{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T03:12:22Z","timestamp":1777864342247,"version":"3.51.4"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Pancreatitis is a heterogeneous inflammatory disorder comprising both acute and chronic forms, with pathogenesis driven by interactions among genetic susceptibility, metabolic factors, inflammatory signaling, and disruption of intestinal barrier function. Despite advances in imaging and supportive care, its management remains largely non-specific, and effective targeted therapies are limited, particularly in severe disease and chronic progression. There is increasing evidence suggesting that traditional Chinese medicine (TCM) may provide complementary therapeutic value through multi-target regulation of key pathogenic processes, including inflammatory amplification, gut microbiota imbalance, microcirculatory disturbance, and fibrosis-related pathways. In this review, we synthesize recent advances in the epidemiology, molecular heterogeneity, diagnostic strategies, and pathophysiological mechanisms of pancreatitis, focusing on the mechanistic convergence between TCM interventions and modern biomedical pathways. In addition, we propose a phenotype-driven integrative framework which could be consider to identify patient subgroups likely to benefit from TCM-based therapies, including metabolically driven, microbiota-associated, and fibrosis-related phenotypes. Despite these, current evidence remains limited by methodological heterogeneity, small sample sizes, and lack of standardized outcome measures. Future research for improved alignment between TCM syndrome differentiation and objective biomarkers is needed, and a precision integrative approach may enhance therapeutic effectiveness and support more individualized management of pancreatitis.<\/jats:p>","DOI":"10.3389\/fmed.2026.1796862","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T05:40:17Z","timestamp":1777527617000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Traditional Chinese medicine in pancreatitis: mechanisms, integrative strategies, and clinical perspectives"],"prefix":"10.3389","volume":"13","author":[{"given":"Yinxiong","family":"He","sequence":"first","affiliation":[{"name":"Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming","place":["Yunnan, China"]},{"name":"Heilongjiang University of Chinese Medicine, Harbin","place":["Heilongjiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinyue","family":"Sun","sequence":"additional","affiliation":[{"name":"First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin","place":["Heilongjiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kuanyu","family":"Wang","sequence":"additional","affiliation":[{"name":"First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin","place":["Heilongjiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1016\/S0140-6736(21)00093-3","article-title":"Acute pancreatitis.","volume":"397","author":"Finucane","year":"2021","journal-title":"Lancet."},{"key":"B2","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1038\/s41575-018-0087-5","article-title":"Global epidemiology and holistic prevention of pancreatitis.","volume":"16","author":"Petrov","year":"2019","journal-title":"Nat Rev Gastroenterol Hepatol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1900","DOI":"10.1136\/gutjnl-2023-330694","article-title":"GI highlights from the literature.","volume":"68","author":"McLean","year":"2019","journal-title":"Gut."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1044","DOI":"10.1136\/gutjnl-2017-314657","article-title":"Impact of characteristics of organ failure and infected necrosis on mortality in necrotising pancreatitis.","volume":"68","author":"Schepers","year":"2019","journal-title":"Gut."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1380998","DOI":"10.3389\/fcimb.2024.1380998","article-title":"Gut microbiota influence acute pancreatitis through inflammatory proteins: a Mendelian randomization analysis.","volume":"14","author":"Huang","year":"2024","journal-title":"Front Cell Infect Microbiol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"720","DOI":"10.1016\/j.pan.2017.07.006","article-title":"Guidelines for the understanding and management of pain in chronic pancreatitis.","volume":"17","author":"Drewes","year":"2017","journal-title":"Pancreatology."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e0366422","DOI":"10.1128\/spectrum.03664-22","article-title":"Mechanisms of Qingyi decoction in severe acute pancreatitis-associated acute lung injury via gut microbiota: targeting the short-chain fatty acids-mediated AMPK\/NF-\u03baB\/NLRP3 pathway.","volume":"11","author":"Wang","year":"2023","journal-title":"Microbiol Spectr."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1429546","DOI":"10.3389\/fmed.2024.1429546","article-title":"Efficacy of integrated traditional Chinese and western medicine in managing mild-moderate acute pancreatitis: a real-world clinical perspective analysis.","volume":"11","author":"Jia","year":"2024","journal-title":"Front Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"647647","DOI":"10.3389\/fmolb.2021.647647","article-title":"Electroacupuncture ameliorates acute pancreatitis: a role for the vagus nerve-mediated cholinergic anti-inflammatory pathway.","volume":"8","author":"Zhang","year":"2021","journal-title":"Front Mol Biosci."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1692","DOI":"10.1007\/s10620-017-4601-3","article-title":"Genetic risk in chronic pancreatitis: the trypsin-dependent pathway.","volume":"62","author":"Hegyi","year":"2017","journal-title":"Dig Dis Sci."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1205","DOI":"10.3390\/ijms23031205","article-title":"Molecular features and clinical management of hereditary pancreatic cancer syndromes and familial pancreatic cancer.","volume":"23","author":"Kasuga","year":"2022","journal-title":"Int J Mol Sci."},{"key":"B12","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1053\/j.gastro.2010.09.046","article-title":"Type of CFTR mutation determines risk of pancreatitis in patients with cystic fibrosis.","volume":"140","author":"Ooi","year":"2011","journal-title":"Gastroenterology."},{"key":"B13","doi-asserted-by":"publisher","first-page":"3445","DOI":"10.21037\/apm-21-429","article-title":"The role of gut microbiota in the pathogenesis and treatment of acute pancreatitis: a narrative review.","volume":"10","author":"Lu","year":"2021","journal-title":"Ann Palliat Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1038\/s41575-019-0158-2","article-title":"New insights into acute pancreatitis.","volume":"16","author":"Lee","year":"2019","journal-title":"Nat Rev Gastroenterol Hepatol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1001\/jama.2020.20317","article-title":"Acute pancreatitis: a review.","volume":"325","author":"Mederos","year":"2021","journal-title":"JAMA."},{"key":"B16","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1016\/S0140-6736(21)00094-5","article-title":"Acute pancreatitis - Authors\u2019 reply.","volume":"397","author":"Boxhoorn","year":"2021","journal-title":"Lancet."},{"key":"B17","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1159\/000444141","article-title":"Predictive capacity of biomarkers for severe acute pancreatitis.","volume":"56","author":"Sternby","year":"2016","journal-title":"Eur Surg Res."},{"key":"B18","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1007\/s11605-012-2121-1","article-title":"The prognostic value of the neutrophil-lymphocyte ratio (NLR) in acute pancreatitis: identification of an optimal NLR.","volume":"17","author":"Suppiah","year":"2013","journal-title":"J Gastrointest Surg."},{"key":"B19","doi-asserted-by":"publisher","first-page":"5019","DOI":"10.3748\/wjg.v27.i30.5019","article-title":"Gut microbiome in acute pancreatitis: a review based on current literature.","volume":"27","author":"Patel","year":"2021","journal-title":"World J Gastroenterol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"64","DOI":"10.61369\/AMCMR.202504009","article-title":"Advances in traditional Chinese medicine for acute pancreatitis: a comprehensive review.","volume":"1","author":"Peng","year":"2025","journal-title":"Adv. Modern Chinese Med. Res."},{"key":"B21","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1016\/j.jep.2011.08.045","article-title":"An integrative approach of linking traditional Chinese medicine pattern classification and biomedicine diagnosis.","volume":"141","author":"Lu","year":"2012","journal-title":"J Ethnopharmacol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1097\/MOG.0000000000000195","article-title":"Inflammation in acute and chronic pancreatitis.","volume":"31","author":"Habtezion","year":"2015","journal-title":"Curr Opin Gastroenterol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1034","DOI":"10.1007\/s00108-021-01158-y","article-title":"[Pathogenesis of acute pancreatitis].","volume":"62","author":"Sendler","year":"2021","journal-title":"Internist."},{"key":"B24","doi-asserted-by":"publisher","first-page":"69","DOI":"10.21037\/atm-20-4802","article-title":"A narrative review of acute pancreatitis and its diagnosis, pathogenetic mechanism, and management.","volume":"9","author":"Zheng","year":"2021","journal-title":"Ann Transl Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1038\/s41577-019-0165-0","article-title":"The NLRP3 inflammasome: molecular activation and regulation to therapeutics.","volume":"19","author":"Swanson","year":"2019","journal-title":"Nat Rev Immunol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1634132","DOI":"10.3389\/fmolb.2025.1634132","article-title":"An overview of current research on the modulation of NLRP3 inflammasome by traditional Chinese medicine to combat acute pancreatitis.","volume":"12","author":"He","year":"2025","journal-title":"Front Mol Biosci."},{"key":"B27","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1097\/JP9.0000000000000131","article-title":"The role of gut microbiota in acute pancreatitis: new perspectives in pathogenesis and therapeutic approaches.","volume":"7","author":"Du","year":"2024","journal-title":"J Pancreatol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1016\/j.cgh.2018.08.045","article-title":"The gut microbiome in pancreatic disease.","volume":"17","author":"Akshintala","year":"2019","journal-title":"Clin Gastroenterol Hepatol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"G993","DOI":"10.1152\/ajpgi.00122.2012","article-title":"Autophagy and pancreatitis.","volume":"303","author":"Gukovskaya","year":"2012","journal-title":"Am J Physiol Gastrointest Liver Physiol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1333","DOI":"10.1136\/gutjnl-2014-308553","article-title":"Mechanism of mitochondrial permeability transition pore induction and damage in the pancreas: inhibition prevents acute pancreatitis by protecting production of ATP.","volume":"65","author":"Mukherjee","year":"2016","journal-title":"Gut."},{"key":"B31","doi-asserted-by":"publisher","first-page":"2094","DOI":"10.3748\/wjg.v16.i17.2094","article-title":"Acute lung injury and ARDS in acute pancreatitis: mechanisms and potential intervention.","volume":"16","author":"Zhou","year":"2010","journal-title":"World J Gastroenterol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1016\/j.pan.2012.12.058","article-title":"Pancreatic stellate cells\u2013multi-functional cells in the pancreas.","volume":"13","author":"Masamune","year":"2013","journal-title":"Pancreatology."},{"key":"B33","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1159\/000082799","article-title":"Mechanisms of pancreatic fibrosis.","volume":"22","author":"Apte","year":"2005","journal-title":"Dig Dis."},{"key":"B34","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1016\/j.chmed.2024.12.002","article-title":"Traditional Chinese medicine formulas alleviated acute pancreatitis via improvement of microcirculation: a systematic review and meta-analysis.","volume":"17","author":"Gao","year":"2024","journal-title":"Chin Herb Med."},{"key":"B35","doi-asserted-by":"publisher","first-page":"2865","DOI":"10.2147\/JIR.S415974","article-title":"High-dose vitamin C alleviates pancreatic necrosis by inhibiting platelet activation through the CXCL12\/CXCR4 pathway in severe acute pancreatitis.","volume":"16","author":"Gui","year":"2023","journal-title":"J Inflamm Res."},{"key":"B36","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1186\/s12893-025-02929-2","article-title":"The predictive efficacy of dynamic level changes of plasma endothelial microparticles and plasma soluble thrombomodulin on the prognosis of severe acute pancreatitis.","volume":"25","author":"Chen","year":"2025","journal-title":"BMC Surg."},{"key":"B37","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1038\/s42003-025-07772-y","article-title":"CIRP contributes to multiple organ damage in acute pancreatitis by increasing endothelial permeability.","volume":"8","author":"Liu","year":"2025","journal-title":"Commun Biol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1091780","DOI":"10.3389\/fimmu.2023.1091780","article-title":"Causal associations between modifiable risk factors and pancreatitis: a comprehensive Mendelian randomization study.","volume":"14","author":"Mao","year":"2023","journal-title":"Front Immunol."},{"key":"B39","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1186\/s10020-024-00903-x","article-title":"Molecular mechanism and potential role of mitophagy in acute pancreatitis.","volume":"30","author":"Zhu","year":"2024","journal-title":"Mol Med."},{"key":"B40","doi-asserted-by":"publisher","first-page":"6743","DOI":"10.2147\/IJN.S428924","article-title":"Emodin ameliorates severe acute pancreatitis-associated acute lung injury in rats by modulating exosome-specific miRNA expression profiles.","volume":"18","author":"Yang","year":"2023","journal-title":"Int J Nanomedicine."},{"key":"B41","doi-asserted-by":"publisher","first-page":"118833","DOI":"10.1016\/j.jep.2024.118833","article-title":"Dachaihu decoction alleviates chronic pancreatitis by regulating MAPK signaling pathway: insights from network pharmacology and experimental validation.","volume":"337","author":"Li","year":"2025","journal-title":"J Ethnopharmacol."},{"key":"B42","doi-asserted-by":"publisher","first-page":"5586","DOI":"10.3390\/molecules28145586","article-title":"Pancreatic stellate cells and the targeted therapeutic strategies in chronic pancreatitis.","volume":"28","author":"Chang","year":"2023","journal-title":"Molecules."},{"key":"B43","doi-asserted-by":"publisher","first-page":"3528","DOI":"10.7150\/ijms.118338","article-title":"Metabolism and targeted therapy of fibrosis in chronic pancreatitis: a review.","volume":"22","author":"Luo","year":"2025","journal-title":"Int J Med Sci."},{"key":"B44","doi-asserted-by":"publisher","first-page":"562097","DOI":"10.2147\/JPR.S562097","article-title":"Differences in experimental pain sensitivity between non-African and African American healthy individuals and patients with painful chronic pancreatitis.","volume":"19","author":"Phillips","year":"2026","journal-title":"J Pain Res."},{"key":"B45","doi-asserted-by":"publisher","first-page":"1622845","DOI":"10.3389\/fphys.2025.1622845","article-title":"Navigating chronic pancreatitis pain: a pathophysiological and therapeutic overview.","volume":"16","author":"Lin","year":"2025","journal-title":"Front Physiol."},{"key":"B46","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1097\/MPA.0000000000000749","article-title":"Acupuncture for pain in chronic pancreatitis: a single-blinded randomized crossover trial.","volume":"46","author":"Juel","year":"2017","journal-title":"Pancreas."},{"key":"B47","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1016\/j.joim.2023.10.004","article-title":"Electroacupuncture for abdominal pain relief in patients with acute pancreatitis: a three-arm randomized controlled trial.","volume":"21","author":"Kee Jang","year":"2023","journal-title":"J Integr Med."},{"key":"B48","doi-asserted-by":"publisher","first-page":"1372","DOI":"10.1056\/NEJMoa2100826","article-title":"Immediate versus postponed intervention for infected necrotizing pancreatitis.","volume":"385","author":"Boxhoorn","year":"2021","journal-title":"N Engl J Med."},{"key":"B49","doi-asserted-by":"publisher","first-page":"17562848231202133","DOI":"10.1177\/17562848231202133","article-title":"Gut microbiota interacts with inflammatory responses in acute pancreatitis.","volume":"16","author":"Wu","year":"2023","journal-title":"Ther Adv Gastroenterol."},{"key":"B50","doi-asserted-by":"publisher","first-page":"945","DOI":"10.3390\/biology13110945","article-title":"Understanding the role of NLRP3 inflammasome in acute pancreatitis.","volume":"13","author":"Papantoniou","year":"2024","journal-title":"Biology."},{"key":"B51","doi-asserted-by":"publisher","first-page":"156424","DOI":"10.1016\/j.phymed.2025.156424","article-title":"Qingyi decoction and its active ingredients ameliorate acute pancreatitis by regulating acinar cells and macrophages via NF-\u03baB\/NLRP3\/Caspase-1 pathways.","volume":"139","author":"An","year":"2025","journal-title":"Phytomedicine."},{"key":"B52","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.3390\/biom14091101","article-title":"Natural compounds for the treatment of acute pancreatitis: novel anti-inflammatory therapies.","volume":"14","author":"Jiang","year":"2024","journal-title":"Biomolecules."},{"key":"B53","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1007\/s11655-023-3562-y","article-title":"Honokiol prevents intestinal barrier dysfunction in mice with severe acute pancreatitis and inhibits JAK\/STAT1 pathway and acetylation of HMGB1.","volume":"30","author":"Li","year":"2024","journal-title":"Chin J Integr Med."},{"key":"B54","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1080\/13880209.2022.2160768","article-title":"Da-Cheng-Qi decoction improves severe acute pancreatitis-associated acute lung injury by interfering with intestinal lymphatic pathway and reducing HMGB1-induced inflammatory response in rats.","volume":"61","author":"Liu","year":"2023","journal-title":"Pharm Biol."},{"key":"B55","doi-asserted-by":"publisher","first-page":"1292","DOI":"10.1053\/j.gastro.2013.01.069","article-title":"Genetic risk factors for pancreatic disorders.","volume":"144","author":"Whitcomb","year":"2013","journal-title":"Gastroenterology."},{"key":"B56","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/j.pan.2016.01.005","article-title":"Therapeutic effects of quercetin on early inflammation in hypertriglyceridemia-related acute pancreatitis and its mechanism.","volume":"16","author":"Zheng","year":"2016","journal-title":"Pancreatology."},{"key":"B57","doi-asserted-by":"publisher","first-page":"1242","DOI":"10.7150\/ijbs.108858","article-title":"Updated review of research on the role of the gut microbiota and microbiota-derived metabolites in acute pancreatitis progression and inflammation-targeted therapy.","volume":"21","author":"Liu","year":"2025","journal-title":"Int J Biol Sci."},{"key":"B58","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.3390\/ijms25021159","article-title":"The role of the gut microbiome in the development of acute pancreatitis.","volume":"25","author":"Zhou","year":"2024","journal-title":"Int J Mol Sci."},{"key":"B59","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1097\/MOG.0000000000000665","article-title":"Precision medicine for pancreatic diseases.","volume":"36","author":"Shelton","year":"2020","journal-title":"Curr Opin Gastroenterol."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1796862\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T05:40:18Z","timestamp":1777527618000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1796862\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":59,"alternative-id":["10.3389\/fmed.2026.1796862"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1796862","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,30]]},"article-number":"1796862"}}