[Exploring the role of the liver-bone axis in inflammatory and immunomodulation of osteoporosis based on the Shaoyang () pivot theory].

Through theoretical review and literature integration, this paper innovatively proposes the theoretical framework of "Shaoyang () as the pivot-liver-bone axis-osteoimmunology" and explores the key pivotal role of the liver in the inflammatory and immune regulation of osteoporosis (OP). The article indicates that the dysfunction of the Shaoyang pivot and the failure of the liver to maintain free flow may be key initiating factors that disrupt the homeostasis of the body's neuro-endocrine-immune network. Based on this, the paper further analyzes and demonstrates how the subsequent release of liver-derived pro-inflammatory factors, bile acid metabolism disorders, and overactivation of the sympathetic nervous system act on the bone marrow microenvironment via the "liver-bone axis". These abnormal signals induce local immune imbalance in the bone, abnormally activating the receptor activator of nuclear factor kappa-B and its ligand (RANK/RANKL) signaling axis and inhibiting the Wnt/β-catenin osteogenic pathway, ultimately accelerating bone loss. Meanwhile, existing studies suggest that Chinese herbal formulas designed to harmonize Shaoyang, soothe the liver, and clear heat can precisely intervene in the aforementioned pathological processes, reshaping the homeostasis of the liver-bone microenvironment. By exploring the pathogenesis of OP from the perspective of the "liver-bone axis" based on the "Shaoyang as the pivot" theory, this paper expands the traditional Chinese medicine (TCM) understanding of the complex pathology of OP and provides novel biological evidence and intervention strategies for the prevention and treatment of OP through integrative medicine.