Discussion on Mechanisms of "State-Target Differentiation and Treatment" for Diabetic Foot Ulcers from the Perspective of Epithelial-Mesenchymal Transition
10.13288/j.11-2166/r.2025.01.005
- VernacularTitle:从上皮间充质转化探讨“态靶辨治”糖尿病足溃疡的机制
- Author:
Hong CHEN
1
;
Weijing FAN
1
;
Renyan HUANG
1
;
Guobin LIU
1
Author Information
1. Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine，Shanghai，201203
- Publication Type:Journal Article
- Keywords:
diabetic foot ulcers;
state-target differentiation and treatment;
epithelial-mesenchymal transition;
collate-ral injury
- From:
Journal of Traditional Chinese Medicine
2025;66(1):23-29
- CountryChina
- Language:Chinese
-
Abstract:
Building on the theory of "state-target differentiation and treatment" proposed by Academician TONG Xiaolin， diabetic foot ulcers （DFUs） are considered to belong to the "collateral injury" stage， characterized by the interplay of five states，i.e. dampness， heat， stasis， deficiency， and impairment. The dynamic biological process of epithelial-mesenchymal transition （EMT） is closely associated with the healing process of DFUs. The treatment of DFUs through staged differentiation under the "state-target differentiation and treatment" theory not only provides a basis for precise clinical treatment， but also offers insights into the regulatory roles of EMT in different states and potential intervention targets. The dampness state typically exits during the inflammatory phase， local inflammation and fluid metabolism disorders inducing EMT. Treatment focuses on draining dampness and alleviating edema， promoting local microcirculation， and improving tissue hypoxia. The heat state often reflects acute local inflammatory responses. Treatment emphasizes clearing heat and resolving toxins， regulating the EMT process to reduce inflammation， control infection， and alleviate redness， swollen， heat， and pain in the affected area. The stasis state mainly occurs during the proliferation phase. Treatment centers on invigorating blood and dissolving stasis， and unblocking the channels and quickening the collaterals. EMT plays a role in remodeling the extracellular matrix， promoting tissue repair and angiogenesis. The deficiency state is common in chronic phase， where treatment prioritizes tonifying qi and nourishing blood while reinforcing healthy qi and dispelling pathogens. EMT regulation focuses on restoring local tissue metabolism and improving the micro-environment to enhance tissue repair capacity. The impairment state represents the progression of disease deterioration. Treatment should focus on supplementing qi， blood， yin， and yang， and also promoting muscle growth and strengthening bones， supplementing by resolving toxins and stasis. EMT plays a role by regulating the activity of extracellular matrix-degrading enzymes to prevent excessive tissue repair and scarring， thereby facilitating the reconstruction of normal tissue structures.
