| Sarcopenia in patients with chronic kidney disease (CKD) significantly impairs quality of life and clinical outcomes. This review systematically summarizes the pathogenesis and advances in traditional Chinese medicine (TCM) treatment for CKD-related sarcopenia. Current evidence indicates that CKD-associated sarcopenia is driven by three interconnected mechanisms: metabolic dysregulation, persistent inflammatory activation, and gut-muscle axis disruption. According to TCM theory, sarcopenia falls within the category of "Wei syndrome" (flaccidity syndrome), with its pathological essence being spleen-kidney deficiency and qi-blood insufficiency. The therapeutic principle emphasizes tonifying the spleen and kidney, supplementing qi and activating blood circulation, while also enhancing cardiac yang and microcirculation. Clinical data demonstrate that TCM herbal formulas targeting spleen-kidney tonification and external therapies such as acupuncture can improve muscle function and nutritional parameters. Mechanistic studies reveal that Chinese herbal medicines regulate muscle protein metabolism and mitochondrial function through PI3K/Akt and AMPK/SIRT1 signaling pathways. However, most current clinical studies are limited by small sample sizes and non-randomized designs, lacking high-quality evidence. Future research should prioritize syndrome standardization, multi-omics mechanistic investigations, and large-scale randomized controlled trials to advance precision TCM interventions for CKD-related sarcopenia. |