Objective:To investigate the distribution characteristics of TCM syndromes in patients with diabetic nephropathy (DN) and their relationship with microinflammatory status and nutritional status.Methods:A retrospective study. Gender, age, TCM syndrome types, chronic kidney disease (CKD) staging, nutritional status and other medical records of 302 patients with DN from January 2021 to October 2024 in Affiliated Guangzhou Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine were collected and retrospectively analyzed. The neutrophil count and lymphocyte count were detected by automatic blood cell analyzer, and the neutrophil lymphocyte ratio (NLR) was calculated; the levels of IL-1β and IL-10 were detected by ELISA; malnutrition inflammation score (MIS) was used to evaluate nutritional status. Cramer's V and Eta2 correlation coefficient were used to analyze the correlation between TCM syndrome types and CKD stage, micro inflammatory state and nutritional status in patients with DN. Results:Among the 302 patients, the primary syndromes in descending order were qi-yin deficiency (106 cases), spleen-kidney deficiency (94 cases), liver-kidney yin deficiency (71 cases), and yin-yang deficiency (31 cases). The associated syndromes in descending order were blood stasis (75 cases), phlegm-stasis (66 cases), dampness-turbidity (62 cases), damp-heat (52 cases), and none (47 cases). The top three combined syndromes were spleen-kidney deficiency with damp-heat, qi-yin deficiency with blood stasis, and qi-yin deficiency with phlegm-stasis. For primary syndromes, CKD stage I was mainly qi-yin deficiency and liver-kidney yin deficiency; stage Ⅱ, qi-yin deficiency and liver-kidney yin deficiency; stage Ⅲ, qi-yin deficiency and spleen-kidney deficiency; stage Ⅳ, spleen-kidney deficiency. Differences across CKD stages were statistically significant ( χ2=86.08, P<0.001). For associated syndromes, CKD stage Ⅰ was mainly none; stage Ⅱ and Ⅲ, blood stasis; stage Ⅳ, dampness-turbidity, with statistical significance ( χ2=58.92, P<0.001). NLR and IL-1β levels in yin-yang deficiency, spleen-kidney deficiency, and liver-kidney yin deficiency were higher than in qi-yin deficiency, while IL-10 levels were lower ( P<0.05); for associated syndromes, dampness-turbidity showed higher NLR and IL-1β and lower IL-10 compared with blood stasis and phlegm-stasis ( P<0.05). There was statistical significance in the distribution of DN patients with different syndrome types and nutritional status ( χ2=75.16, P<0.001); there was no statistical significance in the distribution of patients with different syndrome types and nutritional status ( χ2=13.93, P>0.05). Qi-yin deficiency and liver-kidney yin deficiency were mainly mildly malnourished, while spleen-kidney deficiency and yin-yang deficiency were mainly moderately malnourished. Cramer's V/ Eta2 analysis indicated that primary TCM syndromes were correlated with CKD stage, nutritional status (Cramer's V values were 0.308, 0.288), NLR, IL-1β, IL-10 ( Eta2 values were 0.865, 0.984, 0.916) ( P<0.001), while associated syndromes were correlated with CKD stage (Cramer's V=0.255), NLR, IL-1β, and IL-10 ( Eta2 values were 0.891, 0.958, 0.908) ( P<0.001). Conclusions:DN patients is mainly qi-yin deficiency syndrome, and blood-stasis syndrome. The TCM syndrome type is mainly spleen-kidney deficiency and damp-heat syndrome, and the TCM syndrome type is related to micro inflammatory state and nutritional status.