This study involved eight kinds of traditional Chinese medicine prescriptions.

The effective rate and the incidence of adverse reactions were outcome indicators.

We determined the benefits of different combinations to guide clinical practice.

Myasthenia gravis is an autoimmune disease that primarily affects the acetylcholine receptors on the postsynaptic membrane at the neuromuscular junction. Traditional Chinese medicine (TCM) TSQNM formulas have been widely utilized in clinical practice and have shown effectiveness in treating Myasthenia gravis. There is a broad spectrum of TCM formulas with varying effectiveness, but there is a lack of direct comparative evidence between them. Bayesian network meta-analysis was utilized to evaluate the clinical efficacy and safety of TCM formulations that focus on spleen tonification, qi enhancement, and marrow nourishment (referred to as TSQNM) for treating myasthenia gravis. The results are anticipated to provide valuable insights into the treatment of myasthenia gravis.

Pertinent randomized controlled trials were retrieved from databases from the inception of the databases to October 17, 2023. The quality of studies was assessed using the risk of bias assessment tool developed by the Cochrane Collaboration. It was also preregistered in PROSPERO (ID: CRD42023482260). Network meta-analysis was conducted using STATA16 and R4.2.3.

Twenty studies were included, involving 1 473 participants, with 739 cases in the experimental group and 734 cases in the control group. These studies examined the effectiveness of eight TCM formulas.

Combining conventional Western medicine treatment with TSQNM formulas has been shown to provide superior therapeutic effects for patients with myasthenia gravis, compared to using prescription drugs alone. Notably, when Buzhong Yiqi Decoction is combined with conventional Western medicine treatment, it has shown remarkable efficacy in reducing hormone-induced obesity and gastrointestinal tract discomfort.

Conventional Western medicine treatment

Deviance information criterion

Low-density lipoprotein receptor-related protein 4

Muscle-specific tyrosine kinase

Systematic Reviews and Network Meta-Analysis

Randomized controlled trials

Cumulative ranking curve

Combination of traditional Chinese medicine

Network meta-analysis

Traditional Chinese medicine formulations

Myasthenia gravis

Adverse reaction

Efficient

© 2025 The Authors. Published by Elsevier GmbH.