基于“泻热破瘀法”探讨大黄牡丹汤治疗急性胰腺炎的作用机制

Exploring the Mechanism of Dahuang Mudan Decoction in Treating Acute Pancreatitis Based on the “Purging Heat and Breaking Stasis Method”

摘要: 急性胰腺炎(Acute pancreatitis, AP)是一种常见的急腹症，尽管西医已形成较为成熟的治疗方案，但对AP复杂病理链的干预效果仍有限，尤其在重症急性胰腺炎(Severe Acute Pancreatitis, SAP)中，病死率仍较高。本文基于中医“泻热破瘀法”理论，提出了“AP热瘀腑实三阶段演进假说”，将AP分为“热邪炽盛期”“瘀热互结期”和“腑实瘀毒期”三个阶段，通过构建“组分–阶段–病机”的精准对应模型，探讨了经典方剂大黄牡丹汤在AP不同病程阶段的治疗机制。研究表明，大黄牡丹汤的核心活性成分通过多靶点协同作用，分别在不同阶段通过清热、破瘀、通腑等机制，抑制炎症反应，改善胰腺微环境，修复肠道屏障，降低脓毒症风险。该研究为AP的中医精准辨证治疗提供了新的理论框架，也为中西医结合治疗AP及其他复杂疾病提供了创新性思路。

Abstract: Acute pancreatitis (AP) is a common acute abdominal condition. Although Western medicine has established relatively mature treatment protocols, its intervention effects on the complex pathological cascade of AP remain limited, especially in severe acute pancreatitis (SAP), where the mortality rate remains high. Based on the traditional Chinese medicine (TCM) theory of “purging heat and breaking stasis method”, this paper proposes the “three-stage evolution hypothesis of heat, stasis, and fu-organ constipation in AP”, dividing AP into three stages: the “stage of intense heat pathogen”, the “stage of intermingled heat and stasis”, and the “stage of fu-organ constipation with stasis-toxin”. By constructing a precise “component-stage-pathogenesis” matching model, the study explores the therapeutic mechanisms of the classic formula Dahuang Mudan Decoction at different stages of AP. The results indicate that the core active components of Dahuang Mudan Decoction exert multi-target synergistic effects, including clearing heat, breaking stasis, and relieving constipation at different stages, thereby inhibiting inflammatory responses, improving the pancreatic microenvironment, repairing the intestinal barrier, and reducing the risk of sepsis. This study provides a new theoretical framework for precise TCM syndrome-based treatment of AP and offers innovative ideas for integrating TCM and Western medicine in the treatment of AP and other complex diseases.