Abstract： Objective： To investigate the therapeutic effect of targeted transdermal delivery of Bushen Huoxue Prescription on postmenopausal osteoporosis of kidney deficiency and blood stasis type under the guidance of the theory of the kidney stores essence and governs the bones. Methods：A total of 60 patients with postmenopausal osteoporosis of kidney deficiency and blood stasis type admitted to Yuyao Hospital of Traditional Chinese Medicine from March 2024 to February 2025 were enrolled. They were randomly divided into the control group and the observation group using the random number table method， with 30 cases in each group. The control group received conventional western medicine treatment ， while the observation group received targeted transdermal delivery of Bushen Huoxue Prescription in addition to the treatment of the control group. The course of treatment was three months for both groups. The clinical efficacy， traditional Chinese medicine syndrome scores， pain improvement [assessed by Visual Analogue Scale （VAS）]， and bone metabolism markers [serum calcium （Ca）， phosphorus （P）， bone alkaline phosphatase （BAP）] were compared between the two groups before and after treatment. Results：After treatment，the total effective rate was 93.33% （28/30） in the observation group and 73.33% （22/30） in the control group， with a statistically significant difference between the two groups （P＜0.05）. After treatment，the traditional Chinese medicine syndrome scores for low back and general pain，pain of fixed location，pain that is intolerable to pressure，and muscle spasm decreased in both groups compared with those before treatment （P＜0.05）， and all scores in the observation group were lower than those in the control group （P＜0.05）. At one week， two weeks， and three months after the treatment，the VAS scores in both groups decreased compared with those before treatment （P＜0.05），and the scores in the observation group were lower than those in the control group at the same time points （P＜0.05）. After treatment， serum levels of Ca，P，and BAP in both groups increased compared with those before treatment （P＜0.05），and the levels of Ca，P，and BAP in the observation group were higher than those in the control group （P＜0.05）. Conclusion： Treatment with targeted transdermal delivery of Bushen Huoxue Prescription for postmenopausal osteoporosis of kidney deficiency and blood stasis type，based on the theory that the kidney storing essence and governing bones，can improve clinical efficacy，significantly relieve pain，and enhance bone metabolism.