Traditional Chinese medicine for frailty and sarcopenia in aging populations: a bibliometric and visualized analysis of research trajectories and emerging frontiers.

Abstract

Background: By 2050, the proportion of people aged 65 and older is projected to reach 16% globally, up from roughly 10% in 2022. Frailty and sarcopenia are among the most clinically consequential age-related conditions, independently associated with falls, hospitalization, and death. Traditional Chinese medicine (TCM)-encompassing herbal formulas, acupuncture, tai chi, and qigong-has shown therapeutic potential for both conditions, yet no systematic bibliometric overview of this research area exists.

Methods: Publications on TCM interventions for frailty and sarcopenia were retrieved from the Web of Science Core Collection on 14 March 2026. After a four-phase screening (identification, document-type screening, title/abstract relevance screening, and inclusion), 405 publications were retained. Bibliometric and visualization analyses were performed using CiteSpace (6.2.R6), VOSviewer (1.6.20), and the R package bibliometrix (4.3.0). To avoid tautological bias, all Boolean search terms were removed from the keyword field before every keyword-based analysis (co-occurrence, growth, burst detection, thematic mapping, and thematic evolution).

Results: A total of 405 publications from 2011 to 2026 were included. Annual output grew sharply after 2019 and peaked at 77 publications in 2025. China was the overwhelmingly dominant contributor (910 author appearances), followed by the USA (152) and Japan (131). With search terms excluded, keyword co-occurrence resolved into interpretable clusters: exercise/physical activity/aging; randomized controlled trials of muscle strength and physical function; falls, balance and rehabilitation; evidence synthesis (systematic review/meta-analysis); and cachexia/nutrition/skeletal-muscle inflammation. Burst detection showed early activity in falls, balance, elderly, and exercise (2011-2018) shifting toward network pharmacology, molecular docking, ninjin'yoeito, and nutrition (2020-2026). Co-citation analysis identified the seminal frailty-phenotype study as the foundational reference, with a strong tai-chi fall-prevention trial base and the EWGSOP/AWGS sarcopenia consensus definitions as intellectual pillars.

Conclusion: TCM research on frailty and sarcopenia has grown substantially, particularly since 2019, with China as the primary driver and Japan and the USA as secondary contributors. Network pharmacology, nutrition-based intervention science, and oxidative-stress/inflammation mechanisms represent the most promising emerging frontiers. These findings provide a structured evidence map for prioritizing future research and translational efforts in TCM-based geriatric care.