Yinchen Decoction from the Waitai Miyao and Yinchen Pills from the Qianjin Yaofang Both Treat Jaundice

The Waitai Miyao (Arcane Essentials from the Imperial Library) contains a formula called Yinchen Decoction, composed as follows: Yinchen (Herba Artemisiae Scopariae) 4 liang (12 g), Huangqin (Radix Scutellariae) 2 liang (6 g), Zhizi (Fructus Gardeniae) 3 liang (9 g), Shengma (Rhizoma Cimicifugae) 3 liang (9 g), Dahuang (Radix et Rhizoma Rhei) 3 liang (9 g), Longdancao (Radix Gentianae) 2 liang (6 g), Zhishi (Fructus Aurantii Immaturus, prepared) 2 liang (9 g), Chaihu (Radix Bupleuri) 4 liang (12 g). Add two large bowls of water (800 ml) and decoct to one bowl (400 ml); take warm in two divided doses daily.

This formula clears heat, drains dampness, and resolves jaundice. It is indicated for jaundice in which the body, face, and eyes are all yellow as gold, and the urine is dark and concentrated like decocted phellodendron juice. This closely resembles the presentation of acute icteric hepatitis in modern medicine. Many diseases can induce acute icteric hepatitis—for example, gallstones, gallbladder carcinoma, cholangiocarcinoma, liver cancer, cirrhosis, and hepatitis may all give rise to it. If acute icteric hepatitis is not treated promptly and effectively, the patient's life may be in danger.

Acute icteric hepatitis usually has a sudden onset and progresses rapidly, so TCM treatment should mainly use decoctions to achieve rapid effect; the dosage in Yinchen Decoction should be large rather than small. Converting 1 liang to 3 g is actually a very conservative conversion; for critical patients, one may convert 1 liang to 15 g. The Waitai Miyao is a Tang dynasty work and used Tang dynasty weights and measures, under which 1 liang may be converted to 15 g.

The Qianjin Yaofang (Essential Prescriptions Worth a Thousand Gold) also contains a jaundice-treating formula, "Yinchen Pills," composed as follows: Yinchen, Zhizi, and Tiandong (Radix Asparagi) each 120 g; Dahuang and Guixin (Cortex Cinnamomi) each 9 g; Tongcao (Medulla Tetrapanacis) and Shigao (Gypsum Fibrosum) each 60 g; Banxia (Rhizoma Pinelliae) 180 g. These doses have all been converted from the original proportions to modern units. The above herbs are ground together into a fine powder, and refined honey is used as an excipient to form pills the size of soybeans. Take 3 pills each time, 3 times daily; if ineffective, gradually increase the dose to 10 pills.

This formula also clears heat and drains dampness. It is indicated for jaundice in which the body, face, and eyes are all yellow; or for alcohol jaundice with shortness of breath and inability to rest. This also closely resembles the presentations of acute icteric hepatitis and gallstones in modern medicine. Using a pill form here, however, seems to lack enough force.

Both formulas above share the herbs Yinchen, Zhizi, and Dahuang; these three are the key herbs for treating jaundice, and among them Yinchen is the most important. Folk practice uses Yinchen alone, decocted in water, to treat jaundice. The Yinzhihuang granules produced by modern pharmaceutical companies are made mainly from Yinchen, Zhizi, and Dahuang.

Acute icteric hepatitis is an acute disease; if mishandled, the patient's liver damage can be severe and, in serious cases, life-threatening, so those who can should consider hospitalization. During hospitalization, Chinese and Western medicine may be combined to control the condition faster and better.

If the patient's jaundice is caused by a stone or tumor obstructing the bile duct so that bile cannot drain normally, these TCM formulas are unlikely to have reliably definite effect. Such patients should consider drainage to divert the bile out, together with comprehensive medication. The bile duct is only 3 mm in diameter and, even when dilated, can dilate only to a limited degree; if a large gallstone or tumor obstructs the duct, oral medication cannot solve the problem. At this point, relying solely on oral medicine in the hope that it will resolve the issue may delay the patient's optimal treatment window and lead to consequences that are difficult to manage.