Abstract：Objective：To observe the clinical efficacy of Buyang Huanwu Decoction in the treatment of diabetic peripheral neuropathy （DPN） and its effects on serum ATG13 methylation levels and the expression of autophagyrelated proteins （LC3- Ⅱ ， Beclin-1） in peripheral blood. Methods： A total of 96 patients with DPN from the Endocrinology Department or Inpatient Department of Hangzhou Lin'an Traditional Chinese Medicine Hospital from June 2022 to May 2024 were collected and divided into a trial group and a control group using the random number table method，with 48 cases in each group. The control group received conventional treatment，while the trial group received additional treatment with Buyang Huanwu Decoction. Clinical efficacy，traditional Chinese medicine（TCM） syndrome scores， motor nerve conduction velocity （MCV）， sensory nerve conduction velocity （SCV）， serum ATG13 methylation levels，and LC3-Ⅱ and Beclin-1 protein expression levels were compared between the two groups before and after treatment. Results：After treatment，the total effective rate in the trial group was 93.75% （45/48），higher than that in the control group at 75.00% （36/48） （P＜0.05）. TCM syndrome scores were decreased significantly in both groups after treatment （P＜0.05）， with the trial group achieving lower scores than the control group （P＜0.05）. The MCV and SCV were increased significantly in both groups after treatment （P＜0.05）， with the trial group showing higher speed than the control group （P＜0.05）. The two groups exhibited a significant decrease in ATG13 DNA methylation levels after treatment， with the levels in the trial group were lower than those in the control group （P＜ 0.05）. Beclin-1 and LC3-Ⅱ protein expression levels were increased significantly in the two groups after treatment， with the levels in the trial group were higher than those in the control group （P＜0.05）. Conclusion：Buyang Huanwu Decoction combined with conventional western medicine treatment for DPN can improve clinical efficacy， alleviate patient symptoms and signs，and promote the repair of damaged nerves . The mechanism may be related to the inhibition of ATG13 methylation and the promotion of autophagy.