Diagnostic criteria: 1. extrahepatic bile duct stones do not block the common bile duct, no obvious symptoms; stone blockage of the bile duct after the first paroxysmal epigastric colic, nausea, vomiting, followed by chills, high fever, jaundice, and Charcot (Charcot) triad. 2. On physical examination, there is pressure pain in the right epigastrium, below the raphe, and even muscle tension. 3. The accuracy of ultrasonography in the diagnosis of choledocholithiasis is 40-60%. 4. Diagnosis mainly relies on direct cholangiography PTC, ERCP, whose diagnostic accuracy can reach more than 95%. 5. Because CT can show calcium bilirubin components, and bile duct stones are mainly calcium bilirubin stones, so CT has a certain value for the diagnosis of stones in the lower part of the common bile duct. Chinese and western medicine combination of identification 1, name: dystocia 2, location: liver, gallbladder, spleen, stomach 3, etiology: seven emotions, internal injuries, dietary intolerance, or accumulation of worms, etc. 4, pathogenesis: the patient is mostly due to emotional depression, desire, resulting in the liver and qi stagnation, liver loss of detoxification, transverse violation of the spleen, the spleen is not healthy, the stagnation of the water and grain in the middle jiao not to be transformed, and the accumulation of dampness and heat in the end of the day, congestion and qi to see the coercion and distention pain of epigastric cavity, dullness, nausea and vomiting when stomach is out of harmony and descending, and the damp-heat cross-steam, bile gas is not favorable, bile and heat are not favorable, the bile is not good. Dampness-heat intermingles with vaporization, bile gas is unfavorable, bile overflows, impregnates the skin, and jaundice occurs. If the stagnant heat does not come out, pus accumulates for a long period of time, and heat injures the fluids, it is easy to trigger the dangerous change of yin and yang being separated from each other. This disease can also be caused by dietary irregularities, leading to dysfunction of the liver, gallbladder, spleen and stomach. (1) Liver-qi stagnation syndrome (1) The main symptom: equivalent to non-episodic choledocholithiasis. The main manifestation is hidden pain in stomach and epigastrium, without fever and jaundice. Light pressure pain in the epigastric region, no obvious elevation of blood image. Thin white or slightly yellow tongue coating, tongue slightly red, tight pulse. ②Treatment: dredge the liver and regulate qi ③Prescription: Chai Hu Shu Liver Tang plus subtractions ④Disease nature: solid evidence of the liver and gallbladder (2) Damp-heat evidence of the liver and gallbladder ①Principle: equivalent to the acute attack of choledochal stones combined with infection. The main manifestations are severe pain in the right upper abdomen, obvious pressure pain, chills, high fever with yellow gangrene, yellow and greasy tongue coating, reddish tongue texture, and stringy pulse. ② Treatment: dredge the liver and gallbladder, diarrhea and laxative ③ prescription: clear gallbladder Cheng Qi Tang plus reduction ④ nature of the disease: solid heat evidence (3) liver and gallbladder toxic heat ① evidence: equivalent to the choledochal stone acute attack period combined with infection and toxic shock. ② treatment and prescription: Western medicine surgery and symptomatic treatment ③ prescription: Qing gallbladder Cheng Qi Tang plus reduction with the treatment ④ nature of the disease: solid heat syndrome three, treatment 1. non-surgical treatment Indications: hepatic and biliary sedimentary stones, choledochal stone diameter less than 1.0cm, as long as the lower end of the common bile duct is not narrowed, can be tried non-surgical lithotripsy therapy. (1) Chinese medicine therapy: Chinese medicine has rich experience in the treatment of gallstone disease, it has the function of improving biliary function, controlling infection; biliary stone removal, etc. According to the Chinese medicine diagnosis, it adopts the method of soothing the liver and regulating the qi, clearing away the heat and bile, and removing the stone through the lining. (2) “Total Attack” therapy: its principle is firstly to promote bile, prompt the contraction of sphincter of Oddi, in order to cause temporary “biliary high pressure”, and then make the sphincter relax, the gallbladder contraction, in order to cause bile impact discharge, in order to facilitate the discharge of stones in the bile ducts. (3) litholytic therapy: the dissolving agent of gallstones also has the following conditions: ① with the ability to promote the dissolution of cholesterol, bile pigment; ② non-toxic to the body; ③ can be in contact with the gallstones for a longer period of time or can maintain a certain concentration. Methods: ① 2% compound porcine bile acid sodium solution; ② 2% edetate solution (EDTA); ③ 1% goose deoxycholic acid solution (CDCA); ④ 2% sodium metaphosphate solution; ⑤ tangerine oil compound bile salt sodium emulsion (10% tangerine oil, compound bile salt sodium 1:9); ⑤ cholesterol 2,500~1,500 units added to 250 ml of saline once a day for a total of 4~6 times. 2. Endoscopic treatment of common bile duct stones (1) Lithotripsy: injecting gallstone dissolver into the bile duct or performing biliary lavage through fiberoptic duodenoscopy or percutaneous hepatic cholangioscopy (PTCS), which is good for fewer or sediment-like stones. (2) Stone removal therapy: For patients with common bile duct or intrahepatic bile duct stones accompanied by lower bile duct stenosis, endoscopic papillotomy (EST) can induce the discharge of stones, and together with traditional Chinese medicine stone removal, it achieves satisfactory curative effect. (3) lithotripsy: endoscopic lithotripsy has two routes: ① transduodenoscopic lithotripsy: lithotripsy with mesh blue or lithotripsy forceps; ② choledochoscopy or percutaneous hepatic choledochoscopy lithotripsy: lithotripsy can be done during the operation, or lithotripsy can be done after the operation through the T-tube sinusoidal tract. Percutaneous hepatic cholangioscopy is only used for cases with bile duct stenosis or those who cannot undergo reoperation. (4) Lithotripsy: mostly used for residual stones after biliary surgery, its lithotripsy methods are: ① mechanical lithotripsy; ② liquid electro lithotripsy; ③ laser lithotripsy. 3. Surgical treatment (1) cholecystectomy, choledochotomy, T-tube drainage: suitable for the first operation of choledochotomy with insignificant enlargement of choledochotomy, no intrahepatic stones, and patent lower end of choledochotomy. (2) Combined two-mirror: there are two methods: ① combined endoscopy and laparoscopy: ERCP, EST and mesh basket stone extraction, liquid electrostatic stone extraction, followed by LC. ② combined laparoscopy and choledochoscopy: for patients who have failed ERCP, ENBD and stone extraction, and have no history of upper abdominal surgery. Perform laparoscopic choledochotomy, intraoperative choledochoscopy to remove stones, T-tube drainage. (3) Combination of three mirrors: endoscopy, laparoscopy and choledochoscope combined. It is suitable for choledochal stones with large number and large size, which are difficult to remove and crush; duodenal diverticulum, diverticulum parapapapillary papilla, which is difficult to perform a large incision; Mirizzi’s syndrome and elderly patients, who are unable to tolerate multiple endoscopic treatments, this method can be used. Fourth, the efficacy of judgment 1.cure: the common bile duct stone completely clean, symptoms disappear. 2. Improvement: Symptoms are significantly reduced, with a small amount of residual intrahepatic bile duct stones. 3. Ineffective: no change in symptoms, stones still exist, or new complications.