nav emailalert searchbtn searchbox tablepage yinyongbenwen piczone journalimg journalInfo journalinfonormal searchdiv searchzone qikanlogo popupnotification paper paperNew
2026, 03, v.67 271-276
急性胰腺炎中医临床诊疗现状及策略
基金项目(Foundation): 中国科学技术协会2024年中医脾胃病学学科发展研究(2024XKFZYJ); 湖北省2023年省科技计划项目(2023BCB032); 湖北中医药大学2023年度重大项目(2023ZDXM003)
邮箱(Email): txdly@sina.com;
DOI: 10.13288/j.11-2166/r.2026.03.008
摘要:

中医药参与急性胰腺炎(AP)的临床救治已获得广泛认可,结合文献、相关共识或指南重点阐述中医药诊疗AP的临床研究进展。目前研究多集中在AP中医证型与疾病严重程度相关性研究、微观辨证研究、临床疗效研究及分层治疗研究等方面。发现中医药治疗AP的优势在于中医药动静结合、上下共进的综合治疗措施,早期介入、全程参与、病证结合、分期与危重分层辨证论治等诊治策略在AP治疗中发挥了积极作用。中医药干预可通过改善微循环、减轻炎症反应及胰腺损伤、调节机体免疫水平及肠道菌群平衡,进而提高总有效率、缩短病程、降低重症率和死亡率。

Abstract:

The involvement of traditional Chinese medicine(TCM) in the clinical management of acute pancreatitis(AP) has gained broad recognition. Drawing on published literature as well as relevant consensuses and guidelines, this paper summarizes recent progress in TCM-based clinical research on the diagnosis and treatment of AP. Current studies mainly focus on the correlations between TCM syndrome patterns and disease severity, micro-level pattern differentiation, clinical efficacy evaluation, and stratified treatment strategies. Existing evidence indicates that the advantages of TCM in AP lie in its comprehensive therapeutic approach, characterized by the integration of dynamic and static interventions and coordinated regulation of upper and lower aspects of the body. Diagnostic and therapeutic strategies such as early intervention, whole-course participation, integration of disease and syndrome differentiation, and stage-based and severity-stratified treatment have played a positive role in AP management. TCM interventions may improve microcirculation, alleviate inflammatory responses and pancreatic injury, and regulate immune function and intestinal microbiota balance, thereby increasing overall treatment efficacy, shortening disease duration, and reducing the incidence of severe disease and mortality.

参考文献

[1]李慧臻,周正华,程红杰,等.急性胰腺炎中医诊疗专家共识(2023)[J].中华中医药杂志,2024,39(7):3549-3557.

[2]BANKS PA, BOLLEN TL, DERVENIS C, et al. Classification of acute pancreatitis 2012:revision of the Atlanta classification and definitions by international consensus[J]. Gut,2013,62(1):102-111.

[3]IANNUZZI JP, KING JA, LEONG JH, et al. Global incidence of acute pancreatitis is increasing over time:a systematic review and meta-analysis[J]. Gastroenterology,2022,162(1):122-134.

[4]中华中医药学会《重症急性胰腺炎中西医结合诊疗指南》起草组.重症急性胰腺炎中西医结合诊疗指南[J].临床肝胆病杂志,2024,40(6):1114-1125.

[5]金涛,夏庆.中西医结合治疗重症急性胰腺炎的要点和进展[J].中国实用外科杂志,2024,44(5):529-532.

[6]吴瑶麒.急性胰腺炎的中医证型分布规律及通腑泻下法对其的疗效分析[D].郑州:河南中医药大学,2022.

[7]刘良.重症急性胰腺炎中医证型分布与处方用药规律的临床研究[D].北京:北京中医药大学,2023.

[8]奉典旭.急性胰腺炎的中西医结合治疗[M].北京:科学出版社,2025:14.

[9]中国中西医结合学会消化系统疾病专业委员会.急性胰腺炎中西医结合诊疗共识意见(2017年)[J].中国中西医结合消化杂志,2017,25(12):901-909.

[10]董绮,胡仕祥,陈乾,等.中医药治疗急性胰腺炎微循环障碍的研究进展[J].中国中医急症,2024,33(4):735-738.

[11]石卫华,高伟杰,向云霞,等.基于肠道微生态探讨中医药治疗重症急性胰腺炎的研究进展[J].现代医药卫生,2024,40(15):2631-2635.

[12]牛小龙,姚广涛.中药复方治疗急性胰腺炎作用机制的研究进展[J].山东医药,2024, 64(1):93-97.

[13]AN Y, TU Z, WANG A, et al. Qingyi decoction and its active ingredients ameliorate acute pancreatitis by regulating acinar cells and macrophages via NF-κB/NLRP3/Caspase-1 pathways[J]. Phytomedicine,2025,139:156424.doi:10. 1016/j. phymed. 2025. 156424.

[14]易志忠,陈国忠,袁铁超,等.大承气汤治疗重症急性胰腺炎临床疗效的Meta分析[J].中国中医急症,2020,29(8):1370-1373.

[15]LIN J, HAN C, DAI N, et al. Effectiveness of Chengqiseries decoctions in treating severe acute pancreatitis:a systematic review and meta-analysis[J]. Phytomedicine,2023,113:154727. doi:10. 1016/j. phymed. 2023.154727.

[16]YANG J, JIANG YH, ZHOU X, et al. Material basis and molecular mechanisms of Chaihuang Qingyi Huoxue Granule in the treatment of acute pancreatitis based on network pharmacology and molecular docking-based strategy[J]. Front Immunol,2024,15:1353695. doi:10. 3389/fimmu. 2024. 1353695.

[17]李兆霞,许才明,罗亚岚,等.大黄对重症急性胰腺炎肠道屏障保护的研究进展[J].中国中医急症,2020,29(4):732-734,752.

[18]傅敏根,易苏红.芒硝外敷联合乌司他丁治疗急性胰腺炎的效果及对实验室指标水平的影响[J].中国医学创新,2025 ,22(18):131-134.

[19]刘礼剑,钟焕英,刘园园,等.中药方剂治疗重症急性胰腺炎及并发症研究进展[J].辽宁中医药大学学报,2023,25(11):14-19.

[20]刘畅,夏士林,尚东.中药单体治疗急性胰腺炎的研究进展[J].辽宁中医杂志,2018,45(10):2232-2236.

[21]章茜,刘斌斌,黎思琪,等.通肠清胰汤调控TLR4/NF-κB通路减轻重症急性胰腺炎大鼠肺肠损伤的实验研究[J].联勤军事医学,2024,38(10):817-823.

[22]喻翩,刘妍,万莹.柴胡清胰汤联合中药保留灌肠治疗急性胰腺炎(湿热内蕴型)疗效及对患者血清炎症因子和胃肠道功能的影响[J].四川中医,2022,40(10):107-110.

[23]万昌俭.柴胡清胰汤灌肠联合西医综合疗法治疗急性胰腺炎疗效观察[J].广西中医药,2022,45(5):25-27.

[24]代晓玉,吴秋葶,姚佳琦.等.升降散治疗急性胰腺炎并发多器官功能障碍机制研究[J].陕西中医,2022,43(5):550-554.

[25]MIAO YF, KANG HX, LI J, et al. Effect of Sheng-jiang powder on multiple-organ inflammatory injury in acute pancreatitis in rats fed a high-fat diet[J]. World J Gastroenterol,2019,25(6):683-695.

[26]ZHAO X, ZHU S, LI J, et al. Epigenetic changes in inflammatory genes and the protective effect of cooked rhubarb on pancreatic tissue of rats with chronic alcohol exposure[J]. Biomed Pharmacother,2022,146:112587.doi:10. 1016/j. biopha. 2021. 112587.

[27]HU Q, YAO J, WU X, et al. Emodin attenuates severe acute pancreatitis-associated acute lung injury by suppressing pancreatic exosome-mediated alveolar macrophage activation[J]. Acta Pharm Sin B,2022,12(10):3986-4003.

[28]ZHAO J, TANG W, WANG J, et al. Pharmacokinetic and pharmacodynamic studies of four major phytochemical components of Da-Cheng-Qi decoction to treat acute pancreatitis[J]. J Pharmacol Sci,2013,122(2):118-127.

[29]ZHAO X, ZHANG Y, LI J, et al. Tissue pharmacology of Da-Cheng-Qi decoction in experimental acute pancreatitis in rats[J]. Evid Based Complement Alternat Med,2015:283175. doi:10. 1155/2015/283175.

[30]辛宛铃,陈国忠,李偲嘉,等.中医药治疗重症急性胰腺炎相关并发症的研究进展[J].中国中医急症,2024, 33(2):349-351,356.

[31]丁伟超,周京江,耿润露,等.基于网络药理学探讨大黄治疗急性胰腺炎的机制研究[J].中国新药与临床杂志,2023, 42(7):474-480.

[32]沙俊生,张楠,孙维义,等.大承气汤在脓毒症治疗中的相关研究进展[J].中国实验方剂学杂志,2023, 29(17):274-282.

[33]柯菁菁,闫超,董爱金.大承气汤治疗急性胰腺炎作用机制的研究进展[J].环球中医药,2023, 16(10):2134-2140.

[34]宋倩,付裕,仁德芳,等.柴黄清胰活血颗粒治疗重症急性胰腺炎患者的疗效观察[J].西南医科大学学报,2019,42(1):44-47.

[35]章茜,刘斌斌,苏成霞,等.通肠清胰汤对重症急性胰腺炎大鼠肠道功能的实验研究[J].华南国防医学杂志,2020,34(5):301-305.

[36]王涵潇,黄俊玲,乔通.复发性急性胰腺炎病因的研究进展[J].中外医学研究,2024,22(10):180-184.

[37]涂强.舒胆泻肝汤在治疗泥沙样胆道结石及黄疸中的临床价值[J].医学理论与实践,2016, 29(16):2199-2200.

[38]廖翠平,高雅,刘云璐,等.中医药及民族医药防治高脂血症临床研究进展[J].世界科学技术-中医药现代化,2025,27(3):658-667.

[39]郝余庆,蒋徐维,丁俊.临时小口径胰管支架置入联合清胰通腑汤治疗胆源性急性复发性胰腺炎的效果[J].长春中医药大学学报,2024,40(2):189-192.

[40]谢思远.以和胃通泻合剂为主的中西医结合方案对急性胆源性胰腺炎胆红素及复发率影响的临床研究[D].成都:成都中医药大学,2023.

[41]中华医学会急诊医学分会,上海市医学会急诊专科分会.急性胰腺炎急诊诊治专家共识[J].中华急诊医学杂志,2024,33(4):470-479.

[42]王奡,金彦彤,郑慧瑜,等.柴芩承气汤加减联合九消散外敷治疗腑实热结型中度重症急性胰腺炎的临床疗效观察[J].中国中西医结合消化杂志,2023,31(8):615-619.

[43]WEN Y, HAN C, LIU T, et al. Chaiqin chengqi decoction alleviates severity of acute pancreatitis via inhibition of TLR4 and NLRP3 inflammasome:identification of bioactive ingredients via pharmacological sub-network analysis and experimental validation[J]. Phytomedicine,2020,79:153328. doi:10. 1016/j. phymed. 2020. 153328.

[44]张玉梅,康鸿鑫,李娟,等.五苓散洁净府调控水通道蛋白以防治重症急性胰腺炎ALI-AKI的机理[C]//中国中西医结合学会消化系统疾病专业委员会.第三十届全国中西医结合消化系统疾病学术会议论文集.郑州:中国中西医结合学会消化系统疾病专业委员会,2018:365-366.

[45]邓贤斌,王明健,穆记兰,等.急性胰腺炎经典中医治疗[J].中医药导报,2023,29(7):206-209.

[46]闫铁静,王宏,安莹.清胰汤加减对急性胰腺炎患者肠道菌群及肠黏膜功能的影响[J].中国微生态学杂志,2023,35(11):1329-1333.

[47]易琼,戴飞跃,郭志华,等.清胰汤加减联合血液净化对腑实热结型重症急性胰腺炎合并MODS的临床疗效[J].中国实验方剂学杂志,2020,26(8):95-104.

[48]苏杭,唐文富.寒温统一论治急性胰腺炎[J].中国普外基础与临床杂志,2024,31(2):134-139.

[49]苏杭,唐文富.伤寒腹诊法辨治急性胰腺炎[J].中国中西医结合消化杂志,2024,32(2):125-129.

[50]金涛,李兰,张潇颖,等.《急性胰腺炎中西医结合诊疗指南》解读[J].中国普外基础与临床杂志,2024,31(2):205-211.

[51]王颖彬,吴俊杰.中药灌肠干预急性胰腺炎选药的数据挖掘分析[J].中国城乡企业卫生,2024,12(12):169-171.

[52]袁红,徐培鑫,李航宇,等.穴位注射治疗急性胰腺炎胃肠功能障碍的研究进展[J].中外医学研究,2022,20(36):165-168.

[53]FORSMARK CE,SWAROOP VEGE S,WILCOX CM.Acute pancreatitis[J]. N Engl J Med,2016,375(20):1972-1981.

[54]HUANG SW,MAO EQ,WANG HS,et al. Clinical characteristics of 5375 cases of acute pancreatitis from a single Chinese center,1996—2015[J]. Chin Med J,2019,132(10):1233-1236.

[55]杨国红,赵文霞.急性胰腺炎早期中医药干预与机理探析[J].临床肝胆病杂志,2018,34(4):710-715.

[56]朱锋,瞿昌晶,陈慧丽,等.柴芩承气汤对重症急性胰腺炎并发肠梗阻患者免疫功能及血清血管活性肠肽、胃动素、胃泌素水平的影响[J].中国药物与临床,2022, 22(2):165-168.

[57]唐义爽,周秉舵,孔婧,等.大承气汤对重症急性胰腺炎大鼠肠屏障及肠淋巴组织炎症因子的影响[J].中国中西医结合杂志,2021, 41(2):218-223.

[58]李君秋.基于调节肠道菌群探讨大承气汤治疗急性胰腺炎的临床研究[D].上海:上海中医药大学,2021.

[59]马尚贤.厚朴三物汤早期干预对重症急性胰腺炎相关肠粘膜机械屏障损伤的影响[D].兰州:兰州大学,2023.

[60]卓玉珍,崔立华,李彩霞,等.中药复方治疗急性胰腺炎作用机制研究进展[J].中国中西医结合外科杂志,2019,25(3):394-398.

[61]王瑞香,李志刚.柴芩承气汤联合乌司他丁和奥曲肽治疗对急性重症胰腺炎患者疗效、临床症状改善、氧化应激指标、炎性因子指标的影响[J].辽宁医学杂志,2024, 38(1):76-80.

基本信息:

DOI:10.13288/j.11-2166/r.2026.03.008

中图分类号:R259

引用信息:

[1]胡运莲,唐文富,陈国忠,等.急性胰腺炎中医临床诊疗现状及策略[J].中医杂志,2026,67(03):271-276.DOI:10.13288/j.11-2166/r.2026.03.008.

基金信息:

中国科学技术协会2024年中医脾胃病学学科发展研究(2024XKFZYJ); 湖北省2023年省科技计划项目(2023BCB032); 湖北中医药大学2023年度重大项目(2023ZDXM003)

检 索 高级检索

引用

GB/T 7714-2015 格式引文
MLA格式引文
APA格式引文