Gallstones or cholelithiasis refers to the formation or presence of calculi (gallstones) in the gallbladder, and accounts for most clinical disorders of the extrahepatic biliary tract. Factors that increase the probability of (cholesterol) gallstones include female sex, obesity, increased age, North American Indian ethnicity, a Western diet, and a positive family history.

Most gallstones (75%) consist of cholesterol, the remainder consisting of calcium bilirubinate or other calcium salts. The pathogenesis of cholesterol stones relates to the supersaturation of bile, which precipitates in the gall bladder as solid cholesterol crystals. This appears to be related to a deficiency of 7-hydroxylase, an enzyme that that is involved in the production of bile salts from cholesterol. From a herbal perspective, this enzyme deficiency occurs in poor liver function, i.e. ‘hepatic torpor,’ caused by dietary factors, xenobiotic insult, excess liver burden, and a lack of bitter foods (which stimulate bile excretion and synthesis). The formation of pigment stones appears to be unrelated to the risk factors that predispose the formation of cholesterol stones, and is related specifically to unconjugated bilirubin in the bile. (Berkow 1992; Rubin and Farber 1990, 439-441)

The signs and symptoms of cholelithiasis can vary, with many patients remaining with symptoms for long periods, some never presenting with any at all. During periods of transient duct obstruction from a stone lodging somewhere in the biliary tree the result is cholecystalgia, a condition characterized by nausea, vomiting and epigastric or right upper quadrant pain that often radiates to the lower right scapula. When the obstruction persists it usually produces inflammation, resulting in acute cholecystitis and when the obstruction promotes the reflux of pancreatic juices acute pancreatitis. Perforation of the gall bladder and the release of bile into the peritoneum is a complication of acute cholecystitis, usually occurring as the result of a secondary bacterial infection. (Berkow 1992; Rubin and Farber 1990, 439-441)

Medical treatment

Where gallstones have been detected and are asymptomatic there is a debate as to the correct medical procedure, which is largely based upon the proclivities of the attending physicians. Although surgeons invariably recommend a cholecystectomy, they base this recommendation upon a cumulative risk of symptoms developing (about 2% per year). (Berkow 1992)

Medical treatment for gallstones typically consists of a cholecystectomy, at one time performed by removing the gall bladder through a right subcostal or midline incision. Laparoscopic cholecystectomy however has replaced this technique, consisting of the insertion of surgical instruments and a video camera into the peritoneal cavity through multiple small incisions in the abdominal wall. (Berkow 1992).

The relative frequency of cholecystectomy is reflected in the belief that it does not result in nutritional problems, and has no side-effects, a claim which is a subject of some debate. German physician Rudolf Weiss discusses what has been long recognized in Europe as postcholecystectomy syndrome,which he describes as a “…heterogenous condition,” which can be as diverse as the formation of new stones, duodenal ulcers or the “…regulatory failure of in the whole complex of biliary system, pancreas, duodenum and jejunum (Weiss 1988, 77). In many cases the underlying condition of gallstones, what Weiss terms biliary dyskinesia, continues untreated, providing patient with continued symptoms such as poor digestion and fat malabsorption (including fat soluble vitamins and essential fatty acids), and no reduction in the risk of liver disease.

Holistic treatment

The holistic treatment of cholelithiasis is another example of the benefit of natural holistic methods that are orientated to correcting the underlying problems of bile synthesis and excretion, and over a relatively short period of time, can provide enormous relief to the patient and essentially result in a cure. The primary issue of concern is the presence of very large stones, that if induced to leave the gall bladder can pass into the common bile duct to become lodged in the hepatopancreatic ampulla, causing a reflux of pancreatic juice into the pancreas, causing acute pancreatitis. Thus gall stones should be identified and their size should be determined before recommending treatment. Weiss states that the key to treating gallstones is to observe three basic components: the usage of cholagogues, antispasmodics and carminatives. Weiss notes that cholagogues are never used in active inflammation, only when the condition has more or less achieved a latent state. Antispasmodics and carminatives are the mainstay of treatment in acute conditions (Weiss 1988, 77).

1. Dietary modifications.

  • Dietary fiber: Among the dietary strategies to inhibit stone formation is to increase the consumption of dietary fiber, which reduces the bile acid concentration in the bile by inhibiting the bacterial activity that causes secondary and tertiary bile salt to be absorbed. Not all sources of fiber however should be considered equal: a diet rich in legume fiber is associated with a higher incidence of cholelithiasis (Pizzorno and Murray 1999, 1244). Fiber can thus be included from above-ground vegetables, vegetable peels (on underground vegetables) and to a lesser extent, whole grains. Low fiber foods, especially refined carbohydrates including flour and potatoes as they are associated with increasing the cholesterol saturation of bile (Pizzorno and Murray 1999, 1244).
  • Food allergens: Food allergens are theorized to play a role in cholelithiasis, and such foods, including eggs, pork and milk should be determined through an elimination-challenge die, (Pizzorno and Murray 1999, 1244)
  • Saturated fat: Fatty meats should be avoided in favor of lean meats (e.g. venison, buffalo), poultry and fish.
  • Water: Water consumption should be increased to maintain the water content of the bile (Pizzorno and Murray 1999, 1244).
  • Terpene-containing foods, e.g. citrus fruits, culinary mints, etc. can help to break down stones (Tillotson 2001, 323).

2. Ease spasm and colic.

  • Antispasmodics, to ease pain and spasm associated with acute cholelithiasis, e.g. Wild Yam (Dioscorea villosa), Kava (Piper methysticum),Crampbark (Viburnum opulus), Caraway (Carum carvi), Fennel (Foeniculum vulgare), Jamaican Dogwood (Piscidia erythrina), Valerian (Valeriana officinalis), Marijuana (Cannabis indica), Shatavari (Asparagus racemosa), Yan Hu Suo (Corydalis yanhusuo) Bai Shao (Paeonia lactiflora); tropane-alkaloid containing plants, e.g. Belladonna (Atropa belladonna), Henbane (Hyocyamus niger)

3. Dissolve the gall stones and thin the bile.

  • Cholagogues and hepatics, used in smaller dosages initially, gradually increasing dose: e.g. Radish (Raphnus sativus), Black-root (Leptandra virginica), Barberry (Berberis vulgaris), Oregon Grape (Mahonia aquifolium), Milk Thistle (Silybum marianum), Artichoke (Cynara scolymus), Dandelion (Taraxacum officinale), Boldo (Peumus boldus), Turmeric (Curcuma longa), Artemisia spp, Fumitory (Fumaria officinalis),Agrimony (Agrimonia eupatoria)
  • Choleretics, to be used with caution only where no obstruction exists (i.e. better for catarrhal conditions or prevention), e.g. Celandine Poppy (Chelidonium majus), Fringe Tree (Chionathus virginicus)
  • ”Jin Qian Cao” herbs, referring to herbs with capability to break down stones, e.g. Jin Qian Cao (Lysimachia christinae), and Guang Jin Qian (Desmodium spp.)

4. Chinese formulae:

  • Chai Hu Kuei Chioh Tang (Buplerum and Cinnamon combination); Rx: decoction (1:4), one cup thrice daily (Hsu and Peacher 1982, 136)
  • Xiao Chai Hu Tang (Major Buplerum combination); Rx: decoction (1:4), one cup thrice daily (Bensky and Barolet 1990, 139)
  • Xiao Chai Hu Tang (Minor Buplerum combination); Rx: decoction (1:4), one cup thrice daily (Bensky and Barolet 1990, 136)
  • Hao Qin Qing Dan Tang (Artemisa and Scutellaria Decoction to Clear Gall Bladder); Rx: decoction (1:4), one cup twice daily (Bensky and Barolet 1990, 141)
  • Li Gan Pian (Benefit Liver tablets), contains 30% pig bile, Rx: 2-3 tabs thrice daily (Fratkin 1986, 97)

5. Ayurvedic formulae:In Ayurvedic medicine biliary dyskinesia with attendant colic pains is called Parinamasula.

  • Narikela lavanam (Chakradatta, 27:20)
  • one part Samudradi churna (Chakradatta, 27:16-19) combined with five parts Amalakyadi churna (Chakradatta, 1:106)

6. Lithotriptic supplements.

  • Vitamin C, 1-3 g daily
  • Vitamin E, 400-800 IU daily
  • Phosphatidylcholine,500-1000 mg daily
  • Choline, 1 g daily
  • Vitamin B complex (with B12), 100 mg daily
  • Bile acids: Ox bile,ursodeoxycholic acid
  • Lecithin, improves the solubility of cholesterol, 2-3 g daily
  • Peppermint EO (terpenes), enteric coated, 1-2 capsules thrice daily, between meals

7. Additional considerations.

  • Obesity is associated with a higher incidence of gallstones.
  • Regular exercise can inhibit gallstone formation.
  • Diets that promote quick weight loss by drastic caloric restriction can promote gallstones (Tillotson 2001, 323)

The liver-gall bladder flush is a folk technique for removing stones from the gall bladder. There are a variety of techniques that are utilized, all of which focus on the internal usage of relatively large amounts of an oil such as olive oil, along with terpene-rich fruit juices such as lemon or grapefruit, to dissolve the stones and induce bile synthesis and ejection. While many who perform this technique feel that what they have eliminated are gall stones, others suggest that what appear to be “stones” are really just a soft saponified complex of minerals, olive and lemon juice formed in the lumen of the bowel. Thus it is difficult to gauge the success of such treatments, and debate will continue until practitioners publish their clinical results in a peer-reviewed journal, complete with an analysis of the “stones” eliminated. The primary concern over the usage of the liver-gall bladder flush is that the great volume of fat consumed during the course of treatment can cause a large stone to be thrown from the gall bladder and lodge somewhere in the biliary tree or in the hepatopancreatic ampulla, promoting a life-threatening emergency. Suffice it to say that the liver-gall bladder flush should never be used in acute conditions.

The most common liver-gall bladder flush method consists of consuming 250 mL of olive oil with the juice of two lemons before bed, in small amounts every 15 minutes until finished. If the patient desires to use this method it is best used after at least one month of using lithotripic botanicals and supplements to dissolve the stones first. An additional approach is consume large volumes of organic, cold-pressed unpasteurized apple juice several days before doing the flush, which is also thought to help dissolve the stones. It should be remembered that on the day of the flush the patient should eat no solid food, only drinking apple juice until about 6 pm. An additional technique requires the administration of a tepid coffee enema, administered first thing in the morning on an empty stomach. The oil should be shortly eliminated via the feces, and sieve can be used to collect the stones, which can then be analyzed.