Symptoms arise from contraction of the gallbladder during transient obstruction of the cystic duct by gallstones. Biliary pain usually is a steady ache in the epigastriumor right upper quadrant, which comes on quickly, reaches a plateau of intensity over a few minutes, and begins to subside gradually over 30 minutes toseveral hours. Referred pain may be felt at the tip of the scapula or right shoulder. Nausea and vomiting may accompany biliary pain, whereas fever, leukocytosis, and a palpable mass (signs of acute chole-cystitis) are not evident. Attacks occur at variable intervals (days to years). Other symptoms such as dyspepsia, fatty food intolerance, bloating and flatulence, heartburn, and belching may occur in patients with gallstones; however, they are nonspecific and frequently occur in individuals with normal gallbladders.

Gallstones can be best demonstrated by ultrasonography (sensitivity and specificity > 95%). Oral cholecystography (sensitivity 90%, specificity 75%) is reserved for ensuring cystic duct patency in patients whom dissolution therapy or ex-tracorporeal shock wave lithotripsy is planned.

Diagnosis in Traditional Chinese Medicine

Cholecystitis is categorized as " xie tong ", " Huang dan", etc.

1. Acute cholecystitis has an acute onset and persistent pain in the right upper quadrant radiating to the right shoulder accompanied with nausea, vomiting and fever. Jaundice may be present in some patients. Physical examination reveals prominent tenderness, rebounding tenderness and muscular tension in the right upper abdomen, sometimes the enlarged gallbladder is palpable.

2. Patients suffering from chronic cholecystitis usually have such chronic symptoms as discomfort in the right upper quadrant, vague pain, abdominal distension, aversion to greasy food, eruction and other dyspeptic manifestations. Physical examination may re-veal slight tenderness or no specific signs.

Differetiation and Treatment of Common Syndromes in Traditional Chinese Medicine

1. Damp-heat in the Liver and Gallbladder (frequently oc-curring in acute cholecystitis or in acute attack of chronic form) :

Clinical manifestations: Alternate spells of fever and chill or fever without chill, pain in the right upper abdomen or right ribs, poor appetite, bitterness in the mouth, even ac-companied with nausea and vomiting, constipation, deep-coloured urine, sometimes with jaundice, red tongue with yel-low and greasy fur, and taut rapid pulse.

Therapeutic method: Clearing away pathogenic heat and dampness, soothing the liver and normalizing the function of gallbladder.

Recipe: The combination of Oriental Wormwood Decoc-tion and Decoction of Gentian for Purging Liver-fire with addi-tional ingredfents.

Ingredients:

Herba Artemisiae Capillaris 12g
Fructus Gardeniae 9g
Radix et Rhizoma Rhei 15g
Radix Scutellariae 15g
Radix Bupleuri 15g
Radix Curcumae 30g
Flos Lonicerae 15g
Fructus Forsythiae 12g
Radix Gentianae 9g
Fructus Aurantii Immaturus 9g
Radix Aucklandiae 9g
Radix Glycyrrhizae 30g

Administration: All the above drugs are to be decocted in water to get 200-- 300ml of decoction. Take equal shares in the morning and in the evening.

Modification: For the case with high fever, add

Gypsum Fibrosum 30g
Radix Isatidis 30g

For the case with nausea and vomiting, add

Rhizoma Pinelliae 9g
Caulis Bambusae in Taeniam 9g

For the case with poor appetite, add

Endothelium Corneum Gigeriae Galli 9g
Fructus Crataegik 9g
Massa Fermentata Medicinalis 9g
Fructus Hordei Germinatus 9g