热射病是以核心体温显著升高、中枢神经系统功能障碍和多器官损伤为主要特征的急危重症。快速降温和器官支持能够控制持续性热损伤，但内脏低灌注、肠屏障破坏及内毒素移位可进一步放大免疫炎症反应，并与程序性细胞死亡、氧化应激、线粒体功能障碍及内皮-凝血-微循环异常相互作用，使器官损伤在体温下降后仍可能继续进展。经典型与劳力型热射病具有相似的继发损伤基础，但在易感人群、诱因、器官损伤特点和干预时机等方面存在差异。近年来，复方及中成药、中药注射剂、有效部位和天然活性成分在热射病及相关热应激损伤中的研究逐渐增多，其作用涉及肠屏障保护、免疫炎症调节、程序性细胞死亡、氧化还原与线粒体稳态及内皮-凝血-微循环等环节。在梳理上述研究进展的基础上，进一步从制剂化学表征、体内暴露、暴露-效应关联和因果验证4个方面讨论中医药干预热射病的药效物质基础。现有研究提示中医药具有多器官保护潜力，但证据以动物实验和预处理研究为主，药效物质基础及临床有效性与安全性尚待明确。未来应在规范救治基础上，结合疾病分型与干预时间，加强体内暴露、作用机制及临床结局的关联验证，推动临床转化。

Heat stroke is a critical life-threatening condition characterized by markedly elevated core body temperature, central nervous system dysfunction, and multiple organ injury. Although rapid cooling and organ support can limit ongoing thermal damage, visceral hypoperfusion, intestinal barrier disruption, and endotoxin translocation further amplify systemic inflammatory responses. These processes interact with programmed cell death, oxidative stress, mitochondrial dysfunction, and endothelial-coagulation-microcirculatory disturbances, allowing organ injury to progress even after normalization of body temperature. Classical heat stroke and exertional heat stroke share common mechanisms underlying secondary injury; however, they differ in susceptible populations, triggering factors, patterns of organ involvement, and optimal intervention windows. In recent years, increasing attention has been paid to herbal formulas, Chinese patent medicines, traditional Chinese medicine (TCM) injections, active fractions, and natural bioactive compounds in treatment of heat stroke and related heat stress-induced injuries. These interventions have been reported to exert protective effects through multiple pathways, including preservation of intestinal barrier integrity, modulation of immune-inflammatory responses, regulation of programmed cell death, maintenance of redox and mitochondrial homeostasis, and improvement of endothelial-coagulation-microcirculatory dysfunction. This review summarizes current advances in TCM-based interventions for heat stroke and further evaluates their pharmacodynamic material basis from four perspectives: chemical characterization, in vivo exposure, exposure-response relationships, and causal validation. Current evidence suggests that TCM interventions possess potential multiorgan protective effects, however, available evidence is predominantly derived from animal studies and preconditioning models, while the pharmacodynamic material basis, clinical efficacy, and safety profiles remain insufficiently defined. Future studies should integrate disease classification and intervention timing with investigations of in vivo exposure, mechanism validation, and clinical outcomes under standardized supportive care conditions, thereby facilitating the evidence-based translation of TCM for prevention and treatment of heat stroke.

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国家自然科学基金资助项目（82504982）；中央高校基本科研业务费专项资金资助项目（25625214）