Background: To explore the mechanism of Shenmai injection (SMI) on severe acute pancreatitis (SAP) through heme oxygenase-1 (HO-1) signaling. Methods: A total of 40 male SpragueeDawley (SD) rats (220-260 g) were grouped into the following four categories (n ¼ 10): SAP þ SMI þ Zinc protoporphyrin (ZnPP), SAP þ SMI, SAP, and sham surgery groups. ZnPP is a specific inhibitor of HO-1. Four percent of sodium taurocholate (1 mL/kg) was retrogradely injected via the pancreatic duct to induce the SAP model. The SAP group rats received 1.6 mL/kg saline by intravenous injection 30 min after the induction of SAP. The SAP þ SMI group rats received 1.6 mL/kg SMI by intravenous injection 30 min after the induction of SAP. The SAP þ SMI þ ZnPP group rats received an intravenous injection of 1.6 mL/kg SMI and intraperitoneal administration of 30 mg/kg ZnPP 30 min after the SAP induction. Twenty-four hours after the SAP induction, blood samples were collected for the measurement of amylase, lipase, creatinine, myeloperoxidase, interleukin-10 (IL-10), tumor necrosis factor-a (TNF-a), and HO-1 level, while tissue specimens were harvested for the determination of HO-1, TNF-a, and IL-10 mRNA level. Meanwhile, histopathological changes in organs (pancreas, lung, and kidney) were stored. Results: The serum concentration of amylase, lipase, creatinine, and myeloperoxidase was higher in the SAP group than in the SAP þ SMI group. Treatment with SMI increased HO-1 and IL-10 level and reduced TNF-a level in serum and tissues compared to the SAP group (P < 0.05). Treatment with SMI abolished the organ-damaging effects of SAP (P < 0.05). Furthermore, suppression of HO-1 expression by ZnPP canceled the aforementioned effects. Conclusions: SMI confers protection against the SAP-induced systemic inflammatory response and multiple organs damage via HO-1 upregulation.