# Regulatory mechanisms of Traditional Chinese Medicine on gut microbiota in diabetic microvascular complications **Authors:** Yiyang Peng, Chenyao Sun, Zheng Wang, Xiaohui Fan PMC · DOI: 10.1186/s13020-026-01374-4 · Chinese Medicine · 2026-03-18 ## TL;DR This paper reviews how Traditional Chinese Medicine may help treat diabetes-related complications by influencing gut bacteria. ## Contribution The paper systematically reviews recent evidence on TCM-gut microbiota interactions in diabetic microvascular complications. ## Key findings - TCM has shown therapeutic effects in alleviating diabetic microvascular complications. - Gut microbiota regulation, including the gut-retina and gut-kidney axes, is linked to microvascular injury. - Current limitations and future directions for studying TCM-microbiota interactions are discussed. ## Abstract Diabetic microvascular complications are the most common and serious late-stage problems with diabetes patient, while existing antidiabetic treatments still have limited effects in preventing or reversing microvascular damage. Traditional Chinese Medicine (TCM) has been applied in clinical practice for centuries, showing excellent therapeutic effects in alleviating diabetic microvascular complications. Recently, the regulatory effects of gut microbiota, especially concepts such as the “gut-retina axis” and “gut-kidney axis” have been proposed and supported by accumulating experiment, which shows the importance of gut microbiota in microvascular injury. This review focuses on how TCM-gut microbiota interactions contribute to the prevention and treatment of diabetic microvascular complications, reviewing and organizing the latest evidence from experimental and clinical research. We further summarize current limitations in the field and discuss future direction to better uncover the mechanisms of TCM-microbiota interactions. ## Linked entities - **Diseases:** diabetes (MONDO:0005015) ## Full-text entities - **Genes:** Ocln (occludin) [NCBI Gene 18260] {aka Ocl}, Tab1 (TGF-beta activated kinase 1/MAP3K7 binding protein 1) [NCBI Gene 66513] {aka 2310012M03Rik, Map3k7ip1, b2b449Clo}, Cdh5 (cadherin 5) [NCBI Gene 12562] {aka 7B4, Cd144, VE-Cad, VECD, VEcad, Vec}, Cldn5 (claudin 5) [NCBI Gene 12741] {aka MBEC1, Tmvcf}, HDAC [NCBI Gene 4364205], Tnf (tumor necrosis factor) [NCBI Gene 21926] {aka DIF, TNF-a, TNF-alpha, TNFSF2, TNFalpha, Tnfa}, Ppargc1a (peroxisome proliferative activated receptor, gamma, coactivator 1 alpha) [NCBI Gene 19017] {aka A830037N07Rik, Gm11133, PGC-1, PPARGC-1-alpha, Pgc-1alpha, Pgc1}, Nrg1 (neuregulin 1) [NCBI Gene 211323] {aka 6030402G23Rik, ARIA, D230005F13Rik, GGF, GGFII, HRG}, Akr1b1 (aldo-keto reductase family 1 member B) [NCBI Gene 11677] {aka ALR2, AR, Ahr-1, Ahr1, Akr1b3, Aldor1}, Muc2 (mucin 2) [NCBI Gene 17831] {aka 2010015E03Rik, MCM, wnn}, Nfkb1 (nuclear factor of kappa light polypeptide gene enhancer in B cells 1, p105) [NCBI Gene 18033] {aka NF-KB1, NF-kappaB, NF-kappaB1, p105, p50, p50/p105}, Il17a (interleukin 17A) [NCBI Gene 16171] {aka Ctla-8, Ctla8, IL-17, IL-17A, Il17}, Tgfb1 (transforming growth factor, beta 1) [NCBI Gene 21803] {aka TGF-beta1, TGFbeta1, Tgfb, Tgfb-1}, Tjp1 (tight junction protein 1) [NCBI Gene 21872] {aka ZO1}, Il6 (interleukin 6) [NCBI Gene 16193] {aka Il-6}, Ppara (peroxisome proliferator activated receptor alpha) [NCBI Gene 19013] {aka 4933429D07Rik, Nr1c1, PPAR-alpha, PPARalpha, Ppar}, Nlrp3 (NLR family, pyrin domain containing 3) [NCBI Gene 216799] {aka AGTAVPRL, AII/AVP, Cias1, FCAS, FCU, MWS}, GLP1R (glucagon like peptide 1 receptor) [NCBI Gene 2740] {aka GLP-1, GLP-1-R, GLP-1R}, Tlr4 (toll-like receptor 4) [NCBI Gene 21898] {aka Lps, Ly87, Ran/M1, Rasl2-8}, Ager (advanced glycosylation end product-specific receptor) [NCBI Gene 11596] {aka RAGE}, Sirt1 (sirtuin 1) [NCBI Gene 93759] {aka SIR2L1, Sir2, Sir2a, Sir2alpha}, PRRT2 (proline rich transmembrane protein 2) [NCBI Gene 112476] {aka BFIC2, BFIS2, DSPB3, DYT10, EKD1, FICCA}, Fdxr (ferredoxin reductase) [NCBI Gene 14149] {aka AR} - **Diseases:** metabolic dysregulation (MESH:D021081), Diabetic microangiopathy (MESH:D003925), sensory dysfunction (MESH:D012678), tubular injury (MESH:D000230), neuropathic (MESH:D009437), insulin resistance (MESH:D007333), injury (MESH:D014947), DR (MESH:D003930), diabetic complications (MESH:D048909), DPN (MESH:D010523), vascular damage (MESH:D057772), NOD (MESH:D009765), bacterial (MESH:D001424), glomerular injury (MESH:D007674), spleen and kidney deficiency (MESH:D007680), Gut dysbiosis (MESH:D064806), neuroinflammation (MESH:D000090862), diabetic neuropathy (MESH:D003929), neurotoxic (MESH:D020258), TMAO (MESH:C536108), microvascular damage (MESH:D017566), Diabetes (MESH:D003920), neuropathic symptoms (MESH:D001750), glomerulosclerosis (MESH:D005921), retinal damage (MESH:D012164), PC (MESH:C535298), capillary occlusion (MESH:D001157), organ injury (MESH:D009102), diabetic microvascular disease (OMIM:612623), metabolic (MESH:D008659), proteinuria (MESH:D011507), chronic (MESH:D002908), fibrosis (MESH:D005355), DKD (MESH:D003928), tissue injury (MESH:D017695), Diabetic microvascular complications (OMIM:603933), hyperglycemia (MESH:D006943), complications (MESH:D008107), colitis (MESH:D003092), metabolic and vascular complications (MESH:D020739), edema (MESH:D004487), neuronal degeneration (MESH:D009410), chronic inflammation (MESH:D007249) - **Chemicals:** citric acid (MESH:D019343), glycyrrhetinic acid (MESH:D006034), glycyrrhizic acid (MESH:D019695), STZ (MESH:D013311), H2S (MESH:D006862), sulfate (MESH:D013431), glycosides (MESH:D006027), DPN (-), Germacrone (MESH:C048393), pyridoxamine (MESH:D011733), terpenoids (MESH:D013729), fatty acid (MESH:D005227), LPE (MESH:C008301), ginsenosides (MESH:D036145), branched-chain amino acids (MESH:D000597), ginsenoside Rb1 (MESH:C442759), butyric acid (MESH:D020148), sorbitol (MESH:D013012), caproic acid (MESH:C037652), Berberine (MESH:D001599), K (MESH:D011188), TCA (MESH:D014238), propionate (MESH:D011422), Inulin (MESH:D007444), aglycones (MESH:C458179), NADPH (MESH:D009249), polysaccharide (MESH:D011134), lipid (MESH:D008055), fat (MESH:D005223), succinic acid (MESH:D019802), saponins (MESH:D012503), Artemisinin (MESH:C031327), rosmarinic acid (MESH:C041376), PC (MESH:D010713), isoleucine (MESH:D007532), ROS (MESH:D017382), LPC (MESH:D008244), PCS (MESH:C408690), valine (MESH:D014633), TMAO (MESH:C005855), leucine (MESH:D007930), glutathione (MESH:D005978), bile acid (MESH:D001647), diacylglycerol (MESH:D004075), flavonoid (MESH:D005419), Alkaloids (MESH:D000470), phosphatidylethanolamine (MESH:C483858), kynurenine (MESH:D007737), Metformin (MESH:D008687), ECH (MESH:C060297), LPS (MESH:D008070), polyphenols (MESH:D059808), ATP (MESH:D000255), SCFA (MESH:D005232), glycerophospholipid (MESH:D020404), acetate (MESH:D000085), quercetin (MESH:D011794), polyol (MESH:C024617), glucose (MESH:D005947), nitrogen (MESH:D009584) - **Species:** Carthamus tinctorius (safflower, species) [taxon 4222], Mus musculus (house mouse, species) [taxon 10090], Acetatifactor muris (species) [taxon 879566], Akkermansia muciniphila (species) [taxon 239935], Bacteria Latreille et al. 1825 (Bacteria stick insect, genus) [taxon 629395], Homo sapiens (human, species) [taxon 9606], Muribaculum (genus) [taxon 1918540], Ligilactobacillus murinus (species) [taxon 1622], Paraleonurus japonicus (Chinese motherwort, species) [taxon 4138], Pseudomonas (RNA similarity group I, genus) [taxon 286], Zingiber officinale (ginger, species) [taxon 94328], Roseburia (genus) [taxon 841], Alloprevotella (genus) [taxon 1283313], Faecalibaculum (genus) [taxon 1729679], Achromobacter (genus) [taxon 222], Enterobacteriaceae (enterobacteria, family) [taxon 543], Pueraria montana (species) [taxon 132459], Lycium barbarum (Duke of Argyll's teatree, species) [taxon 112863], Faecalitalea (genus) [taxon 1573534], Bifidobacterium (genus) [taxon 1678], Rattus norvegicus (brown rat, species) [taxon 10116], Klebsiella (genus) [taxon 570], Citrus (genus) [taxon 2706], Limosilactobacillus reuteri (species) [taxon 1598], Vigna radiata (mung bean, species) [taxon 157791], Enterococcus (genus) [taxon 1350], Dubosiella (genus) [taxon 1937008], Astragalus membranaceus (species) [taxon 649199], Prevotella (genus) [taxon 838], Portulaca oleracea (species) [taxon 46147], Bacteroides (genus) [taxon 816] ## Full text _Full body text omitted from this summary view._ Fetch the complete paper as Markdown: https://tomesphere.com/paper/PMC12997932/full.md ## Figures 2 figures with captions in the complete paper: https://tomesphere.com/paper/PMC12997932/full.md --- Source: https://tomesphere.com/paper/PMC12997932