Research advances in traditional Chinese medicine therapy for cholelithiasis
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摘要: 胆石症是临床常见、多发病症,目前西医以手术为首要治疗手段,但存在手术创伤、复发率高及术后易发生并发症等问题。中医药治疗胆石症方法多样,疗效满意,近年来在临床上被广为应用。主要从中医对胆石症的认识、中医药治疗方法及其作用机制,以及中西医联合治疗等3个方面对中医药治疗胆石症的研究进展进行归纳总结。认为中医药可明显改善或抑制胆石症的形成,具有疗效可靠、副作用小、复发率低的优势。但目前因存在作用机制不清、临床研究质量不高、可重复性差等缺陷,限制了其进一步推广应用。建议今后进一步加强基础研究及开展高水平的临床随机对照研究,为胆石症的临床诊疗提供更科学、客观的证据,以期提高中医药治疗胆石症的临床疗效。Abstract: Cholelithiasis is a common disease in clinical practice. At present, surgery is the primary Western treatment method for this disease, but there are problems such as surgical trauma, a high recurrence rate, and postoperative complications. Various traditional Chinese medicine ( TCM) methods for the treatment of cholelithiasis have achieved satisfactory results and have been widely used in clinical practice in recent years. This article summarizes the research advances in TCM therapy for cholelithiasis from the aspects of the understanding of cholelithiasis in TCM, TCM treatment methods for cholelithiasis and their mechanisms, and integrated traditional Chinese and Western medicine therapy. It is pointed out that TCM can significantly improve or inhibit the information of cholelithiasis and has the advantages of reliable therapeutic effect, few side effects, and a low recurrence rate; however, its further application is limited by the unclear mechanism of action of TCM and defects of related clinical research such as low quality and poor repeatability. It is recommended to strengthen basic research and conduct high-level randomized controlled clinical trials in the future to provide scientific and objective evidence for clinical diagnosis and treatment of cholelithiasis and thus improve the clinical effect of TCM in the treatment of cholelithiasis.
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Key words:
- cholelithiasis /
- TCM science /
- therapy /
- review
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[1] RUHL CE, EVERHART JE. Gallstone disease is associated with increased mortality in the United States[J]. Gastroenterology, 2011, 140 (2) :508-516. [2] ZENG Q, HE Y, QIANG D, et al. Prevalence and epidemiological pattern of gallstones in urban residents in China[J]. Eur J Gastroenterol Hepatol, 2012, 24 (12) :1459-1460. [3] LI JX, CHEN J, LIANG J. Consensus on the diagnosis and treatment of cholelithiasis by integrative medicine[J]. Chin J Integr Trad West Med Dig, 2018, 26 (2) :132-138. (in Chinese) 李军祥, 陈誩, 梁健.胆石症中西医结合诊疗共识意见 (2017年) [J].中国中西医结合消化杂志, 2018, 26 (2) :132-138. [4] LU XC. Clinical efficacy of Dachaihu Decoction in the treatment of cholelithiasis and cholecystitis[J]. Chin Foreign Med Res, 2015, 13 (36) :34-35. (in Chinese) 陆修成.大柴胡汤加减治疗胆石症、胆囊炎的临床疗效[J].中外医学研究, 2015, 13 (36) :34-35. [5] ZHANG ZQ. Study on the effect of Jiawei Yinchenhao Decoction in the treatment of cholelithiasis[J]. Con Med Forum, 2016, 14 (2) :13-14. (in Chinese) 张志强.用加味茵陈蒿汤治疗胆石症的效果研究[J].当代医药论丛, 2016, 14 (2) :13-14. [6] CHEN XJ, HU XQ, XU YC, et al. Effect of Dachaihu Decoction on mucin secretion and gene expression in guinea pig gallbladder[J]. Jiangxi J Tradit Chin Med, 2015, 46 (10) :34-36. (in Chinese) 陈小菁, 胡晓晴, 许亚超, 等.大柴胡汤对豚鼠胆囊黏蛋白分泌及其基因表达的影响[J].江西中医药, 2015, 46 (10) :34-36. [7] CHEN Y, GUO QP. An experimental study on variant Herbae Artemisiae Capillariae Decoction for treatment of bile pigment calculus[J]. Chin Rem Clin, 2006, 6 (11) :834-836. (in Chinese) 陈筠, 郭勤平.加味茵陈蒿汤治疗胆色素结石的实验研究[J].中国药物与临床, 2006, 6 (11) :834-836. [8] YI YX, DING Y, ZHANG Y, et al. Yinchenhao Decoction ameliorates alpha-naphthylisothiocyanate induced intrahepatic cholestasis in rats by regulating phase II metabolic enzymes and transporters[J]. Front Pharmacol, 2018, 9:510-528. [9] LENG J. Advances in pharmacological effects and clinical application of Yinchenhao Decoction[J]. Nei Mon J Trad Chin Med, 2016, 35 (7) :131-133. (in Chinese) 冷静.茵陈蒿汤药理作用和临床应用进展[J].内蒙古中医药, 2016, 35 (7) :131-133. [10] CHU DS, LIANG JY, LI KL. Pharmacological action of Dachaihu Decoction in the treatment of cholelithiasis[J]. Nei Mon J Trad Chin Med, 2011, 30 (6) :112-113. (in Chinese) 楚得胜, 粱久银, 李凯琅.大柴胡汤在胆石症治疗中的药理作用[J].内蒙古中医药, 2011, 30 (6) :112-113. [11] LYU HZ, GONG HR. Clinical observation on treatment of cholelithiasis with chongjipaishi formula[J]. Mod J Integr Trad Chin West Med, 2016, 25 (21) :2347-2348. (in Chinese) 吕杭州, 巩浩然.冲击排石方治疗胆石症临床观察[J].现代中西医结合杂志, 2016, 25 (21) :2347-2348. [12] HAN KX, XU B, MENG XM. Randomized parallel controlled study on the treatment of liver qi Stagnation cholelithiasis[J]. J Prac Trad Chin Inter Med, 2017, 31 (6) :15-17. (in Chinese) 韩柯鑫, 许斌, 孟宪萌.疏肝利胆汤治疗肝郁气滞胆石症随机平行对照研究[J].实用中医内科杂志, 2017, 31 (6) :15-17. [13] LIU YL, WANG YJ, XU TS. Study on the mechanism of Shugan Lidan Recipe in intervention of gallbladder stone model guinea pigs[J]. Henan Tradit Chin Med, 2017, 37 (3) :417-420. (in Chinese) 刘莹露, 王玉娟, 徐天舒.疏肝利胆方干预胆色素结石模型豚鼠的作用机制研究[J].河南中医, 2017, 37 (3) :417-420. [14] LIU LZ, QIAN Y, HU SS, et al. Anti-inflammatory effect of Danshiliuhao decoction on pigment stones of Guinea pigs[J]. Chin J Clin Pharm, 2015, 31 (12) :1162-1164. (in Chinese) 刘龙忠, 钱英, 胡姗姗, 等.胆石六号汤剂对豚鼠胆色素结石模型胆囊的抗炎作用[J].中国临床药理学杂志, 2015, 31 (12) :1162-1164. [15] LIU LZ, HU SS, QIAN Y, et al. Study on the mechanism of Danshi No. 6 decoction in treating guinea pig cholecystitis[J]. Pharm Clin Chin Mat Med, 2015, 31 (4) :179-183. (in Chinese) 刘龙忠, 胡姗姗, 钱英, 等.胆石六号汤治疗豚鼠胆囊炎的机制研究[J].中药药理与临床, 2015, 31 (4) :179-183. [16] HU SS, ZHAO XQ, QIAN Y, et al. Observation of therapeutic efects of Danshi Liuhao decoction against cholecystitis in guinea pigs[J]. Chin Hosp Pharm J, 2015, 35 (6) :491-494. (in Chinese) 胡姗姗, 赵小倩, 钱英, 等.胆石六号汤剂对豚鼠胆囊炎治疗作用的观察[J].中国医院药学杂志, 2015, 35 (6) :491-494. [17] TANG QL, LYU Z, YU Y, et al. Mechanism of dahuang lingxian capsule for regulating and controling expresion of hepatocyte transporters and bile metabolism spectrum in gallstone mice[J]. Chin J Integr Trad West Med, 2016, 36 (8) :953-959. (in Chinese) 唐乾利, 吕震, 俞渊, 等.大黄灵仙胶囊调控胆结石小鼠肝细胞转运蛋白表达及胆汁代谢谱的机制研究[J].中国中西医结合杂志, 2016, 36 (8) :953-959. [18] TANG QL, LYU Z, WANG B, et al. Study on mechanism of Dahuanglingxian capsule for intervening galstone formation by regulating ABCB11 and ABCC2[J]. Chongqing Med, 2018, 47 (1) :4-6. (in Chinese) 唐乾利, 吕震, 王兵, 等.大黄灵仙胶囊调控ABCB11和ABCC2干预胆结石形成的作用机制研究[J].重庆医学, 2018, 47 (1) :4-6. [19] YU Y, WANG B, TANG QL, et al. Dahuang Lingxian granule treating cholelithiasis by down-regulating IL-6 and EGR-1[J].Liaoning J Tradit Chin Med, 2017, 44 (7) :1514-1518. (in Chinese) 俞渊, 王兵, 唐乾利, 等.大黄灵仙颗粒调控IL-6、EGR-1表达治疗胆石症的实验研究[J].辽宁中医杂志, 2017, 44 (7) :1514-1518. [20] HU SQ, CHEN L, WANG B, et al. The mechanism study of Dahuanglingxian capsules on regulating liver function and ultrastructural pathology in rabbit model of cholelithiasis[J]. Chin J New Clin Med, 2017, 10 (6) :505-508. (in Chinese) 胡嗣钦, 陈林, 王兵, 等.大黄灵仙胶囊调控兔胆石症模型肝功能及超微病理的作用机制研究[J].中国临床新医学, 2017, 10 (6) :505-508. [21] ZHANG W, LI TB. A literature study on the treatment of cholelithiasis by chinese medicine based on data mining[J]. Acta Chin Med Pharm, 2013, 41 (4) :151-152. (in Chinese) 张伟, 李廷保.基于数据挖掘对中医药治疗胆石病用药规律的文献研究[J].中医药学报, 2013, 41 (4) :151-152. [22] FANG BJ, SHEN JY, ZHANG H, et al. Effect of emodin on mobility signal transduction system of gallbladder smooth muscle in Guinea pig with cholelithiasis[J]. Asian Pac J Trop Med, 2016, 9 (10) :991-996. [23] YANG X, WANG BC, ZHANG X, et al. Evaluation of lysimachia christinae hance extracts as anticholecystitis and cholagogic agents in animals[J]. J Ethnopharmacol, 2011, 137 (1) :57-63. [24] ZHAN C, XIONG A, SHEN D, et al. Characterization of the principal constituents of danning tablets, a Chinese formula consisting of seven herbs, by an UPLC-DAD-MS/MS approach[J]. Molecules, 2016, 21 (5) :631-643. [25] LIU H, FAN YF, WANG P, et al. Danning tablet on gallbladder motility and the contents of CCK in the plasma of guinea pigs with induced cholesterol gallstones[J]. J Changchun Univ Trad Chin Med, 2014, 30 (5) :773-776. (in Chinese) 刘皓, 范尧夫, 王平, 等.胆宁片对胆固醇结石模型豚鼠胆囊运动功能及血浆CCK水平的影响[J].长春中医药大学学报, 2014, 30 (5) :773-776. [26] DING L, ZHANG B, ZHAN C, et al. Danning tablets attenuatesα-naphthylisothiocyanate-induced cholestasis by modulating the expression of transporters and metabolic enzymes[J]. BMC Complement Altern Med, 2014, 14 (1) :249-260. [27] DING LL, ZHANG BF, DOU W, et al. Protective effect of Danning tablet on acute livery injury with cholestasis induced byα-naphthylisothiocyanate in rats[J]. J Ethnopharmacol, 2005, 99 (2) :222-229. [28] YANG JY, ZHANG JZ. Clinical study on effects of Shengqing capsule on nucleoproteinα1-acid glycoprotein and biochemical indicators of bile in patients with cholelithiasis[J]. J Hepatol Surg, 2012, 24 (6) :459-462. (in Chinese) 杨吉勇, 张静喆.升清胶囊对胆汁促成核蛋白及生化指标影响的临床研究[J].肝胆胰外科杂志, 2012, 24 (6) :459-462. [29] LIANG XQ, ZHANG XL, GU HG, et al. Effect of Shengqing capsule on expression of LXR-α, FXR and ABC transporters in L-02hepatic cholesterol deposition model[J]. J Trad Chin Med, 2017, 58 (7) :592-596. (in Chinese) 梁晓强, 章学林, 顾宏刚, 等.升清胶囊对L-02肝细胞胆固醇沉积模型LXR-α、FXR及ABC转运蛋白表达的影响[J].中医杂志, 2017, 58 (7) :592-596. [30] HU GY, ZHANG SY, YANG M. Summary of diseases suitable for treatment of Danshu capsule and its clinical effects[J]. Nei Mon J Trad Chin Med, 2014, 33 (5) :122. (in Chinese) 胡冠英, 张三印, 杨苗.适于胆舒胶囊治疗的疾病及其临床疗效总结[J].内蒙古中医药, 2014, 33 (5) :122. [31] HU G, YUAN X, ZHANG S, et al. Research on choleretic effect of menthol, menthone, pluegone, isomenthone, and limonene in DanShu capsule[J]. Int Immunopharmacol, 2015, 24 (2) :191-197. [32] LIU SF. Effect of Danshu capsule on coagulation function and levels of immune cells in patients with chronic cholecystitis[J]. Chin Pharm, 2017, 26 (13) :72-74. (in Chinese) 刘爽峰.胆舒胶囊对慢性胆囊炎患者凝血功能及免疫细胞水平的影响[J].中国药业, 2017, 26 (13) :72-74. [33] CHEN Y, KONG J, WU S. Cholesterol gallstone disease:Focusing on the role of gallbladder[J]. Lab Invest, 2015, 95 (2) :124-131. [34] ZHAO J, YU Y, LUO M, et al. Bi-directional regulation of acupuncture on extrahepatic biliary system:An approach in guinea pigs[J]. Sci Rep, 2017, 7 (1) :14066. [35] DIAO YH, SONG CP, YANG B. Study on the effect of electroacupuncture on the systolic function of gallstones in cholelithiasis[J].Shandong J Tradit Chin Med, 2014, 33 (12) :993-994. (in Chinese) 刁永红, 宋翠萍, 杨波, 等.电针对胆石症胆囊收缩功能的影响及时效关系的研究[J].山东中医杂志, 2014, 33 (12) :993-994. [36] XU Z, YAN ZB, XIN Y, et al. Acupuncture exercise for the treatment of gallstones:A clinical study of 970 cases[J]. g j Trad Chin Med, 2013, 28 (5) :977-979. (in Chinese) 徐臻, 延壮波, 辛颖, 等.针刺运动治疗胆结石970例临床研究[J].光明中医, 2013, 28 (5) :977-979. [37] CAO ZY, ZHANG YB, ZHANG HC, et al. Effects of electroacupuncturing at Yanglingquan on cholecystokinin change and arterial hemodynamics of gallbladder in patients with chronic cholecystitis[J]. Chin Gen Pract, 2016, 19 (33) :4092-4095. (in Chinese) 曹子洋, 张延彬, 张宏春, 等.慢性胆囊炎患者电针针刺阳陵泉穴后胆囊收缩素变化与胆囊动脉血流动力学观察[J].中国全科医学, 2016, 19 (33) :4092-4095. [38] ZHOU ML, JIA WR, WANG JT, et al. Effect of electroacupuncture at“Yanglingquan” (GB34) acupoint on white blood cell count and galbladder wal thicknes in rabbits with acute cholecystitis[J].Acu Res, 2015, 40 (3) :233-237. (in Chinese) 周明亮, 贾文睿, 王健彤, 等.电针“阳陵泉”穴对急性胆囊炎家兔白细胞计数和胆囊壁厚度的影响[J].针刺研究, 2015, 40 (3) :233-237. [39] LIN ZX, WU YH. Analysis of acupuncture and moxibustion for acupoint selection and acupoints[J]. J Clin Acupunct Moxib, 2016, 32 (4) :53-55. (in Chinese) 林志鑫, 吴艳华.针灸治疗胆结石取穴及配穴规律分析[J].针灸临床杂志, 2016, 32 (4) :53-55. [40] LIU P, CHEN SZ. Acupoint prescription rule and empirical statistics of acupuncture in treatment of biliary disease[J]. J Liaoning Univ Tradit Chin Med, 2013, 15 (6) :91-92. (in Chinese) 刘鹏, 陈少宗.针刺治疗胆系疾病取穴组方规律与经验分析[J].辽宁中医药大学学报, 2013, 15 (6) :91-92. [41] LI TH, WANG Y, MA JJ. Intervention of gallstones in minimally invasive surgery recovery study by electric acupuncture adopted distant and neighboring point selection[J]. J Changchun Univ Chin Med, 2016, 32 (3) :531-533. (in Chinese) 李统虎, 王一, 马俊杰.电针远近取穴干预胆石症保胆取石术后恢复研究[J].长春中医药大学学报, 2016, 32 (3) :531-533. [42] GE YH, HU ZY, GE S, et al. Research progress of auricular pressure in the treatment of cholelithiasis[J]. Mod Diagn Treat, 2014, 8 (16) :3675-3676. (in Chinese) 戈阳华, 胡著云, 戈思, 等.耳穴贴压治疗胆石症的临床研究进展[J].现代诊断与治疗, 2014, 8 (16) :3675-3676. [43] TANG JJ. Therapeutic effect of auricular acupoints on relieving biliary colic[J]. Zhejiang Tradit Chin Med, 2016, 51 (5) :366. (in Chinese) 唐建娟.耳穴埋豆缓解胆绞痛的疗效观察[J].浙江中医杂志, 2016, 51 (5) :366. [44] GE YH, WANG ZL. Therapeutic effect of postoperative auricular acupoint pressing on prevention of gallstone recurrence in 102 patients with gallstone removal[J]. Prac Clin J Integr Trad Chin West Med, 2013, 13 (6) :27-28. (in Chinese) 戈阳华, 王招玲. 102例保胆取石患者术后耳穴贴压预防胆石复发疗效观察[J].实用中西医结合临床, 2013, 13 (6) :27-28. [45] ZHAO YH. Analysis of the effect of Dachaihu decoction combined with acupuncture on hepatobiliary stones[J]. Prac Clin J Integr Trad Chin West Med, 2014, 14 (10) :76-77. (in Chinese) 赵永红.大柴胡汤加减联合针刺治疗肝胆结石效果分析[J].实用中西医结合临床, 2014, 14 (10) :76-77. [46] GUARINO MP, COCCA S, ALTOMARE A, et al. Ursodeoxycholic acid therapy in gallbladder disease, a story not yet completed[J].World J Gastroenterol, 2013, 19 (31) :5029-5034. [47] ZHAO DK, ZHAO CX. Clinical observation on efficacy of combination of herbal medicine and ursodesoxycholic acid in treatment of patients with cholelithiasis and chronic cholecystitis[J]. J Prac Hepatol, 2017, 20 (5) :633-634. (in Chinese) 赵登科, 赵彩霞.疏肝利胆通泄法联合熊去氧胆酸治疗胆结石合并慢性胆囊炎患者疗效初步研究[J].实用肝脏病杂志, 2017, 20 (5) :633-634. [48] HUANG Y, HUANG JN, ZHONG S. Analysis of effect of bile duct stone mixture and biliary stone in treatment of biliary residual stones after cholelithiasis[J]. Chin Arch Tradit Chin Med, 2017, 35 (6) :1538-1540. (in Chinese) 黄谊, 黄嘉年, 钟祟.胆道排石合剂联合胆道取石对胆石症术后胆道残余结石的治疗效果分析[J].中华中医药学刊, 2017, 35 (6) :1538-1540. [49] ZHANG SL, MENG LJ. The observation on treatment of gallbladder stones with minimally invasive and Chinese medicine cleaning fossil decoction[J]. Chin Med J Res Prac, 2017, 31 (5) :65-67. (in Chinese) 张淑玲, 孟令军.清胆化石汤配合保胆取石术治疗胆结石临床观察[J].现代中药研究与实践, 2017, 31 (5) :65-67. [50] FENG DX. Effect of Dachaihu decoction on serum inflammatory factors and immune function in patients undergoing laparoscopic cholecystectomy[J]. Guid J Tradit Chin Med Pharmacol, 2017, 23 (8) :95-97. (in Chinese) 冯德新.大柴胡汤对腹腔镜胆囊切除术患者血清炎症因子及免疫功能的影响[J].中医药导报, 2017, 23 (8) :95-97. [51] WANG W, SHI X, MIAO FL. Effects of ursodeoxycholic acid combined with Chinese medicines on bile acids, cholesterol anabolism in rabbit models with cholecystolithiasis after minimally invasive cholecystolithotomy[J]. Hebei Med J, 2017, 39 (5) :663-667. (in Chinese) 王威, 石鑫, 苗伏龙, 等.熊去氧胆酸联合中药对胆囊结石家兔模型保胆取石术后胆汁酸、胆固醇合成代谢的影响[J].河北医药, 2017, 39 (5) :663-667.
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