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Chronic heart failure(CHF) represents the terminal phase of severe cardiovascular diseases, with concomitant skeletal muscle atrophy significantly compromising patients' motor function and quality of life, as well as increasing risks of adverse clinical outcomes. Current therapeutic agents and interventions targeting CHF-associated muscle atrophy remain limited. Grounded in a holistic approach and syndrome differentiation, traditional Chinese medicine(TCM) offers unique advantages in managing CHF comorbidities. This review explored the pathological mechanisms underlying skeletal muscle atrophy in CHF through the lens of the "heart Yin deficiency" theory in TCM. A pathogenic triad was proposed, encompassing collateral malnutrition due to Yin deficiency, toxin-stasis interaction, and physical-mental exhaustion. The triad was examined in relation to modern biomedical mechanisms including neuroendocrine dysregulation, oxidative stress-inflammation, microcirculatory dysfunction, and protein metabolic imbalance, highlighting the central role of heart Yin deficiency in disease progression. From the therapeutic perspective of nourishing heart Yin, the multi-target effects of herbal compound formulae and acupuncture therapy in improving cardiac function and alleviating muscle atrophy were analyzed. This analysis aims to provide both theoretical foundations and practical guidance for the clinical management of CHF with skeletal muscle atrophy.