I. Traditional Chinese Medicine’s Understanding of Acute Pancreatitis

I. Traditional Chinese Medicine’s Understanding of Acute Pancreatitis

Although traditional Chinese medical literature does not explicitly mention “acute pancreatitis,” there are numerous records describing clinical manifestations similar to this condition. For example, in “Shanghan Lun: Differentiation and Treatment of Taiyang Disease Symptoms,” it is stated: “...If the area below the heart and above the abdomen feels full and painful, and cannot be touched, Da Xianxiong Tang is the principal prescription.” In “Jin Gui Yao Lue: Treatment of Abdominal Fullness, Cold Hernia, and Chronic Food Stagnation,” it is pointed out: “If pressing on the lower abdomen causes fullness and pain, this indicates a real condition, and purgation is indicated; Da Chaihu Tang is appropriate.” “If abdominal fullness does not decrease, or decreases insufficiently, purgation is necessary; Da Chengqi Tang is suitable.” In “Zhubing Yuanhou Lun: Discussion on Heart and Abdominal Pain,” the etiology and pathogenesis are analyzed as follows: “Heart and abdominal pain arise from weakness of the internal organs, with wind-cold invading the space between them. When pathogenic factors attack, they clash with righteous qi; if they surge upward toward the heart, there is heart pain; if they descend downward toward the abdomen, there is abdominal pain; when the upper and lower parts clash, there is heart-and-abdominal cramping, and qi cannot flow freely.” In “Danxi Xinfa: Heart and Spleen Pain,” it is recorded: “For instance, if heart pain is caused by a fondness for hot foods, leading to stagnant blood in the stomach and causing pain, Taoren Chengqi Tang can be used to purge it.” Clearly, acute pancreatitis falls under the categories of “Jie Xiong,” “Wan Tong,” and “Xin Pi Tong” in traditional Chinese medicine, indicating that the disease primarily arises from dietary indiscretion—overeating, consumption of cold and unclean foods, preference for greasy foods, and excessive alcohol intake. It can also result from emotional distress, liver dysfunction in dispersing and draining, or ascariasis disrupting the gallbladder; additionally, trauma or surgical injury can obstruct the flow of liver-gallbladder qi, leading to stagnation and transformation into fire. On the other hand, liver qi stagnation and the interaction between liver wood and earth can cause blockage in the middle jiao, with damp-heat accumulating and failing to dissipate, resulting in symptoms of fullness, dryness, and hardness. Edematous acute pancreatitis often corresponds to this pathological change. If the condition progresses further and righteous qi is unable to overcome pathogenic qi, it turns into a state of deficiency of righteous qi and invasion of pathogenic qi, with rotting flesh turning into pus, heat toxins spreading into the nutritive blood, and blood rushing uncontrollably, leading to symptoms such as faint rashes, nosebleeds, bloody stools, and even collapse. Acute hemorrhagic-necrotic pancreatitis is generally in this situation.

In view of the pathological characteristics of fullness, dryness, and hardness in acute pancreatitis, the main therapeutic principle should be purgation and unblocking of the bowels, while also integrating traditional Chinese and Western medicine approaches, prescribing formulas and medications based on different causes such as qi stagnation, gallstones, and ascariasis.