Chinese Medicine Paper I
Non-operative treatment of senile cholelithiasis with integrated traditional chinese medicine
Cholelithiasis is a prevalent condition affecting the digestive system, particularly in the elderly. This paper details our experience in treating 26 elderly patients with cholelithiasis through a non-operative approach that integrates Traditional Chinese Medicine (TCM) and Western medicine.
1. Clinical Data
1.1 Patient Demographics
The study included 7 males and 19 females, with age distributions as follows: 17 patients were between 60-70 years old, 6 were between 70-80, and 3 were over 80. Cholelithiasis was confirmed in all cases through B-scan ultrasound. Sub-categories of the condition included 8 cases of gallbladder stones, 9 of common bile duct stones, 5 of gallbladder bile duct stones, and 4 of intrahepatic bile duct stones. Stone diameters ranged from <5mm in 5 cases, 6-10mm in 6 cases, 11-15mm in 11 cases, 16-20mm in 2 cases, and 21-30mm in 2 cases. Multiple calculi were found in 17 patients, while 9 had single calculi.
1.2 TCM Dialectical Classification
Dialectical classifications in TCM primarily focused on liver-qi stagnation, liver and gallbladder damp-heat, and liver stagnation with spleen deficiency.
Common symptoms across these classifications included varying degrees of pain in the right upper quadrant, which could extend to the shoulders and back. Additional symptoms were nausea, vomiting, oil aversion, and reduced appetite and belching.
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Liver-Qi Stagnation: Patients typically experienced fluctuating pain points and intensity in the right upper quadrant, often influenced by emotional changes. Additional symptoms included a bitter taste, dry throat, pale tongue with white coating, and a tight pulse. This type is often seen in the early stage of the condition and may be accompanied by biliary colic.
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Liver and Gallbladder Damp-Heat: This type often presents with the interplay between cold and heat, episodic biliary colic, and mild to moderate yellowing of the sclera or skin. Urine may appear concentrated, and the tongue often has a yellow and greasy coating. Wiry or slippery pulses are common in patients with concurrent biliary tract infections.
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Liver Stagnation and Spleen Deficiency: Symptoms include dull pain in the right upper quadrant, loss of appetite, white tongue coating, and a wiry, thin pulse. This type is more common in patients with chronic cholecystitis.
2. Treatment Methods
2.1 Eligibility Criteria for Integrated Therapy
All patients in this study were treated non-operatively using a combination of Traditional Chinese Medicine and Western medicine. The criteria for selecting this therapeutic approach were as follows:
- Gallstones smaller than 5mm and well-functioning gallbladders
- Gallstones larger than 5mm in patients with cardiopulmonary dysfunction
- Choledocholithiasis smaller than 20mm in diameter or mild cholangitis
- Presence of intrahepatic bile duct stones in patients unfit for surgical intervention
2.2 Therapeutic Approaches
2.2.1 Traditional Chinese Medicine (TCM)
The base TCM prescription for oral administration consisted of:
- Herba Lysimachiae 20g
- Radix Bupleuri 10g
- Radix Scutellariae 12g
- Radix Curcumae 12g
- Radix Aucklandiae 12g
- Fructus Aurantii Immaturus 12g
- Semen Arecae 12g
- Radix Glycyrrhizae 10g
The herbs were decocted in water and administered orally once a day for a treatment duration of 1-2 months. Additional herbs were tailored to individual TCM diagnoses.
2.2.2 Acupuncture Therapy
Acupuncture was performed at the acupoints Ganshu (BL 18), Danshu (BL 23), Yanglingquan (GB 34), and Dannang (BL 20). Sessions were held once or twice a day, with each needle being retained for 30 minutes. Each 10-day period constituted a treatment course, with a two-day interval between courses. The acupuncture therapy aimed to clear meridians, enhance gallbladder function, and aid in stone removal.
2.2.3 Western Medicine
Fluid replacement was used to correct imbalances in water and electrolytes. For antibiotic and antipyretic therapy, 4g of Ampicillin was added to 250-500 ml of saline drip. Metronidazole was prescribed at a dosage of 0.4g three times a day, for a 10-20 day course. Blood cultures and antibiotic sensitivity tests were performed if clinical symptoms did not improve. For patients experiencing vomiting, 5mg of Metoclopramide was injected alternately at the Zusanli (ST 36) acupoint.
Patients with comorbid conditions like coronary heart disease, hypertension, chronic bronchitis, and diabetes were advised to follow an integrated TCM and Western medicine approach for optimum results.
3. Treatment Outcomes
3.1 Efficacy Assessment
The efficacy of the treatment was evaluated based on clinical symptoms, physical signs, and supplementary diagnostic tests.
3.1.1 Complete Cure
Complete disappearance of symptoms and physical signs. Body temperature and hemogram return to normal levels. A follow-up B-scan ultrasonography confirms the absence of any residual stones in the gallbladder or hepatobiliary ducts.
3.1.2 Significantly Effective
Symptoms have fully resolved, body temperature and hemogram are normal, and follow-up B-scan ultrasonography indicates a substantial reduction in the size or number of gallstones or hepatobiliary calculi.
3.1.3 Improved
Symptoms are essentially managed, with normal body temperature and hemogram. However, B-scan ultrasonography shows no significant reduction in gallstones or hepatobiliary calculi.
3.1.4 Ineffective
No changes in symptoms or physical signs post-treatment, and no expulsion of stones as verified by B-scan ultrasonography. Alternative treatment methods are required.
3.2 Summary of Outcomes
Out of the 26 patients treated:
- 8 patients (31%) were completely cured
- 12 patients (46%) showed significant improvement
- 4 patients (15%) showed some improvement
- 2 patients (7%) did not respond to the treatment
The overall efficacy rate was 93%.
4. Case Study
Patient Details
Name: Mrs. Zhang (anonymized)
Age: 67 years
Occupation: Retired worker
Initial Diagnosis Date: July 10, 1993
Mrs. Zhang had a previous history of cholelithiasis. She experienced recurring pain in her right upper abdomen three times in the past month. On the day of the consultation, she experienced acute colic in her right upper abdomen that radiated to her right shoulder and back. Accompanying symptoms included:
- Continuous moaning
- Cold intolerance
- Fever
- Nausea and vomiting
- Loss of appetite
- Fatigue
- Loose stools
Physical examination revealed:
- Temperature: 38.7°C
- Blood Pressure: 18/12 Kpa
- Mild jaundice in the skin and eyes
- Tense abdominal muscles
- Positive Mofei's sign
Diagnostic Tests
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B-scan Ultrasonography: Multiple gallstones, the largest measuring 20×25 mm, and a left intrahepatic bile duct stone.
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Blood Work: WBC 8.2×10/L, Neutrophils 0.83, Lymphocytes 0.17.
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Liver Function Tests: Jaundice index 29 mmol/L, GPT 74 units, HBSAg negative.
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Lipid Analysis: Cholesterol 4.5 mmol/L, Triglycerides 1.18 mmol/L.
Treatment Approach
Traditional Chinese Medicine (TCM) acupuncture was employed, focusing on points Yanglingquan (GB 34), Ganshu (BL 18), and Danshu (BL 23), specifically to alleviate pain related to liver damp-heat and qi stagnation. Western medicine was also used to balance fluids and electrolytes, especially to treat the acute symptoms caused by frequent nausea, vomiting, and diarrhea.
Summary
Most of the 26 patients in the study had a history of gallbladder and biliary tract inflammation. Elevated white blood cell counts and varying degrees of jaundice and liver damage were common. Treatment strategies combining acupuncture, anti-inflammatory measures, fluid replacement, and traditional Chinese herbal medicine effectively controlled inflammation and improved symptoms. This case exemplifies how an integrated approach combining both Chinese and Western medicine can yield superior treatment outcomes.
This article was originally published in Proceedings of First International Conference on Naturopathy in China (37), 1996/05/11; By Li Mingjie & Li Yangzhen
from 老年胆石症中西医结合非手术治疗
