Effects of Combination Therapy of Buyanghuanwu-tang and Western Medicine on Diabetic Peripheral Vascular Disease: A Systematic Review and Meta-Analysis

Objectives: To evaluate the efficacy of Buyanghuanwu-tang (BYHWT) combined with Western medicine for diabetic peripheral vascular disease (DPVD) by conducting a systematic review and meta-analysis of randomized controlled trials (RCTs).Methods: Searches were conducted in 11 databases up to July 30, 2025, to identify RCTs evaluating BYHWT for DPVD. A meta-analysis was performed using Review Manager Web by pooling outcome data, including total effective rate (TER), blood viscosity at low shear rate (BVL), plasma viscosity (PV), hematocrit (HCT), ankle-brachial index (ABI), fibrinogen level (Fib), and TCM symptom score (TSS). TSS was assessed across four symptoms: cold sensation, pain, intermittent claudication, and numbness. Study quality was evaluated using the Cochrane Risk of Bias tool.Results: Ten RCTs met the inclusion criteria. The meta-analysis showed statistically significant improvement in the treatment group (BYHWT plus Western medicine) compared with the control group (Western medicine alone) in TER (RR: 1.18, 95% CI 1.12 -1.25, P<0.00001), BVL (RR: -1.00, 95% CI -1.86 to -0.14, P=0.02), PV (RR: -0.28, 95% CI -0.44 to -0.13, P=0.0003), ABI (RR: 0.08, 95% CI 0.06–0.09, P<0.00001), Fib (RR: -0.81, 95% CI -1.35 to -0.26, P=0.004), and cold sensation (RR: -0.95, 95% CI -1.48 to -0.42, P=0.0005), among others. Regarding safety, one study reported minor adverse events including gastrointestinal distress and dizziness (p>0.05).Conclusion: Combining BYHWT with Western medicine may be effective for DPVD; however, further high-quality, large-scale studies are required to confirm efficacy and safety.