Traditional Chinese medicine for diabetic lower extremity arterial disease: A review of recent advances.

Diabetic lower-extremity arterial disease (LEAD) is a prevalent macrovascular complication of diabetes and a critical pathological foundation for diabetic foot lesions. Its pathogenesis involves glycolipid metabolic disturbance, excessive oxidative stress, persistent vascular inflammation, and endothelial dysfunction, leading to limb ischemia, refractory foot ulcers, and increased amputation risk. Current standard treatments, including glycemic and lipid control, antiplatelet therapy, and endovascular revascularization, have improved clinical outcomes but still face challenges in fully ameliorating microcirculatory impairment and preventing long-term restenosis. Traditional Chinese medicine (TCM) exerts multi-component and multi-target protective effects against diabetic LEAD. This review summarizes pharmacological advances in representative TCM agents, including Salvia miltiorrhiza, Astragali Radix, and their bioactive constituents (e.g., tanshinone IIA sulfonate, salvianolic acid B, astragaloside IV, and Astragalus polysaccharide), as well as classical formulas and patent medicines such as Huangqi Guizhi Wuwu Decoction, Tongxinluo capsule, Tangbi capsule, and Danggui Sini Decoction. Their mechanisms involve protecting vascular endothelium, regulating glycolipid metabolism, suppressing vascular inflammation via NF-κB and NLRP3 pathways, and activating Nrf2-mediated antioxidant defense, HIF-1α/VEGF, PI3K-AKT, and Ang-1/Tie-2 signaling to restore microcirculation and promote angiogenesis. Clinically, TCM-assisted endovascular intervention reduces postoperative restenosis and improves lower-limb perfusion; external preparations promote diabetic foot ulcer healing; acupuncture, moxibustion, and mind-body exercises improve microcirculation and long-term management. TCM is a promising adjunctive strategy for diabetic LEAD, and further mechanistic and clinical studies are needed to advance its standardized application and improve patient prognosis.