{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T02:25:41Z","timestamp":1777861541040,"version":"3.51.4"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diabetic peripheral neuropathy (DPN) is a common diabetes complication. Buyang Huanwu Decoction (BYHWD) combined with \u03b1-lipoic acid (ALA) is used clinically, but evidence consistency and heterogeneity sources remain unexplored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate efficacy\/safety of BYHWD+ALA for DPN and deconstruct heterogeneity via a multi\u2212tiered framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched PubMed, Web of Science, EMbase, Cochrane Library, CNKI, Wanfang, VIP, and CBM up to December 2025 for RCTs. Two reviewers independently screened studies, extracted data, and assessed risk of bias (Cochrane tool). Meta\u2212analysis used RR (dichotomous) and SMD (continuous) with 95% CI. Heterogeneity (I\u00b2) was explored through subgroup analysis, sensitivity analysis, meta\u2212regression, and descriptive synthesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twelve RCTs (926 patients) were included. BYHWD+ALA significantly improved overall response rate (RR\u00a0=\u00a01.24, 95%CI 1.17\u20131.32; I\u00b2=0%) and TCM syndrome scores (SMD=\u20130.76, 95%CI \u20130.98 to \u20130.54). For nerve conduction velocity (NCV), fundamental heterogeneity emerged (I\u00b2&amp;gt;92%). A five\u2212tiered analysis revealed that only peroneal nerve motor NCV showed a robust improvement trend (SMD\u00a0=\u00a01.01, 95%CI 0.48\u20131.54), though heterogeneity remained high (I\u00b2=92%). Heterogeneity sources included non\u2212standardized NCV measurement and complex intervention\u2212patient matching. Oxidative stress markers (SOD, MDA, T\u2212AOC) trended favorably; HbA1c and adverse events did not differ between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>BYHWD+ALA safely improves subjective DPN symptoms, but NCV evidence is too heterogeneous to draw reliable quantitative conclusions. This study provides a methodological framework for deconstructing heterogeneity and guides future standardized research.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/display_record.php?RecordID=1267606<\/jats:ext-link>\n                      , identifier CRD420251267606.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1778262","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T04:24:14Z","timestamp":1777523054000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and safety of Buyang Huanwu Decoction combined with \u03b1-lipoic acid for diabetic peripheral neuropathy: a systematic review with in-depth heterogeneity deconstruction and methodological appraisal"],"prefix":"10.3389","volume":"17","author":[{"given":"Qi","family":"Yong","sequence":"first","affiliation":[{"name":"Clinical Medical College, Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]},{"name":"Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peiying","family":"Zhang","sequence":"additional","affiliation":[{"name":"Clinical Medical College, Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]},{"name":"Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunxi","family":"Xu","sequence":"additional","affiliation":[{"name":"Clinical Medical College, Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]},{"name":"Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao","family":"Xu","sequence":"additional","affiliation":[{"name":"Clinical Medical College, Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]},{"name":"Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hua","family":"Bai","sequence":"additional","affiliation":[{"name":"Clinical Medical College, Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]},{"name":"Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hejiang","family":"Ye","sequence":"additional","affiliation":[{"name":"Clinical Medical College, Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]},{"name":"Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.2337\/dc10-1303","article-title":"Toronto Diabetic Neuropathy Expert Group. 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