Chronic pancreatitis refers to recurrent or persistent inflammatory lesions of the pancreas, where pancreatic acinar tissue is gradually replaced by fibrous tissue, causing severe impairment of pancreatic function and noticeable digestive disturbances. Patients often have recurrent upper abdominal pain, with severe pain accompanied by nausea and vomiting, and cannot sleep after eating fatty foods.
They suffer from upper abdominal distension and discomfort, diarrhea, and often lose weight due to reduced food intake. This condition falls under the categories of “gastric pain,” “abdominal pain,” and “rib pain” in traditional Chinese medicine.
Chronic pancreatitis has shown a clear increasing trend in recent years, commonly seen in individuals with binge eating, excessive consumption of rich foods, and excessive alcohol intake. It can also be triggered by emotional factors, and in some cases, the cause remains unknown. It is often caused by repeated or persistent episodes of acute pancreatitis leading to pancreatic duct obstruction, or chronic alcohol intoxication.
1. Diagnostic Criteria
Long-term indigestion, weight loss, recurrent upper abdominal pain radiating to the back, flanks, and scapular regions, often triggered by alcohol consumption, overeating, or fatigue. Elevated serum and urine amylase levels, presence of fat globules in stool. After excluding other gastrointestinal diseases, a clinical diagnosis can be made. Selective imaging such as pancreatic X-ray, ultrasound, and endocrine tests can assist in confirmation.
2. Syndrome Differentiation and Treatment
1. Accumulation of Heat in the Intestines and Stomach
External pathogens entering the body transform into heat, or excessive consumption of spicy, rich foods leads to damp-heat and food stagnation, accumulating internally and disrupting qi flow, causing intestinal obstruction. Clinical symptoms include abdominal distension and pain with tenderness, epigastric fullness and obstruction, nausea, vomiting, dry mouth, and constipation. Red tongue with yellow, dry coating, slippery, rapid pulse. Treatment: Clear heat, resolve dampness, purge the bowels, and relieve stagnation. Formula: Qingyi Tang combined with Da Chengqi Tang with modifications: Chai Hu 10g, Zhi Ke 10g, Huang Qin 12g, Huang Lian 6g, Bai Shao 12g, Mu Xiang 6g, Yin Hua 30g, Xuan Hu 12g, Sheng Da Huang (added later) 10g, Mang Xiao (dissolved) 10g, Hou Po 12g.
2. Damp-Heat in the Liver and Gallbladder
External pathogens invading internally or dietary irregularities lead to damp-heat accumulating in the liver and gallbladder, impairing their free flow and regulation. Clinical symptoms include pain in the epigastrium and flanks, aversion to greasy foods, fever, nausea, heaviness, fatigue, or jaundice. Yellow, greasy coating, slippery, rapid pulse. Treatment: Soothe the liver, clear the gallbladder, clear heat, and drain dampness. Formula: Qingyi Tang combined with Longdan Xiegan Tang with modifications: Long Dan Cao 15g, Yin Chen 30g, Sheng Shan Zhi 15g, Chai Hu 15g, Huang Qin 12g, Hu Huang Lian 10g, Bai Shao 12g, Mu Xiang 6g, Sheng Da Huang (added later) 10g, Jin Qiao Cao 30g, Yi Ren 30g, Cang Zhu 10g, Jiao San Xian each 10g.
3. Spleen Deficiency with Food Stagnation
Constitutional spleen and stomach weakness, followed by binge eating, leading to spleen dysfunction, gastrointestinal injury, and food stagnation, disrupting qi flow. Clinical symptoms include epigastric fullness, poor appetite, postprandial distension, diarrhea, foul-smelling stools with undigested food, sallow complexion, fatigue, and weakness. Pale, swollen tongue with white coating, weak pulse. Treatment: Strengthen the spleen, eliminate food stagnation, and regulate qi flow. Formula: Qingyi Tang combined with Zhi Shi Huazhi Wan with modifications: Jiao Bai Zhu 20g, Jiao San Xian each 15g, Fu Ling 20g, Zhi Shi 10g, Yin Hua 30g, Huang Qin 10g, Chai Hu 10g, Ze Xie 20g, Chen Pi 10g, Yi Ren 30g, Mu Xiang 6g.
4. Internal Blood Stasis
Chronic illness penetrating the meridians leads to internal blood stasis and disrupted qi flow. Clinical symptoms include aggravated epigastric and abdominal pain, fixed location, palpable mass in the epigastrium or left flank, X-ray or ultrasound revealing calcification or cyst formation in the pancreas. Purple-dark tongue with ecchymosis or petechiae,涩pulse. Treatment: Activate blood, resolve stasis, regulate qi, and relieve pain. Formula: Shao Fu Zhu Yu Tang with modifications: Xiang Fu 10g, Yuan Hu 15g, Mo Yao 10g, Dang Gui 10g, Chuan Xiong 10g, Chi Shao 10g, Pu Huang 15g, Wu Ling Zhi 10g, Chai Hu 10g, Yi Ren 30g, Huang Qin 10g, Dan Shen 30g.
3. Typical Case Studies
Case 1: Ms. Zhao, female, 52 years old, initial consultation on April 23, 2000. She was obese by constitution. Five years ago, she suffered from chronic cholecystitis and gallstones, underwent cholecystectomy on June 17, 1999, recovered and discharged, but six months later developed gradual epigastric distension due to fatigue, with intermittent stabbing pain radiating to the left flank, worsening after consuming fatty foods, and foul-smelling loose stools. On April 9, 2000, she was hospitalized due to severe upper abdominal pain and nausea/vomiting. Serum amylase level was 229μ (Westergren method), CT showed blurred images around the pancreatic head measuring approximately 4–5 cm, diagnosed as chronic pancreatitis. After conservative Western treatment, symptoms improved poorly, so she requested traditional Chinese medicine treatment.
The patient appeared lethargic, with puffy face, intermittent needle-like pain in the epigastrium and abdomen, fluctuating in severity, difficulty swallowing, obvious tenderness above the umbilicus, palpable medium-consistency mass, white greasy coating with distinct tooth marks on the sides, visible ecchymosis on both sides, prominent sublingual veins, weak and涩pulse. Diagnosis: Deficiency of vital energy with blood stasis. Currently, the priority is to support vital energy; initially prescribed: Chao Dang Shen 15g, Chao Bai Zhu 15g, Fu Ling 20g, Jiang Ban Xia 9g, Gan Jiang 3g, Fo Shou 12g, Chao Mai Ya 15g. After taking 6 doses, appetite gradually improved, spleen function strengthened, stabbing pain in the epigastrium and flanks slightly reduced, white greasy coating thinned at the front, ecchymosis on the sides remained, pulse became moist, deep palpation revealed a涩pulse—indicating blood stasis in the chest. Treatment shifted to strengthening the spleen and tonifying qi combined with Xuefu Zhuyu Tang. After taking over 10 doses, pain disappeared. Subsequent treatment based on symptoms for over a month led to complete resolution of all symptoms.
Case 2: Mr. Chen, male, 35 years old. On June 19, 2001, after binge eating, he experienced acute abdominal pain at around 11 PM and was admitted to hospital for emergency care. Western diagnosis: acute pancreatitis. After treatment, on the 28th, he requested a consultation with traditional Chinese medicine. The patient had a sallow complexion, severe knife-like or needle-like pain in the epigastrium and flanks, even minimal liquid food caused abdominal distension and desire to vomit, defecation every 3–4 days, small volume, foul-smelling. Yellow, thick, greasy tongue coating, red tip and edges with tooth marks, deep, fine pulse. Ultrasound showed blurred image around the pancreatic head. Diagnosis: chronic cholecystitis with sand-like stones. This case resulted from overindulgence in food and alcohol, leading to damp-heat accumulation in the liver, gallbladder, spleen, and stomach, disrupting normal ascending and descending functions. Treatment: soothe the liver, clear the gallbladder, and gently purge the bowels. Prescription: Yin Chen 30g, Chao Shan Zhi 12g, Zhi Da Huang 6g, Huang Qin 12g, Jin Qiao Cao 30g, Chai Hu 9g, Chuan Lian Zi 9g, Jiang Ban Xia 12g, Zhu Ru 10g, Sheng Gan Cao 6g. After taking the fifth dose, black-green, muddy stool was passed, and symptoms rapidly disappeared over the next few days. Follow-up ultrasound showed the gallstone image had diminished significantly, and the pancreatic head image gradually became clearer. Subsequently, treatments focused on gentle purging, soothing the liver, strengthening the spleen, and nourishing the stomach were applied. After two weeks, the patient was discharged with good recovery. Advised against binge eating, excessive consumption of rich foods, and excessive alcohol intake. Follow-up over a year showed no recurrence.
4. Reflections
The pathogenesis of this condition is often a mixture of deficiency and excess, though one aspect may predominate. When excess predominates, it involves damp-heat in the liver and gallbladder, and stomach disharmony, requiring treatment to clear the liver and gallbladder, harmonize the stomach, and prioritize purging the bowels, but effectiveness lies in the method of soothing the liver and strengthening the spleen and stomach. When deficiency predominates, it involves spleen deficiency and liver overactivity, with blood stasis and qi stagnation, requiring treatment to strengthen the spleen, soothe the liver, tonify qi, and remove stasis, with effectiveness achieved through strengthening the spleen, soothing the liver, tonifying qi, and removing stasis. Modern research also indicates that traditional Chinese medicine plays multiple roles in treating pancreatitis: rhubarb, coptis, scutellaria, and peony can inhibit pancreatic enzyme activity; rhubarb, honeysuckle, forsythia, scutellaria, coptis, and dandelion not only have antibacterial effects but also significant anti-endotoxin properties; rhubarb, tree peony, red peony, and corydalis can improve microcirculation and increase pancreatic blood perfusion; rhubarb also has a significant analgesic effect; bupleurum, costus, and corydalis have beneficial effects on the pancreas.
|
