Gallbladder is the first of the six fu-organs, which belongs to strange and constant fu-organs. The gallbladder is connected with the liver and attached between the short lobes of the liver. The gallbladder meridian is connected with the liver meridian, which belongs to exterior and interior. Su Wen Ben Cao said that "gallbladder is the place of essence" contains clean liquid, namely bile, which directly contributes to the digestion of food and drink.

The physiological function of bile is to store and excrete bile. The metaplasia and excretion of bile are controlled and regulated by the catharsis function of the liver. It is produced by the essence of the liver, gathers in the gallbladder and excretes in the small intestine to help the digestion and absorption of food and drink. If the liver is not excreted smoothly, it will lead to abnormal bile production and excretion, affect the digestion and absorption of diet, and appear various dyspeptic symptoms, such as anorexia, abdominal distension, loose stool and so on. Bile overflow is jaundice, manifested as yellow eyes, yellow body and yellow urine.

Because the gallbladder meridian itself has no physiological function of transmitting diet and storing essence and juice, it is also a strange and unchanging viscera.

Bile is secreted by the liver. Traditional Chinese medicine believes that the gallbladder meridian is a meridian from head to toe. When bile is cold, it will often lead to poor meridians and directly affect the digestion of the human body. The place where gallbladder meridian is most vulnerable to cold is the outer thigh, and it is also the place where cold is most likely to accumulate. The gallbladder meridian at this time is the most convenient to beat, so it is suggested that it is best to develop the habit of lifelong pursuit, which can be completed in less than 10 minutes every day.

Gallstones include cholecystitis and gallstones.

Cholecystitis and cholelithiasis are two independent diseases, but they are often mutually causal and coexist. Its clinical manifestations are all characterized by epigastric pain, and there are many similarities in prevention and treatment, so it is discussed together. Cholecystitis is divided into acute and chronic. Acute cholecystitis may become chronic if it is not treated in time, and chronic cholecystitis often appears in the form of acute attack. Acute and chronic cholecystitis can be complicated with cholelithiasis, which leads to biliary obstruction and gallbladder infection on the basis of bile retention. This disease belongs to the categories of chest pain, hypochondriac pain, jaundice and jaundice addiction in traditional Chinese medicine.

Prevention before illness.

Maintaining a good mood and avoiding depression is an important prerequisite for preventing this disease. According to clinical observation, most patients have a history of emotional disorders before they get sick.

Eat well and avoid greasy, fatty, sweet and cold food. Eat more fresh vegetables, fruits and nutritious and digestible foods.

When intestinal parasites, especially ascaris lumbricoides, appear, they should be actively treated to avoid retrograde infection.

Thoroughly treat inflammation of adjacent organs and prevent inflammation from spreading and spreading to biliary tract.

Middle-aged women and obese people should strengthen physical exercise, lose weight reasonably, strengthen their physique and prevent problems before they happen.

Prevention and change of diseases

After the illness, in addition to the pain in the right upper abdomen, it mainly affects the digestive function, manifested as loss of appetite and so on. Delayed for a long time, physical decline, and even gallbladder colic and other dangerous diseases due to incarceration of stones, should be thoroughly treated as soon as possible. People who are already ill should follow the above preventive measures and take medicine actively. When acute cholecystitis occurs, it should be treated thoroughly. After the clinical symptoms disappear, you still need to take the medicine for a week to avoid prolonged treatment.

(A) Chinese medicine treatment

1. Intermittent dull pain in the right upper abdomen, abdominal distension, frequent fever, loss of appetite, red tongue, thin and white fur, and thready pulse are manifestations of stagnation of liver qi. It is advisable to soothe the liver and relieve depression, promote gallbladder function and relieve pain. Prescription Qingdan Decoction: Bupleurum 10g, Coptidis Rhizoma 10g, Pinellia ternata 10g, Fructus Aurantii 10g, Radix Curcumae 10g, Rhizoma Corydalis 10g, and Fructus Toosendan 10g.

2. Abdominal pain in the right upper abdomen is severe, with obvious tenderness, fever and aversion to cold, bitter taste in the mouth and dry throat, nausea and vomiting, loss of appetite, yellow skin, constipation, Huang Chi in urine, red tongue, yellow greasy fur, slippery pulse, mainly damp-heat accumulation, excess heat in the liver and gallbladder, so it is advisable to clear away damp-heat. Prescriptions of Qingdan Lishi Decoction: Bupleurum 10g, Coptidis Rhizoma 10g, Pinellia ternata 10g, Radix Aucklandiae 10g, Radix Curcumae 10g, Semen Plantaginis 10g and Caulis Akebiae 10g.

3. Persistent severe pain in the right upper abdomen, obvious tenderness and rebound pain, persistent high fever or frequent cold and heat, yellow staining all over the body, constipation, short and red urine, dark as tea, crimson tongue, yellow rough or prickly fur, and slippery or thin pulse. Even people who are delirious and have cold limbs are hot and humid, and hot poison invades them. It is advisable to soothe the liver and regulate qi, dredge damp-heat, and clear away heat and toxic materials. Prescriptions of Qingdan Xiehuo Decoction: Bupleurum 15g, Scutellaria baicalensis 15g, Polygonum cuspidatum 15g, Pinellia ternata 10g, Gardenia 10g, Radix Aucklandiae 10g, and Radix Curcumae 10g.

"general attack" therapy

This method is a combination of traditional Chinese and western medicine. Here are some examples:

Tong Dan Paishi Decoction: Herba Lysimachiae Christinae 30g, Herba Artemisiae Scopariae 30g, Lygodium japonicum 30g, Radix Curcumae 15g, Fructus Aurantii 12g, Radix Aucklandiae 12g, Radix et Rhizoma Rhei 10 ~ 15g, and Fructus Gardeniae 15g.

General attack plan: 2 ~ 3 times a week, 6 ~ 7 times as a course of treatment.

Examples of drugs and time are as follows:

This method is a combination of traditional Chinese medicine and the best treatment for gallstones. The transverse diameter of the stone is not more than one centimeter and the diameter is not more than three centimeters. In most cases, stones can be discharged. Here are some examples:

Time therapy measures

A pair of Paishi Soup (300 ml thick soup) was taken orally at 7: 30.

At 8: 30, morphine 5mg was injected subcutaneously (not needed during the attack of biliary colic).

9: 10 atropine 0.5 mg subcutaneous injection.

9: 15 33% magnesium sulfate 40ml, oral.

9: 20 0.5% dilute hydrochloric acid 30 ml, oral.

9: 25 fat meal (2 ~ 3 fried eggs or 3 fats).

9: 30 electroacupuncture at You Danshu (cathode), Ermen or Taichong (anode).

(3) Acupuncture therapy

Acupoints such as gallbladder, Zusanli, Zhongyu, Yanglingquan, Danshu, Taichong and Zhigou were selected, and the methods of strong stimulation and purgation were adopted. Ear acupoints are Shenmen, Sympathy, Gallbladder, Pancreas and Duodenum. Take 2-3 acupoints on each side, and twist the needle with moderate and strong stimulation for 20-30 minutes.

(4) Single prescription

1 .30g of Radix Isatidis, dandelion15g, Herba Artemisiae Scopariae15g, 9g of Radix et Rhizoma Rhei (below), 9g of Scutellariae Radix, 9g of Cortex Phellodendri, 6g of Magnolia Officinalis and 9g of Natrii Sulfas (orally) once a day.

2. Platinum pills, 3g in the morning or 9g in the evening, 10 to 30 days, one course of treatment.

(5) Gravel

If the diameter of gallstones is greater than 1.0 cm, and it is difficult to discharge them, they can be crushed with a stone crusher and then discharged with a stone crusher. Most patients are satisfied with the curative effect.

(6) Operation

After the above treatment, there is no obvious curative effect, so it should be cured by surgery.

gallbladder polyps

Gallbladder polyp is the name of morphology, which generally refers to the lesions protruding or protruding into the gallbladder cavity. Pathologically, it can be divided into 1, adenoma, adenocarcinoma and other redundant polyps; 2. Non-redundant polyps, such as cholesterol polyps, inflammatory polyps and adenomyosis. Because the nature of gallbladder polyp is difficult to be diagnosed before operation, it is collectively called polypoid lesion of gallbladder. Cholesterol polyp is cholesterol crystal deposition on the surface of gallbladder mucosa; Inflammatory polyp is the hyperplasia of gallbladder mucosa, multiple, often less than 65438±0cm in diameter, often accompanied by gallbladder stones and cholecystitis. Adenomyosis of gallbladder is a proliferative lesion of gallbladder. If it is localized, it is similar to a tumor, but benign.

Most of this disease is found by ultrasound during physical examination, and it is asymptomatic. A few patients may have pain in the right upper abdomen, nausea and vomiting, and changes in appetite. And the physical examination may have tenderness in the right upper abdomen. The diagnosis depends on conventional ultrasound, endoscopic ultrasound and spiral CT.

Treatment principle of gallbladder polyps: gallbladder polyps are mostly benign lesions. A small number of gallbladder polyps may be early cancer or canceration, and the risk factors that can be regarded as malignant lesions are as follows: diameter over cm, age over 50 years old, single lesion, polyps gradually increasing, and gallbladder stones should be actively operated. The main surgical methods are laparoscopic cholecystectomy (LC), small incision cholecystectomy (MC) and open cholecystectomy (OC).

At present, the treatment of gallbladder polyps in western medicine is mainly surgical treatment. However, there are two problems in surgical treatment; One is intraoperative complications, such as extrahepatic bile duct injury, blood vessel injury, organ injury and so on. No matter what kind of complications, once they occur, they may lead to serious consequences. Second, surgical treatment only focuses on the focus, not the cause, and cannot fundamentally solve the problem. Call it a temporary solution, not a permanent cure.

Treating both symptoms and root causes is one of the advantages of traditional Chinese medicine in treating gallbladder polyps. Especially in recent years, Chinese medicine has carried out prospective and multi-channel clinical research on the treatment of gallbladder polyps, and the curative effect has been further improved. Traditional Chinese medicine is welcomed by many patients because it can regulate the function of human viscera and treat the etiology, and will not cause drug dependence, let alone iatrogenic diseases.

The following is an interview with CCTV:

CCTV International March 2004 12 16: 10

1, Professor Wang Qiusheng, chief physician of minimally invasive surgery in Peking University People's Hospital, a famous laparoscopic surgeon, engaged in clinical and pathological research of gallbladder polyps 15, accumulated more than 600 cases of gallbladder polyps, published more than 80 papers and edited more than 20 academic monographs. (Left)

2. Professor Zhang Zheng, chief physician of the Department of Gastroenterology, Peking University People's Hospital, and member of the Standing Committee of Chinese Medical Laboratory Society, studied in the Asian Liver Disease Center of Tokyo Institute of Clinical Medicine for many years, engaged in laboratory diagnosis of microorganisms and infectious diseases, published more than 80 papers, and won the science and education award from the Ministry of Health and the Municipal Health Bureau. (right)

Moderator: Hello, audience friends! This is CCTV's live program "The Road to Health". Today we are going to talk about gallbladder polyps.

Reporter: Mr. Yang Jixiang is a retired cadre, and his health has always been particularly tough, but a physical examination in 2000 broke the quiet life of Lao Yang.

Patient: A gallbladder polyp of 0.9 cm was found in physical examination (B-ultrasound). I'm worried that polyps are the tumors in my memory. Tumors are divided into benign and malignant, so I naturally thought of whether it was cancer or not.

Reporter: In fact, there are many people who are diagnosed with gallbladder polyps like Uncle Yang every year. According to statistics, there are about 50 million patients with gallbladder polyps in China, accounting for about 5% of our population.

Patient with gallbladder polyp: I know what's in the gallbladder. I heard that a single one seems to be more dangerous, but many don't seem to be terrible.

Patient: To tell you the truth, I'm afraid of the possibility of pathological changes.

Patient: I'm not worried. I believe it will be fine.

Wang Qiusheng: First, let's look at the anatomical position of the gallbladder. Gallbladder is like a green gourd hanging on a gall tree. So what is gallbladder polyp? As we all know, some people will grow some fleshy growth on their skin. If this fleshy growth grows in the gallbladder cavity, then we call it gallbladder polyp.

Zhang Zheng: This kind of polyp is called gastric polyp if it grows in the stomach, and colon polyp if it grows in the intestine. This polyp can grow in many organs.

Moderator: What exactly is gallbladder polyp?

Wang Qiusheng: After cutting open the gallbladder, you can see the dense gallbladder vegetation. It can also be clearly seen from the B-ultrasound that this polyp can be very small, even as small as 1mm or 3-4cm. The bigger the polyp, the greater the possibility of real tumor and cancer.

Moderator: What are the uncomfortable feelings after getting gallbladder polyps? Let's listen to the patient's feelings:

Patient (Yang Jixiang): I have had heart disease since I was diagnosed with gallbladder polyp in 2000, but I don't feel anything, so I don't care if it hurts or not. I didn't care until 2002.

Reporter: But in the following years, the original gallbladder polyp of 0.9 cm has changed obviously.

Patient: in 200 1 year, it was 1. 1 cm, and in 2002 it was 1.5 cm. Later, the doctor suggested re-examination. If I continue, he suggested that I have an operation. At the beginning of 2003, I went to the People's Hospital for reexamination, and it grew again, reaching 2. 1 cm.

Reporter: In March 2003, Lao Yang began to feel unwell.

Patient: When it grows to 2. 1 cm, there will be electric pain in this area of the liver. I'm afraid it will affect the liver.

Reporter: It is also a gallbladder polyp found in the investigation, but everyone's physical reaction is different.

Patient: You can eat while eating, but your appetite is not very good. Then there is discomfort after meals, especially in the right upper abdomen.

Reporter: Lao Yan's condition is more prominent among patients with gallbladder polyps, so he took many detours.

Patient Lao Yan: I have a stomachache. The whole area is like a minefield. I feel pain and irritability. After going to the hospital, it is either gastritis or enteritis. In any case, it is not well diagnosed.

Reporter: It was not until Lao Yan got gallbladder polyps last year that he realized that his stomach pain for many years was actually caused by gallbladder polyps.

Patient: Now I know that it is courage to relieve pain.

Moderator: Why do patients with gallbladder polyps feel different?

Zhang Zheng: This is related to the specific location of gallbladder polyps and whether there are other diseases in the surrounding organs.

Clinical manifestations of gallbladder polyps

1, no symptoms were found in the physical examination by B-ultrasound.

2. Nonspecific gastrointestinal symptoms

3. Typical biliary symptoms

The third situation is the real symptom of biliary tract. Generally speaking, it is a little pain in the right upper abdomen and radiates to the back. Others are typical, and the pain symptoms get worse after eating greasy food. In the worst case, it will spread to some surrounding organs. If gallstones are complicated with cholecystitis, symptoms of cholecystitis will often appear, leading to biliary colic. In addition, sometimes spread to the pancreas, there will be pain in the left middle back, which is heavier.

Compere: Is there jaundice?

Zhang Zheng: There is such a situation. Three years ago, I saw a patient with jaundice in the gastroenterology department, from Henan. There was no liver disease at that time, and later further examination proved that it was gallbladder cancer. Then when asked about the medical history, the patient said that he had gallbladder polyps 10 years ago. The next year, the doctor asked for a reexamination, and he also went. there will be no changes. I forgot after retirement, and now it has developed into gallbladder cancer. Gallbladder polyps generally require examination once every six months. If some symptoms of patients get worse within half a year, they should be examined in detail in time.

Moderator: Is it possible for gallbladder polyps to become cancer?

Wang Qiusheng: About 1%- 10% of patients with gallbladder polyps will become cancerous. Gallbladder polyps are small warts in the gallbladder cavity. The official scientific name should be polypoid lesion of gallbladder, covering nearly 20 kinds of lesions.

Pathological classification of gallbladder polyps

1, true tumor: more than ten kinds of lesions such as adenoma.

2. Pseudotumor: 10 cholesterol polyp, adenomyoma and other pathological changes.

This has also brought some problems to many interns and patients in clinic. In the face of such uninvited guests detected by B-ultrasound, how should we judge whether they are benign or malignant? In addition, the imaging situation also includes early gallbladder cancer. Therefore, it is a state of true and false tumors, benign and malignant coexistence. In this way, after years of research, we put forward a clinical classification method.

Clinical classification of gallbladder polyps

Category I: Cholesterol polyp

The second category: benign non-cholesterol polyps.

Class ⅲ: early polypoid gallbladder carcinoma.

Everyone is most concerned about the third kind of early polypoid gallbladder cancer, although it only accounts for about 15%, but once it is found, it should be operated as soon as possible and radical surgery should be carried out. The first type accounts for a large proportion, about 60%, and will not become malignant. Most patients have good gallbladder function and few clinical symptoms. Most patients only need follow-up observation, and once symptoms appear, they can turn to surgery. In addition, the rest of the lesions were classified into the second category. This kind of disease is more complicated. Most patients have certain symptoms, and some have precancerous lesions. Patients have the necessity of surgery and can choose surgery.

Moderator: What factors have led to the formation of these different categories?

Wang Qiusheng: At present, the cause of the first type of cholesterol polyp is quite clear, which is caused by the disorder of cholesterol metabolism in the liver. In addition, we have a scoring table of four cancer risk factors that cause cancer polyps.

Risk factors and scoring table of gallbladder polyp carcinoma

Age (years)

Polyp size (mm) times 4

Neck (42)

The bottom (28) of the polyp site

Text (14)

Cholelithiasis has (27)

None (0)

Moderator: So what is the number of patients in Lao Yang?

Wang Qiusheng:

Mr. Yang's B-ultrasound data score

Age (years) 66 years 66 minutes

Polyp size 15cm times 4 60 points.

The polyp is located at 42 points in the neck.

Gallstones have no score of 0.

Wang Qiusheng: The total score of Lao Yang is 168. Through our analysis, the value is 145, and Lao Yang's score exceeds this score, so the possibility of malignancy is greater than 90%.

Moderator: How to judge that the patient's gallbladder polyp has reached the point where surgery is needed,

Zhang Zheng: Which gallbladder polyps need surgery?

1, symptomatic gallbladder polyp

2. Polyps larger than 10 cm.

3. Polyps are located in the neck of gallbladder.

This patient is over 50 years old.

5. Patients with gallstones and cholecystitis

Moderator: Let's take a look at Lao Yang's surgery:

Lao Yang: I'm afraid I can't get off the operating table because I'm a little old and I'm under general anesthesia. Before the operation, the doctor said to reassure me that there would be no problem.

Wang Qiusheng: First, we make four small incisions on the patient's abdominal wall, and then put the puncture instrument in. We can clearly see through the laparoscope inserted from the navel that we can perform a good resection. At present, the amount of surgical bleeding is less than 3-5 ml.

Moderator: How about recovery after the operation?

Wang Qiusheng: The patient's postoperative wound is very small, and it is usually difficult to trace it after three months to six months. As shown in the figure, compared with the current laparoscopic surgery, the traditional open surgery has a large opening, a large scar and a slow postoperative recovery. On the second day after laparoscopic surgery, you can go to the ground and eat something (liquid food, water, rice, etc. ).

Moderator: For those patients who don't need gallbladder polyp surgery, what kind of treatment methods will they generally consider?

Zhang Zheng: Generally speaking, people who don't have any symptoms don't need to take medicine, just have regular checkups. If you have digestive tract symptoms, you can treat them symptomatically. For example, if the stomach is uncomfortable, you can take some gastritis-related drugs.

Moderator: Is it possible to prevent gallbladder polyps from becoming malignant?

Zhang Zheng: Generally speaking, prevention is very difficult, but in some cases, we should attach great importance to it, such as patients with liver disease and patients with elevated cholesterol. These people should pay special attention, go to the hospital for physical examination regularly, and find and treat them in time.

Moderator: Ms. Huang from Inner Mongolia, 52 years old. I am a hepatitis B patient, and I found gallbladder polyps the year before last. I have 3 polyps and 2 stones recently. Can I treat it by laparoscopy?

Wang Qiusheng: Yes. The patient's liver function has been damaged. It should be said that most patients have cholesterol polyps, depending on whether there are symptoms. If it affects their lives, they can consider surgery. We have a set of instruments specially designed for the operation of anti-positive patients in Australia.

Moderator: Mr. Dai, from Anhui, aged 63. Three years ago, B-ultrasound showed gallbladder polyps, the size of broad beans, and the body felt nothing. Do I need treatment?

Wang Qiusheng: Polyps the size of broad beans are very big. Even if there are no symptoms, we recommend the patient to have surgery, depending on the size and location. If cancer is highly suspected, we advise patients to treat it with a very positive attitude and have surgery as soon as possible.