Case Study: An existence of upper abdominal pain after a laparoscopic cholecystectomy
Ms. P N who is 53 years old of Yoga teachers manifests a constant pain in the right upper abdomen after a laparoscopic cholecystectomy for three months. Since she suffered from recurrent pain on the right upper abdomen, accompanied with nausea, belching, cramp, and distension in the stomach, she has been diagnosed a gallbladder stone and proved by the ultrasound, so she was given a Cholecystectomy through a laparoscope in the early of 2009. The operation was done very well and she has recovered quickly. But she feels that the constant pain in the upper abdomen still exists.
Due to just meeting her menopause, she always appears hot flashes, tiredness, sweat during the night and insomnia, constipation, depression, anxiety and irritable emotion. These discomforts aggravate her feeling of the pain in the upper abdomen. The Co-codamol which a painkiller is prescribed by her GP makes her more constipation, so she visits me to look for a TCM treatment.
Ms. Jiang’s examination:
There is a pressed pain on the right upper abdomen with a soft feeling and without rebounding pain, distension and minor pain in general abdomen with weakness on the gurgling sound from intestines, a positive reaction on the Morphers syndrome which is palpating examination on the gallbladder region, but no jaundice is found.
The diagnosis on CWM is that:
Post-cholecystectomy syndrome which may leave inflammation at the fossa of gallbladder, possible complicated with Gastritis and Duodenitis.
The identification of patterns on TCM is that the Qi accumulated in the liver and spleen which obstruct in the abdominal Qi moving through.
So the treating principle is made to push the liver and spleen Qi moving through, clear the excessive heat and detoxification.
Acupuncture: Baihui (Du20), Jiuwei (Ren15), Tianshu (St25), Zusanli (St36), Neiting (St44), Yanglingquan (Gb34), Zulinqi (Gb41), Waiguan (Sj5), Yinlingquan (Sp9), Sanyinjiao (Sp6), Taixi (Ki3), Taichong (Liv3) Hegu (Li4);
Herbal medicine: The mixed traditional formula of Dachaihu Tang and Yinchenhao Tang which is prescribed as below:
Chaihu10, Yinchen10, Zhizi10, Dahuang10 (later), Zhiqiao10, Chuanlianzi10 Danggui10, Chishao10, Yuanhu10, Houpo10, Huashi15, Huangbai10, Zhimu10 Sharen10, Gancao5.
Above herbs are decocted as a juice which is taken twice daily.
After two weeks, her pain in the right upper abdomen has reduced a lot, hot flashes disappear, regular bowel movement and good sleep, so the adjusted treatment is given as below:
The treating principle has been continued as before, so acupuncture is preformed once every two weeks and the patent herbal pills of DachaihuTang Wan which is required 15pills twice daily; and Zhibaidihuang Zhibaidihuang Wan 1pill twice daily are given to her. After 4 weeks, her pain at the upper abdomen has disappeared completely and menopause has also been controlled well.