Treatment of Gallstones with Chinese Herbs and Acupuncture

Acupunture for gall stones: It is unclear whether acupuncture, by itself, can cause expulsion of gallstones, but acupuncture is used to treat symptoms of gallstones, such as billiary colic. The two acupuncture points mentioned qimen (LV-14) and riyue (GB-24), are the main ones mentioned in the literature. These points lie over the liver on the right side, and are located one rib apart and directly below the nipple. An extensive analysis of the value of these points was presented in an article on treatment of biliary colic (6), along with brief mention of the nearby point juque (CV-14). The theory of acupuncture and moxibustion of Zhang Zhongjing [author of Shanghan Lun] is an important component part of his academic thinking, of which the frequent use of qimen point is quite characteristic. The indications of qimen point include fullness of abdomen, delirium, fullness of the chest and flanks, distention of gastric region resistant to pressure, and fever or alternative spells of fever and chills, which are similar to the clinical manifestations during a bout of biliary colic.... We found that the most sensitive and tender point of qimen [among our patients with biliary colic] is in the area defined by the lines connecting qimen, riyue, and juque points, which, according to traditional Chinese medicine, is the dividing line between the liver and the gallbladder, and is indicated mainly for treating diseases of the internal organs in the vicinity. Qimen is the mu point [alarm point] of the liver, riyue is the mu point of the gallbladder, and juque is the mu point of the heart. The front mu points are used mainly in the treatment of diseases of the internal organs. Various painful lesions are the result of failure of the heart and liver to remove stagnancy of vital energy, leading to impediment to the flow of qi of the gallbladder, thus producing the pain. Basing on the principle of treating pain by needling the location where pain exists, the most marked tender spot was detected in the region of the three points....

Other points frequently mentioned in the literature for treating gallstones include the lower leg points yanglingquan (GB-34), qiuxu (GB-40), and zusanli (ST-36); in addition, there is an extra point known as the gallbladder point (dannangxue), just below GB-34 (about 1-2 cun lower). The nausea and pain associated with cholecystitis and with billiary blockage is treated at neiguan (PC-6) and zhigou (TB-6), above the wrist. In explaining the use of these points, the Advanced Textbook of Traditional Chinese Medicine and Pharmacology states: Qimen and riyue are the front mu points of the liver and gallbladder meridians respectively; zhigou and yanglingquan can relieve hypochondriac pain, while zusanli helps strengthen the spleen and disperse dampness-heat. Ear acupuncture developed a reputation for being a method for expelling gallstones during the 1980s 1. It was reported to be especially effective for the damp-heat type and less so for the qi-stagnation types of patients, but not effective for those with qi deficiency. Over 60 auricular points have been used in the treatment of gallstones, making it difficult to pick out points that might be particularly effective.

Not surprisingly, the most commonly used points were those associated with the liver, gallbladder, bile duct, pancreas, duodenum, stomach, spleen, and small intestine. A course of treatment would be thirty days with pressure applied to the point using various kinds of pellets, especially vaccaria seeds (which have a sharp point and may be substituted by the small "ear tacks"). Pressure would be applied for 20-30 minutes after meals (about 15 minutes after eating). Despite the high efficacy of the therapy in alleviating symptoms, the number of cases reported to have complete elimination of stones was usually only about 10%, sometimes as high as 20%. During treatment, stone expulsion would yield a sensation of distention or pain in the region of the gallbladder. Unfortunately, it was found that in patients who had only a portion of the stones expelled, new stones appeared very rapidly, sometimes leading to a worsened condition after treatment. One researcher, Shang Cenruo of the Nanjing College of TCM, cautioned that a higher efficacy of ear acupuncture for stone expulsion should be attained before recommending wide spread use of the technique.

Other researchers noted superior effects when ear acupuncture was combined with herbal therapy. In an extensive review of the experiences and opinions expressed by several researchers in this field 2, the editor concluded that: In some reports, the therapeutic efficacy was overestimated or overstated. As far as I know, besides exaggeration, the most important reason for this was that evaluation was not made on a scientific basis....Obviously, it is not sufficient to evaluate the therapeutic effects merely on the basis of presence or absence of subjective symptoms and the amount of gallstones expelled with the stools. At present, auriculo-point seed pressing therapy may be used to expel gallstones, but the evacuation rate is still very low. This remains to be further improved.

The therapeutic efficacy [among the results reported by several researchers] was basically the same with different prescriptions of otopoints: part of the gallstones could eventually be expelled from every patient. Local inflammation and clinical symptoms were accordingly alleviated or disappeared with a decrease in the amount of gallstones in the biliary tract. In some patients, the duration of colicky attacks became shorter, and the time interval between two attacks became longer. This is the main reason why this therapy has won the patient's confidence....

We propose that in order to further enhance the therapeutic efficacy of this therapy, the following measures be adopted: Clinical practice must be combined with experimental research so that the mechanisms of evacuation of gallstones can be clarified, and the most effective methods and otopoints be detected through the latter which, in turn, guide clinical practice; and, Since it is quite difficult to enhance the therapeutic effects by merely using the auriculo-point seed pressing method for treating cholelithiasis, it can only be taken as the main method in a combined therapy. Fig:1 The acupoints riyue (GB-24) and qimen (LV-14).