Pear paste is a traditional preparation with both medicinal and nutritional functions. The “pear”, as its core ingredient, plays a crucial role in the efficacy of the preparation. This paper, through the interdisciplinary integration of evidence from traditional Chinese medicine, food chemistry, molecular biology, and clinical medicine, constructs a complete “raw material-component transformation-biological regulation” model for the first time. It is found that in pear paste, pears not only serve as a functional matrix. The polysaccharide-polyphenol-triterpene complex system forms a multi-target cough-relieving and anti-inflammatory network through dual regulation of TRPV1/TRPA1 ion channels, inhibition of the NLRP3 inflammasome, and metabolites of gut microbiota such as SCFAs. The research results provide a theoretical breakthrough for the modern development of pear paste and a scientific basis for the modernization of traditional preparations.