Combining Traditional Chinese and Western Medicine for the Treatment of Dry Gangrene in Diabetic Foot
Diabetic foot, particularly ischemic dry gangrene, remains one of the most challenging complications of diabetes mellitus. Characterized by prolonged treatment duration, high medical costs, and elevated amputation rates, this condition demands a more comprehensive and integrative approach than what conventional Western medicine alone often provides.
Limitations of Relying Solely on Vascular Interventions
While endovascular procedures such as stenting and balloon angioplasty are commonly used to restore blood flow in patients with lower limb ischemia, they are not always the optimal long-term solution—especially in diabetic patients. The nature of diabetic peripheral artery disease is typically diffuse and multisegmental, affecting not only large arteries but also small vessels and microcirculation. Even after successful intervention in major arteries, microvascular occlusion may persist, leaving distal tissues inadequately perfused.
This limitation explains why many patients continue to suffer from non-healing ulcers despite technically successful revascularization. Moreover, restenosis following endovascular treatment remains a significant concern. Recurrent blockages often necessitate repeat procedures, increasing both physical trauma and financial burden. For patients who are not surgical candidates, the outcome frequently leads to partial or complete limb amputation.
The Timing and Suitability of Intervention Matter
As emphasized by Professor Cao Yemin from Shanghai University of Traditional Chinese Medicine's affiliated hospital, the timing of vascular intervention plays a critical role in determining patient outcomes. Performing the procedure too early or too late can diminish its effectiveness. However, timing is just one factor; appropriate patient selection based on indications and contraindications is equally vital.
Some patients may benefit greatly from stenting, while others—particularly those with extensive microvascular disease—may see little improvement. Therefore, an overreliance on interventional techniques without considering alternative strategies can lead to suboptimal results.
Beyond Revascularization: A Holistic Approach to Wound Healing
Improving blood circulation is only one component of diabetic foot management. Equally important is the comprehensive care of the wound itself. Unfortunately, vascular surgeons often conclude their involvement post-intervention, transferring patients to endocrinology or wound care units. This fragmented model disrupts continuity of care and hampers effective healing.
Western treatments like negative pressure wound therapy (NPWT), skin grafting, and systemic antibiotics are standard practices, yet they come with drawbacks—such as high infection recurrence, antibiotic resistance, and limited tissue regeneration capacity. In contrast, integrative approaches that incorporate Traditional Chinese Medicine (TCM) offer a more continuous and holistic pathway to recovery.
The Role of TCM in Microcirculation and Tissue Regeneration
TCM offers a well-established theoretical framework for understanding circulatory disorders, aligning closely with modern concepts of thrombosis, coagulation, and vascular obstruction. Concepts such as "blood stasis" (yu xue) and "activating blood circulation to remove stasis" (huo xue hua yu) parallel Western ideas of anticoagulation and thrombolysis.
Through the strategic use of herbal decoctions, oils, ointments, plasters, injections, and topical agents, TCM practitioners apply a multi-modal strategy to enhance local perfusion. Notably, acupoint injection therapy delivers medicinal compounds directly into targeted areas, promoting collateral circulation, improving microvascular flow, and increasing local oxygen saturation—essential factors for tissue repair.
Wound Healing Through "Purulent Muscle Nourishment" Therapy
One of the most distinctive strengths of TCM lies in its approach to wound management known as "wei nong sheng ji" (warming and promoting pus formation to generate healthy tissue). Rather than aggressively suppressing all exudate, this method encourages controlled inflammatory response, allowing natural debridement and pathogen clearance through increased purulent discharge.
By applying specific herbal powders or ointments tailored to individual syndromes, clinicians stimulate the body's innate healing mechanisms. This process enhances local immunity, boosts fibroblast proliferation, and supports granulation tissue formation—leading to faster, more sustainable wound closure without the need for skin grafts or invasive devices.
Minimizing Antibiotic Use and Avoiding Surgical Trauma
A key advantage of integrating TCM into diabetic foot care is the reduced reliance on broad-spectrum antibiotics and invasive procedures. Many patients treated with combined modalities avoid NPWT, repeated surgeries, and prolonged antimicrobial regimens—factors that contribute significantly to morbidity and healthcare costs.
Clinical evidence continues to accumulate showing that conservative, integrated treatments achieve high limb salvage rates. While the healing timeline may be longer compared to aggressive surgical interventions, the outcome—preservation of functional limbs and improved quality of life—is overwhelmingly favorable.
Embracing Integration: The Future of Diabetic Foot Care
Despite growing support, some skepticism around integrative medicine persists—and rightly so. Scientific inquiry thrives on debate and scrutiny. Yet, for physicians trained in both systems, the goal isn't to replace one with the other, but to synergize their strengths.
Young doctors entering the field are increasingly recognizing the limitations of purely interventional models. After witnessing remarkable recoveries through conservative TCM-enhanced protocols, many now advocate for earlier integration of complementary therapies.
In conclusion, treating ischemic diabetic foot requires more than reopening blocked arteries—it demands a unified, patient-centered strategy that values both scientific innovation and time-tested wisdom. By combining the precision of Western medicine with the holistic depth of TCM, we can transform outcomes, reduce amputations, and offer real hope to millions living with diabetic foot syndrome.