Molecular Mechanisms of Traditional Chinese Medicine in Treating Osteoarthritis

Osteoarthritis (OA) is a prevalent degenerative joint disease characterized by chronic inflammation, cartilage degradation, and disrupted cellular homeostasis. Traditional Chinese medicine (TCM) has been widely applied in OA management, and exhibits distinct therapeutic advantages due to its multi-component and multi-target pharmacological properties. This review summarizes the molecular mechanisms by which TCM exerts therapeutic effects in OA, and offers a particular focus on the modulation of key signaling pathways involved in inflammation, apoptosis, autophagy, oxidative stress, and cartilage metabolic balance. Relevant studies were retrieved from the PubMed, Web of Science, Embase, and ScienceDirect databases, from their inception up to November 2025, and systematically analyzed. Evidence from experimental studies involving representative active compounds (e.g., Icariin, Geniposide, Ginsenoside Rb1, and Bilobalide) and classical formulas (such as Duhuo Jisheng Decoction, Yougui Pills, and Osteoking) indicates that TCM alleviates inflammation by inhibiting NF-κB, MAPK, and JAK/STAT signaling; promotes autophagy and metabolic homeostasis through regulation of the PI3K/Akt and AMPK pathways; attenuates oxidative stress via activation of the Nrf2 pathway; and maintains cartilage matrix equilibrium by modulating Wnt/β-catenin, TGF-β/Smad, and Notch signaling. TCM therefore exerts disease-modifying effects in OA through coordinated regulation of multiple signaling pathways, which both highlights its ethnopharmacological value and supports the rational development of TCM-based therapeutic strategies for OA.