Chronic cholecystitis is a clinically common chronic inflammatory disease of the gallbladder. It is characterized by vague pain and fullness in the mid-upper abdomen or right upper abdomen, with onset or worsening when eating a fatty diet or emotional changes, and the pain may radiate to the right subscapular region with recurrent onset. The clinical classification is mostly chronic calculous cholecystitis and chronic non-calculous cholecystitis. Western medicine conservative treatment is mostly based on the principles of anti-inflammatory, biliary, antispasmodic and pain relief; the indications for surgical treatment are: recurrent biliary colic, non-functional gallbladder, or acute attacks with stones.
Compared with Western medicine, Chinese medicine has clear efficacy in relieving pain, enhancing diet and improving the overall condition of patients, and has its advantages in conservative treatment. The main points of the diagnosis and treatment of this disease in TCM are as follows, based on personal experience in the treatment of this disease: the attack phase, the chronic phase and the intractable pain.
The attack phase.
Emphasis should be placed on draining the liver and gallbladder, relieving heat and pain.
In acute attacks of chronic cholecystitis or biliary colic, the main manifestation is persistent distension or episodic colic under the abdomen, with attacks or aggravation after eating or in the early morning, localized refusal to press, pain can involve the right shoulder and back, accompanied by nausea, loss of appetite, may be accompanied by vomiting, abdominal distension and constipation. The tongue is yellowish and greasy, and the pulse is stringent. The formula is Da Chai Hu Tang. The specific drugs are.
Radix Bupleurum Chinense 24g, Radix Scutellariae Sinensis 12g, Radix Citrus Aurantium 10g, Radix Paeoniae Alba 15g, Radix Eryngium 10g, Radix Ziziphi 15g.
Addition and subtraction.
If constipation is obvious, change Prepared Rhubarb to Raw Rhubarb 10g; if right upper abdominal pain is obvious, add Yujin 15g; if upper abdominal pain is obvious and hard when pressed, add our Gao Qimin old Chinese medicine experience formula: 1g of Gansui powder (divided and brewed), 15g of Tiger Balm.
Chronic phase.
Then it should be based on the whole body and treated with evidence.
Although this disease is dominated by gallbladder damage, it often has obvious systemic symptoms, manifesting as appetite, sleep, menstruation and mental and physical disorders. When using drugs, if only based on gallbladder damage, or only from the regulation of the liver and gallbladder, the effect is often not ideal; should pay more attention to the systemic performance, from the overall identification of evidence to start, pay attention to the organic connection between the internal organs, in order to achieve better results.
The following types of evidence are common in clinical practice.
1, liver qi stagnation
Symptoms: Distension and pain under the abdominal junction, mainly fullness, which may involve the right upper abdomen or the right shoulder and back, aggravated by depression and anger. Yellow tongue coating and string pulse.
Treatment: Diversify the liver, regulate Qi and relieve depression.
Radicals: Chai Hu Dredging Liver San is the main formula.
Radix Bupleurum Chinense 15g, Radix Paeoniae Alba 15g, Frying Citrus Aurantium 10g, Radix Aromaticus 12g, Rhizoma Ligustici Chuanxiong 10g, Pericarpium Citriodorus 10g, Radix Glycyrrhiza Uralensis 6g, Radix Ulmoides 15g.
Addition and subtraction: If there is bitterness in the mouth and dryness in the throat, dizziness, nausea or vomiting, with obvious evidence of depression and heat, Xiao Chai Hu Tang with addition should be used instead: Chai Hu 15g Baicalin 12g Radix Scutellariae Sinensis 12g Radix Codonopsis 10g Yu Jin 15g Sheng Oyster 30g Ginger 15g Jujube 10g; if pain is obvious, add Yuan Hu 10g Neem 6g.
2. Liver depression and spleen deficiency
Symptoms: Distension and vague pain under the abdomen, which may involve the right upper abdomen or the right shoulder and back, with a light degree, preferring to get warm pressure, aggravated by depression and anger or eating greasy food, accompanied by loose stools and fatigue. The tongue is light red, with thin white tongue coating and weak pulse on the right string and left side.
Legislation: Nourishing Blood, softening Liver and strengthening Spleen.
Formula: Prosperity San is the main formula.
Radix Bupleurum 15g Radix Angelicae Sinensis 12g Radix Paeoniae Alba 12g Rhizoma Atractylodis Macrocephalae 15g Poria 15g Radix Ginger 10g Radix Aromaticus 12g Radix Glycyrrhiza Uralensis 6g Radix Ginger 12g Jujube 15g.
Addition and subtraction: If the heart is irritable and insomnia, add 10g of peony skin and 6g of fried gardenia; if the pain is obvious, add 6g of rhubarb, 6g of sizzling slices of sorrel, and 3g of fine spice.
3.Phlegm-heat in the bile meridian
Symptoms: Distension and vague pain under the Jiantu of the upper abdomen or in the right upper abdomen, mild and prolonged, aggravated by mood swings or dietary indiscretions, accompanied by thoughtfulness and fear, restlessness in the heart, easy mood swings, insubstantial sleep at night, dreaming and waking easily, and irregular bowel movements. The tongue is light red, with thin yellow coating and a slippery pulse or with count.
Legislation: Clearing and relieving phlegm-heat in the bile meridian.
Formula: Warm Gallbladder Soup as the main formula.
Bamboo Roo 10g, Fried Citrus Aurantium 6g, Pericarpium Citri Reticulata 10g, Radix Fructus Parasil 12g, Poria 15g, Roasted Licorice 6g, Ginger 15g, Fried Jujube 15g, Raw Oyster 15g.
Addition and subtraction: If fatigue is obvious, add 12g each of Radix Rehmanniae, 12g Radix Codonopsis Pilosulae, 6g Fructus Schisandrae.
4.Liver Yin deficiency
Symptoms: Swelling and pain in the epigastric region under the sword prominence or right epigastric region, which may involve the right shoulder and back, with a mild degree and like to press, triggered or aggravated by exertion or depression, accompanied by dry mouth and desire to drink, dizziness and fatigue, dry and thin stool. The tongue is thin and red, the tongue coating is thin and dry, and the pulse is thin and weak.
Legislation: Nourishing Yin, softening the liver and relieving pain.
Prescription: Radix Rehmanniae 12g
Bei Sha Shen 12g Radix Angelicae Sinensis 10g Fructus Lycii 10g Mai Dong 12g Neem 6g Radix Paeoniae Alba 12g Radix et Rhizoma Glycyrrhizae 6g.
For those with persistent pain: when emphasis is placed on the sympathetic Yin Liver meridian and Blood stasis.
For those with prolonged pain, the following three conditions can be considered.
1. Blood stasis under the hypochondrium
Symptoms: Stabbing pain without rest under the Jiandu in the upper abdomen or in the right upper abdomen, obvious by pressure, not relieved for a long time, sometimes with enlarged gallbladder. The tongue is dark and stagnant, with thin tongue coating and string veins.
Treatment: Promote blood circulation, resolve blood stasis and relieve pain.
Formula: Diaphragmatic subdiaphragmatic Stasis Expelling Tang is the main formula.
Peach kernel 10g, safflower 10g, red peony 10g, angelica 10g, chuanxiong 10g, mudanpi 10g, yuan hu 10g, wuling fat 10g, methanol 12g, fried heliotrope 10g, roasted licorice 6g.
2.Heat in the upper part and cold in the lower part
Symptoms: Pain in the upper abdomen under the sword prominence, involving the right upper abdomen for a long time. Cold, then abdominal distension, or diarrhea, cold below the waist, and a little hot food and “on fire”, easy to get mouth sores. The tongue is dark red with a thin yellow coating, and the pulse is stringent.
Treatment: Calm the cold and heat in the sympathetic yin.
Remedy: Wu Mei Wan is the main formula.
Ume plum 30g, Radix Aconiti 6g, Ginger 6g, Gui Zhi 6g, Sichuan pepper 6g, Hossein 3g, Radix Codonopsis 10g, Radix Angelicae Sinensis 10g, Huang Lian 6g, Huang Bai 10g.
3.Yin deficiency and liver vigor
Symptoms: Pain in the epigastrium under the prominence of the sword, involving the right upper abdomen and even the right side of the chest and abdomen and back, accompanied by dizziness and redness, weakness of the knees and poor sleep, constipation. The tongue is reddish in color, with yellow tongue coating and a hard and stringent pulse.
Treatment: Nourish Yin, calm the Liver and subdue Yang.
Formula: Calm the liver and quench the wind.
Huai Niu Knee 30g Hanging White Peony 15g Dai Ochre 20g Roasted Tortoise Board 15g (first decoction) Sheng Longmu 30g each Raw Malt 12g Neem 6g Roasted Licorice 6g.
Two suggestions.
1. The diagnosis of this disease by its TCM name is easy and simple. However, for Western medicine, chronic cholecystitis lacks a specific symptom or sign, although it is a disease. Many diseases, such as gallbladder cancer, liver and gastrointestinal diseases, can present with manifestations similar to cholecystitis; sometimes, the symptoms and signs are consistent with the characteristics of chronic cholecystitis and ultrasound suggests chronic cholecystitis, but after careful examination, the true cause is not chronic cholecystitis but a serious lesion of the hepatobiliary and gastrointestinal tract. This requires us, in the clinic, not to be satisfied with the relief of symptoms, but must be treated after a clear diagnosis, especially when the symptoms cannot be relieved by treatment of chronic cholecystitis, attention should be paid to further examination so as not to delay the disease.
2, clinically, many so-called “chronic cholecystitis”, in fact, is the gallbladder performance of chronic liver disease, spleen and stomach function has been very poor. However, the following two tendencies are common in the clinic.
(1) long-term medication in order to thin the thickened gallbladder wall and expel stones from the gallbladder.
(2) In order to treat the “inflammation” of the gallbladder, a large number of heat-clearing and detoxifying drugs are often added to attack the bottom. As a result, it is likely to aggravate liver damage, and also damage the function of the spleen and stomach, which in turn aggravates the gallbladder pathology. Therefore, long-term medication is inappropriate for asymptomatic chronic cholecystitis; it should be recognized that Chinese medicine treatment, like Western medicine, is difficult to fundamentally change its pathological changes and is allopathic. Long-term medication should be taken with caution.