III. Cholecystitis Gallstone Disease

III. Cholecystitis (Gallstone Disease)

Cholecystitis and gallstone disease often occur together, with each condition potentially being a consequence of the other. Approximately two-fifths of patients experience pain in the upper abdomen—pain that is slightly higher than the location of pain in the stomach and duodenum, often situated just below the xiphoid process—and is often accompanied by pain in the right hypochondrium, radiating to the right shoulder and back. Some patients may only experience pain in the right back. Gallbladder pain is often exacerbated by consumption of fatty foods, meat, and eggs. Most patients can be diagnosed via ultrasound; however, in a very small number of cases, ultrasound findings do not reveal any signs of inflammation or gallstones. Such cases of cholecystitis are often misdiagnosed; I frequently encounter patients who suffer from long-term right-back pain that fails to respond to conventional treatments, yet whose ultrasound shows no signs of biliary or pancreatic disease. After administering liver-soothing and bile-promoting medications, these patients often experience relief. Herbal treatments for cholecystitis and gallstone disease are highly effective; the basic diagnostic principle is often “the pathogenic factor resides in the Shaoyang region, where liver and gallbladder are filled with damp-heat,” with additional therapies focusing on regulating qi, promoting blood circulation, and relieving pain. A commonly used formula is Compound Xiaochaihu Decoction. Its composition includes: 10g Chai Hu, 10g Huang Qin, 6g Ban Xia, 10g Dang Shen, 6g Gan Cao, 10g Da Huang, 3g Huang Lian, 10g Dang Shen, 10g Mu Xiang, 6g Cao Kou, 10g Yuan Hu, 20g Chuan Dong Zi, 6g Zhi Ru Mo, 6g Chuang Xiang, 6g Shan Zhi, 100g Cao Kou, decocted and taken once daily. For shoulder and back pain, add 10g Qiang Du Hua and 12g Fang Feng; for constipation, add 10g Mang Xiao (Yan Hua); for high fever, add 30g Sheng Shi Tao, 10g Zhi Mu; for loss of appetite, add 10g Jiao San Xian; for abdominal distension, add 10g Hou Pu; for left flank pain, add 10g Chuan Jiao and 6g Gan Jiang; for epigastric pain, add 6g Ban Xia.