IV. Pancreatitis

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Patients with this condition show no signs of gallbladder or pancreatic disease on ultrasound, but respond rapidly to liver-soothing and bile-promoting medications. Traditional Chinese medicine demonstrates excellent efficacy in treating cholecystitis (gallstone disease), typically based on the fundamental pattern of "pathogenic factors invading Shaoyang and damp-heat in the liver and gallbladder," supplemented by methods to regulate qi, invigorate blood circulation, and relieve pain. The author commonly prescribes a modified formula of Xiaochaihu Tang: Chaihu 10 g, Huangqin 10 g, Banxia 6 g, Dangshen 10 g, Gancao 6 g, Dahuang 10 g, Huanglian 3 g, Danshen 10 g, Muxiang 10 g, Caokou 6 g, Yuanhu 10 g, Chuanlianzǐ 20 g, Zhimuruyu and Zhimu each 6 g, Jinqiancao 30 g, Huzhang 20 g, Banzhilian 15 g, Zhi Shi 15 g, Baizhu 10 g. The herbs are decocted in water and taken once daily. For shoulder and back pain, add Qiangdohuo 10 g and Fangfeng 12 g; for severe constipation, add Mangxiao 10 g (melted); for high fever, add Shengshigao 30 g and Zhimu 10 g; for poor appetite, add Jiaosanxian each 10 g; for abdominal distension, add Houpu 10 g; for left rib pain, add Chuanjiao 10 g and Ganjiang 6 g; for severe epigastric pain, add Banxia 6 g.

IV. Pancreatitis Among patients presenting with epigastric pain, approximately one-fifth have pancreatitis. Since the pancreatic duct and bile duct share a common opening into the duodenum, about half of patients with cholecystitis (gallstone disease) also have concurrent pancreatitis, meaning that pancreatitis often occurs alongside cholecystitis. The pancreas is a long, horizontal organ located posterior to the stomach and superior to the transverse colon; due to the large amount of gas in the stomach and transverse colon, imaging findings for pancreatitis can easily lead to misdiagnosis. Diagnostic tests primarily rely on measuring serum amylase and urinary amylase levels; however, these two indicators usually return to normal within 3 days to 1 week after the onset of pancreatitis, making it relatively easy to diagnose during the acute phase. Most cases of chronic pancreatitis, however, are misdiagnosed, especially when patients also have chronic gastritis or gastric and duodenal ulcers, as the misdiagnosis rate is even higher in such situations. Some patients are treated for gastric diseases for extended periods, which seriously hinders their recovery. The author believes that if a patient presents with epigastric pain accompanied by left rib pain radiating to the left back and lower back, it should generally be considered pancreatitis; if there is also bilateral rib pain, it indicates a combined gallbladder and pancreatic condition. This disease often worsens after consuming greasy foods or high-protein diets, and the incidence is higher among patients with a history of gallbladder disease or biliary surgery. The overall pattern recognition for this condition includes liver qi stagnation, damp-heat in the liver and gallbladder, and qi stagnation with blood stasis; treatment should focus on soothing the liver and resolving qi stagnation, clearing heat and drying dampness, and promoting qi circulation and blood flow. A commonly used formula is Fufang Chaihu Shugan San (also known as the gallbladder-pancreas syndrome formula): Chaihu 10 g, Zhi Shi 10 g, Baishao 15 g, Gancao 6 g, Chuanxiong 6 g, Xiangfu 6 g, Danshen 10 g, Muxiang 10 g, Caokou 6 g, Yuanhu 10 g, Chuanlianzǐ 20 g, Zhimuruyu and Zhimu each 6 g, Chuanjiao 6 g, Ganjiang 6 g. The herbs are decocted in water and taken once daily. For severe pain, add Hongteng 20 g, Gongying 20 g, and Baijiang 20 g; for severe constipation, add Mangxiao 10 g (melted); for back pain, add Qiangdohuo and Fangfeng each 15 g; for nausea and vomiting, add Banxia 6 g and Shengzhe 20 g; for loose stools, reduce the dosage of Dahuang to 3 g; for obvious diarrhea, add Fupian; for poor appetite, add Jiaosanxian; for abdominal distension, add Houpu 10 g and Chaolaiyazi 10 g.