The clinical data of patients with severe acute pancreatitis admitted to the Department of Intensive Care Unit in our hospital from January 1, 2016 to December 31, 2020 were retrospectively collected.The patients were divided into electroacupuncture combined with Qingyi decoction treatment group (acupuncture group) and conventional group according to whether the patients received electroacupuncture combined with Qingyi decoction treatment.A prediction model of treatment propensity score was established for paired screening, with 122 cases in each group.The acupoints such as Zusanli, Sanyinjiao, Hegu, Shangjuxu, Xiajuxu, and Taichong were selected, and then electroacupuncture treatment was performed after qi arrival using the manipulation technique, 1 or 2 times per day.Qingyi decoction was injected through the stomach and/or Qingyi decoction was given by coloclysis, 2-4 doses per day.The main outcome was the incidence of acute respiratory distress syndrome (ARDS), and the secondary outcome was the occurrence of complications and outcome of discharge.Compared with conventional group, the incidence of ARDS was significantly decreased, the time of mechanical ventilation was shortened, the incidence of renal dysfunction, score for acute physiology and chronic health score system, sequential organ failure score, and score for the severity of bedside acute pancreatitis were decreased, the rate of surgical intervention was increased, the total length of hospital stay was prolonged, and the fatality rate during hospitalization was reduced in acupuncture group ( P<0.05). The results of subgroup analysis showed that the onset time of disease (<1 week), a history of cardiovascular disease, diabetes mellitus, biliary pancreatitis and alcoholic pancreatitis, high fever, puncture and drainage were influencing factors for ARDS developed in the patients who received electroacupuncture combined with Qingyi decoction for treating severe acute pancreatitis.In conclusion, electroacupuncture combined with Qingyi decoction as an adjuvant treatment for severe acute pancreatitis can reduce acute lung injury, promote recovery, and decrease fatality rate.