Abstract
Pancreatic fibrosis (PF), the primary pathological hallmark of chronic pancreatitis (CP), is recognized as a pivotal driver of CP progression. Currently, no therapies are approved by the U.S. Food and Drug Administration (FDA) specifically for PF treatment, highlighting an urgent need for novel therapeutic strategies. Emerging evidence positions Traditional Chinese Medicine (TCM) as a promising multi-target approach against PF. This paper summarizes the pathogenesis of PF and provides a detailed review and comprehensive analysis of the mechanisms underlying Chinese herbal formulas and active ingredients investigated for PF prevention and treatment in existing experimental studies. Numerous studies indicate that TCM combats PF by inhibiting pancreatic stellate cells (PSCs) activation, regulating extracellular matrix (ECM) breakdown, suppressing macrophage infiltration and polarization, and inhibiting pancreatic acinar cell apoptosis. Current basic research predominantly focuses on PSC activation and associated signaling pathways, particularly key pathways such as TGF-β/Smad, MAPK, NF-κB, and Hedgehog. This work thus offers novel insights and approaches for PF treatment and further research.