Objective: To investigate the clinical efficacy and mechanism of action of retention enema Qing Yi Decoction combined with ERCP in the treatment of acute cholinergic pancreatitis. Methods: 97 cases of patients with acute cholinergic pancreatitis from Jan. 2015 to Dec. 2017 in our hospital were selected and divided into the control group (ERCP, 46 cases) and the observation group (retention enema Qing Yi Decoction combined with ERCP, 53 cases) according to different treatment methods. The clinical efficacy of TCM between the two groups were observed and compared. The levels of serum TNF-α, CRP, IL-6, IL-8, IL-10, amylase, abdominal pain relief time, average hospitalization time and average hospitalization cost were observed and compared before and at 12 h, 24 h, 7 days after treatment. Results: After treatment, the cure rate and markedly effective ratio of observation group were significantly higher than those of the control group (P<0.05). The levels of serum TNF-α, CRP, IL-6, IL-8 and IL-10 in the two groups were significantly lower than those before treatment, and the levels of serum TNF-α, CRP, IL-6 and IL-8 in the observation group were significantly lower than those in the control group (P<0.05); there was no significant difference in the average hospitalization expense between the two groups (P>0.05); the abdominal pain relief time and the average hospitalization time in the observation group were significantly lower than those in the control group (P<0.05). Compared with those before treatment, the serumamylase levels of both groups at 12 h, 24 h and 3 d after treatment were significantly decreased, and the serum amylase levels of observation group at 12 h and 24 h after treatment were significantly lower than those of the control group (P<0.05). Conclusion: Retention enema Qing Yi Decoction combined with ERCP treatment could significantly improve the heal and efficacy rate of acute cholinergic pancreatitis, and its mechanism may be related to the reduction of serum TNF-α, CRP, IL-6, IL-8 and amylase levels. [ABSTRACT FROM AUTHOR]