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Research Article

Research Trends and Hotspots of Traditional Chinese Medicine for Knee Osteoarthritis from 2005 to 2025: A Bibliometric Analysis

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DOI:

10.3791/70528

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July 14th, 2026

 ,  ,  ,  ,  ,  ,  ,  ,  , 
1Center of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, 2Graduate School of Beijing University of Chinese Medicine

* These authors contributed equally

In This Article

Summary

This bibliometric analysis reveals rapid growth in research on Traditional Chinese Medicine for knee osteoarthritis, with China leading contributions. Current hotspots include ginger, peony., and Duhuo Jisheng Decoction. Mechanistic studies on inflammation, oxidative stress, and apoptosis are likely to be a future research trend.

Abstract

Knee osteoarthritis (KOA) is a prevalent degenerative joint disease that causes significant pain, functional impairment, and reduced quality of life, particularly among the aging population worldwide. While Traditional Chinese Medicine (TCM) has been widely used in clinical practice for KOA management, there has been a lack of systematic, data-driven synthesis to map the global research trends, key contributors, and core themes in this area. This study conducts a comprehensive bibliometric analysis to map the research landscape, identify trends, and forecast future directions in the application of TCM for KOA. Articles published between 2005 and 2025 were retrieved from the Web of Science Core Collection. A total of 339 relevant publications were analyzed using VOSviewer, CiteSpace, and the Bibliometric R package to assess contributions and trends related to countries, institutions, journals, authors, references, and keywords. Our study elucidates the global research landscape of TCM for KOA. Findings indicate a rapidly growing trend in publications, with China as the predominant contributor, although international collaboration remains limited. Leading contributors include authors Wang Peimin and Liu Jun, the Journal of Ethnopharmacology (publication volume), and Osteoarthritis & Cartilage .(citation impact). Research focuses on herbs such as ginger and peony, as well as on formulas such as Duhuo Jisheng Decoction. Emerging methodologies such as network pharmacology and molecular docking are clarifying the mechanisms of TCM, with future trends pointing to inflammation, oxidative stress, and apoptosis. This study provides valuable insights to guide future research and advance the modernization of TCM for KOA.

Introduction

Knee osteoarthritis (KOA) is the most common degenerative joint disease and has become a major public health challenge affecting the quality of life of middle-aged and elderly populations1. According to statistics from the World Health Organization (WHO), nearly 10% of men and 18% of women over 60 years old worldwide are affected by KOA, and its incidence is rising rapidly with the acceleration of population aging2,3. These conditions manifest through a series of clinical symptoms, such as pain, knee swelling, and functional impairment, bringing significant difficulties to patients, families, and society, while imposing a heavy economic burden4. Faced with this severe reality, although modern medicine has various approaches to the treatment of KOA, such as non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain, intra-articular injections to improve function, and ultimate joint replacement surgery, it has always been difficult to avoid multiple predicaments, including drug dependence, long-term side effects, surgical risks, and economic costs5,6. Therefore, exploring effective therapeutic strategies and drugs against KOA is a key and challenging long-term pursuit. Our goal is to identify promising pharmaceutical interventions that can hinder or improve KOA to a certain extent, while investigating the underlying mechanisms, in order to reveal new insights and methods for its management.

Traditional Chinese medicine (TCM), with a long history and documented records in ancient medical literature, is one of the oldest continuously practiced therapeutic systems7. TCM refers to the medicines used in the traditional Chinese medical system for preventing and treating diseases, which has been widely applied worldwide. It encompasses Chinese herbal medicines (including botanical, mineral, and animal-derived medicines), herbal formulas, proprietary Chinese medicines (TCM preparations), and TCM extracts. It not only demonstrates prominent efficacy in anti-inflammation and antioxidation but also further inhibits cell apoptosis through these effects while improving the body's microcirculation8,9,10. In modern pharmacological studies of TCM in KOA, it has been found that the active ingredients of Chinese medicinal herbs can exert synergistic protective effects through multiple pathways, such as inhibiting inflammatory factors, regulating cartilage metabolism, improving microcirculation, and resisting oxidative stress11,12. A large number of clinical randomized controlled trials (RCTs) have also confirmed that comprehensive TCM therapies have definite efficacy in significantly relieving pain, improving joint function, delaying disease progression, and enhancing quality of life, with generally good safety13. Currently, in the field of degenerative diseases such as KOA, where the efficacy of Western Medicine remains elusive, TCM provides new perspectives and potential new approaches.

With the vigorous development of research on TCM for the prevention and treatment of KOA, a massive amount of academic literature has shown explosive growth. However, the surge in knowledge has also brought new challenges: vague core issues, insufficient depth of interdisciplinary integration, and unclear context of knowledge inheritance and innovation have become increasingly prominent. Therefore, it is crucial to thoroughly grasp the current situation, research trends, and emerging themes in this field. Bibliometrics applies mathematical and statistical methods to quantitatively analyze the external characteristics of literature, such as the number of publications, authors, institutions, countries, journal distribution, and citation networks. Combined with content analysis, it can objectively depict the academic influence, cooperation networks, and evolution of research hotspots in specific fields14. However, comprehensive and systematic bibliometric reports specifically focusing on TCM for KOA remain limited.

This study aims to conduct a systematic, in-depth analysis of the research literature on TCM for the treatment of KOA from the Web of Science Core Collection (WOSCC) database over the past two decades, using bibliometric and visual analysis methods. By drawing the annual number of articles, country/institution collaboration networks, author co-occurrence networks, journal co-citations, literature co-citations, and keyword co-occurrence and clustering maps, we aim to conduct in-depth research on the current status, popular themes, and constantly developing trends in this field, with the aim of providing potential theoretical foundations for clinical drug development and strong evidence for the treatment of KOA.

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Protocol

The entire process of bibliometric analysis is presented in Supplementary Figure 1.

Data sources and retrieval strategy
This study utilized Web of Science (WoS) as its primary database due to its reliability, broad multidisciplinary scope, and the inclusion of over 12,000 international academic journals15. A comprehensive bibliometric search was performed in the Web of Science Core Collection (SCI-Expanded) on July 23, 2025. Two researchers independently screened the literature, and disagreements were resolved by a third researcher. The search strategy is illustrated in the Supplementary Table. A total of 743 records were initially identified. Following the removal of 404 duplicates and studies deemed irrelevant based on title and abstract screening by two independent reviewers, 339 studies were included for analysis. The search and screening process is illustrated in Figure 1. All tools are described in the Table of Materials.

Data analysis and result visualization
The bibliometric analysis and the generation of scientific knowledge maps in this study were conducted employing the Bibliometric package in R software (version 5.1.0), VOSviewer (version 1.6.20), and CiteSpace (version 6.3.R1 Basic). CiteSpace (version 6.3.R1 Basic) was applied to perform a multi-dimensional visual analysis, including co-authorship, co-citation, clustering, timeline, and burst detection, across entities such as countries, institutions, references, and keywords. This process mapped the complex scientific landscape of TCM and KOA research16. For more accessible visualizations, VOSviewer (version 1.6.20)17 and the biblioshiny web interface of the Bibliometrix package (version 5.1.0) were used to illustrate straightforward relationship networks and the spatial distribution of publications, respectively. To balance the retention of critical core nodes with a moderate density of node connections while ensuring visualization readability, the parameters for VOSviewer and CiteSpace were selected accordingly in Supplementary Figure 1. The parameter settings in this study (e.g., a minimum publication count of 3 for authors in VOSviewer, and a g-index of k = 25 in CiteSpace) were aligned with widely adopted benchmarks in the field of bibliometric visualization16,17, thereby ensuring comparability of our analytical results with the existing literature.

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Results

Global trends in publication and citations
Using the implemented search strategy, a total of 6847 publications related to TCM and KOA were identified, spanning from January 1st, 2005, to July 23rd, 2025. Among these, 273 articles (80.53%) and 66 reviews (19.47%) were encompassed. The global trend in annual publications and citations is illustrated in Figure 2. The annual number of global publications on TCM for KOA has shown a fluctuating upward trend year by year. From ...

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Discussion

KOA is a degenerative joint disease characterized by decreased chondrocyte synthesis and increased catabolism, infiltration of macrophages and T lymphocytes into the synovium, abnormal functions of osteoblasts and osteoclasts, and impaired repair capacity of mesenchymal stem cells. These abnormal cellular changes interact with each other, ultimately leading to joint structural destruction and functional impairment18,19,20. ...

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Disclosures

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors declare that no Generative AI was used in the creation of this manuscript.

Acknowledgements

We would like to acknowledge all the participants of the study. This study was funded by the China National Natural Science Foundation (82274642, 82474631, 82205246), the Beijing Hospital Management Center "peak" talent training plan team (DFL20241001), and the Fundamental Research Funds for the Beijing Municipal Universities (XJJS202555).

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Materials

List of materials used in this article
NameCompanyCatalog NumberComments
CiteSpaceDeveloped and maintained by Professor Chaomei Chen of Drexel University.CiteSpace 6.3. R1 BasicCiteSpace (version 6.3. R1 Basic) was employed for visual analysis, illustrating the intricate yet informative scientific landscapes concerning TCM and KOA.This analysis encompassed diverse dimensions ranging from Countries, institutions, references, to keywords, leveraging methods such as co-authorship, co-citation, clustering, timelines and burstiness. 
R softwareRStudioR software version 5.1.0The biblioshiny within the Bibliometric package (version 5.1.0) enables a reproducible workflow for data import, transformation, cleaning, comprehensive scientometric analysis, and direct visualization of scientific knowledge structures.
VOSviewerCentre for Science and Technology Studies (CWTS)VOSviewer version 1.6.20It transforms massive and complex literature data (such as thousands of academic papers) into intuitive and easy-to-understand visual network maps, thereby helping researchers quickly grasp the macro-level structure, evolutionary trajectory, and emerging trends of a research field.

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