IV. Pancreatitis

IV. Pancreatitis

Among patients experiencing pain in the epigastric region, approximately one-fifth are suffering from pancreatitis. The pancreatic duct and the bile duct share a common opening that leads into the duodenum; therefore, roughly half of patients with cholecystitis also develop pancreatitis—meaning that pancreatitis often occurs alongside cholecystitis. The pancreas is a long, rectangular organ located beneath the stomach and above the transverse colon. Due to the extensive gas content in the stomach and transverse colon, pancreatic inflammation can easily be misdiagnosed during imaging studies. Diagnosis primarily relies on measuring serum amylase and urinary amylase levels; however, within 3 to 7 days after the onset of pancreatitis, these test indicators often return to normal. Thus, pancreatitis is often difficult to diagnose in the acute phase, and most cases of chronic pancreatitis are misdiagnosed—especially when patients also suffer from chronic gastritis or gastric and duodenal ulcers. Some patients have been treated for gastric issues for extended periods, which significantly impacts their recovery. My understanding of this condition is that patients presenting with epigastric pain accompanied by left flank pain, radiating to the left back and waist, should predominantly be treated for pancreatitis. If pain is also present in both flanks, it is likely a combined pancreatic-gastric condition. This condition often worsens after consuming fatty foods or high-protein diets; patients with a history of gallbladder disease or biliary surgery are at higher risk of developing this condition. The basic diagnostic principles for this condition are often liver qi stagnation, damp-heat in the liver and gallbladder, and qi stagnation with blood stasis; the treatment principles involve soothing the liver and resolving qi, clearing fire and drying dampness, and regulating qi and activating blood circulation. Commonly used formulas include Compound Xiaochaihu Resolving Liver Dispersion (also known as the Pancreatic-Gastric Syndrome Formula): 10g Chai Hu, 10g Zhi Ru, 15g Bai Shao, 6g Gan Cao, 6g Chuan Xiong, 6g Yuan Hu, 10g Dang Shen, 10g Mu Xiang, 6g Cao Kou, 10g Yuan Hu, 20g Chuan Dong Zi, 6g Zhi Ru Mo, 6g Chuang Xiang, 6g Shan Zhi, decocted and taken once daily. For severe pain, add 20g Hong Teng, 20g Gong Ying, and 20g Bai Jiang; for constipation, add 10g Mang Xiao (Yan Hua); for back pain, add 15g Qiang Du Hua and 12g Fang Feng; for nausea and vomiting, add 6g Ban Xia and 20g Sheng He Shi Tao; for diarrhea, reduce the amount of Da Huang to 3g; for severe diarrhea, add Fu Pi; for loss of appetite, add 10g Jiao San Xian; for abdominal distension, add 10g Hou Pu and 10g Chao Lai Fu Zi.