Acute Cholecystitis

Acute cholecystitis is an acute inflammatory condition of the gallbladder that may result from cystic duct obstruction, chemical irritation, bacterial infection, and other causes. Clinical manifestations may include fever, right upper abdominal pain, or distending pain in the right hypochondrium radiating to the shoulder and back, accompanied by nausea and vomiting; mild jaundice, a positive Murphy sign, and an elevated peripheral white blood cell count may also occur.

In Traditional Chinese Medicine (TCM), acute cholecystitis may be classified under “hypochondriac pain” (xietong). The Huangdi Neijing: Lingshu, “Five Pathogenic Factors” states: “When pathogenic factors affect the Liver, pain occurs in both hypochondria.” The Huangdi Neijing: Suwen, “Discourse on Needling at Points Along the Channels” states: “When pathogenic factors lodge in the network vessel of the Foot Shaoyang channel, they cause hypochondriac pain that prevents the person from breathing freely.”

TCM Pattern Differentiation and Medication Reference

|Common Symptoms

Clinical Description:

Main symptoms: Persistent, severe burning or colicky pain in the right hypochondrium; episodic worsening of hypochondriac pain, sometimes radiating to the shoulder and back. Additional symptoms: Bitter, sticky taste in the mouth; nausea and vomiting; fever and chills; marked yellowing of the skin and eyes; scant, dark urine and constipation; red tongue with a yellow or thick, greasy coating; slippery, rapid pulse.

In Plain Language:

  • Persistent, severe burning or cramping pain may occur on the right side below the ribs and may be difficult to relieve.
  • The pain below the ribs may worsen in episodes and, when severe, may radiate to the shoulder and back.
  • Your mouth may taste bitter and feel sticky or coated.
  • You may feel nauseated or vomit, with a queasy, unsettled stomach.
  • You may have a fever and feel cold or chilled at the same time.
  • Your skin and eyes may appear noticeably yellow.
  • You may pass small amounts of dark yellow or reddish urine, and have hard stools that are difficult to pass.
  • Your tongue may look red, with a yellow coating that may be thick and greasy.
  • Your pulse may feel slippery and fast, with a somewhat rapid beat.

|Treatment Approach

Clinical Description:

Clear heat and drain dampness; promote qi movement and facilitate bile flow.

In Plain Language:

  • Use methods intended to clear “heat” and excess dampness from the body, with the aim of easing a feeling of heat and stickiness, stuffiness and fatigue, a bitter or sticky taste in the mouth, a heavy feeling in the body, a thick, greasy tongue coating, and scant, dark urine.
  • Use methods intended to regulate qi and promote the free movement and discharge of bile, with the aim of easing distending pain in the ribs and a feeling of fullness in the chest and hypochondrium, as well as a bitter taste, poor appetite, nausea, acid regurgitation, post-meal fullness, and dark urine.

|Related Medications

The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and package insert, and use under the guidance of a physician or pharmacist.

|Common Symptoms

Clinical Description:

Main symptoms: Persistent high fever; severe pain in the right hypochondrium; pain that is sensitive to pressure. Additional symptoms: Yellowing of the skin and eyes, with a bright yellow color; constipation and scant, dark urine; restlessness and agitation; a deep-red tongue with a yellow, dry coating; wiry, rapid pulse.

In Plain Language:

  • A persistent high fever may develop and may be difficult to bring down.
  • Severe pain may occur on the right side below the ribs and may be difficult to tolerate.
  • The pain below the ribs may worsen when pressed, making you reluctant to have the area touched.
  • Your skin and eyes may become noticeably yellow, with a bright yellow appearance.
  • You may have hard stools that are difficult to pass and scant, dark yellow or reddish urine.
  • You may feel restless and agitated, with a sense of unease and irritability.
  • Your tongue may be deep red, with a yellow and dry coating.
  • Your pulse may feel wiry and fast, with a somewhat rapid beat.

|Treatment Approach

Clinical Description:

Clear heat and resolve toxins; unblock the bowels and purge fire.

In Plain Language:

  • Use methods intended to clear internal “heat” and pathogenic toxins, with the aim of easing symptoms associated with excess heat, such as fever, irritability, sore throat, mouth ulcers, and red, swollen, hot, painful skin.
  • Use methods intended to unblock the bowels and promote elimination, carrying “heat” out through the stool, with the aim of easing hard stools, straining, abdominal bloating and pain, bad breath, and dry mouth.

|Related Medications

The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and package insert, and use under the guidance of a physician or pharmacist.

References

  1. Editorial Board of Practical Internal Medicine, Shanghai Medical College, Fudan University. Practical Internal Medicine (13th ed.) [M]. Beijing: People’s Medical Publishing House, 2009.
  2. Biliary Surgery Group, Society of Surgery, Chinese Medical Association. Guidelines for the Diagnosis and Treatment of Acute Biliary Tract Infections (2011 edition) [J]. Chinese Journal of Digestive Surgery, 2011, 10(1): 9–13.
  3. Spleen and Stomach Disease Branch, China Association of Chinese Medicine. Consensus on TCM Diagnosis and Treatment of Cholecystitis [J]. Chinese Journal of Integrated Traditional and Western Medicine, 2012, 32(11): 1461–1465.
  4. Chinese Pharmacopoeia Commission. Pharmacopoeia of the People’s Republic of China (2015 edition) [M]. Beijing: China Medical Science Press, 2015.
  5. Song Minxian, Yang Ming. New Compendium of National Chinese Patent Medicines (2nd ed.) [M]. Beijing: People’s Medical Publishing House, 2011.