Efficacy and Safety of Buyang Huanwu Decoction Plus α-Lipoic Acid for Diabetic Peripheral Neuropathy

Overview

This systematic review of 12 RCTs involving 926 patients demonstrates that combined Buyang Huanwu Decoction (BYHWD) and α-lipoic acid (ALA) therapy significantly improves subjective symptoms and traditional Chinese medicine (TCM) syndrome scores in diabetic peripheral neuropathy (DPN). However, high heterogeneity in nerve conduction velocity (NCV) outcomes limits definitive conclusions on objective nerve function improvements.

Background

Diabetic peripheral neuropathy (DPN) affects about half of diabetic patients and leads to debilitating symptoms and increased risk of complications such as foot ulcers and amputations. Its pathogenesis involves oxidative stress, microcirculatory impairment, and metabolic disturbances. α-Lipoic acid (ALA) is an antioxidant recommended for symptom relief, but monotherapy shows limited effects on nerve repair. Traditional Chinese Medicine (TCM) approaches, including Buyang Huanwu Decoction (BYHWD), target qi deficiency and blood stasis, potentially complementing ALA. Combining BYHWD with ALA may offer synergistic benefits, yet evidence consistency and heterogeneity sources require thorough evaluation.

Data Highlights

Key Findings

• BYHWD combined with ALA significantly improves overall clinical response rate in DPN patients (RR=1.24, 95% CI 1.17–1.32) with no observed heterogeneity (I²=0%).
• TCM syndrome scores reflecting symptom severity are significantly reduced (SMD=–0.76), indicating subjective symptom relief.
• Objective nerve conduction velocity (NCV) outcomes exhibit substantial heterogeneity (I²>92%), limiting quantitative synthesis.
• Among NCV measures, only peroneal nerve motor conduction showed a consistent improvement trend (SMD=1.01), despite persistent heterogeneity.
• Sources of heterogeneity include non-standardized NCV measurement methods and complex intervention-patient matching.
• Oxidative stress biomarkers (SOD, MDA, T-AOC) showed favorable trends, while HbA1c levels and adverse event rates did not differ significantly between groups.

Clinical Implications

The combination of BYHWD and ALA appears to safely enhance subjective symptom control in DPN, supporting its use as an adjunctive therapy. However, clinicians should interpret improvements in nerve conduction cautiously due to methodological heterogeneity. Standardization of electrophysiological assessments and patient selection criteria is essential for future research to clarify objective nerve repair effects.

Conclusion

BYHWD plus ALA therapy offers a promising and safe approach to ameliorate subjective symptoms of diabetic peripheral neuropathy, though current evidence on nerve conduction improvements remains inconclusive due to high heterogeneity. This review provides a methodological framework to guide future standardized investigations.

References

1. Systematic Review Registration CRD420251267606