Causes and Treatments of Jaundice

Jaundice is a clinical sign characterized by yellow staining of the sclera, skin and mucous membranes, body fluids, and other human tissues, caused by elevated serum bilirubin. In some patients the jaundice is not visible to the naked eye, but serum tests show bilirubin above normal; this is called latent jaundice. Jaundice has many causes and different treatments, so it cannot be treated uniformly. Treatment must first identify the cause and then address it.

Based on its mechanism, jaundice is classified into hemolytic jaundice, hepatocellular jaundice, obstructive jaundice, and congenital (constitutional) non-hemolytic jaundice.

Hemolytic jaundice is the general term for jaundice caused by various hemolytic diseases; it is divided into acute and chronic types. Acute hemolytic jaundice is mainly caused by mismatched blood transfusion. Once signs of hemolysis appear during transfusion, the transfusion must be stopped immediately, fluids given to expand blood volume, and renal function protected. If hemolysis is detected, 5% sodium bicarbonate may be infused to alkalinize the urine, dissolve hemoglobin crystals, and prevent tubular blockage. There is currently no reliable TCM regimen for acute hemolytic jaundice; treating it with Chinese medicine is very dangerous, and the patient must be hospitalized.

Neonatal jaundice is also a form of hemolytic jaundice, and its prognosis is generally good. But attention must be paid to preventing bilirubin encephalopathy (also called kernicterus) induced by neonatal jaundice. Bilirubin encephalopathy usually appears on days 4-7 after birth; without treatment it easily causes permanent neurological damage. If a newborn's skin is yellow and stools are clay-colored, jaundice may be present and the baby should seek medical attention promptly.

Chronic hemolytic jaundice is caused by chronic hemolytic diseases; such patients usually also have hemolytic anemia. They are relatively weak, and once infected by pathogens, serious complications easily occur. They should avoid staying up late, keep regular hours, moderately supplement iron and folic acid, wash hands frequently, pay attention to the safety of food and drinking water, and even keep tableware and cups clean and disinfected before use.

Hepatocellular jaundice is caused by liver disease: various types of hepatitis, liver fibrosis, cirrhosis, and liver cancer can all cause it. Patients with jaundice usually also have abnormal liver function and need further examination to identify the cause.

If the jaundice is caused by viral hepatitis, antiviral drugs must be used alongside diuresis to relieve jaundice. Currently, hepatitis A, B, and C all have corresponding antiviral drugs and interferferons available. Treatment of liver fibrosis, cirrhosis, and liver cancer is relatively complex and requires professional help.

Obstructive jaundice is caused by gallstones or by malignant tumors of the digestive system such as liver cancer, gallbladder cancer, cholangiocarcinoma, or pancreatic cancer. Stones or tumors blocking the common bile duct or pancreatic duct cause cholestasis and trigger jaundice. This type requires identifying the cause and treating it accordingly.

For example, gallstone patients may need endoscopic cholecystectomy. Patients with few stones or small individual stones may take ursodeoxycholic acid tablets, Danshu capsules, Dangfei Ligan capsules, Yinzhihuang granules, Shugan Hewei Wan, or trepibutone (a bile-duct dilator). Small gallstones can be expelled from the common bile duct by these methods, but the common bile duct is only 1-8 mm in diameter, so when stones are too large or too numerous, internal treatment carries some risk and surgery should be considered.

Jaundice caused by malignant-tumor bile duct obstruction can only be fundamentally relieved once the tumor is effectively controlled. Such patients should complete examinations, assess tumor stage, and devise a personalized anti-cancer plan based on their condition, while taking appropriate liver-protecting and bile-promoting drugs to lower bilirubin and treat the jaundice.

Congenital jaundice is a chronic jaundice caused by congenital abnormal bilirubin metabolism; chronic idiopathic jaundice, intermittent childhood jaundice or constitutional hepatic dysfunction, Rotor syndrome, and Crigler-Najjar syndrome all belong to congenital non-hemolytic jaundice.

TCM has a long history of treating jaundice. Zhang Zhongjing's Jin Gui Yao Lue of the Han Dynasty has a dedicated chapter on "Jaundice Disease Pulse and Treatment," in which Zhang classified jaundice into three types: gu dan (grain jaundice), jiu dan (alcohol jaundice), and nülao dan (fatigue jaundice). The Northern Song Sheng Ji Zong Lu further classified jaundice into nine dan and thirty-six huang. Luo Qianyi, a disciple of Li Dongyuan (one of the four great masters of the Jin-Yuan period), building on earlier experience, was the first to divide jaundice into yang huang and yin huang; this standard is still widely used in TCM today.

Ancient TCM also recognized that certain jaundices were contagious, and that such jaundice progressed extremely rapidly with a poor prognosis. For example, Shenshi Zunsheng Shu notes: "When epidemic pestilence (plague) causes yellowing, it is called wen huang (pestilential jaundice), and it kills most swiftly"—a description like modern infectious jaundice hepatitis. The Sheng Ji Zong Lu also mentions "ji huang" (rapid jaundice), which must have been acute hemolytic jaundice or infectious jaundice hepatitis.

Except for acute hemolytic jaundice and neonatal jaundice, which should not be treated with TCM or integrated Chinese-Western medicine, other types may be considered for TCM or integrated treatment. The overall TCM principle for jaundice is diuresis—"for all jaundice diseases, urination should be promoted"—which is basically consistent with modern symptomatic treatment of jaundice. Besides treating the cause, Western medicine also often uses diuretics such as furosemide or spironolactone. The specific TCM herbs for jaundice include Yinchen (Artemisia), Jinqiancao (Lysimachia), Huzhang (Polygonum cuspidatum), Yumixu (corn silk), and Zhizi (Gardenia), of which Yinchen is the most potent; these herbs usually have strong bilirubin-lowering and diuretic effects.

Contemporary Chinese integrated hepatology expert Professor Yao Xixian classified jaundice from the TCM perspective into four major patterns: yang huang, yin huang, wen huang (pestilential jaundice), and biliary obstruction, and proposed corresponding TCM treatment principles for each. His classification both follows TCM tradition and is scientific, and is worth learning from.

Yang huang is generally acute jaundice: the patient's skin and eyes are yellow, with a bright, orange-like yellow color. Urine is also yellow and stools are clay-colored. It is often accompanied by fever, nausea, vomiting, and oliguria. Representative formulas are Yinchenhao Tang (Artemisia Decoction; the patent medicine Yinzhihuang granules is based on it) and Yinchen Wuling San.

Yinchenhao Tang (from the Jin Gui Yao Lue): Yinchen (Artemisia) 30-100 g, Zhizi (Gardenia) 10-15 g, Sheng Dahuang (raw Rhubarb) 6-30 g. This formula is indicated for yang jaundice of the heat-excess-over-dampness type; besides jaundice, patients often have fever, thirst, oliguria, abdominal distension, nausea and vomiting, constipation, red tongue, greasy coating, and rapid pulse. If fever is marked, Yinchenhao Tang may be combined with Xiao Chaihu Tang or Xiao Chaihu granules, adding Banlangen (Isatis), Daqingye (Isatis leaf), and Kushen (Sophora) to clear heat and detoxify; Yinchen may be used in a large dose up to 100 g. For severe constipation, Dahuang may be used up to 30 g, but should be started low and titrated up. For nausea and vomiting, combine with Jupi Zhuru Tang, Erchen Wan, or Ping Wei Wan.

Yinchen Wuling San (from Zhu Shiji Yan Fang): Yinchen 30-100 g, and Baizhu, Zexie, Fuling, Zhuling, and Guizhi (or Rougui), 10 g each. This formula is indicated for jaundice with or without fever, heaviness of the head and body, fatigue and lassitude, thirst but no desire to drink, bland sticky taste, poor appetite, abdominal distension, loose stools, and thick greasy coating. It may be modified according to symptoms; for marked nausea and vomiting, add Huoxiang (Agastache), Peilan (Eupatorium), Baidoukou (Amomum), Jupi (tangerine peel), Zhuru (bamboo shavings), Pipaye (loquat leaf), Huanglian (Coptis), and Zisugeng (perilla stem) to clear heat, downbear counterflow, and stop vomiting.

Yin huang is generally chronic jaundice: the yellow color is dull, without a bright luster, and patients usually also show various deficiency patterns. Representative formulas are Yinchen Fuzi Ganjiang Tang, Guipi Tang (Spleen-Restoring Decoction), and Taohong Siwu Tang (Peach-Blossom Four-Substance Decoction).

Yinchen Fuzi Ganjiang Tang (from Wei Sheng Bao Jian): Fuzi (Aconite) 10 g, Yinchen 6 g, Baizhu 2 g, Caodoukou (cardamom) 3 g, Fuling 3 g, Chao Zhishi (fried Immature Bitter Orange) 1.5 g, Fabanxia 1.5 g, Zexie (Alisma) 1.5 g, Chenpi 1 g. Indications: yin jaundice caused by overuse of cooling herbs, with yellowing of body and eyes, cold limbs and skin, hard glomus below the heart, dry eyes, drowsiness, heavy limbs, spontaneous sweating, normal urination, fatigue and reluctance to speak, sticky stools, tight fine pulse that feels empty on pressure. TCM holds this pattern arises from the combination of cold-dampness causing yin-type yellowing; treatment should warm yang and drain dampness, hence combining yang-supporting herbs (Fuzi, Ganjiang) with damp-draining herbs (Yinchen, Zexie, Fuling, Baizhu).

Modified Guipi Tang (from Ji Sheng Fang): Renshen 10 g, Huangqi (Astragalus) 15-30 g, Chao Baizhu 10 g, Fuling 10 g, Danggui (Angelica) 10 g, Longyanrou (Longan aril) 6 g, Suanzaoren (Sour Jujube Seed) 10 g, Yuanzhi (Polygala) 10 g, Yinchen 10 g, Muxiang (Aucklandia) 10 g, Houpo (Magnolia) 10 g, Yumixu (corn silk) 10 g, Dongguapi (Winter Melon Peel) 10 g. Indications: sallow complexion, weak limbs and fatigue, palpitations and insomnia, abdominal distension and poor appetite, loose stools, pale tongue, deep fine pulse, lower-limb edema (or not), which pits on pressure. This formula treats patients with chronic hepatitis or hepatobiliary-pancreatic cancer who have righteous-qi deficiency with concurrent jaundice.

Modified Taohong Siwu Tang: Herbs include Taoren (Peach Kernel), Honghua (Safflower), Shengdi, Danggui, Chishao (Red Peony), Chuanxiong (Sichuan Lovage), Biejia (Trionyx), Yinchen, Danshen (Salvia), Huangqi, Xiangfu (Cyperus), Yuanhu (Corydalis), Mudanpi (Moutan), Wuyao (Lindera), Zhiqiao (Aurantium), Zhishi, Baizhu, and Houpo. This formula treats patients with cirrhosis or liver cancer who show scaly dry skin, yellowish or dark complexion, and dark eye sockets. It may be combined with Renshen Biejia Jian Wan, Dahuang Zhechong Wan, Xihuang Wan, Dangfei Ligan Ning capsules, Fule Kang, and Hugan Pian.

Biliary-obstruction-type jaundice is mostly caused by gallstones or pancreatic/bile duct cancer. Such patients may use ready-made medicines such as Shugan Hewei Wan, Zhizhu Kuanzhong capsules, ursodeoxycholic acid tablets, Danshu capsules, Yuanhu Zhitong Pian, and Yinzhihuang granules for symptomatic support. To address the root cause, cholecystectomy or anti-cancer treatment is still needed based on the patient's condition. For advanced tumor patients with bile duct obstruction who do not respond to drugs and are not surgical candidates, hepatobiliary surgery may consider biliary drainage to improve quality of life and prolong survival.

If the patient has abnormal liver or kidney function, or concurrent complications such as ascites or thrombosis alongside jaundice, a specialist should evaluate and give more targeted treatment advice; self-medication is not appropriate.