Cholecystitis and cholelithiasis are two distinct diseases but often mutually causative and coexist clinically, both characterized by upper abdominal pain. They share many preventive and therapeutic measures, thus discussed together. Cholecystitis is divided into acute and chronic types. Untreated acute cholecystitis may progress to chronic form, while chronic cholecystitis often presents as acute episodes. Both acute and chronic cholecystitis may be complicated by cholelithiasis, which can lead to biliary obstruction and subsequent gallbladder infection due to bile retention. This condition falls under the categories of "Jie Xiong," "Xie Tong," "Huangdan," and "Pi Huang" in Traditional Chinese Medicine.
Prevention Before Illness
Maintaining emotional well-being and avoiding emotional distress are crucial for prevention. Clinical observations show most patients have a history of emotional unrest prior to illness.
Adhere to regular diet, avoid excessive intake of greasy, rich, and cold foods. Consume more fresh vegetables, fruits, and nutritious, easily digestible foods.
Actively treat intestinal parasitic infections, especially ascariasis, to prevent retrograde infection.
Completely treat adjacent organ inflammations to prevent spread to the biliary tract.
Middle-aged women and obese individuals should engage in physical exercise, lose weight reasonably, and enhance physical fitness to prevent disease.
Prevent Progression After Onset
After onset, besides right upper quadrant pain, digestive function is significantly impaired, manifesting as poor appetite. If prolonged, physical strength declines, and severe complications such as biliary colic due to stone impaction may occur. Therefore, early and thorough treatment is essential. Patients already affected should follow the above preventive measures and actively undergo medication. During acute cholecystitis, complete treatment is necessary; even after clinical symptoms disappear, medication should continue for one week to prevent recurrence.
(1) TCM Treatment
1. Intermittent dull pain in the right upper abdomen, epigastric distension, frequent belching, poor appetite, pale red tongue, thin white coating, wiry pulse—indicating Liver Qi stagnation. Treat by soothing the liver, resolving stagnation, and relieving pain. Formula: Qingdan Tang Modified: Bupleurum 10g, Coptis 10g, Pinellia 10g, Citrus Aurantium Shell 10g, Curcuma 10g, Corydalis 10g, Toona Sinensis Fruit 10g, Sandalwood 10g, White Peony Root 15g, Rhubarb 10g (added later).
2. Severe right upper abdominal pain, obvious tenderness, fever with chills, bitter mouth, dry throat, nausea, vomiting, loss of appetite, jaundiced skin, constipation, dark yellow urine, red tongue, yellow greasy coating, rapid wiry or slippery pulse—indicating damp-heat accumulation and excessive heat in liver and gallbladder. Treat primarily by clearing damp-heat. Formula: Qingdan Lishi Tang: Bupleurum 10g, Coptis 10g, Pinellia 10g, Sandalwood 10g, Curcuma 10g, Plantain Seed 10g, Mu Tong 10g, Gardenia 10g, Gentiana 10g, Artemisia 15g, Rhubarb 12g (added later).
3. Persistent severe pain in the right upper abdomen, marked tenderness and rebound tenderness, high fever unrelenting or alternating chills and fever, generalized jaundice, constipation, short, deep red urine resembling tea, red-purple tongue, yellow rough coating or prickles, slippery rapid or deep fine pulse. Severe cases may present with delirium and cold extremities—indicating damp-heat transforming into fire, toxic heat invading internally. Treat by soothing the liver, regulating Qi, promoting diuresis, clearing heat, and detoxifying. Formula: Qingdan Xiehuo Tang Modified: Bupleurum 15g, Scutellaria 15g, Polygonum 15g, Pinellia 10g, Gardenia 10g, Sandalwood 10g, Curcuma 10g, Artemisia 30g, Gentiana 15g, Rhubarb 10g (added later), Mirabilite 10g (dissolved).
(2) "Total Attack" Therapy
This is an integrative approach combining traditional Chinese and Western medicine. Example:
Dan Tong Pailishi Tang: Golden Thread Grass 30g, Artemisia 30g, Sea Gold Sand 30g, Curcuma 15g, Citrus Aurantium Shell 12g, Sandalwood 12g, Rhubarb 10–15g (added later), Gardenia 10g, Mirabilite 10g (dissolved).
Total Attack Protocol: Perform 2–3 times weekly, 6–7 sessions constitute one course.
Example of Timing and Measures:
This method is the best approach for treating biliary stones. Stones with transverse diameter ≤1 cm and diameter ≤3 cm can generally be expelled. Example:
Time |
