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?-39?.
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
Source Prescription Type and Drugs
Hospital Affiliated
to Guangzhou TCM College Decoction for Cholelithiasis Qi-Stagnation type: lysimachia
30g, oriental wormwood shoot 30g clematis root 30g, curcuma root 15g, turmeria
15g, fruit of citron or trifoliate orange 15g, aucklandia root 24g, bupleurum
root 12g, green tangerine peel 9g For damp-heat type: lysimachia 30g, oriental
wormwood shoot 30g, giant knotweed rhizome 30g, aucklandia root 15g, corydalis
tuber 9g, capejasmine 9g, bupleurum root 9g, grass leaved sweetflag rhizome 9g,
chicken's gizzard-skin 1.5g For septicopyemia type: lysimachia 60g, oriental wormwood
30g, aucklandia root 24g, dried glauber's salt 24g, bupleurum root 18g, curcuma
root 15g, toosendan fruit 12g, corydalis tuber 12g, rhubarb 12g, gentian root
5g, utrmeria 5g
Qingdao Municipal Hospital Decoction for Removing Stones from
Biliary Tract For type: lysimachia 30g, rhubarb 30g, aucklandia root 18g, buplerum
root 15g, curcuma root 15g, citron fruit 15g For damp-heat type and toxic type:
lysimachia 30g, honeysuckle flower 30g, oriental wormwood 30g, forsythia fruit
30g, rhubarb 30g, curcuma root 30g, aucklandia root 18g, citron fruit 12g, mirabilite
6g
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
Time 1 Measures
8:30
a.m.
9:30 a.m.
10:10 a.m.
10:15 a.m.
10:20 a.m.
10:25 a.m.
10:30
a.m. 200 ml of Decoction for Removing Stones for oral administration
5mg of
morphine by subcutaneous injection
0.5mg of atropine by subcutaneous injection;
or 1 ampule of isoamyl nitrite by inhalation
40 ml of 33% of magnesium sulfate
for oral administration
30 ml of 0.5% of dilute hydrochloric acid for oral
administration.
Fat meal (2-3 fried eggs)
Acupuncture with electric stimulation:
connect cathode to danshu (UB 19) and connect anode to
Riyue (GB 24) or
Taichong
(Liv 3) and Liangmen (St 21) for 30 minutes
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 .
Dr. Ming's TCM Medical Center,
Hua
Xi Xiao Yuan, Hutian Developing Area,
Huaihua city, Hunan province
China