Qingyi decoction combined with western medicine comprehensive therapy for acute pancreatitis: intestinal barrier protection and sepsis prevention-a retrospective clinical study.

BACKGROUND: Acute pancreatitis (AP) is a common acute abdominal condition with high morbidity, mortality, and treatment costs. Approximately 20% of patients progress to moderately severe or severe acute pancreatitis (MSAP/SAP), with mortality rates reaching 20%-40%. Sepsis, as a critical and life-threatening complication of severe acute pancreatitis, significantly worsens prognosis through intestinal barrier dysfunction and bacterial translocation. The pathophysiology of AP involves premature activation of pancreatic enzymes leading to acinar cell death, including apoptosis, necrosis, and pyroptosis, which trigger the inflammatory cascade and subsequent systemic complications. Traditional Chinese medicine (TCM), particularly Qingyi Decoction combined with Western medicine comprehensive therapy, has shown promising effects in alleviating abdominal symptoms, activating intestinal physiological function, and reducing the severity rate of AP. However, clinical studies specifically evaluating sepsis prevention and modulation of cell death pathways through intestinal barrier protection are limited. AIM: To retrospectively evaluate the clinical efficacy and safety of Qingyi Decoction (Qingyi Tang combined with Dachaihu Tang) combined with Western medicine comprehensive therapy in the treatment of mild to moderate acute pancreatitis, with a primary focus on its protective effects against sepsis progression through intestinal barrier function improvement and modulation of cell death pathways. METHODS: A single-center, retrospective clinical study was conducted from January 2024 to December 2025 (data lock date: 31 December 2025) at Tongliang District People's Hospital. A total of 108 patients with mild to moderate acute pancreatitis (intestinal damp-heat syndrome) were enrolled and divided into two groups: the Group A (Qingyi Decoction enema and oral administration combined with Western medicine comprehensive therapy, n = 54) and the Group B (Western medicine comprehensive therapy alone, n = 54). Primary outcomes included TCM syndrome scores, modified CT severity index (MCTSI) scores, and intestinal barrier function indicators (D-lactate, diamine oxidase, endotoxin). Secondary outcomes encompassed inflammatory markers (CRP, IL-6, white blood cells, neutrophils), SIRS scores, antibiotic usage rate and duration, length of hospital stay, hospitalization costs, and sepsis incidence defined by Sepsis-3 criteria. Assessments were performed at baseline, day 3 of hospitalization, and before discharge. RESULTS: The Group A demonstrated significantly greater improvements in TCM syndrome scores compared to Group B at day 3 (MD = -4.82, 95%CI: -6.15 to -3.49, p < 0.001) and before discharge (MD = -6.35, 95%CI: -7.89 to -4.81, p < 0.001). MCTSI scores were significantly lower in Group A at day 3 (MD = -1.25, 95%CI: -1.78 to -0.72, p < 0.001) and before discharge (MD = -1.68, 95%CI: -2.31 to -1.05, p < 0.001). Intestinal barrier function markers including D-lactate (MD = -2.15, 95%CI: -2.89 to -1.41, p < 0.001), diamine oxidase (MD = -3.42, 95%CI: -4.28 to -2.56, p < 0.001), and endotoxin (MD = -0.18, 95%CI: -0.25 to -0.11, p < 0.001) were significantly improved in the treatment group. Inflammatory markers CRP (MD = -28.5, 95%CI: -36.2 to -20.8, p < 0.001) and IL-6 (MD = -15.3, 95%CI: -19.7 to -10.9, p < 0.001) showed significant reductions. Most notably, the sepsis incidence was significantly lower in Group A (3.7% vs. 14.8%, OR = 0.22, 95%CI: 0.05-0.98, p = 0.046), representing a 75% relative risk reduction. Antibiotic usage rate (44.4% vs. 66.7%, p = 0.021), antibiotic duration (MD = -3.5 days, 95%CI: -4.8 to -2.2, p < 0.001), length of hospital stay (MD = -4.2 days, 95%CI: -5.6 to -2.8, p < 0.001), and hospitalization costs (MD = -4,850 yuan [approximately USD 683, based on average RMB/USD exchange rate of 7.1 for 2024-2025], 95%CI: -6,320 to -3,380, p < 0.001) were all significantly reduced in the treatment group. CONCLUSION: Qingyi Decoction combined with Western medicine comprehensive therapy significantly improves clinical symptoms, reduces inflammatory response, enhances intestinal barrier function, markedly decreases sepsis incidence from 14.8% to 3.7% (75% relative risk reduction), and shortens hospitalization duration and costs in patients with mild to moderate acute pancreatitis. This integrated approach represents a promising therapeutic strategy for AP management and sepsis prevention through intestinal barrier protection.