Objective To observe the effect of Modified Dachengqi Decoction（ 加味大承气汤） retention enema on severe acute pancreatitis（ SAP） complicated with acute respiratory distress syndrome（ ARDS）. Methods A total of 90 patients with SAP complicated with ARDS were randomly divided into an observation group and a control group.The control group received routine treatment. The observation group was treated with Modified Dachengqi Decoction retention enema on the basis of treatment of the control group

200 ml each time

2 times a day for 5 days. The patient’s abdominal pain and bloating relief time

first defecation/exhaustion time

mechanical ventilation time

ICU hospitalization days

and patient mortality were recorded. Pancreatitis related indicators were measured before treatment and on the 3 rd and 5 th day of treatment including blood amylase（ AMS）

urinary amylase（ UAMY）

intra-abdominal pressure（ IAP）; intestinal mucosal barrier function indicators including diamine oxidase（ DAO）

endotoxin（ ET）

tumor necrosis factor α（ TNF-α）

interleukin 6（ IL-6）

high-sensitivity C-reactive protein（ hs-CRP） and ARDS evaluation index including peak airway pressure（ Peak）

airway platform pressure（ Plat）

respiratory rate（ F）

arterial oxygen partial pressure（ PaO2）

oxygenation index（ PaO2/Fi O2） were detected. Traditional Chinese medicine（ TCM） syndrome scores were evaluated before and after treatment

and the efficacy of TCM syndromes was evaluated after treatment. Results The total effective rate of TCM syndromes in the observation group was 82. 2%

and that in the control group was 64. 5%. The observation group was significantly higher than the control group（ P < 0. 01）.On the 3 rd day and the 1 st day

the levels of AMS

UAMY

IAP

DAO

ET

TNF-α

IL-6

hs-CRP

Peak

Plat

and F of both groups were significantly decreased compared with the time before treatment

and PaO2 and Pa O2/Fi O2 were significantly increased（ P < 0. 05）. Compared with the control group on the 3 rd and 5 th day

the AMS

UAMY

IAP

DAO

ET

TNF-α

IL-6

hs-CRP

Peak

Plat

F were significantly decreased in the observation group at the corresponding time points（ P < 0. 05）

and Pa O2

PaO2/Fi O2 increased significantly（ P < 0. 05）; Compared with the control group

abdominal pain and bloating relief time

first defecation/exhaustion time

mechanical ventilation time

ICU hospitalization days of the observation group patients were significantly reduced

and mortality was significantly decreased（ P < 0. 05）. Conclusion On the basis of comprehensive treatment of western medicine

Modified Dachengqi Decoction enema in the treatment of SAP with ARDS of fu-viscera excess and heat stagnation syndrome

can promote the recovery of intestinal function

repair damaged intestinal mucosal barrier

reduce abdominal pressure and improve oxygenation

reduce airway pressure

reduce respiratory failure caused by ARDS

improve the condition

delay the progress of the disease

reduce the length of hospital stay

reduce the mortality rate

and the clinical effect is better than the comprehensive treatment with western medicine.