Biliary tract infections and cholelithiasis are collective terms for acute and chronic inflammation and calculous lesions of the biliary tract system. Infection and gallstones are interrelated; 80–90% of cases of gallstone obstruction are complicated by infection. Common pathogenic bacteria include Escherichia coli, Pseudomonas aeruginosa, and anaerobic bacteria.
Factors Contributing to Gallstone Formation
1. Dietary Factors: A high-cholesterol diet, skipping breakfast, obesity, and a sedentary lifestyle can lead to the precipitation of cholesterol from oversaturated bile. Animal studies have confirmed that foreign bodies combined with a high-cholesterol diet can induce gallstone formation.
2. Foreign Body Core Theory: A large number of domestic case reports confirm that the cores of gallstones often consist of Ascaris remnant fragments and eggs. A statistical analysis of over 400 cases of pigment gallstones in Qingdao showed that 78–82% of stone cores consisted of Ascaris remnant fragments. Cross-sections of the stones reveal annular, layered deposits.
3. Metabolic Disorders: Pregnancy and estrogen elevate cholesterol levels, leading to an imbalance in bile composition.
4. Infectious Obstruction: Biliary tract infections alter bile composition; spasm of the sphincter of Oddi, scarring and strictures, retention of foreign bodies, bacterial infections, and the precipitation of bile pigments into stones.
5. Disease and Medication Factors: Diabetes and hypothyroidism cause elevated blood lipid levels; certain lipid-lowering drugs promote stone formation. Clinically, there are cases where gallbladder stones disappeared after treatment for hypothyroidism.
6. Psychological factors: Depression, irregular eating habits, and bile stasis.
7. The “Four Fs” population: Fat (obesity), Female, Fertile (multiparous), and Forty (age 40) are high-risk groups, though this is not absolute; adolescent males can also develop the condition.
According to Traditional Chinese Medicine, emotional distress, a greasy diet, and parasitic infestations lead to stagnation of liver and gallbladder qi, damp-heat accumulation, and the coagulation of bile into stones.
Clinical Manifestations
1. Acute calculous cholecystitis: Colicky pain in the right upper abdomen that intensifies paroxysmally and radiates to the right shoulder and back; triggered by greasy meals; accompanied by fever, tenderness and muscle guarding in the right upper abdomen, and a palpable enlarged gallbladder.
2. Chronic cholecystitis and small gallstones: Upper abdominal bloating, belching, and aversion to greasy foods; often misdiagnosed as a gastric disorder; gallstone impaction while lying flat at night can trigger biliary colic; approximately 50% of cases are asymptomatic “silent stones.”
3. Common bile duct stones: Classic Charcot’s triad—abdominal pain, chills, high fever, and jaundice; dark yellow urine and clay-colored stools; severe toxic shock. Intrahepatic bile duct stones cause recurrent episodes of distending pain in the hepatic region, fever, and jaundice. Ultrasound and CT scans have an accuracy rate of over 95%.
Treatment
1. Chronic cholecystitis in the quiescent phase, small stones
Body acupuncture: Riyue, Qimen; auxiliary points: Zusanli, Yanglingquan, Dan Shu.
Ear acupuncture: Pancreas-Gallbladder, Sympathetic, Shenmen, Liver, Endocrine.
Herbal medicine: Modified Chaihu Shugan Decoction, to soothe the liver, regulate qi, reduce inflammation, and promote bile secretion.
2. Acute attack of common bile duct stones: Acupuncture points as above; Chinese herbal formula: Bile Duct Stone-Expelling Decoction, which clears heat, drains dampness, promotes bowel movement, expels stones, and regulates qi. Close monitoring is required during stone expulsion; actively treat shock if present, and perform bile duct drainage surgery if necessary.
Traditional Chinese Medicine classifies this condition into three patterns:
1. Qi Stagnation Pattern (Quiet Phase): Dull pain in the right upper abdomen, no fever or jaundice, thin white tongue coating, and a string-like, thin pulse. Treatment should focus on regulating qi and relieving depression, soothing the liver and promoting bile flow; use Bile Duct Stone-Expelling Decoction No. I.
2. Damp-Heat Pattern (Acute Phase): Severe pain, chills and fever, jaundice, thick, greasy yellow tongue coating, and a slippery, rapid pulse. Treatment involves clearing heat, eliminating toxins, promoting bile flow, and expelling stones using Bile Duct Stone-Expelling Decoction No. II, with close monitoring of the patient’s condition.
3. Toxic Pattern (Sepsis-Induced Shock): Apathetic expression, cold and clammy extremities, a deep red tongue with a yellow, dry coating, and a deep, rapid pulse. Treatment involves promoting blood circulation, removing blood stasis, regulating qi, and expelling stones, while simultaneously administering anti-shock therapy; if ineffective, perform surgical drainage as soon as possible.