Table 1.

Clinical efficacy and mechanism of action of Chinese herbs and active ingredients for DKD treatment.

Categories	Component	Result	Pathway
Tripterygium	Tripterygium glycosides	Reduce 24-h UP, UAER and urinary β2-microglobulin	Up-regulate autophagy through mTOR/Twist1, inhibit TLR4/NF-κB to decrease EMT and apoptosis/PI3K/Akt, immune-inflammatory [60–63]
	Triptolide
Polyphenols	Puerarin	Reduce UAER and SCr	RAGE pathway, regulate SIRT1 to induce autophagy and reduce PKC activity [65–68]
	Breviscapinun	Reduce 24-h UP, SCr, BUN, and elevate TC and TG to decrease dyslipidemia	Regulate the Nrf2 /HO-1, TGF-β1, and PKC pathways [69–71]
	Resveratrol	Improve UACR, and increase production of antioxidant enzymes	Inhibit caspase 3, TGF-β/Smad and ERK1/2 to reduce early glomerulosclerosis [73–76]
	Icariin	Blood lipid-lowering, anti-aging, and anti-inflammation	TLR4/NF-κB, Keap1/Nrf2, Col-IV/TGF-β1, miR-192-5p/GLR-1R [77–80]
	Silymarin	Reduce UACR, urinary TNF-α, and MDA	Protect against kidney fibrosis via the JAK/STAT3/SOCS1 and TGF-β1/Smad pathways [82–84]
	Curcumin	Anti-oxidization and anti-inflammation	Regulate Nrf2 to inhibit NF-κB, TGF-β1, CTGF, fibronectin and Col IV [85–88]
	Salvianolic acid	Reduce blood glucose	Suppress TNF-α and IL-6 [89]
	Safflower amine	Inhibit platelet/neutrophil adhesion, decrease fibrosis [90]
Polysaccharides	Lycium barbarum polysaccharides	Enhance activity of antioxidant enzymes and scavenge of oxygen radicals	Decrease ERK 1/2 activation via the PKC pathway [91–93]
	Ramulus mori polysaccharides	Dispel wind and activate collaterals, ease joint movement, dry dampness and alleviate water retention, regulate glycolipid metabolism, and improve the body’s immune function	Up-regulate the expression of SIRT1 and FoxO1 proteins and decrease NF-KB to resist oxidative stress [94]
	Chinese yam polysaccharides	Elevate insulin level, decrease glucagon level and FBG	Enhance multiple anti-oxidative stress pathways including the PI3K [95]
Alkaloids	Berberine	Reduce UER, FBG, HbA1c and GPx	Regulate the expression of GRKs in the G protein-AC-cAMP signaling pathway [99–104]
	Ligustrazine	Reduce 24-h UP, blood glucose, and BUN	Anti-oxidative stress, anti-inflammation, and anti-fibrosis [106–107]
Saponins	Astragalosides	Alleviate albuminuria and glomerulosclerosis, and simultaneously inhibit podocyte apoptosis and recover impaired autophagy	PI3K/Akt/FoxO1, AMPK and SIRT/NF-κB signaling pathways [108–116]
	Paeoniflorin	Reduce UAER	Alleviate oxidization and inflammation through the TLR2/4 and JAK2/STAT3 pathways, up-regulate p-mTOR level to promote autophagy [117–119]
	Ginsenoside	Reduce blood glucose and lipid levels, improve oxidative stress	Akt/GSK-3β, PI3K/Akt, TGF-β1/Smad [121–126]
	Notoginsenoside	Reduce FBG, Ccr, UAlb and kidney index	Enhance BMP-7 and Smad7 via inhibiting VEGF and TGF- β1 [127]
Other	Emodin	Reduce 24-h UP	Regulate the AMPK/mTOR-mediated autophagy and activate the PI3K/Akt/GSK-3β pathway to inhibit inflammation [128–131]