半夏泻心汤治疗消化系统疾病的多维药理机制研究与临床转化应用进展

Research Progress on the Multidimensional Pharmacological Mechanisms and Clinical Translation of Banxia Xiexin Decoction in Treating Digestive System Diseases

摘要: 半夏泻心汤是医圣张仲景所创的经典经方，其基本治法可十分清楚、妥帖地概括为辛开苦降、寒热并调、补泻兼施，在消化系统疾病的治疗中已有极其悠久的应用史和明确的临床疗效。因此本文从“多病同治、异病同治”的中医理论出发，系统、有层次地阐述半夏泻心汤多维多靶点的药理机制，先对相关文献加以梳理，归纳出半夏泻心汤在六大方面的现代药理作用机制：脑肠轴信息转导、代谢重编程、抗炎免疫调节、黏膜屏障修复、肠道菌群稳态调控及细胞自噬平衡。上述机制彼此衔接、互为补充，由此推测出其在常见消化系统疾病，诸如功能性消化不良、慢性胃炎、消化性溃疡、溃疡性结肠炎、胃癌、脂肪肝等病症治疗中的科学依据及基础。本文对临床应用中所涉的“方–证–效”关系界定模糊、高质量循证证据不足、药效物质基础不清诸种问题做了详细的分析。提出未来研究宜从“宏观–中观–微观”整合、循证医学升级、从“有效”到“精准有效”转化三大方向突破，真正为半夏泻心汤的现代化应用及临床精准转化打开新的思路。

Abstract: Banxia Xiexin Decoction is a representative formula of the therapeutic principle “acrid for opening, bitter for descending, simultaneous regulation of cold and heat, and combination of tonification and purgation”. It boasts a long history and proven efficacy in treating digestive system diseases. This article aims to systematically integrate existing research, constructing a comprehensive explanatory framework for the multi-dimensional and multi-target pharmacological mechanisms of Banxia Xiexin Decoction, based on the TCM theory of “treating different diseases with the same method” and “treating the same disease with different methods”. Through literature review, this article summarizes the modern pharmacological mechanisms of this formula across six dimensions: anti-inflammatory and immune regulation, mucosal barrier repair, regulation of gut microbiota homeostasis, brain-gut axis signal transduction, metabolic reprogramming, and cellular autophagy balance. These interconnected mechanisms collectively form the scientific basis for Banxia Xiexin Decoction in treating a variety of complex digestive system disorders, including chronic gastritis, peptic ulcers, functional dyspepsia, ulcerative colitis, and even gastric cancer and fatty liver disease. Furthermore, this article delves into key challenges in clinical application, such as the ambiguous definition of the “Formula-Syndrome-Efficacy” relationship, insufficient high-quality evidence-based data, and unclear active material basis. Finally, it proposes future research directions focusing on three breakthroughs: integration of “macro-meso-micro” perspectives, upgrading evidence-based medical research, and the transformation from “effective” to “precisely effective”, aiming to provide novel research insights for the modern application and precise clinical translation of Banxia Xiexin Decoction.