Post-cholecystectomy syndrome (PCS) is the term used to describe the persistence of right upper quadrant abdominal pain after surgical removal of gallbladder with a variety of gastrointestinal symptoms similar to those in patients with cholecystitis prior to cholecystectomy.
The incidence of PCS has been reported to be as high as 40%, and the onset of symptoms may range from 2 days to 25 years. There may also be gender-specific risk factors for developing symptoms after cholecystectomy. One study shows female patients is 43%, compared to 28% among male patients.
Characteristic symptoms include indigestion, nausea, belching, upper abdominal discomfort, upper abdominal distention after eating, abnormal defecation, fatigue, and in severe cases, jaundice and fever.
In Traditional ChineseMedicine, PCS falls under the following classes of disorders: 胁痛 (ribcage pain), 胃脘痛 (stomach duct pain), 心悸 (heart palpitations), and 黄疸 (jaundice). The root cause of PCS is liver qi stagnation. Thus, the treatment principle of this problem is to course the liver and fortify the spleen, and to activate qi and blood circulation. Si Ni San (四逆散) was first mentioned in the Shang Han Lun, where it is indicated for liver qi stagnation and counterflow qi. Principle signs would be those of liver qi stagnation, hypochondriac pain, or abdominal pain.
A modified version of the herbal formula Si Ni San works very well. Main ingredients are Chai Hu(柴胡), Bai Shao(白芍), Zhi Ke(枳壳), Bai Dou Kou(白豆蔻), Yu Jin(郁金), Hou Po(厚朴), Da Huang(大黄), Gan Cao(甘草).Additional herbs can be added according to specific diagnostic considerations. For liver-stomach disharmony, we can add Huang Lian(黄连), Ban Xia(半夏), Mu Xiang( 木香); For spleen deficiency, add Ren Shen(人参), Chen Pi(陈皮), Shao Yao(山药); For liver-stomach damp-heat, add Shan zhi Zi(山栀子), Yin Chen(茵陈), Ze Xie(泽泻).
The main acupuncture points selected are Back Shu(背腧 )and He-Sea points like ST36, GB34. Those are specifically indicated for benefitting major internal organs and digestion. The TCM treatment principles are to move the liver and gallbladder qi, invigorate blood, dispel blood stasis, disperse swelling, anti-inflammation and alleviate pain. A combination of herbs and acupuncture are beneficial to PCS patients and produce significant positive patient outcomes.
Acupuncture treatment should be frequent at the first two weeks for best result (every day or every other day). Herbal formula should be adjusted weekly according to patients’ responds. Most patients get instant relief at the first treatment.
Although Chinese herbs are considered safe generally, some may cause side effect for long term use. If you have questions about herbal therapy, always consult a knowledgeable healthcare provider for advice.