Jaundice - Huang Dan
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Definition
A syndrome marked by yellow colour pigmentation of the eye, skin and urine. Of these, the yellow pigmentation of the eye (icteric sclera) is the most important sign.
Causes and Pathological Mechanisms
- Exogenous Evils: Damp Heat: damp-heat stagnates the Middle Jiao and steams within, the Liver can not disperse, bile leaks into the skin, eye and urinary bladder causing jaundice. Pestilence: flaring Fire and exuberant Toxin forces the bile to leak. Cold Damp: cold-dampness suppresses the Middle Jiao causing Liver Qi Stagnation and Gall Bladder Qi Stagnation and bile to leak out.
- Improper Diet: irregular eating habit, unhygienic food, alcoholism, rich, greasy and spicy food impair the Spleen and Stomach, resulting in Damp Heat steaming within. The Liver cannot disperse, bile leaks into skin, eye and urinary bladder causing jaundice.
- Spleen and Stomach deficiency-cold: Spleen Yang Deficiency (Constitution weakness, overwork or after major illnesses) causes abnormal fluid transportation and distribution. Dampness forms and transforms into Cold. Cold suppresses the Middle Jiao and obstructs the bile leading to its leakage.
- Transformed from Ji Ju: Protracted Ji Ju. Stagnated blood obstructs the bile causing to leak out or protracted jaundice. Dampness stagnates for a long time, leading to Blood Stasis.
Patterns
Yang Huang
Heat Dominance
- Symptoms: Skin and eye bright yellow, dark yellow, scanty urine, fever, thirsty, constipation, abdominal distension, vexation, bitter and dry mouth, nausea and vomiting.
- Tongue: Red with yellow and greasy coating
- Pulse: Wiry and Rapid
- Treatment strategy: Clear heat and drain dampness, aided with purgation
- Formula: Yin Chen Hao Tang
- Modifications: To drain dampness add Fu Ling, Zhu Ling and Hua Shi. For abdominal distension add Yu Jin, Chuan Lian Zi, Qing Pi to disperse the liver and regulate qi. For nausea and vomiting add Chen Pi and Zhu Ru. For vexation add Huang Lian and Long Dan Cao. For nose bleeding add Chi Shao and Mu Dan Pi. When constipation and fever have eased add Bai Zhu, Fu Ling and take away bitter and cold herbs.
- Acupoints:
Damp Dominance
- Symptoms: Less bright and less dark, Hiding fever, heavy head and body, poor appetite, chest and epigastrium distension, thirsty but drink little, bloated abdomen, nausea and vomit, loose and sticky feces.
- Tongue: Thick, greasy and slightly yellow tongue coating
- Pulse: Wiry and Slippery or Soggy and Moderate
- Treatment strategy: Drain dampness and turbidity, clear heat and resolve jaundice
- Formula: Yin Chen Wu Ling San plus Gan Lu Xiao Du Yi
- Modifications: For nausea, vomiting, poor appetite and distension add add Cang Zhu, Hou Po and Ban Xia
- Acupoints:
Ji Huang (Fatal Jaundice)
- Symptoms: Golden yellow and getting deeper rapidly, Sudden onset, high fever, vexation and very thirsty, hypochondriac pain, bloated abdomen, unconsciousness, delirium, bleeding (epistaxis, hematochezia and purpura).
- Tongue: Red and crimson tongue with yellow and dry coating
- Pulse: Wiry, Slippery and Rapid or Thready and Rapid
- Treatment strategy: Clear heat and toxin, cool ying and open orifice
- Formula: Xi Jiao San and Xi Jiao Di Huang Tang
- Modifications: For unconsciousness and delirium add An Gong Niu Huang Wan or Zhi Bao Dan. For bleeding add cooling blood and stop bleeding herbs such as Ce Bai Ye and Di Yu. For ascites add Bai Mao Gen, Che Qian Cao and Da Fu Pi.
- Acupoints:
Yin Huang
- Symptoms: Skin and eye jaundice, dull as if smoked, Epigastrium and abdomen distension, poor appetite, loose faeces, lack of shen, aversion to cold, tasteless mouth and not thirsty.
- Tongue: Pale tongue with white and greasy coating
- Pulse: Wiry, Soggy and Moderate or Deep and Slow
- Treatment strategy: Invigorate spleen and stomach, warm to expel cold-damp
- Formula: Yin Chen Zhu Fu Tang
- Modifications: To regulate qi and drain dampness add Yu Jin, Hou Po]], Fu Ling and Ze Xie. To disperse liver qi stagnation and spleen qi deficiency add Xiao Yao San. For spleen and stomach deficiency-cold add Liu Jun Zi Tang. For masses with hypochondriac stabbing pain add blood activating and stasis removing herbs.
- Acupoints:
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