脏器纤维化是多种慢性疾病进展至终末期的重要病理基础，其发生发展与慢性损伤、炎症免疫反应、成纤维细胞活化、细胞外基质（extracellular matrix，ECM）沉积及组织结构重塑等密切相关。目前，临床抗纤维化治疗仍存在疗效有限、晚期病变难以逆转等问题。中药具有多成分、多靶点等特点，在脏器纤维化防治中显示一定研究潜力。通过综述近年来中药防治脏器纤维化的研究进展，介绍纤维化发生发展的病理基础及中医“本虚标实”“久病入络”等理论认识，重点总结中药通过调控转化生长因子-β/Smad、核因子-κB、核因子E2相关因子/血红素加氧酶-1等信号通路，影响炎症反应、氧化应激、ECM代谢、细胞表型转化、自噬、铁死亡、细胞衰老及代谢重编程等过程发挥抗纤维化作用的相关机制，并对肝、肺、肾及心肌纤维化领域中代表性中药复方、中成药及活性成分的研究现状进行归纳。当前，中药抗纤维化研究仍存在作用机制不够明确、药效物质基础不清及长期疗效和安全性证据不足等问题。今后应结合多组学、单细胞测序等技术，进一步明确主要活性成分和作用靶点，并通过规范的临床试验评价其长期疗效与安全性，为中药防治脏器纤维化的临床应用提供依据。

Organ fibrosis is an important pathological basis for the progression of many chronic diseases to the end stage. Its development is closely associated with chronic injury, inflammatory and immune responses, fibroblast activation, extracellular matrix (ECM) deposition, and tissue structural remodeling. Current antifibrotic therapies have limited efficacy, and advanced fibrosis remains difficult to reverse. Traditional Chinese medicine (TCM), characterized by multiple components and multiple targets, has been investigated as a potential approach for the prevention and treatment of organ fibrosis. This review summarizes recent progress in the use of TCM for organ fibrosis, including the pathological basis of fibrosis and TCM concepts of “root deficiency with branch excess” and “chronic illness entering the collaterals.” Particular attention is given to mechanisms involving transforming growth factor-β/Smad, nuclear factor-κB, and nuclear factor E2 related factor 2/heme oxygenase-1 signaling and to processes including inflammation, oxidative stress, ECM metabolism, cell phenotypic transition, autophagy, ferroptosis, cellular senescence, and metabolic reprogramming. The current research on representative TCM formulas, proprietary Chinese medicines, and active compounds for liver, pulmonary, renal, and myocardial fibrosis is also reviewed. Current studies on TCM antifibrosis still have limitations such as insufficiently clarified mechanisms of action, unclear pharmacodynamic material basis, and inadequate evidence of long-term efficacy and safety. Future studies should identify the major active components and molecular targets of TCM by integrating multi-omics, single-cell sequencing and other technologies, and evaluate long-term efficacy and safety in well-designed clinical trials, so as to provide evidence for the clinical application of TCM in the prevention and treatment of organ fibrosis.

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国家自然科学基金资助项目（81973637）；国家自然科学基金资助项目（82373933）