Diabetic Foot

Diabetic foot (DF) refers to foot infection, ulceration, and/or deep tissue destruction in people with diabetes, associated with local neuropathy and peripheral vascular disease of the lower limbs. It results from diabetic neuropathy and vascular disease in the lower limbs. The condition can affect tissues from the skin to the bones and joints; in severe cases, localized or whole-foot gangrene may occur. In traditional Chinese medicine (TCM), diabetic foot falls under the category of “tuo ju” (gangrene).

TCM Pattern Identification and Medication Reference

|Common Symptoms

Clinical Description:

Numbness and pain in the affected limb, with a needle-like quality that is especially severe at night and remains localized; dark-red skin or purple spots on the foot, or intermittent claudication; alternatively, slow granulation tissue growth in the affected foot after the surrounding redness and swelling have subsided. The tongue is dark purple or has ecchymotic spots, with a thin white coating; the pulse is thin and choppy, and the dorsalis pedis pulse is weak or absent. The local skin temperature is cool.

In Plain Language:

  • The affected limb feels numb and painful, like pins and needles. Symptoms are more noticeable at night, and the pain is often confined to one spot. The foot may look dark red or have purple spots, or leg pain may develop after walking and ease with rest (intermittent claudication).
  • New tissue in the affected foot wound grows slowly, while the redness and swelling around it have subsided.
  • The tongue is dark purple or has bruised-looking spots, with a thin white coating. The pulse feels thin and uneven. The pulse on the top of the foot is markedly weak or cannot be felt, and the skin over the affected area feels cool to the touch.

|Treatment Approach

Clinical Description:

Invigorate blood, dispel blood stasis, and unblock the vessels and channels.

In Plain Language:

  • Promote blood flow and gradually help disperse stagnant blood.
  • Promote circulation through the vessels and channels and help clear blockages in the channels.

|Related Products

The products listed below are for informational reference only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

|Common Symptoms

Clinical Description:

Weight loss, fatigue and weakness, easy sweating, dry mouth, palpitations, and insomnia; a red tongue with a thin white coating and a weak, thin pulse. The affected limb may be numb and painful, especially at night, with reduced or absent sensation in the skin of the foot, local redness and swelling, and intermittent claudication. Alternatively, the wound may produce a large amount of thin, watery pus, or granulation tissue on the foot wound may grow slowly and remain difficult to heal.

In Plain Language:

  • A thin build, with difficulty maintaining weight or gradual weight loss.
  • Frequent tiredness and weakness, or becoming tired easily after mild activity.
  • Easy sweating, including with light activity.
  • A dry mouth and a frequent desire to drink water.
  • A pounding or uneasy heartbeat, difficulty falling asleep, or waking easily at night.
  • The tongue appears red overall.
  • A thin, white tongue coating that is not thick or greasy.
  • A weak, thin pulse that feels faint when pressed.
  • The affected limb feels numb and painful, with symptoms worse at night.
  • Sensation in the skin of the foot is reduced or absent, with diminished response to touch.
  • There is localized redness and swelling in the affected area.
  • Leg pain develops after walking for a while and requires stopping; it eases with rest, but recurs when walking resumes.
  • The wound may produce a large amount of thin pus, or new tissue on the foot wound may grow slowly, making the wound slow to heal.

|Treatment Approach

Clinical Description:

Tonify qi and nourish yin.

In Plain Language:

  • Support qi to help improve energy and reduce fatigue.
  • Nourish yin fluids to help maintain the body’s balance and reduce dryness and heat.

|Related Products

The products listed below are for informational reference only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

|Common Symptoms

Clinical Description:

Mental and physical fatigue, a dull complexion, shortness of breath and reluctance to speak, thirst, a dark tongue with a thin white coating, and sublingual stasis. Numbness, pain, or abnormal sensation in the extremities and trunk; or rough, dry skin; reduced or absent sensation in the foot; localized redness and swelling; and intermittent claudication. Alternatively, the wound may produce a large amount of thin, watery pus, or the devitalized tissue on the foot wound may have cleared while granulation tissue grows slowly and the wound remains unhealed for a long time. The dorsalis pedis pulse is weak or absent.

In Plain Language:

  • Feeling mentally and physically exhausted and lacking energy.
  • A dull, lackluster complexion.
  • Becoming short of breath easily and not wanting to talk much.
  • Feeling thirsty and wanting to drink water.
  • The tongue appears dark, with a thin white coating.
  • The veins under the tongue look purple and swollen, suggesting blood stasis.
  • Numbness, tingling pain, or abnormal sensation in the extremities and trunk.
  • The skin is dry and rough, like fish scales. Sensation in the foot is reduced or absent, with localized redness and swelling; leg pain may develop after walking for a while and require stopping.
  • The wound may produce a large amount of thin pus, or devitalized tissue may have cleared from the foot wound but new tissue grows slowly and healing is delayed. The pulse on the top of the foot may be weak or absent.

|Treatment Approach

Clinical Description:

Tonify qi and invigorate blood.

In Plain Language:

  • Support qi to help improve energy and reduce fatigue.
  • Promote blood circulation and help disperse stagnation.

|Related Products

The products listed below are for informational reference only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

References

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  2. Tong Xiaolin. Standards for the Prevention and Treatment of Diabetes with Traditional Chinese Medicine (Draft) [M]. Beijing: Science Press, 2014: 73.
  3. Diabetes Branch of the Chinese Medical Association. Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2013 Edition) [J]. Chinese Journal of Diabetes Mellitus, 2014, 08: 2-42.
  4. obbins JM，Strauss G，Afon D，et al. Mortality rates and diabetic foot ulcers：i8 it time to communicate mortality risk to patients wit diabetic foot ulceration?[J]. J Am Podiatr Med Assoc，2008，98：489，493.
  5. China Association of Chinese Medicine. Guidelines for the Prevention and Treatment of Diabetes with Traditional Chinese Medicine [M]//Interpretation of the Guidelines for the Prevention and Treatment of Diabetes with Traditional Chinese Medicine. China Press of Traditional Chinese Medicine, 2009: 148-151.
  6. Zhang Xiuli, Liang Chaoxia. Treatment of 35 cases of diabetic foot with Liyu Wang soft capsules [J]. Shaanxi Journal of Traditional Chinese Medicine, 2006, 27(10): 1241.
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  8. Lian Bo, Ma Dongmei. Clinical observation of 32 cases of diabetic foot treated with Mailuoning combined with prostaglandin E1 [J]. Journal of Difficult and Complicated Cases, 2004, 3(6): 352.
  9. Zhu Feng, Wei Jie. Treatment of 30 cases of diabetic foot with Mailuoning injection and Buyang Huanwu Decoction [J]. Jilin Journal of Traditional Chinese Medicine, 2000, 33(4): 45.
  10. Xu Wencan, Lin Jiancai, Zhang Yun, et al. Study of the effects and mechanism of breviscapine injection in the treatment of diabetic foot [J]. Modern Journal of Integrated Traditional Chinese and Western Medicine, 2005, 14(3): 296.
  11. Cheng Yao, Lu Tao, Xiao Caihong. Observation of the efficacy of Ginaton in the treatment of diabetic foot [J]. Harbin Medical Journal, 2000, 20(1): 17.
  12. Li Xiumei, Mi Yanxu, Mi Yanhong. Nursing study of 80 cases of diabetic foot treated with Mudan Granules [J]. Hebei Journal of Traditional Chinese Medicine, 2015, 11(10): 1574-1576.
  13. Xie Haiying, Wan Qirong, Zheng Chenghong, et al. Study of the efficacy of Naomaitai capsules in the treatment of early diabetic foot [J]. Chinese General Practice, 2008, 12(16): 1499-1500.
  14. Mo Taisong. Clinical observation of Shenmai Mai injection in the treatment of diabetic foot [J]. Zhejiang Journal of Integrated Traditional Chinese and Western Medicine, 2000, 10(3): 169.
  15. Xiao Zhenghua, Chen Dingyu, Liang Wei, et al. Observation of the efficacy of topical Astragalus injection in treating 52 cases of diabetic foot ulcers [J]. New Journal of Traditional Chinese Medicine, 2005, 37(12): 47.
  16. Zhu Xiaojuan, Zhang Didi, Yao Jing, et al. Nursing care of 28 patients with diabetic foot of the damp-heat toxin exuberance pattern treated with topical Shengji Yuhong Ointment [C]//Diabetes Branch of the China Association of Chinese Medicine. Proceedings of the 14th National Conference on Diabetes in Traditional Chinese Medicine. Diabetes Branch of the China Association of Chinese Medicine, 2012: 3.
  17. Huang Shuyun, Huang Lili, Jiang Tiancui, et al. Application of Wumiao Shuixian Ointment in the treatment of diabetic foot [J]. Journal of Modern Medicine & Health, 2003, 19(3): 313.