Diabetic Neuropathy: From Etiopathogenesis to Integrative Therapeutic Strategies with Traditional Chinese Medicine

Diabetic neuropathy is a common and disabling complication of diabetes leading to numbness, pain, sensory loss and reduced quality of life. This review summarizes its diagnosis, epidemiology, genetic basis, pathophysiological mechanisms and current treatment strategies, with a focus on the role of traditional Chinese medicine (TCM). Its current common diagnostic methods include nerve conduction studies and corneal confocal microscopy. The development of diabetic neuropathy has been closely linked to chronic hyperglycemia, metabolic disorders, oxidative stress, inflammation, and mitochondrial dysfunction, and the current treatment mainly relies on glycemic control, neuroprotective agents, pain relief, exercise, and physical therapy, despite clinical benefits remain limited in many patients. TCM has shown potential value through herbal formulas, active natural compounds, acupuncture, moxibustion, and external therapies such as herbal foot baths, which have shown efficacies in relieving symptoms and protecting nerve function through antioxidant, anti-inflammatory, and autophagy-related effects, as well as regulation of gut microbiota. This review also highlights current research gaps, including uneven study quality, insufficient mechanistic evidence, and lack of standardized evaluation. Overall, we integrate recent basic and clinical evidence to provide a clearer framework for future research and more standardized development of TCM-based strategies for diabetic neuropathy.