According to “bone wilting”，“cachexia in bone”，and “bone exhaustion” in the Huangdi's Internal Classic (Huang Di Nei Jing)，the clinical manifestations of osteoporosis，and the modern medical understanding of osteoporosis，the etiology and pathogenesis，as well as the therapeutic principles based on syndrome differentiation of osteoporosis were explored.It is believed that liver and kidney deficiency，spleen and kidney deficiency，qi stagnation and blood stasis are the main causes of osteoporosis.Therapeutic principles should be dominated by tonifying liver combined with replenishing kidney，invigorating spleen combined with tonifying kidney，and moving qi combined with activating blood circulation.The Huangdi's Internal Classic is of high guiding significance for the treatment of osteoporosis.Therefore，in clinical practice，treatment based on syndrome differentiation should be carried out in the context of explicit pathogen nature according to the deficiency and excess of the syndrome，so as to improve the clinical efficacy and facilitate clinical optimization of osteoporosis treatment.