从“肾主骨”到“多器官–骨轴”：中医脏腑理论防治骨质疏松症的系统生物学诠释

From “Kidney Governs Bone” to “Multi-Organ-Bone Axis”: A System Biology Interpretation of Traditional Chinese Medicine Zang-Fu Theory in the Prevention and Treatment of Osteoporosis

摘要: 骨质疏松症(OP)的发病机制认知正从“局部骨骼退化”拓展为“全身系统性网络失调”。现代医学提出的“多器官–骨轴”(Multi-Organ-Bone Axis, MOBA)理论，与中医学“整体观念”及“脏腑辨证”在思维逻辑上具有一定的相通。本文以“肾主骨”理论为核心，系统梳理了中医脏腑理论与现代多器官–骨轴的跨学科映射关系：从“肾主骨”到“肾–骨轴”的分子网络互释，从“脾肾互资”到“肠–肾–骨轴”的肠道微生态调控，从“肝肾同源”到“肝–骨轴”的脂代谢–骨代谢对话，从“心肾相交”到“心(脑)–肾–骨轴”的神经内分泌调节，逐层构建了中医多脏协同调控骨代谢的系统生物学诠释框架。在此基础上，进一步探讨了补肾中药通过调控能量代谢与铁死亡、重塑骨免疫微环境、激活肠道菌群及发挥植物雌激素样作用等多途径，实现从单轴解析到多轴协同的网络调控优势，以期为骨质疏松症的中西医结合防治提供新的理论依据。

Abstract: Osteoporosis (OP) is a chronic skeletal disease characterized by low bone mass and microarchitectural deterioration, and the understanding of its pathogenesis is shifting from “local skeletal degeneration” to “systemic network dysregulation”. The “Multi-Organ-Bone Axis” (MOBA) theory proposed by modern medicine is highly consistent with the “holistic concept” and “Zang-Fu syndrome differentiation” of traditional Chinese medicine (TCM) in logical thinking. Taking the “Kidney Governs Bone” theory as the core, this article systematically reviews the interdisciplinary mapping between TCM Zang-Fu theory and the modern MOBA framework: from the molecular network interpretation of “Kidney Governs Bone” to the “Kidney-Bone Axis”, from the gut microbiota regulation of “Spleen-Kidney Mutual Support” to the “Gut-Kidney-Bone Axis”, from the lipid metabolism-bone metabolism dialogue of “Liver-Kidney Common Origin” to the “Liver-Bone Axis”, and from the neuroendocrine regulation of “Heart-Kidney Interaction” to the “Heart (Brain)-Kidney-Bone Axis”, thereby constructing a systems biology interpretive framework for multi-organ synergistic regulation of bone metabolism in TCM. Furthermore, the article explores the multi-pathway mechanisms by which kidney-tonifying herbal medicines achieve network regulation advantages from single-axis analysis to multi-axis synergy, including modulating energy metabolism and ferroptosis, reshaping the bone immune microenvironment, activating gut microbiota, and exerting phytoestrogen-like effects. This study aims to provide a new theoretical basis for the integrated Chinese and Western medicine prevention and treatment of osteoporosis.