Acute cholecystitis is caused mainly by bacterial infection and
biliary tract obstruction; chronic cholecystitis usually
coexists with gallstone besides a history of acute
cholecystitis. In TCM, this disease is categorized as "xie tong"
(hypochondriac pain), "huang dan" (jaundice), etc.
Main
Points of Diagnosis
1. Acute cholecystitis has an acute onset and
persistent pain in the right upper quadrant radiating to the
right shoulder accompanied with nausea vomiting and fever.
Jaundice may be present in some patients. Physical examination
reveals prominent tenderness, rebounding tenderness and muscular
tension in the right upper abdomen, sometimes the enlarged
gallbladder is palpable.
2. Patients suffering from chronic cholecystitis usually have
such chronic symptoms as discomfort in the right upper quadrant,
vague pain, abdominal distension, aversion to greasy food,
eruction and other dyspeptic manifestations. Physical
examination may reveal slight tenderness or no specific signs.
3. Laboratory examination
(1) In the stage of acute attack, leucocytosis, elevated icterus
index and hepatic lesion to some extent may be present.
(2) Abdominal X-ray plain film may show positive radio-opaque
stone, enlarged gallbladder and calcified opacity.
Cholecystography reveals the form of gallbladder and its
concentrating function or radio-oaqque stone. It is helpful for
the diagnosis of chronic cholecystitis.
(3) Duodenal drainage is valuable in detecting the pathogen as
well as confirming the diagnosis, giving some hints for
treatment. Ultrasonic examination is practical to evaluate the
function of gallbladder and suggest the existence of gallstones.
Differentiation and Treatment of Common Syndromes
1. Damp-Heat in the Liver and Gallbladder
(frequently occurring in acute cholecystitis or in acute attack
of chronic form)
Main Symptoms and signs: Alternate spells of fever and chill or
fever without chill ,pain in the right upper abdomen or right
ribs, poor appetite, bitterness in the mouth, even accompanied
with nausea and vomiting, constipation, deep-colored urine,
sometimes with jaundice, red tongue with yellow and greasy fur,
and taut rapid pulse.
Therapeutic Principle: Clearing away pathogenic heat and
dampness, soothing the liver and normalizing the function of
gallbladder.
Recipe: The combination of Oriental Wormwood Decoction and
Decoction of Gentian for Purging Liver-Fire with additional
ingredients.
oriental wormwood
gardenia fruit
rhubarb
scutellaria root
bupleurum root
curcuma root
honeysuckle flower
forsythia fruit
gentian root
immature bitter orange
aucklandia root
licorice root
All the above drugs are to be decocted in water for oral
administration.
In addition to the above ingredients, 30 grams of gypsum and 30
grams of isatis root ought to be employed for the case with high
fever; 9 grams of pinellia tuber and 9 grams of bamboo shavings
for the case with nausea and vomiting; 9 grams of chicken's
gizzard 9 grams of parched hawthorn fruit 9 grams of parched
medicated leaven and 9 grams of parched germinated barley for
the case with poor appetite.
2. Stagnation in the Liver and Gallbladder (frequently occurring
in chronic cholecystitis)
Main Symptoms and Signs: Right-sided hypochondriac pain which
sometimes radiates to the right shoulder and back, epigastric
distension and fullness, which are aggravated by anger or intake
of greasy foods, poor appetite, eruction, nausea, red tongue
with thin yellowish fur, and taut pulse.
Therapeutic Principle: Soothing the liver and normalizing the
function of gallbladder.
Recipe: Modified Major Bupleurum Decoction.
bupleurum root
scutellaria root
curcuma root
chicken's gizzard
blimbing fern spore
bitter orange
aucklandia root
honeysuckle flower
forsythia fruit
white peony root
rhubarb
licorice root
All the above ingredients are to be decocted in water for oral
administration.
Moreover, for the case with poor appetite, 9
grams of parched hawthorn fruit, 9 grams of parched medicated
leaven and 9 grams of parched germinated barley should be
administered; for the case with distinct symptoms of spleen
deficiency, 9 grams of white atractylodes rhizome, 9 grams of
codonopsis root and 9 grams of poria should be administered.
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