Traditional Chinese medicine in pancreatitis: mechanisms, integrative strategies, and clinical perspectives

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.