脓毒症是宿主对感染所致的危及生命的多器官功能障碍，发病机制涉及炎症反应、血管内皮、凝血、免疫、微循环等多位点、多系统的异常和相互作用。四妙勇安汤（ Simiao Yongan Decoction， SMYAD）是治疗热毒炽盛之脱疽的经典名方，SMYAD 加减化裁具有抗炎、抗氧化、抗凝、免疫调节等药理作用，可改善脓毒症发生发展过程中的多系统紊乱和多脏器功能障碍，对脓毒症有良好的治疗效果。通过系统综述脓毒症的发病机制、 SMYAD 加减化裁治疗脓毒症的研究进展、后续应用开发所面临的科学问题，为经典名方加减化裁在脓毒症等危重症治疗领域的应用开发提供重要理论依据。

Sepsis is a life-threatening multi-organ dysfunction caused by the host's response to the infection, and the pathogenesis involves the abnormalities and interactions of inflammatory response, vascular endothelium, coagulation, immunity, and microcirculation. Simiao Yongan Decoction (四妙勇安汤, SMYAD), a classic formula for treating digital gangrene caused by intense heat-toxicity, has been modified to exhibit various pharmacological effects such as anti-inflammatory, antioxidant, anticoagulant, and immunomodulatory activities. These modifications can ameliorate the dysfunction of multiple systems and organs during the development of sepsis, demonstrating a promising therapeutic effect. This paper systematically reviews the pathogenesis of sepsis, the research progress of modified SMYAD in treatment of sepsis, and the scientific problems faced by the subsequent application development, with a view to providing an important theoretical basis for application and development of the modified classic formula in treatment of sepsis and other critical illnesses.

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国家自然科学基金资助项目(81703773);江苏省自然科学基金资助项目(BK20170560);江苏省中医药科技发展计划(MS2023173)