[Research progress on mechanism of diabetes peripheral neuropathy based on macrophage polarization and prevention and treatment of traditional Chinese medicine].

Diabetic peripheral neuropathy(DPN) is one of the most common chronic complications of diabetes, characterized by a complex pathogenesis and limited clinical treatment options. In recent years, increasing attention has been drawn to the role of macrophage polarization in DPN development and progress. This paper systematically reviewed the mechanisms of M1/M2 macrophage polarization in DPN, as well as research advances in traditional Chinese medicine(TCM) for DPN prevention and treatment by macrophage polarization regulation. Under normal conditions, M1/M2 macrophages are in a dynamic balance, maintaining peripheral nerve homeostasis. In a diabetic environment, metabolic disorders, such as persistent hyperglycemia, can lead macrophages towards excessive M1 polarization, triggering pro-inflammatory factor release, neuroinflammation, and oxidative stress, ultimately causing nerve fiber damage and abnormal pain signaling. Meanwhile, a reduced quantity or impaired function of M2 macrophages weakens nerve repair and anti-inflammatory capacity. TCM can modulate macrophage polarization by multiple components at various targets. For example, active ingredients such as astragaloside Ⅳ and curcumin promote M2 polarization while inhibiting M1 polarization. Compound prescriptions like Taohong Siwu Decoction and Huangqi Guizhi Wuwu Decoction improve nerve conduction velocity by regulating signaling pathways, including nuclear transcription factor-κB(NF-κB) and Janus kinase-activator of signal transduction and transcription(JAK-STAT). This paper also analyzed current research limitations and proposed future directions, aiming to provide new insights and theoretical foundations for TCM-based DPN prevention and treatment.