Gallstones.

Gallstones are mostly asymptomatic and are unlikely to occur below the age of 30. Diagnosis of gallstones is made most efficiently by abdominal ultrasound. Other symptoms include pain when pressure is applied to the abdomen in the area of the gallbladder. Also, greasy stools that float indicate improper fat absorption from the intestines. The stones are formed by the crystallisation of bile within the gall bladder. In order for this to occur, three factors must be present:

• The bile must be supersaturated with cholesterol.
• The bile must also contain factors which promote crystallisation.
• Gall bladder motility must be low.

(Kumar & Clark, 2002, p. 387-389) (www.mercola.com/)

Short-term aims are to increase liver bile production and secretion, increase gall bladder motility, and increase bile secretion into the intestines. This will be the case, provided the following contraindicated situations do not exist:

• "Obstructed bile ducts"
• "Unconjugated hyperbilirubinaemia"
• "Acute or severe hepatocellular disease"
• "Septic cholecystitis"
• "Intestinal spasm or ileus"
• "Liver cancer"

(Mills & Bone, 2000, p. 187)

Longer-term aims are to reduce the size of the gallstones so they can be safely passed out via the bile duct into the intestines.

Phytotherapeutics, their Actions and Therapeutic Ranges:

• Globe artichoke - Anticholestatic, antiemetic, bitter, cholagogue, choleretic, depurative, diuretic, hepatic trophorestorative, hepatoprotective, hypocholesterolaemic, hypolipidaemic. (Mills & Bone, 2000, p. 433) (Newall, et al., 1996. p. 36)

Range: 20-55 ml/wk of a 1:2 tincture in 60% ethanol. (Bone, 2003, p. 478)

• Greater celandine - Anodyne, anti-inflammatory, antiviral, cholagogue, choleretic, mild laxative, purgative, spasmolytic, vulnerary (topical). (Mills & Bone, 2000, p. 335) (Hoffmann, 2002. p. 59)

Range: 7-15 ml/wk of a 1:2 tincture in 45% ethanol. (Bone, 2003, p. 478)

• Peppermint - Antiemetic, antimicrobial, antitussive, carminitive, cholagogue, diaphoretic, sedative, spasmolytic. (Mills & Bone, 2000, p. 507)

Range: 10-30 ml/wk of a 1:2 tincture in 45% ethanol. (Bone, 2003, p. 480)

• Turmeric - Choloretic, anti-inflammatory, antioxidant. (Blumenthal, et al., 1998, p. 222) (Bone, 2003, p. 436)

Range: 35-100 ml/wk of a 1:1 tincture in 45% ethanol. (Bone, 2003, p. 480)

Synergistic compounding:

Two of the four herbs selected, globe artichoke and greater celandine, have the actions of choleretic and cholagogue. Synergistically they will work to increase bile production and secretion from the gall bladder. Greater celandine also has a mild laxative effect, so will assist in removing the bile from the intestines as quickly as possible. This will help to minimise the deconjugation of the bile acids that may occur whilst in the intestines. (Mills & Bone, 2000, p. 187)

Turmeric is a valuable herb in this formula, as it has been shown in animal studies to achieve a degree of reduction of gallstones. (Mills & Bone, 2000, p. 573) Peppermint may also be valuable as although it may not dissolve gallstones itself directly, Mills and Bone state that "a terpene mixture similar to oil of peppermint has been shown to dissolve gallstones." (Mills & Bone, 2000, p. 194) Furthermore, a controlled study showed menthol (one of the most predominant essential oils in peppermint) added to ursodeoxycholic acid (a metabolite of bile salts) actually reduced the size of gallstones and stone calcification. (Mills & Bone, 2000, p. 510) In a synergistic combination of turmeric and peppermint, the potential to dissolve gallstones may be further enhanced. Peppermint is also carminitive and spasmolytic, so may assist in alleviating intestinal, gallbladder or bile duct spasm. (Bone, 2003, p. 369) Mills and Bone advise the precaution that in patients with gallstones, care should be taken when using peppermint. (Mills & Bone, 2000, p. 512)

Dosage: In this case the administration dosage will be 100 ml for one week, and will comprise the following:

• Globe artichoke - 25 ml
• Greater celandine -  15 ml
• Peppermint - 25 ml
• Turmeric - 35 ml

Suggested daily dosage is 5 ml 3 times per day.

I have chosen a low dose of Globe artichoke as its desired actions in gallstones of cholagogue and choleretic are duplicated in Greater celandine. I did want it for its hepatic trophorestorative and hepatoprotective properties, however. . (Mills & Bone, 2000, p. 433) (Newall, et al., 1996. p. 36)

I have chosen the maximum dosage of Greater celandine as it is a low dose herb, and has the desired property of being a mild laxative in addition to its cholagogue and choleretic actions. (Mills & Bone, 2000, p. 335) (Hoffmann, 2002. p. 59)

I have chosen a higher-range dosage of Peppermint for its ability to dissolve gallstones in certain experimental situations. It is also the only herb in the mixture that is spasmolytic and carminitive. (Mills & Bone, 2000, p. 194, 507 & 510)

I have chosen the low dosage of Turmeric primarily because it is such a high dose herb I couldn't include more of it without reducing the quantities of the other herbs. In this case I would most likely advise the client to add turmeric to their cooking or to supplement with one teaspoon in water each day.