Biliary colic develops when gall stones temporarily obstruct the cystic duct or the common bile duct. Cholecystitis occurs when this obstruction is prolonged, resulting in inflammation of the gall bladder wall. The phrase ‘fair, female, fat and fertile’ summarizes the major risk factors for the development of gall stones and gall bladder disease. Typical symptoms include constant pain in the abdomen on the right upper side, nausea, vomiting and fever. Most patients usually give a history of recurrent episodes of such pain.
The management of patients with biliary colic depends upon the severity of the symptoms. Acute and severe inflammation can result in gangrene and perforation and therefore, all patients in the acute phase need to be hospitalized and observed carefully. Once the acute phase has settled down, treatment is given to reduce the inflammation, remove the obstruction, and prevent recurrence of symptoms. For persistent pain, Ayurvedic medicines like Shank-Vati, Hingashtak-Churna, Agnitundi-Vati, Vishtinduk-Vati, Vat-Gajankush-Ras, and Triphala-Guggulu are used. If investigations reveal a high degree of inflammation in the gall bladder, medicines like Shankh-Bhasma, Praval-Panchamrut, Kamdudha-Ras, Sutshekhar-Ras and Chandrakala-Ras are used. In order to remove the obstruction of gall stones, medicines like Arogya-Vardhini, Sharpunkha (Tephrosia purpuria), Kutki (Picrorrhiza kurroa), Tamra-Bhasma, Punarnava (Boerhaavia diffusa), Kalmegh (Andrographis paniculata), Devdangri (Luffa echinata), Bhrungraj (Eclipta alba), Bhumiamalaki (Phyllanthus niruri), Yav-Kshar, Swarjika-Kshar, Surya-Kshar and Apamarga-Kshar are used.
In order to prevent a recurrence of this condition, medicines like Arogya-Vardhini, Sutshekhar-Ras and Shankh-Vati are used in low doses for prolonged periods. Diabetes, HIV, cardio-vascular disease, obesity and prolonged fasting are known risk factors for gall bladder disease and gall stones. Other preventive treatment specific to these conditions needs to be given in order to prevent cholecystitis and biliary colic in such patients. Triphala-Guggulu and Arogya-Vardhini are useful medicines which can achieve this purpose in patients with cardio-vascular disease and obesity. Chandraprabha-Vati can be added to the treatment of patients with diabetes. For patients with HIV, medicines like Bhumiamalaki, Yashtimadhuk (Glycerrhiza glabra) and Bhrungraj can be added to other treatment in order to prevent gall bladder pathology.
Biliary colic and cholecystitis thus need a judicious combination of pre-hospital, hospital and post-hospital treatment. Surgery may be required for patients suspected of having an imminent perforation or other serious complications of the disease. Surgery may also be required for patients with recurrent symptoms who do not respond to standard medical therapy.