小建中汤在消化系统疾病中的研究进展

Research Progress of Xiaojianzhong Decoction in Digestive System Diseases

摘要: 小建中汤源自《伤寒论》，是在桂枝汤基础上倍芍药加饴糖而成的温中补虚经典名方，主治中焦虚寒证。本文综述了其近年在消化系统疾病中的药理研究与临床应用进展。药理研究表明，方中饴糖、桂枝、白芍等药物通过多成分、多靶点协同作用，具有抗氧化(提升SOD、降低MDA)、抗炎(抑制COX-2、NF-κB通路)、调节肠道菌群平衡及修复黏膜屏障的功效。临床应用显示，小建中汤对慢性胃炎、消化性溃疡、肠易激综合征(IBS)、慢性肠炎等属虚寒型者疗效确切，不仅能显著改善脘腹疼痛、胀满等症状，还能通过调节免疫、改善微循环及脑-肠轴功能，降低疾病复发率。尽管现有研究证实其具有“甘温除热、和里缓急”的显著优势，但仍存在样本量偏小、缺乏多中心大样本随机对照试验等局限。未来需进一步深入机制研究，为临床推广提供更高级别的循证医学证据。

Abstract: The Xiao Jian Zhong Tang (Minor Construct the Middle Decoction), derived from the Treatise on Cold Damage Diseases, is a classic formula for warming the middle and tonifying deficiency. It is modified from the Gui Zhi Tang (Cinnamon Twig Decoction) by doubling the dosage of White Peony Root (Paeonia lactiflora) and adding maltose. This paper reviews recent pharmacological research and clinical applications of Xiao Jian Zhong Tang in digestive system diseases. Pharmacological studies indicate that the formula’s components—including maltose, Cinnamon Twig (Ramulus cinnamomi), and White Peony Root—exert synergistic effects through multiple components and targets. These effects include antioxidant activity (enhancing superoxide dismutase [SOD] and reducing malondialdehyde [MDA]), anti-inflammatory actions (inhibiting cyclooxygenase-2 [COX-2] and nuclear factor-kappa B [NF-κB] signaling pathways), regulation of gut microbiota balance, and repair of the mucosal barrier. Clinically, Xiao Jian Zhong Tang has demonstrated definitive efficacy in treating deficiency-cold type syndromes such as chronic gastritis, peptic ulcers, irritable bowel syndrome (IBS), and chronic enteritis. It not only significantly alleviates symptoms like epigastric and abdominal pain and distension but also reduces recurrence rates by modulating immunity, improving microcirculation, and regulating the brain-gut axis. Although existing studies confirm its distinct advantages in “warming with sweet-warm herbs to clear heat” and “harmonizing the interior to relieve spasms”, limitations remain, including small sample sizes and a lack of large-scale, multicenter randomized controlled trials (RCTs). Future research should focus on deeper mechanistic exploration to provide higher-level evidence-based medical support for clinical application.