Objective To investigate the traditional Chinese medicine (TCM) syndromes of postmenopausal osteoporosis (PMOP) and its syndrome elements and core pathogenesis, and to provide a theoretical basis for the clinical TCM treatment of PMOP. Methods CNKI, Wanfang Data, and VIP were searched for the articles on PMOP, and TCM syndrome types were extracted from qualified articles for standard processing. The syndrome types were decomposed into syndrome elements, and the core pathogenesis of PMOP was analyzed. Results A total of 512 articles on PMOP were obtained, among which 186 were included in this study. A total of 15 TCM syndrome types were obtained, and 6 syndrome elements of disease location and 6 syndrome elements of disease nature were extracted. The top 3 syndrome elements of disease location in terms of frequency were the kidney, the liver, and the spleen, and the top 3 syndrome elements of disease nature were deficiency, blood stasis, and Qi stagnation. The above two types of syndrome elements were summarized according to "deficiency and excess". "Deficiency" referred to the deficiency syndrome of the kidney, the liver, and the spleen, while "excess" refers to the excess syndrome caused by the pathological factors such as Qi stagnation, blood stasis, cold, heat, and dampness. The formation of deficiency syndrome was centered around "deficiency" and involved the kidney, the liver, and the spleen, forming the following syndrome types: deficiency of liver and kidney, kidney deficiency and blood stasis, liver depression and spleen deficiency, and spleenkidney Yang deficiency. The excess syndrome was centered around "Qi stagnation and blood stasis" and involved the invasion of the human body by the pathological factors such as cold, heat, and dampness, forming the following syndrome types: Qi stagnation and blood stasis, internal retention of dampheat, and blood stasis due to cold accumulation. Conclusion The kidney, the liver, and the spleen are the core syndrome elements of disease location for PMOP, and deficiency syndrome and syndrome of Qi stagnation and blood stasis are the syndrome elements of disease nature for PMOP. Deficiency syndrome is more common and is often accompanied by the syndrome of Qi stagnation and blood stasis, suggesting that menopause is the essence of PMOP. In addition to the livertonifying and kidneynourishing therapy and the spleenstrengthening and Qitonifying therapy, bloodactivating and stasisresolving TCM drugs should be used for the clinical treatment of PMOP.