Introduction
Biliary tract infection includes acute and chronic cholecystitis and cholangitis; cholelithiasis includes chilelithiasis, choledocholithiasis and calculus of intrahepatic duct. Biliary tract infection and cholelithiasis often exist simultaneously and are responsible for each other. Chronic cholecystitis usually occurs after cholelithiasis and is often the sequela of acute cholecystitis, clinically marked by pain in the upper or right upper abdomen. According to the clinical symptoms, biliary tract infection and cholelithiasis pertain to the conception of hypochondriac pain, jaundice in TCM. This problem is usually caused by exogenous pathogenic factors, emotional changes and improper diet that lead to interior accumulation of damp-heat and failure of the liver and gallbladder to disperse; or by prolonged accumulation of damp-heat that condenses bile into stone. The clinical manifestations are either of sthenia syndrome or of heat syndrome.
Syndrome differentiation
1. Stagnation of Liver and Gallbladder Qi
Oppression and distension in the right upper abdomen, colic at intervals, migratory pain, mental depression, belching and sighing, dysphoria and susceptibility to rage, thin and yellow tongue fur, taut and rapid pulse.
2. Damp-heat in the Liver and Gallbladder
Acute onset, fever, bitter taste in the mouth and dry throat, yellow coloration of eyes and body, yellow urine, constipation, red tongue with yellow and greasy (or dry) fur, taut and rapid pulse.
3. Accumulation of Heat-Toxin
Chills and fever, flushed cheeks and yellow coloration of body, restlessness, scanty and brown urine, constipation, even delirium and coma, cold limbs, deep-red or purplish tongue with yellow and dry or prickly fur, slippery and rapid or deep and latent pulse.
Treatment
1. Body Acupuncture
Prescription: Zhongwan (CV 12), Riyue (GB 24), Danshu (BL 19), Taichong (LR 3) and Dannang (EX-LE 6).
Modification: For stagnation of liver and gallbladder qi, Qimen (LR 14) and Yanglingquan (GB 34) are added; for damp-heat in the liver and gallbladder, Yinlingquan (SP 9) and Xiaxi (GB 43) are added; for accumulation of heat-toxin, Quchi (LI 11), Neiting (ST 44) and Xiaxi (GB 43) are added; for high fever, Dazhui (GV 14) and Erjian (TE 2) are added; for colic of gallbladder, Yanglingquan (GB 34) and Hegu (LI 4) are added; for nausea and vomiting, Neiguan (PC 6) and Zusanli (ST 36) are added; for jaundice, Zhiyang (GV 9) and Zusanli (ST 36) are added; for constipation, Zhigou (TE 6) and Tianshu (ST 25) are added; for coma and prostration, Shuigou (GV 26), Baihui (GV 20), Neiguan (PC 6), Hegu (LI 4) and Zusanli (ST 36) are added.
Performance: Riyue (GB 24) and Qimen (LR 14) are needled obliquely lateral along the costal space, vertical needling should be avoided. Zhongwan (CV 12) is needled obliquely downward to the right hypochondrium to enable the needling sensation radiate to the affected region. Vertical needling should not be too deep. Dazhui (GV 14) and Erjian (LI 2) are pricked for bloodletting. All the acupoints are needled with reducing techniques. At the same time electropuncture can be applied with continuous wave and high frequency for 40 - 60 minutes of strong stimulation.
2. Ear Acupuncture
Prescription: Liver ( CO12 ), Gallbladder ( CO11 ), Spleen (CO13), Stomach (CO4), Triple Energizer (CO17), Duodenum (CO5), Sympathetic Nerve (AH6a), Ear Shenmen (TF4), Erjian (LI 2) and Ermigen (R2).
Performance: Each time 3 - 5 acupoints are selected and needled with routine procedure. Strong stimulation is required for acute syndrome (bloodletting from the tip of ear), while moderate stimulation is required for chronic syndrome. Or Wangbuliuxingzi (Semen Vaccariae) is used for ear pressure.