used. The results illustrated that the combined effect of quantity of OR and 95% CI were 5.91, (3.51, 9.94), P < 0.001, which had significant difference in statistical analysis (Z = 6.70, P < 0.001). It is indicated that the experimental group is better than the control group from the curative effect perspective [Figure 3].
Figure 3: Forest map of effective rate comparison in study group and control group (MS)

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Clinical symptom score multiple sclerosis

The clinical symptom score was observed in four studies, and the data could be extracted from four studies. There was a heterogeneity in four studies (χ2 = 70.99, P < 0.001, I2= 96%), so the random effect model was used. Through the comparison of the clinical symptom score of both two groups, the results illustrated that the combined effect of quantity of MD and 95% CI were 0.30, (− 3.71, 4.31), P = 0.88, which had no difference in statistical analysis (Z = 0.15, P = 0.88). It is indicated that the difference between the experimental group and the control group is not obvious in improving the clinical symptoms [Figure 4].
Figure 4: Forest map of clinical symptom score comparison in study group and control group multiple sclerosis

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Neurological functional sign score multiple sclerosis

The neurological functional sign score was observed in three studies, and the data could be extracted from three studies. There was a heterogeneity in three studies (χ2 = 44.83, P < 0.001, I2= 96%), so the random effect model was used. Through the comparison of the neurological functional sign score of both two groups, the results illustrated that the combined effect of quantity of MD and 95% CI were −2.11, (−6.86, 2.64), P = 0.38, which had no significant difference in statistical analysis (Z = 0.87, P = 0.38). It is indicated that there is no significant difference between the experimental group and the control group in improving the neurological functional signs [Figure 5].
Figure 5: Forest map of neurological functional sign score comparison in study group and control group multiple sclerosis

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Recurrence frequency multiple sclerosis

The recurrence frequency was observed in three studies, and the data could be extracted from three studies. There was a tiny heterogeneity in three studies (χ2 = 2.03, P = 0.36, I2= 1%), so the fixed effect model was used. The results illustrated that the combined effect of quantity of MD and 95% CI were −0.41, (−0.56, −0.26), P < 0.001, which had significant difference in statistical analysis (Z = 5.27, P < 0.001). It is indicated that the experimental group has an advantage over the control group in preventing recurrence of MS [Figure 6].
Figure 6: Forest map of recurrence frequency comparison in study group and control group multiple sclerosis

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Incidence rate of adverse reactions multiple sclerosis

The incidence rate of adverse reactions was observed in four studies, the data could be extracted from three studies. There was a heterogeneity in three studies (χ2 = 5.18, P = 0.07, I2= 61%), so the random effect model was used. The results illustrated that the combined effect of quantity of OR and 95% CI were 0.20, (0.03, 1.42), P > 0.05, which had no significant difference in statistical analysis (Z = 1.61, P = 0.11). It is indicated that there was no significant difference in the incidence of adverse reactions between the experimental group and the control group [Figure 7].
Figure 7: Forest map of incidence rate of adverse reactions comparison in study group and control group multiple sclerosis

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Effective rate Guillain–Barre syndrome

A total of nine studies were (out of nine studies) observed effective rate. There was no heterogeneity in the total nine studies (χ2 = 6.54, P = 0.59, I2= 0%), so the fixed effect model was adopted. The combined effect of quantity of OR and the 95% CI were 3.38, (1.87, 6.14), which showed statistically significant differences (Z = 4.01, P < 0.001). The results implicated that the curative effect of the experimental group was better than control group [Figure 8].
Figure 8: Forest map of effective rate comparison in study group and control group (GBS)

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Hughes score Guillain–Barre syndrome

A total of three studies were (out of nine studies) observed Hughes score. There was not obvious heterogeneity in three studies (χ2 = 3.52, P = 0.17, I2= 43%), so the fixed effect model was adopted. The combined effect of quantity of MD and 95% CI were −0.41, (−0.75, −0.07), which showed statistically significant differences (Z = 2.33, P = 0.02). The results implicated that the experimental group had an advantage over the control group in terms of improving limb function [Figure 9].
Figure 9: Forest map of Hughes Score comparison in study group and control group (GBS)

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Risk of bias in included studies

Funnel graphs were made by RevMan 5.3 to evaluate the risk of bias of the included studies. There was no obvious bias in the funnel graphs of effective rate of both MS and GBS, indicating that the relevant experimental design was rigorous and the study method was good, especially the allocation concealment was done well. These figures were beneficial to expound the results of the meta-analysis. The scatter graph of EDSS score and the clinical symptom score showed apparent publication bias. Due to the small number of studies included, there was still a publication bias in the scatter graph of neurological functional sign score and incidence rate of adverse reactions, as well as in the funnel graph of Hughes score. In the case of recurrence frequency of MS, the two scatter points were symmetrically distributed on both sides of the vertical line at the top of the funnel, but one scatter was located in the lower part of the funnel. Therefore, the scatter graph of recurrence frequency also showed a publication bias. It was indicated that the obvious publication bias was a very important factor that may lead to the lack of statistical difference in the results of meta-analysis [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15], [Figure 16], [Figure 17].
Figure 10: Funnel plot of Extended Disability Status Scale score into nine articles multiple sclerosis

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Figure 11: Funnel plot of effective rate into ten articles multiple sclerosis

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Figure 12: Funnel plot of clinical symptom score into four articles multiple sclerosis

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Figure 13: Funnel plot of neurological functional sign score into three articles multiple sclerosis

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Figure 14: Funnel plot of recurrence frequency into three articles multiple sclerosis

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Figure 15: Funnel plot of incidence rate of adverse reactions into three articles multiple sclerosis

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Figure 16: Funnel plot of effective rate into nine articles Guillain–Barre syndrome

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Figure 17: Funnel plot of Hughes Score into three articles Guillain–Barre syndrome

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  Discussions Top


Neurological autoimmune diseases are autoimmune diseases in which the autoimmune cells and immune molecules attack the nervous system as a pathological mechanism, leading to pathological changes such as neuronal or axonal injury and myelin loss.[45] The continuous progress of the diseases leads patients to bear great physical and mental burdens. At present, the treatments of neurological autoimmune diseases are mainly based on comprehensive therapy, including immunotherapy, glucocorticoids, and other interventions. The therapeutic effect is relatively limited and there is no ideal method. A number of studies have shown that the combination of TCM and Western medicine in the treatment of neurological autoimmune diseases has a good clinical effect.

In this study, meta-analysis was used to analyze the published RCTs using integrated Chinese and Western medicine in the treatment of MS and GBS. Eventually, 25 studies were included and the results showed that the therapy of integrated Chinese and Western medicine in treating MS improved the efficiency, reduced the recurrence frequency, and improved nerve defect compared with the Western medicine treatment. In the case of GBS, the therapy of integrated Chinese and Western medicine not only has obvious efficiency but also improves the physical function of the limbs. It further demonstrates that integrated Chinese and Western medicine has a remarkable clinical curative effect in the treatment of neurological autoimmune diseases and is worthy of clinical promotion. However, there was no statistically significant difference between the experimental group and the control group in the clinical symptom score, neurological physical function score, and incidence rate of adverse reactions of MS. It may be related to the following factors: (1) the published literature is biased; (2) the quality of the literature is generally low; (3) The scoring criteria of clinical symptoms score and neurological functional sign score may be different; and (4) Less literature on MS involving incidence rate of adverse reactions have been included.

In the 25 studies included, all the studies described the baseline status of each group and all the groups were comparable after statistical processing. The grouping methods adopted were all mentioned random grouping. Among them, only six studies have indicated that they were grouped by random number table method. The rest of the studies did not describe the detailed random method. Only one was hidden by an envelope, and the rest of the studies were not mentioned. Three of the 25 studies were used a single-blind method, while the rest was not mentioned. In addition, the duration of treatment in each study ranged from 1 to 10 months, and the follow-up time also varied from 1 year to 10 years. Even in some studies, the follow-up time was not indicated. Based on the above information, the quality of the literature is generally low. Many aspects need to be improved to ameliorate the quality of the literature, such as random grouping method, the use of blind methods, lost to follow-up and exit, the control of treatment duration, and the arrangement of follow-up time. Therefore, randomized clinical trials with large sample, multicenter, double blind are needed to study the efficacy of integrated Chinese and Western medicine in the treatment of neurological autoimmune diseases. Furthermore, we should form a unified evaluation criterion for the outcome effect indicators of diseases, pay attention to the safety evaluation of TCM, and establish a unified evaluation standard that reflects the medical efficacy of TCM characteristics, so as to provide better evidence-based medical evidence for the clinical practice.


  Conclusion Top


Through the available randomized controlled clinical trials, we conducted a meta-analysis and found that integrated Chinese and western medicine had a remarkable clinical curative effect in the treatment of neurological autoimmune diseases, and was worthy of clinical promotion

Financial support and sponsorship

This study was supported by National Natural Science Foundation of China (No. 81673669, No. 81703782), the Interdisciplinary Project of “Clinical Immunology of Traditional Chinese Medicine” in Shanghai (No. 30304113598), and the “TCM Peak Discipline” Project in Shanghai University of Traditional Chinese Medicine (No. 30304114323).

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dutta R, Trapp BD. Relapsing and progressive forms of multiple sclerosis: Insights from pathology. Curr Opin Neurol 2014;27:271-8.  Back to cited text no. 1
    
2.
Grigoriadis N, van Pesch V, ParadigMS Group. A basic overview of multiple sclerosis immunopathology. Eur J Neurol 2015;22 Suppl 2:3-13.  Back to cited text no. 2
    
3.
Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. Lancet 2016;388:717-27.  Back to cited text no. 3
    
4.
van den Berg B, Walgaard C, Drenthen J, Fokke C, Jacobs BC, van Doorn PA, et al. Guillain-Barré syndrome: Pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol 2014;10:469-82.  Back to cited text no. 4
    
5.
Li C. An overview on traditional Chinese medicine therapy in treating Guillain-Barre syndrome. Hebei J Tradit Chin Med 2007;29:273-5.  Back to cited text no. 5
    
6.
Wang DH. The etiology and pathogenesis of Guillain-Barre syndrome. Chin Community Doctors 2010;26:4.  Back to cited text no. 6
    
7.
Jiang LY, Liu WD, Yuan FQ, Fang W. Progress in drug therapy for multiple sclerosis. J Med Theory Pract 2017;30:2212-4.  Back to cited text no. 7
    
8.
Gan HB. Progress in the treatment of Guillain-Barre syndrome. Chin J Ethnomed Ethnopharmacy 2009;18:81.  Back to cited text no. 8
    
9.
Ling H, Shang XL. Progress in traditional Chinese medicine research on multiple sclerosis. Clin J Chin Med 2016;8:141-4.  Back to cited text no. 9
    
10.
Ye MG, Jian W. Wang RZ's syndrome differentiation characteristics of Flaccidity Syndrome. J Anhui Coll Tradit Chin Med 2011;30:16-8.  Back to cited text no. 10
    
11.
Qiao WH, Wang YX, Huang AY. Knowledge with syndrome differentiation of flaccidity syndrome. Chinas Naturopathy 2008;16:52.  Back to cited text no. 11
    
12.
Zhi HP, Li GH. The principle of cultivating spleen-kindey should be adopted by syndrome differentiation of flaccidity syndrome. Shanghai J Tradit Chin Med 2005;8:39-40.  Back to cited text no. 12
    
13.
Wang HF, Li MQ, Xiang BD. Progress in traditional Chinese medicine research on Guillain-Barre syndrome. Jilin J Tradit Chin Med 2006;26:59-60.  Back to cited text no. 13
    
14.
Wang YH, Hui Z, Huang JQ, Su ZL. The clinical research of Jiweiling Tang for the treatment of multiple sclerosis. Mod J Integr Tradit Chin West Med 2006;15:1608-9.  Back to cited text no. 14
    
15.
Zhang GZ, Zhang JS. The clinical research of GuSuiTongLuo Tang for the treatment of multiple sclerosis. J Emerg Tradit Chin Med 2006;15:1608-9.  Back to cited text no. 15
    
16.
Zhou YL. The curative effect observation that combining traditional Chinese and western medicine treatment of multiple sclerosis. Orient Diet Therapy Health Care 2016;14:120.  Back to cited text no. 16
    
17.
Fan YP, Ping W, Zhang XH, Gong HY, Li Z, Liu XZ, et al. Treatment of relapsing multiple sclerosis with erhuang formula. J Beijing Univ Tradit Chin Med 2006;29:273-6.  Back to cited text no. 17
    
18.
Shi LH, Wang QW. The curative effect of combination of Chinese and western medicine in the prevention and treatment of relapsing multiple sclerosis. Guangxi J Tradit Chin Med 2004;27:14-7.  Back to cited text no. 18
    
19.
Qian L, Duo Z. Combining traditional Chinese and western medicine treatment of multiple sclerosis in 30 cases. Tradit Chin Med Res 2012;25:22-3.  Back to cited text no. 19
    
20.
Wang JY, Zhang CF, Zhang YF. The curative effect observation that combining traditional Chinese and western medicine treatment of 32 cases of multiple sclerosis. J Mudanjiang Med Coll 2007;28:52-3.  Back to cited text no. 20
    
21.
Hu YY, Tai L, Hu YQ, He QC, Zhang QP, Ni L. The clinical research of combining traditional Chinese and western medicine in the treatment of multiple sclerosis in 35 cases. Jiangsu J Tradit Chin Med 2010;42:23-4.  Back to cited text no. 21
    
22.
Zhang WH, Guo GH, Jiao JS, Jiao YJ. The curative effect of the combine traditional Chinese and western medicine in the treatment of multiple sclerosis. Chin J Med 2013;48:93-4.  Back to cited text no. 22
    
23.
Zhuang YS. Observation of curative effect of integrated traditional Chinese and western medicine on multiple sclerosis. J Pract Tradit Chin Med 2013;29:443-4.  Back to cited text no. 23
    
24.
Xu XM, Xiao ZY. Combining traditional Chinese and western medicine treatment of multiple sclerosis in 38 cases. Jiangsu J Tradit Chin Med 2011;42:34-6.  Back to cited text no. 24
    
25.
Ying W, Jie W. Clinical Observation on Treating Multiple Sclerosis with Acupuncture by only Using Yangming Channel. Beijing: The 1st International Grand Ceremony of Huang Fumi and Zhenjiu Jiayi Jing Academic Thinking Conference; 2012. p. 164-7.  Back to cited text no. 25
    
26.
Quispe-Cabanillas JG, Damasceno A, von Glehn F, Brandão CO, Damasceno BP, Silveira WD, et al. Impact of electroacupuncture on quality of life for patients with relapsing-remitting multiple sclerosis under treatment with immunomodulators: A randomized study. BMC Complement Altern Med 2012;12:209.  Back to cited text no. 26
    
27.
Zhou YQ, Mao WQ, Zhang XJ, Tao Li. Effects of shugan jianpi gusui recipe on multiple sclerosis recurrence: A primary report. Chin J Integr Tradit West Med 2013;33:31.  Back to cited text no. 27
    
28.
Qing S, SZ Y. The curative effect observation that combining traditional Chinese and western medicine treatment of multiple sclerosis. Guangdong Med J 2007;28:1352-3.  Back to cited text no. 28
    
29.
Wang YR. The curative effect observation that combining traditional Chinese and western medicine treatment of multiple sclerosis. Contemp Med Forum 2015;13:163-4.  Back to cited text no. 29
    
30.
Guo YP, Xiao LG, Zhu CQ. The clinical observation that combining traditional Chinese and western medicine treatment of Guillain-Barre Syndrome in 36 cases. Pract Clin J Integr Tradit Chin West Med 2004;4:10-11.  Back to cited text no. 30
    
31.
Li SG, Li XR. Combining traditional Chinese and western medicine treatment of Guillain-Barre Syndrome in 20 cases. J New Chin Med 2004;36:59-60.  Back to cited text no. 31
    
32.
Ying S, Han JH. Combining traditional Chinese and western medicine treatment of Guillain-Barre Syndrome in 40 cases. Mod Tradit Chin Med 2009;29:19-21.  Back to cited text no. 32
    
33.
Gong DH, Wei Y, Xiao J. Clinical observation on the treatment of 50 cases of Guillain-Barre Syndrome with three stages of combination of TCM and western medicine. Guiding J TCM 2007;13:45-6.  Back to cited text no. 33
    
34.
Chen FQ. The clinical observation that combining traditional Chinese and western medicine treatment of Guillain-Barre Syndrome. Chin J Inf Tradit Chin Med 2006;13:67-8.  Back to cited text no. 34
    
35.
Qin D, Ping W, Ping G, Zhong YM, Yan H, Xu LF. Effects of acupuncture on the functional recovery of limbs in patients with Guillain-Barre syndrome. J Nanjing Univ Tradit Chin Med 2003;19:296-8.  Back to cited text no. 35
    
36.
Ping W, Guo YP, Jiang WW. The effect of electro-acupuncture on the functional recovery of limbs of Guillain-Barre syndrome. J Chengdu Univ Tradit Chin Med 2010:18-20.  Back to cited text no. 36
    
37.
Wang HF, Wang FC, Jian W, Zhang EL, Dong GR. Clinical observation on electro-acupuncture at shu-points of the five zang-organs for treatment of acute Guillain-Barre syndrome. Chin Acupunct Moxibustion 2004;24:823-4.  Back to cited text no. 37
    
38.
Zou HJ. Combining acupuncture and western medicine treatment of Guillain-Barre syndrome in 38 cases. J Shandong Univ TCM 2010;34:221-2.  Back to cited text no. 38
    
39.
Polman CH, Reingold SC, Edan G, Filippi M, Hartung HP, Kappos L, et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald criteria”. Ann Neurol 2005;58:840-6.  Back to cited text no. 39
    
40.
Wang WZ. Neurology. Ver. 5. Beijing: People's Medical Publishing House; 2004. p. 191.  Back to cited text no. 40
    
41.
Poser CM, Paty DW, Scheinberg L, McDonald WI, Davis FA, Ebers GC, et al. New diagnostic criteria for multiple sclerosis: Guidelines for research protocols. Ann Neurol 1983;13:227-31.  Back to cited text no. 41
    
42.
Diagnostic criteria of Guillain-Barre syndrome. Chin J Neuropsychiatry 1994;27:380.  Back to cited text no. 42
    
43.
Hu WM, Wang WZ. 699 Questions from Neurology Attending Physician. Beijing: Beijing Medical University, China Union Medical University, Union Press; 1998. p. 236-7.  Back to cited text no. 43
    
44.
Shi YQ. Practical neurology. Ver. 2. Shanghai: Shanghai Scientific and Technical Publishers; 1994. p. 212.  Back to cited text no. 44
    
45.
Long YM, Hu XQ. Pathogenesis and progress in treatment research of neurological autoimmune disease. Chin J Contemp Neurol Neurosurg 2010;10:49-63.  Back to cited text no. 45
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15], [Figure 16], [Figure 17]
 
 
    Tables

  [Table 1], [Table 2]



 

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