It seems then rational in these cases to try Cholesterium which seems to act better in high dilutions. It may be alternated with Phosphorus M, 200 or DM, every 8, 15, or 30 days. The effect is often remarkable. The patient no more fabricate calculus, and even if they exist, is not covered with a hard calcarious coating, We may cause diminution of their volume. Besides these cases, often the percentage of cholesterin in the Blood remains the same or high inspite of the general amelioration of the subject and also of the liver. It is therefore important to know the remedies that are indicated by lipemia which often leads to obesity and by hypercholesterinemia that may coexist with it or alone on its own account.
We have often mentioned these remedies. They are : Phosphorus, Graphites, Calcarea carbonica, Natrum sulphuricum, China, Cholesterinum and possible also Lecithin in ponderable doses.
China is classic (Cartier). It prevents biliary lithiasis. Graphites, Calcarea carbonica. Natrum sulphuricum evolves towards obesity, with frequent lipemia and often cholesterinemia.
Phosphorus seems to me marvellously indicated in persons who have cholesterinemia and great thirst, who, like Natrum Muriaticum, and Bryonia, drink large quantity of cold water, drink much during meals, because cholesterin is avid of water.
Moreover Phosphorus acts on degenerescents, which may cause excess of cholesterin in the blood and the tissues (arteritis, cataract etc.)
This question has not yet been solved but it seems to play an important part and later on it will be necessary to know well the homoeopathic remedies indicated by laboratory findings, also by subjective symptoms or by objective symptoms that individualises the patient.
B–By the side of Cholesterin diathesis there is the infection factor. Some micro-organisms have been discovered in the nucleus of the stones. The infections therefore play a determinating part in person predisposed to lithiasis.
Besides, almost half of chronic cholecystitics are not stone forming. Most of these cholecystitis which are not lithiasics are of intestinal origin, and seen in patients who are constipated with right sided painful stasis. It is perhaps the infection of the liver : enterohepatic syndrome or there is entero-renal syndrome.
These patients are to be treated like cholecystitic lithiasic patients, predominantly by medicines of infection than by remedying the lithiasis. But often in these cases there is also high rates of cholesterin. There is therefore between the two cases very close relation and probably the same etiology : Colibacillinum may be used and Enterococcin as well.
By the side of these cases, the infection, instead of being colibacillary may be Eberth’s bacillus. Cholecystitis of Acute Typhoid Fever, subacute or tending towards chronic stage. In these cases nosode Eberihinum may help.
But let there be infection or no infection the indicated remedies will generally be the same as those of lithiasic cholecystitis.
In order that lithiasic cholecystitis is formed, there must be at the sametime hepato-biliary insufficiency with the formation of stone and infection.
The hepato-biliary insufficiency is more or less profound. But by interrogating the patient it is easy to find that it has developed in a latent manner during long period before the phase of confirmed cholecystitis.
This affection is of extreme frequency and develops for some general causes in relation to the modern life, the shocks of all sorts that it gives to our sensorial organs and to our overworked modern sympathetic system. Emotion, cares, different mental traumatisms and above all defective food, too rich in indigestible substances in our sedentary habits, cause soon hepato-biliary insufficiency. Hypercholesterinemia which predisposes to formation of gall stones is seen extraordinarily frequent in all dyspeptics, plethorics, hereditary or acquired arthritics.
Infection causes later on by ascending passage or by descending passage, through blood particularly in case of Eberth’s bacillus or paratyphic bacillus.
The evolution is variable. Very often cholecystitis exists alone but choledocitis may be associated; rarely there is angiocholitis with infection causing lesions up to the interior of the liver in and around the bile ducts. There are angiocholecystitis or chronic cholecystitis which may be subacute, evolving towards atrophic sclerosis of the bladder. Its evolution is slow, the temperature does not exceed 38 or 38.5. There are also some acute suppurated cholecystitis with puffiness of the hypochondria and vascular plastron. Finally there are over-acute or gangrenous forms which may suddenly show in the form of very grave generalised peritonitis.
In case of these last two cases of acute or gangrenous cholecystitis immediate surgical recourse is to be taken. The homoeopathic remedies should yield its place to surgery or should be used as secondary treatment before and after the operation. But very often we will speak specially of it. What should be their therapeutics.
D–Search for a Rational Therapeutic of cholecystitis In official medicine the dilemma is : should be operated or not? When one should operate? If the disease seems to be cured by itself in time and with much patience, regimen, rest and some therapeutic trials, one should think that it is fortunate to have such a result thanks to the chance of the patient and in such a case the doctor does not merit the result because the treatment is neither audacious nor complicated : Absolute rest, application of ice, diet which must be strict and which can cause rapid emaciation, prescriptions of some chemicals as medicine, that pretend to modify the intestinal content or disinfect it.
More rational is the use of cholagogs, when the content of the bile allows it. Because, in fact, it may be dangerous to mobilise the gall stone more or less voluminous by a brutal drive of the bile from liver to intestines. On this matter it is interesting to recall the trials that have been done to valorise and classify different eliminatory substance or substances forming bile. It is necessary to distinguish with Brugsch and Horster, the property called Cholagogs and Choleretics. The cholagogs only eliminate the bile content in the extrahepatic bile duct and in the bladder. They are Magnesium Sulphuricum, Peptone, Olive Oil, Yellow of the Egg, Milk and even Simple Water and wine, finally Vichy water, water of Carlsbad and of Chatilguyon, But almost all the substances have value as preventives, only to check the cholecystitis.
In the biliary infection, in the developed stage, their use is dangerous.
The choleretics directly increases the flow of the bile secretion not only in the liver, but within the tissues, on the surface of the interstitial lymphs and lacunary system. We may divide them in 5 groups (Charbol)
The Aromatic Group. Which corresponds to Atophan, Naphtolate and Oxynaphtolate of sodium or potassium, Biliary salts. Very active choleretics may be included in this group but not used in Homoeopathy.
The Fat Group. Oil of Haarlem, Oleic acids and Oleates, double product of oil and chloralose.
The Diastasic Group. Secretine, Histamin and possibly Insulin.
The Mineral Group. Sodium sulphate and Magnesium chloride, Calomel, the action is disputable and not well known. Nephtal, a new diuretic, is dangerous and rapidly toxic, having a mercury base.
The Vegetable Group. The bark of alder, root of Eupatorium, Rhizopoda, flowers of Rosemary and of Artichaks, flowers and roots of Chicorea, Aloe, Rhubarb, Cascara, Boldo, Mentha, Podophyllum.
It is interesting to note here the scientific confirmation of our homoeopathic remedies such as Eupatorium perf., Taraxacum, Aloe, Rheum, Podophyllum, in the vegetable group; Natrum sulphuricum, Magnesia muriatica, Mercurius dulcis (Calomel) in the mineral group. Compare also in the group of bile salts and in the oil group : Calculi biliaris, Fel tauri. As preventive the mineral waters may give good effect but they may be dangerous when the cholecystitis is confirmed.
Hepato-biliary organotherapy should not be neglected. To homoeopaths also it may give good help as Barishac and Martiny use it.
Pancreatic optotherapy should not be neglected according to the gravity of hepatic troubles and lesions of pancreas co-existing with cholecystitis.
In spite of these different medicines, the doctor has often no arm against an infection, increasing slowly and rapidly, of the gall bladder and specially if the fever rises, if the pain increases, if the contraction of the abdominal wall in the region of hypochondria persists, if the nausea augments, if there is the danger of icterus or sub-icterus and finally if X-ray plates show one or many stones, surgical intervention is necessary but even then there is risk.
It is necessary to avoid the ablation of the gall bladder and try to cure medically and if such a result is not possible, the surgeon will try to do only cholecystostomy which is always preferable to cholecystectomy.