| BackgroundIn Traditional Chinese Medicine (TCM), acute pancreatitis (AP) is ascribed to "Yishan" disease. The most important risk factors for pancreatitis are gallstones and excessive alcohol use, or ascarid, and "noxious hygropyrexia" in pancreas played a main role. The clinical diagnosis of acute pancreatitis was based on characteristic abdominal pain and nausea, fever, combined with elevated serum or urine levels of pancreatic enzymes. AP includes mild acute pancreatitis (MAP) and severe acute pancreatitis (SAP). The severity of acute pancreatitis is defined by the presence or absence of organ failure, local complications, or both. SAP is a kind of common disease in digestive system, associated with high mortality rate of approximately 14-30%. Although some progresses have made in recent years, the mortality rate has remained at that level because of the multiple organ systemic failure and complex complications. Traditional Chinese Medicine plays an important role in the treatment of SAP with the mean effective power of 89.12%. The recent research on SAP showed that the disturbance of pancreatic microcirculation was one of the leading causes, which was considered to be the initiated, continued and aggravated factor of SAP. It could make pancreatic hemorrhage and necrosis more severely. Recently, it was found that SAP is usually complicated with systemic inflammatory response syndrome (SIRS). An abundant of inflammatory mediators triggered by several etiological factors diffused into systemic circulation and participated in the process of SIRS and multiple organ dysfunction syndrome (MODS) by 'a casecade'. So it's important to inhibit those mediators to diffuse into circulation. The integrated traditional Chinese and western medicine appears to be a useful and practical approach in the management of patients with SAP. Although the mechanism of it remains unclear, more and more trials have showed out its effectiveness. However, most herbal decoctions are too complex to use widespread in AP patients. So in this study, we intend to study the rules in the treatment of SAP with Chinese herbal drugs by reviewing all articles on the use of herbal medicine in SAP published in key journals. To the best of our knowledge, the randomized controlled trials of TCM were so few that the clinical data from these studies can't support the effectiveness reasonable. What's more most trials compared herbal decoction versus pure west medicine management. The use of rhubarb for SAP treatment had been accepted by most people for its apparently benefit, clear mechanism and it was recommend in SAP treatment guidelines. Red peony root decoction which was proposed by department of TCM and department of gastrology of Changhai hospital, has showed its superiority to west medicine only. So a randomized study comparing red peony root decoction versus rhubarb has been performed to evaluate its effectiveness and safety.Objective1 To study the rules in the treatment of severe acute pancreatitis (SAP) with Chinese herbal drugs.2 To compare the therapeutic effects of red peony root decoction, a compound Chinese herbal medicine, with rhubarb which has been accepted widely on SAP patients.Methods1 We reviewed all articles on the use of herbal medicine in SAP published in key journals between 1970 and 2006, and 83 herbal decoctiontions fit to screening standards were selected for evaluation. The status of herb use in the treatment of SAP is discussed by evaluation of their mean effective power and efficiency index.2 A total of 87 consecutive patients with objectively graded SAP were randomized to receive either red peony root decoction or rhubarb treatment via gastric tube. Comparisons were made of days of abdominal tenderness, fever, abdominal distension in each group. The total days of using antibiotics, enzyme inhibitor, protease inhibitor, and nasojejunal feeding start, nasojejunal feeding, gastrointestinal decompression, fasting diet were also compared. Secondary outcome measures were hospital stays, cost of hospitalization.Results1 The important methods for curing SAP were purgation, regulating vital energy, eradicating phlegmonosis, and promoting blood flowing. The most frequently used substance is rhubarb, which appears in all herbal decoctions studied. The mean effective power of herbs used for the treatment of SAP was 89.12%, and its main mode of administration was via nasal feeding with retained herbal decoctions. The average course of treatment was 8.7 days. The curative effect of herbs was mainly to improve symptoms.2 Days of abdominal tenderness, fever, abdominal distension, antibiotics (including anti-bacteria drug and antifungal agent) use, nasojejunal feeding start, nasojejunal feeding, gastrointestinal decompression, fasting diet and hospital stays, cost of hospitalization were decreased in red peony root decoction group(P<0.05),while no significant differences were found in enzyme inhibitor and protease inhibitor requirement. Mortality and adverse reactions' differences between two groups were not significant.Conclusion1 The main methods of TCM to cure SAP are purgation, regulating vital energy, eradicating phlegmonosis, and promoting blood flow. Herbal use is effective in treating SAP, but more normalization about the performance of herbs is needed.2 red peony root decoction is more effective than rhubarb alone for patients with SAP.
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