Advances in Traditional Chinese Medicine for Diabetic Glaucoma: A Systematic Review From Holistic Pathogenesis to Multi-Target Interventions.

Abstract

Diabetic glaucoma, a severe microvascular and neurodegenerative complication of diabetes, involves complex pathological mechanisms including chronic hyperglycemia‑induced oxidative stress, inflammatory responses, microcirculatory disturbances, and retinal ganglion cell (RGC) apoptosis. While conventional Western medicine has achieved significant success in intraocular pressure (IOP) control, it faces challenges in providing long‑term neuroprotection and delaying disease progression. Traditional Chinese Medicine (TCM), guided by its holistic concept and treatment based on syndrome differentiation, demonstrates unique advantages through multi-component, multi‑target, and multi‑pathway synergistic regulation. This review systematically elucidates the TCM pathogenesis evolution pattern of "deficiency leading to stasis, ocular collateral damage" in diabetic glaucoma and establishes correlation networks between TCM syndrome types and modern pathological mechanisms. Integrating epidemiological evidence, we analyze the core mechanisms of representative Chinese herbs and formulas-including Ginkgo biloba extract, indirubin‑related components, and the Si‑Hua formula-in exerting antioxidant, anti‑inflammatory, microcirculation‑improving, and direct neuroprotective effects through regulation of key signaling pathways such as PI3K/AKT, Nrf2, and NF‑κB. Importantly, this article employs network pharmacology methods to visually present the synergistic "component‑target‑pathway" interaction network of the Si‑Hua formula, and introduces a quantitative comparison of the regulatory intensity of key herbal components on signaling pathways. We also discuss the chemical structures of major secondary metabolites from these herbs and the principles of reverse pharmacology that connect TCM to modern drug discovery. By quantitatively evaluating the regulatory intensity of key herbal components on signaling pathways and exploring the interventional potential of TCM in emerging mechanisms like ferroptosis (Figure 9), this review aims to establish a comprehensive scientific framework for TCM prevention and treatment of diabetic glaucoma, providing solid academic support for the modernization and internationalization of TCM.

Key Findings

• Diabetic glaucoma involves oxidative stress, inflammatory responses, microcirculatory disturbances, and retinal ganglion cell apoptosis.
• Traditional Chinese Medicine (TCM) demonstrates multi-target and multi-pathway regulation, including antioxidant and anti-inflammatory effects.
• Key signaling pathways regulated by TCM herbs include PI3K/AKT, Nrf2, and NF-κB, contributing to neuroprotection and microcirculation improvement.

Clinical Significance

Citation

Liu Jinshen, Yu Yujia, Hu Chenet al.. Advances in Traditional Chinese Medicine for Diabetic Glaucoma: A Systematic Review From Holistic Pathogenesis to Multi-Target Interventions. Medicinal research reviews. 2026-Jul-18.