Classical prescriptions of Chinese medicine represent the crystallized wisdom of millennia of clinical practice, enduring as cornerstones of therapeutic intervention due to their demonstrated efficacy across generations. Their evolving role in modern healthcare systems reflects shifting disease patterns, scientific advancements, and global health priorities. Banxia Xiexin Decoction (BXD), formulated by Zhang Zhongjing in the Treatise on Febrile and Miscellaneous Diseases (Shanghanlun), is a time-honored classical prescription renowned for its therapeutic versatility in managing gastrointestinal disorders, both in China and internationally. Recent advancements in clinical research and pharmacological studies on BXD underscore the necessity for a comprehensive bibliometric analysis to summarize and elucidate its specific clinical benefits. Through an extensive literature review of publications from the Web of Science, PubMed, Scopus, and the China National Knowledge Infrastructure (CNKI) between 1997 and 2024, 11 major categories of clinical applications for BXD were identified, along with an analysis of the potential pharmacological mechanisms, such as chronic gastritis, functional dyspepsia, and inflammatory bowel disease. We believe this review will provide new insights into the understanding of clinical value of BXD and identify potential future perspectives for its research and development.