Research Progress in Traditional Chinese Medicine Interventions for the Pre-Ulcerative Stage of Diabetes-Related Foot Disease Based on the Theory of Blood Stasis Obstructing the Vessels

The pre-ulcerative stage of diabetes-related foot disease is a key opportunity to prevent first ulcers, reduce recurrence, and preserve lower-limb function.Its clinical definition, pattern criteria, and outcome measures remain inconsistent.This narrative review examines the stage through the traditional Chinese medicine (TCM) concept of blood stasis obstructing the vessels, focusing on pathogenesis, risk assessment, interventions, and mechanisms.Qi-yin deficiency and spleen-kidney insufficiency are viewed as the basis, while blood stasis obstructing the channels impairs local nourishment; cold and phlegm-dampness may aggravate this process.Herbal therapies that replenish qi and activate blood, warm the channels, and acupuncture may improve symptoms and selected neurovascular measures.Evidence for foot baths, moxibustion, and tuina remains conditional on protective sensation, ischemia, skin integrity, and safety.Existing evidence is largely derived from populations with peripheral neuropathy, those in the ulceration stage, or those with mixed-stage conditions; there is a lack of research specifically targeting the "blood stasis obstructing the vessels" pattern in the pre-ulcerative stage, with the development of new ulcers as the primary outcome.TCM should complement risk stratification, foot care, and metabolic and vascular management.Future efforts should standardize syndromes and core outcomes, and conduct long-term randomized trials to evaluate the benefits provided beyond those of routine preventive measures.