Objective To observe the clinical effect of Chinese herbal medicine（CHM）-based triple therapy combined with western medicine in treatment of severe acute pancreatitis（SAP） with binding of blood stasis and toxins pattern as well as the underlying possible mechanism. Methods Eighty-eight SAP patients with binding of blood stasis and toxins pattern were randomized into treatment group and control group with 44 patients in each group. The control group was treated with conventional western medicine

and the treatment group additionally received CHM-based triple therapy including nasal feeding or oral administration of Qingyi Lidan Formula（清胰利胆方）

enema with Qingfu Guanchang Formula（清腑灌肠方） and external application of Xiaohuag Tazi Formula（硝黄塌渍方）

administered for seven days. The scores of traditional Chinese medicine（TCM） symptoms and signs including fever

abdominal pain and distension

tenderness

rebound tenderness

and constipation were compared between groups before and after treatment

and the syndrome-related clinical effectiveness was evaluated; biochemistry indicators including serum amylase（AMS）

urine amylase（UAMY）

alanine aminotransferase（ALT）

aspartate aminotransferase（AST）

total bilirubin（TBiL） and inflammation indicators including C-reactive protein（CRP）

nuclear factor κB p65（NF-κB p65）

tumor necrosis factor α（TNF-α）

interleukin 6（IL-6） were assessed before treatment and at the 3 rd and 7 th day after treatment. Results There were three cases of drop-outs in each group. The scores of fever

abdominal pain and distension

tenderness

rebound tenderness

and constipation of both groups significantly decreased after treatment（P<0.05）

and more changes were seen in treatment group（P<0.05）. The syndrome-related total effectiveness rate of treatment group was 97.56%

significantly higher than 70.73% of control group（P<0.01）. The levels of AMS

UAMY

ALT

AST

TBiL

NF-κB p65

CRP

TNF-α and IL-6 measured on the 3 rd day after treatment significantly decreased in both groups

and there were lower levels measured on the 7 th day（P<0.05）. The results of biochemistry indicators and inflammation indicators favored treatment group than control group when measured on the 3 rd and 7 th day after treatment（P<0.05）. Conclusion The CHM-based triple therapy combined with conventional western medicine is better than western medicine alone in increasing clinical effectiveness and improving liver function and clinical symptoms for SAP patients with binding of blood stasis and toxins pattern

and its mechanism may be related to the inhibition of inflammatory factors.