Abstract： Objective： To observe the clinical efficacy of Chaishao Chengqi Decoction combined with low molecular weight heparin（LMWH）in treating hypertriglyceridemia-induced acute pancreatitis（HLAP）with fu-organ excess-heat accumulation syndrome. Methods：A total of 82 HLAP patients with fu-organ excess-heat accumulation syndrome admitted to Hangzhou Lin'an Traditional Chinese Medicine Hospital from January 2023 to December 2024 were divided into the trial group and the control group using the random number table method，with 41 cases in each group. Both groups received conventional treatment，with the control group additionally receiving LMWH and the trial group receiving both LMWH and Chaishao Chengqi Decoction for seven days. Clinical efficacy，gastrointestinal function recovery time between the two groups were compared， traditional Chinese medicine syndrome scores， inflammatory factors， blood lipid indexes， pancreatic indexes， and intestinal barrier function markers before and after treatment between the two groups were compared. Results： After seven days of treatment， the total effective rate in the trial group was 92.50%（37/40），which was higher than the control group's 76.32%（29/38）（P＜0.05）. The disappearance time of abdominal pain，bloating，nausea and vomiting，as well as the time of first flatus and defecation in the trial group were shorter than those in the control group（P＜0.05）. After seven days of treatment，the scores of abdominal pain，bloating，constipation，chest congestion，nausea and vomiting，dry mouth and bad breath，hot flashes in the late afternoon， short and red urine， and the total score of traditional Chinese medicine syndromes in both groups decreased compared with those before treatment（P＜0.05）. The scores of the above eight traditional Chinese medicine syndromes and the total score of traditional Chinese medicine syndromes in the trial group were lower than those in the control group（P＜0.05）. After seven days of treatment， the levels of serum tumor necrosis factor- α（TNF - α）， interleukin-6（IL-6），triglycerides（TG），lipase（LPS），amylase（AMY），D-lactate（D-LA），diamine oxidase （DAO）， soluble advanced glycation end product receptor（sRAGE）， and endotoxin（ET）in both groups decreased compared to before treatment（P＜0.05）， while the levels of serum interleukin-10（IL-10）increased compared to before treatment（P＜0.05）；the serum levels of TNF-α，IL-6，TG，LPS，AMY，D-LA，DAO，sRAGE，and ET in the trial group were lower than those in the control group（P＜0.05），while the serum level of IL-10 was higher than that in the control group（P＜0.05）. Conclusion： Chaishao Chengqi Decoction combined with LMWH significantly improves HLAP with fu-organ excess-heat accumulation syndrome by alleviating symptoms，promoting gastrointestinal recovery，and demonstrating inflammatory reaction-reduce and intestinal barrier-protective mechanisms.