Acute cholecystitis is caused mainly by bacterial infection and biliary tract obstruction; chronic cholecystitis usually coexists with gallstone besides a history of acute cholecystitis. In TCM, this disease is categorized as "xie tong" (hypochondriac pain), "huang dan" (jaundice), etc.  

Main Points of Diagnosis

1. Acute cholecystitis has an acute onset and persistent pain in the right upper quadrant radiating to the right shoulder accompanied with nausea vomiting and fever. Jaundice may be present in some patients. Physical examination reveals prominent tenderness, rebounding tenderness and muscular tension in the right upper abdomen, sometimes the enlarged gallbladder is palpable.

2. Patients suffering from chronic cholecystitis usually have such chronic symptoms as discomfort in the right upper quadrant, vague pain, abdominal distension, aversion to greasy food, eruction and other dyspeptic manifestations. Physical examination may reveal slight tenderness or no specific signs.

3. Laboratory examination

(1) In the stage of acute attack, leucocytosis, elevated icterus index and hepatic lesion to some extent may be present.

(2) Abdominal X-ray plain film may show positive radio-opaque stone, enlarged gallbladder and calcified opacity. Cholecystography reveals the form of gallbladder and its concentrating function or radio-oaqque stone. It is helpful for the diagnosis of chronic cholecystitis.

(3) Duodenal drainage is valuable in detecting the pathogen as well as confirming the diagnosis, giving some hints for treatment. Ultrasonic examination is practical to evaluate the function of gallbladder and suggest the existence of gallstones.  

Differentiation and Treatment of Common Syndromes     

1. Damp-Heat in the Liver and Gallbladder (frequently occurring in acute cholecystitis or in acute attack of chronic form)

Main Symptoms and signs: Alternate spells of fever and chill or fever without chill ,pain in the right upper abdomen or right ribs, poor appetite, bitterness in the mouth, even accompanied with nausea and vomiting, constipation, deep-colored urine, sometimes with jaundice, red tongue with yellow and greasy fur, and taut rapid pulse.

Therapeutic Principle: Clearing away pathogenic heat and dampness, soothing the liver and normalizing the function of gallbladder.

Recipe: The combination of Oriental Wormwood Decoction and Decoction of Gentian for Purging Liver-Fire with additional ingredients.

oriental wormwood

gardenia fruit

rhubarb

scutellaria root

bupleurum root

curcuma root

honeysuckle flower

forsythia fruit

gentian root

immature bitter orange

aucklandia root

licorice root

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

In addition to the above ingredients, 30 grams of gypsum and 30 grams of isatis root ought to be employed for the case with high fever; 9 grams of pinellia tuber and 9 grams of bamboo shavings for the case with nausea and vomiting; 9 grams of chicken's gizzard 9 grams of parched hawthorn fruit 9 grams of parched medicated leaven and 9 grams of parched germinated barley for the case with poor appetite.

2. Stagnation in the Liver and Gallbladder (frequently occurring in chronic cholecystitis)

Main Symptoms and Signs: Right-sided hypochondriac pain which sometimes radiates to the right shoulder and back, epigastric distension and fullness, which are aggravated by anger or intake of greasy foods, poor appetite, eruction, nausea, red tongue with thin yellowish fur, and taut pulse.

Therapeutic Principle: Soothing the liver and normalizing the function of gallbladder.

Recipe: Modified Major Bupleurum Decoction.

bupleurum root

scutellaria root

curcuma root

chicken's gizzard

blimbing fern spore

bitter orange

aucklandia root

honeysuckle flower

forsythia fruit

white peony root

rhubarb

licorice root

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

Moreover, for the case with poor appetite, 9 grams of parched hawthorn fruit, 9 grams of parched medicated leaven and 9 grams of parched germinated barley should be administered; for the case with distinct symptoms of spleen deficiency, 9 grams of white atractylodes rhizome, 9 grams of codonopsis root and 9 grams of poria should be administered.

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