Treatment of Gallstones With Chinese Herbs and Acupuncture

8/2/2019 Treatment of Gallstones With Chinese Herbs and Acupuncture

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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, andby 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 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 traditionalChinese 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 theShennong 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 formulaNiuhuang 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 notobtained 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 intoand is stored by the gallbladder. The function of secretion and excretion of bile are two


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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 todredge 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 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.

MODERN KNOWLEDGE OFGALLSTONES, THEIR SYMPTOMS,

AND THEIR CAUSE

The gallbladder is a pear shaped organ that rests under the liver in the right abdomen; it

is attached to the liver via the biliary ducts (see Figure 1). The gallbladder receives bile

from the liver, where it is continually produced. Bile is made from cholesterol and is

comprised almost entirely of a mixture of cholesterol-like fatty substances known as

bile acids, mainly cholic acid and desoxycholic acid (see Figure 2). It also containsbilirubin (breakdown products of hemoglobin) and cholesterol. The bile acids combine

with minerals, such as sodium and calcium to form neutral salts.

Under normal physiologic conditions, the gallbladder gradually collects bile that is

being pumped out of the liver and expands to hold the bile, and then releases most of

the collected bile, via the bile duct, into the duodenum (upper part of the small

intestine) upon stimulus from eating. The bile combines with the partially digested food

material: starches are digested during chewing, proteins upon mixing with stomach

acids. In the duodenum, bile helps solubilize the fats in the food to make digestion

easier, and digestive enzymes from the pancreas, including a group of lipases to break

down fats, complete most of the digestive process. In cases of insufficient secretion of
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bile, fat metabolism can be aided by oral administration of ox bile salts, usually given in

a dose of about 300 mg with each meal.

Although the exact mechanism of gallstone formation is not established, it is believed

that it occurs primarily when there is a lack of sufficient bile flow-when there is

stagnation of the fluids in the gallbladder. During an extended period of low bile flow,cholesterol can begin to crystallize. It is possible that defects in cholesterol processing

in the liver lead to easier crystallization of the excreted material in the gallbladder.

Excessive cholesterol excretion, even of normal cholesterol, can lead to easier

nucleation of the crystals, since the cholesterol becomes saturated in relation to the total

bile fluid.

Gallstones are primarily comprised of cholesterol and calcium, as calcium bilirubinate

or calcium palmitate. Depending on the precise composition, the stones may be soft

(more cholesterol) or relatively hard (more calcium). There may be a large number of

small sticky stones, or just one large hard stone, as well as many intermediate

conditions, such as a few medium size firm stones (see Figure 3). The presence ofstones may be accompanied by inflammation of the gallbladder wall (cholecystitis).

Cholecystis may stimulate stones to form, or the stones may induce such inflammation,

with each condition progressively worsening the other.

Gallstones are usually diagnosed when they produce obvious symptoms. Since only

about half of persons with gallstones experience significant symptoms, many people are

unaware that they have a condition that could be diagnosed. Colicky pain is one of the

symptoms of gallstones that often leads to a medical visit for diagnosis; it is due to

gallbladder contractions, which may last for a few minutes to several hours, with pain

usually located in the gallbladder region, though it may radiate to other areas of the

abdomen or to the back. A fatty meal may trigger this type of painful reaction, which

can be accompanied by bloating, nausea, or vomiting. If the bile duct becomes

obstructed by a stone(see Figure 4), the person can experience jaundice as the bile

backs up into the liver and into the blood, while the stool becomes whitish, being

deprived of the coloring bilirubin. Jaundice is often accompanied by fever and nausea.

In cases of cholecystitis, a steady dull pain may be experienced instead of sharp pain.

Even so, the pain may become severe at times, and usually remains localized to the

upper right abdomen; additionally, there may be fever and nausea.

If the gallstones do not yield evident symptoms when they first form, the person may

remain asymptomatic for many years. A relatively sudden appearance of symptoms islikely an indication that 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 conditioncan rapidly become fatal. Since bile duct blockage is associated with strong pain, the
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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 beaccelerated 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 moderngallstone 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.

MODERN CHINESE TREATMENTS

FOR GALLSTONES

Treatments aimed specifically at removal of gallstones with Chinese herbs were first

described in the Chinese literature of the post-revolutionary period. A review of

accomplishments in this field was published in the English language Journal of

Traditional Chinese Medicine, in a 1986 article:Advances in the treatment of

cholelithiasis by expulsion of the gallstones (2). Beginning in the 1950's, various

gallstone expulsion decoctions (referred to as lithogogues) were devised by doctorsworking on this problem and these were proclaimed moderately successful. The

decoctions mainly contained herbs from three therapeutic categories:

regulating qi to improve the flow of bile and vitalizing blood to alleviate

abdominal aching;

dispelling heat and dampness that are the main physiological causes of

the qi stagnation; and

removing stagnation by purgation.

The most frequently mentioned herbs in the various decoctions were: bupleurum,

saussurea, chih-shih (or chih-ko), and melia for regulating qi; curcuma and corydalis for


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vitalizing blood; lysimachia, scute, gardenia, and capillaris for clearing damp heat; and

rhubarb and mirabilitum for purgation. Sample decoctions are (9):

lysimachia (100 grams), saussurea (15 grams), chih-shih (15 grams),

scute (15 grams), melia (15 grams), rhubarb (10 grams)

lysimachia (100 grams), saussurea (25 grams), chih-shih (25 grams), hu-chang (100 grams), rhubarb (25 grams), gardenia (20 grams), corydalis (25

grams).

According to laboratory animal studies, these decoctions relaxed Oddi's sphincter (this

is mainly attributed to the action of rhubarb) and promoted duodenal peristalsis (most

strongly affected by mirabilitum). It is believed that the expulsion of stones came about

primarily from increasing the flow of bile (herbs with this property are called

cholegogues and this action is accomplished mainly by the herbs that clear damp-heat)

while relaxing the sphincter that controls the output of bile, thus allowing stones to

exist. This method of therapy relies on heavy dosage decoctions with quick action,

usually taken over a period of just one week.

Although most patients so treated would excrete some stones, the effectiveness of this

method was somewhat limited in terms of the proportion of patients who could become

either free of stones or have very few residual stones, so new methods were developed,

mainly during the 1970's. The new methods involved a "general attack therapy" aimed

at an even stronger and more rapid stone expulsion. The method had three steps:

1. Herbs were used to stimulate the liver's production and excretion of bile

to the gallbladder;

2. Herbs and drugs were then given to contract Oddi's sphincter in order to

get a temporary retention of bile;

3. Herbs and acupuncture were administered to relax the sphincter and

drain the bile.

The whole procedure lasts about 2 hours. The phase of retention of bile is carried out as

long as the patient can tolerate it, which is usually about 40 minutes. The explanation of

how this method works is that "with the bile rushing out in large quantities and the

pressure in the bile ducts falling suddenly, stones in the latter are expelled in one fell

swoop or in quick succession." This approach is carried out in the hospital and, with all

diagnostics and any repeat treatments, takes only a few days, though patients may be

hospitalized for longer in order to check for residual stone problems.

It is claimed that this general attacking method of therapy gives a higher rate of success

than the simple stone-expelling decoctions tried previously. The strong therapy, using

heavy doses of mirabilitum (magnesium sulfate) and injection of herb extracts or drugs

intramuscularly, is not something that could be used in the West. Indeed, in order to

tolerate the retention of bile phase and the potentially painful expulsion of larger stones,

continuous anesthesia was applied via an epidural catheter in some cases. As detailed

accounting of one of the regimens was outlined in Pharmacology and Applications of

Chinese Materia Medica (9):

8:30 Lithogogue decoction, 200 ml orally, is given. This stimulates bile secretion.


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9:30 Morphine, 5 mg, is injected. This restricts Oddi's sphincter, builds up bile

pressure, and relieves pain.

10:10 Amyl nitrite, 1 ampoule, is inhaled. This relaxes Oddi's sphincter to allow bile to

flow out.

10:15 33% magnesium sulfate, 40 ml, is given orally. This induces rapid bile flow and

duodenal emptying.

10:20 0.5% dilute HCl, 30 ml, is given orally. This further stimulates flow of bile.

10:25 Rich meal (2-3 fried eggs). This stimulates further dispensing of bile.

10:30 electroacupuncture for 30 minutes. This causes the gallbladder to contract and

alleviates symptoms of stone passage.

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 alongwith 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 nottoo 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 thehospital, with the usual recommendation at the hospital of immediate surgery to remove
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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.

STONE SHRINKING WITH CHINESE

HERBS

One way to pass stones more easily is to first shrink them. The ability to reduce the size

of stones using herbs or other methods is not an established fact. However, certain

Chinese herbs have been selected as stone-dissolving herbs. There is one traditional-

style formula that is reputed to dissolve stones, called San Jin Tang, or the Decoction of

Three Golds. The three golds (jin = gold) arejinqiancao, haijinsha, andjineijin. The

formula was devised at the Shuguang Hospital of the Shanghai College of Traditional

Chinese Medicine.

Jinqiancao (literally, golden coin weed) refers to a group of herbs that are used

interchangeably, and are identified by the region of China in which the herb is found:

Sichuan Da Jinqiancao also called guoluhuang, is from Lysimachia christinae (see

Figure 6);

Sichuan Xiao Jinqiancao is fromDichondra repens;

Guang Jinqiancao is fromDesmodium styracifolium (see Figure 7);

Jiangxi Jinqiancao is fromHydrocotyle spithorpioides;

Jiangsu Jinqiancao is from Glechoma hederaea(see Figure 8); and

Kunming Jinqiancao is fromLysimachia kunmingcensis.

The first two are from Sichuan Province, one being large leaved (da) and the other

being small leaved (xiao). The next is from the "guang" region of China, which includes

Guangdong, Guangxi, and Hunan (formerly, Huguang); the next three are from Jiangxi

Province (north of Guangdong), Jiangsu Province (on China's central east coast), and
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from the area of Kunming, the capital of Yunnan Province (in southwest China),

respectively.

In general, these herbs are said to be sweet, cooling, and able to promote urination.

They are mainly used to treat damp-heat syndromes that involve urinary retention, and

they are reputed to dispel urinary stones. The herbs are mild in nature and often used inhigh dosage (e.g., 15-60 grams of the dried herb per day in decoction, and double that

dose for the fresh herb, with some recommendations of up to 250 grams fresh herb per

day). San Jin Tangwas originally made with Guang Jinqiancao (Desmodium). The

species ofjinqiancao obtained in the West will depend on the market source relied on

by the herb supplier. Among the most commonly supplied items in the West are

Desmodium and Glechoma; However, the widely-used common name for the herb is

lysimachia and the most frequently referenced material in Chinese texts, as well as the

species listed in the Pharmacopoeia of the PRC, isLysimachia christinae.

Haijinsha is a very slippery material, that looks like yellowish sea sand (hai = sea,jin =

gold,sha = sand); it is the spores of a fern,Lygodium japonicum, commonly calledlygodium (see Figure 9). The slippery quality is associated with the ability to dissolve

stones. The material is described as sweet and cold in nature, and it is diuretic. Like

jinqiancao, this herb is mainly used for damp-heat syndromes with urinary retention

and it is said to help remove urinary stones. The usual daily dosage is 6-12 grams in

decoction, or 2-3 grams in powder form.

Jineijin is the inner lining of the gizzard of the chicken (ji = chicken; nei = inside),

commonly called gallus (the genus name of the chicken). The chicken gizzard is

capable of reducing hard food masses to small pieces; it is included in some herb

formulas because it is thought to resolve masses. The material has a sweet taste, a

neutral property, and is used mainly to eliminate food stagnation. The usual dosage is 6-

12 grams and it may be used in decoction or a smaller amount, 1.5 to 3 grams, taken as

a powder.

The entire Three Golds Formula includes three additional herbs for damp-heat that

affects the kidney and bladder, thus making it a treatment for urinary stones in persons

with damp-heat syndrome and urinary retention. The three herbs are pyrrosia (shiwei),

abutilon (dongkuizi), and dianthus (qumai) and this combination is derived from Shiwei

San, a traditional formula for blocked urinary flow that contains those three herbs plus

plantago and talc. A variant of the Three Golds Formula retains the talc and plantago

seed ofShiwei Sanbut replaces dianthus with achyranthes (or cyathula), vaccaria,magnolia bark, and chih-shih. The three golds may be added to any traditional formula

for urinary blockage when stones are diagnosed. A typical recommendation is to add 30

grams lysimachia, 9 grams of lygodium, and 9 grams of gallus (15).

The original urinary stone formula can be adjusted to treat gallstones by replacing the

three herbs for damp-heat of the kidney/bladder with herbs for damp-heat of the

liver/gallbladder. The herbs suitable for 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.
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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 toquestion 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 thatjineijin "removes stones and is indicated for urinary calculus and

biliary calculus." On the other hand, haijinsha is only mentioned in that text as atreatment for urinary stones. Whether or notjinqiancao 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.

STONE EXPULSION WITH CHINESE

HERBS

The herbs used in the strong stone expelling decoctions, as described earlier, have been

formulated into easy to use tableted patent formulas that are given at much lower

dosage. For example,Lidan Pian (Gallbladder Normalizing Tablets) andLidan Paishi

Pian (pai = expel;shi = stones) are readily available patent remedies recommended forcholecystitis and cholelithiasis. These tablets have a milder action than the

corresponding decoctions and may be used in a complete program of gallstone therapy

for treating smaller sized stones or mild gallbladder inflammation.

Lidan Pian contains lysimachia, scute, saussurea, capillaris, bupleurum, isatis leaf,

lonicera, and rhubarb. Isatis leaf and lonicera are included as anti-infection herbs for

cholecystitis.

Lidan Paishi Pian contains lysimachia, saussurea, capillaris, rhubarb, areca peel,

magnolia bark, chih-shih, curcuma, and mirabilitum. The amount of mirabilitum

present is relatively small and does not cause a strong purgative effect.


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The latter formula is based on the traditionalDa Chengqi Tang(Major Rhubarb

Combination) of theShanghan Lun, comprised of rhubarb, mirabilitum, magnolia

bark, and chih-shih, which had been formulated as a purgative therapy for severe

abdominal stagnation. This formula's action has been extensively investigated (see

Appendix 1). The modification to makeLidan Paishi addresses stagnation of qi and

blood in the abdomen. A decoction of theLidan Paishi formula was tested in patientswho were monitored for gallbladder function (4). The treatment, using 10 grams of each

ingredient, increased the frequency of bile excretion and did so to an extent greater than

that accomplished byDa Chengqi Tang, indicating a valuable contribution for the

added herbs. Lidan Paishi Tablets are produced by several 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), aformula calledDandao 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 calledPaishi 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.

PROPOSAL FOR COMPREHENSIVE

GALLSTONE THERAPY

A patient presenting with gallstone reduction or elimination as the objective of

treatment should be provided with a substantial number of therapeutic approaches to beused in combination. These include:

1. A diet and exercise program that emphasizes a low fat, high fiber diet

and regular daily exercise. For obese patients, a carefully monitored diet with

appropriate caloric controls should have a goal of gradual weight loss of not

more than 2 pounds per week on average. A digestive enzyme preparation that

includes ox bile and lipase may be used to help treat symptoms of poor fat

digestion.

2. A regular meal schedule that encourages the gallbladder to fill

completely between meals. This means minimizing snacking (which is an

approach contrary to some dietary recommendations for managing eatingdisorders and some other health problems).


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3. Daily consumption of stone dissolving substances, including the "three

golds" and, if possible, bile salts.

4. Consumption of moderate amounts of coffee (with or without caffeine)

and/or other herbs that promote bile flow (mainly herbs that treat qi stagnation

and damp-heat).

5. Acupuncture therapy to regulate circulation of qi, purge the gallbladder,and alleviate pain in the gallbladder region (see Appendix 2).

6. A gallstone purging therapy to eliminate stones that have a diameter of

less than 1 cm, to be taken over a period of several days. This therapy would

include rhubarb and mirabilitum.

The dietary program is no different than that widely recommended for maintaining

health and normal body weight, such as following the U.S.D.A. food pyramid

recommendations or the modified food pyramid for a high flavonoid diet (see: The role

of dietary and herbal flavonoids in gastro-intestinal health). The exercise program is

also no different than that generally recommended, which involves a daily minimum of

20-30 minutes of moderate exercise (e.g., fast walking), with more vigorous exercisefor those who are physically capable. The dosage of stone-dissolving substances should

be relatively high, corresponding to about 50-60 grams per day in decoction, or about

10-12 grams per day in dried extract form. As with the treatment using bile salts, stone-

dissolving therapies may require as much as six months continual treatment. The

gallstone flushing therapy, relying on purgative herbs, may be accompanied by a high

fat meal to stimulate gallbladder emptying (some Western practitioners use the so-

called "liver flush" which is actually a gallbladder purge, comprised of a large dose of

olive oil moderated by lemon juice).

REFERENCES1. 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 NewWorld Press, Beijing.


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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 chroniccholecystitis 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 TraditionalChinese Medicine, 1997 Paradigm Publications, Brookline, MA.

August 2001

APPENDIX 1: Da Chengqi Tang

In theShanghan Lun, three formulas named Chengqi Tangwere presented:Da

Chengqi Tang,Xiao Chengqi Tang, and Tiaowei Chengqi Tang. All three are purgative

preparations with rhubarb as the common ingredient. Tiaowei Chengqi Tangincludes

mirabilitum and licorice, whileXiao Chengqi Tangincludes chih-shih and magnolia

bark.Da Chengqi Tangincludes all the ingredients except licorice. These formulas

have been studied as part of a larger and ongoing evaluation ofShanghan Lun

formulas (5). All the prescriptions stimulate intestinal peristalsis, withDa Chengqi

Tanghaving 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 thatXiao Chengqi Tanghas the mildest laxative action of the three

Chengqi formulas.


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APPENDIX 2: Acupuncture for

Gallstones

It is unclear whether acupuncture, by itself, can cause expulsion of gallstones, butacupuncture is used to treat symptoms of gallstones, such as billiary colic. The two

acupuncture points mentioned in this article, qimen (LV-14) and riyue (GB-24), are the

main ones mentioned in the literature. These points lie over the liver on the right side,

and are located one rib apart and directly below the nipple. Only the right side is

treated. An extensive analysis of the value of these points was presented in an article on

treatment of biliary colic (6), along with brief mention of the nearby point juque (CV-

14). In the discussion of their treatment, the authors stated:

The theory of acupuncture and moxibustion of Zhang Zhongjing [author ofShanghan

Lun] is an important component part of his academic thinking, of which the frequent

use of qimen point is quite characteristic. The indications of qimen point includefullness of abdomen, delirium, fullness of the chest and flanks, distention of gastric

region resistant to pressure, and fever or alternative spells of fever and chills, which are

similar to the clinical manifestations during a bout of biliary colic....

We found that the most sensitive and tender point ofqimen [among our patients with

biliary colic] is in the area defined by the lines connecting qimen, riyue, andjuque

points, which, according to traditional Chinese medicine, is the dividing line between

the liver and the gallbladder, and is indicated mainly for treating diseases of the internal

organs in the vicinity. Qimen is the mupoint [alarm point] of the liver, riyue is the mu

point of the gallbladder, andjuque is the mupoint of the heart. The front mupoints are

used mainly in the treatment of diseases of the internal organs. Various painful lesions

are the result of failure of the heart and liver to remove stagnancy of vital energy,

leading to impediment to the flow of qi of the gallbladder, thus producing the pain.

Basing on the principle of treating pain by needling the location where pain exists, the

most marked tender spot was detected in the region of the three points....

Other points frequently mentioned in the literature for treating gallstones include the

lower leg pointsyanglingquan (GB-34), qiuxu (GB-40), andzusanli (ST-36); in

addition, there is an extra point known as the gallbladder point (dannangxue), just

below GB-34 (about 1-2 cun lower). The nausea and pain associated with cholecystitis

and with billiary blockage is treated at neiguan (PC-6) andzhigou (TB-6), above thewrist. In explaining the use of these points, the Advanced Textbook of Traditional

Chinese Medicine and Pharmacology states:

Qimen and riyue are the front mupoints of the liver and gallbladder meridians

respectively;zhigou andyanglingquan can relieve hypochondriac pain, whilezusanli

helps strengthen the spleen and disperse dampness-heat.

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


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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 inalleviating 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 inthis 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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Figure 1: The gallbladder and biliary ducts.


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Figure 2: cholic acid and desoxycholic acid.


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Figure 3: Assorted gallstones.

Figure 4: Stones depicted in the gallbladder and biliary duct.


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Figure 6:Lysimachia christinae .


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Figure 7:Desmodium styracifolium.


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Figure 8: Glechoma hederaea.


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Figure 9:Lygodium japonicum.

Treatment of Gallstones With Chinese Herbs and Acupuncture

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