The best treatment of cholecystitis
Damp-heat syndrome of gallbladder depression is a type of cholecystitis in traditional Chinese medicine.
Clinical manifestations: hypochondriac pain, anorexia, abdominal distension, bitter taste, nausea, vomiting, hypothermia, irregular stool, short and red urine, or cold and heat, yellow eyes, red tongue with yellow and greasy coating and slippery pulse.
Treatment principle: clearing away dampness and heat, soothing liver and benefiting gallbladder? Pu Caoqing Fang Dan? . Dietotherapy: cucumber vine and egg beverage raw materials: cucumber vine 100g, fresh egg 1. Cooking method: After cleaning the cucumber vine, add 200ml water to fry it into 100ml, and then take the eggs. Edible method: daily 1 time.
Raw materials of pig bile mung bean pill: pig bile 10 (together with bile), 250g mung bean and 50g licorice. Cooking method: Put mung beans into gallbladder respectively, sew them tightly with thread, wash away the dirt outside the gallbladder, steam them in a pot for about 2 hours, take them out and mash them, then mix them with licorice soup to make pills and bake them for later use. How to eat: Take 1 capsule every morning, noon and evening, and 10 day is 1 course of treatment.
Treatment of cholecystitis
First, acute cholecystitis
1, general treatment: bed rest, giving digestible liquid diet, avoiding greasy food, fasting in severe cases, gastrointestinal decompression, intravenous nutrition, water and electrolyte.
2, spasmolytic and analgesic drug treatment: atropine 0.5 mg or 654-25 mg intramuscular injection; Nitroglycerin 0.3-0.6 mg, administered sublingually; Vitamin K38- 16mg, intramuscular injection; Morphine is not suitable for analgesia such as dolantin or isosorbide dinitrate.
3. Antibacterial treatment: ampicillin, ciprofloxacin, metronidazole; Aminoglycosides or cephalosporins can also be selected, and antibiotics should be selected according to the results of bacterial culture and drug sensitivity test.
4, cholagogic: oral Shudantong, Xiaoyan cholagogic tablets or Qinggan cholagogic oral liquid, can be applied only after the attack is relieved.
Surgical treatment: necrosis, suppuration, perforation and incarcerated stones should be treated surgically in time, and cholecystectomy or cholecystostomy should be performed.
Second, chronic cholecystitis
1. Surgical treatment: Patients with chronic cholecystitis and gallstones should undergo cholecystectomy. Surgery is usually performed 2 months after the onset of cholecystitis, which can reduce the adhesion around the gallbladder and gallbladder edema.
2, comprehensive treatment: low-fat diet, oral cholagogic drugs, such as magnesium sulfate, Xiaoyan cholagogic tablets, Qinggan cholagogic oral liquid, Baodanjin, etc. ; Ursodeoxycholic acid, chenodeoxycholic acid, Xiaoshi powder, etc. People infected with parasites should receive anthelmintic treatment.
3, Chinese medicine therapy: Chinese medicine believes that chronic cholecystitis is mostly caused by stagnation of the liver and gallbladder and abnormal excretion. It should be treated by clearing the liver and benefiting gallbladder, soothing the liver and promoting qi, and regulating qi.
For patients with cholecystitis with mild illness in convalescence, it is ok to do some simple and easy work or sports activities with little exercise, such as Tai Ji Chuan, Tai Chi Sword, walking, broadcast gymnastics, etc., which can also enhance the contractility of gallbladder muscles and prevent bile from accumulating in the gallbladder.
Tips: Cholecystectomy is the fundamental treatment for acute cholecystitis. Surgical indications: gallbladder gangrene perforation, complicated with diffuse peritonitis; Repeated acute attacks of acute cholecystitis with definite diagnosis; After active medical treatment, the condition continued to develop and deteriorate; Surgery has no contraindications and can tolerate surgery. Chronic cholecystitis with gallstones; Once diagnosed, cholecystectomy is a reasonable and basic treatment. If the patient suffers from serious diseases, such as heart disease, liver disease, lung disease, etc. Or can't tolerate surgery in general, he can be treated by internal medicine.
Dietotherapy for chronic cholecystitis
1. The main manifestations of dyspepsia are hypochondriac pain, epigastric fullness, or nausea and vomiting, and unpleasant stool. It is advisable to regulate qi and digestion, and regulate stomach stagnation. You can choose pepper Amomum belly: pepper 30g, Amomum villosum 10g, ginger 15g, 5 jujubes, pork belly 1, and appropriate amount of salt. Wash pork belly, remove the core of jujube, grind pepper and Amomum into fine powder, and cut ginger into fine powder. Put all the medicines into the pig's belly, add appropriate amount of water, and stew with slow fire, 1 dose, once every two days.
2. Liver-qi invading the stomach is mainly manifested as hypochondriac pain, fullness in the stomach, frequent belching and poor stool, each of which is caused by emotional factors. Treatment should be soothing the liver and regulating qi. Danshen Sanqi Decoction can be selected from: Danshen 30g, Jujube 10g and Sanqi 250g. Wrap Saviae Miltiorrhizae Radix with cloth, remove the core from Jujube, peel and wash Notoginseng Radix, stew in water until cooked, take out the medicine bag, add salt and monosodium glutamate to taste, and take it every day 1 dose.
3. Stagnation of heat in the liver and stomach is mainly manifested as hypochondriac pain, fullness and burning pain in the upper abdomen, irritability, dry mouth and bitter taste. Treatment should be soothing the liver and clearing heat, promoting qi circulation and relieving pain. You can choose Qianqian Zhuyeqing porridge: 30g of Lysimachia christinae, 0/0g of bamboo leaves/kloc, 50g of rice, and appropriate amount of sugar. Wash Lysimachia christinae and bamboo leaves, put them in a pot, add appropriate amount of water, soak for 5 ~ 10 minutes, then add water to decoct to get juice, add rice to cook porridge, add sugar when cooked, and cook once or twice, once a day 1 dose.
4. Blood stasis block is mainly manifested as hypochondriac pain, refusal to press when the pain is local, swelling pain in the upper abdomen, dark purple tongue and unsmooth pulse. Treatment should promote blood circulation to remove blood stasis, regulate qi and relieve pain. You can choose hawthorn and notoginseng porridge: hawthorn 10g, notoginseng 3g, rice 50g, and proper amount of honey. Grinding Radix Notoginseng into fine powder, first taking Fructus Crataegi and rice to cook porridge, adding Radix Notoginseng and honey when boiling, and cooking until porridge is cooked. Daily 1 dose, taken at breakfast.
Second, what food is good for the health of chronic cholecystitis:
1. Eat more fresh fruits and vegetables, and eat more low-fat and low-cholesterol foods such as mushrooms, fungus, celery, bean sprouts, kelp, lotus roots, fish, rabbit meat, chicken and fresh beans.
2. Eat more dried beans and their products.
Vegetable oil should be used instead of animal oil.
4. When drinking water, pinch a little hawthorn, seabuckthorn, ginkgo leaf and Gynostemma pentaphyllum in a cup to drink tea.
Third, what food is best not to eat for chronic cholecystitis:
Eat less spicy or irritating foods such as peppers and raw garlic.
General strategies for the treatment of cholecystitis
(1) treatment
Some non-gallstone chronic cholecystitis can be prevented by diet control and drug treatment, but the curative effect is not reliable. People who have been accompanied by stones have more chances of acute attacks, which will cause a series of serious complications and occasionally lead to gallbladder cancer. Therefore, whether this disease is accompanied by stones or not, the best treatment is surgery, and the best surgical method is cholecystectomy. Only by removing the gallbladder can we fundamentally remove the infected focus and prevent all complications. However, patients with mild symptoms or long-standing symptoms, especially older patients with other serious organic diseases, should not be operated by laparotomy casually to prevent more serious complications and consequences caused by the operation. In areas with high incidence of gallstones, especially primary bile duct stones, about 80% of chronic cholecystitis is caused by repeated attacks of bile duct stones. Of course, in addition to cholecystectomy, these cases must be accompanied by common bile duct incision and drainage or some kind of cholangioenterostomy. On the other hand, for countless small stones (pomegranate-like infectious stones) in the gallbladder, besides cholecystectomy, the common bile duct must be cut and explored to avoid the future trouble of gallbladder stones entering the common bile duct. Generally speaking, if the symptoms of chronic cholecystitis are obvious, the attack is frequent and severe, especially those with gallstones, the surgical resection effect is mostly good; On the other hand, if the symptoms are mild, especially chronic cholecystitis without stones, the curative effect of cholecystectomy may be poor and should be paid attention to.
For elderly patients with poor constitution, comprehensive conservative treatment can be taken, such as limiting fat intake, taking cholagogic drugs, and combining traditional Chinese and western medicine, which is helpful to relieve symptoms.
There are still some gallbladder diseases in clinic, such as obvious inflammatory manifestations, such as gallbladder effusion, gallbladder adenomyosis, gallbladder cholesterolemia, gallbladder neuroma and so on. Its clinical manifestations are similar to cholecystitis. If the symptoms are serious, cholecystectomy should also be done.
For acute and chronic cholecystitis, the currently available surgical methods are gallbladder-preserving lithotomy or cholecystectomy. If the gallbladder is found to be functional by preoperative examination, it should be preserved. Recently, it has been reported that gallstones (such as cholesterol supersaturation) are formed by lithogenic bile in the liver, so since 2007, minimally invasive gallbladder-preserving lithotomy has been carried out in China, mainly using choledochoscope to completely remove gallstones from the gallbladder. In 2009, Professor Zhang Baoshan of Peking University Hospital summarized the follow-up results and reported that this method had few postoperative complications and low recurrence rate of stones. The recurrence rate of different hospitals is between 2- 10%, which is equivalent to the recurrence rate of urinary calculi after treatment (2). In 2007 and 2009, two national conferences on minimally invasive stone extraction were held. Professor Qiu Fazu strongly supported this new operation and wrote? Attach importance to gallbladder function, give full play to gallbladder function and protect gallbladder existence? Inscription of. The advantages of this operation are: retaining the digestive function of gallbladder, preventing colon cancer caused by cholecystectomy and avoiding bile duct injury caused by cholecystectomy. At present, Shanghai Xuhui District Central Hospital is one of the first hospitals in China to carry out this operation, and has achieved good results. For atrophic gallbladder and gallbladder cancer, the gallbladder should be removed.
1, non-surgical therapy:
It can also be used as preoperative preparation, including: a. Bed rest, fasting and gastric tube decompression for patients with abdominal distension; B, fluid replacement to correct water, electrolyte, acid-base imbalance; C. relieving spasm and pain; D. Intravenous application of effective antibiotics, such as gentamicin, ampicillin, chloramphenicol, cephalosporin, etc. It is effective for 80% ~ 85% of early cases.
2. Surgical treatment
① Acute cholecystitis: Generally speaking, it is recommended to take active medical treatment 12 ~ 24 hours, and then choose surgery after the symptoms are relieved. At present, some hospitals have carried out emergency gallbladder-preserving surgery.
② Chronic cholecystitis: Minimally invasive gallbladder-preserving surgery is the first choice, and the gallbladder of very few patients has shrunk and become cancerous, so the gallbladder should be removed.
3. Comprehensive management
Low-fat diet, oral cholagogic drugs, such as magnesium sulfate, Xiaoyan cholagogic tablets, Qinggan cholagogic oral liquid, Baodanjin, etc. Ursodeoxycholic acid, chenodeoxycholic acid, Xiaoshi powder, etc. People infected with parasites should receive anthelmintic treatment.
(2) Prognosis
Serious complications and deaths caused by surgery are rare. The operative mortality of patients under 50 years old is about 0. 1%, and that of patients over 50 years old is 0.5%. Surgical death is common in patients who are considered to be at high risk before operation. In about 95% cases, symptoms can be relieved after operation.
Treatment of chronic cholecystitis with traditional Chinese medicine
1. Traditional Chinese medicine therapy:
Traditional Chinese medicine believes that chronic cholecystitis is mostly caused by liver and gallbladder stagnation and abnormal excretion. It should be treated by clearing the liver and benefiting gallbladder, soothing the liver and promoting qi, and regulating qi. Syndrome differentiation and dietotherapy in traditional Chinese medicine are generally divided into the following categories:
1) Diet stagnation type: mainly manifested as hypochondriac pain, fullness in the stomach, or nausea and vomiting, unpleasant stool, thick and greasy fur and slippery pulse. When regulating qi and promoting digestion and regulating stomach stagnation are the treatment methods, you can choose the following diet therapy.
1, hawthorn yam cake: hawthorn, yam, sugar. Peel hawthorn, steam with yam, cool, add white sugar, stir, and press into pancakes. The daily dosage is 1. 2. Dried ginger and pepper Amomum belly: 6 grams of dried ginger, 6 grams of pepper, 6 grams of Amomum villosum, 3 grams of cinnamon, 3 grams of dried tangerine peel, pork belly 1, and appropriate seasoning. Wash the pig's belly, wrap all the medicines in cloth, add water until the pig's belly is cooked, remove the residue and take the juice for drinking, take out the pig's belly and slice it, and take it with seasoning, 1 dose for 2 days.
2) Liver-qi invading the stomach type: mainly manifested as hypochondriac pain, epigastric fullness, abdominal distension pain, gas at room temperature, poor stool, emotional pain, thin and white tongue coating and thready pulse. When soothing the liver and regulating qi is the treatment method, you can choose the following diet therapy.
1. Chenpi areca: 20g Chenpi, 200mg areca, clove, cardamom and Amomum villosum 10g. Wash the medicine and put it into the pot. Add an appropriate amount of water, boil with strong fire, and then turn to slow fire for slow cooking; Boil until the liquid medicine is dry, turn off the fire and wait for it to cool. When the liquid medicine is cold, take out the betel nut and cut it into pieces the size of soybeans with a knife for later use. Eat a little after every meal.
2. Danshen Chicken Soup: 30g of Danshen, 0g of jujube10g, and 20g of frog. Wrap Salvia Miltiorrhiza with cloth, core jujube, peel frog and wash. Add water to stew until the frog is cooked, take out the medicine bag, and add salt and monosodium glutamate. And take 1 dose every day.
3) Stagnation of liver and stomach: mainly manifested as hypochondriac pain, fullness and burning pain in the upper abdomen, irritability, sour noise, dry mouth and bitter taste, red tongue with yellow coating, and thready or rapid pulse. When soothing the liver and clearing heat, promoting qi circulation and relieving pain are the treatment methods, you can choose the following diet therapy.
1. Fried shredded pork with burdock: burdock 10g, lean meat 150g, shredded carrot 100g, and proper amount of seasoning. Decocting Fructus Arctii with water, and collecting juice. Wash and shred pork and season with burdock juice and starch. Heat vegetable oil in the pot, stir-fry shredded pork, then add carrot H and seasoning, stir-fry until cooked, daily 1 dose.
2. Gold coin bamboo leaf porridge: 30g of gold coin grass, 0g of bamboo leaves10g, 50g of rice and proper amount of sugar. Select golden grass and bamboo leaves, put them into a pot, add appropriate amount of water, and soak for 5 ~ 10 minutes. Decoct with water to get juice, add rice to cook porridge, add sugar when cooked, and cook twice. Every day 1 dose.
4) Blood stasis block: mainly manifested as hypochondriac pain, local pain but refusal to press, epigastric pain, dark purple tongue and unsmooth pulse. When promoting blood circulation and removing blood stasis, regulating qi and relieving pain are the treatment methods, you can choose the following diet therapy.
1. hawthorn and notoginseng porridge: hawthorn 10g, notoginseng 3g, rice 50g, and proper amount of honey. Grind Radix Notoginseng into fine powder, first take Fructus Crataegi and rice, cook porridge, add Radix Notoginseng and honey when it boils, and cook until the porridge is cooked. Take it daily 1 dose, breakfast.
2. Figs, auricularia and red dates: 250g lean pork, 60g figs, 5 red dates, auricularia15g, and proper seasoning. Cleaning and slicing pork; Jujube is pitted; Wash the auricularia auricula, put it into the pot with figs, add water to boil, and then add onion, ginger, pepper, salt, etc. After monosodium glutamate is cooked, prepare 1 dose every day.
3. Peach-blossom cuttlefish: 6 grams of peach, 0/0 gram of angelica sinensis/kloc, 0/strip of cuttlefish/kloc, and proper amount of seasoning. The cuttlefish has its head and bones removed, washed, shredded, wrapped with peach kernel and angelica, boiled in water, and defoamed. Cook cuttlefish with slow fire until cooked, take out the medicine bag and season.
A folk prescription:
【 Syndrome Differentiation 】 Stagnation of qi in liver and gallbladder, accumulation of damp heat.
[Treatment] Soothing the liver, benefiting gallbladder, regulating qi and eliminating dampness.
Shugan Lidan decoction
[Composition] Radix Bupleuri 12g, Radix Paeoniae Alba 20g, Fructus Aurantii 10g, Radix Aucklandiae 10g, Rhizoma Corydalis 12g, Fructus Toosendan 15g, Herba Artemisiae Scopariae 30g, Radix et Rhizoma Rhei 6g (hereinafter), Herba Lysimachiae 30g and malt 30g.