Multi-target mechanisms and therapeutic potential of Dahuang Zhechong pill in lower extremity peripheral artery disease: a structured narrative review

Lower extremity peripheral artery disease (PAD) is a chronic ischemic disorder primarily driven by atherosclerosis (AS) and characterized by endothelial injury, lipid deposition, inflammation, oxidative stress, and hemorheological abnormalities. From the perspective of traditional Chinese medicine (TCM), its pathogenesis is commonly interpreted within the concept of “ Tuoju ”, in which blood stasis obstructs the collaterals/meridians and may coexist with qi deficiency, blood heat, or phlegm-dampness. Dahuang Zhechong Pill (DHZCP), first recorded in the Jingui Yaolue , is traditionally prescribed to remove blood stasis, clear heat, and resolve masses, while also supporting vital qi and nourishing yin, which conceptually aligns with TCM pattern differentiation in PAD. Preclinical studies and limited clinical reports suggest that DHZCP may be associated with multi-domain effects relevant to PAD pathophysiology, including endothelial-related readouts, lipid metabolism, inflammation, oxidative stress, and hemorheological parameters. Clinical studies (mostly small-sample trials) indicate that DHZCP may be associated with improvements in ankle–brachial index (ABI), lipid profiles, blood viscosity, and microcirculatory perfusion, particularly when used as an adjunct to acupuncture, blood-activating prescriptions, or conventional therapies, with generally favorable short-term safety signals. This review summarizes the traditional rationale and modern evidence on DHZCP for PAD, critically appraises the current evidence base and its limitations, and proposes priorities for future research to support standardized clinical use and potential international application. This article is a structured narrative review based on a predefined literature search and study selection strategy. In silico findings (e.g., network approaches and molecular docking) are treated as hypothesis-generating evidence and are clearly distinguished from in vitro / in vivo and clinical studies.