Zhishi Xiebai Guizhi Decoction,a classic formula for the treatment of chest impediment syndrome,is included in the first batch of the Catalogue of Ancient Classic Prescriptions published by the National Administration of Traditional Chinese Medi-cine.Clinically,it is widely used to treat cardiovascular,respiratory,and digestive system diseases,with particularly notable efficacy in managing coronary heart disease.It serves as an important source for developing innovative drugs for cardiovascular conditions.However,unclear active components and undefined mechanisms of action have posed significant challenges to its modern develop-ment.By reviewing and integrating research advancements on Zhishi Xiebai Guizhi Decoction over the past 30 years,this study com-prehensively analyzes its active components and systematically summarizes its pharmacological mechanisms,aiming to provide valu-able insights into the clinical applications and drug development potential of Zhishi Xiebai Guizhi Decoction.