🌿 Folk Prescriptions

Chronic pancreatitis refers to recurrent or persistent inflammatory lesions of the pancreas, gradually replacing pancreatic acinar tissue with fibrous tissue, severely damaging pancreatic function and causing significant digestive impairment. Patients often experience recurrent upper abdominal pain, severe pain frequently accompanied by nausea and vomiting, inability to sleep after consuming fatty foods.
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Upper abdominal fullness and discomfort, diarrhea, and gradual weight loss due to reduced food intake. This condition falls within the scope of traditional Chinese medicine's "epigastric pain," "abdominal pain," and "costal pain."
Chronic pancreatitis has shown a marked increase in recent years, commonly affecting individuals with excessive drinking, overindulgence in rich flavors, or chronic alcohol abuse, and can also be triggered by emotional factors, with some cases having unknown causes. It is typically caused by repeated or persistent episodes of acute pancreatitis leading to pancreatic duct obstruction, or chronic alcohol intoxication.
I. 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. If other gastrointestinal diseases are ruled out, a clinical diagnosis can be made. Selective imaging such as pancreatic X-ray, ultrasound, and endocrine tests may assist in confirmation.
II. Syndrome Differentiation and Treatment
1. Accumulation of Heat in the Intestines and Stomach
External pathogens invade and transform into heat, or excessive consumption of spicy and greasy foods leads to damp-heat and food stagnation blocking internally, disrupting qi movement and preventing intestinal passage. Clinical symptoms include abdominal distension and pain that worsens with pressure, epigastric fullness, nausea, vomiting, dry mouth, constipation. Tongue: red, yellow and dry coating; pulse: slippery and rapid. Treatment aims to clear heat, resolve dampness, and purge the bowels. Formula: Qing Yi Decoction combined with Da Cheng Qi Tang with modifications: bupleurum 10g, citrus aurantium 10g, coptis 12g, phellodendron 6g, white peony 12g, safflower 6g, honeysuckle 30g, cyperus 12g, raw rhubarb (added later) 10g, mirabilite (mixed) 10g, magnolia bark 12g.
2. Damp-Heat in Liver and Gallbladder
External pathogens invading internally or dietary indiscretion leads to accumulation of damp-heat in the liver and gallbladder, impairing their free flow and regulation. Clinical symptoms include pain in epigastrium and flanks, aversion to greasy foods, fever, nausea, heaviness, fatigue, or jaundice. Tongue coating: yellow and greasy; pulse: slippery and rapid. Treatment aims to soothe liver, drain gallbladder, clear heat, and promote diuresis. Formula: Qing Yi Decoction combined with Long Dan Xie Gan Tang with modifications: gentian 15g, capillary wormwood 30g, gardenia 15g, bupleurum 15g, coptis 12g, picrorhiza 10g, white peony 12g, safflower 6g, raw rhubarb (added later) 10g, coin grass 30g, coix seed 30g, atractylodes 10g, stir-fried three shen each 10g.
3. Spleen Deficiency with Food Stagnation
Constitutional spleen and stomach weakness, exacerbated by binge eating, leading to inadequate spleen function, intestinal injury, and food stagnation, disrupting qi movement. Clinical symptoms include epigastric fullness, poor appetite, postprandial abdominal distension, diarrhea, foul-smelling stools or undigested food, sallow complexion, emaciation, fatigue. Tongue: pale and swollen, white coating; pulse: weak. Treatment aims to strengthen spleen, eliminate food stagnation, and regulate qi movement. Formula: Qing Yi Decoction combined with Zhi Shi Hua Zhi Wan with modifications: stir-fried atractylodes 20g, stir-fried three shen each 15g, poria 20g, citrus aurantium 10g, honeysuckle 30g, coptis 10g, bupleurum 10g, alisma 20g, tangerine peel 10g, coix seed 30g, safflower 6g.
4. Internal Blood Stasis
Prolonged illness penetrates the collaterals, leading to internal blood stasis and blocked qi movement. Clinical symptoms include worsening epigastric and abdominal pain with fixed location, palpable masses in epigastrium or left hypochondrium, imaging showing pancreatic calcification or cyst formation. Tongue: purple-dark or with ecchymoses; pulse:涩. Treatment aims to activate blood circulation, resolve stasis, and relieve pain. Formula: Shao Fu Zhu Yu Tang with modifications: cyperus 10g, Corydalis tuber 15g, myrrh 10g, angelica 10g, ligusticum 10g, red peony 10g, safflower 15g, five-lingzhi 10g, bupleurum 10g, coix seed 30g, coptis 10g, salvia 30g.
III. Typical Case Reports
Case 1: Ms. Zhao, female, 52 years old, first visit on April 23, 2000. She had been obese for years. Five years ago, she suffered from chronic cholecystitis and gallstones, underwent cholecystectomy on June 17, 1999, recovered and discharged. Half a year later, she gradually felt epigastric and abdominal distension, intermittent stabbing pain radiating to the left flank, worse after consuming fatty foods, loose and foul-smelling stools. On April 9, 2000, she was hospitalized due to aggravated upper abdominal pain and nausea/vomiting. Serum amylase was 229μ (West method), CT showed blurred image around the pancreatic head measuring 4–5 cm, diagnosed as chronic pancreatitis. Despite conservative Western treatment, symptoms improved minimally, so she requested TCM treatment.
The patient appeared lethargic, with puffy face, dull, needle-like pain in epigastrium and abdomen, fluctuating in severity, difficulty swallowing, obvious tenderness above the umbilicus, palpable mass of moderate consistency, white greasy coating, distinct tooth marks on the sides, visible ecchymoses on both sides, prominent sublingual veins, pulse weak and涩, diagnosed as deficiency with blood stasis. Currently, priority is given to reinforcing the body. Prescribed: stir-fried codonopsis 15g, stir-fried atractylodes 15g, poria 20g, ginger pinellia 9g, dried ginger 3g, foeniculum 12g, stir-fried malt 15g. After six doses, appetite gradually improved, spleen function strengthened, stabbing pain in epigastrium and flanks slightly reduced, white greasy coating thinned at front, tooth marks still visible, pulse soft, deep pulse涩. This indicates blood stasis. Treatment now combines strengthening spleen and tonifying qi with Xue Fu Zhu Yu Tang. After more than ten 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 about 11 pm and was admitted to hospital for emergency care. Western diagnosis: acute pancreatitis. After treatment, on June 28, he requested TCM consultation. Patient had sallow complexion, sharp, needle-like pain in epigastrium and flanks, even small amounts of semi-fluid food caused abdominal distension and desire to vomit, defecation every 3–4 days, small volume, loose and foul-smelling. Tongue coating: thick, yellow, greasy, red edges and tip with tooth marks, deep and fine pulse. Ultrasound showed blurred image around pancreatic head, diagnosed as chronic cholecystitis with sandy stones. This resulted from excessive eating and drinking, leading to damp-heat accumulation in liver, gallbladder, spleen, and stomach, disrupting ascending and descending functions. Treatment: soothe liver, drain gallbladder, and gently purge. Prescription: capillary wormwood 30g, stir-fried gardenia 12g, processed rhubarb 6g, coptis 12g, coin grass 30g, bupleurum 9g, chinquapin 9g, ginger pinellia 12g, bamboo juice 10g, raw licorice 6g. After five doses, black-green, muddy water-like stool passed, followed by rapid symptom relief. Re-examination ultrasound showed disappearance of gallstone shadows, pancreatic head image gradually clarified. Subsequently, treatment continued using gentle purging, soothing liver, strengthening spleen, and nourishing stomach methods. Discharged after two weeks with good results. Advised patient to avoid binge eating, greasy foods, and excessive alcohol. Follow-up over one year showed no recurrence.
IV. Experience
The pathogenesis of this condition is often a mixture of deficiency and excess, but with varying emphasis. When excess predominates—liver-gallbladder damp-heat, stomach disharmony—treatment focuses on clearing liver and gallbladder, harmonizing stomach, and purging the bowels, with effectiveness achieved through softening liver and strengthening spleen and stomach. When deficiency predominates—spleen deficiency allowing liver overactivity, blood stasis—treatment emphasizes strengthening spleen, softening liver, tonifying qi, and removing stasis, with success achieved through strengthening spleen, softening liver, tonifying qi, and removing stasis. Modern research also confirms that Chinese herbal medicine plays multiple roles in treating pancreatitis: rhubarb, coptis, scutellaria, and white peony inhibit pancreatic enzyme activity; rhubarb, honeysuckle, forsythia, scutellaria, coptis, and dandelion not only have antibacterial effects but also strong anti-endotoxin actions; rhubarb, moutan, red peony, and Corydalis tuber improve microcirculation and increase pancreatic blood perfusion; rhubarb also has significant analgesic effects; bupleurum, safflower, and Corydalis tuber have beneficial effects on pancreatic function.