Disease and Condition Overview
Cholecystitis is characterized by acute and chronic inflammation of the gallbladder. Its primary clinical symptoms include acute pain in the upper right quadrant of the abdomen, with pain radiating towards the right shoulder or chest and back regions. It may be accompanied by nausea and vomiting. In Chinese medicine, all types of liver and gallbladder damp heat, spleen and stomach deficiency, qi and blood blockage, can all cause cholecystitis.

Clinically, it is differentiated into acute cholecystitis and chronic cholecystitis. Acute cholecystitis is the initial onset of the disease while chronic cholecystitis is the prolonged reoccurrence of the disease. Acute cholecystitis is related to the over consumption of high cholestrol foods, exhaustion and emotional problems. In addition, gallbladder stone is the pnmary cause of acute cholecystitis. The initial onset of acute cho1ecystitis inevitably leads to chronic cholecystitis. In fact, clinical symptoms of chronic cholecystitis are mostly atypical. Patients often feel vague pain in the upper right quadrant of the abdomen, distension, belching, nausea, dislike of greasy foods and other indigestion issues. Some patients even feel pain on the lower right shoulder, ribs and waist regions. The pain is more intense when standing, during movement and after cold showers. Abdominal CT scan or gallbladder scan aids correct diagnosis of the disease.

Pair-point Treatment Combinations

(1) Waiguan (SJ5), Yangfu (GB38) (Fig 108)
Waiguan (SJ5): on the dorsum of the forearm, on the line connecting Yangchi (SJ4) and the olecranon, 2 cun proximal to the dorsal crease of the wrist, between the radius and the ulna.
Yangfu (GB38): on the lateral side of the lower leg, 4 cun superior to the tip of the lateral malleolus, slightly anterior to the anterior border of the fibula.
Waiguan (SJ5) disperses and opens the qi of Sanjiao (upper, middle and lower jiao). Yangfu (GB38) disperses and resolves the blockage of liver and gallbladder. This point in this combination, located on the same channeh echo each other's effects to disperse and reduce liver and gallbladder, which in turn, resolves shaoyang. This treatment is appropriate for acute cholecystitis caused by qi stagnation.

Needling techniques:
1. Waiguan (SJ5) towards Neiguan (PC6) direction penetration needling to a depth of 1 cun.
2. Yangfu (GB38) perpendicular insertion to a depth of 1 cun.

(2) Danshu (BL19), Yanggang (BL48) (Fig 109)
Danshu (BL19): on the back, below the spinous process of the tenth thoracic vertebra (T10), 1.5 cun lateral to the posterior midline.
Yanggang (BL48): on the back, below the spinous process of the tenth thoracic vertebra (T10), 3 cun lateral to the posterior midline.
Danshu (BL19) soothes liver qi, clear gallbladder fire while Yanggang (BL48) disperses and reduces liver and gallbladder and clears and resolves damp heat. This pair point combination disperses liver, reduces gallbladder, clears heat, drains dampness and clears jaundice. This treatment is appropriate for acute cholecystitis accompanied by jaundice.

Needling techniques:
1. Danshu (BL19) towards spine oblique insertion to a depth of 1 cun.
2. Yanggang (BL48) perpendicular insertion to a depth of 0.5 cun.

(3) Zhigou (SJ6) Yanglingquan (GB34) (Fig 105)
Zhigou (SJ6) clears and harmonizes Sanjiao (upper, middle and lower jiao) while Yanglingquan (GB34) disperses and reduces liver and gallbladder. These points in this combination, one superior and one inferior, both on the same channel, echo each other's effects. Together they have greater effects on the qi of that channel, resolve shaoyang, disperse liver and facilitate gallbladder. This treatment is appropriate for cholecystitis caused by rib pain, etc.

Needling techniques:
1. In sitting or prone position, perpendicular insertion or upwards oblique insertion Zhigou (SJ6) to a depth of 1 cun.
2. Yanglingquan (GB34) towards Yinlingquan (SP9) direction penetration needling to a depth of 2 cun, manipulates for 5 ninutes.

(4) Danshu (BL19), Riyue (GB24) (Fig 110)
 Danshu (BL19): on the back, below the spinous process of the tenth thoracic vertebra (T1O), 1.5 cun lateral to the posterior midline.
Riyue (GB24): directly below the nipple, in the seventh intercostal space, 4 cun lateral to the anterior midline.
Danshu (BL19) is the back-shu point of gallbladder. Riyue (GB24) is the fron-mu point of gallbladder. This pair point combination, one anterior and one posterior, one yin and one yang, work to regulate gallbladder functions, disperse and reduce liver and gallbladder and open the luo-connecting channels to stop pain. This treatment is appropriate for all types of cholecystitis.

Needling techniques:
1. Danshu (BL19) towards spine oblique insertion to a depth of 1 cun.
2. Riyue (GB24) oblique insertion to a depth of 0.5 cun.

Commentanes
Acupuncture is effective in the treatment of both acute and chronic cholecystitis.
Generally, for acute cholecystitis caused by qi stagnation, select Waiguan (SJ5), Yangfu (GB38). For acute cholecystitis accompanied by jaundice, select Danshu (BL19), Yanggang (BL48) combination. For cases accompanied by rib pain, select Zhigou (SJ6) and Yanglingquan (GB34) combination. Overall, Danshu (BL19), Riyue (GB24) pair-point combination is appropriate for all types of cholecystitis.