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Cholelithiais (chole = gall; lith = stone), commonly called gallstones, is a frequent health problem
and one of the major reasons for abdominal surgery, responsible for over half a million cholecystectomies
(gallbladder removals) in the U.S. each year. Surgery is performed to prevent several potential problems:
severe abdominal pain due to movement of a stone into the bile duct; potential blockage of bile flow
causing liver and pancreatic damage; and inflammation of the gallbladder (cholecystitis), causing fever,
pain, and digestive disturbance.
Laparoscopic cholecystectomy, a relatively new surgical technique, requires only a small incision in
the navel plus two other slits made elsewhere in the abdomen to gain access to the gallbladder with
microsurgical tools. This procedure results in minimal damage to surrounding tissues and quick recovery
time; most patients go home within 24 hours of the procedure. About 98% of all gallbladder removals can
be accomplished with this technique rather than standard abdominal surgery.
After gallbladder removal, most patients are relieved of symptoms that they have suffered, including
some chronic digestive disturbances and abdominal aches that might not have been recognized initially as
being related to gallstones or gallbladder inflammation. Another result of cholecystectomy is reduced bile
excretion with a meal. Bile excretion, with or without a gallbladder, is an ongoing process that involves a
pump-like action in the liver biliary system, dispensing fluid about six times per minute. With the
gallbladder present, there is an additional pump-like action, in which bile is stored and then excreted in
larger quantities during digestion of a meal. Thus, those who have their gallbladder removed can lead a
normal life, but may have to be careful about eating any large quantity food at one time, particularly fatty
foods, since bile is a valuable contributor to efficient digestion of fats, solubilizing the fats for enzymatic
breakdown and for absorption.
Despite the improvements in surgical techniques and the generally positive outcomes, many people
diagnosed with gallstones would prefer to avoid surgery and retain their gallbladder. This is to be
accomplished by dissolving the stones and/or purging the stones from the gallbladder via the intestines.
One alternative to surgery that was tried, but later discarded, was lithotripsy. This procedure was used for
patients with large stones that involved breaking the stones into small pieces with powerful sound waves.
Unfortunately, there were too many cases of bile duct blockage from the pieces of stone as they were
excreted to consider this procedure generally successful. A stone dissolving therapy with bile salts,
mainly ursodeoxycholic acid, is another procedure that has been tried; administered only in cases of
relatively small stones. About 6-24 months of continuous use is required to attain the desired results,
which is complete removal of stones. The therapy has some drawbacks, such as causing symptoms of gas,
bloating, and nausea in some patients, but it is still being investigated to find improved methods that
might yield superior results. A problem with these and other alternatives to surgery is that when the
gallbladder has not been removed, it is common for recurrence of gallstones because the stone-forming
processes are still present. Nonetheless, those who are willing to make adequate changes in diet and
exercise may be able to avoid producing stones that are of a dangerous size.
Chinese medicine is commonly sought out as an alternative to surgery by those diagnosed with
gallstones. It is evident from comments made by these individuals, and by Western practitioners of
Chinese medicine, that many patients hope to take only a small amount of herbs in a convenient form to
remove the stones. Further, they expect to do so without risk of adverse effects, such as abdominal pain
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due to stones becoming caught in the bile duct during expulsion; otherwise, they reject further
consideration of the therapy. In order to determine whether or not such expectations are reasonable, it is
necessary to examine how Chinese doctors actually treat gallstones in order to learn of the herbs to use,
their dosage, duration of treatment, and incidence of adverse reactions. Acupuncture is a therapy that
commonly accompanies use of herbs and is also mentioned here.
In China, the diagnosis of gallstones is a new one: it has not been part of traditional Chinese
medicine prior to the introduction of modern Western medicine. Symptoms of gallstones were no doubt
detected in the past, such as findings of abdominal pain and reactions to fatty foods, but the cause of such
symptoms would usually be attributed to disorders such as qi stagnation and abdominal accumulation,
rather than gallstones, which cannot be detected directly by traditional Chinese diagnostics.
However, since ancient times, the Chinese have been aware of the gallbladder (identified as one of
the six fu organs) and aware of its ability to form stones. Gallstones of the ox (niuhuang) have long been
used in traditional medicine: they were listed in the Shennong Bencao Jing (ca. 100 A.D.). It is thought
that the medicinal use of the ox gallstone may have originated in India, from which it was then adopted in
China (1), along with other ancient Indian remedies, such as ginger root. In the Chinese tradition, ox
gallstone is used to "open the orifices of the heart," when there are symptoms of delirium, convulsions,
and loss of consciousness in feverish diseases, and also to treat swellings in the throat and mouth. This
latter application is addressed by the popular patent formula Niuhuang Jiedu Pian (Tablet of Ox Gallstone
to Remove Toxins). In China, the extracted bile or the whole gallbladder (with bile) from several animals
has been used medicinally, such as snake gallbladder given as a health tonic and as a treatment for phlegm
disorders, and bear gallbladder as a treatment for injuries and back pain. The Western treatment for
dissolving gallstones, ursodeoxycholic acid, is the main bile salt found in bear bile (urso = bear), though
the clinical material is not obtained from bears. In modern China, bear bile (combined with curcuma and
capillaris) was developed as a treatment for gallstones and gallbladder inflammation (cholecystitis).
Even with the Chinese knowledge of gallstones from animals used in medicine, early Chinese
medical references to the gallbladder in humans did not include problems specifically related to stone
formation. Rather, there was an understanding that the gallbladder stored and, at times, poured out bile. In
a review of liver and gallbladder functions and disorders (10), this was explained:
The liver forms and secretes bile with the aid of "overflowing liver qi" that flows into and is
stored by the gallbladder. The function of secretion and excretion of bile are two of the most
important aspects of the liver dredging function. If there is a disturbance in the dredging
function, there may be a disturbance in the secretion of bile, resulting in jaundice, bitter taste in
the mouth, emesis of bile, distention and pain in the subcostal regions, abdominal distention,
and decreased food intake....
Liver qi congestion and entanglement are manifestations of the liver's inability to dredge and
maintain the smooth flow of liver qi. This dysfunction is defined as an imbalance of qi function
and, more specifically, as qi congestion and qi stasis. The etiology may be emotional trauma,
invasion of external wet-heat evil, and an insufficiency of liver blood. Liver qi congestion and
entanglement is chiefly manifested as emotional depression, disturbance of qi functions, and
dysfunction of the secretion of bile.
Any disturbance in the secretion or excretion of bile may alter the physiology of the spleen,
stomach, and intestines, resulting in disturbance of both the qi functions and mental or
emotional activities.
Put another way, the normal flow of bile is a manifestation of the smooth flow of liver qi; liver qi
stagnation-often caused by emotional depression, leads to lack of bile flow. When there is a reduction of
bile flow, this will disrupt the qi functions and lead to further problems, generally involving emotional
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distress, and thus reinforcing the pattern of stagnancy and abdominal distress. As we know now, the low
level of bile flow contributes to stone formation. Since the diagnosis of gallstones, rather than simple
stasis of bile flow, is a modern one, it is valuable to examine modern information of gallstones.
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gallstones have recently formed or recently enlarged. Persons with long-term gallstone disorders are more
likely to discover their disorder only if there is an ultrasound screening for other complaints. Even in the
chronic asymptomatic cases, however, gallstone disorders will eventually cause symptoms in some
individuals as the severity of the disease slowly progresses and causes more stagnation of the bile flow.
The major threat of untreated or unsuccessfully treated gallstones is the possibility of a gallstone
blocking the bile duct. This blockage can lead to pancreatitis, which potentially develops into a life
threatening condition. Also, gallstones can lead to the development of cholangitis, an infection of the bile
ducts within the liver; this condition can rapidly become fatal. Since bile duct blockage is associated with
strong pain, the combination of pain and threat to health are usually sufficient reason for going ahead with
emergency gallbladder surgery.
Gallstones mainly occur in association with the combination of having a sedentary life style with a
diet that is high in fat and low in fiber. While the process of stone formation may be slow, with stones
forming over a period of years, gallstone formation can be accelerated in some circumstances. The two
known situations that acutely increase the risk of gallstone formation and gallstone growth are: a
substantial rapid weight loss (as occurs when obese persons follow a drastic weight control diet), and
pregnancy (women who become pregnant several times are especially susceptible to stone formation).
Hospital procedures, including major abdominal surgery, total parenteral nutrition (which is usually given
in association with abdominal surgeries), and non-surgical gallstone treatments make a patient more likely
to develop gallstones by contributing to bile stasis and/or gallbladder irritation. Finally, the use of
cholesterol-lowering drugs, mainly the fibrates and the somatostatin analogue octreotide, are associated
with increased incidence of gallstones. Women are more likely than men to develop gallstones,
particularly after age 40. The most typical profile of a modern gallstone sufferer is a woman in her 40s or
50s who has had two or more children, is obese, and has participated in weight loss programs to attain
rapid weight loss.
Practitioners of natural healing should be alerted to the fact that coffee is a stimulant to bile flow and
that having patients suddenly cease coffee consumption due to the belief that coffee is harmful can
increase the chances of gallstone formation and gallstone enlargement. This is particularly of concern for
obese patients who adopt a dietary change that successfully reduces body weight. Additionally,
recommending a diet that is too low in fat may cause further problems by reducing the bile flow.
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A similar method was reported in the Xinjiang Journal of Traditional Chinese Medicine (11).
Patients with cholecystitis or cholelithiasis were hospitalized for an average of 34 days. They were treated
daily with a lithogogue decoction containing bupleurum, capillaris, lysimachia, clematis, gardenia,
curcuma, crataegus, chih-shih, and rhubarb. The general attacking method was then administered for four
consecutive days using the procedure outlined above, except with a higher doses of magnesium sulfate
(50 ml of 50% solution), and an additional injection of atropine. After waiting 3-5 days, the four-day
course of therapy might be repeated if residual stones were detected. For chronic cholecystitis, a longer
course of 10 days was utilized.
Another example of the general attacking method involves using mirabilitum along with
electroacupuncture stimulus at riyue (GB-24) and qimen (LV-14; see Figure 5). The same treatment was
recently tested again and claimed to be effective in expelling gallstones (3). The patients first took 30-40
ml (about one fluid ounce) of 33% solution of magnesium sulfate, and then strong electrostimulation was
given to the acupuncture points on the right side only (that is, on the side where the gallbladder is located)
for 30 minutes, followed by decreased stimulus for 15-20 minutes, and strong stimulation again for 10
minutes. This procedure was performed three days consecutively, once per day, to produce a full course of
treatment that would expel stones.
Using such vigorous stone-expelling methods, it was reported that stones somewhat over 1 cm in
diameter could be excreted. The largest stones expelled are long but not too wide, with a maximum length
of about 3 cm, but a width of no more than about 1 cm. When expelling large stones, it is common for the
patients to experience what is called a "stone expulsion reaction," with biliary colic, and temporary fever
and jaundice (the result of stones becoming temporarily caught in the duct). Rates of such reactions are as
high as 90%. Silt-like stones, which are easy to pass because of their small size, are reportedly not
excreted well because they tend to adhere to the wall of the gallbladder.
In the West, one of the greatest fears associated with applying a stone-expelling therapy is the
problem of billiary colic as the stone becomes stuck in the bile duct, especially at the sphincter. The pain
can be extreme and may require an emergency visit to the hospital, with the usual recommendation at the
hospital of immediate surgery to remove the gallbladder. By contrast, in China, the herbal procedure may
be carried out at the hospital and measures are taken to alleviate the pain while continuing with the
procedure. Based on the Chinese reports of the stone-expelling reactions, it appears that the rapid method
of stone removal will not be acceptable in other countries.
According to the information from this review of the medical literature through 1985, the largest
stones that appear capable of being passed are on the order of one centimeter in diameter. This size is
probably a reasonable upper limit for anyone considering a non-surgical procedure and may represent the
maximum dilation of the duct. The gentler stone-expelling methods to be used by Western practitioners
who are not working in a hospital setting may not be able to expel stones of quite this size, since the
strong build up of bile pressure and the sudden relaxation of the sphincter are unlikely to be
accomplished. Therefore, somewhat smaller than 1 cm stones may be the largest one can expel and
patients seeking to expel larger stones should be cautioned about the lower chance of success.
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this purpose generally have a bitter taste, a cold property, and a dispersing or purging action; for example,
one can administer bupleurum, scute, capillaris, and rhubarb. One can also add to the therapy herbs to
disperse liver-qi stagnation and accumulation, such as saussurea, magnolia bark, chih-shih, and areca
peel.
Urinary stones are generally comprised of uric acid, calcium oxalate, and calcium phosphate and
their formation may be related to processes similar to those involved in forming gallstones, namely low
fluid flow through the renal tubules. Low water consumption, with corresponding low urinary excretion,
is a major risk factor for kidney stones (high levels of dietary oxalate and high levels of acidic
components in foods and beverages can also contribute to urinary stone formation). It is reasonable to
question whether herb components that help to dissolve and pass urinary stones would also effectively
dissolve and pass gallstones, given the differences in stone composition. Jinqiancao, one of the three
golds, has been incorporated into numerous modern Chinese therapies for both liver and gallbladder
diseases, including most formulas for treating gallstones and cholecystitis. In the Advanced Textbook of
Traditional Chinese Medicine and Pharmacology (8), lysimachia is said to be useful for stone
expulsion, including gallstones: "For its effects in expelling stones, this drug is frequently used to treat
hepatic, cholecystic, and urinary stones. To achieve the desired results, it is usually used in large dosage
and administered for a long time." The same text mentions that jineijin "removes stones and is indicated
for urinary calculus and biliary calculus." On the other hand, haijinsha is only mentioned in that text as a
treatment for urinary stones. Whether or not jinqiancao actually dissolves stones, it is known to stimulate
bile secretion; further, haijinsha has been used clinically in some formulas for treating gallstones (9) and
was mentioned as one of the more commonly used herbs for that purpose in a recent review article
examining 40 different gallstone formulas (12).
There are two main uses for a stone-dissolving formula: one is to attempt to shrink stones prior to
expelling them, by reducing the outer layer that has recently been deposited and is most susceptible to
re-suspension into the bile fluid, and the other is to prevent stones from forming or enlarging in persons
who have a history of developing stones. The stone dissolving therapies are given for at least 2-3 months.
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Chinese companies. One company lists the following ingredients, with proportions used in
manufacturing: lysimachia (250 grams), capillaris (250 grams), scute (75 grams), saussurea (75 grams),
curcuma (75 grams), and rhubarb (125 grams); this formula listing leaves out areca peel, magnolia bark,
chih-shih, and mirabilitum.
Treatment time with stone expelling formulas is usually several months, though excretion of
gallstones may begin to occur within days. In one clinical report (14), a formula called Dandao Paishi
Tang (dan = bile or gallbladder; dao = movement) was administered twice daily. The formula included
lysimachia, chih-ko, saussurea, scute, lonicera, gardenia, peony, red peony, atractylodes, gallus, rhubarb,
and glauber's salt (xuangmingfen; sodium sulfate); in addition, mirabilitum was given separately, 40 ml
each time, twice daily, at 33% solution. Treatment time ranged from one month to 10 months (a few cases
continued for longer).
A formula called Paishi Tang (Stone Expulsion Decoction) was reported to be moderately effective
for treating residual stones in the biliary tract after gallbladder surgery (13). The decoction contains
lysimachia, capillaris, bupleurum, cyperus, melia, chih-ko, saussurea, citrus, and rhubarb (mirabilitum
was given separately, 30-40 ml of 50% solution, once or twice daily). Complete removal of stones was
claimed for just over half of the patients treated.
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which is actually a gallbladder purge, comprised of a large dose of olive oil moderated by lemon juice).
REFERENCES
1. Hong-Yen Hsu, et al., Oriental Materia Medica: A Concise Guide, 1986 Oriental Healing
Arts Institute, Long Beach, CA.
2. He Ruilin, Advances in the treatment of cholelithiasis by expulsion of the gallstones, Journal of
Traditional Chinese Medicine 1986.
3. Lu Longzhang, 26 patients with cholelithiasis treated by acupuncture therapy, Chinese
Acupuncture and Moxibustion 1996; (2): 8.
4. Deng Xuejia, et al., Video-choangiographic study of the effect of Li Dan Pai Shi Tang on
biliary dynamics in 130 cases, Chinese Journal of Integrated Traditional and Western Medicine
1985; 6(5): 338-339.
5. Jiang Tingliang and Fu Hangyu, Progress of experimental studies on prescriptions designed by
Zhang Zhongjing, Journal of Traditional Chinese Medicine 1996; 16(1): 55-64.
6. Jiang Yongsheng and Chen Yehua, Treatment of biliary colic by water injection in the region
of qimen, riyue, and juque points, Journal of Traditional Chinese Medicine 1995; 15(3):
185-188.
7. Wang Tianjun and Xiao Shaoqing, Auricular acupoint pellet pressure therapy in the treatment
of cholelithiasis, Journal of Traditional Chinese Medicine 1990; 10(2): 126-131.
8. State Administration of Traditional Chinese Medicine, Advanced Textbook on Traditional
Chinese Medicine and Pharmacology, 1995-6 New World Press, Beijing.
9. Hson-Mou Chang and Paul Pui-Hay But (eds.), Pharmacology and Applications of Chinese
Materia Medica, 1986 World Scientific, Singapore.
10. Cheung CS and Belluomini J (translators), The liver and gallbladder, Journal of the American
College of Traditional Chinese Medicine 1983; (2): 30-44.
11. Zhang Xiangde and Ma Zonglin, Treatment of 127 cases of chronic cholecystitis and
cholecystolithiasis mainly by traditional Chinese medicine, Xinjiang Journal of Traditional
Chinese Medicine 1985; (4): 25-28.
12. Pan Tianfu, A review of treatment of cholelithiasis, Journal of the Shandong College of
Traditional Chinese Medicine 1994; 198(3): 203-208.
13. Zhang Shiguo, Treatment of post-operational biliary tract residual cholelithiasis by integrated
Chinese and Western medicine, Sichuan Journal of Traditional Chinese Medicine 1986; 4(1):
32-33.
14. Chen Ying, Treatment of 67 cases of choelithiasis by integrated Chinese and Western
medicine, Chinese Traditional Patent Medicine 1989; 11(10): 24-25.
15. Yan Wu and Fischer W, Practical Therapeutics of Traditional Chinese Medicine, 1997
Paradigm Publications, Brookline, MA.
August 2001
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the prescriptions stimulate intestinal peristalsis, with Da Chengqi Tang having the strongest action.
Rhubarb acts as a secretory purgative that stimulates the large intestine; it produces a delayed laxative
action and cannot soften hard stool; mirabilitum acts as an osmotic purgative, affecting mainly the small
intestine. By combining mirabilitum with rhubarb, the laxative action is quicker (due to the effect of
mirabilitum on the small intestine) and the moisture retaining effect of magnesium softens the stool. In
Western studies of gallbladder function, mirabilitum is known as a useful agent to induce bile flow and to
purge the duodenum. Magnolia bark and chih-shih act mainly on the large intestine and have a milder
effect than rhubarb and mirabilitum; magnolia bark and chih-shih also serve to dispel gas and bloating.
When rhubarb and licorice are cooked together, as in Tiaowei Chengqi Tang, there is a reduced
laxative effect, due to binding of licorice ingredients with anthraquinones, the main laxative component of
rhubarb. But, without the mirabilitum, the laxative effect is more limited, so that Xiao Chengqi Tang has
the mildest laxative action of the three Chengqi formulas.
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Ear acupuncture developed a reputation for being a method for expelling gallstones during the 1980s
(7). It was reported to be especially effective for the damp-heat type and less so for the qi-stagnation types
of patients, but not effective for those with qi deficiency. Over 60 auricular points have been used in the
treatment of gallstones, making it difficult to pick out points that might be particularly effective. Not
surprisingly, the most commonly used points were those associated with the liver, gallbladder, bile duct,
pancreas, duodenum, stomach, spleen, and small intestine. A course of treatment would be thirty days
with pressure applied to the point using various kinds of pellets, especially vaccaria seeds (which have a
sharp point and may be substituted by the small "ear tacks"). Pressure would be applied for 20-30 minutes
after meals (about 15 minutes after eating). Despite the high efficacy of the therapy in alleviating
symptoms, the number of cases reported to have complete elimination of stones was usually only about
10%, sometimes as high as 20%. During treatment, stone expulsion would yield a sensation of distention
or pain in the region of the gallbladder.
Unfortunately, it was found that in patients who had only a portion of the stones expelled, new stones
appeared very rapidly, sometimes leading to a worsened condition after treatment. One researcher, Shang
Cenruo of the Nanjing College of TCM, cautioned that a higher efficacy of ear acupuncture for stone
expulsion should be attained before recommending wide spread use of the technique. Other researchers
noted superior effects when ear acupuncture was combined with herbal therapy. In an extensive review of
the experiences and opinions expressed by several researchers in this field (8), the editor concluded that:
In some reports, the therapeutic efficacy was overestimated or overstated. As far as I know,
besides exaggeration, the most important reason for this was that evaluation was not made on a
scientific basis....Obviously, it is not sufficient to evaluate the therapeutic effects merely on the
basis of presence or absence of subjective symptoms and the amount of gallstones expelled
with the stools. At present, auriculo-point seed pressing therapy may be used to expel
gallstones, but the evacuation rate is still very low. This remains to be further improved.
The therapeutic efficacy [among the results reported by several researchers] was basically the
same with different prescriptions of otopoints: part of the gallstones could eventually be
expelled from every patient. Local inflammation and clinical symptoms were accordingly
alleviated or disappeared with a decrease in the amount of gallstones in the biliary tract. In
some patients, the duration of colicky attacks became shorter, and the time interval between
two attacks became longer. This is the main reason why this therapy has won the patient's
confidence....
I propose that in order to further enhance the therapeutic efficacy of this therapy, the following
measures be adopted:
Some research centers or cooperation groups headed by a department concerned [with this
special topic] should be established;
Clinical practice must be combined with experimental research so that the mechanisms of
evacuation of gallstones can be clarified, and the most effective methods and otopoints be
detected through the latter which, in turn, guide clinical practice; and,
Since it is quite difficult to enhance the therapeutic effects by merely using the auriculo-point
seed pressing method for treating cholelithiasis, it can only be taken as the main method in a
combined therapy.
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