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BY 4.0 license Open Access Published by De Gruyter Open Access February 29, 2020

Integrated Chinese and western medicine for acute guillain-barré syndrome treatment

Liu Yang and Xiumin Zhao EMAIL logo

Abstract

Introduction

Guillain-Barré syndrome (GBS) is a worldwide demyelinating polyradiculopathy and polyneuropathy. Currently, there is no specific drug for GBS, and established treatment is generally based on immune-modulating treatment with plasma exchange or intravenous immunoglobulin in combination with supportive care. This study aimed to investigate the efficiency of integrated Chinese and Western medicine for acute GBS treatment.

Methods

We enrolled 73 subjects, and randomly divided them into two groups: 35 cases in the traditional Chinese medicine (TCM) group, and 28 in the Control group. The Control group was treated with the common Western medicine for one month; and the TCM group was administrated with one month of common treatment combined with TCM medication.

Results

Compared to the controls, TCM significantly enhanced the treatment efficiency in symptom expression, including the TCM syndrome score, the activity of daily living score, Hughes functional score and sensory dysfunction assessment. The total effective rate of the TCM group was 94.29%, significantly better than controls (78.59%). Moreover, TCM provide better improvement in motor nerve conduction functions (distal motor latency and motor conduction velocity) and sensory nerve conduction functions (sensory conduction velocity and sensory nerve action potential) in median nerve, ulnar nerve, and common fibular nerve.

Conclusion

When combined with TCM administration, the GBS treatment could acquire better outcomes.

1 Introduction

Guillain-Barré syndrome (GBS) is a multifactorial and lethal inflammatory demyelinating polyradiculopathy and polyneuropathy, characterized by flaccid paralysis and acute demyelinating changes in the peripheral nervous system. It is characterized by symmetric limb paralysis, occasionally accompanied by limb paresthesia and autonomic dysfunction. About 20% GBS patients have a phenotype of respiratory paralysis [1, 2]. GBS can be caused by a range of infectious factors and acute traumas [3]. Diagnosis and management of GBS are complicated as its clinical presentation and disease course are heterogeneous, and no international clinical guidelines are currently available [4]. However, the pathology of GBS can be categorized into two types: acute inflammatory demyelinating polyneuropathy and acute motor axonal neuropathy. Almost all GBS patients would suffer from acute inflammatory demyelinating polyradiculoneuropathy, and this could be reflected by systematic analysis of the clinical and electrophysiological features.

Modern medical treatment majorly applies symptomatic and supportive therapies [5, 6]. IVIg and plasma exchange are equally effective treatments for GBS; and there are some other special treatments, such as immunoglobulin therapy, plasmapheresis therapy, hormone therapy, and cerebrospinal fluid filtration [4, 7, 8, 9]. Currently, there is no specific drug for GBS treatment, and classical treatments are generally based on etiological programs, combined with neurotrophic and anti-inflammatory approaches. Besides, intravenous injection of high-dose immunoglobulin was reported to yield beneficial outcomes, but it is expensive so far and may induce side effects. To date, this disease still needs effective supporting therapeutic strategies, for example traditional Chinese medicine (TCM) approaches. TCM has been reported about unique advantages in autoimmune neuritis, demyelinating and neurodegenerative diseases (such as Parkinson’s disease, Alzheimer’s disease, amyotrophic lateral sclerosis, autoimmune encephalomyelitis, etc.) [10, 11, 12, 13, 14, 15, 16, 17, 18]. In our pilot clinical experiment, we observed that when combined an empirical TCM formula with the current treatment of GBS, better outcomes could be acquired. This study aimed to investigate the efficiency of integrated Chinese and Western medicine for acute GBS treatment.

2 Material and methods

2.1 Patients

We collected the patients admitted to the Second Hospital of Hebei Medical University from July 2017 to December 2018.

The necessary diagnostic criteria for GBS were as follow [19, 20, 21, 22, 23]: (1) more than two limbs in paralysis; (2) the sputum reflex disappeared. And supportive diagnostic criteria included: (1) Clinical features: with a rapid symptom progress (reaching a peak) within 4 weeks, and a gradually recover after 4 weeks; (2) with symmetrical paralysis; (3) subjective sensory symptoms are more obvious compared to objective signs; (4) some patients exhibited cranial nerve symptoms (50% with bilateral facial paralysis, and often with tongue muscle and swallowing muscle paralysis); (5) with a slowdown of nerve conduction velocity.

The exclusion criteria for patients were as follow: (1) with a recent history of chemical abuse; (2) with abnormal porphyrin metabolism, which suggested an acute onset of porphyria; (3) with diphtheria infection or myocarditis; (4) with symptoms similar to lead-toxic neuritis and with strong evidences of plumbism; (5) confirmedly diagnosed acute poliomyelitis, botulism, toxic peripheral neuropathy (such as nitrofurantoin, dapsone, organophosphate poisoning, etc.).

Overall, we enrolled 73 subjects, and randomly divided them into two groups. One group (control) was treated with the common Western medicine; and the other (the TCM group) was administrated with the common Western medicine method combined with traditional Chinese medicine (TCM).

Ethical approval: The research related to human use has been complied with all the relevant national regulations, institutional policies and in accordance the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.

Informed consent: Informed consent has been obtained from all individuals included in this study.

2.2 Therapy programs

The Western medicine treatment was as follow. (1) General treatments: in the acute phase, the patient was allowed to rest in bed and the limbs were placed in the functional position. Doctors carefully observed the vital signs, lung and heart function, kept the airway open, turned over the patient on time and discharge respiratory secretions. Those who have difficulty swallowing received nasogastric feeding and was paid attention to the balance of water and electrolytes. Symptomatic treatment was given when abnormalities were found in blood pressure, heart rhythm, defecation, and urination. (2) Intravenous infusion of 5% glucose or 0.9% normal saline plus vitamin B6 (0.2 g/250 ml) once a day; intramuscular injection of vitamin B12 (0.5 mg, once a day); and intravenous infusion of gamma globulin (0.4 g/kg/d) for 5 days.

The additional TCM treatment besides the Western medicine program in the TCM group was as follow. Each patient was given a TCM herbal formula for one month (one package per day). For each package, the herbs were boiled for half an hour, and 600 ml drug juice were acquired. The drug juice drug juice was taken twice per day: half in the morning and half in the evening. The herbal formula was composed by astragalus 60 g, raw licorice 12 g, atractylodes 10 g, phellodendron 10 g, coix seed 10 g, salvia miltiorrhiza 10 g, red peony root 10 g, poria cocos 12 g.

During the treatment process, safety indexes were continually observed, including vital signs, routine blood test indexes, routine urine indexes, acid-base balance, electrocardiogram, liver and kidney functions, adverse reactions or side effects due to medication.

Evaluation of the effect of combined therapy was performed at two time points (before and after one month of treatment), and different dimensions were assessed by according methods, like scale scores and electrophysiology tests.

2.3 TCM syndrome score

The scale was completed by the TCM physician of each patient. Scores are assigned based on the weight of each symptom in the TCM syndrome score system [24, 25, 26, 27]. A score of 4 or more was set for diagnosis, a score above 4 and below 8 indicated a mild syndrome, that above 8 and below 12 indicated a moderate type, and that greater than or equal to 12 implied a severe type. Thereby, the TCM syndrome score should be between 4 to 30.

2.4 Assessment of the activity of daily living

The activity of daily living was assessed by the Barthel indexes [28, 29, 30]. The items include the activity of eating, bathing, dressing, and so on (in all 10 items). This assessment has a full mark of 100, and a score below 60 means the patient has impaired self-care capability.

2.5 Limb function assessment

The limb function was assessed by Hughes functional score [31]. This score is between 0 and 6. A zero score refers to a healthy limb function and score 6 implied the patient dies. A higher score means a more severe function loss of limbs.

2.6 Sensory dysfunction assessment

The sensory dysfunction was determined by a questionnaire with 5 levels (0-4 score) [32]. A zero score refers to a normal sensory and the score 4 means feeling fading or disappearing beyond the shoulder. A higher score indicates a more severe situation of sensory function impairment.

2.7 Efficacy evaluation

The efficacy of each treatment was evaluated, and four outcomes were classified.

Cure: the muscle strength returned to normal, respiratory muscle paralysis and bulbar paralysis disappeared.

Significant efficacy: the muscle strength was improved for at least one grade (score), and the symptoms of respiratory muscle paralysis and bulbar paralysis disappeared within 10 days.

Improvement: muscle strength began recovering and no progression was found, respiratory muscle paralysis and bulbar paralysis symptoms were controlled.

Ineffectiveness: muscle strength did not recover, and paralysis was not improved.

2.8 Electrophysiological examination

We here applied the Dantec CantataTM electromyograph (Denmark, Danish) to examine nerve electrophysiological changes. For each patient, the skin temperature was maintained at 31°C or higher during examination. The sensory and motor conduction ability of median nerve, ulnar nerve and common fibular nerve were measured. The proximal end of each nerve was stimulated by skin electrode, and the compound action potential of the muscle was recorded by the skin electrode at the distal end. For motor nerve conduction, the distal motor latency (DML) and motor conduction velocity (MCV) were measured. And for conduction of sensory nerves, the antidromic technique method was performed to record the sensory conduction velocity (SCV) and sensory nerve action potentials (SNAPs). The stimulating electrodes were placed longitudinally over the nerve to avoid transversally oriented stimuli. A single stimulus was enough to obtain a sizeable action potential.

2.9 Statistical analysis

All the data were expressed as mean ± standard error. The homogeneity of variance was first tested. The paired t-test was used to compare between two time points. Student t-test was used to compare the mean values between two groups. The rank sum test was used for unequal variances. Fisher’s exact test was performed for efficiency rate comparison. A P value less than 0.05 was considered statistically significant.

3 Results

3.1 Clinical features of patients

There were 28 subjects in the control group, including 19 males and 9 females, aged 10 to 67 (37.8±14.0) years, among which 22 cases had prodromal symptoms within 2 weeks before onset. The mean time since onset was 6.3 days [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14]. There were 5 mild cases, 17 moderate, and 6 severe cases. There were 35 patients in the TCM group, including 24 males and 11 females, aged 12-63 (40.1±16.9) years. Before onset, 22 patients exhibited prodromal symptoms within 2 weeks. The TCM group had 6 mild cases, 20 moderate, and 9 severe cases. As table 1 shown, there were no statistically significant differences in age, gender, and disease period (P>0.05) in two groups, and the basal features were comparable.

Table 1

Clinical features of two groups of patients

Group Cases Age Disease period
Control 28 40.143±16.896 6.75±3.82
TCM 35 37.771±13.988 6.31±4.46

3.2 TCM enhanced the treatment efficiency in symptom expression

First, the TCM syndrome scores before and after treatment were analyzed between groups. No differences were found before treatment, and the scores were significantly reduced after treatment in both groups of patients (P < 0.05 for both groups, after treatment vs. before treatment). The TCM group showed an even more dramatical improvement when compared to controls (P < 0.05) (Figure 1A). Next, the ADL score was observed, and, consistently, both groups showed improved daily living activity after treatment (P < 0.05, vs. before treatment). When combined with TCM, the patients exhibited higher ADL score compared to general treatment alone (P < 0.05) (Figure 1B). Similar to ADL, the Hughes functional score suggested that although both therapies had benefited the limb function (P < 0.05, vs. before treatment), TCM showed extra effects in compared with control (P < 0.05) (Figure 1C). Further, the sensory dysfunction was evaluated for each patient. This parameter did not significantly decrease in paired comparison with the basal level for the control group, while it was significantly attenuated in the TCM group, referring to not only one month before (P < 0.05, vs. before treatment) but also the control group (P < 0.05) (Figure 1D). Moreover, the effective rate, as well as all subtypes, were listed in table 2. One month after treatment, two groups showed distinct effective rates. In the control group, there were 6 (21.43%) ineffective cases, 10 (35.71%) improved cases, 11 (39.29%) significantly effective cases, and 1 (3.57%) cured patient. The overall effective rate was 78.59%. In the TCM group, there accounted 2 (5.7%) ineffective, 8 (22.9%) improved, 20 (57.1%) significantly effective, and 5 (14.3%) cured cases. The total effective rate was 94.29%, significantly better than controls (Fisher’s Chi square = 6.7, P < 0.01).

Figure 1 
            TCM enhanced the treatment efficiency in symptom expression. A. The TCM syndrome scores were significantly reduced after treatment in both groups of patients, we observed an even more dramatical improvement in the TCM group compared to controls. B. The activity of daily living (ADL) score was improved in both groups after treatment, patients in the TCM group exhibited higher ADL score compared to general treatment alone. C. TCM showed extra effects in Hughes functional score. D. The sensory dysfunction did not significantly decrease in paired comparison with the basal level for the control group, while it was significantly attenuated in the TCM group. *P < 0.05, paired t-test, after vs. before treatment, #P < 0.05, TCM vs. Control.
Figure 1

TCM enhanced the treatment efficiency in symptom expression. A. The TCM syndrome scores were significantly reduced after treatment in both groups of patients, we observed an even more dramatical improvement in the TCM group compared to controls. B. The activity of daily living (ADL) score was improved in both groups after treatment, patients in the TCM group exhibited higher ADL score compared to general treatment alone. C. TCM showed extra effects in Hughes functional score. D. The sensory dysfunction did not significantly decrease in paired comparison with the basal level for the control group, while it was significantly attenuated in the TCM group. *P < 0.05, paired t-test, after vs. before treatment, #P < 0.05, TCM vs. Control.

Table 2

Efficiency of the general treatment and TCM combination

Group Ineffectiveness Improvement Significant Efficacy Cure Overall Efficiency
Control 6 (21.4%) 10 (35.7%) 11 (39.3%) 1 (3.6%) 78.6%
TCM 2 (5.7%) 8 (22.9%) 20 (57.1%) 5 (14.3%) 94.3%**
  1. **P < 0.01 TCM vs Control.

3.3 TCM improved nerve conduction functions

Electrophysiological examination was performed as well at two time points, which aimed to reveal the nerve conduction mechanism underlying the symptom improvement. We majorly observed the sensory and motor conduction ability of median nerve, ulnar nerve and common fibular nerve. As Figures 2 and 3 shown, each parameter had a similar comparable level between groups before treatment. In the aspect of motor nerve conduction, the TCM group exhibited an overwhelming advantage. The distal motor latency (DML) of median nerve was much shorter, and its motor conduction velocity (MCV) was higher after TCM combination treatment compared to the control (P < 0.05), when both treatments had recovered the DML and MCV in comparison with the baseline (P < 0.05) (Figure 2A and 2B). The two parameters in ulnar nerve failed to recover in the control treatment (P > 0.05), while they were significantly improved in the TCM group (P < 0.05, vs. before treatment) (Figure 2C and 2D). In addition, ulnar MCV in the TCM group was higher compared to the control (P < 0.05) (Figure 2D). As expected, both treatments contributed to the DML and MCV recovery in common fibular nerve (P < 0.05, vs. before treatment) (Figure 2E and 2F); and TCM provided extra benefits compared to the control (P < 0.05) (Figure 2E and 2F). Sensory nerve conduction is another crucial indication of neurologic function and limb recovery. Sensory parameters were recorded, especially sensory conduction velocity (SCV) and sensory nerve action potential (SNAP). In the median nerve and ulnar nerve, SCV and SNAP values in the control patients after treatment were identical as before (P > 0.05) (Figure 3A-D); besides, their SCV levels in the common fibular nerve were also unchanged (P > 0.05) (Figure 3E); only sensory nerve action potential in the common fibular nerve was improved in the control group (P < 0.05, vs. before treatment) (Figure 3F). On the other hand, the TCM group showed significant increases in medium/ ulnar-nerve SCV, and ulnar-nerve SNAP after treatment (P < 0.05, vs. before treatment) (Figure 3A-D). Moreover, the SCV value in the medium nerve was higher than the control group (P < 0.05) (Figure 3A). The SNAP level in common fibular nerve kept unchanged in both groups under therapy administration (P > 0.05) (Figure 3E). Collectively, combination with TCM strongly enhanced the motor and sensory nerve conduction functions compared to general treatment alone.

Figure 2 
            TCM improved motor nerve conduction functions in electrophysiological examination. A, B. The distal motor latency (DML) of median nerve was much shorter, and its motor conduction velocity (MCV) was higher in the TCM group. Both treatments had recovered the DML and MCV in comparison with the baseline. C, D. DML and MCV in ulnar nerve failed to recover in the control treatment, while they were significantly improved in the TCM group. Ulnar MCV in the TCM group was higher compared to the control. E, F. Both treatments contributed to the DML and MCV recovery in common fibular nerve; and TCM provided extra benefits compared to the control. *P < 0.05, paired t-test, after vs. before treatment, #P < 0.05, TCM vs. Control.
Figure 2

TCM improved motor nerve conduction functions in electrophysiological examination. A, B. The distal motor latency (DML) of median nerve was much shorter, and its motor conduction velocity (MCV) was higher in the TCM group. Both treatments had recovered the DML and MCV in comparison with the baseline. C, D. DML and MCV in ulnar nerve failed to recover in the control treatment, while they were significantly improved in the TCM group. Ulnar MCV in the TCM group was higher compared to the control. E, F. Both treatments contributed to the DML and MCV recovery in common fibular nerve; and TCM provided extra benefits compared to the control. *P < 0.05, paired t-test, after vs. before treatment, #P < 0.05, TCM vs. Control.

Figure 3 
            TCM improved sensory nerve conduction functions in electrophysiological examination. In the median nerve and ulnar nerve, sensory conduction velocity (SCV) and sensory nerve action potential (SNAP) values in the control patients after treatment were identical as before (A-D). Their SCV levels in the common fibular nerve were also unchanged (E), only sensory nerve action potential in the common fibular nerve was improved in the control group (F). TCM group showed significant increases in medium/ulnar-nerve SCV, and ulnar-nerve SNAP after treatment (A-D). The SCV value in the medium nerve was higher than the control group (A). The SNAP level in common fibular nerve kept unchanged in both groups under therapy administration (E). *P < 0.05, paired t-test, after vs. before treatment, #P < 0.05, TCM vs. Control.
Figure 3

TCM improved sensory nerve conduction functions in electrophysiological examination. In the median nerve and ulnar nerve, sensory conduction velocity (SCV) and sensory nerve action potential (SNAP) values in the control patients after treatment were identical as before (A-D). Their SCV levels in the common fibular nerve were also unchanged (E), only sensory nerve action potential in the common fibular nerve was improved in the control group (F). TCM group showed significant increases in medium/ulnar-nerve SCV, and ulnar-nerve SNAP after treatment (A-D). The SCV value in the medium nerve was higher than the control group (A). The SNAP level in common fibular nerve kept unchanged in both groups under therapy administration (E). *P < 0.05, paired t-test, after vs. before treatment, #P < 0.05, TCM vs. Control.

4 Discussion

GBS is commonly known to include acute infectious demyelinating polyneuropathy and often shows a rapidly development of multiple peripheral neuropathy. It is also a sort of autoimmune disease and a rare but severe neurologic complication after trauma. At the beginning of GBS, inflammatory cells may disintegrate Schwann cells and phagocytose the myelin sheath, causing segmental demyelination, and occasionally even secondary axonal degeneration [33, 34]. When controlled timely, Schwann cells may begin to proliferate after two weeks of acute demyelination, followed by remyelination and inflammation extinction. As mentioned above, there is no specific drug for GBS treatment, and classical treatments urgently need more supporting therapeutic strategies, e.g. TCM approaches.

Very few researchers have probed to combine TCM medication with current classical GBS treatments. Only one published study suggested that tripterygium polyglycoside, a Chinese herbal medicine, hastened GBS recovery more rapidly than corticosteroids [35]. However, the etiology of GBS is so complicated that any effect of a single component or herb could be extremely limited. The clinical manifestations of GBS are highly similar to the category of flaccidity disease in TCM theory, which might be caused in part by lack of Qi and Yin, as well as “evil heat”, and could be treated by the tonifying-Qi herbs (e.g. astragalus, licorice and Poria cocos) and the removing-damp-heat herbs (e.g. atractylodes, cork, coix seed, radix paeoniae and salvia miltiorrhiza). Here we first proved that compound TCM significantly enhanced the efficiency of common Western medicine in GBS treatment, not only in TCM-symptom scores but also ADL, limb function and sensory function.

In the TCM theory, a lack of Qi is associated with impaired limb function and activities of daily living [36, 37, 38, 39], and the damp-heat evil (a pathogenic factor formed by combination of heat and dampness evils) can cause inflammatory/pain reaction combined with a damage in capacity for action [40, 41, 42]. In the acute phase of GBS, there are frequently symptoms including extensive peripheral nerve demyelination and inflammatory response, motor nerve damage, and even vegetative nerve damage. The performance of these dysfunctions is in consistency with damp-heat syndromes, and theoretically (in TCM), the patients are under the condition of Qi lacking. Given the TCM syndrome differentiation on GBS, our formula mainly applied two strategies: tonifying-Qi and removing-damp-heat. Astragalus and Poria cocos are widely used and low-cost tonifying-Qi herbs in China [39, 43], and licorice is a tonifying-Qi drug with a detoxifcation capability (towards the damp-heat evil)[44, 45]; besides, Poria cocos can also fight the damp evil and accelerate the recovery of limb function [46, 47]; atractylodes and semen coicis are commonly used removing-damp-heat herbs [48, 49, 50], and the combination of salvia, red peony root and phellodendron can remove heat evil in blood and tissues [51, 52, 53]. Together, this TCM formula aimed to cure GBS according to the most frequent performance in the TCM syndrome differentiation when combined with routine medicine treatments.

For those patients divided in the TCM group, we chose an empirical formula to aid the classical treatment. Our formula was expected to exert an additional therapeutic role in GBS recovery theoretically. Wherein, astragalus polysaccharide could promote angiogenesis and fasten the tissue repair [54]. Licorice root shares a similar function to astragalus. Also, licorice has an anti-inflammatory and estrogen-like activity, which helps to attenuate the GBS symptoms [45, 55]. Salvia miltiorrhiza and radix paeoniae are effective in promoting limb function recovery through improving blood supply [56, 57]. Notably, it was reported that that severe fatigue after Guillain-Barré syndrome is related to more pronounced axonal loss [58]. In our TCM prescription, a group of tonifying-Qi herbs had a clear anti-fatigue role [59, 60, 61, 62]. This could be a mechanism of the recovery promoting effect shown in the TCM group.

Electrophysiological examination provides an auxiliary diagnosis for GBS, especially for classifying GBS into subgroups. For those GBS patients with respiratory paralysis, phrenic nerve electrophysiological abnormalities could be applied as important indicators and predictors [63, 64]. Electrodiagnosis was suggested to apply based on various reported phenomenon, such as reversible conduction failure, abnormal distal compound action potentials, etc. [20, 65, 66]. Under demyelination, GBS may lead a decreased motor conduction velocity and prolonged F wave latency in more than 70% of patients [67, 68]. And successful treatment of GBS was known to be accompanied with decreased DMLs, according to Hosokawa et al [66]. In the present study, we observed that GBS treatment decreased the DML and elevated the MCV. This was consistent with known studies. Overall, the changes of SNAP in GBS patients were not significant based on our study, but TCM could intensify the SNAP in ulnar and common fibular nerves. This suggest that there may exist different mechanisms about SNAP changes underlying the onset of GBS and the TCM treatment. Some published studies have also implied abnormal SNAPs (like absent SNAP) in GBS [69]. There are still controversies about whether GBS induces decreased SNAPs so far [65], and more investigations are merited. Finally, a proportion of GBS patients are electrophysiologically unclassified because the underlying pathophysiological mechanisms and lesion distributions are not well defined [66]. Our results may provide some commonalities in electrophysiological changes of GBS, in particular in impaired motor conduction.

5 Conclusion

In conclusion, when combined with TCM administration, the GBS treatment could acquire improved outcomes, including better performance in TCM-symptom score, ADL score, Hughes functional score, sensory dysfunction score, motor nerve conduction and sensory nerve conduction.

  1. Conflict of interest: Authors state no conflict of interest

Abbreviations

DML

distal motor latency

GBS

Guillain-Barré syndrome

MCV

motor conduction velocity

SCV

sensory conduction velocity

SNAPs

sensory nerve action potentials

References

[1] Kalita J, Ranjan A, Misra UK. Outcome of Guillain-Barre syndrome patients with respiratory paralysis. QJM. 2016 May;109(5):319–23.10.1093/qjmed/hcv190Search in Google Scholar

[2] Wolfenden WH, McGUINNESS AE. The Guillain-Barré syndrome with special reference to respiratory paralysis and recurrence. Med J Aust. 1958 Aug;45(5):163–6.10.5694/j.1326-5377.1958.tb67048.xSearch in Google Scholar

[3] Jones HR Jr. Childhood Guillain-Barré syndrome: clinical presentation, diagnosis, and therapy. J Child Neurol. 1996 Jan;11(1):4–12.10.1177/088307389601100102Search in Google Scholar

[4] Leonhard SE, Mandarakas MR, Gondim FA, Bateman K, Ferreira ML, Cornblath DR, et al. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol. 2019 Nov;15(11):671–83.10.1038/s41582-019-0250-9Search in Google Scholar

[5] Toamad U, Kongkamol C, Setthawatcharawanich S, Limapichat K, Phabphal K, Sathirapanya P. Clinical presentations as predictors of prolonged mechanical ventilation in Guillain-Barré syndrome in an institution with limited medical resources. Singapore Med J. 2015 Oct;56(10):558–61.10.11622/smedj.2015152Search in Google Scholar

[6] Wijfjes G. [Medical information for nurses. Guillain-Barré syndrome]. Tijdschr Ziekenverpl. 1987 Sep;41(18):578–83.Search in Google Scholar

[7] Rhee DY, Park GH, Chang SE, Lee MW, Choi JH, Moon KC, et al. Pompholyx after intravenous immunoglobulin therapy for treatment of Guillain-Barré syndrome. J Eur Acad Dermatol Venereol. 2009 May;23(5):602–4.10.1111/j.1468-3083.2008.02980.xSearch in Google Scholar

[8] Velioğlu SK, Ozmenoğlu M, Boz C. Cerebral infarction following intravenous immunoglobulin therapy for Guillain-Barre syndrome. J Stroke Cerebrovasc Dis. 2001 Nov-Dec;10(6):290–2.10.1053/jscd.2001.123772Search in Google Scholar

[9] van Doorn PA. Diagnosis, treatment and prognosis of Guillain-Barré syndrome (GBS). Presse Med. 2013 Jun;42(6 Pt 2):e193–201.10.1016/j.lpm.2013.02.328Search in Google Scholar

[10] Jarrell JT, Gao L, Cohen DS, Huang X. Network Medicine for Alzheimer’s Disease and Traditional Chinese Medicine. Molecules. 2018 May;23(5):E1143.10.3390/molecules23051143Search in Google Scholar

[11] Zhang G, Xiong N, Zhang Z, Liu L, Huang J, Yang J, et al. Effectiveness of traditional Chinese medicine as an adjunct therapy for Parkinson’s disease: a systematic review and meta-analysis. PLoS One. 2015 Mar;10(3):e0118498.10.1371/journal.pone.0118498Search in Google Scholar

[12] Wei S. Potential therapeutic action of natural products from traditional Chinese medicine on Alzheimer’s disease animal models targeting neurotrophic factors. Fundam Clin Pharmacol. 2016 Dec;30(6):490–501.10.1111/fcp.12222Search in Google Scholar

[13] Zhu J, Shen L, Lin X, Hong Y, Feng Y. Clinical Research on Traditional Chinese Medicine compounds and their preparations for Amyotrophic Lateral Sclerosis. Biomed Pharmacother. 2017 Dec;96:854–64.10.1016/j.biopha.2017.09.135Search in Google Scholar

[14] Zhang E, Li M, Zhao J, Dong Y, Yang X, Huang J. Traditional Chinese medicine Yisui Tongjing relieved neural severity in experimental autoimmune neuritis rat model. Neuropsychiatr Dis Treat. 2016 Sep;12:2481–7.10.2147/NDT.S110813Search in Google Scholar

[15] Huang KK, Lin MN, Hsu YL, Lu IH, Pan IH, Yang JL, et al. Alpinia oxyphylla Fruit Extract Ameliorates Experimental Autoimmune Encephalomyelitis through the Regulation of Th1/Th17 Cells. Evid Based Complement Alternat Med. 2019 Mar;2019:6797030.10.1155/2019/6797030Search in Google Scholar

[16] Li W, Wu H, Gao C, Yang D, Yang D, Shen J, et al. Radix Rehmanniae Extract Ameliorates Experimental Autoimmune Encephalomyelitis by Suppressing Macrophage-Derived Nitrative Damage. Front Physiol. 2018 Jul;9:864.10.3389/fphys.2018.00864Search in Google Scholar

[17] Zhong SS, Xiang YJ, Liu PJ, He Y, Yang TT, Wang YY, et al. Effect of Cordyceps sinensis on the Treatment of Experimental Autoimmune Encephalomyelitis: A Pilot Study on Mice Model. Chin Med J (Engl). 2017 Oct;130(19):2296–301.Search in Google Scholar

[18] Nomura T, Bando Y, You H, Tanaka T, Yoshida S. Yokukansan Reduces Cuprizone-Induced Demyelination in the Corpus Callosum Through Anti-inflammatory Effects on Microglia. Neurochem Res. 2017 Dec;42(12):3525–36.10.1007/s11064-017-2400-zSearch in Google Scholar

[19] Van der Meché FG, Van Doorn PA, Meulstee J, Jennekens FG; GBS-consensus group of the Dutch Neuromuscular Research Support Centre. Diagnostic and classification criteria for the Guillain-Barré syndrome. Eur Neurol. 2001;45(3):133–9.10.1159/000052111Search in Google Scholar

[20] Kalita J, Misra UK, Das M. Neurophysiological criteria in the diagnosis of different clinical types of Guillain-Barre syndrome. J Neurol Neurosurg Psychiatry. 2008 Mar;79(3):289–93.10.1136/jnnp.2007.118000Search in Google Scholar

[21] van den Berg B, Walgaard C, Drenthen J, Fokke C, Jacobs BC, van Doorn PA. Guillain-Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol. 2014 Aug;10(8):469–82.10.1038/nrneurol.2014.121Search in Google Scholar

[22] Nasiri J, Ghazavi M, Yaghini O, Chaldavi M. Clinical Features and Outcome of Guillain-Barré Syndrome in Children. Iran J Child Neurol. 2018;12(2):49–57.Search in Google Scholar

[23] Zeng Y, Liu Y, Xie Y, Liang J, Xiao Z, Lu Z. Clinical Features and the Validation of the Brighton Criteria in Guillain-Barré Syndrome: Retrospective Analysis of 72 Hospitalized Patients in Three Years. Eur Neurol. 2019;81(5-6):231–8.10.1159/000503101Search in Google Scholar

[24] Li S, Li JP. Treatment effects of Chinese medicine (Yi-Qi-Qing-Jie herbal compound) combined with immunosuppression therapies in IgA nephropathy patients with high-risk of end-stage renal disease (TCM-WINE): study protocol for a randomized controlled trial. Trials. 2020 Jan;21(1):31.10.1186/s13063-019-3989-9Search in Google Scholar

[25] Chen Z, Zhou D, Wang Y, Lan H, Duan X, Li B, et al. Fire needle acupuncture or moxibustion for chronic plaque psoriasis: study protocol for a randomized controlled trial. Trials. 2019 Dec;20(1):674.10.1186/s13063-019-3736-2Search in Google Scholar

[26] Xiong C, Li Y, Zeng Y, Wei H, Zhuang GT, Li L, et al. Chinese Herbal Medicine Versus Placebo for the Treatment Of Chronic Obstructive Pulmonary Disease: A Protocol of Systematic Review and Meta-analysis. Medicine (Baltimore). 2019 Aug;98(35):e17002.10.1097/MD.0000000000017002Search in Google Scholar

[27] Wang Y, Zhang Y, Du Y, Yang Y, Wei J, Zhang N, et al. A multicenter, randomized, double-blind, placebo-controlled trial evaluating the efficacy and safety of Taoren Honghua Jian granule in patients with stable coronary artery disease. Medicine (Baltimore). 2019 Nov;98(44):e17753.10.1097/MD.0000000000017753Search in Google Scholar

[28] Schlote A, Krüger J, Topp H, Wallesch CW. [Inter-rater reliability of the Barthel Index, the Activity Index, and the Nottingham Extended Activities of Daily Living: the use of ADL instruments in stroke rehabilitation by medical and non medical personnel]. Rehabilitation (Stuttg). 2004 Apr;43(2):75–82.10.1055/s-2003-814898Search in Google Scholar

[29] Barthel Activities of Daily Living (ADL) Index. Barthel Activities of Daily Living (ADL) Index. Occas Pap R Coll Gen Pract. 1993 Apr;(59):24.Search in Google Scholar

[30] Chino N. Efficacy of Barthel index in evaluating activities of daily living in Japan, the United States, and United Kingdom. Stroke. 1990 Sep;21(9 Suppl):II64–5.Search in Google Scholar

[31] Freeman JM, Bennett MR. The growth of segmental nerves from the spinal cord to the hind limb-bud in the axolotl. Aust J Exp Biol Med Sci. 1982 Apr;60(Pt 2):133–46.10.1038/icb.1982.14Search in Google Scholar

[32] Hughes RA, Newsom-Davis JM, Perkin GD, Pierce JM. Controlled trial prednisolone in acute polyneuropathy. Lancet. 1978 Oct;2(8093):750–3.10.1016/S0140-6736(78)92644-2Search in Google Scholar

[33] Kuwabara S, Yuki N, Koga M, Hattori T, Matsuura D, Miyake M, et al. IgG anti-GM1 antibody is associated with reversible conduction failure and axonal degeneration in Guillain-Barré syndrome. Ann Neurol. 1998 Aug;44(2):202–8.10.1002/ana.410440210Search in Google Scholar

[34] Yuki N, Sato S, Inuzuka T, Miyatake T, Yoshino H. Axonal degeneration in the Guillain-Barré syndrome and anti-GM1 ganglioside antibodies. Muscle Nerve. 1992 Jan;15(1):116.10.1002/mus.880150806Search in Google Scholar

[35] Hughes RA, Pritchard J, Hadden RD. Pharmacological treatment other than corticosteroids, intravenous immunoglobulin and plasma exchange for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2013 Feb;(2):CD008630.10.1002/14651858.CD008630.pub3Search in Google Scholar

[36] Chen S, Yao X, Liang Y, Mei W, Liu X, Zhang C. Alzheimer’s disease treated with combined therapy based on nourishing marrow and reinforcing Qi. J Tradit Chin Med. 2015 Jun;35(3):255–9.10.1016/S0254-6272(15)30094-7Search in Google Scholar

[37] Su K, Zhu F, Guo L, Zhu Y, Li W, Xiong X. Retrospective study on Professor Zhongying Zhou’s experience in Traditional Chinese Medicine treatment on diabetic nephropathy. J Tradit Chin Med. 2013 Apr;33(2):262–7.10.1016/S0254-6272(13)60137-5Search in Google Scholar

[38] Yang XH, et al. [Observation on 27 elderly women in britain with lymphedema syndrome treated by acupuncture combined with medicine]. Zhongguo Zhenjiu. 2009;29(12):998–1000.Search in Google Scholar

[39] Chen R, Shao H, Lin S, Zhang JJ, Xu KQ. Treatment with Astragalus membranaceus produces antioxidative effects and attenuates intestinal mucosa injury induced by intestinal ischemia-reperfusion in rats. Am J Chin Med. 2011;39(5):879–87.10.1142/S0192415X11009275Search in Google Scholar

[40] Wan TX, Dai EL, Wang WG, Liu TX, Liu F, Li YX, et al. [Correlation Study on Pathological Characteristics of Target Organs and Excess Evil Syndrome in IgA Nephropathy]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2015 Sep;35(9):1044–9.Search in Google Scholar

[41] Liu M, et al. Relationship between ultrasound imaging and traditional Chinese medicine syndrome in limb lymphedema. J Chin Integr Med. 2009;7(5):418–21.10.3736/jcim20090504Search in Google Scholar

[42] Liu D, Yan J, Yun M, Yang M, Luo Y, Zhang J, et al. Effect of Sanhuangyilong decoction plus methotrexate on tumor necrosis factor alpha and interferon gamma in serum and synovial fluid in rheumatoid arthritis patients with symptom pattern of damp heat obstruction. J Tradit Chin Med. 2016 Oct;36(5):625–33.10.1016/S0254-6272(16)30082-6Search in Google Scholar

[43] Zhang Q, Zhang ZJ, Wang XH, Ma J, Song YH, Liang M, et al. The prescriptions from Shenghui soup enhanced neurite growth and GAP-43 expression level in PC12 cells. BMC Complement Altern Med. 2016 Sep;16(1):369.10.1186/s12906-016-1339-ySearch in Google Scholar

[44] Zhang Y, Wang M, Yang J, Li X. The Effects of the Honey-Roasting Process on the Pharmacokinetics of the Six Active Compounds of Licorice. Evid Based Complement Alternat Med. 2018 Jun;2018:5731276.10.1155/2018/5731276Search in Google Scholar

[45] Yang R, Yuan BC, Ma YS, Zhou S, Liu Y. The anti-inflammatory activity of licorice, a widely used Chinese herb. Pharm Biol. 2017 Dec;55(1):5–18.10.1080/13880209.2016.1225775Search in Google Scholar

[46] Zhao J, Niu X, Yu J, Xiao X, Li W, Zang L, et al. Poria cocos polysaccharides attenuated ox-LDL-induced inflammation and oxidative stress via ERK activated Nrf2/HO-1 signaling pathway and inhibited foam cell formation in VSMCs. Int Immuno-pharmacol. 2020 Jan;80:106173.10.1016/j.intimp.2019.106173Search in Google Scholar

[47] Kang KY, Hwang YH, Lee SJ, Jang HY, Hong SG, Mun SK, et al. Verification of the Functional Antioxidant Activity and Antime-lanogenic Properties of Extracts of Poria cocos Mycelium Fermented with Freeze-Dried Plum Powder. Int J Biomater. 2019 Jun;2019:9283207.10.1155/2019/9283207Search in Google Scholar

[48] Xu D, Li B, Cao N, Li W, Tian Y, Huang Y. The protective effects of polysaccharide of Atractylodes macrocephala Koidz (PAMK) on the chicken spleen under heat stress via antagonizing apoptosis and restoring the immune function. Oncotarget. 2017 Jul;8(41):70394–405.10.18632/oncotarget.19709Search in Google Scholar

[49] Xu D, Tian Y. Selenium and Polysaccharides of Atractylodes macrocephala Koidz Play Different Roles in Improving the Immune Response Induced by Heat Stress in Chickens. Biol Trace Elem Res. 2015 Nov;168(1):235–41.10.1007/s12011-015-0351-2Search in Google Scholar

[50] Nie DR, Wang J, Huang XW, Guo JC, Zong YP, Zhang PW, et al. [Study on characteristics and data mining of 464 cases of lung diseases in Xin’an Wang’s medicine]. Zhongguo Zhong Yao Za Zhi. 2019 Jun;44(11):2397–402.Search in Google Scholar

[51] Zhou X, Chan SW, Tseng HL, Deng Y, Hoi PM, Choi PS, et al. Danshensu is the major marker for the antioxidant and vasorelaxation effects of Danshen (Salvia miltiorrhiza) water-extracts produced by different heat water-extractions. Phytomedicine. 2012 Nov;19(14):1263–9.10.1016/j.phymed.2012.08.011Search in Google Scholar

[52] Xie WG, Ma XC, Shao NS. [Preliminary study on change of serum proteome in noxious heat blood stasis syndrome treated by radix Paeoniae rubra]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2005 Jun;25(6):520–4.Search in Google Scholar

[53] Oshima N, Shimizu T, Narukawa Y, Hada N, Kiuchi F. Quantitative analysis of the anti-inflammatory activity of orengedokuto II: berberine is responsible for the inhibition of NO production. J Nat Med. 2018 Jun;72(3):706–14.10.1007/s11418-018-1209-7Search in Google Scholar

[54] Tu S, Shao A, Ren L, Chen T, Yao D. Angiogenesis effect of Astragalus polysaccharide combined with endothelial progenitor cells therapy in diabetic male rat following experimental hind limb ischemia. Chin Med J (Engl). 2014;127(11):2121–8.Search in Google Scholar

[55] Somjen D, Knoll E, Vaya J, Stern N, Tamir S. Estrogen-like activity of licorice root constituents: glabridin and glabrene, in vascular tissues in vitro and in vivo. J Steroid Biochem Mol Biol. 2004 Jul;91(3):147–55.10.1016/j.jsbmb.2004.04.003Search in Google Scholar

[56] Zhang JY, Liu JL, Hu MZ, Chai BF. Hemodynamic chanaes after limb trauma. II. The effects of Radix Salviae Miltiorrhizae on the blood volumes of rabbit forearms following soft tissue contusion. Chin Med J (Engl). 1980 Jul;93(7):451–8.Search in Google Scholar

[57] Zhao LJ, Men XL, Kong XY, Li HJ, Zhao X, Zhang LY. [Preventive effects of Salvia miltiorrhiza on multiple organ edema in the rats of limb ischemia/reperfusion]. Zhongguo Ying Yong Sheng Li Xue Za Zhi. 2012 May;28(3):281–3.Search in Google Scholar

[58] Drenthen J, Jacobs BC, Maathuis EM, van Doorn PA, Visser GH, Blok JH. Residual fatigue in Guillain-Barre syndrome is related to axonal loss. Neurology. 2013 Nov;81(21):1827–31.10.1212/01.wnl.0000436073.21406.e6Search in Google Scholar

[59] Zhang G, Zhou SM, Zheng SJ, Liu FY, Gao YQ. Astragalus on the anti-fatigue effect in hypoxic mice. Int J Clin Exp Med. 2015 Aug;8(8):14030–5.Search in Google Scholar

[60] Xiaoming W, Ling L, Jinghang Z. Antioxidant and anti-fatigue activities of flavonoids from Puerariae radix. Afr J Tradit Complement Altern Med. 2011 Dec;9(2):221–7.10.4314/ajtcam.v9i2.6Search in Google Scholar

[61] Tan W, Yu KQ, Liu YY, Ouyang MZ, Yan MH, Luo R, et al. Anti-fatigue activity of polysaccharides extract from Radix Rehmanniae Preparata. Int J Biol Macromol. 2012 Jan;50(1):59–62.10.1016/j.ijbiomac.2011.09.019Search in Google Scholar

[62] Sheng R, Xu X, Tang Q, Bian D, Li Y, Qian C, et al. Polysaccharide of radix pseudostellariae improves chronic fatigue syndrome induced by poly I:C in mice. Evid Based Complement Alternat Med. 2011;2011:840516.10.1093/ecam/nep208Search in Google Scholar

[63] Bolton CF, Sharshar T, Lofaso F. Significance of phrenic nerve electrophysiological abnormalities in Guillain-Barré syndrome. Neurology. 2006 Jun;66(12):1961.10.1212/01.wnl.0000227126.77643.71Search in Google Scholar

[64] Durand MC, Prigent H, Sivadon-Tardy V, Orlikowski D, Caudie C, Devaux C, et al. Significance of phrenic nerve electrophysio-logical abnormalities in Guillain-Barré syndrome. Neurology. 2005 Nov;65(10):1646–9.10.1212/01.wnl.0000184589.62101.b9Search in Google Scholar

[65] Chan YC, Punzalan-Sotelo AM, Kannan TA, Shahrizaila N, Umapathi T, Goh EJ, et al. Electrodiagnosis of reversible conduction failure in Guillain-Barré syndrome. Muscle Nerve. 2017 Nov;56(5):919–24.10.1002/mus.25577Search in Google Scholar

[66] Hosokawa T, Nakajima H, Unoda K, Yamane K, Doi Y, Ishida S, et al. Serial electrophysiological findings in Guillain-Barré syndrome not fulfilling AIDP or AMAN criteria. J Neurol. 2016 Sep;263(9):1709–18.10.1007/s00415-016-8192-2Search in Google Scholar

[67] Baraba R, Sruk A, Sragalj L, Butković-Soldo S, Bielen I. Electro-physiological findings in early Guillain-Barré syndrome. Acta Clin Croat. 2011 Jun;50(2):201–7.Search in Google Scholar

[68] Zhang X, Tang X, Zhang Z, Du H, Li B. Electrophysiological forms of Guillain-Barre syndrome in Beijing suburb. Chin Med J (Engl). 1997 Nov;110(11):856–8.10.1016/0924-980X(95)93264-TSearch in Google Scholar

[69] Rajabally YA, Hassan-Smith G, Notturno F, Eames PJ, Hayton T, Capasso M, et al. Motor and sensory conduction failure in overlap of Guillain-Barré and Miller Fisher syndrome: two simultaneous cases. J Neurol Sci. 2011 Apr;303(1-2):35–8.10.1016/j.jns.2011.01.019Search in Google Scholar

Received: 2019-10-23
Accepted: 2020-01-31
Published Online: 2020-02-29

© 2020 Xiumin Zhao, Liu Yang published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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