Research progress of TCM characteristic treatment and research on diabetic foot

2022-03-16 13:47:07XianBaiZongLiangSongYuHongDuanXiaoKeZhang
Journal of Hainan Medical College 2022年3期

Xian Bai, Zong-Liang Song , Yu-Hong Duan, Xiao-Ke Zhang

1. Shaanxi University of Traditional Chinese Medicine

2. Department of Endocrinology, Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Xianyang 712000, China

Keywords:Diabetic foot Chinese medicine Treatment

ABSTRACT The pathogenesis of diabetic foot disease is complex and its clinical manifestations are diverse.Western medicine mainly focuses on hypoglycemic, improving circulation, controlling infection, interventional and surgical treatment, and the clinical effect is not good. Chinese medicine has obvious advantages in the treatment of diabetic foot, including syndrome differentiation, staging treatment, prescription plus or minus treatment, Chinese patent medicine,external foot bath, fumigation and washing, massage, acupuncture and moxibustion, ointment powder application and comprehensive treatment of traditional Chinese and western medicine.This paper discusses the treatment of diabetic foot with traditional Chinese medicine.

Diabetic foot refers to foot ulcers caused by lower extremity neuropathy and/or varying degrees of vascular disease caused by diabetes. It is one of the serious clinical complications of diabetes[1]. According to statistics, amputations caused by diabetic feet accounted for 27.3% of all surgical amputations and 56.5% of nontraumatic amputations [2-3]. Early identification of high-risk feet,control of blood sugar, blood lipids, blood pressure, and prevention of high-risk factors are essential for treating and delaying the occurrence and development of foot ulcers. Chinese medicine uses the theory of yin and yang, starting from the overall and local differentiation of symptoms and signs, judging the nature of the disease from different perspectives of cold and heat deficiency and excess, achieving both symptoms and root causes, and the effect is like a drum. This article summarizes the treatment of diabetic foot with TCM characteristics.

1. Pathogenesis of TCM

Diabetes Chinese medicine name "quench thirst ", to drink more, eat more, more urine and wasting as typical symptoms.The main pathogenesis is Yin deficiency and heat dryness.Tong Xiaolin believes that the onset of diabetes is a process from the actual deficiency, put forward "depression "," heat "," deficiency"," damage" theory. In the late stage of complications, mainly to"damage syndrome" mainly. For a long time, Qi and Yin deficiency,the deficiency gradually heavy, long illness into the collaterals,collaterals and blood stasis, forming gangrene [4]."General record of Saint-Ji quench thirst door [5] cloud :" quench thirst...... If you don't treat it for a long time, then the meridians will stay in the muscles and become carbuncle gangrene ."Traditional medicine belongs to the category of thirst, gangrene, pulse arthralgia, blood arthralgia and so on.Deng Tietao believes that diabetic foot is based on deficiency of heart, spleen and kidney function, which is caused by different factors: qi stagnation, blood stasis and phlegm obstruction.Combined with the diversity of external factors, the pathogenesis presents particularity and complexity, resulting in the complex pathogenesis changes the combination of cold and heat and deficiency[6].Professor Zhang Xuewen believes that diabetes is sufficient for yin deficiency and dryness and heat. Under the stress of high sugar environment, the four poisons are endogenetic,such as sugar poison,blood stasis poison,turbid and heat poison,and emphasize that the four poisons have different bias in different stages of onset[7]. Comprehensive its core pathogenesis is not separated from the word "deficiency" and "blood stasis ", treatment should be to promote blood circulation and remove blood stasis.

2. Knowledge of Western Medicine

Wound healing is a phased, dynamic and complex process involving four stages of hemostasis, inflammation, proliferation and remodeling, involving the interaction of multiple cells, extracellular components, growth factors and cytokines. In diabetic patients, one or more stages of wound healing are inhibited due to various factors,such as blood sugar, blood lipids, blood pressure, abnormal urine protein, and the regeneration and repair of nerve myelin sheath and synapse are damaged, the energy supply and oxygen supply of cell tissue are reduced, and apoptosis is promoted. Ulcer progression and occurrence [8-9].At present, the related pathways of therapeutic targets of traditional Chinese medicine, such as CD147 regulated RSK2/Slug/EMT pathways, RhoA/ROCK pathways, Notch related inflammatory signaling pathways, and Toll TLRs) Signal pathways,classic mitochondrial autophagy pink1 and parkin signaling pathways, Traditional Chinese medicine single or compound active ingredients can inhibit vascular endothelial injury, antioxidant stress,Anti-inflammatory, For wound tissue regeneration, It provides scientific theoretical basis for the treatment of diabetic foot with traditional Chinese medicine [10-14].

3. Traditional Chinese Medicine

3.1 Syndrome differentiation and treatment

"Diabetic Foot TCM Diagnosis and Treatment Standards" divide the diabetic foot into four types: deficiency of both qi and yin and obstruction of the veins and collaterals. The treatment is to promote qi and blood circulation, remove blood stasis and relieve pain, and select Shengmaiyin and Xuefu Zhuyu Decoction plus or minus; To cure heat and dampness, promote blood circulation and detoxification, select the addition and subtraction of Simiao Yongan Decoction and Yinzhilian Decoction; Qi and blood deficiency, damp toxin internal syndrome, treat with nourishing qi and nourishing blood, clearing dampness and toxin, and selecting Danggui Buxue Decoction Modification of Heermiao Powder; liver and kidney yin deficiency, phlegm and blood stasis mutual obstruction syndromes,the treatment is to regulate and invigorate the liver and kidney,dissipate phlegm and dredge collaterals, and choose Liuwei Dihuang Wan addition and subtraction; spleen and kidney yang deficiency,meridian failure, treatment with warming and spleen Kidney, blood circulation and maiming are the methods, and Jinkui Shenqi Pills are selected as the method [15]. Maozhe [16] treats diabetic foot.The syndrome differentiation is divided into four types: heat and meat rot, qi stagnation and blood stasis, spleen and kidney yang deficiency, and other types. Different treatment plans are given. The medication is Shangxiaofang, Zhongxiaofang, The treatment method of Xiaxiaofang can achieve the effects of clearing, smoothing and warming. Different doctors have different understandings of diabetic foot. For example, Qin Qiangang[17] based on the basic theory of Chinese medicine, and divided the syndromes of diabetic foot into damp-heat injection syndrome, blood stasis syndrome, yincold syndrome, spleen and kidney yang deficiency, and heat toxin The five types of Chisheng syndrome are treated according to the characteristics of syndrome types.

3.2 Stage treatment

According to the different severity of the four poisons, Zhang Xuewen, a master of traditional Chinese medicine, divided the course of the disease into ischemic, infectious, necrotic and recovery periods. In the early ischemic period, blood stasis and qi deficiency and blood stasis appear, and the body’s collaterals appear ischemic,which leads to neurovascular damage. Clinically, Xuefu Zhuyu Decoction and Huangqi Guizhi Wuwu Decoction are used to modify the blood; Wuwei Disinfection Decoction combined with Simiao San addition and subtraction, the recovery period of Qi and blood deficiency, with Bazhen Decoction or Ginseng Yangrong Decoction as the main prescription addition and subtraction, the later period of dry and burnt wounds are treated with Xianfang Huoxing Decoction[7].According to the characteristics of different tissues such as skin, nerves, tendons, blood vessels, and bones, Xi Jiuyi concluded that diabetic gangrene occurs in the extensor tendons and fascia of the toes, plantars, ankles, and calves, and tendon degeneration and necrosis are important contradictions of diabetic foot , Clinical focus is on differentiation of symptoms and signs by stages, which are divided into acute onset period, remission period and recovery period. Acute is to clear dampness and detoxification,clear inactive tendons, slow to invigorate qi, nourish yin and nourish muscles, establish a "clearing method" rule, formulate detoxification,dehumidification, cooling blood, removing blood stasis, softening and dispelling wind according to pathogenic factors Governance. In the acute phase, Chen Lanhua Granules are used to clear away damp heat and damp toxins, and during the remission and recovery phase,they are mainly used to replenish qi and nourish yin, adjust qi and blood, and choose Siwu Decoction to add and subtract[18]. Professor Wang Bingnan[19] According to the characteristics of the bias of righteous and evil and the deficiency of Qi and blood in the course of the disease, it is divided into the early stage, the failure to treat the wrong treatment stage, and the late stage. The three stages are treated by the three methods of elimination, support and supplementation.The early syndrome is Qi deficiency and blood stasis. For cold coagulation syndrome, use Huangqi Guizhi Wuwu Decoction to warm the meridian, promote blood circulation and remove blood stasis; fail to treat the mistaken treatment of "tuogangle" syndrome by differentiation as the syndrome of positive deficiency and prosperous toxin, use Tuoli Duli San and Si Miao Yongan Decoction to invigorate Qi Blood, detoxification and swelling; in the later stage,the syndrome of detoxification of righteousness and deficiency of the evil is strengthened by Bazhen Decoction and Simiao Yongan Decoction.

3.3 Prescription plus or minus

Professor Qi Luguang[20] proposed that long-term diabetes must be deficient, chronically ill will have blood stasis, qi and blood will not work, and blood stasis will lead to foot disease. When Qi deficiency and blood stasis and collateral blockage are the pathogenesis, the clinical method is to promote blood circulation and remove blood stasis. The key to the treatment is to combine years of clinical experience and start from the theory of "blood stasis", take internal medicine (astragalus, mulberry, angelica,salvia, spatholobi, silver flower vine, etc.) and decoction of herbal residues Thick foot bath, the effect is remarkable. Xiong Manqi [21]believes that diabetes is sufficient for qi deficiency and blood stasis,and Yang Qi is not reached as the key. He focuses on tonifying qi and nourishing yin to cure its roots, promoting blood circulation to remove blood stasis, warming meridians to treat its symptoms, and self-made Qitao Decoction (astragalus, rehmannia, peach kernel,White peony, etc.) as the basic prescription, with the addition and subtraction of the syndrome, can significantly improve the patient's lower limb numbness, chills and paresthesia, and the changes in hemorheological indicators have significant statistical significance(P<0.05).

3.4 Chinese patent medicine

Tongsaimai tablets have the effect of promoting blood circulation,clearing collaterals, nourishing qi and nourishing yin. It is composed of angelica, achyranthes, astragalus, codonopsis, dendrobium,scrophulariaceae, honeysuckle, licorice. The active ingredients of the compound traditional Chinese medicine chlorogenic acid, verbasil glucoside, glycyrrhizin, etc. can reduce serum malondialdehyde(MDA), interleukin-6 (IL-6) and tumor necrosis factor (TNF-α) in diabetic biped model rats ) Level, inhibit oxidative stress response and inhibit the occurrence and development of foot ulcers [22-23]. Dragon's Blood Capsules, the main ingredients of flavonoids,Dragon's Blood steroidal saponins, can change the blood lipid viscosity and the hypercoagulable state of platelets, reduce capillary permeability and body inflammation, thereby accelerating the nerve conduction speed of EMG And the speed of wound healing of foot ulcers [24-25]. Mudan granules, the salvia and hematoxylin can block or inhibit the accumulation of sorbitol products, reduce the production of advanced glycosylation products, and at the same time affect the expression of Cytcd protein in mitochondria,down-regulate the level of p38MAPK in serum, and inhibit phosphorylation of p38MAPK, etc. The pathway exerts the level of pro-inflammatory factors, repairs damaged nerve fibers, and accelerates the sensory conduction velocity [26-28]. Others, such as Puerarin injection, Lulutong injection, Ciwujia injection, etc., have the effects of promoting blood circulation, removing blood stasis and dredging collaterals, and are also clinically used to treat related vascular diseases and improve microcirculation [29-31].

3.5 Other treatments (foot bath, fumigation and washing,massage, acupuncture and electro-acupuncture, application treatment)

3.5.1 Foot bath therapy

Professor Deng Tietao believes that diabetes lies in the blood vessels, and the key to treatment is to improve the blood supply of the lower extremities. Choosing qi, vigor, and fragrant medicine to directly act on the affected area so that the medicine can reach directly, and it can also have a local acupuncture-like stimulating effect and promote blood. Circulation and gland secretion, selfmade Futong Waixiong prescription, for those who have no open pathological changes of diabetic foot and obvious blood supply shortage, Guiwei, safflower promote blood circulation and gland secretion, and have transdermal effect; Chuanwu , Evodia, Asarum,Mugwort, etc. have acupuncture-like stimulating effects on local acupoints; raw green onions, wine, vinegar and other pungent and sour, good-natured, not only can strengthen the exertion of medicinal power, but also help the body to absorb; Guizhi, continued Dispels the warm meridian, dispels cold, relieves coagulation and relieves pain, plays the effect of dispelling cold and relieving pain, dispelling wind, promoting blood and dredging collaterals[32] Tian Weiping[33] gave foot bath prescriptions (Pitrus bark, Salvia, safflower,Chuanxiong for activating blood circulation to remove blood stasis, dredging collaterals and pain, Angelica, Caulis spatholobi,Tougucao to clear meridians and activating blood circulation,honeysuckle, wild chrysanthemum for swelling and pain relief, heat and dampness , Aiye Wenjing pain relief) combined with acupoint massage treatment of diabetic feet, the patient's numbness, pain and sense of ant movement were significantly improved. Yang Ting et al.[34] treated patients with severe ischemia, pale complexion and fear of cold, using Xi’s traditional Chinese medicine surgical technique, self-made Tongmai No. 2 lotion (Angelica sinensis,Caulis spatholobi, Sangzhi, Pueraria lobata, Guizhi, Hong Flowers,Asarum) soaking the feet, the symptoms of numbness, itching, and coldness in the affected limbs are improved, and the skin color is improved.

3.5.2 Fumigation

Lv Yanwei [35] used "inducing evils to go out, dispelling rot and creating new" as the external treatment principle, and proposed that "yang gangrene should be drained early, and yang gangrene should be incised and drained after the pus is formed. Washing can clear the heat and fumigation can strengthen the body" Selfmade Qingmaikang (dandelion, violet, honeysuckle, etc.) decoction and decoction, clearing away heat and detoxification, removing dampness and pus; Tongmaikang (pangolin, fangfeng, safflower,etc.) decoction steam bath, warming the channels . Zhu Yuhua et al.[36] self-made Tangzukang lotion, consisting of chuanxiong,peach kernel, safflower, white peony, red peony, angelica, cassia twig, frankincense, etc. After treatment, the symptoms of lower limb numbness, pain, and resting pain were significantly improved,the ankle-brachial index (ABI) was significantly higher than before treatment, and the levels of vascular endothelial factor (VEGF), NO and vascular endothelin-1 (ET-1) were slightly better than those of the treatment. Rising, indicating that Tangzukang lotion is effective.Lin Liying [37] used Yiqi Huoluoshengji Decoction to treat diabetic foot with Qi deficiency and blood stasis type. It was observed that it can accelerate the blood circulation of the affected limb, increase the level of basic fibroblast factor, and promote the regeneration of granulation tissue.

3.5.3 Massage massage massageZhang Chongyuan [38] According to the distribution of the meridian of the foot, five basic reflex areas of the plantar kidney, bladder,ureter, urethra, and celiac nerve plexus were selected. Press to stimulate the circulation of human blood and select the symptomatic reaction area. , The inner side of the calf tibia, that is, the blood glucose metabolism area for 5 minutes each to regulate the endocrine system; then use the thumb of the thumb to press the associated reflection area of Yongquan, Taichong, Xiexi, Xuehai, Zusanli,Sanyinjiao and other points for 3 to 5 minutes The whole body is ventilated and the blood runs once a day. After treatment, it is found that foot massage combined with foot bath has positive significance in improving the blood rheology of diabetic feet. The foot is called the second heart of the human body. It is the end point of the three yang of the human body and the starting point of the three yin of the foot. It is closely connected with the internal organs and the limbs.Because the foot is at the lowest point, the blood flow is the fastest when passing through it. Slow, unused toxic substances in the blood circulation of the body tend to stay here. Acupoint massage can stimulate the reflex area of the feet, expand the capillaries of the feet, enhance permeability, promote metabolism, accelerate blood circulation and make peripheral nerve ischemia , The hypoxia state is improved, the nerve excitability is enhanced, and the effect of relaxing the channels and collaterals, promoting blood circulation and removing blood stasis is achieved.

3.5.4 Acupuncture, electroacupunctureZhang Jianping [39] Applying acupuncture and moxibustion to treat grade I-III diabetic foot, take the acupoints of the three-yin and threeyang meridians of the feet: bilateral Sanyinjiao, Zusanli, Fenglong,Yanglingquan, Yinlingquan, once a day , Treatment was performed 6 times a week. After 3 weeks, the microvessel density, superficial peroneal nerve movement, sensory conduction velocity, changes in wound ulcer area and various inflammatory factors were evaluated.The effective rate was 93.5% in the treatment group and 78.3% in the control group (P< 0.05), further prove that acupuncture can inhibit the body's inflammatory response, increase the microvessel density of the wound, accelerate the nerve conduction speed, and improve the progression of foot ulcers. Yangmei[40] Apply electroacupuncture to take the Zusanli, Inner Court, Yanglingquan, and Xuanzhong on both sides, and choose the density wave, 30 minutes each time, once a day, 2 weeks of treatment, 3 courses of treatment, the patient’s lower limb motor conduction and sensation Movement has improved significantly. Relevant studies have shown that acupuncture at Zusanli, Xuanzhong, Diji, Sanyinjiao, Yinlingquan and other acupoints has the effect of nourishing yin, nourishing the kidney, replenishing qi, activating blood, and clearing the pulse.Further studies have shown that acupuncture can effectively increase serum IGF-1 (recombinant human insulin). -Like growth factor-1),bFGF (recombinant human basic fibroblast growth factor), VEGF(vascular endothelial growth factor) levels, down-regulation of matrix metalloproteinase-9 (MMP-9), TNF-α, hs-CRP (super Sensitive C-reactive protein) level, effectively expand blood vessels and protect nerves, relieve vasospasm, improve micro-inflammatory state, and increase blood perfusion to achieve therapeutic effects[41-44].

3.5.5 Application therapy

External application of Tianlou Jiedu Xiaozhong Powder can up-regulate hypoxia-inducible factor, VEGF protein expression and MVD (microvessel density), to a certain extent, improve the inhibitory effect of hyperglycemia on the normal response of hypoxia, improve the wound microenvironment, and promote the formation of new blood vessels , To speed up wound healing[45]. Zhang Yue[46] treated diabetic foot dry and mixed gangrene,the control group was treated with conventional disinfectant debridement, and the observation group was externally used red ointment for dry gangrene, and externally used Yanghe Decoction plus raw ephedra, honeysuckle, and After fumigation of attached tablets and achyranthes bidentata, after debridement, they were fixed with red oil ointment. The treatment cycle was 4 months.The effective rate of observation group was 96.7% (control group 73.3%), P<0.05. Wang Guangyu [47] used the three representative formulas of the three methods for promoting muscle growth,namely, purple gangrene ointment, Huiyang Shengji ointment, and Zhuhong ointment to treat the three typical wounds of diabetes with chronic ulcer wounds with Yang deficiency syndrome, blood stasis syndrome, and damp-heat syndrome. All three methods can affect the growth status of VEGF, bFGF, TNF-α, which are important cytokines. In addition, pharmacological studies have found that Shengjixiangpi ointment, Sixiaosan, and Huayu Shengji Recipe can increase the levels of VEGF, b FGF, MVD and fibroblasts in the blood to form a large number of fibroblasts and new capillaries. , So that granulation tissue is formed, which is beneficial to the healing of diabetic foot ulcers[48-52].

4. Comprehensive therapy of Chinese and Western medicine

Li Heng et al.[53] treated diabetic foot grades I-VI. The control group was given low-molecular-weight heparin calcium, alprostadil intravenously after interventional therapy, and oral cilostazol, and the intervention group was given Tongluojuyu prescription on the basis of the control group After oral administration (peach kernel,safflower, schisandra, etc.) combined with huoxuezhitong lotion(Bletilla striata, safflower, hematoxylin, etc.) for 4 weeks, the clinical effective rate of the traditional Chinese medicine intervention group was higher than that of the control group (88.37%>76.19%,P< 0.05), the results show that Tongluojuyu Decoction plus Huoxuezhitong topical lotion can significantly inhibit inflammation and repair vascular endothelial function. Yang Yulong [54] treated 120 cases of diabetic foot, and they were randomly divided into a control group and an experimental group. The control group was given basic treatments such as routine general health education,hypoglycemic, blood pressure, lipid reduction, and anti-infection.The experimental group was based on the control group. Fumigation and washing with traditional Chinese medicine (Tougucao, Guizhi,Huajiao, etc.) combined with Qiguitongluo decoction (turmeric,angelica, pueraria lobata, etc.) for continuous treatment for 30 days. After treatment, the experimental group was compared with the control group for tendon reflexes, paresthesias, and limbs The improvement of clinical symptoms such as pain further proves that Chinese medicine fumigation and washing combined with oral administration can change the blood flow velocity of the dorsal artery and the stenosis of the artery diameter. Niu Xuerui et al[55] used randomized treatment of 76 cases of diabetic foot. The control group was treated with conventional Western medicine. The observation group was treated with traditional Chinese medicine,warm acupuncture and local debridement on the basis of control.The total nerve conduction velocity was better than the control group. The levels of TNF-α, IL-6 and advanced glycation end products in the treatment group were significantly down-regulated.The total effective rate of the observation group was higher than that of the control group (94.74%>81.58%, P<0.05) ). At the same time,combined with surgical removal of rot and tendons, cannibalization and debridement, and swallowing debridement can prevent further infections and promote granulation tissue regeneration [56].

5. Single Herbal Research

With the deepening of pharmacological research, related studies have found that the effective ingredients of traditional Chinese medicine, including plant polysaccharides, flavonoids and alkaloids,can affect the expression level of basic fibroblast growth factor,increase the level of vascular endothelial growth factor, and regulate hypoxia-inducible factors. -1α, intervention in wnt/β-catenin pathway and other different pathways play a role, further clarifying the scientificity and effectiveness of TCM treatment.

5.1 Astragalus Polysaccharide

Astragalus polysaccharide has many functions such as regulating immunity, anti-inflammatory, anti-infective, and protecting the function of islet cells [57]. Astragalus polysaccharides can improve the healing process of scalded rats by improving the immune defense ability of macrophages and inhibiting the inflammatory response [58].Astragalus polysaccharides can increase the phosphorylation level of PKB/Akt serine in skeletal muscle, increase insulin sensitivity,reduce blood sugar and at the same time be beneficial to the growth of wound facial nerve muscle, at the same time, it can strengthen the secretion of vascular endothelial protein, promote the growth of fibroblasts, and inhibit Wnt/β- The activation of catenin signaling pathway reduces cell apoptosis and promotes wound remodeling [59-60].

5.2 Puerarin

Pueraria lobata has the effects of removing rash, relieving muscles, removing irritability and quenching thirst. Pueraria lobata isoflavones can control the level of advanced glycation end products,reduce vascular endothelial damage, and resist oxidative stress. In animal experiments, puerarin may reduce the level of macrophage apoptosis by activating Sirt3 expression, reduce macrophage infiltration, and increase the stability of atherosclerotic plaques [61].Puerarin injection can improve the dorsal hemodynamics of the foot, accelerate the conduction velocity of the common peroneal nerve, and inhibit the progressive inhibition of platelets induced by adenosine diphosphate [62]. Studies have found that puerarin can protect and repair damaged nerves by reducing excitatory amino acid toxicity, anti-Ca2+ overload, and inhibiting cell apoptosis [63]. In addition, it is also widely used in multi-system fields such as blood diseases, tumors, and cerebrovascular diseases.

5.3 Ligustrazine

Ligustrazine injection has the effect of promoting blood circulation and removing blood stasis. Pharmacological studies have found that it can dilate small arteries, improve blood rheology, and resist platelet aggregation [64]. Related studies have found that ligustrazine can improve hypertension through different mechanisms such as improving vascular endothelial dysfunction, inhibiting smooth muscle cell proliferation and migration, improving blood circulation,delaying phenotypic transformation of adventitia fibroblasts, and balancing the synthesis and degradation of extracellular matrix.Vascular remodeling[65]. Ligustrazine can inhibit platelet aggregation,adhesion, and release through the ERK5/P70S6K/Rac1 signaling pathway, and inhibit thrombosis[66]. In addition, it was found that ligustrazine can control the activity of aldose reductase to indirectly improve blood viscosity and delay the formation of ulcers[67].

5.4 Angelica Flavonoids

Angelica has the effects of nourishing blood and promoting blood circulation, breaking blood stasis and regenerating new life, relieving pain and regulating menstruation. The main chemical components are volatile oils, organic acids, flavonoids, etc., which have antioxidant,anti-inflammatory, and antibacterial effects[68]. In the diabetic ulcer mouse model, Angelica can promote signal transduction by activating HIF-1α(hypoxia-inducible factor)/PDGF-β (plateletderived growth factor-β) in vitro, effectively enhancing the formation of blood vessels in regenerated tissues and promoting In vivo wound healing, experimental results show that Angelica has the potential to treat wounds related to vascular injury [69]. The active ingredient ferulic acid in Angelica can reduce inflammation by enhancing the autophagy flux of damaged endothelial cells, protect endothelial cells and play an anti-atherosclerotic effect[70].

6. Summary and outlook

In summary, the advantages of traditional Chinese medicine in the treatment of diabetic foot have become increasingly prominent,including special treatments such as oral administration of traditional Chinese medicine, external use of fumigation and washing, lotion,acupuncture and massage, plaster and powder application, which can effectively improve the clinical symptoms of patients. Modern pharmacological research has also continuously confirmed the scientific nature of Chinese medicine treatment, laying a foundation for the development and popularization and application of Chinese medicine, and also providing better choices for clinical treatment of patients. However, the clinical manifestations of diabetic foot are very different, the pathogenesis is complicated, the syndrome differentiation is diverse, and the treatment lacks uniform standards.Although the research on the components of Chinese medicines has been in-depth, there are not many studies on the pathogenesis of diabetic foot, and most of them stay in the evaluation of clinical efficacy. The variability of clinical research samples, methods,dosages of Chinese medicines, and the unclear mechanism of action and material basis of Chinese medicine compound prescriptions restrict clinical application. Therefore, further optimization research becomes necessary.