II. Syndrome Differentiation and Treatment

II. Syndrome Differentiation and Treatment

(1) Liver Qi Stagnation Type

① Symptoms: Distending pain in the epigastrium and flanks, worsening in waves, frequent belching, nausea, vomiting, and even severe constipation; thin yellow tongue coating, and stringy or tight pulse.

② Treatment Principle: Soothe the liver and regulate qi, clear heat, and promote bowel movements.

③ Prescription: Qingyi Tang. Ingredients: Bupleurum 15 g, Scutellaria 9 g, Picrorhiza 10 g, White Peony 15 g, Agarwood 10 g, Corydalis 10 g, Raw Rheum 15 g (added later), Glauber’s Salt 9 g (taken orally), Citrus Aurantium 10 g. Decoct twice, mix well, divide into three doses, take one dose daily.

④ Note: This syndrome corresponds to edematous acute pancreatitis. The pathogenic mechanism is qi stagnation. Qingyi Tang was developed by Tianjin Nankai Hospital specifically for treating edematous acute pancreatitis and is one of the earliest achievements in integrated traditional Chinese and Western medicine treatment of acute abdominal conditions. It is easy to see that Qingyi Tang is essentially a modified version of Da Chaihu Tang. The reason it achieves good clinical efficacy, in my opinion, is that like Da Chaihu Tang, Qingyi Tang combines holistic treatment with localized treatment. The formula uses Bupleurum and Scutellaria to mimic the effect of Da Chaihu Tang, focusing on overall regulation and emphasizing harmony; while Rheum and Glauber’s Salt have the effect of Chengqi Tang, focusing on local unblocking and emphasizing thoroughness. Since acute pancreatitis involves both local lesions and systemic reactions, only by combining “harmony” and “thoroughness” can the problem be solved comprehensively. Furthermore, according to Professor Jiao Donghai, a renowned expert in Rheum application research in Shanghai, among digestive diseases treated with Rheum, the best therapeutic effect is seen in edematous acute pancreatitis.

(2) Liver-Gallbladder Real Fire Type

① Symptoms: Severe pain in the epigastrium and flanks, refusal to press, fever, jaundice, nausea and vomiting, bitter taste in the mouth and dry throat, red tongue, greasy yellow coating, and stringy, slippery, or deep and rapid pulse.

② Treatment Principle: Drain the real fire of the liver and gallbladder, and clear damp-heat in the middle jiao.

③ Prescription: Qingyi Tang combined with Longdan Xiegan Tang, adjusted accordingly. Ingredients: Artemisia 30 g, Gentiana 15 g, Gardenia 10 g, Akebia 6 g (or Talc 12 g), Bupleurum 15 g, White Peony 15 g, Scutellaria 10 g, Picrorhiza 10 g, Citrus Aurantium 10 g, Agarwood 10 g, Corydalis 10 g, Raw Rheum 10 g (added later), Glauber’s Salt 10 g (taken orally), all decocted twice, mixed well, divided into three doses, take one dose daily.

④ Note: This syndrome corresponds to pancreatitis caused by biliary tract infection, including some cases of hemorrhagic-necrotic pancreatitis. Qingyi Tang clears the real fire of the liver and gallbladder, and when combined with Sanhuang Xie Xin and Longdan Xiegan Tang, the effect of clearing fire and eliminating damp-heat is even more pronounced. Clinically, it is usually used in conjunction with antibiotics, large-volume intravenous fluids, and blood transfusions, which can cure most patients with acute pancreatitis and also provide some benefit to certain patients with hemorrhagic-necrotic pancreatitis.

(3) Ascariasis Disruption Type

① Symptoms: Piercing abdominal pain, profuse sweating and cold limbs during attacks, nausea and vomiting, often with regurgitation of worms, white patches on the face, or red flower tongue—signs of ascariasis; white or slightly yellow tongue coating, and pulse that fluctuates wildly.

② Treatment Principle: Soothe the liver and regulate qi, calm and expel the worms.

③ Prescription: Qingyi Tang combined with Wumei Wan, adjusted accordingly. Ingredients: Bupleurum 15 g, White Peony 15 g, Scutellaria 10 g, Picrorhiza 10 g, Areca nut 10 g, Wumei 10 g, Asarum 10 g, Sichuan pepper 10 g, Shijunzi 15–24 g, Neem bark 15–24 g, Glauber’s Salt 10 g (taken orally), all decocted twice, mixed well, divided into three doses, take one dose daily.

④ Note: It goes without saying that this syndrome is clearly a case of pancreatitis complicated by biliary ascariasis, so the treatment builds on Qingyi Tang’s ability to soothe the liver and dispel qi, clear heat, and promote downward flow, supplemented by the formula of Wumei Wan, which combines sour, bitter, and pungent flavors to pacify, quiet, and expel the worms. Once the worms are eliminated, the pancreatic ducts are unblocked, and pancreatitis naturally heals.