Jaundice

Western medicine – acute or chronic hepatitis, cirrhosis, pancreatitis, gallbladder problems (stones, inflammation)

TCM – Damp/Heat in the Liver Gallbladder pushes bile out of it's regular tract causing *yellowing of the eyes, skin, and sclera. Often caused by poor diet or alcohol which damages the Spleen Stomach then finally reaches the Liver Gallbladder.

 

Jaundice is mainly manifested by yellow discoloration of the sclera, skin andurine, resulted from the dampness in the spleen and heat in the stomach, leadingto abnormal circulation of the bile which spreads to the skin surface. It is divided into yang jaundice and yin jaundice according to its nature.

 

Etiology and Pathogenesis

The seasonal and epidemic pathogenic factors accumulate in the spleen and stomach, leading to internal formation and collection of damp heat. Dampness after mixed with heat is apt to penetrate deeper, while heat mixed with dampness is apt to get more exuberant. The liver and gallbladder are steamed by the heat in the spleen and stomach, leading to overflow of the bile to the skin surface, thus jaundice appears.

Irregular diet injures the spleen and stomach, causing disturbance in transportation and transformation and internal formation of dampness, which transforms into heat. Damp heat stains the skin yellow.

Overstrain or general weakness of the spleen qi may give rise to hypoactivity of the yang in the middle jiao, leading to failure in transportation and transformation and stagnation of cold dampness, thus yin jaundice results. As said in A Guide to the Clinic Treatment The cause of yin jaundice is the dampness produced from cold water. If the spleen yang fails to resolve the dampness, the normal distribution of bile is impaired, affecting the spleen, soaking into the muscles, and spreading to the skin which turns yellow as if it were smoked.

Yin jaundice can also result from an improperly treated yang jaundice which leads to injury of the yang qi, hypoactivity of the spleen yang, and internal collection of cold dampness.

 

Differentiation

Yang jaundice :

Main manifestations :Lustrous yellow skin and sclera, fever, thirst, scanty dark yellow urine, heaviness of the body, fullness in the abdomen, stuffiness of the chest, nausea, yellow, sticky tongue coating, string - taut, rapid pulse.

Analysis :Steaming of the damp heat makes the bile spread to the skin surface. Heat being a yang pathogenic factor, makes the yellow discoloration of the skin lustrous. Fever, thirst, scanty dark yellow urine are due to excessive damp heat, which damages the body fluid, and disturbs the activity of the bladder. When the dampness is collected, the pure yang fails to be distributed and heaviness of the body results. In case of obstruction of the qi in the fu organs, fullness in the abdomen occurs. Stuffiness of the chest and nausea are due to the steaming of damp heat, leading to upward perversion of the turbid contents of the stomach. Yellow sticky tongue coating is due to accumulation of damp heat, and string - taut, rapid pulse due to excessive heat in the liver and gallbladder.

Yin jaundice :

Main manifestations :Sallow skin, heaviness of the body, weakness, loss of appetite, epigastric stuffiness, lassitude, aversion to cold, absence of thirst, pale tongue, thick, white tongue coating, deep slow pulse.

Analysis :The stagnation of cold dampness in the spleen and stomach impedes the distribution of yang qi, leading to overflow of the bile, thus the skin is sallow. In case the dampness stays in the spleen, the spleen yang is hypoactive and the transporting and transforming function is impaired, therefore, heaviness of the body, weakness, loss of appetite and epigastric stuffiness occur. Aversion to cold and lassitude are due to weakness of the yang qi. Since this case is of cold - damp nature, thirst is absent. Pale tongue, thick white tongue coating are due to deficiency of yang failing to resolve dampness. Deep, slow pulse is a sign of cold dampness staying in the yin system.

 

Treatment Approach

Method :The points of Taiyin, Yangming and Shaoyang Meridians are selected as the principal points. Reducing is applied to remove heat and dampness in yang jaundice, while even movement with moxibustion is used to warm the middle jiao and resolve dampness in yin jaundice.

Prescription:

  • [SP9 - ST36 - BL18 - BL19 - DU9].
  • Supplementary points :
    • Yang jaundice: LR3 - GB34.
    • Yin jaundice: Moxibustion to BL20, BL48.

Explanation: SP9 and ST36 are used to strengthen the spleen and resolve dampness. BL18, BL19 and DU9 are important points to treat jaundice. Since the damp heat resides in the gallbladder, GB34 is selected to reduce heat, and used in combination with LR3 to regulate the flow ofqi in the liver and gallbladder. Moxibustion to BL20 and BL48 may resolve cold dampness by warmth and treat jaundice.

 

Damp/Heat

bright yellow Yang jaundice, fever, abdominal distension, thirst, bitter taste, nausea, vomiting, constipation, tenesmus, scanty urine, T- red with yellow greasy coat, P- wiry slippery

P/T – induce diuresis, clear Heat, soothe Liver Gallbladder

Acupuncture

  • BL19, GB34, LR3, SI4 (Yuan, separate clear from turbid, induce diuresis)
  • heat, fever: DU 14
  • constipation: BL 25

 

Dampness in low Jiao

dull yellow Yin jaundice, Spleen deficiency and mid Jiao Damp symptoms, T- swollen with greasy coat

P- soft slow or wiry slippery

P/T – strengthen Spleen Stomach, induce diuresis

Acupuncture

  1. neutral, moxa, foot taiyin, yangming,
  2. *DU9 (below T9- level with inferior scapular border), RN12 & ST 36 & BL20 (damp), BL19 & SP6 (soothe Gallbladder, induce diuresis)
  3. mid Jiao symptoms: RN4, ST25

Explanation:

 

Toxic Heat

acute rapid severe dark orange-golden jaundice, Ying Xue level Heat, high fever, thirst, bleeding (from anywhere), T- deep red with yellow dry coat, P- wiry slippery rapid

P/T – clear Heat, detoxify, cool blood, clear Ying Xue Heat

Acupuncture

  • DU14, 26, BL18, 19 & GB34 (purge Liver Gallbladder toxic heat), LI4 & LR3 (4 gates- purge heat, severe), HT9 (bleed)

 

Yang deficient Cold

dull yellow jaundice, poor appetite, bloating, soft stool, sticky tasteless or sweet taste in mouth, no thirst, cold symptoms, T- pale with white greasy coat, P- soft slow or deep retarded

P/T – warm mid Jiao, expel cold, transform Damp, strengthen Spleen

Acupuncture

  • LR 13 & BL 20, RN 12 & ST 36, (warm and transform), SP 6, *SI 4 (empirical for jaundice)
  • more Yang deficiency – RN 4, DU 4

 

Alternative treatment methods

 

  • auricular – GB, LR, SP, ST, mid ear, medium stimulation
  • injection – Ban Lan Gen (antiviral), vitamin B1, Dan Shen, LR 14, GB 24, BL 18, 19, TH 3
    0.5-1.0 ml daily

Remarks

This condition is seen in acute icteric hepatitis, obstructive jaundice and hemolytic jaundice . Acupuncture and moxibustion are more effective to treat hepatogenic jaundice.