On Chronic Pancreatitis, July 22, 1977

On Chronic Pancreatitis, July 22, 1977

Chronic pancreatitis is a common disease; when it develops from acute pancreatitis, diagnosis is relatively straightforward, but when there is no clear history of acute pancreatitis, diagnosis becomes extremely difficult. The misdiagnosis and mistreatment rate for the latter group reaches nearly 80%, and many patients ultimately die from chronic wasting without ever understanding the underlying cause. Clinical manifestations include: ① Chronic upper abdominal pain radiating to the left flank and left chest, with episodes of severe pain; ② Abdominal distension, indigestion, and pancreatic diarrhea; ③ Fatigue, pallor, weight loss, and mild facial edema (malnutrition-related edema). Laboratory tests reveal fat droplets in the stool, while blood amylase and urine amylase levels remain normal (except during acute attacks). Modern medicine offers only replacement therapy with pancreatic enzymes as treatment, with no truly ideal cure available. Although Traditional Chinese Medicine does not have a specific term for chronic pancreatitis, the “Zang Jie” described in the “Shang Han Lun” closely corresponds to this condition. Article 128 of the “Shang Han Lun” states: “The question is asked: There are two types of conditions—Jie Xiong and Zang Jie. What are their characteristics?” The answer is: “If pressing causes pain, the cun pulse is floating, and the guan pulse is sinking, then it is called Jie Xiong.” Article 128 further explains: “What is Zang Jie? It is similar to Jie Xiong—appetite remains unchanged, but there is frequent diarrhea, the cun pulse is floating, and the guan pulse is small, thin, and tight. This is called Zang Jie, and if there is white, slippery coating on the tongue, it is difficult to treat.” Article 130 adds: “Zang Jie has no yang signs, no alternating chills and fevers, the person is actually quiet, and if there is white coating on the tongue, do not attack it.” These two passages describe the symptoms and treatment methods for Zang Jie, indicating that it shares the symptom of oppressive pain below the heart with Jie Xiong. However, Zang Jie is yin in nature and lacks chills and fevers; usually appetite remains normal, but there is frequent diarrhea, which aligns perfectly with pancreatic diarrhea in chronic pancreatitis. The text also mentions that if there is white coating on the tongue, do not attack it, providing a crucial guideline for treating chronic pancreatitis. The “Jin Gui Yao Lue·Abdominal Fullness, Cold Hernia, and Food Retention Disease Pulse and Symptoms” states: “When there is severe cold pain in the chest and abdomen, accompanied by vomiting and inability to eat, with cold spreading throughout the body and rising to the skin, causing pain from head to toe and making the area intolerable to touch, Da Jian Zhong Tang is the primary treatment.” This passage supplements the treatment options for Zang Jie, as previously mentioned, where Zang Jie has symptoms and treatment methods but lacks specific prescriptions. Article 167 of the “Shang Han Lun” says: “If a patient has a痞below the ribs, extending to the area around the navel, with pain radiating down to the lower abdomen and into the yin meridians, this is called Zang Jie, and it is fatal.” This passage closely resembles an acute attack of chronic pancreatitis, with a very poor prognosis, consistent with the characteristics of pancreatitis. Based on the above discussion, the author has used Da Jian Zhong Tang to treat chronic pancreatitis in clinical practice, treating 12 cases between 1969 and August 1977. Eight cases were in Tianshui, two in Jiuquan, and two in Lanzhou, bringing the total to 13 cases including the author himself, all showing significant therapeutic effects. In the autumn of 1963, the author was hospitalized in Ward 3 of the Second Hospital of Lanzhou due to an acute attack of pancreatitis, under the supervision of Dr. An Zhengguang. Due to concurrent gallstones, surgery was recommended. The father argued: “Surgery can only treat the stones; it will be ineffective against acute pancreatitis.” Therefore, the author and his father returned home to Tianshui and self-treated with traditional Chinese medicine for a year, taking over 300 doses, after which the gallstones were expelled and the pancreas greatly improved. In the summer of 1976, the author went to Jiuquan for an internship. Due to the dry climate and the pressure of completing the manuscript for “Blood Syndrome Commentary,” he became overly fatigued, leading to a relapse of pancreatitis. In addition to persistent pain in the left chest and left abdomen, there was also pancreatic diarrhea, and Western medicine diagnosed it as “chronic pancreatitis.” The author primarily used Da Jian Zhong Tang combined with Chai Hu Si Ni San, taking over 100 doses, which significantly alleviated the condition. Since then, the disease has occasionally flared up, but each time this formula has been effective. Formula composition: Chai Hu 15g, Bai Shao 15g, Zhi Ke 6g, Gan Cao 6g, Chuan Xiong 6g, Xiang Fu 6g, Chuan Jiao 6g, Gan Jiang 6g, Gui Zhi 9g, Gua Lou 12g, Xie Bai 9g, Dang Shen 12g, Bai Shu 9g, Fu Ling 12g, Ban Xia 6g, Chen Pi 6g, Mu Xiang 3g, Cao Dou Kou 3g. Decoct in water and take one dose daily.