Application of the External Treatment Method of Traditional Chinese Medicine in the Elderly Diabetic High-Risk Foot Based on the Theory of “Preventive Treatment of Disease”
Download PDF
$currentUrl="http://$_SERVER[HTTP_HOST]$_SERVER[REQUEST_URI]"

Keywords

Diabetic high-risk foot
External Chinese medicine treatment method
Treatment of undiagnosed disorder
Review

DOI

10.26689/jcnr.v9i5.10668

Submitted : 2025-05-05
Accepted : 2025-05-20
Published : 2025-06-04

Abstract

Diabetic foot (DF) has emerged as one of the most common chronic consequences of diabetes mellitus, characterized by prolonged disease duration, high treatment costs, a poor prognosis, and a high disability rate. Diabetic high-risk foot is the early stage of diabetic foot, the “disease prevention” of “treating no disease”, which provides a critical window for clinical prevention and treatment. Traditional Chinese medicine (TCM) has emphasized the importance of preventive health care since ancient times. External therapies such as acupuncture, massage, acupoint injection, foot bath fumigation, and moxibustion have the advantages of simplicity, low cost, precise efficacy, and fewer side effects in preventing and treating diabetic high-risk foot. The multidisciplinary synergistic model formed by TCM complementary therapies and modern medical treatments, such as nutritional, peripheral nerve, and blood glucose regulation, provides new ideas for establishing standardized prevention and treatment protocols. In this paper, studies related to TCM-related complementary therapies for diabetic high-risk feet are systematically reviewed. Current advances in external application in TCM were described to better understand its effectiveness and safety in elderly patients.

References

National Centre for Geriatrics, Chinese Society of Geriatrics, Diabetes Committee of the Chinese Association of Geriatrics, 2024, Guidelines for the Diagnosis and Treatment of Diabetes Mellitus in the Elderly in China (2024 Edition). Concord Medical Journal, 2024(4): 771–800.

International Diabetes Federation, 2021, IDF Diabetes Atlas. International Diabetes Federation, 2021(8th Edn).

Tong T, Yang C, Tian W, et al., 2020, Phenotypes and Outcomes in Middle-Aged Patients With Diabetic Foot Ulcers: A Retrospective Cohort Study. Journal of Foot and Ankle Research, 13: 1–8.

Edmonds M, Manu C, Vas P, 2021, The Current Burden of Diabetic Foot Disease. Journal of Clinical Orthopaedics and Trauma, 17: 88–93.

Lyundup AV, Balyasin MV, Maksimova NV, et al., 2022, Misdiagnosis of Diabetic Foot Ulcer in Patients With Undiagnosed Skin Malignancies. International Wound Journal, 19(4): 871–887.

Song Z, Ou J, Shu L, et al., 2022, Fall Risk Assessment for the Elderly Based on Weak Foot Features of Wearable Plantar Pressure. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 30: 1060–1070.

Al-Mohaithef M, Abdelmohsen SA, Algameel M, et al., 2022, Screening for Identification of Patients at High Risk for Diabetes-Related Foot Ulcers: A Cross-Sectional Study. Journal of International Medical Research, 50(3): 03000605221087815.

Bus S, Van Netten S, Lavery L, et al., 2016, IWGDF Guidance on the Prevention of Foot Ulcers in At-Risk Patients With Diabetes. Diabetes/Metabolism Research and Reviews, 32(S1): 16–24.

Monteiro-Soares M, Hamilton EJ, Russell DA, et al., 2024, Guidelines on the Classification of Foot Ulcers in People With Diabetes (IWGDF 2023 Update). Diabetes/Metabolism Research and Reviews, 40(3): e3648.

Shi XQ, Li HY, Zhou J, et al., 2023, Analysis of the Current Status of the Application of Evidence Quality Evaluation and Recommendation in Chinese Medicine/Integrated Chinese and Western Medicine Clinical Practice Guidelines and Expert Consensus. Journal of Traditional Chinese Medicine, 2023(6): 581–586.

Du YQ, Liu YL, Li YS, et al., 2020, Based on “Surgery Zhengzong – Degeneration of Gangrene” to Explore the Characteristics of Identification and Use of Medicines in External Treatment of Diabetic Foot in Different Stages. World Science and Technology–Modernization of Traditional Chinese Medicine, 2020(8): 2969–2974.

Yan X, Song JF, Zhang L, et al., 2022, Analysis of Risk Factors for Multi-Drug Resistant Organisms in Diabetic Foot Infection. BMC Endocrine Disorders, 22(1): 46.

Nguyen AT, Pham HQ, Nguyen TX, et al., 2020, Knowledge, Attitude and Practice of Elderly Outpatients With Type 2 Diabetes Mellitus in National Geriatric Hospital, Vietnam. Diabetes, Metabolic Syndrome and Obesity, 2020: 3909–3917.

Mariadoss AVA, Sivakumar AS, Lee CH, et al., 2022, Diabetes Mellitus and Diabetic Foot Ulcer: Etiology, Biochemical and Molecular Based Treatment Strategies via Gene and Nanotherapy. Biomedicine and Pharmacotherapy, 151: 113134.

Seth A, Attri AK, Kataria H, et al., 2019, Clinical Profile and Outcome in Patients of Diabetic Foot Infection. International Journal of Applied and Basic Medical Research, 9(1): 14–19.

Silva LB, Silva PAB, Santos JFG, et al., 2019, Risk Strata and Quality of Care for the Elderly in Primary Health Care. Revista Latino-Americana de Enfermagem, 27: e3166.

Andersson E, Persson S, Hallen N, et al. 2020, Costs of Diabetes Complications: Hospital-Based Care and Absence From Work for 392,200 People With Type 2 Diabetes and Matched Control Participants in Sweden. Diabetologia, 63: 2582–2594.

Williams R, Karuranga S, Malanda B, et al., 2020, Global and Regional Estimates and Projections of Diabetes-Related Health Expenditure: Results From the International Diabetes Federation Diabetes Atlas. Diabetes Research and Clinical Practice, 162: 108072.

Park J, Zhang P, Wang Y, et al., 2021, High Out-of-Pocket Health Care Cost Burden Among Medicare Beneficiaries With Diabetes, 1999–2017. Diabetes Care, 44(8): 1797–1804.

Wang L, Lauren BN, Hager K, et al., 2023, Health and Economic Impacts of Implementing Produce Prescription Programs for Diabetes in the United States: A Microsimulation Study. Journal of the American Heart Association, 12(15): e029215.

Sari Y, Upoyo AS, Isworo A, et al., 2020, Foot Self-Care Behavior and Its Predictors in Diabetic Patients in Indonesia. BMC Research Notes, 13: 1–6.

Kaewput W, Thongprayoon C, Mungthin M, et al., 2019, Temporal Trends in Optimal Diabetic Care and Complications of Elderly Type 2 Diabetes Patients in Thailand: A Nationwide Study. Journal of Evidence‐Based Medicine, 12(1): 22–28.

Macdonald KE, Stacey HJ, Harkin G, et al., 2020, Patient Perceptions of Phage Therapy for Diabetic Foot Infection. PLoS One, 15(12): e0243947.

Bekele F, Chelkeba L, 2020, Amputation Rate of Diabetic Foot Ulcer and Associated Factors in Diabetes Mellitus Patients Admitted to Nekemte Referral Hospital, Western Ethiopia: Prospective Observational Study. Journal of Foot and Ankle Research, 13: 1–8.

Liu R, Pang B, Hou W, et al., 2023, Practices and Thoughts on Chinese Medicine’s “Treatment of Future Diseases” in Tumour Research. Beijing Chinese Medicine, 37(12): 1146–1148.

Qin J, Tsui WR, 2020, Discussion on the Prevention and Treatment of Hypertension by External Treatment of Traditional Chinese Medicine Based on the Theory of “Treating the Future Disease”. Journal of Liaoning University of Traditional Chinese Medicine, 22(3): 203–206.

Navarro-Flores E, Cauli O, 2020, Quality of Life in Individuals With Diabetic Foot Syndrome. Endocrine, Metabolic and Immune Disorders-Drug Targets, 20(9): 1365–1372.

Lauwers P, Hendriks JM, Van Bouwel S, et al., 2021, Malnutrition According to the 2018 GLIM Criteria Is Highly Prevalent in People With a Diabetic Foot Ulcer but Does Not Affect Outcome. Clinical Nutrition ESPEN, 43: 335–341.

He M, Chen T, Lv Y, et al., 2022, The Role of Allogeneic Platelet-Rich Plasma in Patients With Diabetic Foot Ulcer: Current Perspectives and Future Challenges. Frontiers in Bioengineering and Biotechnology, 10: 993436.

Bai X, Song Z, Duan Y, et al., 2022, Progress of Chinese Medicine Speciality Treatment of Diabetic Foot. Journal of Hainan Medical College, 2022(3): 235–240.

Lai WY, He CH, Zhang JY, 2023, Clinical Observation on the Treatment of Diabetic Foot by Chinese Medicine Fumigation. Bright Chinese Medicine, 2023(23): 4618–4620.

Zhong H, Wang Y, Xue M, 2023, Effects of Chinese Medicine Fumigation on Clinical Symptoms and Nerve Conduction Function in Patients With Diabetic Peripheral Neuropathy. Medical Theory and Practice, 2023(24): 4300–4302.

Wang K, Zhang P, Luo T, et al., 2023, Clinical Study on the Treatment of Diabetic Peripheral Neuropathy With Yin Deficiency and Blood Stasis by Adding Flavour to Paeonia lactiflora and Glycyrrhiza glabra Soup and Combining With Traditional Chinese Medicine Fumigation. Journal of Liaoning University of Traditional Chinese Medicine, 2023(9): 212–216.

Wang J, Liu JW, 2022, An Overview of the Research on the Treatment of Diabetic Peripheral Neuropathy by External Treatment Based on Chinese Medicine Fumigation. Chinese Ethnic Folk Medicine, 2022(22): 60–63.

Zhang Y, Jiang H, 2022, Application of Chinese Medicine Fumigation in Diabetic Foot. Chinese Medicine Clinical Research, 2022(16): 86–88.

Ding M, Huang HR, He LH, 2023, Meta-Analysis of Acupoint Patch Therapy for Patients With Diabetic Constipation. Chinese Medical Science, 2023(15): 94–97,140.

Wu Q, Sun S, Wang J, et al., 2023, Clinical Efficacy of Traditional Chinese Medicine Acupoint Patch External Therapy in Intervening Diabetic Peripheral Neuropathy. Journal of Practical Clinical Medicine, 2023(20): 137–141.

Yao YH, Zhang H, Li J, et al., 2021, Efficacy and Effect on Serum MyD88/IkB Signalling Pathway in the Treatment of Diabetic Peripheral Neuropathy With Qi and Yin Deficiency in Combination With Auricular Acupoint Pressure Beans by Adding Flavoured Huangqi and Turtle Soup. Chinese Journal of Experimental Formulas, 2021(11): 98–105.

Xia F, Xu M, Zhao Y, et al., 2023, Analysis of Medication and Point Selection Pattern of Acupoint Patch for the Treatment of Diabetic Peripheral Neuropathy. Evidence-Based Nursing, 2023(1): 122–128.

Wang A, Li H, Shi Y, et al., 2021, Net Meta-Analysis and Safety Evaluation of Acupuncture for Diabetic Peripheral Neuropathy. World TCM, 2021(21): 3225–3236.

Zhu YA, Zhang Y, Cao L, et al., 2023, Observations on the Efficacy of Acupoint Injection in the Treatment of Spleen Deficiency Phlegm-Dampness Type Diabetic Peripheral Neuropathy. Shanghai Journal of Acupuncture and Moxibustion, 2023(9): 910–916.

Zhao JD, Li Y, Ni YQ, et al., 2018, Clinical Observation of Chinese Medicine Acupoint Injection for the Treatment of Peripheral Neuropathy in Type 2 Diabetes Mellitus. Journal of Anhui University of Traditional Chinese Medicine, 2018(1): 50–52.

Wang J, Yu Y, Zhang HL, et al., 2020, Effects of Ginkgo Biloba Extract Injection at the Foot-Sanli Acupoint on Lower Limb Arterial Blood Flow, Blood Rheology and Angiogenesis Indexes in Patients With Diabetic Peripheral Vasculopathy. Chinese Medicine Herald, 2020(18): 81–86.

Fei AH, 2012, Effect of Moxibustion for Tonifying Kidney and Activating Blood on the Efficacy and NO of Early Diabetic Nephropathy. Shanghai Journal of Acupuncture and Moxibustion, 2012(12): 891–892.

Zheng XY, 2017, Clinical Observation on 70 Cases of Diabetic Peripheral Neuropathy Treated With Pave Moxibustion Therapy. Chinese Medicine Herald, 2017(19): 94–97.

Luo X, Fei A, Hao L, et al., 2020, Mild Moxibustion of Dorsal Yu Points Combined With Acupuncture in the Treatment of Diabetic Peripheral Neuropathy in 31 Cases. Journal of Jiangxi University of Traditional Chinese Medicine, 2020(2): 62–64.

Wei X, Xu YZ, Wei LL, et al., 2019, Clinical Observation on the Treatment of Diabetic Peripheral Neuropathy by Thunder Fire Moxibustion. China Modern Distance Education of Traditional Chinese Medicine, 2019(21): 83–85.

Tang N, Ban Y, Song B, et al., 2018, Clinical Observation of Thunder Fire Moxibustion to Improve Pain in Painful Diabetic Peripheral Neuropathy With Qi Deficiency and Blood Stasis. China Traditional Chinese Medicine Modern Distance Education, 2018(16): 122–124.

Yang J, Qin L, 2024, Meta-Analysis of the Effects of Acupressure on Postoperative Pain and Knee Function in Patients Undergoing Total Knee Arthroplasty. Evidence-Based Nursing, 2024(6): 992–999.

Guo L, Tian Y, Pendulum X, et al., 2024, Clinical Observation on Acupoint Massage for the Treatment of Blood Stasis Diabetic Peripheral Neuropathy. Chinese Journal of Traditional Chinese Medicine, 2024(7): 3853–3856.

Ma HM, Zhang W, Sun S, et al., 2023, Study on the Effect of Acupressure Care on Patients With Diabetic Peripheral Neuropathy. Chinese Health Care, 2023(23): 154–156.

Zhao Q, Li H, Ji M, et al., 2018, A Systematic Review and Meta-Analysis of the Efficacy and Safety of Tui Na for the Treatment of Essential Hypertension. Journal of Traditional Chinese Medicine, 2018(18): 1568–1573.

Yan H, Zhang C, Wang Y, et al., 2020, Effectiveness of High-Intensity Interval Training Combined With Acupressure in Patients With Type 2 Diabetes Mellitus. Nursing Research, 2020(19): 3394–3400.

Huang ZY, Zou S, Wu JL, et al., 2022, Research Progress of Chinese Medicine in the Treatment of Diabetic Foot. Chinese Folk Therapy, 2022(21): 121–125.

Zhang H, Geng S, 2022, Staged and Stratified Treatment Strategy for Diabetic Foot With External Chinese Medicine. Beijing Traditional Chinese Medicine, 2022(7): 769–772.

Shao R, He Q, 2022, Progress in the Understanding and Treatment of Diabetic Foot in the Elderly. Journal of Tianjin Medical University, 2022(4): 452–455.

Xu XY, Yang BH, Zhao JX, et al., 2021, On the External Treatment of Diabetic Foot in Chinese Medicine and Its Practice. Beijing Traditional Chinese Medicine, 2021(12): 1336–1339.

Zhang YX, Jiang H, 2022, Application of Chinese Medicine Fumigation in Diabetic Foot. Chinese Medicine Clinical Research, 2022(16): 86–88.