Research Progress on Astragalus-Based Traditional Chinese Medicine Formulas for the Treatment of Diabetic Peripheral Neuropathy Based on the Qi-Luo and Blood-Luo Theories of Collateral Disease Theory

Abstract

Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes mellitus, clinically manifested mainly by abnormal limb sensations such as lower limb numbness, formication and pain. The pathogenesis of DPN has not been fully elucidated. Existing studies suggest that it may be associated with the interaction of multiple factors including disordered glycolipid metabolism, oxidative stress injury, deficiency of neurotrophic factors and autoimmune abnormalities. In traditional Chinese medicine (TCM), DPN is categorized as “collateral disease” and “blood bi syndrome”, with the core pathogenesis of “chronic disease invading collaterals and chronic pain invading collaterals”. Its pathological basis involves dysfunction and structural damage of qi collaterals and blood collaterals, manifested as disordered qi collaterals and stasis-obstructed blood collaterals, leading to abnormal qi and blood circulation; prolonged disease further results in collateral damage by toxins. The internal TCM treatment follows the principle of “simultaneous tonification and unblocking”, focusing on tonifying qi to unblock collaterals and activating stagnation to relieve bi pain. Astragalus, an essential herb for tonifying qi, can “tonify qi to activate blood circulation and unblock collaterals to eliminate stasis”. In recent years, in-depth research on prescriptions dominated by Astragalus for DPN treatment has been carried out, covering single herbs, herb pairs, three-herb combinations, compound formulas and combined external therapies, which have demonstrated favorable clinical efficacy and research prospects. Based on the theories of qi collaterals and blood collaterals in collateral disease theory, this paper systematically reviews the research progress of Astragalus-dominated Chinese medicines for DPN treatment.