To analyze the correlation between repetitive nerve stimulation (RNS) characteristics and the severity of myasthenia gravis (MG), and to explore its application in evaluating the efficacy of integrated traditional Chinese and Western medicine treatment for generalized myasthenia gravis (GMG). Methods: Adult GMG patients with spleen-kidney deficiency type, admitted to Wuhan Integrated Hospital of Traditional Chinese and Western Medicine from May 2021 to December 2023, were selected and randomly divided into a Western medicine group and an integrated traditional Chinese and Western medicine group. The neuro-electrophysiological characteristics of RNS in all enrolled patients were compared, including the positive rate, distribution of positive muscles, and the maximum amplitude decrement ratio of the compound muscle action potential (CMAP). The correlation between the CMAP maximum amplitude decrement ratio and the Quantitative Myasthenia Gravis Score (QMGs), the Myasthenia Gravis Activities of Daily Living (MG-ADL) scale, and the traditional Chinese medicine (TCM) symptom score in assessing GMG condition was analyzed. Changes in the CMAP maximum amplitude decrement ratio, QMGs score, MG-ADL score, and TCM symptom score before treatment, and at 3 and 6 months after treatment were compared and analyzed between the two groups. Results: A total of 74 GMG patients were enrolled, with 66 actually completing the clinical observation (35 in the Western medicine group, 31 in the integrated medicine group). Among the enrolled patients, the RNS positive rate was 81.82% to 94.44% , with no statistically significant difference in positive rates among patients of different MGFA types (P>0.05). The distribution of RNS positive muscles was consistent with the range of myasthenia involvement, showing facial nerve > accessory nerve > median nerve. As the MGFA type increased, the CMAP maximum amplitude decrement ratio showed an upward trend, but the difference was not statistically significant (P>0.05). Before treatment, and at 3 and 6 months after treatment, there was no significant correlation between the CMAP maximum amplitude decrement ratio and the QMGs score (P>0.05). Before treatment and at 6 months after treatment, there was a correlation between the CMAP maximum amplitude decrement ratio and the MG-ADL score (P<0.05). Before treatment, there was a correlation between the CMAP maximum amplitude decrement ratio and the TCM symptom score (P<0.05). After treatment, the CMAP maximum amplitude decrement ratio, QMGs score, MG-ADL score, and TCM symptom score in both groups were significantly lower than before treatment (P<0.01). Intergroup comparison results showed that at 3 and 6 months of treatment, the TCM symptom score in the integrated medicine group was lower than that in the Western medicine group (P<0.05). Conclusion: In GMG patients, the RNS positive rate is high. The CMAP maximum amplitude decrement ratio has reference significance in assessing the severity of GMG, the improvement in patients’daily living ability, and the improvement in TCM symptom scores.