Abstract: Diabetic peripheral neuropathy (DPN) is one of the most common chronic complications of diabetes, affecting approximately half of patients during their disease course. The resulting limb numbness, paresthesia, and pain not only deteriorate the quality of life but also increase the risks of foot ulcers and amputation. Western medicine primarily focuses on glycemic control, anti-oxidative stress, and neurotrophic therapies; while having specific targets, these approaches struggle to reverse established nerve damage, and the adverse effects of long-term medication cannot be ignored. Traditional Chinese medicine (TCM) has accumulated substantial clinical experience in alleviating symptoms and promoting nerve repair. However, the overall efficacy of integrated Chinese and Western medicine requires a systematic review of existing evidence.This article systematically reviewed the pathogenesis and therapeutic evidence of DPN in both Western medicine and TCM, and constructed a clinically applicable integrative strategy framework to provide a reference for clinical decision-making. From a pathophysiological perspective, Western medicine considers DPN a complex outcome of metabolic disorders, oxidative stress, microangiopathy, neuroinflammation, and neurotrophic factor deficiency, making it difficult for monotherapy to cover all pathological pathways. TCM categorizes DPN as “Xiaoke Bi syndrome”, with its core pathogenesis centered on “deficiency, stasis, and phlegm”. The collateral vessel pathology in TCM is highly isomorphic with microangiopathy in Western medicine. According to the 2016 TCM clinical practice guidelines, DPN is classified into six syndromes. Regarding therapeutic evidence, the core herbs for internal application include Astragali Radix (Huangqi), Angelicae Sinensis Radix (Danggui), Spatholobi Caulis (Jixueteng), and Cinnamomi Ramulus (Guizhi); acupuncture primarily targets ST36 (Zusanli), SP6 (Sanyinjiao), and LI4 (Hegu). Current research has established various synergistic models, including Western medicine combined with Chinese herbs, acupuncture, or triple therapy.The integrative treatment of DPN relies on the theoretical foundation of “isomorphic pathogenesis”, adopting a collaborative principle where Western medicine manages glycemic control and acute conditions, while TCM alleviates symptoms, promotes nerve repair, and mitigates Western drug toxicities. Based on this, different synergistic combinations are selected according to the disease stage and TCM syndromes. This “stepped synergistic” strategy offers an actionable approach for the standardized integrative treatment of DPN.