Most cholecystitis occurs because there are stones in the gallbladder, which block the cystic duct, make bile discharge not smooth, and then bacterial infection occurs, forming cholecystitis. In some patients, there are no stones in the gallbladder, and bacteria enter the gallbladder from the intestine or from the blood circulation, forming cholecystitis. Cholecystitis patients are prone to gallstones because of the changes of bile composition and bile concentration, with bacteria and inflammatory and necrotic substances as the core, so cholecystitis and gallstones often coexist. References:

Why is gallbladder easy to be inflamed? (1) The gallbladder is an enlarged part at the end of the cystic duct, which can hold 30 ~ 60 ml of bile. Bile enters and exits the gallbladder through the cystic duct. The cystic duct is about 3 ~ 4 cm in length and 2 ~ 3 mm in diameter. There are 5 ~ 7 spiral folds in the mucosa of the cystic duct, which narrows the lumen and makes it easy for gallstones and parasites to embed in the cystic duct. After embedding, the bile in the gallbladder can't be discharged, which makes the excess bile accumulate in the gallbladder, staying for a long time and being too concentrated, which directly stimulates the gallbladder mucosa and causes inflammation. (2) The blood vessel supplying gallbladder nutrition is the terminal artery. When the gallbladder outlet is blocked, the gallbladder mucosa continues to secrete mucus, which makes the gallbladder dilate and accumulate water, so the blood vessels on the gallbladder wall are compressed and ischemic and necrotic. When the gallbladder is ischemic, the resistance of the gallbladder decreases, and bacteria are easy to grow and reproduce, taking the opportunity to move and cause cholecystitis. (3) Because gallbladder has the function of storing and concentrating bile, the contact time between gallbladder and bile is longer than other bile ducts, and the contact bile concentration is also higher. At this time, if there are bacteria in people's bile duct, infection will occur, and the chance of forming cholecystitis will of course increase. What effect does surgery have on cholecystitis? Surgical treatment of cholecystitis is one of the most common operations in abdominal surgery. Millions of patients in the world have to undergo this kind of surgery every year, but the surgical treatment is not an ideal treatment method. Some patients will have complications after surgery, and the mortality rate is still 0.5% ~ 3%. Especially those who were forced to undergo surgery because of the sudden deterioration of their condition, the mortality rate was higher. Generally speaking, the curative effect of surgery depends on the patient's age and the timing of surgery. The older you get, the later the operation time and the worse the effect. With the development of modern medicine and the improvement of surgical methods, the safety and cure rate of surgery have been greatly improved, and satisfactory results can generally be obtained after surgery. Clinically, for those who have the following conditions, surgical treatment should be selected in time. (1) Patients with severe clinical symptoms, ineffective drug treatment, worsening condition and refractory non-surgical treatment. (2) Gallbladder enlargement or gradual enlargement, obvious abdominal tenderness, severe abdominal muscle tension or gangrenous perforation of gallbladder, complicated with diffuse peritonitis. (3) Patients with recurrent acute cholecystitis, definite diagnosis, aggravated abdominal signs and obvious peritoneal irritation after treatment. (4) Laboratory examination showed that the number of white blood cells in the blood increased significantly, with the total number above 20×109/L. (5) Jaundice deepened, belonging to common bile duct stone obstruction. (6) those who suffer from chills, chills, high fever and are prone to poisoning shock. There are generally two surgical methods for acute cholecystitis: one is cholecystectomy; The second is cholecystostomy, which is mostly used for advanced patients. It is estimated that patients who can't tolerate cholecystectomy or have serious complications can drain pus or take stones. Generally, after 6-8 weeks, cholecystectomy can be performed after the condition is stable. If the whole body is extremely weak, cholecystostomy can also be placed for long-term drainage. When there is no stone in cholangiography, the fistula can be removed. If the diagnosis is uncertain, or patients complicated with serious diseases such as heart and lung, cholecystectomy can be performed after the diagnosis is confirmed or the general condition is improved. Clinical practice showed that 15% of the patients who received surgical treatment within 48 hours after onset had gallbladder gangrene or even perforation. If the onset is more than 72 hours, the operative mortality will increase, so once there are indications for surgery, surgical treatment should be carried out as soon as possible. What are the family standing drugs for cholecystitis patients? Patients with cholecystitis and gallstones often have sudden onset, especially poor resistance, or depressed mood, or overeating or satiating, and often have mild cholecystitis symptoms, such as chest tightness, indigestion, nausea, loss of appetite and so on. What should I do if I go to the hospital once? You can prepare some commonly used drugs at home, and you can take them yourself as soon as you have symptoms. For example: oral anti-inflammatory drugs: ① Norfloxacin: 1 ~ 2 capsules (i.e. 0. 1 ~ 0.2g) are taken orally on an empty stomach three times a day. ② Erythromycin: 0.3g, 4 times a day, after meals. ③ Chloramphenicol: 0.5g, 4 times a day, after meals. ④ Clindamycin: 1 ~ 2 capsules (0.25~0.5g), four times a day. ⑤ Metronidazole (metronidazole tablets) is taken three times a day, one tablet each time (i.e. 0.2g), after meals. Pregnant women are prohibited. ⑥ Xianfeng IV Capsule: 0.25~0.5g each time, four times a day. Cholecholagogic drugs: Tong Dan, tannin, Danyining, Danle, sodium cholate, cholic acid, etc. , should also be reserved. At the time of onset, you can choose one of the above drugs to take. Please read the instructions before taking it to avoid taking it by mistake. If the symptoms get worse, you should go to the hospital. What experience does modern famous old Chinese medicine have in treating cholecystitis and cholelithiasis? Pu Fuzhou's experience: TCM syndrome differentiation of chronic cholecystitis is inflammation of gallbladder fire and obstruction of stomach qi, which leads to disharmony between gallbladder and stomach. First of all, the treatment should clear the liver and benefit the gallbladder, regulate the stomach and reduce adverse reactions, and use Sinisan and Zuojin Pill to add flavor. Tung Chee-hwa's experience: I think we must grasp the pathogenesis of stagnation of liver and gallbladder, pay attention to qi stagnation and blood stasis, damp-heat stasis, liver disease, spleen and liver qi invading the stomach, or the combination of civil and social factors, choose Bupleurum as the main prescription, and add and subtract drugs according to syndromes. Yue Meizhong's Experience: Treating Chronic Cholecystitis with Modified Dachaihu Decoction. Drawing lessons from Zhongjing's Treatise on Febrile Diseases, Bupleurum chinense is used to clear away heat from shaoyang gallbladder meridian, and Scutellaria baicalensis is more helpful. The combination of Fructus Aurantii Immaturus and Radix Paeoniae Alba can relieve the feeling of stagnation under the heart, rhubarb can induce blood stasis and reduce heat, and Pinellia, jujube and stomach can be reused to stop vomiting. In addition, Lysimachia christinae can promote gallbladder and clear heat, talc can induce diuresis and relieve fever, and chicken gizzard-membrane can accumulate heat. This prescription is also effective in treating jaundice and gallstones. Huang Wendong's experience: The main treatment is soothing the liver and benefiting gallbladder, clearing away damp heat, and Dachaihu decoction and Chengqi decoction are commonly used prescriptions. The dosage of laxatives should be heavy for constipation patients, and it is not suitable for patients with spleen and stomach weakness to have continuous attacks. Lu's experience: In recent years, people who treat damp-heat in the liver and gallbladder with large doses of clearing away profits and even "general attack" have achieved continuous results. However, it is not suitable for those with deficiency-cold constitution, weakness of spleen and stomach, and weakness in removing stones. Therefore, Zhong Jing has the teaching of "seeing the disease of the liver, knowing that the liver transmits the spleen, and consolidating the spleen first". How can he ignore it? But pure things are clear and indistinguishable, which leads to bitter cold and stomach injury. Therefore, for this kind of diseases, I mostly adopt the methods of strengthening the spleen and regulating the stomach, clearing away dampness and heat, and combining attack with reinforcement. For example, Wang, a patient with bark-like stones in common bile duct, thinks that the bile duct is blocked, the gallbladder expands to the size of an egg, there is no contractility, and the stones are not easy to be discharged, so surgery is needed. But the patient is over 60 years old and unwilling to have surgery. According to his weak constitution, Liuwang Xiangsha, Buzhong Yiqi and other products were used to strengthen the spleen and replenish qi, supplemented by clearing away damp-heat in the liver and gallbladder. After three months of treatment, he actually discharged stones and accepted the job. Zhao Shaoqin's experience: Early cholecystitis: It can be seen that right hypochondriac swelling and pain often occur, accompanied by thick and dry tongue coating, slippery pulse, dry stool and small red stool. This is the stagnation of gallbladder heat, qi stagnation and blood stasis, so it is advisable to clear away gallbladder heat, regulate qi and relieve pain. Prescription: Bupleurum 60g, Scutellaria baicalensis Georgi 10g, Inula 10g, Curcuma longa 6g, Almond 10g, Perillae Stalk 10g, Crataegus pinnatifida, Massa Medicata Fermentata, Malt 10g, Areca catechu 10g. During the treatment, we must pay attention to diet adjustment, reduce food intake, give priority to vegetables, avoid greasy products, and take a walk every morning to help digestion. Acute attack: mostly transferred from chronic cholecystitis, the clinical manifestations are acute pain in the right abdomen, refusal to press, fever, aversion to cold, vomiting, nausea, thick tongue coating, irritability, red and slippery pulse, constipation for several days, and fever in urine. The treatment method is to clear away gallbladder heat and attack gallbladder, and add and subtract Dachaihu decoction: Bupleurum 6g, rhubarb 3g, and immature bitter orange 6 g. Chronic cholecystitis patients who have not been cured for a long time still need to relieve gallbladder heat and enhance digestive function. The method of regulating liver and gallbladder along clearing heat is as follows: 6g of bamboo shavings, 6g of dried tangerine peel, 6g of Pinellia ternata, 6g of cicada slough, 6 g of almond 10g, 6 g of radish seed, 0/0g of burnt hawthorn 10g of chicken gizzard-membrane. Those who are weak, lack of qi and blood, and have poor digestive function should use the methods of invigorating qi, tonifying middle energizer and strengthening transport to relieve pain, and ask them to insist on physical exercise to cooperate with the treatment. Prescription: 6g of Radix Aucklandiae, 2g of Fructus Amomi, 0g of Atractylodis Macrocephalae10g, 0g of Poria10g, 6g of Radix Pseudostellariae, 6g of dried tangerine peel, 6g of bamboo shavings, 0g of Radix Astragali10g, 6g of burnt malt10g, and 6g of Fructus Aurantii. Cholecystitis often occurs, with rapid pulse, red tongue and dry mouth, and symptoms of yin injury and yang hyperactivity. It is appropriate to use the method of nourishing blood, softening liver and dispersing soil: angelica sinensis 10g, Paeonia lactiflora 10g, papaya 10g, raw oyster 20g, rhizoma Cyperi 10g, turmeric 6g and Eclipta prostrata 65438+. If the yin hurts while the yang is hot, the pulse is slightly slippery, and the patient is upset, thirsty and impatient. MUBI sleeps at night, and his body is emaciated, and even has a low fever in the afternoon. Jin Lingzi 10g, Rhizoma corydalis 6g, Rhizoma Cyperi 10g, Inula 10g, Bupleurum 6g, Prunella vulgaris 10g. What are the acupuncture treatments for cholecystitis and cholelithiasis? Acupuncture has the functions of spasmolysis, analgesia, choledocholithiasis, depression, vomiting and so on, and can be used alone or in combination with other therapies. (1) Body acupuncture ① Acupuncture A. Acupoints: Danshu, Zhongwan, Zusanli, Zhidan and Yanglingquan. Colic plus Hegu; High fever plus meandering pool; Vomiting plus internal clearance. B acupuncture method: select the above 2-4 acupoints, deeply prick and repeatedly acupuncture, continuously twist the needle for 3-5 minutes, and hold the needle for 30 minutes, twice a day. ② Electroacupuncture A. Acupoints: You Danshu (cathode), Zhidan (point), Riyue and Taichong (anode). B. method: insert the needle and connect it with electroacupuncture instrument. Using adjustable wave, the intensity gradually increases from weak to tolerable, 30 minutes each time, 2 ~ 3 times a day. 3 water needle a. Acupoints: Danshu, Zusanli, Zhongwan and Zhidan. B. Methods: Select 1 ~ 2 acupoints and inject 2ml of Angelica sinensis solution or safflower solution into each acupoint; Or 5ml 10% glucose solution, and inject it quickly after acupuncture, 1 ~ 2 times, once a day 1 time. Yantai Wendeng Central Hospital used body acupuncture to treat 2 19 cases of cholelithiasis, and discharged 185 cases, accounting for 84.5%. This group 185 patients * * discharged stones1cm×1block, of which the largest was 4.5cm×3.5cm and the largest transverse diameter was 3.5cm. Some patients also discharged stones with ascaris lumbricoides residue and kitchen broom seedlings as the core. Take the right side of the point, the sun, the moon and the gate. For patients with severe epigastric pain and gallbladder distension, Queque is used to treat gallbladder points through abdominal mourning. After the needle is inserted, it is electrified with an electroacupuncture instrument for 60 minutes, once a day 1 time, and twice a day for those with severe pain. At the same time, 40ml of 33% magnesium sulfate was taken orally. (2) Ear acupuncture ① Acupoints: liver, gallbladder, spleen, stomach, duodenum, Shenmen and sympathetic. ② Acupuncture: Select 2-3 acupoints with obvious reaction above, re-stimulate, and keep the needle for 30 minutes, twice a day. In recent years, people in many parts of the country have used vaccaria seed, white mustard seed or rapeseed to apply pressure to select points, and combined with high-fat diet such as pig's trotters to treat gallstones, which has a good effect of removing stones. How to treat cholecystitis and cholelithiasis with massage therapy? (1) Acupoint massage: Look for pain points in the back, mostly near the ninth thoracic vertebra, and at the gallbladder meridian points on both sides. Stimulate the back tenderness point for 3 ~ 5 minutes by point or press, and then stimulate the gallbladder meridian point for 3 ~ 5 minutes. Every day 1 time, 7 days is 1 time course. (2) Push or rub the right gallbladder point, Yanglingquan, right liver, Danshu and bilateral Taichong points with one finger Zen to soothe the liver and benefit the gallbladder. (3) Apply the palm friction method to the ribs on both sides. (4) Acupoint therapy for biliary colic: Diseases include cholecystitis and gallstones. Acupoint selection: Dan Shu (double). Shiatsu, subject to the patient's tolerance, lasts for 10 ~ 15 minutes each time, and the pain is aggravated as appropriate. Then massage this point up and down with the soles of your feet for 30 times. In this group 100 cases, 65 cases were markedly effective (the pain was completely relieved), 30 cases were effective and 5 cases were ineffective, and the effective rate was 95%. In addition, acupuncture points (10 min) and blank control group (50 cases each) were set up, and the maximum cross section of gallbladder and common bile duct was detected by Aloka- 190 ultrasonic instrument. Results: There were 45 cases of gallbladder and 42 cases of common bile duct contraction and 2 cases of dilatation in the two groups. There was significant difference between the two groups (P < 0.0 1). Source: Tan Zimin ...//journal of traditional chinese medicine. 1998,26 (1).-46 (5) Specific massage for hepatolithiasis: chest-expanding shaking method (doctor moves his shoulders with both hands and knees to reach the Danshu point, and shakes it forward forcefully for 2-3 times) and point-through method (doctor lightly holds empty fist): point-pressing the back Danshu, Ganshu and Ganshu points. Then click the conventional gate, Sun Moon, Dovetail, Middle-old, Yangxi, Zusanli, Gongsun, Taichong and Xu Qiu, and take 3-4 acupoints at a time 15-30 seconds for each acupoint according to the meridian flow injection method, so as to get the appropriate degree. Every time 15 minutes, every day 1 time, 1 time is1course of treatment. In this group of 36 cases, after 3 courses of treatment, 9 cases were cured, 2 1 case was effective and 6 cases were ineffective. Source: Zheng Chaomin ...//Massage and Guidance. -1998, (1).-17 ~18 (7) Observation on the analgesic effect of back acupoint massage on cholecystitis: There were 45 cases in this group, including 3 cases of hepatolithiasis and 3 cases of cholecystolithiasis. Treatment: Massage Xinshu, Du Meridian and Shu Ge points is the main method. The patient takes a prone position, and the operator massages the acupoints with the thumb pulp or thenar, or with the palm root, once 10 ~ 20 minutes, twice a day, and the course of treatment is the fifth day 1. Some patients combine cupping in the tenderness area of the back. Results: 40 cases were effective and 5 cases were ineffective (all accompanied by intrahepatic bile duct stones, although the pain was relieved after massage, the duration was short). Source: Qi Chuanhou ...//Journal of Chengdu College of Traditional Chinese Medicine. -1988,11(3).-20 ~ 217 four methods of cholelithiasis massage: the first method: the seventh to ninth thoracic vertebra back tenderness points and bilateral gallbladder meridians are stimulated by acupoint method or by method. The second method: rotate the spinous process of the spine on the plane of the tenderness point of the left back for reduction. The third method: massage along the bladder meridian on both sides of the back for about 6 minutes, then press Danshu, Ganshu and Shu Ge for 65 and 438+0 minutes, and finally press the bladder meridian on the back, with heat penetration as the degree. The fourth method: Knead both ribs, with slight heat penetration as the degree, and then knead both ribs 1 min, with acid swelling as the degree. How to treat cholecystitis and cholelithiasis with qigong therapy? (1) Qigong acupuncture pierces the filiform needle into the branch ditch, Yanglingquan. Then use the dragon-containing style, pull and turn to get angry, and bleed downward with your right hand. (2) Auxiliary exercises ① Pushing "Hush" Qigong: standing or sitting, breathing naturally, eliminating distractions and relaxing the whole body. First knock your teeth 36 times, stir the body fluid to swallow, send it to both sides, and then lead it back to dantian, with the palms of your hands under both sides. Then inhale slowly to fill your mouth; When exhaling, pronounce the word "shh", and gently rub your hands on both sides from top to bottom for 7 times and take 8 breaths. ② Push the chest to guide qi: If the left rib hurts, put the right palm on the left chest, push it to the left from the chest midline, move it for 7 times while pushing, and then rub the middle and early door. ③ Shugan Daoqigong: A. Stand still, hands naturally droop, palms down, fingers slightly tilted, and press slightly hard, with the intention of reaching palms to fingertips. B raise your hands to your chest and push your palms forward to your shoulders, elbows and wrists. C Hands extend horizontally from left to right, like the wings of a bird, with fingers upturned, pushed horizontally from left to right with the palm of your hand, and qi moves to the palm. D put your palms on your chest, with your fingertips facing each other and your palms facing up, then turn your palms down to the pubic symphysis, inhale and walk on your abdomen, and then put your hands on your sides to collect your work. (3) beginning of winter Sitting Exercise: It is advisable to exercise Yangming Five Qi at 3-5 o'clock every day. 1 posture: sit up. Adjust your breathing thinking. ② Exercise: Open your right hand, press your right knee hard, make a fist with your left hand, bend your elbow, and pull back hard for 5 times. Similarly, press the left knee and pull the right elbow five times, alternately from left to right. Then return to the original position, exhale, knock your teeth and rinse your mouth 7 times each. ③ Collection of works: relax, feel at ease and collect works. (4) Stone removal skills: ① posture: sitting or standing, feet parallel, about three feet apart, feet flat on the ground, spine vertical, waist slightly drooping downward, hips slightly retracted, head and neck relaxed and straight. Close your eyes gently and smile. Shoulders droop naturally along the side, elbows are slightly bent, thumbs are extended backward, palms are gently placed in groin, palms are downward, wrists are relaxed, armpits are empty, breath is slowly adjusted, and exhalation time is gradually extended on the basis of natural breathing. ② If the old cow eats grass, stir the dentition up and down with the tongue for 9 times. (3) Hit the waist and abdomen in turn: stand with your feet parallel and shoulder width, calm your mind and breathe naturally. Use your feet, twist your waist and relax your arms. When your waist turns left, punch your abdomen with your right fist (or forearm). When your waist turns right, hit your abdomen with your left fist (or forearm) and then hit your right waist. It looks like a "drum" for children to play with, and the shoulders or arms are as loose as a rope. ④ Riding shock: Put your hands on the back of your hand at Ganshu or Yaowo, with your knees slightly bent and your whole body shaking up and down like a horse. ⑤ Lift your arms and jump: Lift your arms above your head, bend your elbows slightly, relax your wrists and fingers, and jump in place. You should land with the forefoot instead of the heel, and use reaction force. (6) Light acupoints: the left leg is arched, and the right leg is standing in a lunge. Make a light fist with both hands and breathe naturally. The upper body leans forward and punches the gallbladder meridian point left. Lean back and lean back, hit the liver Shu or kidney area with the right fist, and punch the right shoulder with the left fist. Knock 9 ~ 18 repeatedly and rhythmically. Switch left and right