Advances in Traditional Chinese Medicine research in diabetic kidney disease treatment

Figures & data

Figure 1. DKD is primarily caused by a number of interconnected mechanisms, including excessive filtration damage to the GFB, dilatation, and oxidation of the glomerular mesangium. These mechanisms are complex in nature, with links to hemodynamics, metabolism, and immunopathology. The physiological mechanism of DKD is summarized in this diagram.

Table 1. Clinical studies on the efficacy of prescription formulas in the treatment of DKD.

TCM	Composition	Number of enrolled patients	Intervention	Primary outcome	Study period (month)	Outcome	Reference
Tangshen Formula (TSF)	Astragalus membranaceus (Fisch.) Bunge, Rehmannia glutinosa (Gaetn.) DC., Panax notoginseng (Burk.) F.H.Chen, Cornus officinalis Sieb. et Zucc., Euonymus alatus (Thunb.) Sieb, Rheum palmatum L., Citrus aurantium L.	180	TSF vs. placebo	Change of urinary protein level	6	P = 0.024	(Yang et al. 2016)
Shenqi Dihuang decoction	Cornus officinalis Sieb. et Zucc., Codonopsis pilosula (Franch.) Nannf., Astragalus membranaceus (Fisch.) Bunge, Rehmannia glutinosa (Gaetn.) DC., Dioscorea opposita Thunb., Alisma plantago-aquatica Linn., Poria cocos (Schw.) Wolf, Paeonia suffruticosa Andr.	205	Shenqi Dihuang decoction vs. Metformin	m-ALB	3	P < 0.05	(Wang et al. 2018)
Buyang Huanwu decoction	Astragalus membranaceus (Fisch.) Bunge, Angelica sinensis (Oliv.) Diels., Radix Paeoniae Rubra, Ligusticum chuanxiong Hort., Carthamus tinctorius L., Prunus persica (L.) Batsch	100	Buyang Huanwu Decoction vs. placebo	Change of UACR	6	P < 0.05	(Pan et al. 2022)
Zicuiyin decoction	Astragalus membranaceus (Fisch.) Bunge, Rehmannia glutinosa (Gaetn.) DC., Dioscoreaoppositifolia L., Cornus officinalis Siebold et Zucc.	88	Zicuiyin vs. placebo	Change of eGFR	2	P < 0.05	(Liu et al. 2022)

Figure 2. AS-IV may treat DKD by reducing inflammation, attenuating ERS, regulating calcium homeostasis, restoring mitochondrial homeostasis (via the Drp-1 and PINK1/Parkin signaling pathways), countering oxidative stress, and improving EMT and vascular endothelial function.

Figure 3. ROS, ATP and other substances trigger NF-κB dependent pro-IL-1β and pro-IL-18 gene transcription by activating TLR/IL-1 receptors. After Caspase-1 cleavage, these pro-inflammatory factors are released into the cytoplasm in the form of pro-IL-1β and pro-IL-18, thus participating in the inflammatory response.

Yang X, Zhang BX, Lu XG, Yan MH, Wen YM, Zhao TT, Li P. 2016. Effects of Tangshen Formula on urinary and plasma liver-type fatty acid binding protein levels in patients with type 2 diabetic kidney disease: post-hoc findings from a multi-center, randomized, double-blind, placebo-controlled trial investigating the efficacy and safety of Tangshen Formula in patients with type 2 diabetic kidney disease. BMC Complement Altern Med. 16(1):246. doi:10.1186/s12906-016-1228-4.

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Wang M-R, Yu L-H, Wang T-T, Wang Y-M, Han M-X. 2018. Effect of Shenqi Dihuang decoction on inflammatory factor, renal function and microcirculation in patients with early diabetic nephropathy. Chin J Chin Mater Med. 43:1276–1281.

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Pan J, Li H, Shi J. 2022. Clinical application of the classical theory of Traditional Chinese Medicine in diabetic nephropathy. Comput Math Methods Med. 2022:4066385.

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Liu J, Gao L-D, Fu B, Yang H-T, Zhang L, Che S-Q, Xu Y, Du X, Liu Z-C, Xue Y, et al. 2022. Efficacy and safety of Zicuiyin decoction on diabetic kidney disease: a multicenter, randomized controlled trial. Phytomedicine. 100:154079. doi:10.1016/j.phymed.2022.154079.

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Data availability statement

This review uses data from a variety of sources, including PubMed, Cochrane Library, VIP, Wanfang Data, CNKI, and CBM, etc.