Human beings always move from ignorance to awareness of things around them, and form a consensus as their understanding of the laws of things deepens. The process of human understanding of disease is also the same, and the document that finally forms a consensus and has clinical guidance is the “standard”. The process of understanding of severe acute pancreatitis is a typical example. In 1963, the first international “first time” was proposed. The classification of pancreatitis into: (1) acute pancreatitis; (2) recurrent acute pancreatitis; (3) chronic recurrent pancreatitis; (4) chronic pancreatitis. Second, the formation of norms for the diagnosis and treatment of acute pancreatitis in China The formation process of norms for acute pancreatitis in China is not as long as the international norms, but it has also undergone a tortuous process, which is related to the poor exchange of information between China and foreign countries for a long time in the past. For a long time in the past, the international treatment of acute pancreatitis was dominated by medical treatment, and it was only after Watts cured a patient with necrotizing pancreatitis by total pancreatectomy in 1963 that surgical treatment was really emphasized and carried out. In China, surgical treatment of necrotizing pancreatitis still faced great resistance until the early 1980s when Fu Peibin and others proposed it. However, in the face of the fact that surgical treatment has achieved better results and the efficacy has been improving, the number of physicians in favor of surgical treatment has gradually increased. Third, the pathophysiological basis and clinical implications of our SAP guidelines The link between the clinical classification system and treatment strategy in our SAP guidelines is the dynamic changing pathophysiological process. When patients present with early organ dysfunction or early intra-abdominal hypertension, the possibility of fulminant acute pancreatitis (FAP) should be considered, and the development of FAP should be blocked by timely surgical drainage; when patients present with systemic infection, i.e., sepsis syndrome, the source of infection should be found, and if it is caused by pancreatic necrotizing infection or pancreatic abscess, timely drainage is required, and if there is also cholecystitis or biliary duct infection or bile duct obstruction, the bile duct needs to be drained at the same time. If there is an obvious deviation from the principles required by the guidelines in the treatment process, the development of the disease may show difficult manifestations such as refractory shock, refractory infection, refractory bowel dysfunction, abdominal septal compartment syndrome (ACS) with MODS. In order to take fewer detours in practice, it is important to seize the main line and take the initiative when applying the guidelines.