Emulsification is important because it physically breaks down fats into particles than can then be more easily digested by enzymes lipase produced by intestinal cells and the pancreas. Three small elevated structures, called the pre-lingual elevations are placed at the tip of the lower jaw opposite to the sub-rostral fossae. Knots with large gizzards consumed far more molluscs with shells than the birds with smaller gizzards. Here are the top 10…. The pancreas has a series of small tubes that drain into the pancreatic duct. If the Okra-Pepsin-E3 capsules are taken for a few days to several weeks, one after each meal reduce the amount of capsules if diarrhea occurs , the mucus will gradually be digested. The free edges of these flaps project into the ventricle and are connected to the wall of the ventricle with fine contractile but tough thread-like structures known as chordae tendineae.
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This causes the gallbladder to contract and alleviates symptoms of stone passage. Patients with cholecystitis or cholelithiasis were hospitalized for an average of 34 days. They were treated daily with a lithogogue decoction containing bupleurum, capillaris, lysimachia, clematis, gardenia, curcuma, crataegus, chih-shih, and rhubarb.
After waiting days, the four-day course of therapy might be repeated if residual stones were detected. For chronic cholecystitis, a longer course of 10 days was utilized. Another example of the general attacking method involves using mirabilitum along with electroacupuncture stimulus at riyue GB and qimen LV; see Figure 5.
The same treatment was recently tested again and claimed to be effective in expelling gallstones 3. This procedure was performed three days consecutively, once per day, to produce a full course of treatment that would expel stones. Using such vigorous stone-expelling methods, it was reported that stones somewhat over 1 cm in diameter could be excreted.
The largest stones expelled are long but not too wide, with a maximum length of about 3 cm, but a width of no more than about 1 cm. When expelling large stones, it is common for the patients to experience what is called a "stone expulsion reaction," with biliary colic, and temporary fever and jaundice the result of stones becoming temporarily caught in the duct. Silt-like stones, which are easy to pass because of their small size, are reportedly not excreted well because they tend to adhere to the wall of the gallbladder.
In the West, one of the greatest fears associated with applying a stone-expelling therapy is the problem of billiary colic as the stone becomes stuck in the bile duct, especially at the sphincter.
The pain can be extreme and may require an emergency visit to the hospital, with the usual recommendation at the hospital of immediate surgery to remove the gallbladder. By contrast, in China, the herbal procedure may be carried out at the hospital and measures are taken to alleviate the pain while continuing with the procedure. Based on the Chinese reports of the stone-expelling reactions, it appears that the rapid method of stone removal will not be acceptable in other countries.
According to the information from this review of the medical literature through , the largest stones that appear capable of being passed are on the order of one centimeter in diameter. This size is probably a reasonable upper limit for anyone considering a non-surgical procedure and may represent the maximum dilation of the duct.
The gentler stone-expelling methods to be used by Western practitioners who are not working in a hospital setting may not be able to expel stones of quite this size, since the strong build up of bile pressure and the sudden relaxation of the sphincter are unlikely to be accomplished. Therefore, somewhat smaller than 1 cm stones may be the largest one can expel and patients seeking to expel larger stones should be cautioned about the lower chance of success.
One way to pass stones more easily is to first shrink them. The ability to reduce the size of stones using herbs or other methods is not an established fact.
However, certain Chinese herbs have been selected as stone-dissolving herbs. There is one traditional-style formula that is reputed to dissolve stones, called San Jin Tang , or the Decoction of Three Golds.
Jinqiancao literally, golden coin weed refers to a group of herbs that are used interchangeably, and are identified by the region of China in which the herb is found:. Sichuan Da Jinqiancao also called guoluhuang, is from Lysimachia christinae see Figure 6 ;. Guang Jinqiancao is from Desmodium styracifolium see Figure 7 ;.
Jiangsu Jinqiancao is from Glechoma hederaea see Figure 8 ; and. The first two are from Sichuan Province, one being large leaved da and the other being small leaved xiao. The next is from the "guang" region of China, which includes Guangdong, Guangxi, and Hunan formerly, Huguang ; the next three are from Jiangxi Province north of Guangdong , Jiangsu Province on China's central east coast , and from the area of Kunming, the capital of Yunnan Province in southwest China , respectively.
In general, these herbs are said to be sweet, cooling, and able to promote urination. They are mainly used to treat damp-heat syndromes that involve urinary retention, and they are reputed to dispel urinary stones. The herbs are mild in nature and often used in high dosage e. The species of jinqiancao obtained in the West will depend on the market source relied on by the herb supplier.
Among the most commonly supplied items in the West are Desmodium and Glechoma ; However, the widely-used common name for the herb is lysimachia and the most frequently referenced material in Chinese texts, as well as the species listed in the Pharmacopoeia of the PRC , is Lysimachia christinae. The slippery quality is associated with the ability to dissolve stones. The material is described as sweet and cold in nature, and it is diuretic. Like jinqiancao , this herb is mainly used for damp-heat syndromes with urinary retention and it is said to help remove urinary stones.
The usual daily dosage is grams in decoction, or grams in powder form. The chicken gizzard is capable of reducing hard food masses to small pieces; it is included in some herb formulas because it is thought to resolve masses. The material has a sweet taste, a neutral property, and is used mainly to eliminate food stagnation. The usual dosage is grams and it may be used in decoction or a smaller amount, 1.
The entire Three Golds Formula includes three additional herbs for damp-heat that affects the kidney and bladder, thus making it a treatment for urinary stones in persons with damp-heat syndrome and urinary retention. The three herbs are pyrrosia shiwei , abutilon dongkuizi , and dianthus qumai and this combination is derived from Shiwei San , a traditional formula for blocked urinary flow that contains those three herbs plus plantago and talc.
A variant of the Three Golds Formula retains the talc and plantago seed of Shiwei San but replaces dianthus with achyranthes or cyathula , vaccaria, magnolia bark, and chih-shih. The three golds may be added to any traditional formula for urinary blockage when stones are diagnosed. A typical recommendation is to add 30 grams lysimachia, 9 grams of lygodium, and 9 grams of gallus The herbs suitable for this purpose generally have a bitter taste, a cold property, and a dispersing or purging action; for example, one can administer bupleurum, scute, capillaris, and rhubarb.
One can also add to the therapy herbs to disperse liver-qi stagnation and accumulation, such as saussurea, magnolia bark, chih-shih, and areca peel.
Urinary stones are generally comprised of uric acid, calcium oxalate, and calcium phosphate and their formation may be related to processes similar to those involved in forming gallstones, namely low fluid flow through the renal tubules. Low water consumption, with corresponding low urinary excretion, is a major risk factor for kidney stones high levels of dietary oxalate and high levels of acidic components in foods and beverages can also contribute to urinary stone formation.
It is reasonable to question whether herb components that help to dissolve and pass urinary stones would also effectively dissolve and pass gallstones, given the differences in stone composition. Jinqiancao , one of the three golds, has been incorporated into numerous modern Chinese therapies for both liver and gallbladder diseases, including most formulas for treating gallstones and cholecystitis.
In the Advanced Textbook of Traditional Chinese Medicine and Pharmacology 8 , lysimachia is said to be useful for stone expulsion, including gallstones: To achieve the desired results, it is usually used in large dosage and administered for a long time. Whether or not jinqiancao actually dissolves stones, it is known to stimulate bile secretion; further, haijinsha has been used clinically in some formulas for treating gallstones 9 and was mentioned as one of the more commonly used herbs for that purpose in a recent review article examining 40 different gallstone formulas There are two main uses for a stone-dissolving formula: The stone dissolving therapies are given for at least months.
The herbs used in the strong stone expelling decoctions, as described earlier, have been formulated into easy to use tableted patent formulas that are given at much lower dosage. These tablets have a milder action than the corresponding decoctions and may be used in a complete program of gallstone therapy for treating smaller sized stones or mild gallbladder inflammation. Lidan Pian contains lysimachia, scute, saussurea, capillaris, bupleurum, isatis leaf, lonicera, and rhubarb.
Isatis leaf and lonicera are included as anti-infection herbs for cholecystitis. Lidan Paishi Pian contains lysimachia, saussurea, capillaris, rhubarb, areca peel, magnolia bark, chih-shih, curcuma, and mirabilitum.
The amount of mirabilitum present is relatively small and does not cause a strong purgative effect. The latter formula is based on the traditional Da Chengqi Tang Major Rhubarb Combination of the Shanghan Lun , comprised of rhubarb, mirabilitum, magnolia bark, and chih-shih, which had been formulated as a purgative therapy for severe abdominal stagnation. This formula's action has been extensively investigated see Appendix 1.
The modification to make Lidan Paishi addresses stagnation of qi and blood in the abdomen. A decoction of the Lidan Paishi formula was tested in patients who were monitored for gallbladder function 4.
The treatment, using 10 grams of each ingredient, increased the frequency of bile excretion and did so to an extent greater than that accomplished by Da Chengqi Tang , indicating a valuable contribution for the added herbs. Lidan Paishi Tablets are produced by several Chinese companies. One company lists the following ingredients, with proportions used in manufacturing: Treatment time with stone expelling formulas is usually several months, though excretion of gallstones may begin to occur within days.
Treatment time ranged from one month to 10 months a few cases continued for longer. A formula called Paishi Tang Stone Expulsion Decoction was reported to be moderately effective for treating residual stones in the biliary tract after gallbladder surgery Complete removal of stones was claimed for just over half of the patients treated.
A patient presenting with gallstone reduction or elimination as the objective of treatment should be provided with a substantial number of therapeutic approaches to be used in combination. The dietary program is no different than that widely recommended for maintaining health and normal body weight, such as following the U.
The role of dietary and herbal flavonoids in gastro-intestinal health. The exercise program is also no different than that generally recommended, which involves a daily minimum of minutes of moderate exercise e. The dosage of stone-dissolving substances should be relatively high, corresponding to about grams per day in decoction, or about grams per day in dried extract form. As with the treatment using bile salts, stone-dissolving therapies may require as much as six months continual treatment.
The gallstone flushing therapy, relying on purgative herbs, may be accompanied by a high fat meal to stimulate gallbladder emptying some Western practitioners use the so-called "liver flush" which is actually a gallbladder purge, comprised of a large dose of olive oil moderated by lemon juice.
All three are purgative preparations with rhubarb as the common ingredient. Tiaowei Chengqi Tang includes mirabilitum and licorice, while Xiao Chengqi Tang includes chih-shih and magnolia bark. Da Chengqi Tang includes all the ingredients except licorice. These formulas have been studied as part of a larger and ongoing evaluation of Shanghan Lun formulas 5. All the prescriptions stimulate intestinal peristalsis, with Da Chengqi Tang having the strongest action. Rhubarb acts as a secretory purgative that stimulates the large intestine; it produces a delayed laxative action and cannot soften hard stool; mirabilitum acts as an osmotic purgative, affecting mainly the small intestine.
By combining mirabilitum with rhubarb, the laxative action is quicker due to the effect of mirabilitum on the small intestine and the moisture retaining effect of magnesium softens the stool. In Western studies of gallbladder function, mirabilitum is known as a useful agent to induce bile flow and to purge the duodenum. Magnolia bark and chih-shih act mainly on the large intestine and have a milder effect than rhubarb and mirabilitum; magnolia bark and chih-shih also serve to dispel gas and bloating.
When rhubarb and licorice are cooked together, as in Tiaowei Chengqi Tang , there is a reduced laxative effect, due to binding of licorice ingredients with anthraquinones, the main laxative component of rhubarb. But, without the mirabilitum, the laxative effect is more limited, so that Xiao Chengqi Tang has the mildest laxative action of the three Chengqi formulas.
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 in this article, qimen LV and riyue GB , 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. Only the right side is treated. 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 In the discussion of their treatment, the authors stated:. 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 , qiuxu GB , and zusanli ST ; in addition, there is an extra point known as the gallbladder point dannangxue , just below GB about 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. 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 s 7.
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 minutes after meals about 15 minutes after eating. 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 8 , 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 How you will prepare for the test depends on the problem. You will likely be asked not to eat or drink for several hours before the exam. Your provider will go over what you need to do. The meaning of abnormal results depends on the organ being examined and the type of problem.
Talk to your provider if you have any questions or concerns. Elsevier Churchill Livingstone; Diagnostic imaging procedures in gastroenterology. Goldman L, Schafer AI, eds. How the Test is Performed.
Most of the time, the test takes less than 30 minutes. How to Prepare for the Test. How the Test will Feel. There is little discomfort. The conducting gel may feel a little cold and wet. Why the Test is Performed. You may have this test to: Find the cause of abdominal pain Find the cause of kidney infections Diagnose and monitor tumors and cancers Diagnose or treat ascites Learn why there is swelling of an abdominal organ Look for damage after an injury Look for stones in the gallbladder or kidney Look for the cause of abnormal blood tests such as liver function tests or kidney tests Look for the cause of a fever The reason for the test will depend on your symptoms.
What Abnormal Results Mean. An abdominal ultrasound can indicate conditions such as: