Fig. 1

Natural course of diabetic nephropathy (DN) progression and Chinese medicine (CM) interventions in different stages. a In the early stage characterized by hyperfiltration and hypertrophy, CMs have therapeutic effects based on their anti-oxidant or anti-inflammatory activities. Representatives are Panax quinquefolium, Asparagus racemosus, Rosa laevigata, and Piper auritum [5, 42–44]. b In the incipient DN stage characterized by microalbuminuria, CMs such as Cornus officinalis, Abelmoschus manihot, Schisandrae chinensis, and Paeonia lactiflora exhibit anti-microalbuminuric effects and may slow down the propagation of DN [19, 21, 46, 47]. The mechanisms involve protecting podocytes, and suppressing extracellular matrix (ECM) expansion and the endothelin-reactive oxidative species (ET-ROS) axis. As both the early and incipient stages of DN are at least partially reversible, CM interventions, which have superior effects based on their anti-oxidant, anti-inflammatory, and other renoprotective activities, are recommended as early as possible. c In the overt and end-stage renal disease (ESRD) stages of DN characterized by proteinuria and glomerulosclerosis, respectively, CM prescriptions, such as Zhen-wu-tang (ZWT; also called Shinbu-to in Japan) consisting of five herbs including Common Monkshood root, Poria, White Peony root, Atractylodis rhizome, and Zingiberis rhizome, have demonstrated optimal effects on ameliorating proteinuria by suppressing the hyperactivity of the renal renin–angiotensin system [72]