Advances in the treatment of diabetic peripheral neuropathy by modulating gut microbiota with traditional Chinese medicine

Diabetic peripheral neuropathy(DPN)is one of the strongest risk factors for diabetic foot ulcers(neuropathic ulcerations)and the existing ulcers may further deteriorate due to the damage to sensory neurons.Moreover,the resulting numbness in the limbs causes difficulty in discovering these ulcerations in a short time.DPN is associated with gut microbiota dysbiosis.Traditional Chinese medicine(TCM)compounds such as Shenqi Dihuang Decoction,Huangkui Capsules and Qidi Tangshen Granules can reduce the clinical symptoms of diabetic nephropathy by modulating gut microbiota.The current review discusses whether TCM compounds can reduce the risk of DPN by improving gut microbiota.

HHO optimized support vector machine classifier for traditional Chinese medicine syndrome differentiation of diabetic retinopathy

AIM:To develop a classifier for traditional Chinese medicine(TCM)syndrome differentiation of diabetic retinopathy(DR),using optimized machine learning algorithms,which can provide the basis for TCM objective and intelligent syndrome differentiation.METHODS:Collated data on real-world DR cases were collected.A variety of machine learning methods were used to construct TCM syndrome classification model,and the best performance was selected as the basic model.Genetic Algorithm(GA)was used for feature selection to obtain the optimal feature combination.Harris Hawk Optimization(HHO)was used for parameter optimization,and a classification model based on feature selection and parameter optimization was constructed.The performance of the model was compared with other optimization algorithms.The models were evaluated with accuracy,precision,recall,and F1 score as indicators.RESULTS:Data on 970 cases that met screening requirements were collected.Support Vector Machine(SVM)was the best basic classification model.The accuracy rate of the model was 82.05%,the precision rate was 82.34%,the recall rate was 81.81%,and the F1 value was 81.76%.After GA screening,the optimal feature combination contained 37 feature values,which was consistent with TCM clinical practice.The model based on optimal combination and SVM(GA_SVM)had an accuracy improvement of 1.92%compared to the basic classifier.SVM model based on HHO and GA optimization(HHO_GA_SVM)had the best performance and convergence speed compared with other optimization algorithms.Compared with the basic classification model,the accuracy was improved by 3.51%.CONCLUSION:HHO and GA optimization can improve the model performance of SVM in TCM syndrome differentiation of DR.It provides a new method and research idea for TCM intelligent assisted syndrome differentiation.

Detection of consensuses and treatment principles of diabetic nephropathy in traditional Chinese medicine: A new approach

Objective:To propose and test a new approach based on community detection in the field of social computing for uncovering consensuses and treatment principles in traditional Chinese medicine(TCM).Methods:Three Chinese databases(CNKI,VIP,andWan Fang Data)were searched for published articles on TCM treatment of diabetic nephropathy(DN)from their inception until September 31,2014.Zheng classification and herbdatawereextractedfromincluded articlesand usedto construct a Zheng classification and treatment of diabetic nephropathy(DNZCT)network with nodes denoting Zhengs and herbs and edges denoting corresponding treating relationshipsamong them.Community detection was applied to the DNZCT and detected community structures were analyzed.Results:A network of 201 nodes and 743 edges were constructed and six communities were detected.Nodes clustered in the samecommunity captured the samesemantic topic;different communities had unique characteristics,and indicated different treatment principles.Large communities usually represented similar points of view or consensuses on common Zheng diagnoses and herb prescriptions;small communities might help to indicate unusual Zhengs and herbs.Conclusion:The results suggest that the community detection-based approach is useful and feasible for uncovering consensuses and treatment principles of DN treatment in TCM,and could be used to address other similar problems in TCM.

Traditional Chinese Medicine Nursing Protocols for Diabetic Nephropathy

As a dreaded consequence of diabetes mellitus (DM),diabetic nephropathy (DN)accounts for about 40%of end-stage renal disease (ESRD). It is a universal cause of ESRD,and can be considered as an independent risk factor for cardiovascular disease. In recent years,TCM has show n its unique advantages in the treatment of DN. As one of the chronic diseases caused by living styles,DN has the higher requirements for nursing. Nevertheless,TCM nursing based on syndrome differentiation can provide the personalized guidance for the patients w ith DN according to different syndrome patterns and symptoms. Therefore,this article mainly explored the key points of common syndromes,TCM nursing methods and health guidance of DN in order to further develop the advantages of TCM,improve its efficacy and standardized its nursing behavior.

Mechanism analysis of Traditional Chinese Medicine in treatment of Diabetic Nephropathy based on network pharmacology and Traditional Chinese Medicine inheritance support system

Diabetic nephropathy is one of the most serious complications of diabetes mellitus. In the early stage, edema and proteinuria are the main clinical manifestations. In the later stage, glomerulosclerosis and interstitial fibrosis will occur. And the prognosis is poor. Nowadays, traditional Chinese medicine has a remarkable curative effect in the treatment of diabetic nephropathy. There are more and more studies on the treatment of diabetic nephropathy with traditional Chinese medicine, but most of them focus on the syndromes of diabetic nephropathy, which are short of in-depth research and summary on the mechanism of Chinese herbal prescriptions. In this paper, the traditional Chinese medicine inheritance support system and network pharmacology BATMAN-TCM software were used to collect and analyze the relevant literature. It was found that the core compatibility of Shanzhuyu, Fuling and Shuyu in the treatment of diabetic nephropathy is closely related to the signal transduction pathway and target of diabetic nephropathy, and has a positive effect on the improvement of clinical symptoms such as proteinuria, glycometabolism disorder, edema, etc. This paper explores the core compatibility of Shanzhuyu, Fuling and Shuyu on diabetic nephropathy, in order to provide reference for clinical treatment.

Research Progress on Prevention and Treatment of Diabetes with Traditional Chinese Medicine Based on Intestinal Flora

In recent years,the World Health Organization has proposed the concept that only intes‐tinal health can lead to longevity.It can be seen that gut microbiota plays an important role in maintaining human health,and gut microbiota has become a hot topic in medical research.With the change of Chinese residents'lifestyle,the incidence rate of diabetes is increasing rapidly.Research shows that the incidence of diabetes is closely related to intestinal flora imbalance.Traditional Chinese medicine can reduce blood sugar and improve clinical symptoms by regulating intestinal flora.Based on the theory of tradi‐tional Chinese medicine,this paper discusses the etiology and pathogenesis of intestinal flora imbalance,and provides a theoretical basis for traditional Chinese medicine to regu‐late intestinal flora to prevent and treat diabetes.Intestinal flora is a complex ecosystem,which plays an important role in maintaining human health.The imbalance of intestinal flora may lead to the occurrence of diabetes.The dynamic balance of gut microbiota is closely related to the kidneys,spleen,liver,and lungs.Traditional Chinese medicine monomer and compound can prevent and cure diabetes by regulating intestinal flora.

Research Progress of Treating Diabetic Nephropathy with Traditional Chinese Medicine

By collecting and sorting out the literature and journals on the clinical use of Chinese medicine in the treatment of diabetic nephropathy in recent years,it is concluded that Chinese medicine is effective in the treatment of DKD.Chinese medicine therapy has a unique role in the treatment of diabetic nephropathy.How to correct syndrome differentiation and treatment?Improving clinical effects is the research direction that all medical staff will work together in the future.

Advances in traditional Chinese medicine as adjuvant therapy for diabetic foot

Diabetes mellitus(DM)is a complex disease that often causes multiple systemic complications that have become a major international public health problem.Diabetic foot(DF)is one of the severe and frequent chronic complications of DM due to vascular lesions and neuropathy.DF ulcers(DFU)affect approximately 15%of people with DM and are the leading cause of death and disability.The prevalence and recurrence of DF are worrisome,and morbidity and mortality are also on the rise,which poses a substantial socioeconomic burden.Treating DF is difficult for clinicians and requires multidisciplinary cooperation,combining local and systemic therapy to reduce amputation and case-fatality rates.Traditional Chinese Medicine(TCM)has received extensive attention due to noticeable therapeutic effects and few adverse reactions.In recent years,research on DF treatment by TCM has been increasing,and further progress has been made.TCM includes oral medication,injectable preparations,and adjuvant therapy.This article reviews the relevant research on TCM-related adjuvant therapy for DF.We describe current progress in TCM in terms of external application,acupuncture,massage,acupoint injection,foot bath,fumigation,and moxibustion,as well as the mechanisms involved.

Current scenario of traditional medicines in management of diabetic foot ulcers:A review

Diabetic foot infections and diabetic foot ulcers(DFU)cause significant suffering and are often recurring.DFU have three important pathogenic factors,namely,microangiopathy causing local tissue anoxia,neuropathy making the foot prone to injuries from trivial trauma,and local tissue hyperglycaemia favouring infection and delaying the wound healing.DFU have been the leading cause for non-traumatic amputations of part or whole of the limb.Western medicines focus mainly on euglycaemia,antimicrobials,debridement and wound cover with grafts,and off-loading techniques.Advances in euglycaemic control,foot care and footwear,systemic antimicrobial therapy,and overall health care access and delivery,have resulted in an overall decrease in amputations.However,the process of wound care after adequate debridement remains a major cost burden globally,especially in developing nations.This process revolves around two basic concerns regarding control/eradication of local infection and promotion of faster healing in a chronic DFU without recurrence.Wound modulation with various dressings and techniques are often a costly affair.Some aspects of the topical therapy with modern/Western medicines are frequently not addressed.Cost of and compliance to these therapies are important as both the wounds and their treatment are“chronic.”Naturally occurring agents/medications from traditional medicine systems have been used frequently in different cultures and nations,though without adequate clinical base/relevance.Traditional Chinese medicine involves restoring yin-yang balance,regulating the‘chi’,and promoting local blood circulation.Traditional medicines from India have been emphasizing on‘naturally’available products to control wound infection and promote all the aspects of wound healing.There is one more group of chemicals which are not pharmaceutical agents but can create acidic milieu in the wound to satisfy the above-mentioned basic concerns.Various natural and plant derived products(e.g.,honey,aloe vera,oils,and calendula)and maggots are also used for wound healing purposes.We believe that patients with a chronic wound are so tired physically,emotionally,and financially that they usually accept native traditional medicine which has the same cultural base,belief,and faith.Many of these products have never been tested in accordance to“evidence-based medicine.”There are usually case reports and experience-based reports about these products.Recently,there have been some trials(in vitro and in vivo)to verify the claims of usage of traditional medicines in management of DFU.Such studies show that these natural products enhance the healing process by controlling infection,stimulating granulation tissue,antimicrobial action,promoting fibroblastic activity and collagen deposition,etc.In this review,we attempt to study and analyse the available literature on results of topical traditional medicines,which are usually advocated in the management of DFU.An integrated and‘holistic’approach of both modern and traditional medicine may be more acceptable to the patient,cost effective,and easy to administer and monitor.This may also nevertheless lead to further improvement in quality of life and decrease in the rates of amputations for DFU.

Effectiveness and safety of traditional Chinese medicine for diabetic retinopathy:A systematic review and network meta-analysis of randomized clinical trials

BACKGROUND Diabetic retinopathy(DR)is currently recognized as one of the most serious diabetic microangiopathies and a major cause of adult blindness.Commonly used clinical approaches include etiological control,microvascular improvement,and surgical intervention,but they are ineffective and have many side effects.Oral Chinese medicine(OCM)has been used for thousands of years to treat DR and is still widely used today,but it is unclear which OCM is more effective for DR.AIM To estimate relative effectiveness and safety profiles for different classes of OCMs for DR,and provide rankings of the available OCMs.METHODS The search time frame was from the creation of the database to January 2023.RevMan 5.3 and Stata 14.0 software were used to perform the systematic review and Network meta-analyses(NMA).RESULTS A total of 107 studies and 9710 patients were included,including 4767 cases in the test group and 4973 cases in the control group.Based on previous studies and clinical reports,and combined with the recommendations of Chinese guidelines for the prevention and treatment of DR,9 OCMs were finally included in this study,namely Compound Xueshuantong Capsules,Qiming Granules,Compound Danshen Dripping Pills,Hexue Mingmu Tablets(HXMM),Qiju Dihuang Pills(QJDH),Shuangdan Mingmu Capsules(SDMM),Danggui Buxue Decoction(DGBX),Xuefu Zhuyu Decoction and Buyang Huanwu Decoction.When these nine OCMs were analyzed in combination with conventional western medicine treatment(CT)compared with CT alone,the NMA results showed that HXMM+CT has better intervention effect on the overall efficacy of DR patients,HXMM+CT has better effect on improving patients'visual acuity,SDMM+CT has better effect on inhibiting vascular endothelial growth factor,DGBX+CT has better effect on reducing fundus hemorrhage area,HXMM+CT has better effect on reducing fasting blood glucose,and QJDH+CT has better effect on reducing glycated hemoglobin.When there are not enough clinical indicators for reference,SDMM+CT or HXMM+CT treatments can be chosen because they are effective for more indicators and demonstrate multidimensional efficacy.CONCLUSION This study provides evidence that combining OCMs with CT leads to better outcomes in all aspects of DR compared to using CT alone.Based on the findings,we highly recommend the use of SDMM or HXMM for the treatment of DR.These two OCMs have demonstrated outstanding efficacy across multiple indicators.

Effectiveness and safety of traditional Chinese medicine decoction for diabetic gastroparesis:A network meta-analysis

BACKGROUND Diabetic gastroparesis(DGP)is a prevalent complication of diabetes that impairs people's quality of life and places a significant financial burden on them.The gastrointestinal symptoms of DGP patients can be improved by several Traditional Chinese Medicine(TCM)decoctions that have been shown to be effective in treating the disease.There are still many unanswered questions regarding the identification of appropriate therapeutic agents for the treatment of DGP in clinical practice.AIM To analyze the efficacy of several TCM decoctions in the treatment of DGP using Bayesian network meta-analysis for reference.METHODS PubMed,EMBASE,Cochrane Library,Web of Science,China National Knowledge Infrastructure,The China Biology Medicine DVD,Wanfang,and CQVIP were searched from inception to September 17,2022,to collect randomized controlled trials(RCTs)about TCM decoctions for DGP.Clinical effects and symptom scores were the primary outcomes.Additionally,we assessed motilin(MOT),somatostatin(SS),gastrin(GAS),gastric emptying rate,gastric emptying time,and adverse drug events as secondary outcomes.RESULTS A total of 67 eligible RCTs involving 4790 DGP patients and 7 TCM decoctions were included.The results of network meta-analysis(NMA)and surface under the cumulative ranking curve showed that with western medicine(WM)as a common control,the Banxia Xiexin Decoction(BXXD)+WM was most effective in clinical effects and enhancing early satiety scores;the Simo decoction(SMD)+WM was most effective in improving nausea and vomiting scores and anorexia scores,bloating scores;the Chaishao Liujunzi Decoction(CSLJD)was most effective in MOT,the Zhishi Xiaopi Decoction(ZSXPD)was most effective in SS and upgrading emptying rate;the Jianpi Xiaozhi Decoction was most effective in GAS;the CSLJD+WM was most effective in improving gastric emptying time.CONCLUSION These NMA results suggest that the BXXD+WM and SMD+WM may be one of the potential optimal treatments.Due to various limitations,further large-sample,double-blind,multi-center randomized RCTs are needed.

Current Status of Traditional Chinese and Western Medicine Treatment of Diabetic Peripheral Vascular Disease

Diabetic peripheral vascular disease(PVD)is one of the common chronic complications of diabetes.The main clinical manifestations of PVD are numbness and coldness of the limbs,resting pain,intermittent claudication,and other symptoms.The combined treatment involving Chinese and Western medicine for PVD has various clinical methods and definite curative effects.It is worthy of in-depth clinical research and application.

The role of macrophage autophagic polarization in the healing of diabetic ulcers and the prospect of traditional Chinese medicine

The incidence of diabetic ulcer is high, the disability and mortality are also high, and its treatment is difficult, and the healing mechanism is not clear. The main reason for the delayed healing of DU is that the chronic inflammation window period is too long, and macrophages play a key role in its healing process. The polarization of macrophages controls the length of the inflammatory phase, and autophagy is thought to be closely related to the tendency of macrophage polarization. Autophagy regulators have limited clinical application. Traditional Chinese medicine may become an ideal autophagy inducer and provide new ideas and strategies for clinical treatment of diabetic ulcers. This article summarizes the role of macrophage autophagic polarization in the healing of diabetic ulcers and the prospects of traditional Chinese medicine.

Research progress in the treatment of diabetic foot with traditional Chinese medicine

Diabetic foot is one of the chronic complications of diabetes,which is serious and expensive to treat.As an effective method for treating diabetic foot,Chinese medicine plays an important role in improving the clinical symptoms and reducing the suffering of diabetic foot patients.The methods of traditional Chinese medicine to treat diabetic foot include internal treatment method,external treatment method and comprehensive therapy.This article reviews the research results of traditional Chinese medicine treatment of diabetic foot in order to provide reference for the treatment of diabetic foot.

Research progress on inflammatory mechanism and traditional Chinese medicine in the treatment of diabetic retinopathy

Diabetic retinopathy(DR),as a common microvascular complication of diabetes,is the result of the interaction of multiple factors and multiple mechanisms.Inflammation is one of the important pathophysiological mechanisms of DR.Leukocytes accumulate and adhere to the surface of endothelial cells,glial cell activation and its dysfunction,and the release of vascular endothelial growth factor,interleukin and other inflammatory factors are directly related to the occurrence and development of DR inflammation.Antiinflammation plays an important role in the treatment of DR.Studies have shown that traditional Chinese medicine has a unique advantage in targeting the inflammatory mechanism of DR.Therefore,the inflammatory cells,inflammatory factors and related Chinese medicines closely related to DR are reviewed,in order to provide references for the early prevention and treatment of DR.

Analysis of prescription rules in the treatment of diabetic heart disease based on traditional Chinese medicine inheritance support system

Diabetes is a common clinical disease and has many complications,among which diabetic heart disease is the leading cause of death in diabetic patients.This article collected the prescriptions for the treatment of diabetic heart disease,and used the traditional Chinese medicine inheritance support system to explore the prescription formulation rules.Finally,we included 43 prescriptions for analysis.We found that the rules of formulas for treating diabetic heart disease are complex,but Chinese medicines in these formulas are mainly with the effects of nourishing Qi,nourishing Yin and activating blood circulation.At the same time,we obtained 3 new prescriptions and discussed the clinical rationality of the new prescriptions.The purpose of this article is to provide reference for clinical prescription in the treatment of diabetic heart disease and the development of related new drugs.

Efficacy evaluation of high-frequency ultrasound in the treatment of diabetic peripheral neuropathy with α-lipoic acid combined with traditional Chinese medicine package treatment

Objective:To use high-frequency ultrasound to evaluate the efficacy ofα-lipoic acid combined with traditional Chinese medicine in the treatment of diabetic peripheral neuropathy(DPN),so as to provide a basis for clinical medication and evaluation of therapeutic effect.Methods:From December 2018 to December 2019,110 patients with DPN who met the inclusion and exclusion criteria were divided into observation group and control group according to different treatment plans.The control group was treated withα-lipoic acid,and the observation group was treated withα-lipoic acid combined with traditional Chinese medicine encapsulation treatment,and used high-frequency ultrasound,nerve conduction velocity and serological examination to comprehensively evaluate the effectiveness of the two treatment methods.Results:The mean amplitude of glycemic excursions(MAGE)value of the observation group and the control group after treatment was significantly lower than before treatment(P<0.05);After treatment,the SCV of the ulnar nerve,median nerve,and common peroneal nerve in the two groups was significantly faster than before treatment(P<0.05).Similar to SCV,the MCV of the three nerves measured after treatment in the two groups was significantly faster than before treatment(P<0.05).Compared between the groups after treatment,the three kinds of nerve SCV and MCV in the observation group were significantly faster than those in the control group(P<0.05).The cross-sectional area(CSA)value of the ulnar nerve,median nerve and common peroneal nerve in the observation group after treatment was significantly lower than before treatment(P<0.05).Compared with the control group after treatment,the three nerves CSA in the observation group was significantly lower than that in the control group(P<0.05).Abnormal ultrasound performance:The proportion of abnormal ultrasound performances of the ulnar nerve,median nerve,and common peroneal nerve in the observation group after treatment was significantly lower than before treatment(P<0.05).The composition ratio of internal echo reduction and ambiguity in the observation group after three nerve treatments was significantly lower than that in the control group after treatment(P<0.05).In the correlation analysis,the three kinds of nerve CSA before and after treatment were negatively correlated with SCV and amplitude(P<0.05),and positively correlated with latency(P<0.05).Conclusion:The combination ofα-lipoic acid and Chinese medicine encapsulation technology has a good effect on the treatment and repair of DPN nerve damage,and can be routinely applied in clinical treatment.High-frequency ultrasound can intuitively observe changes in peripheral nerves and can be used to evaluate the prognosis of DPN.

ADVANCES IN TREATMENT OF DIABETIC NEUROPATHY BY TRADITIONAL CHINESE MEDICINE

Diabetic neuropathy (DN) is the most commonly seen complication in diabetes mellitus (DM), and can occur in its early stage. With the prolongation of the course of the disease, the incidence of DN can reach 90％. The lesion can involve any location of neural system, it can occur

Traditional Chinese Medicine Nursing in Diabetic Peripheral Neuropathy： A literature review

At present, unified and effective treatment for diabetic peripheral neuropathy （DPN） is still lacking, however Chinese medicine techniques characterized by syndrome differentiation and treatment, for example traditional Chinese medicine preparations, acupuncture, and fumigation, have been considered the promising alternative for DPN. Traditional Chinese medicine nursing, which is development on the basis of traditional Chinese medicine （TCM） theory, uses not only acupuncture, acupoint application and other treatments but also cares for the patient＇s diet and emotions in order to promote the recovery of skin and nerve endings in patients with DPN. Vast amounts of studies have explored the efficacies of various TCM nursing techniques in managing DPN, however, the article, which comprehensively documented these TCM nursing techniques in DNP patients, cannot be cap- tured. In the present article, we summarized the latest findings of TCM research on DPN in recent years in order to provide a reference for DPN.

Unique Traditional Chinese Medicine Therapy for Painful Diabetic Peripheral Neuropathy

Painful diabetic peripheral neuropathy is one of the common chronic complications of diabetes."Pain"is the most typical symptom in patients,which seriously affects their quality of life.Traditional Chinese medicine(TCM)treatment of the disease includes oral administration of Chinese medicine,TCM fumigation and acupuncture,etc.,which can significantly reduce the pain of patients and reduce the frequency of disease.Chinese decoctions regulate the imbalance of yin and yang in the human body through syndrome differentiation,so as to achieve the balance of yin and yang,which will then eliminate the disease.Chinese medicine fumigation make the medicine seep into the body from the skin to exert the medical effects,and nourish and dredge the meridians.There is no pain if the meridians are smooth flowing,there will be pain if the meridians are blocked,fumigation can be used alone or assisted by other treatment methods to enhance the efficacy.The characteristics of acupuncture are rapid painrelief,economic and convenient,and can quickly relieve pain for patients with low tolerance.