Integrated Chinese-Western Medicine Treatment for Cholecystitis and Gallstones
Cholecystitis and gallstones are common surgical conditions in clinical practice. Domestic scholars have accumulated extensive experience through decades of clinical practice. This article introduces the current status and development trends of integrated Chinese-Western medicine treatment for cholecystitis and gallstones, along with the author’s personal experience and insights.
The "Fragmentation, Expulsion, Dissolution, Resection, and Extraction" Therapeutic System for Gallstones
Since the 1950s, through joint efforts of clinical Chinese and Western medical practitioners, a relatively complete integrated Chinese-Western medicine treatment system for gallstones has been preliminarily established. It includes non-surgical methods such as lithotripsy, expulsion, dissolution, and extraction, as well as cholecystectomy—collectively known as the "fragmentation-expulsion-dissolution-resection-extraction" system. Practical experience confirms that each method within this system has specific indications and inherent advantages and disadvantages. Only through proper selection and scientific advancement can the system mature and improve short- and long-term treatment outcomes for gallstones.
1. Non-surgical Treatment for Gallstones
The integrated Chinese-Western medicine non-surgical treatment for gallstones began in the late 1950s with stone expulsion therapy. Initially relying on acupuncture and herbal bile-promoting agents to promote expulsion, it evolved into a comprehensive attack combining Chinese and Western drugs and measures (electroacupuncture, auricular acupressure, massage devices, etc.), gradually increasing expulsion rates. However, compared to the success rate in biliary duct stones, the expulsion rate for gallstones remains relatively low, and complete clearance is even lower. One major reason is inadequate adherence to expulsion criteria. Currently, widely accepted indications for non-surgical stone expulsion include: ① mild gallbladder damage with good contractile function; ② no significant organic narrowing in the cystic duct or lower common bile duct; ③ normal liver function; ④ maximum stone diameter less than 0.5 cm.
Starting in the 1970s, dissolution therapy opened new avenues for non-surgical treatment of gallstones. However, clinical results show that oral dissolution therapy (bile acid preparations, various herbal formulations) has unsatisfactory efficacy, with low complete dissolution rates, prolonged treatment duration, high costs, and a high recurrence rate after cure. Direct intracystic infusion dissolution therapy significantly improves dissolution rates but faces challenges due to serious side effects of the drugs used (e.g., methyl tert-butyl ether, compound bile acid preparations) on gallbladder tissue and the body, limiting its widespread application. The strictness in adhering to indications remains a critical factor affecting efficacy. Besides similar requirements to those for expulsion therapy, current dissolution drugs are effective only against cholesterol stones, with almost no effective options for pigment stones. Given the relatively low proportion of pure cholesterol gallstones in China, improving dissolution therapy awaits the development and application of next-generation safe, effective, multi-targeted Chinese-Western drugs. The application of extracorporeal shock wave lithotripsy in the 1980s marked a significant breakthrough in non-surgical integrated Chinese-Western medicine treatment for gallstones. Combining lithotripsy with Chinese-Western drug-based dissolution and expulsion measures significantly increased cure rates and broadened the range of non-surgical treatment indications. However, longer treatment duration and post-cure recurrence remain issues requiring further exploration by integrated Chinese-Western medicine practitioners.
It is believed that although fragmentation, expulsion, and dissolution therapies still have room for improvement, they remain key comprehensive non-surgical approaches in integrated Chinese-Western medicine. Their development should focus on drug innovation, improved techniques, and enhanced technology. Regarding post-cure recurrence prevention, solutions should be sought from an integrated Chinese-Western medicine perspective. Based on epidemiological findings, patients with high recurrence tendency should not only receive standard bile acid preparations for stone prevention but also benefit from individualized preventive strategies derived from TCM syndrome differentiation, aiming to integrate "fragmentation-expulsion-dissolution-prevention" into a more scientific and rational approach.
2. Surgical Treatment for Gallstones
In integrated Chinese-Western medicine treatment for gallstones, "resection" and "extraction" remain primary therapeutic methods. As definitive treatments, open cholecystectomy has long been considered an effective method for gallstones. However, with the strengthening of minimally invasive surgery concepts and continuous technological innovation, its role has fundamentally changed. Recently, laparoscopic cholecystectomy and mini-incision cholecystectomy have gained popularity due to their minimal trauma, reduced pain, and faster recovery, gradually replacing traditional open cholecystectomy as the preferred surgical option. Nevertheless, due to economic factors, many smaller hospitals in mainland China still rely on open cholecystectomy as the basic surgical procedure.
Mini-incision cholecystotomy with gallstone removal and percutaneous cholangioscopy stone extraction, once popular, failed to gain widespread adoption due to high recurrence rates. However, some domestic researchers have achieved favorable long-term outcomes by applying Chinese-Western medicine preventive measures post-cholecystotomy. Thus, further research from an integrated Chinese-Western medicine perspective is warranted, including strict indication selection, improved suture materials, and screening of Chinese-Western preventive drugs.
Chemical cholecystectomy remains in the exploratory stage. Due to its inherent invasiveness and concerns regarding toxicity of chemical agents and safety/stability of cystic neck occlusion materials, its clinical application is limited. If key issues such as non-toxic, effective drugs (including both Chinese and Western medicines) and safe, stable occlusion materials are resolved, this therapy could serve as a sequential treatment following percutaneous cholangioscopy or cholecystotomy, or even after cholecystostomy for acute cholecystitis.
Emphasis on Early Integrated Chinese-Western Medicine Treatment for Gallstones
Epidemiological data indicate a rising incidence of gallstones. Based on the pathogenesis of gallstone formation, foreign scholars have long advocated initiating non-surgical treatment during the early stage of stone formation—the so-called "YongStone" phase. With rapid advances in imaging diagnostics and the growing prevalence of health check-ups, asymptomatic small gallstones, particularly cholesterol crystals and pseudopolyps formed by cholesterol crystal deposition, are increasingly detected. Recently, among patients admitted for "gallbladder polypoid lesions," the majority were found to have pseudopolyps due to cholesterol crystal deposition. In this group, we applied existing combined dissolution and expulsion therapies using Chinese-Western medicine and observed a high cure rate. Therefore, we believe that early gallstone-related lesions can be effectively managed without invasive surgery through active, comprehensive non-surgical integrated Chinese-Western medicine treatment, leading to full recovery. With accumulating experience, most such patients will eventually be suitable candidates for non-surgical integrated Chinese-Western medicine as the first-line treatment option.
Role of Integrated Chinese-Western Medicine in Cholecystitis Treatment
For chronic cholecystitis complicated by stones, different Chinese and Western medicine treatments are selected based on stone status. For non-stone chronic cholecystitis, if no severe organic pathology is detected, we believe most cases can be effectively managed with TCM syndrome differentiation and treatment, avoiding surgery whenever possible.
Regarding acute cholecystitis, debate continues over the benefits and risks of surgical intervention during the acute phase. While emergency surgery carries higher risks of postoperative complications and sequelae due to limitations in surgeon skill, preoperative preparation time, and surgical conditions, enhancing integrated Chinese-Western medicine measures to improve non-surgical outcomes holds positive significance. Over the past decades, clinical practice in cities like Tianjin, Dalian, and Shanghai has confirmed that integrated Chinese-Western medicine treatment primarily based on promoting bowel movements, clearing heat, detoxifying, and eliminating dampness can effectively control acute symptoms in most cases of acute cholecystitis, thereby avoiding emergency surgery and allowing patients to choose safer, more effective, and reliable treatment options.
Recent studies conducted in Tianjin and our institution reveal that Chinese herbal medicines with purgative, heat-clearing, and cholagogue effects in acute biliary infection differ from traditional antibiotics. They exhibit comprehensive actions including inhibiting bacteria, neutralizing toxins, enhancing immune function, and regulating systemic inflammatory responses during infection.
Thus, integrated non-surgical treatment for acute cholecystitis is not merely conservative but actively helps reduce hasty emergency surgeries, lower surgery-related complications (including secondary surgery and residual stones), and reduce mortality. Of course, for patients with early onset, simple lesions, and favorable surgical conditions, early emergency surgery remains a viable option.