Infection of biliary tract and gall stones are common surgical acute abdominal diseases. They include acute and chronic cholecystitis, acute and chronic cholangitis, cholelithiasis, choledocholith, hepatic duct stones, acute obstructive suppurative cholangitis, etc. As these diseases are caused and affected by one another, inflammation and stones are usually found at the same time and their clinical manifestations and treatments are similar to one other, we shall discuss them together in this section. In TCM, these kinds of diseases belong to the categories of (jaundice), (distending pain of the hypochondriac pain, (jaundice), (jaundice due to accumulation of pathogens in the chest ),etc.

Main Points of Diagnosis 

1.Symptoms

1) Abdominal Pain: A vague and dull pain is usually presenting the middle upper abdomen, right upper abdomen and below the xiphoid process. In an acute attack, the pain can be colicky and also radiate to the shoulder or the back .

2) Pyrexia: The body temperature is in the range between 30¡æ-39¡æ.

3) Jaundice: Icterus occurs in the sclera of the eyes or the skin of the whole body.

4) Symptoms of the Gastrointestinal Tract: There is nausea and vomiting in most cases. The vomitus is gastric content, accompanied with loss of appetite, aversion to greasy foods, flatulence, constipation, etc.

2. Signs: There is an obvious tenderness in the gallbladder area of the right upper abdomen, and abdominal muscular can be felt. If the pathologic change happens to be in the bile duct, tenderness will occur below the xiphoid process. In the hepatic area there will be an obvious percussion pain.

3. Laboratory Examination: The W. B. C. and neutrophil will obviously increase. When there is jaundice, serum bilirubin and icteric index will increase. In the bilirubin qualitative test the direct reaction will be positive and the urine bilirubin also positive. In serious or prolonged cases, the liver function is often found injured.

4. X-ray Examination: In about 10-15 percent of the patients with gallbladder stones, the x-ray film will show the stone shadows. If the patient takes medicine and undergoes travenous cholangiography and cholangiography by puncture of the skin and liver, all these examinations will help find out the function of the gallbladder, the number and size and distribution of stones, as well as the position of an obstruction in the bile duct.

5. Ultrasonic Examination: Through this examination we may fin the shape, size, thickness and other structural conditions of the gallbladder and intrahepatic and extrahepatic ducts. If stones exist, there is a strong echo group, accompanied with the sound shadow in the gallbladder and bile duct. If the posture is changed, the echo group will move along the direction of the gravity.

Differentiation and Treatment of Common Syndromes      

1. Internal Treatment

This therapy is good for acute simple cholecystitis, the choledocholith whose transverse diameter is less than 1 cm, acute infection of biliary tract without an obvious shock, extensive small stones in the hepatic duct or in the hepar, cases in which the stones cannot be entirely cleared out by an operation, those who want to remove the san or small stones before or after the operation for better effects of the operation or for prevention of any recurrence.

1) Liver Stasis Type: This type includes diseases like stones in the hepatic and biliary ducts and cholecystolithiasis without obvious infection, and chronic cholecystitis.

Main Symptoms and Signs: In the right upper abdomen there is a vague pain, distending pain or migrating pain, radiating to the shoulder and back, accompanied with loss of appetite, abdominal fullness, bitterness and dryness in the mouth thin and white or slightly yellowish fur on the tongue and taut and tight or taut and thready pulse, generally, with no fever and no jaundice.

Therapeutic Principle: Soothing the liver and normalizing the function of the gallbladder, regulating the flow of qi to alleviate mental depression.

Recipe: Decoction for Removing Pathogenic Heat from Gallbladder and Promoting the Flow of Qi

bupleurum rot

scutellaria root

pinellia tuber

citron fruit

nutgrass flatsedge rhizome

curcuma root

corydalis tuber

aucklandia root

white peony root

raw rhubarb

All the above drugs are to be decocted in water for oral administration.

2) Damp-Heat Type: This type includes acute cholecystitis, choledocholith with obstruction and infection.

Main Symptoms and Signs: In the right upper abdomen there is a continuous and distending pain which radiates to the shoulder and back, and also muscular rigidity and tenderness. Sometimes, a swollen cholecyst may be felt. It is often accompanied with high fever, shiver, bitterness in mouth and dry throat, nausea, vomiting, lack of desire for food and drink, constipation, yellowish urine or yellowish eyes, yellowish body, red tongue with yellowish greasy fur, slippery and rapid pulse.

Therapeutic Principle: Soothing the liver and normalizing the function of the gallbladder, removing pathogenic heat and dampness.

Recipe: Decoction for Removing Heat and Dampness

bupleurum root

scutellaria root

pinellia tuber

aucklandia root

curcuma root

plantain seed

piece of cloth before it is decocted.

capejasmine fruit

oriental wormwood

raw rhubarb

all the above drugs are decocted in water for oral use.

3) Septicopyemia Type: This type includes suppurative and gangrenous cholecystitis, perforation of the gallbladder accompanied with diffuse peritonitis, acute obstructive suppurative cholangitis, etc.

Main Symptoms and Signs: A continuous severe pain occurs in the right upper abdominal muscular tension, an obvious tenderness and a rebound tenderness. A swollen cholecyst may be felt. Other symptoms are high fever, shiver, jaundice, low spirit or trance, cold limbs, constipation, dark tea-like urine, deep-red tongue with yellowish dry fur, taut and rapid pulse.

Therapeutic Principle: Soothing the liver and normalizing the gallbladder, clearing away pathogenic heat and fire.

Recipe: Decoction for Removing Pathogenic Heat and Fire from the Gallbladder

bupleurum root

scutellaria root

oriental wormwood

pinellia tuber

gentian root

manshurian aristolochia stem

curcuma root

capejasmine fruit

raw rhubarb

mirabillte

All the above drugs are to be decocted in water for oral administration. For those who have stones, add 30 grams each of lysimachia and climbing fern spore. For those with severe heat, add 30 grams of honeysuckle flower 30 grams of Chinese violet and 9 grams of goldthread root. For those with thirsty and deep-red tongue, add 30 grams of gypsum, 9 grams of windweed rhizome and 15 grams of snakegourd root. For those with severe pain, add 12 grams each of toosendan fruit and corydalis tuber. For those with vomiting, add 9 grams each of pinellia tuber prepared with ginger and bamboo shavings. For those who have high fever, unconscious and delirious, add Bezoar Bolus for Resurrection.

Prescriptions Commonly Used for

Cholelithiasis and Cholecystitis

2. General Offensive Therapy for Removing Stones

This therapy is good for cholelithiasis marked by qi-stagnancy type, damp-heat type, hepatolith, residual stones and recurrent stones.

General Offensive Scheme

Course of Treatment: The general offensive therapy may take about 2.5 hours each time. How many times the treatment will be given and how long the interval will be depend on the patient's general constitution and the reaction to the treatment. If the patient is fairly strong and his or her reaction to the treatment is not serious, this treatment may be repeated 2-3 times a week. Otherwise, it should be applied once a week . The whole course consists of 4-6 treatments. If another course is required, the patient should have a rest for a certain period of time. In the meantime, he or she should also take some Chinese drugs to supplement qi, nourish blood and strengthen the spleen and stomach.

The Regular Pattern of the General Offensive Therapy for Removing Stones: When the muddy and sandy stones come out from the body, the patient may not have any reactions. But upon the discharge of the big stone, there is mostly an acute abdominal pain and a biliary colic, accompanied with fever, jaundice and rapid pulse. When the discharge is over, the abdominal pain will clear up, with the temperature going back to normal and the jaundice recessing. This is called the phenomenon of discharge of stones. Then the patient's stool should be collected and sieved to find the stones.

Fundamentals of the General Offensive Therapy for Removing Stones: First take decoction consisting of traditional Chinese drugs to increase biliation, and then use morphine by subcutaneous injection to contract the sphincter of the lower part of the choledochus, reserve the sphincter of the lower part of the choledochus, reserve the gallbladder juice, distend the cholecyst and increase the pressure of the biliary tract. The last step is to use medicines, fat meals, electro-needle, and other methods so that the sphincter suddenly expands and the gallbladder contracts, thus forming a forceful bile excretion which can flush out the stones.

3. Acupuncture Therapy

1) Body Acupuncture

Acupuncture Points: Danshu (UB 19), Zhongwan (Ren 12), Zusanli (St 36) and Yanglingquan (GB 34).

For those with vomiting, add Neiguan (P 6). For those who have pain, add Hegu (LI 4), Shangwan (Ren 13), Zhongwan (Ren 12). For those with high fever, add Quchi (LI 11). For those who have jaundice, add Zhiyang (Du 9).

Manipulation: Use strong stimulation, twice a day, retaining the needle for 20-30 minutes each time.

2) Ear Needling

Auricular Points: Shenmen point and sympathetic part.

Adjunct Auricular Points: points of the liver, gallbladder and duodenum.

Select 2-3 points from the above points which have obvious reaction for strong stimulation for acupuncture, retaining the needle for 30 minutes. It is done twice a day.

3) Electric Needling

Acupuncture Points: Connect cathode to the right Danshu (US 19); connect anode to Dannang (Extra 35), Riyue (GB 24), Zhongwan (Ren 12), Liangmen (St 21) and Taichong (Liv 3).

Manipulation: When a needling sensation is felt, connect the needle with the electric stimulator. Turn the wave switch from weak to strong and the intensity must be as strong as the patient could bear, 20-30 minutes each time, 2-3 times a day .

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