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General Introduction

Jaundice is a disease and syndrome, marked mainly by yellow in eyes, the body and urine. Generally, it is divided into 3 kinds, Yang jaundice, Yin jaundice and acute jaundice. Yang jaundice is more often seen and a part of them is of in-fectivity.

Jaundice in traditional Chinese medicine and western medicine has same meaning, so jaundice in infectious hepatitis, cholecystitis, diseases of biliary tract, cirrhosis, hemolysis, acute or subacute yellow atrophy of liver, leptospirsis etc. All can refere the treatment based on differentiation of symptoms and sings in the chapter.

Causes of disease and pathogenesis.

Causes of disease and jaundice have internal cause and exopathic cause. The exopathic cause is mainly affection by exopathogenic factors or improper diet and the internal cause is more related with deficiency-cold of the spleen and stomach, and internal injury. The internal and external causes are correlated often. They are discussed respectively in the following.

. Affection by external pathogens: affection by damp-heat, fulminant pathogens, from superface to interior, stagnation in the middle-Jia, dysfunction of the spleen and stomach in transport and transformation, accumulation of dampness and heat pathogens in the liver and gallbladder, induce impairment of dispelling function of the liver, bile overflowing and infusing into the muscle and skin, flowing down to the urine bladder, so yellow body, eyes and urine appear. Invasion of excessive dampness, heat and epidemic pathogens with acute or infectivity very quickly manifests as sevious phenomenon of invading the Yin-blood, which is called as acute jaundice.

. Impairment due to improper diet: Improper diet, often hunger or full, or over drinking, over eating fat, sweet ,greasy food, all can impaire the spleen and stomach, even lead to dysfunction of transport and transformation, accumulation of dampness pathogen in the body. Excessive Yang-Qi in the interior, damp-heat is formed due to dampness easily producing heat, and attacking the liver and gallbladder, bile does not circulate in bile tract, infusing into the muscle and skin, so Yang jaundice appears; improper diet,   over cold and cool impairing Yang-Qi of the spleen and stomach, or deficiency-cold in the spleen and stomach, dysfunction of the spleen in transport, so dampness pathogen easily produces from cold, and stagnation of cold-dampness in the middle-Jiao, stagnation of bile, failure of normal circulation, flowing into the muscle and skin to induce Yin jaundice.

. Internal injury due to tiredness: Overwork, weakness of the spleen and stomach can induce jaundice. It is mainly divided into two aspects: Firstly,  injury of the spleen-Yang or deficiency-cold  of the spleen and stomach, failure of transport of water and dampness, dampness produces from cold, leading to stagnation of cold-dampness in the middle-Jiao, blockade of bile excretion, flowing into the muscle and skin to form Yin jaundice. This is caused by deficiency of the spleen and internal excess of cold-damp pathogens; Secondly, failure of pruducing  Qi and blood due to deficiency of the spleen, deficiency of Qi and blood, so results in jaundice. This jaundice is also caused by deficiency, so it is called as jaundice due to deficiency.

. Obstruction of biliary tract by gallstones and ascaris: due to specificity of constitution, or invasion of damp-heat forming gallstones, leaving in the gallbladder, obstructing the biliary tract, or internal accumulation of damp-heat, dysfunction of the spleen and stomach, obstruction of the biliary tract by roundworm induces bile overflowing, forming jaundice.

.protracted abdominal mass: stagnation of biliary tract by blood stasis, bile overflows to form jaundice.

To sum up, dampness pathogen is a key of occurrence of jaundice, and there are damp-heat and clod dampness pathogens. From the point of view of Zhanand Fu-organs, it is mainly involved in the spleen, stomach, liver and gallbladder, and often from the spleen and stomach to the liver and gallbladder. The spleen has the function to transport and transform nutrients, and it is aversion to dampness, both affection by dampness pathogen or improper diet and production of dampness pathogen in the interior all impair firstly functions of the spleen and stomach. Dysfunction of the spleen in transport, stagnation of dampness pathogen in the middle-JIao, dysfunction of the spleen and stomach in ascending and descending, and failure of the spleen-Qi fails in ascending, leading to stagnation of the liver-Qi, failure of scending down stomach-Qi induces disturbance of  transport and excretion of bile. Stagnation of dampness pathogen leads to failure of bile in biliary tract and bile seeping into blood, and then infusing into the muscle and the skin, forming jaundice. It is the difference of Yang jaundice and Yin jaundice that the patient of Yang jaundice has excessive Yang and more heat, more excessive stomach-fire, prduction of dampness pathogen due to heat, inducing stagnation of damp-heat, because dampness and heat are often excessive, so there is difference of dampness over than heat or heat over than dampness in pathogenesis of Yang jaundice. Extremely excessive fire-heat is called as toxin, as excess of heat toxin, the pathogenic factor attacking Ying-blood, and invading pericardium, often forming acute jaundice. The patient of Yin jaundice has excessive Yin and severe cold, insufficiency of the spleen-yang, dampness pathogen is caused by cold, forming cold-dampness; and protracted Yang jaundice, or orver taking drugs of cold in nature, damaging the spleen-Yang, dampness produces from cold pathogen, also forming Yin jaundice. In addition, at once the jaundice caused by obstruction the biliary tract by gallstones and roundworn, symptoms of the liver and gallbladder will be seen, manifesting often heat as main, belongs Yang jaundice. In he patient of the jaundice caused by protracted abdominal mass, stagnation of blood stasis in the biliary tract, Yin jaundice or Yang jaundice is formed often due to consititution of cold and heat.

Diagraph of Causes of Disease and Pathogenesis of Janudice