Acute pancreatitis is an acute abdominal condition caused by the pancreas’s digestive enzymes digesting the pancreas itself. In China, biliary tract diseases are the primary cause; internationally, alcohol intoxication is the leading cause. It falls under the categories of “Jiexiong,” “Abdominal Pain,” and “Spleen-Heart Pain” in Traditional Chinese Medicine.
Etiology
Modern Medicine: Obstruction of the common bile duct (gallstones, roundworms, spasm-induced narrowing of the sphincter); heavy alcohol consumption; overeating; surgical trauma; infections; medications; etc.
Traditional Chinese Medicine: Improper diet, emotional disharmony, roundworms disturbing the upper body, disruption of the qi mechanisms of the liver, gallbladder, spleen, and stomach, and damp-heat obstructing the middle jiao.
Subtypes: Edematous type (mild); hemorrhagic-necrotic type (severe, with high mortality rate).
Differential Diagnosis: Acute gastritis, cholecystitis, cholelithiasis, gastric perforation, myocardial infarction, renal colic, biliary ascariasis, intestinal obstruction.
Complications: Acute respiratory distress syndrome, disseminated intravascular coagulation (DIC), renal failure, pancreatic encephalopathy, pancreatic abscess, heart failure, intestinal obstruction, and fluid and electrolyte imbalances.
Traditional Chinese Medicine Differential Diagnosis
1. Liver Qi Stagnation Type (Mild Edematous Pancreatitis): Persistent upper abdominal pain, chest tightness, nausea, and vomiting; thin, slightly yellow tongue coating; and a string-like, thin pulse. Soothe the liver, regulate qi, unblock the viscera, and clear heat: Da Chai Hu Tang plus white peony root, wood fragrant, corydalis, and mirabilite.
2. Spleen-Stomach Excess Heat Pattern: Pain throughout the abdomen; epigastric fullness, dryness, and hardness; dry mouth, dark urine, and constipation; thick yellow tongue coating; and a洪数 pulse. Clear heat, purge, regulate qi, and resolve stagnation: Da Cheng Qi Tang plus honeysuckle, wood fragrant, and forsythia.
3. Damp-Heat in the Spleen and Stomach Pattern (Biliary Pancreatitis): Upper abdominal distension and pain that resists pressure, jaundice, fever, constipation, and dark urine; red tongue with a thick, greasy yellow coating. Clear heat, drain dampness, unblock the bowels, and purge: Da Chen Qi Tang plus Gentiana, Wood Fragrance, Corydalis, and Moneywort.
4. Ascending Ascaris Type (induced by biliary tract ascaris): Colicky, piercing pain in the upper abdomen that comes and goes intermittently; ascaris may be vomited; thin, yellow, greasy coating on the tongue. Regulate qi, calm the ascaris, clear heat, and relieve pain: Lianmei Anhuo Decoction with appropriate modifications.
Western Medical Treatment
– Non-surgical (primarily for the edema type): Monitor vital signs; Administer antispasmodics and analgesics (atropine; avoid morphine); withhold food and perform gastrointestinal decompression; administer antibiotics; use the Chinese herbal formula Da Chai Hu Tang.
– Surgical (hemorrhagic-necrotic type): Pancreatic capsule incision for decompression, pancreatic bed drainage, debridement of necrotic tissue, biliary tract surgery, peritoneal dialysis, etc.
Prevention: Actively treat biliary tract diseases; abstain from alcohol; strictly avoid overeating and binge drinking; maintain emotional balance.