Objective To investigate the effect of Qingyi Decoction enema on the toll-like receptor (TLR) 4/nuclear factor (NF)-κB signaling pathway in patients with acute pancreatitis (AP).

Methods A total of 100 patients with mild AP were selected as the study objects, and randomly divided into control group (n=50) and observation group (n=50). The control group received conventional western medicine therapy combined with ulinastatin, while the observation group was treated with Qingyi Decoction retention enema on the basis of control group. Clinical efficacy, symptom relief, traditional Chinese medicine syndrome scores, pancreatic function indicators, inflammatory markers as well as TLR4 mRNA and NF-κB mRNA expression levels were compared between the two groups.

Results The clinical effective rate in the observation group was 92.00% which was significantly higher than 76.00% in the control group (P < 0.05). The observation group had significantly shorter times for abdominal distension pain relief, first bowel movement, recovery of bowel sounds and normalization of amylase (AMS) levels compared to the control group (P < 0.05). After 10 days of treatment, both groups showed significantly lower scores for abdominal pain, tenderness, fullness, dryness, nausea, vomiting and short red urine syndrome compared to before treatment, with the observation group showing significantly lower scores than the control group (P < 0.05). After 10 days of treatment, serum AMS and lipase (LPS) levels were significantly lower in both groups compared to before treatment, with the observation group showing significantly lower levels than the control group (P < 0.05). After 10 days of treatment, serum tumor necrosis factor (TNF)-α, triggering receptor expressed on myeloid cells (TREM)-1, microtubule-associated protein 1 light chain 3 (MAP1-LC3) and intercellular adhesion molecule (ICAM)-1 levels were significantly lower in both groups compared to before treatment, with the observation group showing significantly lower levels than the control group (P < 0.05). After 10 days of treatment, TLR4 mRNA and NF-κB mRNA expression levels were significantly lower in both groups compared to before treatment, with the observation group showing significantly lower levels than the control group (P < 0.05).

Conclusion Qingyi Decoction can effectively improve the clinical symptoms of AP patients such as abdominal pain andabdominal distension, inhibit inflammatory response, and promote the recovery of pancreatic function, which may be related to the inhibition of TLR4/NF-κB signaling pathway.