Gallstones

What is Gallstones?

Gallstones are hard deposits that form in the gallbladder, a small organ under the liver that stores bile, and sometimes in the bile ducts. They can be as small as sand or as large as several centimeters.^[1] Most people who have them never know, and about 10% develop symptoms within 5 years and about 20% within 20 years of diagnosis.^[1]

Common symptoms

Gallstones that cause symptoms typically produce biliary colic, which is intermittent pain in the upper right or upper middle abdomen, often after eating.^{[1, 2]} The pain happens when the gallbladder contracts against a stone that partly blocks bile flow.^[1]

Nearly 80% of gallstones are found incidentally and stay silent.^[2]

Causes and risk factors

Gallstones arise from metabolic, environmental and genetic factors.^[1] Risk factors include female sex, older age, certain medicines, type 2 diabetes, fatty liver disease, obesity, rapid weight loss and hemolytic anemia.^[2] A genetic study supports obesity, type 2 diabetes and smoking as causes of gallstone disease, and found that higher coffee intake was linked with lower risk.^[3]

Globally, about 6% of people have gallstones, more often women and older people.^[4]

How it is diagnosed and treated conventionally

Ultrasound is the preferred test for gallstones.^[1] Doctors may add blood tests and other imaging if a complication is suspected.^[2]

Stones that cause no symptoms are generally watched. For biliary colic, anti-inflammatory medicines and antispasmodics are used, and laparoscopic cholecystectomy (gallbladder removal) is the standard treatment for recurring colic or acute cholecystitis.^{[1, 5]} Ursodeoxycholic acid can reduce stone formation during significant weight loss, and is not routinely used to treat established gallstones.^{[2, 5]} A systematic review found that evidence on the best treatment of symptomatic stones remains limited.^[6]

Why Gallstones calls for a whole-person approach

Gallstones are a local problem in the gallbladder, but the conditions that favor stone formation involve metabolism, weight and daily habits. Stones can also cause serious complications, so treatment is directed by physicians and surgeons.^{[1, 5]}

Supportive care can address the factors around the stones, such as healthy habits and comfort, but it does not remove them.

Weight and metabolic health

Obesity and type 2 diabetes have an independent causal role in gallstone disease.^[3] Fatty liver disease is also a risk factor.^[2]

Weight change and diet

Rapid weight loss raises the risk of gallstones, and doctors may prescribe ursodeoxycholic acid to lower this risk after significant weight loss from diet or bariatric surgery.^{[2, 5]} Anyone planning to lose weight should discuss the pace with a physician.

Physical activity

A systematic review concluded that regular physical activity seems likely to reduce the risk of gallstones, although the evidence has limits and the effect on gallbladder motility remains unclear.^[7]

Smoking and coffee

Smoking has a causal link to gallstone disease in genetic analyses, while higher coffee intake was associated with lower risk.^[3]

Acupuncture as supportive care in Gallstones

What the research shows

The research is limited: a few small trials, mostly from China, tested acupuncture-related treatments in people with gallstones or gallbladder inflammation. None shows that acupuncture removes stones.

In a sham-controlled trial of 63 people with gallstones, all taking a bile acid medicine, acupoint catgut embedding (absorbable thread placed at acupuncture points) every 2 weeks for 8 weeks improved gallbladder emptying on ultrasound more than sham embedding. Symptom scores also improved, though they improved in the sham group too.^[8] Catgut embedding is not the same as standard needle acupuncture.

In a trial of 60 people with chronic gallbladder inflammation, needling at a shoulder point (GB 21) relieved pain more than needling a non-acupoint and changed gallbladder volume on ultrasound after a single session.^[9] A 120-person Chinese trial reported a higher effective rate with electroacupuncture than with a comparison regimen of herbs, magnesium sulfate and diet, but its abstract gives few details on how success was measured.^[10] A systematic review of treatments for symptomatic stones identified electroacupuncture as one studied option and described the overall evidence base as a gap in knowledge.^[6]

How acupuncture may work

Researchers have looked at whether acupuncture changes how the gallbladder fills and empties. The small trials above measured gallbladder volume and emptying on ultrasound.^{[8, 9]} Whether this has lasting clinical value is not known, and acupuncture is not shown to dissolve or pass stones.

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes. We reassess after a short course of visits. Acupuncture here is offered for comfort and general support, not as treatment for the stones, and never in place of evaluation of abdominal pain.

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as brief soreness or bleeding at a needle site, and serious events occurred in about 1 in 10,000 patients.^[11] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine as supportive care in Gallstones

The Ayurvedic view

Ayurvedic texts do not describe gallstones in modern terms. Practitioners often relate gallbladder and digestive problems to Pitta and Kapha, impaired digestive fire (agni) and the handling of fats. This is a traditional framework, not a biomedical explanation.

Therapies that may be used

Care is traditionally centered on diet and daily routine, such as regular meals, moderate amounts of fat, spices used in cooking and daily movement. For some people a gentle, individually chosen herbal plan may be used. Transdermal medication therapy, an herbal preparation applied to the skin, can be mentioned for comfort measures.

Panchakarma is not appropriate during pregnancy, acute illness or frailty, and it is not appropriate while gallstones are causing pain or have not been evaluated. Fasting, strong purgation and home "gallbladder flushes" with large amounts of oil are not supported by the research we found. Because a moving stone can block the bile duct, discuss any such plan with your physician first.^[1]

What the research shows

No clinical trials of Ayurvedic medicine for gallstones turned up in PubMed. There is no research basis to claim that Ayurvedic treatment dissolves or prevents gallstones. Any benefit from diet and lifestyle guidance would work through the risk factors described above, such as weight, activity and metabolic health.^{[3, 7]}

Herbal medicine as supportive care in Gallstones

Herbs and formulas that have been studied

Chinese herbal formulas for gallstones, including Paishi capsule, Qingdan capsule and Danshu capsule, have been tested in randomized trials.^[12] A narrative review of cholesterol gallstone treatments lists herbal plants as an area of interest.^[13]

What the research shows

The evidence is limited. A Cochrane review of 11 trials with 1,205 people with mild or symptom-free gallstones found no strong evidence that the Chinese herbs tested help. No trial was placebo-controlled, and most gave no usable data on symptoms or stone changes. Two tablets compared with each other did not differ in upper abdominal pain, and no serious adverse events were reported.^[12]

A narrative review describes herbal plants as an emerging area that needs much more research.^[13] Herbs have not been shown to dissolve or prevent gallstones in people.

Safety and herb-drug interactions

Herbs are active substances. They can interact with medicines, for example bleeding with warfarin and altered levels of other drugs.^[14] Herbal and dietary supplements are a recognized cause of liver injury, which matters if bile flow is already affected.^[15] In theory, herbs that increase bile flow could provoke pain when a stone is lodged in a duct, so tell your physician and us about any plan to use them.

In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[16] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, have liver or kidney disease, or have surgery planned.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes gallstones as damp-heat in the liver and gallbladder or stagnation of liver qi. Researchers studying this area measure things that loosely parallel those ideas: gallbladder emptying, bile composition, metabolic risk factors and inflammation of the gallbladder wall.^{[8, 9, 13]}

Ayurveda's concepts of aggravated Pitta and weak agni resemble, in loose terms, the modern focus on fat handling and digestion.^[1] No study has shown that a dosha or traditional pattern corresponds to a specific biological process.

How this care fits with your medical care

For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Keep your surgeon, gastroenterologist or primary care doctor, and follow their advice about imaging, medicines and gallbladder surgery. Do not delay or decline recommended surgery because of complementary care.

We do not diagnose gallstones or decide whether you need surgery. Please bring your diagnosis, ultrasound or other imaging reports, a full list of medicines and supplements, and any plans for surgery or weight loss.

When to seek urgent medical care

Gallstones can cause serious complications, including inflammation of the gallbladder, bile duct infection and pancreatitis.^{[1, 17]}

• Severe abdominal pain that lasts more than a few hours or keeps getting worse
• Fever or chills with abdominal pain
• Yellowing of the skin or eyes
• Persistent vomiting, or pain that spreads to the back
• Very dark urine or pale stools
• Confusion, a fast heartbeat or feeling faint

If any of these occur, call 911 or go to the nearest emergency department.