Objective: To investigate the effect of Jiawei Dachengqi decoction retention enema combined with gabexate mesilate for injection on gastrointestinal function and inflammatory reaction in patients with acute pancreatitis. Methods 52 patients with acute pancreatitis admitted to our hospital from October 2019 to October 2022 were divided into the control group (26 cases) and the treatment group (26 cases) according to the distribution principle of random number table. Both groups were treated with routine treatment. The control group was treated with gabexate mesylate injection on basis of routine treatment. The treatment group was treated with Jiawei Dachengqi decoction retention enema on basis of the control group. Both groups were treated for 1 week. The efficacy after 1 week of treatment, gastrointestinal function recovery, score of traditional Chinese medicine symptom, pancreatic enzyme indicators, inflammation indicators before and after 1 week of treatment and safety during treatment were compared between the two groups. Results After 1 week of treatment, the total effective rate in the treatment group was 92.31%, higher than 61.54% in the control group (P<0.05). The recovery time of bowel sounds, the duration of abdominal pain and distension, the time of first exhaust and the time of first defecation in the treatment group were shorter than those in the control group (P<0.05). Compared with before treatment, after 1 week of treatment, the scores of abdominal fullness and hypochondriac pain, upper abdominal distension and pain refusal, yellow body and eyes, tiredness and fatigue, nausea and anorexia, pain and dry mouth score, levels of serum amylase (SAMY), procalcitonin (PCT), C-reactive protein (CRP), white blood cell count (WBC) and urine amylase (UAMY) in the two groups decreased, and those in the treatment group were lower than those in the control group (P<0.05). During treatment, the total incidence of adverse events in the treatment group was 11.54%, lower than 34.62% in the control group (P<0.05). Conclusion Jiawei Dachengqi decoction retention enema combined with gabexate mesylate for injection could effectively reduce the level of pancreatic enzymes and inflammatory indicators in patients with acute pancreatitis, reduce the inflammatory reaction of the body, and improve the traditional Chinese medicine symptom and gastrointestinal function of patients, thereby promoting the improvement of patients' conditions, with significant efficacy and high safety.