Gallstones — herbs instead of a scalpel?

Aim of the study: Background gallstones are a common and multiple disease, with a high global prevalence, complications such as cholecystitis, pancreatitis, and even increased risk of cancer. Oral Chinese medicine, as the main treatment method of traditional Chinese medicine, is widely used in the treatment of gallstones. This study aimed to evaluate the efficacy and safety of Chinese medicine combined with Western medicine for the treatment of gallstones.

Results: Ultimately, 912 patients from 8 randomized controlled trials were included. The meta-analysis results of traditional Chinese medicine combined with Western medicine versus Western medicine were as follows: imaging examination (standardized mean difference, SMD = -1.51, 95% confidence interval [CI] (-2.36, -0.65), P < .001), total cholesterol level (SMD = -2.14, 95% CI (-3.61, -0.67), P = .004), total bile acid level (SMD = -0.97, 95% CI (-3.36, -1.42), P = .043), traditional Chinese medicine symptom scores (SMD = -1.88, 95% CI (-3.16, -0.60), P = .004), occurrence of adverse reaction (odds ratio = 0.51, 95% CI (0.21, 1.24), P = .14). The curative effect of Chinese medicine combined with Western medicine in the treatment of gallstones is better than that of Western medicine and is safety.

Aim of the study: Cholesterol gallstones represent a significant global health burden. Current treatments, including surgery and oral dissolution agents, are often invasive or limited by side effects and variable efficacy. This study investigated the in vitro gallstone-dissolving efficacy of a natural combination-sesame oil (SO), extra virgin olive oil (EVOO), psyllium extract (PE), and dandelion extract (DE)-compared to the pharmaceutical agent Rowachol®.

Results: The four-component regimen (G6: PE + DE+SO+EVOO) showed the greatest efficacy at T3, achieving DR = 92.57% ± 4.2 and cholesterol release = 114.48 ± 4.2 mg, significantly exceeding Rowachol® (39.71% ± 1.9; 42.57 ± 1.9 mg; p < 0.001) and all other groups. Effects were time-dependent, with progressive separation from T1 to T3. Key bioactive compounds-oleic acid, taraxacin, arabinoxylan, and linoleic acid-showed strong positive correlations with dissolution outcomes (r = +0.76 to +0.94). A regression model identified these compounds as primary efficacy predictors, accounting for 94% of the observed variance (adjusted R² = 0.94). Under short-term, controlled in vitro conditions, the SO+EVOO+PE + DE combination achieved a ~ 2.3-fold higher dissolution rate than Rowachol® at 144 h. These findings constitute mechanistic, hypothesis-generating evidence that clarifies how dissolution may be enhanced ex vivo.

Aim of the study: Cholelithiasis is a common and frequently occurring disease worldwide that belongs to the category of jaundice in traditional Chinese medicine. Yinchenhao decoction (YD) consists of Artemisia capillaris Thunb., Gardenia jasminoides J.Ellis, and Rheum palmatum L., and is traditionally used to treat jaundice, which has a significant therapeutic effect on cholelithiasis.

Results: The related indicators were detected by automatic biochemical analyzer, PCR, western blot, or ELISA. Statistics were analyzed using χ2-tests and t-tests. As the results, in cholelithiasis, MUC5AC highly expressed in the gallbladder shortened cholesterol supersaturation and promoted cholesterol crystallization via the inflammatory cytokine signaling pathway; MUC2 highly expressed in the small intestine prolonged cholesterol supersaturation and promoted cholesterol absorption via the inflammatory cytokine signaling pathway. YD inhibited mucin expression in the gallbladder and intestine in a concentration-dependent manner for cholelithiasis treatment by inhibiting the inflammatory cytokine signaling pathway, which was attributed to the active components, including chlorogenic acid, geniposide, and rhein.

Aim of the study: To systematically characterize the chemical basis of JSQ, elucidate the pharmacological mechanism of its core active component against cholesterol gallstones (CGS), and provide a scientific basis for improving its quality standards.

Results: Among 74 annotated constituents, the primary bioactive verbascoside stably maintained 4.361-7.168 mg/g across 15 batches of JSQ. In vivo experiments confirmed that this component significantly inhibited CGS formation, ameliorated dyslipidemia, and alleviated liver injury. Integrated multi-omics analysis revealed that cytokine-cytokine receptor interaction, bile acid metabolism, and steroid biosynthesis are key pathways. Mechanistic studies demonstrated that verbascoside regulates the AGE/RAGE/NF-κB/FXR axis to exert anti-gallstone effects, downregulating the mRNA and protein expression of IL-6, IL-1β, TNF-α, and RAGE, while upregulating FXR, BSEP, NTCP, SHP, CYP7A1, CYP8B1, and NR1H3. Verbascoside from JSQ exerts dual anti-inflammatory and bile acid-remodeling effects via the AGE/RAGE/NF-κB/FXR axis, counteracting cholesterol gallstones. This study provides a material basis for a new quality standard centered on the sovereign herb's active component.

Aim of the study: Danning tablets are widely used as a conservative treatment for gallstones in China. However, the underlying pharmacological mechanisms remain to be elucidated.

Results: The gallbladder was stained with HE to assess inflammation, the liver was tested at RNA and protein levels, and bile duct cannulation was used to assess bile secretion function. All these experiments revealed that Danning tablets improved gallbladder inflammation in both humans and mice. Active ingredients such as luteolin in Danning tablet can upregulate the expression of AQP7 by binding to transcription factors such as ESR1, promote the liver to secrete more bile for gallbladder rinsing and relieving cholecystitis. Therefore, we believe that the use of Danning tablets is beneficial for patients with gallstone disease accompanied by inflammation.

Aim of the study: Dietary hypocholesterolemic spices-curcumin (active compound of turmeric (Curcuma longa)) and capsaicin (active compound of red pepper (Capsicum annuum)), the active principles of spices-turmeric (Curcuma longa) and red pepper (Capsicum annuum), fenugreek (Trigonella foenum-graecum) seeds, garlic (Allium sativum), and onion (Allium cepa) are documented to have anti-cholelithogenic property in animal model.

Results: Increased cholesterol saturation index, cholesterol:phospholipid ratio and cholesterol:bile acid ratio in the bile caused by the lithogenic diet was countered by these spices. The antilithogenicity of these hypocholesterolemic spices was considered to be due also to their influence on biliary proteins that have pro-nucleating activity and anti-nucleating activity. Investigations on the involvement of biliary proteins in cholesterol crystal nucleation revealed that in an in vitro bile model, low molecular weight biliary proteins of the lithogenic diet fed animals have a pro-nucleating activity. On the contrary, low molecular weight biliary proteins of the animals fed hypocholesterolemic spices along with lithogenic diet showed a potent anti-nucleating activity.

Aim of the study: Cholesterol gallstones (CGs) are formed in the biliary system due to cholesterol supersaturation in the bile and delayed bile excretion. The current treatments for CGs involve potentially severe complications, and novel therapeutic approaches are still required.

Results: Administration of Shigyakusan to CGD mice reduced the development of CGs and lowered the serum T-CHO and LDL-C levels. Additionally, Shigyakusan administration increased ABCG5/G8 and ABCB4 mRNA expression in the liver, AQP5 expression in the gallbladder, and ABCG5 expression in the ileum of CGD mice. Shigyakusan administration diminished the synthesis of CGs in mice by lowering serum cholesterol and improving bile flow. The results show that Shigyakusan may be a beneficial option for CGD treatment and prevention.