I. TCM Understanding of the Disease

I. TCM Understanding of the Disease

The clinical manifestations of chronic pancreatitis—upper abdominal pain, indigestion, steatorrhea, jaundice, and diabetes—are scattered across various TCM syndromes, including "epigastric pain," "heart-spleen pain," "diarrhea," "jaundice," and "xiao ke" (diabetes). Historical discussions by physicians and insights into etiology and pathogenesis can be found in the section on "acute pancreatitis." It is important to note that, according to modern medical understanding of the pathological changes in chronic pancreatitis, the most characteristic pathogenesis is "blood stasis," with pain, diarrhea, jaundice, and wasting all closely linked to blood stasis. The development of this disease truly reflects Ye Tianshi's theory that "prolonged illness enters the collaterals": initially affecting the qi level, characterized by fullness and pain, repeated episodes then shift the focus to the blood level. Wang Qingren pointed out, "Prolonged illness entering the collaterals means blood stasis." In chronic pancreatitis, fibrous tissue proliferation, pancreatic duct stenosis, and pseudocyst formation all serve as evidence supporting this view. Therefore, in treatment, activating blood circulation and resolving stasis should form the basis of syndrome-based therapy. On this foundation, for patients with prominent abdominal pain, simultaneous treatment of qi and blood is employed using methods that soothe the liver, regulate qi, activate blood circulation, and relieve pain; for those with indigestion primarily manifested as steatorrhea, blood activation is combined with liver-soothing and spleen-strengthening therapies; for severe jaundice, blood activation is paired with liver-soothing and bile-promoting measures; and for those with prominent xiao ke symptoms, yin-nourishing methods are also incorporated. If pseudocysts are the main issue, simply activating blood circulation is not enough; additional herbs that soften hard masses and disperse nodules must be added. In short, no matter how complex the clinical presentation, as long as blood activation and stasis resolution are prioritized, the core of treatment is grasped. From this perspective, we understand that blood stasis is not an isolated phenomenon—it arises from dysfunction and deficiency of the zang-fu organs, simultaneously hindering the generation of qi, blood, and body fluids, thereby further weakening vital energy and promoting the emergence of other secondary symptoms. Thus, balancing blood activation and stasis resolution with tonifying or eliminating pathogenic factors constitutes the correct approach to treating chronic pancreatitis.