Research Progress on the Treatment of Diabetic Foot Ulcers with Traditional Chinese Medicine Preparations

Xiance Che; Tengfei Zhang; Yanfei Gao

doi:10.54097/5j3e5s53

Authors

Xiance Che
Tengfei Zhang
Yanfei Gao

DOI:

https://doi.org/10.54097/5j3e5s53

Keywords:

Traditional Chinese Medicine, Herbal Formulation, Diabetes Wounds, Dosage Form

Abstract

Diabetic foot ulcer (DFU) is a prevalent and severe complication in diabetic patients, characterized by high morbidity, challenging treatment, prolonged healing duration, and substantial medical costs. It stands as a primary cause of disability and even mortality among diabetics. Traditional Chinese medicine (TCM) preparations, including ointments, granules, powders, and decoctions, have demonstrated remarkable efficacy in accelerating wound healing in diabetic patients. Modern pharmacological research reveals that TCM formulas and their active constituents effectively facilitate diabetic wound healing through multifaceted regulatory mechanisms, influencing cell proliferation, angiogenesis, collagen deposition, oxidative stress, and inflammation. This article primarily summarizes the TCM preparations that are efficacious in treating diabetic wounds, aiming to provide a reference for future in-depth research and clinical application.

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References

[1] L.N.Kasiewicz, K.A.Whitehead. Recent advances in biomaterials for the treatment of diabetic foot ulcers. Biomater Sci, Vol 5 (2017) No.10, p. 1962-1975.

[2] Y.X.Hu, T.M. Li, Z.B.Yang, et al. Schisandrone improves the blood glucose in rats with type 2 diabetes mellitus by regulating the AKT/GSK3 signal pathway. Central South Pharmacy, Vol 21 (2023) No.04, p. 933-939.

[3] Y.X.Wang, H.F.Que. Extracellular matrix in the prevention and treatment of diabetic foot ulcer. Central South Pharmacy, Vol 19 (2021) No.09, p. 1865-1870.

[4] L.Kong, Z.Wu, H.Zhao, et al. Bioactive Injectable Hydrogels Containing Desferrioxamine and Bioglass for Diabetic Wound Healing. ACS Appl Mater Interfaces, Vol 10 (2018) No. 36, p. 30103-30114.

[5] J.Xu, Y.Lin, Y.Wang, et al. Multifunctional Regeneration Silicon-Loaded Chitosan Hydrogels for MRSA-Infected Diabetic Wound Healing. Adv Healthc Mater, Vol 13 (2024) No. 10, p. e2303501.

[6] L.Liu, J.Zheng, S.Li, et al. Nitric oxide-releasing multifunctional catechol-modified chitosan/oxidized dextran hydrogel with antibacterial, antioxidant, and pro-angiogenic properties for MRSA-infected diabetic wound healing. Int J Biol Macromol, Vol 263 (2024), p. 130225.

[7] F.Jiang, Y. Duan, Q.Li, et al. Insect chitosan/pullulan/gallium photo-crosslinking hydrogels with multiple bioactivities promote MRSA-infected wound healing. Carbohydr Polym, Vol 334 (2024), p. 122045.

[8] G.Jia, Z.Li, H.Le, et al. Green tea derivative-based hydrogel with ROS-scavenging property for accelerating diabetic wound healing. MATER DESIGN, Vol 225 (2023), p. 111452.

[9] Z.Ding, Y.Zhang, P.Guo, et al. Injectable Desferrioxamine-Laden Silk Nanofiber Hydrogels for Accelerating Diabetic Wound Healing. ACS Biomater Sci Eng, Vol 7 (2021) No. 03, p. 1147-1158.

[10] Z.Xu, M.Dong, S.Yin, et al. Why traditional herbal medicine promotes wound healing: Research from immune response, wound microbiome to controlled delivery. Adv Drug Deliv Rev, Vol 195 (2023), p. 114764.

[11] S.Y.Tao, S.P.Zhang, N.Zhao, et al. Study on the forming process of compound of Huangku Plaster. Chinese Journal of Ethnomedicine and Ethnopharmacy, Vol 29 (2020) No. 02, p.15-18.

[12] X.R.Song, L.Wang. The impact of traditional Chinese medicine nursing intervention combined with external application of Zizhu Ointment on wound healing and quality of life in patients with early-stage diabetic foot ulcers. Xinjiang Journal of Traditional Chinese Medicine, Vol. 41 (2023) No. 06, p. 80-82.

[13] R.Y.Huang, H.F.Wang, X.H.Wang, et al. Effect of Zizhu ointment on wound inflammation and epithelial-mesenchymal transformation of diabetic ulcer. Xiaanxi Journal of Traditional Chinese Medicine, Vol. 44 (2023) No. 12, p. 1673-1677.

[14] Z.L.Xiong, X.L.Sun. Effect of Shengji Xiangpi Ointment combined with Mupirocin Ointment in the treatment of diabetic foot. Chinese Journal of Urban and Rural Enterprise, Vol. 38 (2023) No.11, p. 7-10.

[15] G.X.Liu. Curative Effect Analysis of Compound Polymyxin B Ointment Combined with Recombinant Human Epidermal Growth Factor in the Treatment of Diabetic Skin Ulcers. Diabetes New World, Vol. 26 (2023) No. 07, p. 72-75.

[16] L.S.Lu, H.Li, W.Huang, et al. Study on the Preparation Process of Qingjie Fuzheng Granules. Fujian Journal of Traditional Chinese Medicine, Vol. 54 (2023) No. 10, p. 48-52.

[17] Z.Sun, Y.Kong, N.Li, et al. Effect of Yupingfeng granules on the skin barrier in atopic dermatitis mice models. J Tradit Chin Med, Vol. 38 (2018) No. 06, p. 872-878.

[18] X.Yang, F.Liu, J.Guo, et al. Antioxidation and anti-inflammatory activity of Tang Bi Kang in rats with diabetic peripheral neuropathy. BMC Complement Altern Med, Vol. 15 (2015) No. 66.

[19] G.Wang. Curative Effect and Value of Mecobalamin Combined with Mudan Granules in Treatment of Diabetic Peripheral Neuropathy. Liaoning Journal of Traditional Chinese Medicine, Vol. 50 (2023) No. 10, p. 167-170.

[20] L.L.Du, D.Y.Zeng, D.Z.He, et al. Clinical Observation on Treating Diabetic Foot Ulcers with Autologous Concentrated Growth Factor Gel Combined with Mudan Granules. World Journal of Integrated Traditional and Western Medicine, Vol. 18 (2023) No. 04, p. 719-722.

[21] J.Wang, M.Wang, L.Zhao, et al. Investigating the efficacy and safety of mineral smectite granules on wound healing. Exp Ther Med, Vol. 21 (2021) No. 02, p. 160.

[22] F.Li, G.Wang, B.Wu. Clinical application of traditional Chinese medicine powder in the treatment of acute and chronic wounds. Int Wound J, Vol. 20 (2023) No. 03, p. 799-805.

[23] S.X.Wang, D.Y.Li. Study on Mechanism of Badu Shengji Powder on Regulating Keap1 / Nrf2 Pathway to Promote Skin Ulcer Healing in diabetes Rats . Journal of Basic Chinese Medicine, Vol. 29 (2023) No. 10, p. 1645-1649.

[24] J.W.Hu, Q.H. Feng, Y.H.Wang, et al. Influences of Wangshi Shengji powder on wound healing and HIF-1α/VEGF signaling pathway in rats with perianal abscess. Shanxi Journal of Traditional Chinese Medicine, Vol. 44 (2023) No. 09, p. 1179-1183.

[25] H.Y.Li, Q.Kong, Y.L.Hao, et al. The Effects of Tongxinluo Capsule, a Traditional Chinese Medicine, on Nephrin and Podocin Levels, M1 Phenotype of Macrophages, and VEGF Protein Expression in Diabetic Foot Rats. Chinese Journal of Gerontology, Vol. 44 (2024) No. 01, p. 137-142.

[26] X.Q.Li, S.R.X, T.Y.H, et al. Clinical evaluation of Shumai capsules in the treatment of early-stage diabetic foot neuropathic ulcers. Chinese Journal of Surgery of Integrated Traditional and Western Medicine, Vol. 30 (2024) No. 01, p. 9-12.

[27] W.Song, Y.Sun, X.Liang, et al. Jinmaitong ameliorates diabetes-induced peripheral neuropathy in rats through Wnt/β-catenin signaling pathway. J Ethnopharmacol, Vol. 266 (2021), p. 113461.

[28] M.Wang, C.X.Wang, H.X.Yan, et al. Curative Effect of Furong Tongmai Capsule Combined with Herbal Foot Bath on High-risk Diabetic Feet and Its Influences on Levels of Serum NGF and IL-1β. Journal of Liaoning University of Traditional Chinese Medicine, 2024.

[29] J.S.Tay, Y.J.Kim. Efficacy of moxibustion in diabetes peripheral neuropathy. Medicine, Vol. 100 (2021) No. 49, p. e28173.

[30] W.Mai, A.Wei, X.Lin, et al. Efficacy and safety of traditional Chinese medicine injection with mecobalamin in treating diabetic peripheral neuropathy: A protocol for systematic review and meta-analysis. Medicine, Vol. 100 (2021) No. 01, p. e23702.

[31] Z.Deng, M.Wang, Y.Fan, et al. Salviae miltiorrhizae and ligustrazine hydrochloride injection combined with mecobalamin for treating diabetic peripheral neuropathy: A protocol for systematic review and meta-analysis. Medicine, Vol. 100 (2021) No. 03, p. e24103.

[32] X.Zhang, H.Wang, Y.Zhang, et al. Danggui Sini decoction for treating diabetic peripheral neuropathy: A protocol of systematic review and meta-analysis of randomized controlled trials. Medicine, Vol. 99 (2020) No. 21, p. e20482.

[33] B.Xie, Q.Wang, C.Zhou, et al. Efficacy and Safety of the Injection of the Traditional Chinese Medicine Puerarin for the Treatment of Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis of 53 Randomized Controlled Trials. Evid Based Complement Alternat Med, Vol. 2018 (2018), p. 2834650.

[34] C.Berce, M.Muresan, O.Soritau, et al. Cutaneous wound healing using polymeric surgical dressings based on chitosan, sodium hyaluronate and resveratrol. A preclinical experimental study. Colloids Surf. B, Vol. 163 (2018), p. 155-166.

[35] F.Hu, J. Lin, L. Xiong, et al. Exploring the molecular mechanism of Xuebifang in the treatment of diabetic peripheral neuropathy based on bioinformatics and network pharmacology. Front Endocrinol, Vol. 15 (2024), p. 1275816.

[36] Y.Zhang, G.Gong, X.Zhang, et al. Huangqi Guizhi Wuwu decoction for diabetic peripheral neuropathy: Protocol for a systematic review. Medicine, Vol. 98 (2019) No. 31, p. e16696.

[37] W.Li, Y.Chen, Z.Cai, et al. Traditional Chinese medicine Qingre Huoxue decoction enhances wound healing in through modulation of angiogenic and inflammatory pathways. Int Wound J, Vol. 21 (2024) No. 03, p. e14724.

[38] Y.L.Bao, H.Lei, J.Ma, et al. Huangqi Yanghe Decoction regulates PI3K/AKT/NF-κB signaling pathway to promote wound healing in diabetes foot ulcer rats. Tianjin Medical Journal, Vol. 52 (2024) No. 03, p. 266-272.

[39] Q.Q.He, X.H.Yang, Y.Cao, et al. The mechanism of Buyang Huanwu Decoction promotion of diabetic foot ulcer healing based on analysis of the ERK signaling pathway. Zhejiang Journal of Integrated Traditional Chinese and Western Medicine, Vol. 33 (2023) No. 11, p. 997-1001.

[40] Y.H.Ren, H.F.Di, H.Liu, et al. Regulation effeets of Simiao Yong'an decoetion on angiogenesis, microcirculation and wound healing diabetic foot rats based on nerve growth factor/protein kinase B/glycogen synthase kinase 3β pathway. China Medicine, Vol. 18 (2023) No. 10, p. 1552-1556.

[41] Z.Li, P.Zhao, Z.Lin, et al. An Ultraswelling Microneedle Device for Facile and Efficient Drug Loading and Transdermal Delivery. Adv Healthc Mater, Vol.13 (2024) No. 02, p. e2302406.

[42] C.Sun, X.Zhou, C.Liu, et al. An Integrated Therapeutic and Preventive Nanozyme-Based Microneedle for Biofilm-Infected Diabetic Wound Healing. Adv Healthc Mater, Vol. 12 (2023) No. 30, p. e2301474.

[43] Z.Zhao, S.Yan, Y.Yu, et al. An aqueous extract of Yunnan Baiyao inhibits the quorum-sensing-related virulence of Pseudomonas aeruginosa. J Microbiol, Vol. 51 (2013) No. 02, p. 207-212.

[44] C.Mao, C.Lin, X.Chen, et al. Enhanced healing of full-thickness diabetic wounds using bioactive glass and Yunnan baiyao ointments. J WUHAN UNIV TECHNOL, Vol. 29 (2014) No. 05, p. 1063-1070.

[45] J.Yang, X.Wang, D.Wu, et al. Yunnan Baiyao-loaded multifunctional microneedle patches for rapid hemostasis and cutaneous wound healing. J Nanobiotechnology, Vol. 21 (2023) No. 01, p. 178.

[46] J.Chi, L.Sun, L.Cai, et al. Chinese herb microneedle patch for wound healing. Bioact, Vol. 6 (2021) No. 10, p. 3507-3514.

[47] S.Kang, Y.Zhong, D.Liu, et al. Traditional Chinese medicine fumigation as auxiliary treatment of diabetic peripheral neuropathy: A protocol for systematic review and meta-analysis. Medicine, Vol. 100 (2021) No. 04, p. e24200.

[48] Y.Qu, Z.Zhang, Y.Lu, et al. Network Pharmacology Reveals the Molecular Mechanism of Cuyuxunxi Prescription in Promoting Wound Healing in Patients with Anal Fistula. Evid Based Complement Alternat Med, Vol. 2019, p. 3865121.

[49] X.L.Jiang, L.H.Zhu. The Effect of Compound Huangbai Liquid on Modulating the NF-κB/MAPK Signaling Pathway and Influencing the Inflammatory Response in Rats with Skin Ulcers. Chinese Journal of Gerontology, Vol. 44 (2024) No. 04, p. 935-939.

[50] H.W.Zhao.Exploration of the Mechanism of Action and Clinical Efficacy of Modified Sanmiao Ointment in Diabetic Foot Ulcers. Heilongjiang Province: Heilongjiang University of Traditional Chinese Medicine, 2023.

[51] F Liu, Y Li, X Guo, et al. Advances in traditional Chinese medicine as adjuvant therapy for diabetic foot. World J Diabetes, Vol.13 (2022) No. 10, p. 851-860.

[52] L.Wu, H.Guo, Y.S.Yang, et al. Effect of Huiyang Shengji Ointment on inflammatory reaction of microvascular endothelial cells of diabetic foot ulcer. Beijing Journal of Traditional Chinese Medicine, Vol. 40 (2021) No. 09, p. 956-962.

[53] Q.Han, G.B.Liu, S.M.Yan, et al. Zizhu ointment promoteshealing of diabetic foot ulcers by inhibiting inflammatory reaction. Journal of Hainan Medical University, Vol. 26 (2020) No. 21, p. 1617-1624.

[54] H.M.Lu, L.X.Wang, X.Yang, et al. Effect of Fuyuan Tongluo Formula on streptozotocin-induced diabetic foot injury and its related mechanism . Journal of Toxicology, Vol. 37 (2023) No. 04, p. 282-288.

[55] J.Q.Yan, D.B.Lin, Y.J.Zhang, et al. The Impact of Nuahuazizhu on Wound Healing in Rats with Diabetic Foot Ulcers by Regulating the IGF-1/PI3K/Akt Signaling Pathway. Chinese Journal of Gerontology, Vol. 43 (2023) No. 06, p.1458-1462.

[56] Yun Zhang, C.L.Zhang, W.Zhao, et al. Mechanism of Dan-Huang-San powder in the treatment of diabetic foot ulcers through regulating mitophagy autophagy pathway. Modern Journal of Integrated Traditional and Western Medicine, Vol. 32 (2023) No. 03, p. 315-319.

[57] S.Y.Chen, Y.Gan. Effects of Shengji Yuhong Ointment on the Expressions of bFGF, HIF-1α and VEGF in Ulcer Tissue of the Rats Suffering Diabetic Foot. Western Journal of Traditional Chinese Medicine, Vol. 34 (2021) No. 09, p. 23-26.

[58] Z.Z.Sun, Z.H.Liu, Q.H.Chen, et al. Effects of Xiangpi Shengii ointment on EMT in wound tissues of diabetic ulcer rats. Shanxi Journal of Traditional Chinese Medicine, Vol. 43 (2022) No. 12, p. 1664-1668.

[59] Q.W.Lu, J.Wang, Z.Z.Lu, et al. Danhuang Anti-inflammatory Liquid's Efect on the Expression of TGF-β1, Twist1, Clusterin and the EMT Process of Diabetic Ulcer Rat's Wound. Lishizhen Medicine and Materia Medical Research, Vol. 33 (2022) No. 01, p. 55-59.

[60] H.Zhang, Y.Zhang, Y.L.Cao, et al. Effect of Fufang Zuyangping on wound healing of skin ulcer and expression of RAGE/NF-κBp65/VEGF in diabetic rats. Chinese Journal of Hospital Pharmacy, Vol. 41 (2021) No. 14, p.1405-1409.

[61] Q.H.Huang, J.X.Chang, S.Zheng, et al. Effect of Danggui Buxue Decoction on Angiogenesis and Inflammatory Reaction in Rat Models with Diabetic Foot. Clinical Misdiagnosis & Mistherapy, Vol. 34 (2021) No. 06, p.101-106.

[62] B.W.Li, Y.A.Jin, L.Xu, et al. Effect of Shengji Xiangpi Ointment on Wound Healing and Notch Signaling Pathway in Diabetic Foot Ulcer Rats. Frontiers in Pharmaceutical Science, Vol. 22 (2019) No. 09, p. 1634-1638.

[63] L.Chen, L.Y.Liao, F.Y.Dai, et al. Mechanism of Jiedu Shengji Ointment on skin microecological balance of diabetic ulcer. Jilin Journal of Traditional Chinese Medicine, Vol. 41 (2021) No. 02, p. 225-229.

[64] Z.Y.Nan, M.Liu, Y.Zhang, et al. Effect of Simiao Yong'an Decoction on the Expression of Wnt/β-catenin Signaling Pathway in Diabetic Ulcer Model Rats. Chin J Integr, Vol. 37 (2017) No. 01, p. 79-85.

[65] B.Liu, C.Yu, X.Meng, et al. Effects of Qizhi Jiangtang capsule on dermal ulcer in type 2 diabetic rats. China J Chin Mater Med, Vol. 41 (2016) No. 01, p. 118-123.

[66] L.Fang, L.Chen, M.Song, et al. Naoxintong accelerates diabetic wound healing by attenuating inflammatory response. Pharm Biol, Vol. 59 (2021) No. 01, p. 252-261.

[67] D.Yang, Y.Tan, Y.Zhang, et al. Sheng-ji Hua-yu ointment ameliorates cutaneous wound healing in diabetes via up-regulating CCN1. J Ethnopharmacol, Vol. 303 (2023), p. 115954.

[68] Y.Yue, W.L.Hao, Y.K.Gan, et al. Effect and mechanism of Jingwanhong Ointment on diabetic foot rats. Drugs & Clinic, Vol. 37 (2022) No. 05, p. 924-930.

[69] Y.F.Li, M.Yu, W.H.Sun, et al. Network pharmacology and experimental study of compound Phellodendron liquid in treating diabetic foot ulcer. Chinese Journal of Surgery of Integrated Traditional and Western Medicine, Vol. 29 (2023) No. 03, p. 287-292.

[70] L.Y.Chou. Astragalus injection solution guides Wnt/β-Catenin signal pathway to regulate epidermal stem cell proliferation and differentiation mechanism to promote the healing of diabetes ulcers. Shanghai: Shanghai University of Traditional Chinese Medicine, 2019. 2019.

[71] L.Sun, H.Yin, Y.Li, et al. Shengjihuayu formula ameliorates the oxidative injury in human keratinocytes via blocking JNK/c-Jun/MMPs signaling pathway. J Ethnopharmacol, Vol. 326 (2024), p. 117938.

[72] R.Chakraborty, P.Borah, P.P.Dutta, et al. Evolving spectrum of diabetic wound: Mechanistic insights and therapeutic targets. World J Diabetes, Vol. 13 (2022) No. 09, p. 696-716.

[73] Z.X.Sun, Y.H.Zhang, Y.Shi, et al. Effect of Astragalus and Anemarrhenae on diabetic cognitive impairment and hippocampal JAK2/STAT3 signaling pathway in rats . Central South Pharmacy, Vol. 22 (2024) No. 10, p. 2643-2649.

[74] N.R.Chanu, P.Gogoi, P.A.Barbhuiya, et al. Natural Flavonoids as Potential Therapeutics in the Management of Diabetic Wound: A Review. Curr Top Med Chem, Vol. 23 (2023) No. 08, p. 690-710.