Colorectal cancer is a common malignant tumor of the digestive tract with high incidence and mortality, and the existing treatment methods can prolong the survival of the patients to a certain extent, but it faces challenges such as high recurrence rate, strong drug resistance and serious adverse reactions, which cannot fully meet the overall needs of patients. Banxia Xiexin Decoction (半夏泻心汤) created by the medical saint ZHANG Zhongjing is a classic prescription for the treatment of cold and heat syndrome, and is often used for the prevention and treatment of colorectal cancer in modern clinical practice. A large number of studies have found that Banxia Xiexin Decoction can treat precancerous lesions in the early stage, by inhibiting inflammatory response, regulating a variety of signaling pathways, improving intestinal flora dysbiosis, effectively treating ulcerative colitis and colorectal adenoma, blocking the process of precancerous lesion transformation, and reducing the incidence of colorectal cancer. In the medium term, it can be combined with chemotherapy to reduce the adverse reactions of delayed diarrhea, nausea and vomiting, bone marrow suppression, peripheral neuropathy and oral ulcers caused by chemotherapy, alleviate intestinal injury, improve bone marrow hematopoietic function and relieve pain caused by chemotherapy, and adjuvant chemotherapy can be carried out smoothly to improve the overall efficacy. In the later stage, it can inhibit recurrence and metastasis, promote colorectal cancer cell apoptosis by regulating protein expression, and induce ferroptosis to inhibit cell proliferation and migration through multiple pathways, thereby reducing the rate of colorectal cancer metastasis and recurrence, and is widely used in the whole treatment of the disease. This article reviewed the relevant research progress on the prevention and treatment of colorectal cancer using Banxia Xiexin Decoction through literature retrieval, including theoretical foundations, pharmacological basis and various aspects of prevention and treatment applications. It also addressed the shortcomings and improvement measures of current research, aiming to provide new ideas for the development of new drugs and clinical applications for the prevention and treatment of colorectal cancer in the future.