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Jaundice

Jaundice

WESTERN MEDICAL KNOWLEDGE: Jaundice is the yellow discoloration of tissues and body fluids with bile pigment. It is apparent when the total serum
bilirubin is > 3mg / 100 ml, but a total serum bilirubin level> 1.5mg 1100ml is jaundice by definition.

SYMPTOMS AND SIGNS: Jaundice is characterized by yellow sci era, skin and urine. The yellow with lustre indicates Yang type; while lustreless yellow indicate
Yln type of Jaundice. Jaundice of Yang type Is usually accompanied with fever, heavy sensation of the body, thirst, fullness in the abdomen, yellow greasy tongue coating, and wiry pulse. Jaundice of Yin type also shows the heavy sensation of the body; others are lassitude, somnolence, absence of thirst, thick white tongue coating, and deep slow pulse.

ETIOLOGY AND PATHOLOGY: The major etiologic factor of jaundice is the dysfunction of the spleen and stomach In transporting and transforming which leads to internal accumulation of dampness. The damp factor combined with some other pathogenic factors, such as cold and heat, impedes the normal excretion of bile so as to cause a yellowish discoloration of the skin. There are two types of jaundice: jaundice of Yang type in which damp-heat is dominant· and jaundice of Yln type in which cold-damp is dominant or due to the deficiency of spleen.

DIFFERENTIATIONS:

1. Jaundice of Yang Type:

(1 ). Jaundice due to More heat and Less Damp: 

Indications: Lustrous yellow sclera, skin and  urine, fever, thirsty, restlessness, vomiting, nausea, scanty urine, constipation, or abdominal fullness, yellow and greasy tongue coating, wiry and rapid pulse.

Treatment and Formulas: Clear heat, eliminate dampness and moisten the large intestine so as to lubricate stool. 

Products:

    • Yin Chen Hao Tang (Capillaris Combination, Item No. 2142): This is a typical formula for jaundice due to more heat than damp type. It is also applied to pneumonia, nephritis, nephrosis, food poisoning due to the heat­ damp factors. 
    • Shan Huang Xie Xin Tang (Coptis and Rhubarb Combination, Item No. 2026): This is also a very good formula for strong heat with damp symptoms in stomach, large intestine, gallbladder. It can be used for jaundice of internal heat type. It is also applied for fever, irritability, habitual constipation, hypertension, hemoptysis, nasal bleeding, uterine bleeding due to excessive internal heat. 

(2). Jaundice due to More Damp and Less Heat:

Indications: Yellow sclera, skin and urine, less lustrous yellowish than the above mentioned first type, no fever, or recessive fever, heavy head and body, lassitude, tastelessness, full and extended feeling at chest, gastric and abdominal regions, poor appetite dislikes oily and greasy food, loose stool, thick and greasy or yellowish tongue coating, soft slow or slight rapid pulse. 

Treatment & Formula: Eliminate the turbid damp factor, assisted by some herbs to clear the internal heat. 

Products:

    • Yin Chen Wu Lin San (Capillaris and Hoelen Five Formula, Item No. 2143): This is a typical formula for jaundice with more damp than heat type by its diuretic function. It is also used for nephritis, renal necrosis ascites pneumonia.

(3). Jaundice due to the Obstruction of Biliary Duct: 

Indications: Quick appearance of jaundice, strong pain at right hypochondriac area, radiates to shoulder and back, or fever, aversion to cold, or fever and chill in exchange, bitter taste in mouth, dry throat, nausea, vomiting, fullness at abdominal region, poor appetite, pale grey stool or white stool, scanty yellowish urine, hot sensation when urinating, red tongue, yellow thick tongue coating, wiry and rapid pulse. This type often has a recurrent history of jaundice.

Treatment & Formulas: Regulate the liver and gallbladder, clear the heat and promote the biliary circulation. 

Products:

    • Da Chai Hu Tang (Major Bupleurum Combination, Item No. 2036): This is a typical formula to mediate the Shao-Yang (MinorYang) channel (the alternate fever and chill is its typical symptom) and clear the internal heat. It is broadly used for jaundice, acute cholecystitis, biliary calculus, hepatitis, gastritis, simple intestinal obstruction, acute pancreatitis, etc. 
    • Wu Mei Wan (Mume Formula, Item No. 2291 ): It is for sudden jaundice, alternate fever and chill, recurrent abdominal pain, vomiting (or with ascaris) due to obstruction of biliary duct by ascaris. It can be combined with Yin Chen Hao Tang (Capillaris Combination, Item No. 2142) which strengthens the function of clearing the internal heat. 

2. Jaundice of Yin Type:

(1). Jaundice due to Cold-Damp: 

Indications: Lusterless yellow sclera, skin and urine, poor appetite, fullness and extension at gastric and abdominal regions, lassitude, cold body, loose stool, pale tongue, white and greasy coating, soft and slow pulse. 

Treatment & Formulas: Warm and tonify the spleen, eliminate the damp factor. 

Products:

    • Yin Chen Zhu Fu Tang is the typical formula for this type. Its ingredients are the following: 
      • Yin Chen (Artemisia Herbs, Item No. 1134)
      • Bai Zhu (Atractylodes, White, Item No. 1051)
      • Zhi Fu Zi (Baked Aconitum Radix, Item No. 1294)
      • Gan Jiang (Dry Ginger, Item No. 1198)
      • Rau Gui (Cinnamomum Cortex, Item No. 1079)
      • Zhi Gan Cao (Licorice, Item No. 1072)
      • Li Zhong Tang (Ginseng and Ginger Combination, Item No. 2191): It tonifies the spleen and warm the cold so as to eliminate the cold­ dampness. 
      • Da Jian Zhong Tang (Major Zanthoxylum Combination, Item No. 2037): This is a very good formula for the deficiency of Yang of spleen and stomach. 

(2). Jaundice due to Spleen and Blood Deficiency:

Indications: Dull yellowish face and skin, general fatigue, weak limbs, poor appetite, shortness of breath, palpitation, loose stool, pale tongue, thin coating, thready and soft pulse.

Treatment & formulas: Tonifies the Blood and Qi by promoting the functions of spleen and stomach. 

Products:

    • Huang Qi Jian Zhong Tang (Astragalus Combination, Item No. 2213): This is a very good formula for the weak spleen and stomach. It is often used for weakness during convalescence, otitis media, chronic ulcers, hemorrhoids, carbuncles, delicate body constitution of children. 
    • Ren Shen Yang Rong Tang (Ginseng Nutritive Combination, Item No. 2007): It tonifies the Qi and blood by promoting the function of the spleen and heart. 
    • Bu Zhong Yi Qi Tang (Ginseng and Astragalus Combination, Item No. 2225): It promotes the function of spleen so as to topify the middle Qi. 
    • Gui Pi Tang (Ginseng and Longan Combination, Item No. 2261 ): It is a tonic formula for the Qi and blood. 

(3). Jaundice due to Blood Stasis: 

Indications: Dark yellowish sclera and skin, purple green complexion, or mass formed at hypochondriac region, pain, irritated small blood veins can be seen from skin, black stool, purple tongue, or petechiae of the tongue, wiry irregular or thready irregular pulse.

Treatment & Formula: To invigorate blood circulation and remove stasis so as to relieve jaundice. 

Products:

    • Ge Xia Zhu Yu Tang: It is the right formula to treat blood stasis below the diaphragm. The ingredients are as follows: 

Comments: 

  1. At the recovery period of jaundice, the following formulas are often used:
    • Xiao Yao San (Tang-kuei and Bupleurum Formula, Item No. 2195): Regulates the liver, harmonizes the spleen and stomach. lt is good for recovering jaundice, when patient still feels fullness and pain at hypochondriac areas, poor appetite, fatigue, irregular stool, wiry pulse.
    • Xiang Sha Liu Jun Zi Tang (Saussurea Cardamon Combination, Item No. 2125): Regulate and tonify the Qi by promoting the function of spleen and stomach. It is used after jaundice, when patient still feels fullness at gastric region, nausea, vomiting sometimes, fatigue, poor appetite, loose stool, weak pulse.

2. On the whole, Yin Chen (Artemisia Herba, Item No. 1134) is the only single herb which is suitable for any types of jaundice. It clears damp heat from the liver and gallbladder so as to relieve jaundice. Its daily extract dosage is from 6g - 10g according to each individual's own situation. Practitioner's careful observance is highly recommended.

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