Liver–Spleen–Kidney Synergy in Skeletal Muscle Homeostasis: A TCM ‐Informed Physiological Framework for Sarcopenia

ABSTRACT

Sarcopenia is an age‐related syndrome characterized by progressive loss of skeletal muscle mass, reduced muscle strength, and impaired physical function, with substantial consequences for mobility, independence, and mortality. This narrative review examines a traditional Chinese medicine (TCM)‐informed Liver–Spleen–Kidney framework for understanding skeletal muscle homeostasis and sarcopenia. Throughout this review, the Liver, Spleen, and Kidney refer to TCM functional systems rather than anatomical organs, and the proposed biomedical parallels are intended as heuristic correspondences rather than direct anatomical or mechanistic equivalences. Classical theories concerning muscular nourishment, sinew function, skeletal support, Qi, blood, and essence are considered alongside contemporary evidence relating to nutrient assimilation, metabolic and endocrine regulation, mitochondrial dysfunction, chronic inflammation, protein turnover, renal clearance, hepatic dysfunction, and muscle–bone and muscle–organ crosstalk. The review further examines the pairwise relationships of Spleen–Kidney, Liver–Kidney, and Liver–Spleen coordination and integrates them into a tripartite framework. Available descriptive, clinical, and preclinical findings provide preliminary support for interventions guided by these principles; however, the evidence remains limited by small study samples, heterogeneous diagnostic and treatment protocols, frequent co‐interventions, and reliance on animal models. The proposed framework should therefore be regarded as hypothesis‐generating. Well‐designed multicenter trials and mechanistic studies are needed to determine its clinical relevance and biological basis.