External Traditional Chinese Medicine for Chemotherapy-Induced Peripheral Neuropathy and Hand-Foot Syndrome: Patterns of Use and Shared Therapeutic Strategies postprint

Abstract: Background　Chemotherapy-induced peripheral neuropathy (CIPN) and hand-foot syndrome (HFS) significantly compromise treatment tolerance and quality of life in cancer patients. The two above adverse effects often co-occur, yet external Traditional Chinese Medicine (TCM) therapies have demonstrated notable efficacy. Objective　This study systematically characterizes the usage patterns of external TCM for CIPN and HFS, identifies core herbal combinations, elucidates their pharmacological properties and meridian tropism, and maps associated syndrome distributions, providing evidence-based strategies for the prevention and management of hand-foot complications in patients undergoing combination chemotherapy. Methods　We systematically retrieved literature up to October 2025 from China National Knowledge Infrastructure (CNKI), China Science Periodical Database (CSPD), Chinese Science and Technology Periodical Database (CCD), China Biology Medicine Database (CBM), and PubMed. Key information, including TCM names and properties, was extracted independently by two researchers to build a comprehensive database. Co-occurrence analysis was performed using COOC 14.9 to quantify the frequency and co-use of herbs and their attributes. Cluster analysis was conducted in SPSS 27.0 using centroid clustering with the Jaccard similarity coefficient. Correlations between TCM properties and meridian tropisms were analyzed in Origin 2025 using Pearson correlation coefficient (r), with results visualized via radial bar charts, efficacy radar plots, and heatmaps. Results　A total of 198 studies were included. For CIPN, the most frequent herbs were Cinnamomi Ramulus and Carthami Flos, while for HFS, Cinnamomi Ramulus and Angelicae Sinensis Radix predominated. Ninety herbs overlapped between the two diseases, sharing common traits: mainly warm, cold, or neutral properties; predominantly pungent, bitter, or sweet tastes; and belonging to liver, spleen, or kidney meridian tropisms. Both were primarily associated with blood stasis and Qi deficiency patterns. Correlation analysis showed that bitter liver-meridian herbs(r=0.80) and cold stomach-meridian herbs (r=0.67) were most frequently used in comorbid cases. Differences included a higher prevalence of cold and blood-deficiency patterns in CIPN, versus heat-toxin patterns in HFS. CIPN treatments mainly involved wind-damp dispersing herbs, whereas HFS relied on heat-clearing herbs. Conclusion　External TCM interventions for CIPN and HFS converge on the strategies of“promoting blood circulation and detoxification, balancing cold and warm properties, and supporting organ function.” Huangqi Guizhi Wuwu Decoction and Shaoyao Gancao Decoction emerged as core prescriptions. However, clinical use should be individualized based on disease-specific features.