Gallstones Gallstones are formations of crystals, composed of either cholesterol or calcium salts, in the gallbladder or the bile duct. In the United States, up to 20% of people over 65 have gallstones. Patients with gallstones in the gallbladder usually remain asymptomatic, while patients with gallstones blocking the bile duct may experience severe or life-threatening infection of the bile duct, the pancreas, or the liver. Risk factors of gallstones include female gender, old age, obesity, a Western diet and heredity. Clinical Manifestation Most patients with gallstones remain asymptomatic for long periods of time. However, should gallstones grow in size, they may obstruct the bile duct causing severe pain or infections. Signs and symptoms of cholecystitis and gallstones include fullness and pain in the right hypochondriac region, low grade fever, constipation and leukorrhea. Acute onset is characterized by jaundice, severe colicky pain in the upper right quadrant, which may radiate to the right shoulder and back, nausea, vomiting, aversion to oily and greasy foods, lack of appetite, etc. Conditions commonly associated with gallstones include cholecystitis and pancreatitis. Cholecystitis occurs when the gallstone blocks the cystic duct causing inflammation of the gallbladder. Pancreatitis occurs when a gallstone blocks the pancreatic duct leading to inflammation of the pancreas. Diagnosis Gallstones may be diagnosed with ultrasound, cholecystography, or blood test. Ultrasound scanning is generally considered the best and the most reliable method. Cholecystography is sometimes inconclusive, especially if the gall bladder is not functioning properly. Blood test results may show a pattern of abnormal liver function indicative of bile duct obstruction. Diagnostic physical exams include a positive response to Murphy's sign and tenderness at the inferior-right scapula. Treatment with Western Medicine Patients with asymptomatic gallstones do not require treatment. If there is severe pain associated with the presence of gallstones, then surgery is the treatment of choice. Treatment with Traditional Chinese Medicine The fundamental etiology of gallstones and cholecystitis is Damp-Heat. Cholecystitis is characterized by Damp Heat in the Gallbladder and gallstone is characterized by Damp Heat drying up fluid in the Gallbladder. Dissolve(*) is the herbal formula of choice for treating gallstones and cholecystitis. The ingredients are as follows: - Gentiana / long dan cao / Gentianae Longdancao, Radix - Capillaris / yin chen hao / Artemisiae Yinchenhao, Herba - Glechoma / jin qian cao / Lysimachiae, Herba - Clematis / wei ling xian / Clematidis, Radix - Litchi Seed / li zhi he / Litchi Chinensis, Semen - Aurantium Fruit / zhi ke / Citri Auran tii, Fructus - Gallus/ ji nei jin / Corneum Gingeriae Galli, Endothelium - Rhubarb / da huang / Rhei, Radix et Rhizoma Gentiana (long dan cao) enters the Liver and the Gallbladder to clear damp heat. It is an herb commonly used to treat various types of hepatic and gall bladder disorders including, but not limited to hepatitis, acute and chronic cholecystitis.(1) Capillaris (yin chen hao), an empirical herb in treating hepatic and gall bladder disorders, has a cholagogue function which increases the secretion of bile and the excretion of bile salt and bilirubin. It also lowers serum cholesterol and beta-lipoprotein. Capillaris (yin chen hao) and rhubarb (da huang) are used in conjunction with gentiana (long dan cao) for their synergistic effects to treat jaundice, cholecystitis and gallstone.(2) In addition, the combination of capillaris (yin chen hao) and rhubarb (da huang) can also treat hepatitis. It was demonstrated in a study of 32 cases of icteric hepatitis that after seven days of treatment, the patients showed dramatic improvement, with reduction of fever, disappearance of jaundice, and normalization of liver enzymes. It was found in another study that capillaris (yin chen hao) and rhubarb (da huang) have excellent effects in the treatment of neonatal jaundice.(3) Glechoma (jin qian cao), clematis (wei ling xian), litchi seed (li zhi he) and aurantium fruit (zhi ke) regulate the qi circulation and dissolve gall stones.(4) Glechoma (jin qian cao), dissolves gall stones and increases the secretion of bile by the liver cells. In addition, "The Journal of Traditional Chinese Medicine" reported glechoma (jin qian cao) had dramatic effects in the treatment of gallstone through case reports of 4 patients.(5) Furthermore, in a study involving 52 patients with cholecystitis, glechoma (jin qian cao) was given for two to three months, and over 76% of patients showed significant improvement.(6) Clematis (wei ling xian) unblocks the channels and helps to dissolve stones. Litchi seed (li zhi he) relieves abdominal and epigastric pain due to Liver qi constraint. Aurantium fruit (zhi ke) unblocks qi obstruction and facilitates the passage of gall stones. Gallus (ji nei jin) transforms hardness, dissolves stones, and improves digestive functions. Lastly, gallus (ji nei jin), commonly used as a digestive herb to facilitate digestion of fatty and greasy foods, also has excellent properties to dissolve gall stones. (2) Modification of Herbal Treatment Modification of herbal treatment must be - For hepatitis, jaundice, or high liver enzyme levels, combine with Liver DTX.(*) - For constipation, combine with Gentle-Lax(*) (Excess). - For angina or chest pain, combine with Circulation.(*) - For peptic ulcers or gastritis, combine with GI Care.(*) - For patients with prominent signs and symptoms of Damp Heat in the Liver and Gall Bladder, combine with Gentiana Complex.(*) - To reduce blood cholesterol and triglyceride levels, use Cholisma.(*) Lifestyle Instructions For patients with cholecystitis, advise against eating solid food for a few days. They should drink distilled water and fresh juices. Liquid foods can be introduced slowly after three or four days. For patients with gall stones, advise taking three tablespoons of olive oil with lemon juice before going to bed and upon awakening. Gallstones are sometimes passed and eliminated with this method. Advise patients to avoid eating red meat, shrimp, lobster, oysters, fatty or greasy food, fried food, spicy foods, margarine, soft drinks, commercial oils and processed foods. Encourage patients to consume as much raw food as possible, including apple-sauce, yogurt, fresh apples and beets. Clinical Notes Cholecystitis and gallstone commonly occur simultaneously. They are most commonly seen in female patients over 30 to 40 years of age, and in patients who are obese. Often times they are undiagnosed or mis-diagnosed as gastritis, peptic ulcers, viral hepatitis, angina or acute pancreatitis. X-ray results are not always accurate. Ultrasound of the gall bladder is more reliable and has approximately 90-95% accuracy. Patients or conditions most suitable for Chinese herbal treatment include those with chronic cholecystitis, the presence of gallstones in the liver, gallstones composed primarily of calcium, small gall, stones, and the presence of gallstones after removal of the gall bladder. Elderly or weak patients not suitable for surgical treatment can also benefit from Chinese herbal treatment. Patients with high risks of developing cholecystitis or gall stones will benefit from prophylactic treatment by taking Dissolve on a preventative basis. Risk factors of cholecystitis or gall stones include being female, fair, fertile, and obese. Caution Herbal treatment is not suitable for the following patients or conditions: - Acute onset with severe colic, - Large stones with obstruction of the bile duct (surgery is the treatment of choice), - Sudden deterioration in the overall health of the patient, - Sudden deterioration in cholecystitis/gallstone, - Poor results from previous treatments and the emergence of signs of liver damage, Pregnant women. - (*) Propriepary formulas of Lotus Herbs. (1.) Bensky, D, et al, Chinese Herbal Medicine Materia Medica, Eastland Press, 1993. (2.) Yeung, HC, Handbook of Chinese Herbs, Institute of Chinese Medicine, 1996. (3.) Traditional Chinese Medicine and Treatment of Neonatal Jaundice, Department of Neonatology, Kandang Kerbau Hospital, Singapore. Singapore Med J;3 7(6):645-65 I, Dec 1996. (4.) Zhang, XP, Treatment of Endocrine Disorders with Herbs. Presentation given by Professor Zhang at the Seminar hosted by California Association of Acupuncture and Oriental Medicine,July 1998. (5.) Observation on the effectiveness of Jinqiancao in treating Cholelithiasis,
Journal of Traditional Chinese Medicine, 11:749, 1958. |