Abstract： Renal osteodystrophy （ROD） is a common and severe complication during the progression of chronic kidney disease （CKD）， with its incidence increasing as CKD advances. Characterized by disrupted bone metabolism and abnormal bone remodeling， ROD significantly impairs the quality of life of patients. Traditional Chinese medicine （TCM） offers distinct advantages in treating this condition， grounded in the classical theory of kidney governing bones and generating marrow. This article begins by tracing the classical origins and elucidating the connotations of this theory，analyzing its intrinsic alignment with the pathological process of bone depletion and marrow reduction in ROD. Based on clinical research， it outlines the TCM syndrome differentiation patterns of ROD， noting that the core zang-fu organs involved are the kidney，liver，and spleen，while the primary pathological factors include blood stasis， turbid toxin， and water-dampness. The article systematically elaborates on the theoretical basis and clinical application of three core treatment approaches：Supplementing the kidney to strengthen bones and consolidate the root，tonifying the kidney and strengthening the spleen to regulate water metabolism，and supplementing the kidney to invigorate blood and unblock collaterals. It also emphasizes key therapeutic principles， such as coordinating the regulation of the liver and spleen and avoiding blind supplementation，thereby providing theoretical insights for the TCM clinical diagnosis and treatment of ROD.