Research progress on the treatment of diabetic cardiomyopathy with traditional Chinese medicine

doi:10.12092/j.issn.1009-2501.2026.06.005

Abstract

Abstract:

Diabetic cardiomyopathy (DCM) is one of the severe complications of diabetes mellitus with complex pathogenesis. Currently, there are no specific therapeutic drugs for DCM in Western medicine. Traditional Chinese medicine (TCM) exhibits promising prospects in the prevention and treatment of DCM due to its multi-target and multi-pathway characteristics. This article systematically reviews the advances in experimental research on TCM intervention for DCM over the past five years, and summarizes the functional targets and signaling pathways of TCM from three categories: TCM monomers, classical compound prescriptions and modern proprietary Chinese medicines. The results demonstrate that TCM monomers (e.g., curcumin, astragalus polysaccharide, berberine, astragaloside IV and resveratrol) mainly activate signaling pathways including PI3K/AKT/mTOR, AMPK/mTOR, SIRT3/FOXO3a and Nrf2/HO-1/GPX4, thereby inhibiting oxidative stress, apoptosis, ferroptosis and pyroptosis, and improving myocardial structure and cardiac function. Classical compound prescriptions such as Buyang Huanwu Decoction, Zhigancao Decoction, Shengmai Yin and Didang Decoction can regulate insulin signaling pathway, TLR4/NF-κB axis, miR-181a-5p/SPHK2 and proteins related to mitochondrial dynamics, and alleviate myocardial inflammation and fibrosis. Modern proprietary Chinese medicines, including Tongxinluo Capsule, Zuojiang Jiangtang Shuxin Formula, Zhilong Huoxue Tongyu Capsule, Shexiang Tongxin Dropping Pills and Ziquan Tongmai Decoction, regulate AMPK-mTOR, TGF-β1/Smads and AGE-RAGE pathways to promote autophagy and ameliorate vascular endothelial dysfunction and microcirculatory disorders. All types of TCM can reduce blood glucose and blood lipid levels in DCM models, downregulate the expression of myocardial injury markers (CK-MB, MDA), and enhance the activities of antioxidant indicators (SOD, GSH-Px). TCM exerts synergistic therapeutic effects on DCM via multiple targets. Nevertheless, further in-depth studies are still required to elucidate its molecular network and promote clinical transformation.

Key words: diabetic cardiomyopathy, traditional Chinese medicine, mechanism of action, signaling pathway, research progress

CLC Number:

R285.5

Xiao XU, Shuailin WANG, Xin QIAN, Yi YAO, Zhangyu WANG, Xiaoyi ZHU, Qing MAO, Qi GUO. Research progress on the treatment of diabetic cardiomyopathy with traditional Chinese medicine[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2026, 31(6): 764-773.

Figures/Tables 3

References 48

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Drug	Model	n (minimal)	Target	Mechanism	Reference
Curcumin	DCM rats	6	PI3K/AKT/mTOR signaling pathway	↓MDA ↑SOD, PI3K, mTOR, p-AKT	[4]
	DCM mice	5	SIRT3/FOXO3a signaling pathway	↓MDA, ROS, Bax, Cleaved caspase-3 ↑SOD, GSH-Px, SIRT3, FOXO3a, Bcl-2	[5]
	DCM rats	10	CYP2J2/PPARs signaling pathway	↑PPARα, PPARβ, PPARγ, CYP2J2	[6]
	DCM mice	6	Nrf2/HO-1/GPX4 signaling pathway	↓CK-MB, cTNT, LDH, MDA, ROS, Fe2? ↑SOD, GSH-Px, Nrf2, HO-1, GPX4	[7]
	DCM rats	20	AMPK/mTOR signaling pathway	↓Cleaved caspase-3, C-PARP, p62, p-mTOR ↑LC3, Beclin-1, p-AMPK	[8]
Astragalus polysaccharide	DCM rats	10	AMPK/mTOR signaling pathway	↓LVEDD, LVESD, mTOR, p-mTOR ↑LVEF, LVFS, AMPK, p-AMPK	[10]
	DCM rats	10	LC3, p62	↓p62 ↑LC3	[11]
	SOD2?/KO mice	6	Nitrosine, 8-OH-dG, SOD2	↓ROS, Nitrosine, 8-OH-dG ↑SOD2	[12]
Berberine	H9c2 cells	—	CCNA2, PLK1, RRM2	↓ROS, CCL2, CCL7, NRBP2, SOX9 ↑BIRC5, CCNA2, CCNB1, CDC20, MYBL2, PLK1, RRM2	[14]
	DCM mice, H9c2 cells	6	SIRT3/lipophagy axis	↓CK, CK-MB, Plin5 ↑Beclin1, Sirt3, LC3Ⅱ/LC3Ⅰ, Opa1, Drp1, Mfn2, Mff	[15]
	DCM mice, H9c2 cells	6	mTOR/mtROS signaling pathway	↓CollagenⅠ, CollagenⅢ, NLRP3, Caspase-1, IL-1β, IL-18, GSDMD, p-mTOR, TGF-β	[16]
	DCM mice, H9c2 cells	6	AMPK/mTOR signaling pathway	↓ROS, MFF, p-Drp1Ser616, Parkin, p-mTORSer2481/mTOR ↑ATP, MMP, Mfn2, p-Drp1Ser637, LC3-Ⅱ, PGC-1α, Nrf1, Nrf2, Tfam, Tfb1m, Tfb2m	[17]
Astragaloside IV	DCM mice	10	IL-17 signaling pathway	↓CK-MB, TG, LDL-C, IL-1β, IL-6, CXCL-10, IL-17, IL-17R, TRAF6, MAPKs, c-Jun, NF-κB p65 ↑HDL-C	[19]
Astragaloside IV	DCM mice, H9c2 cells	6	NLRP3/Caspase-1/GSDMD signaling pathway	↓TC, TG, IL-1β, IL-18, IL-6, TNF-α, NLRP3, ASC, Caspase-1, GSDMD, GSDMD-N, pro-IL-1β, IL-1β ↑LDH, CK-MB	[20]
	DCM mice	6	AMPK/ULK1 signaling pathway	↓TG, LDL-C, p62 ↑Beclin-1, LC3, p-AMPK	[21]
	DCM mice	15	PI3K/Akt signaling pathway	↓LDH, CK-MB, cTnT, MDA, TNF-α, IL-1β, IL-6, MCP-1 mRNA ↑GSH, GSH-Px, p-PI3K/PI3K, p-Akt/Akt	[22]
Resveratrol	DCM mice	8	SIRT3	↓TC, TG, LDL-C, Bax, Cleaved caspase-3 ↑HDL-C, Bcl-2, p-AMPK, PGC-1α, p-FOXO-1, SIRT3	[24]
	DCM mice	10	Mst1/SIRT3	↓Bax, Bax/Bcl-2, p62, p-Mst1 ↑Bcl-2 mRNA, Sirt3, LC3Ⅱ/LC3Ⅰ	[25]
	DCM mice	6	AMPK-P53	↓P62, P53 ↑Parkin, p-AMPK	[26]

Drug	Model	n (minimal)	Target	Mechanism	Reference
Curcumin	DCM rats	6	PI3K/AKT/mTOR signaling pathway	↓MDA ↑SOD, PI3K, mTOR, p-AKT	[4]
	DCM mice	5	SIRT3/FOXO3a signaling pathway	↓MDA, ROS, Bax, Cleaved caspase-3 ↑SOD, GSH-Px, SIRT3, FOXO3a, Bcl-2	[5]
	DCM rats	10	CYP2J2/PPARs signaling pathway	↑PPARα, PPARβ, PPARγ, CYP2J2	[6]
	DCM mice	6	Nrf2/HO-1/GPX4 signaling pathway	↓CK-MB, cTNT, LDH, MDA, ROS, Fe2? ↑SOD, GSH-Px, Nrf2, HO-1, GPX4	[7]
	DCM rats	20	AMPK/mTOR signaling pathway	↓Cleaved caspase-3, C-PARP, p62, p-mTOR ↑LC3, Beclin-1, p-AMPK	[8]
Astragalus polysaccharide	DCM rats	10	AMPK/mTOR signaling pathway	↓LVEDD, LVESD, mTOR, p-mTOR ↑LVEF, LVFS, AMPK, p-AMPK	[10]
	DCM rats	10	LC3, p62	↓p62 ↑LC3	[11]
	SOD2?/KO mice	6	Nitrosine, 8-OH-dG, SOD2	↓ROS, Nitrosine, 8-OH-dG ↑SOD2	[12]
Berberine	H9c2 cells	—	CCNA2, PLK1, RRM2	↓ROS, CCL2, CCL7, NRBP2, SOX9 ↑BIRC5, CCNA2, CCNB1, CDC20, MYBL2, PLK1, RRM2	[14]
	DCM mice, H9c2 cells	6	SIRT3/lipophagy axis	↓CK, CK-MB, Plin5 ↑Beclin1, Sirt3, LC3Ⅱ/LC3Ⅰ, Opa1, Drp1, Mfn2, Mff	[15]
	DCM mice, H9c2 cells	6	mTOR/mtROS signaling pathway	↓CollagenⅠ, CollagenⅢ, NLRP3, Caspase-1, IL-1β, IL-18, GSDMD, p-mTOR, TGF-β	[16]
	DCM mice, H9c2 cells	6	AMPK/mTOR signaling pathway	↓ROS, MFF, p-Drp1Ser616, Parkin, p-mTORSer2481/mTOR ↑ATP, MMP, Mfn2, p-Drp1Ser637, LC3-Ⅱ, PGC-1α, Nrf1, Nrf2, Tfam, Tfb1m, Tfb2m	[17]
Astragaloside IV	DCM mice	10	IL-17 signaling pathway	↓CK-MB, TG, LDL-C, IL-1β, IL-6, CXCL-10, IL-17, IL-17R, TRAF6, MAPKs, c-Jun, NF-κB p65 ↑HDL-C	[19]
Astragaloside IV	DCM mice, H9c2 cells	6	NLRP3/Caspase-1/GSDMD signaling pathway	↓TC, TG, IL-1β, IL-18, IL-6, TNF-α, NLRP3, ASC, Caspase-1, GSDMD, GSDMD-N, pro-IL-1β, IL-1β ↑LDH, CK-MB	[20]
	DCM mice	6	AMPK/ULK1 signaling pathway	↓TG, LDL-C, p62 ↑Beclin-1, LC3, p-AMPK	[21]
	DCM mice	15	PI3K/Akt signaling pathway	↓LDH, CK-MB, cTnT, MDA, TNF-α, IL-1β, IL-6, MCP-1 mRNA ↑GSH, GSH-Px, p-PI3K/PI3K, p-Akt/Akt	[22]
Resveratrol	DCM mice	8	SIRT3	↓TC, TG, LDL-C, Bax, Cleaved caspase-3 ↑HDL-C, Bcl-2, p-AMPK, PGC-1α, p-FOXO-1, SIRT3	[24]
	DCM mice	10	Mst1/SIRT3	↓Bax, Bax/Bcl-2, p62, p-Mst1 ↑Bcl-2 mRNA, Sirt3, LC3Ⅱ/LC3Ⅰ	[25]
	DCM mice	6	AMPK-P53	↓P62, P53 ↑Parkin, p-AMPK	[26]

Drug	Model	n (minimal)	Target	Mechanism	Reference
Buyang Huanwu Decoction	DCM mice	10	AKT, GSK3β	↓GSK3β, p-GSK3β ↑INSR, p-PI3K, p-AKT	[27]
	DCM mice	8	TNF-α, DRP1, MFN2	↓LDH, CK-MB, IL-2, TNF-α, MDA, DRP1, MFF ↑SOD, MFN2	[28]
	DCM mice	10	TLR4/NF-κB	↓CK-MB, IL-6, MCP-1, TNF-α, TG, LDL-C, TLR4, NF-κB p65, Cleaved caspase-3, Cleaved PARP, CollagenⅠ, Collagen Ⅲ ↑HDL-C	[29]
Zhigancao Decoction	DCM rats	10	miR-181a-5p, SPHK2	↓α-SMA, CollagenⅠ, CollagenⅢ, SPHK2 ↑miR-181a-5p	[30]
Zhigancao Decoction	DCM rats	10	LC3-Ⅰ, LC3-Ⅱ, Beclin-1, P62	↓BNP, Bax, P62 ↑Bcl-2, Beclin-1, LC3-Ⅱ/LC3-Ⅰ	[31]
Shengmai Decoction	DCM mice	10	Alkbh5-Atg7	↓LDH, CK-MB, cTN1 ↑ANP mRNA, BNP mRNA, Alkbh5, Lc3, Atg7	[32]
	DCM rats	10	CaMKII/PLB/p-PLB/SERCA2a	↓PLB, CaMKII ↑p-PLB, SERCA2a, NCX1, PPAR-α, SERCA2a/PLB, PLBSer16+Thr17/PLB	[33]
	DCM rats	10	PPARα/CD36	↓MDA, PPARα, CD36 ↑SOD, GSH-Px, miR-19a	[34]
Didang Decoction	DCM mice	12	Mfn2, Opal, Drp1, Fis-1	↓Mfn2, Opa1, ROS ↑Drp1, Fis-1	[35]
Didang Decoction	DCM mice	8	NLRP3	↓TC, TG, ROS, NLRP3, TXNIP, Caspase-1, IL-1β	[36]

Drug	Model	n (minimal)	Target	Mechanism	Reference
Buyang Huanwu Decoction	DCM mice	10	AKT, GSK3β	↓GSK3β, p-GSK3β ↑INSR, p-PI3K, p-AKT	[27]
	DCM mice	8	TNF-α, DRP1, MFN2	↓LDH, CK-MB, IL-2, TNF-α, MDA, DRP1, MFF ↑SOD, MFN2	[28]
	DCM mice	10	TLR4/NF-κB	↓CK-MB, IL-6, MCP-1, TNF-α, TG, LDL-C, TLR4, NF-κB p65, Cleaved caspase-3, Cleaved PARP, CollagenⅠ, Collagen Ⅲ ↑HDL-C	[29]
Zhigancao Decoction	DCM rats	10	miR-181a-5p, SPHK2	↓α-SMA, CollagenⅠ, CollagenⅢ, SPHK2 ↑miR-181a-5p	[30]
Zhigancao Decoction	DCM rats	10	LC3-Ⅰ, LC3-Ⅱ, Beclin-1, P62	↓BNP, Bax, P62 ↑Bcl-2, Beclin-1, LC3-Ⅱ/LC3-Ⅰ	[31]
Shengmai Decoction	DCM mice	10	Alkbh5-Atg7	↓LDH, CK-MB, cTN1 ↑ANP mRNA, BNP mRNA, Alkbh5, Lc3, Atg7	[32]
	DCM rats	10	CaMKII/PLB/p-PLB/SERCA2a	↓PLB, CaMKII ↑p-PLB, SERCA2a, NCX1, PPAR-α, SERCA2a/PLB, PLBSer16+Thr17/PLB	[33]
	DCM rats	10	PPARα/CD36	↓MDA, PPARα, CD36 ↑SOD, GSH-Px, miR-19a	[34]
Didang Decoction	DCM mice	12	Mfn2, Opal, Drp1, Fis-1	↓Mfn2, Opa1, ROS ↑Drp1, Fis-1	[35]
Didang Decoction	DCM mice	8	NLRP3	↓TC, TG, ROS, NLRP3, TXNIP, Caspase-1, IL-1β	[36]

Drug	Model	n (minimal)	Target	Mechanism	Reference
Tongxinluo Capsule	H9c2 cells	—	AMPK-mTOR signaling pathway	↓ROS, LDH, MDA, P62, p-mTOR ↑Beclin-1, LC3Ⅱ/Ⅰ, p-AMPK	[37]
Tongxinluo Capsule	DCM rats	8	TGF-β1-p38MAPK-CREB signaling pathway	↓TGF-β1, p-p38MAPK, Caspase-3 ↑Bcl-2, p-CREB	[38]
Zuogui Jiangtang Shuxin Formula	DCM mice	6	Foxo1-ANP-β-MHC signaling pathway	↓Foxo1, ANP, β-MHC	[39]
Zuogui Jiangtang Shuxin Formula	DCM mice	10	TLR4/NF-κB signaling pathway	↓TNF-α, IL-1β, TLR4, NF-κB p56, p-NF-κB p56/NF-κB p56, CollagenⅠ, CollagenⅢ, α-SMA	[40]
Zhilong Huoxue Tongyu Capsule	DCM mice	8	P38MAPK signaling pathway	↓TG, TC, p-P38MAPK, TNF-α, α-SMA, Collagen-Ⅰ	[41]
	DCM rats	10	PI3K, AKT1, FoxO3a	↓GHb, TC, TG, LDL-C ↑HDL-C, PI3K, AKT1, FoxO3a, p-PI3K, p-AKT1, p-FoxO3a	[42]
	DCM rats	9	Adiponectin	↓ICAM-1, VCAM-1 ↑Adiponectin	[43]
Shexiang Tongxin Dropping Pill	DCM rats	6	AGE-RAGE	↓p-p38, p-JNK, Cleaved caspase-3	[44]
Shexiang Tongxin Dropping Pill	DCM mice	6	VEGF, ZO-1, Occludin, VE-Cadherin, Claudin-5, JAM-A	↓TC, TG, LDL-C ↑VEGF, VEGFR2, PI3K, AKT, eNOS, ZO-1, Occludin, VE-Cadherin, Claudin-5, JAM-A	[45]
Zicui Tongmai Decoction	DCM rats	9	TGF-β1/Smads signaling pathway	↓TGF-β1, Smads3 ↑Smads7	[46]
Zicui Tongmai Decoction	DCM rats	9	PKC-βⅡ	↓FPG, FINS, HOMA-IR, TG, T-CHO, LDL-C, HbAlc, MDA, PKC-βⅡ, VEGF ↑SOD, VE-cadherin, VEGFR2	[47-48]