Diabetes mellitus is complicated by biliary tract disease, with cholelithiasis being the most common clinical condition. The main pathological changes are acute and chronic cholecystitis and gallstones. In acute cholecystitis, the lesions start in the mucosal layer and gradually spread to the whole layer. It can be clinically divided into three types: simple cholecystitis, purulent cholecystitis and gangrenous cholecystitis, the latter being prone to pericholitis and perforation of the gallbladder. Chronic cholecystitis is a sequel to acute cholecystitis and is characterized pathologically by increased fibrous tissue of the gallbladder and thickening of the cystic wall; chronic inflammatory cell infiltration. The mucosa is atrophied to different degrees and the muscle fibers are atrophied, resulting in reduced contractile function; mechanical stimulation and compression of stones can lead to ulceration of the cyst wall and even the formation of chronic perforation. If the gallbladder duct is completely blocked due to chronic inflammation, it can form gallbladder fluid, and acute infection can lead to pus accumulation in the gallbladder. Gallstones can be clinically classified as cholesterol stones, bilirubin stones, mixed stones and rare stones. According to the location of stones, they can be divided into gallbladder stones, common bile duct stones and hepatic bile duct stones. Diabetic patients with combined gallbladder stones and chronic non-stone cholecystitis have the characteristics of high incidence and inconspicuous clinical manifestations, and the symptoms of chronic cholecystitis are more vague and atypical. Usually there is dull pain or discomfort in the right upper abdomen, with indigestion symptoms such as bloating, belching, aversion to oil and burning in the stomach, and some often feel vague pain in the right shoulder, etc. Or clinically asymptomatic,. If there is obvious enlargement of the gallbladder and reduced contractile function, it is called “diabetic neurogenic gallbladder”. If there is a high degree of neurological dysfunction, due to the increased threshold of perception, in the event of infection or perforation, the clinical symptoms are not obvious, but the condition changes rapidly and the mortality rate is high, 5-22 times higher than that of non-diabetic patients. Acute attacks can be identical to acute cholecystitis, and most patients can be free of signs and symptoms in remission. The symptoms of gallbladder stones depend on the size and location of the stones, the presence or absence of obstruction of the gallbladder duct and infection. In diabetic gallstones, the symptoms are usually mild and atypical, often with a feeling of stuffiness and distension in the right upper abdomen, dyspepsia or chronic cholecystitis. Half of the patients do not have any symptoms, which is called “invisible gallbladder stones” or “asymptomatic gallbladder stones”. When small stones in the gallbladder contract after eating or eating fatty food, or block the cystic duct at night when lying down, it can cause sudden biliary colic. If the stone is blocked in the gallbladder neck or common bile duct, it can lead to acute cholecystitis or even necrosis or perforation of the gallbladder. In a few cases, stones may block the cystic duct for a long time without infection, and only gallbladder effusion may form. Based on the patient’s history of diabetes, combined with clinical symptoms and signs and laboratory tests, the diagnosis of the disease is not difficult. Treatment includes both Western medical treatment and Chinese medical treatment. Western medical treatment includes the treatment of the primary disease, which is the active control of diabetes. Lipid-lowering therapy, that is, the use of lipid regulators, is used to treat hyperlipidemia; acute cholecystitis and cholelithiasis are treated with anti-infective therapy or surgery, depending on the circumstances. Chinese medicine treatment adopts evidence-based treatment, and the clinical evidence is divided into external damp-heat, liver-yin deficiency, liver-biliary stagnation-heat and gallstone obstruction, which are used to clear heat and dampness, nourish yin and soften the liver, clear the liver and bile, as well as bile and stone removal. Commonly used formulas include: Gentian and Liver Diarrhea Tang, Consistent Decoction, Clear Bile Tang and Bile Drainage Tang.