CLINICAL APPLICATIONS

* Cholelithiasis ¡V gallstones

* Cholecystitis ¡V inflammation of the gallbladder and bile duct

* Other liver and gallbladder conditions: cholestasis, bile stasis, biliary sludge

 

WESTERN THERAPEUTIC ACTIONS

* Dissolves and drains stones

* Cholagogic effect to promote bile flow and prevent biliary stasis and sludge

* Antihyperlipidemic function to treat and prevent cholesterol-type gallstones

* Reduces inflammation of the gallbladder and bile duct

 

CHINESE THERAPEUTIC ACTIONS

* Dissolves gallstones

* Facilitates the passage of gallstones

* Spreads Liver qi

* Clears damp-heat

 

DOSAGE

Take 4 capsules three times daily on an empty stomach with warm water. Dissolve (GS) must be taken continuously for at least three months. In cases of multiple or large stones, the treatment should be continued until the stones are dissolved or passed out. In cases where the patient feels severe discomfort, pain or sensation of obstruction after taking the herbs, reduce the dosage as they may be signs that the big stones are becoming obstructed. In such cases, reduce the dosage to a level comfortable to the patient and stretch the treatment period so the stones can be dissolved and flushed slowly. Dissolve (GS) can also be taken after surgery to prevent formation of new stones. In such cases, take 2 capsules a day for three months and 1 capsule per day for another six months.

 

INGREDIENTS

Da Huang (Radix et Rhizoma Rhei)

Hai Jin Sha (Spora Lygodii)

Jin Qian Cao (Herba Lysimachiae)

Li Zhi He (Semen Litchi)

Long Dan (Radix et Rhizoma Gentianae)

Wei Ling Xian (Radix et Rhizoma Clematidis)

Yin Chen (Herba Artemisiae Scopariae)

Zhi Qiao (Fructus Aurantii)

 

BACKGROUND

Cholelithiasis and cholecystitis are two of the most common disorders affecting the gallbladder and the bile duct. Signs and symptoms of cholelithiasis and cholecystitis include fullness and pain in the right hypochondriac region, low-grade fever, constipation and leukorrhea. Acute onset is characterized by jaundice, severe colicky pain in the upper right quadrant that may radiate to the right shoulder and back, nausea, vomiting, aversion to oily and greasy foods, lack of appetite, anxiety and related symptoms. Diagnostic signs and symptoms include a positive response to Murphy¡¦s sign and tenderness at the inferior right scapula.

 

FORMULA EXPLANATION

The fundamental etiology of cholecystitis and cholelithiasis is damp-heat. Cholecystitis is characterized by damp-heat in the Gallbladder and cholelithiasis is characterized by damp-heat drying up fluids in the Gallbladder.

        Long Dan (Radix et Rhizoma Gentianae) enters the Liver and the Gallbladder to clear damp-heat. Yin Chen (Herba Artemisiae Scopariae), an empirical herb for treating hepatic and gallbladder disorders, has a cholagogic function that increases the secretion of bile and the excretion of bile salt and bilirubin. It also lowers serum cholesterol and beta-lipoprotein. Jin Qian Cao (Herba Lysimachiae) dissolves gallstones and increases the secretion of bile by the liver cells. Wei Ling Xian (Radix et Rhizoma Clematidis) unblocks the channels and helps to dissolve stones. Li Zhi He (Semen Litchi) relieves abdominal and epigastric pain due to Liver qi constraint. Zhi Qiao (Fructus Aurantii) unblocks qi obstruction and facilitates the passage of gallstones. Hai Jin Sha (Spora Lygodii) transforms hardness and dissolves stones. Da Huang (Radix et Rhizoma Rhei) lowers cholesterol and eliminates damp-heat accumulation by its purgative action.

 

CAUTIONS & CONTRAINDICATIONS

* This formula is contraindicated during pregnancy and nursing.

* Regardless of size and number of stones, surgery may be the treatment of choice for the following conditions:

¡± acute onset with severe colic

¡± sudden deterioration in the overall health of the patient

¡± sudden deterioration in cholecystitis or cholelithiasis

¡± poor results from previous treatments and initial signs of liver damage

* The following warning statement is required by the State of California:: ¡§This product contains Da Huang (Radix et Rhizoma Rhei). Read and follow directions carefully. Do not use if you have or develop diarrhea, loose stools, or abdominal pain because Da Huang (Radix et Rhizoma Rhei) may worsen these conditions and be harmful to your health. Consult your physician if you have frequent diarrhea or if you are pregnant, nursing, taking medication, or have a medical condition.¡¨

 

CLINICAL NOTES

* Cholelithiasis is the presence of gallstones, which are formed as a result of cholesterol and pigments in bile bind to each others. While most gallstones are asymptomatic, some may cause symptoms such as biliary colic, and complications such as cholecystitis, biliary tract obstruction, cholangitis, and gallstone pancreatitis. Successful treatment of cholelithiasis requires dissolution and draining of gallstones, alleviation of the symptoms and complications, and prevention of future gallstones.

* Cholecystitis and cholelithiasis commonly occur simultaneously. They are most commonly seen in women over 30 to 40 years of age, and in individuals who are obese. Often times they are un-diagnosed or mis-diagnosed as gastritis, peptic ulcers, viral hepatitis, angina or acute pancreatitis. X-ray results are not always accurate. Ultrasound of the gallbladder is more reliable and has approximately 90 to 95% accuracy. Conditions most suitable for Chinese herbal treatment include chronic cholecystitis, the presence of gallstones in the liver, gallstones composed primarily of calcium, small gallstones, and the presence of gallstones after removal of the gallbladder. Ideal candidates for herbal treatment are individuals who are asymptomatic with stone(s) less than 30 mm in diameter. Elderly or weak patients not suitable for surgical treatment can also benefit from Chinese herbal treatment.

* Individuals with high risk of developing cholecystitis or gallstones will benefit from prophylactic treatment by taking Dissolve (GS) on a preventative basis. Risk factors of cholecystitis or gallstones include the four F's: female, fair, fertile, and fat.

* Ultrasound should be performed prior to using herbs so the size of the stones can be determined. Non-aggressive dosing of herbs is optimal in cases of large stones. Never prescribe a high dose of herbs to flush large stones as it may result in obstruction, which may then require immediate surgical intervention.

* Dissolve (GS) is an herbal formula developed by Professor Xiao-Ping Zhang of Anhui Hospital of Traditional Chinese Medicine. Dissolve (GS) is an empirical formula designed to treat cholecystitis and cholelithiasis. It has been used for over 30 years in China and has helped several thousand patients with cholecystitis and cholelithiasis. It is imperative, however, that patients comply with instructions and continue to take the herbal formula for at least three months for optimal results.

 

Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:

* Bird¡¦s beak / pen tip pulse, a convex-shaped pulse that is approximately 0.1 cm in length that feels like a pen¡¦s tip, on the deep level of the left guan.

 

SUPPLEMENTARY FORMULAS

* For hepatitis, jaundice, or high liver enzyme levels, combine with Liver DTX.

* For constipation, combine with Gentle Lax (Excess).

* With blood stagnation, add Circulation (SJ).

* With excess heat, add Gardenia Complex.

* With prominent signs and symptoms of Liver fire or damp-heat in the Liver and Gallbladder, combine with Gentiana Complex.

* To reduce blood cholesterol and triglyceride levels, use Cholisma.

* To reduce cholesterol and triglyceride levels in individuals with fatty liver and obesity, use Cholisma (ES).

* For peptic ulcers or gastritis, combine with GI Care.

* For severe pain, use with Herbal ANG.

* For bloating and distension, add GI Harmony.

* For angina or chest pain, combine with Circulation.

* For excess damp and phlegm in the body, add Pinellia Complex.

* For obese patients with an excess appetite, add Herbalite.

* For diabetes mellitus and high blood glucose, add Equilibrium.

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Zulinqi (GB 41), Zhigou (TH 6), Dannangxue, Zusanli (ST 36), Zhangmen (LR 13), Qimen (LR 14), Ganshu (BL 18), Danshu (BL 19), Zhongwan (CV 12)

 

Classic Master Tung's Points:

* Gallstones: Huozhi (T 88.15), Tianhuang (T 88.13), Minghuang (T 88.12), Qihuang (T 88.14), Muzhi (T 1010.18), Makuaishui (T 1010.14), Yizhong (T 77.05), Erzhong (T 77.06), Sanzhong (T 77.07), Tianhuang (T 77.17), Dihuang (T 77.19), Renhuang (T 77.21), Ganmen (T 33.11). Bleed Majinshui (T 1010.13), Makuaishui (T 1010.14) or dark veins nearby. Bleed before needling for best result.

* Cholecystitis: Huozhi (T 88.15), Tianhuang (T 88.13), Minghuang (T 88.12), Qihuang (T 88.14), Muhuang (T 88.47)*, Ganmen (T 33.11), Changmen (T 33.10), Waisanguan (T 77.27), Muzhi (T 1010.18), Huoying (T 66.03), Huozhu (T 66.04), Sansheng (T 55.07)*, Huoquan (T 88.16). Bleed tender points on the LR area in the back with cupping. Bleed before needling for best result.

 

Master Tung¡¦s Points by Dr. Chuan-Min Wang:

* Gallstones: Qihuang (T 88.14), Huozhi (T 88.15), Huoquan (T 88.16)

 

Balance Method by Dr. Richard Tan:

* Left side: Hegu (LI 4) or ah shi points nearby, Sanyangluo (TH 8) or ah shi points nearby, Zhongdu (LR 6) or ah shi points nearby

* Right side: Yanglingquan (GB 34) or ah shi points nearby, Yangjiao (GB 35) or ah shi points nearby, Quze (PC 3) or ah shi points nearby

 

Ear Acupuncture:

* Pancreas, Gallbladder, Duodenum, Liver. Use ear seeds.

* Alternate sets between ears every seven days and instruct the patient to massage the points several times a day. Strongly stimulate the points or use electric stimulation.

¡± Set 1: Shenmen, Abdomen, Endocrine, Gallbladder

¡± Set 2: Liver, Adrenal Gland, Upper Abdomen, Shoulder

* On the right ear, needle Shenmen towards the Abdomen, Sympathetic, Gallbladder. Needle 0.2 mm below the Gallbladder towards the Duodenum.

* On the left ear, needle Gallbladder towards the Duodenum.

 

Auricular Medicine by Dr. Li-Chun Huang:

* Gallstones: Sympathetic, San Jiao, Digestive Subcortex, Gallbladder, Gallbladder Node of the Posterior, Bile Duct, Duodenum

* Cholecystitis, cholangitis: Bile Duct, Liver, Duodenum, Stomach, Spleen, San Jiao, Endocrine, Gallbladder (Front and Back), Digestive Subcortex

* Improving the function of gallbladder: Gallbladder, Duodenum, San Jiao, Spleen, Digestive Subcortex, Upper Back and Shoulder, Gallbladder Area of Posterior, Bile Duct, Stomach, Liver, Endocrine

 

NUTRITION

* For patients with cholecystitis, advise against eating solid foods for a few days. They should drink distilled water and fresh juices. Liquid foods can be introduced slowly after three or four days.

* For patients with gallstones, advise taking three tablespoons of olive oil with lemon juice before going to bed and upon awakening. Small gallstones can sometimes be passed and eliminated with this method. Ultrasound should be performed prior to using this method to prevent large stones from obstructing the bile duct which may then require immediate surgery.

* Increase the consumption of applesauce, yogurt, fresh apples, and beets.

* Avoid eating red meat, shrimp, lobsters, oysters, fatty or greasy foods, fried foods, spicy foods, margarine, soft drinks, commercial oils and processed foods.

* Food allergies can cause inflammation and obstruction of the bile duct. Avoid foods that commonly cause gallbladder disorders, such as eggs, pork, onion, fowl, milk, coffee, and citrus fruits.

 

The Tao of Nutrition by Dr. Maoshing Ni and Cathy McNease:

* Recommendations: corn silk, water chestnuts, seaweed, beet tops, watermelon, celery, watercress, winter melon, pearl barley, walnuts, watermelon rind, winter melon rind, green tea powder, and distilled water.

* Drink watermelon juice.

* Drink celery, carrot, and water chestnut juice.

* Drink corn silk tea for water; three to five glasses daily.

* Drink tea from beet tops, winter melon rind, and watermelon rind.

* Take two teaspoons ground walnuts in corn silk tea.

* Take one teaspoon green tea powder in warm water three times daily.

* After consuming any of the above diuretics remedies, do some mild jumping exercise to help loosen up the stones.

* Avoid spicy foods, fried foods, oily foods, coffee, hard water, spinach, citrus, tomatoes, spinach combined with tofu or dairy products.

 

LIFESTYLE INSTRUCTIONS

* Individuals with gallbladder colic should fast, keep warm, and rest in bed.

* Detoxification of liver and colon are helpful for long-term management.

* Sitz bath is helpful to decongest and detoxify the intestines.

 

CASE STUDIES

* S.T., a 54-year-old female, presented with complaints of waking at 3:00 a.m., feeling cold easily, craving sweets, overweight, and hot flashes in the morning. Her blood pressure was 125/80 mmHg and her heart rate was 75 beats per minute. Her lab report revealed gallstones and elevated liver enzymes. The TCM diagnosis was cold and damp in the Spleen with Spleen deficiency, and damp-heat in the Liver. Dissolve (GS) was prescribed at 12 grams a day for a week. The patient reported she passed two gallstones, which were recovered, through the stool. The practitioner concluded that patients with gallstones should take Dissolve (GS) prior to considering surgery because it is less invasive and less expensive. Submitted by S.C., Colonie, New York.

* J.J., a 55-year-old female patient, presented with right upper quadrant stomach pain. After visiting the Urgent Care it was confirmed that she had three gallstones present, 2 to 4 cm each. It was suggested by the Western doctor that she remove them with surgery. After discussing with the patient about trying an herbal formula before two weeks prior to receiving surgery, she was prescribed Dissolve (GS). The patient was directed to take 5 capsules three times daily until her pain was gone. Once the pain subsided, she was told to continue for two more weeks at 5 capsules two times daily. Following three days of taking the herbs, the patient¡¦s symptoms of nausea, acid feeling in the throat, and right upper quadrant pain were resolved. Ten days after taking the formula she felt 100% better, followed by her visit to her primary care physician confirming that there were no gallstones anywhere via ultrasound. The patient has not had a recurrence since. Submitted by B.W., St. Helens, Oregon.

* A 51-year-old female housekeeper presented with pain in the upper right quadrant of the abdomen within the gallbladder region. The practitioner diagnosed the condition as damp-heat in the Gallbladder. After taking Dissolve (GS) for a period of nine months, there was a complete cessation of upper right quadrant pain. Submitted by D.K., Forestville, California.

* C.B., a 72-year-old female, presented with gallstones, pain under the right ribcage, poor digestion, and pain in the right shoulder. Her blood pressure was 180/95 mmHg and the heart rate was 85 beats per minute. Ultrasound was performed to confirm the stones. The Western diagnosis was gallstones and high cholesterol. The TCM diagnosis was damp-heat accumulation with Liver qi stagnation. She was prescribed Dissolve (GS) at 4.5 grams daily and Cholisma at 1.5 grams daily. The patient also received acupuncture. After eight weeks, the patient reported the pain in the right shoulder had improved fully. Digestion was much better with no more bloating or constipation. Submitted by W.F., Bloomfield, New Jersey.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Dissolve (GS) is formulated to treat cholelithiasis (gallstones) and cholecystitis (inflammation of the gallbladder and bile duct). It contains many herbs with significant effects to dissolve and drain the gallstones, reduce inflammation of the gallbladder and bile duct, and relieve pain.

        Pharmacologically, Jin Qian Cao (Herba Lysimachiae) has a cholagogic effect that increases the production and excretion of bile acid, which in turn help to resolve the current gallstones and prevent the formation of new ones.[1] Long Dan (Radix et Rhizoma Gentianae) and Da Huang (Radix et Rhizoma Rhei) also have marked cholagogic activities when administered via oral ingestion or intravenous injection.[2]^,[3] Yin Chen (Herba Artemisiae Scopariae) has a stimulating effect on gallbladder function, as the use of this herb is associated in the flow of bile to prevent biliary stasis and sludge.[4] Clinically, oral administration of Wei Ling Xian (Radix et Rhizoma Clematidis) in decoction showed 87% effective in treating 120 patients with cholelithiasis.[5]

        Dissolve (GS) also contains many herbs to treat the symptoms and complications of gallstones. Da Huang (Radix et Rhizoma Rhei), Wei Ling Xian (Radix et Rhizoma Clematidis) and Yin Chen (Herba Artemisiae Scopariae) all have significant anti-inflammatory effects to reduce inflammation and relieve pain. Da Huang (Radix et Rhizoma Rhei) shows a significant anti-inflammatory effect via inhibition of inducible nitric oxide synthase.[6] Wei Ling Xian (Radix et Rhizoma Clematidis) exhibits its anti-inflammatory effect by blocking the production of the pro-inflammatory mediators, nitric oxide and prostaglandin E(2).[7] The essential oils of Yin Chen (Herba Artemisiae Scopariae) show significant anti-inflammatory effect by blocking the expression of cyclo-oxygenase-2 and inhibiting the production of inflammatory mediators, such as nitric oxide and prostaglandin E(2).[8] Clinically, one study showed that ten patients with acute cholecystitis were treated with marked success using Da Huang (Radix et Rhizoma Rhei). The clinical signs and symptoms were resolved after an average of 2.3 days, the patients¡¦ temperature returned to normal after 2 days, and the WBC count returned to normal after 3.4 days. The treatment protocol was to administer 30 to 60 grams of Da Huang (Radix et Rhizoma Rhei) decoction every 1 to 2 hours until the abdominal pain was resolved. Another clinical study reported complete recovery in all 41 cases of acute cholecystitis using the following formula in decoction three times daily: Da Huang (Radix et Rhizoma Rhei) 20-50g, Yin Chen (Herba Artemisiae Scopariae) 25g, Jin Qian Cao (Herba Lysimachiae) 25g, and others.[9]

        Finally, as over 85% of gallstones are cholesterol stones in the Western world, proper management of cholesterol levels is important for treatment and prevention.[10] Pharmacologically, Yin Chen (Herba Artemisiae Scopariae) has an antihyperlipidemic effect to lower both plasma cholesterols and beta-lipoproteins.[11] It also has an antiobesity function to effectively reduce body weight and inhibit lipid accumulation.[12] Clinically, a preparation of Da Huang (Radix et Rhizoma Rhei) given three times daily for three weeks was 76% effective in reducing plasma triglycerides and beta-lipoprotein levels in 47 patients.[13] According to another study, daily consumption of Yin Chen (Herba Artemisiae Scopariae) as a tea for one month per course of treatment was effective in reducing serum cholesterol levels. Of 82 patients, the study reported an average reduction of 42.4 mg/dL, or a 14.3% decrease, per person.[14]

        In summary, Dissolve (GS) is an herbal formula with many herbs that dissolve gallstones, manage the symptoms, and treat the complications. Dissolve (GS) may be taken in regular doses for treatment of gallstones, or lower doses for their prevention.

 

COMPARATIVE ANALYSIS

Cholelithiasis and cholecystitis are two conditions that often occur together. In Western medicine, if these two conditions are asymptomatic, treatment may not be necessary, as risks often outweigh the benefits. If symptomatic, bile acids [such as Ursodiol (ursodeoxycholic acid)] are usually given to dissolve stones. However, these drugs must be given for a long period of time, and have only limited success rate of about 30%. Furthermore, these drugs may cause side effects such as bladder pain, bloody or cloudy urine, burning or painful urination, dizziness, fast heartbeat, indigestion, lower back or side pain, severe nausea, shortness of breath, skin rash, stomach pain, vomiting, weakness, wheezing, and others. Lastly, if drugs fail, invasive treatments, such as surgery and sonic shock wave, are the last alternatives.

        Cholelithiasis and cholecystitis are two conditions that are successfully treated with herbs. The mechanisms of action of herbs are to dissolve and expel stones from the gallbladder and bile duct. Herbal therapies are effective to treat and to prevent stones. Depending on the number and size of the stones, the duration of treatment ranges from days to months. Nonetheless, use of herbs should be limited to individuals with mild to moderate cases of cholelithiasis and cholecystitis. If there are acute manifestations, or if herbal therapy is ineffective after three months, then patients should be referred to Western medicine for surgery and sonic shock wave treatments.