Treatment based on
differentiation of symptoms and signs
Main points of differentiation of syndrome and signs
(Ⅰ) Firstly, confirm whether
it is jaundice. Yellow conjunctivas are an important basis for diagnosis of
jaundice, so clinically should observe colour of the conjunctiva, skin and
(Ⅱ)Differentiation of jaundice
differentiation from time
of attack and duration of disease: Yang jaundice
attackes suddenly, with short duraton of disease; Yin jaundice attackes
slowly with long duration; Acute jaundice attackes suddenly and changes quickly.
colour of jaundice: Yang jaundice is of fresh yellow colour, belonging to heat
syndrome and excess syndrome; Yin jaundice is of dull or dim, belonging to
deficiency syndrome and cold syndrome; Aute jaundice is of yellow body like gold
colour, belonging excessive heat pathogen, and deficiency syndrome complicated
by excess syndrome may appear due to exhausion of Qi Ying at late stage.
of state of illness: Mainly observe colour of jaundice.
That colour of jaundice darkens gradually suggestes exacerbation of the disease; That Jaundice becomes gradually light indicates improvement of state of illness; Fresh colour jaundice and consciousness indicate favorable case, mild state of disease; Dull colour and restlessness indicate a deteriorating case, sevious state of disease.
of dis- ease pathoge-nesis
by damp-heat, often by exopathogens
of cold-dampness. often with deficiency of Qi of the spleen
Specificity of Syndromes
Fresh yellow like orange
Dark like smoking
Specificity of Syndromes
Excess syndrome, heat syndrome
syndrome, cold syndr-ome or deficiency syndrome compl-icated with excesss
Duration of disease
State of illness
Generally, mild in most cases except acute jaundice
Severe in most cases
Clearing away heat and eliminating dampness as main methods,
clearing away heat and detoxicating and removing heat from blood for acute
the spleen and warming and dispelling cold-dampness as main methdos,
Jaundice should be
differentiated with Wei-jaundice
(Ⅰ) Causes of disease and pathogenesis: Causes of disease of
jaundice are affection by exopathogens, impairment due to improper diet,
deficiency and cold in the spleen and stomach, and turning of mass in abdomen,
and its pathogenesis is stagnation of dampness pathogen in the middle-Jiao,
failure of the liver and gallbladder in excretion, or obstruction of biliary
tract by blood stasis, roundworm and gallstones, etc. Leading to failure
of bile to circulate in normal tract, flowing into the muscle and skin to
produce yellow; or due to deficiency of the spleen and lochioschesis, and
unability to flourih due to retention of lochioschesisin the body lead to
appearance of yellow. Wei-jaundice is caused by retention of worm and food,
inducing deficiency of the spleen, failure of food to transform into neutrients
and to produce Qi and blood, or bleeding, dificiency of Qi and blood after
illness, insufficiency of Qi and blood, yellow appears in the muscle and skin.
(Ⅱ) Main syndrome: Yellow
eyes, body and urine are main syndromes for jaundice, and with different
pathogenesis of damp-heat, cold-dampness and stagnation of blood stasis in the
interior, the yellow may show the differences of fresh yellow and dark yellow.
Main symptoms of Wei-jaundice
are: the muscle and skin show light yellow ,dry and no gloss, but without yellow
in eyes and urine, often accompanied by dizziness, tinnitus, palpitation,
insomina and other symptoms.
Main points of therapeutic principle
Because jaundice is caused by dampness pathogen, eliminating dampness and diuresis are basical principle for treatment of jaundice. The method of eliminating dampness includes mainly inducing diuresis with bland drugs, clearing away heat and promoting diuresis, warming Yang for diuresis. In treatment of jaundice, eliminating dampness, resolving dampness and dispelling dampness are often used for removing dampness and resolving yellow. Resolving dampness, i.e. warming Yang for diuresis, clearing away heat and eliminating dampness, eliminating dampness with aromatics, removes dampness pathogen from the middle-Jiao; dispelling dampness,i.e. relaxing the bowels to eliminating dampness, removing stagnation to dispel dampness, eliminate dampness pathogen from stool. Clinically, different methods of eliminating dampness are respectively used for jaundice of different properties. For Yang jaundice, clearing away heat and eliminating dampness method is mainly used, and if it is necessary, relaxing the bowels is combined; Yin jaundice adopts mainly warming Yang for removing dampness, and its combination with nourishing Qi and blood, or soothing the liver and promoting flow of blood; acute jaundice belongs Yang jaundice, and it is caused by excessive heat pathogen, pathogen invading Ying-blood, so clearing away heat and toxic material, and removing heat from Ying and inducing resuscitation methods should adopted.
Treatment based on classifications of jaundice
Yang jaundice has mainly three
types, always with damp-heat.
Heat and Dampness with external symtoms
Jaundice at initial stage, white
eye area change to yellow is not serious, urine yellow, chest is not
comfortable, don’t want to eat, feeling cold, headache and body
feels heavy tire.
Tongue and pulse: thin white fur
tongue, taut and rapid pulse.
Analysis: At summer time, Body
suffer heat, dampness and exterior wind symtoms.
Therapeutic principle: clearing
away heat, dampness and exterion wind symtoms.
Heat over dampness
Main symptoms: Yellow body and
eyes, orange-like fresh yellow, with brightness, and scanty dark urine.
Accompanying symptoms: often
fever and thirst, restlessness, fullness of abdomen, nausea and desire to vomit,
dry mouth and bitter taste, constipation.
Tongue and pulse: yellowish and
greasy fur on the tongue, taut and rapid pulse.
Analysis: Accumulation of
damp-heat, bile flowing into the muscle and skin, heat is yang pathogen, so
fresh yellow appears. Excess of damp-heat in the interior, over heat pathogen,
heat consumes of body fluid, so fever and thirst occur. Damp-heat interfering
the gallbladder, hypofunction of Qi-transmission
induces scaty dark urine. Excessive heat in Yangming causes constipation, and
failure of the flow of Forgan-Qi results in distention and fullness of abdomen;
accumulation of damp-heat, turbit of the stomach and bile adversely flow
up,causing restlessness, nausea and desire to vomit, dry mouth and bitter taste.
Yellowish and greasy fur, and taut
and rapid pulse are signs of excessive damp-heat of the liver, gallbladder,
spleen and stomach in the interior.
Therapeutic principle: Clearing
away heat and eliminating dampness.
dampness over heat
Main symptoms: Yellow body and
eyes, with no so bright yellow as that in more heat syndrome.
Accompanying symptoms: No high
fever, heaviness of head, tastelessness with no thirst, fullness in the chest
and the stomach, anoresia, distention in abdomen, aversion to greasy food,
nausea and desire to vomit, loose stool.
Tongue and pulse: Thick, greasy
and yellow fur on the tongue, taut
and slippery, or weak and slow pulse.
Analysis: Retention of dampness
and heat, failure of bile to circulate in normal tract, flowing into muscle and
skin and inducing yellow body and conjunctivas. Because of dampness over heat,
and dampness is Yin pathogen, so the yellow is not so bright as that in more
heat. No high fever occurs due to excessive dampness. Retention of damp-heat in
interior, clear Yang can not be dispeled, so haviness of the head appears.
Tastelessness with no thirst, fullness in the chest and stomach, anoresia,
nausea and desire to vomit, distention in abdomen all are caused by retention of
dampness in the spleen, and dysfunction of the spleen and stomach. Thick, greasy
and yellow fur, and taut and slipery or weak and slow pulse are signs of more
dampness syndrome with less heat syndrome.
Eliminating dampness and turbit-transmission, clearing away heat as adjunctment
Heat at gallbladder
Main symptoms: Bright yellowish
color at body and eyes, painful at hypochondium and painful will like
electricity to the back shoulder, feeling cold and hot, come and forth, bitter
and thirsty, nausea and desire to vomit, yellow urine, no stool.
Tongue and pulse: Dry yellow fur
on the tongue, taut and rapid pulse.
Therapentic principle: clearing
the hot and dampness at the gallbladde and let the bile flowing smooth and at
Excessive noxius heat type(acute jaundice)
Main symptoms:Sudden and acute
attack,jaundice rapidly becomes darkness,gold-like colour.
Accompanying symptoms:High fever
and excessive thirst, hypochondrial pain and abdominal fullness, coma and
delirium,or epistaxis, hemafecia,or ecchymosis on the skin, bright red tongue.
Tongue and pulse:Bright red tongue with yellowish and dry fur, taut, slippery and rapid or fine and rapid pulse.
Analysis: Damp-heat with noxious
pathogen, excessive noxious heat, induce rapid attack; high fever and thirst,
noxious heat inducing bile flowing into the muscle and skin, so jaundice rapidly
becomes dark with yellow body and conjunctias, like gold colour. Excessive
noxious heat in interior, disorder of activity of Qi induces hypochondrial pain
and abdominal fullness; noxious heat causes failure of blood to circulate in
blood vessels, so epistaxis and hemafecia appear ,or ecchymosis occurs on the
skin. Bright red tongue, yellowish and dry fur,and taut slippery, rapid or fine,
rapid pulse are signs of excessive noxious heat in the liver and gallbladder.
Therapeutic principle: Clearing
away heat and toxic material, removing heat from blood and inducing
(Ⅱ) Yin jaundice
Retention of cold-damp pathogen
Main symptoms: Dark yellow, like
Accompanying symptoms: Mental
tiredness and aversion to cold, anorexia and indigestion, fullness in the
stomach, loose stool, tastelessness and no thirst.
Tongue and pulse: Pale tongue
with and greasy fur, weak and slow or deep and rapid pulse.
Analysis: retention of cold-damp
pathogen in the spleen and stomach, hypofunction of Yang-Q
i, bile overflowing, and cold –dampness is Yin pathogen, so dark yellow skin
appears like smoking; retention of dampness in the spleen, hypofunction of the
spleen-Yang, disorder of transporting and transforming nutrients, lead to
anorexia, fullness in the stomach, loose stool, tastelessness, no thirst and
other symptoms. Insufficiency of Yang, deficiency of Qi and blood induce
aversion to cold and mental tiredness. Pale tongue with greasy fur, weak and
slow or deep and slow pulse are often signs of Yang-deficiency and unability to
remove dampness, and retention of cold-dampness in Yin system.
Strengthening the spleen and regulating the stomach, warming and removing
Retention of blood stasis
Main symptoms: Dark yellow body
Accompanying symptoms: vascular
spider in the skin, darkish complexion, mass in hypochondrium with fixed pain,
Tongue and pulse: green and
purple tongue or with ecchymosis, taut and uneven or fine and uneven pulse.
Analysis: Retention of blood
stasis, ckecking of the flow of bile result in yellow body and eyes; retention
of blood stasis in interior, new blood can supply to the face, so dimmish and
blackish complexion appears; retention of blood stasis in the hypochondium,
ckecking of circulation of Qi and blood bring about mass in the hypochondium
with pain. And vascular spider in the skin,dark stool and changes of tongue and
pulse are signs of blood stasis.
Activating circulation of blood, removing blood stasis and eliminating jaundice.
Deficiency of the spleen and blood(Jandice of deficiency type)
Main symptoms: yellow eyes and
skin, pale and dim complexion, dark urine, or obvious in night.
Accompanying symptoms: mental
tiredness and weakness, lassitude in limbs, palpitation and shortness of breath,
anorexia and loose stool, restlessness in night.
Tongue and pulse: Pale tongue
with and fur, fine and weak pulse.
Analysis: Deficiency of the
spleen and stomach, dysfunction of transporting and transforming nutrients,
insufficiency of resource of Qi and blood, poor blood supplying to the face and
the body, so appearence of yellow face and skin, pale and dim complexion, dark
urine ,or being obvious in night. Insufficiency of the spleen-Qi induces mental
tirdness and weakness, lassitude in limbs, shortness of breath and dislike to
speak. Deficiency of blood is inable to nurish the heat, irritability induces
palipitation and restlessness in night. Hypofunction of transport due to
deficiency of the spleen, leading to anorexia and loose stool. Pale tongue with
thin and white fur, and fine and weak pulse are signs of deficiency of the
spleen and blood.
strengthening the spleen and warming the middle-Jiao, supplementing and
nourishing Qi and blood.
Appendix: Obstructive jaundice
Obstructive jaundice has some
differences with jaundice, its main symptoms are no yellow in both eyes, light
yellow in muscle and skin in whole body, dry skin with no gross, free urination
with no yellow, tiredness and weakness, dizziness and tinnitus, palpitation and
insomnia, loose stool, pale tongue with thin fur, weak and fine pulse.
In the disease, retention of
worm and food induce deficiency of the spleen and stomach, failure of food in
transforming nutrients to produce Qi and blood, and deficiency of Qi and blood
can not nourish the skin and muscle, and viscera, leading to yellow muscle and
skin with no gross. In addition, loss of blood, or after servere disease,
exhaustion of Qi and blood induces insufficiency of Qi and blood, leading to
attack of this disease, which is commonly-seen clinically.
For treatment of the disease,
regulating the spleen and stomach, nourishing Qi and supplementing blood should
mainly adopted, with Huang Qi Jian Zhong Decoction or Ren Shen Yin Yany
Decoction selected. For the disease caused by hookworm, antiscolic therapy
should be adopted.
Measures of Prevention and
Pay attention to take
rest, bed rest is a main when jaundice has not been eliminated.
Proper diet, avoid fat,
oil, greasy, sea food and purgent food, sea and fornbid drinking.
For the patients with
infectivity, should take isolation for prevention from transport to noxious
Keep optimistic and
stable emotion, actively coorperate for treatment.
Jaundice is marked by yellow
conjunctivas, body and urine. Yellow conjunctivas is a key for diagnosis of the
disease. Its attack is always related with affection by exopathogens, improper
diet, deficiency and cold of the spleen and stomach, blood stasis, obstruction
of gallstones and worm in bibiary tract, and injury of internal organs, but it
is mainly caused by dampness pathogen, most invading the liver, gallblader,
spleen and stomach.
Clinically, should differentiate
Yang jaundice and Yin jaundice, jaundice due to deficiency and obstructive
jaundice. Both Yang jaundice and Yin jaundice are caused by dampness pathogen,
and Yang jaundice belongs to excess syndrome heat syndrome, and Yin jaundice
belongs to deficiency syndrome, cold syndom or deficiency syndrome accompanied
by excess syndrome. The differences of Yang jaundice and Yin jaundice are not
obsolute, they can transform each other. Both Jaundice due to deficiency and
obstructive jaundice belong to deficiency syndrome, jaundice due to deficiency
is marked by yellow conjunctiva, body and urine as main symptoms, and
obstructive jaundice does not have yellow conjunctiva and urine, which can be
used for their differentiation.
Removing dampness from urine is an important therapeutic principle for treatment of jaundice. The drugs of clearing or warming, and expelling dampness from stool, and strengthening the spleen and nourishing blood, activating circulation of blood, etc. can be combined according to property of jaundice. The patient who at initial stage receives in time proper treatment, has favourable prognosis. In the patient with protracted disease, repeated attack, stagnation of Qi and blood stasis, mass in the hypocondrium, body resistance weakened while pathogenic factors prevailing, is difficult to be cured. Acute jaundice is a crisis of jaundice, it should actively receive emergince treatmeat. After elimination of jaundice, midication can not be suddenly stopped and should properly administer drugs of regulating the spleen and stomach according to differences of syndromes.