by Alan Tillotson, MA, AHG and Naixin Hu Tillotson, OMD, LAC, AHG

In TCM, jaundice is usually divided into two general types: Yang Huang type,
which is acute, and Yin Huang type, which is chronic. The causal mechanisms are usually divided into two external causes, and one internal cause. Of course, in TCM there are always exceptions, or cases when other diagnostic patterns come into play.

The first type of external cause is toxic heat-dampness from the external
Universe going inside the body where it accumulates and stagnates in the
middle jiao (Spleen and Stomach area), weakening the digestive system. This form of toxic heat and dampness from the Universe is commonly seen in epidemics. When the Spleen and Stomach are oppressed, they fail to digest and transform the food into nutrients, and instead dampness and mucous
accumulates. As the stagnation progresses, it blocks the Liver and Gall
Bladder Qi, which blocks bile flow through the biliary duct system.

The blocked bile cannot flow out, so it backs up and overflows until it
contaminates and dyes the skin yellow. If the bile goes downwards to the
bladder, the urine turns yellow. If it goes upwards, the eyes become yellow.

The second type of external cause is excessive greasy food and alcohol. These
overpower the Spleen and Stomach function, so dampness accumulates. The
stagnant dampness produces heat, and the heat-dampness then blocks the Liver and Gall Bladder channels. This causes the bile to overflow as above.

The internal cause, which occurs much less frequently, happens when a patient
develops a deficiency of the Spleen and Stomach Qi, and as Qi deficiency
includes the Yang (heat) deficiency, cold and dampness accumulate in the
middle jiao, blocking the Liver and Gall Bladder, making the bile overflow
and causing jaundice.

If the jaundice is caused by heat-dampness, it is Yang jaundice. If it is
caused by cold-dampness, it is Yin jaundice. In both cases, the main strategy
is to dissolve the dampness. This can be done with herbs that remove dampness (such as diuretics), or by strengthening the Stomach and Spleen Qi. However, the relative ratios of heat reducing to damp reducing herbs depends on the type of jaundice. In addition, improper treatment of Yang juandice can lead to deficiency, in which case it transforms into Yin jaundice. This is usually
caused by the excessive use of cold herbs, which then weaken the spleen qi.
Yin huang is most often found in the clinic, as Yang huang usually resolves
by itself.

Capillaris Formula

If heat is more than dampness, the jaundice will appear all over as bright
yellow, with symptoms of thirst, heat sensation, abdominal bloating, dry
mouth, bitter taste in the mouth, nausea, scanty yellow urine, and
constipation. The tongue will have a yellow greasy coat, and the pulse will
be wiry and rapid.

In this case, reduce the heat with Capillaris formula. Capillaris (Yin chen
hao - Artemisia Capillaris Herba) is bitter and pungent in taste, and cool
in property. It enters the liver, spleen, gallbladder and stomach channels.
It removes heat and dampness from the liver and gallbladder, increases bile
secretion, and is diuretic. It is used for symptoms such as intermittent
fever and chills, bitter taste in mouth, nausea and loss of appetite For
these reasons it is the number one herb for jaundice, gall bladder disorders
and hepatitis. It occupies the position of King in all the formulas for
jaundice

Use high doses of this herb when writing the formula, about 10-30 grams of
crude herb per day, or 2.5-7.5 grams of the condensed decoction powder. The
other herbs in the formula are adjusted and dosed according to signs and
symptoms. The total dose of the formula is about 30-60 grams per day of crude
herbs, or 7.5 - 15 grams of condensed decoction powder. This works out to
2.5-5 grams of condensed powder three times per day. Due to the coldness of
this formula, the patient must be re-evaluated every three days to one week.

The three main herbs in this formula are:
Capillaris (Yin chen hao - Artemisia Capillaris Herba)
Gardenia (Zhi zi - Gardenia jasminoides fructus)
Rhubarb (Da huang - Rheum emodi rhizoma)

Adjuct herbs are:
If there is pain, add Bupleurum (Chai hu - Bupleurum chinensis radix),
Turmeric (Jiang huang - Curcuma longa rhizoma) and Sichuan chinaberry (Chuan
lian zi - Melia toosendan fructus)

If there is nausea, add Pinellia (Ban xia - Pinellia ternata rhizoma) and
Agastaches (Huo xiang - Agastaches rugosa / Pogstemi herba).

If there is agitation and nervousness from the liver heat, add Coptis (Huang
lian - Coptis chinensis Rhizoma), Gentiana (Long dan cao -Gentiana scabra
radix), or Bupleurum (Chai hu - Bupleurum chinensis radix).

If the urine is scanty and yellow, add Poria (Fu ling - Poria cocos
sclerotium), Talcum (Hua shi - Calcium carbonate), Grifola mushroom (Zhu ling
- Polyporus umbellatus / Grifola umbellata) or Plantago (Che quian zi -
Plantago ovata semen).

If the heat signs are severe, add Scute (Huang qin - Scutellaria baicalensis
radix) and Turmeric (Jiang huang - Curcuma longa rhizoma)

Capillaris and Poria Formula

If the dampness is more than the heat the yellowness of the jaundice is not
as bright, other symptoms being a heavy sensation in the body, fatigue, poor
appetite, nausea, vomiting, abdominal bloating, stomach distention, and
loose stools. The tongue will have a thick, greasy coat, and the pulse will
be slippery or soft. The primary strategy is to dissolve the dampness and
remove mucous, using less hot herbs. Capillaris and Poria formula is used,
with high doses of Capillaris, as mentioned before, and the other ingredients
modified according to signs and symptoms. The aromatic quality of cluster and
agastaches is also important, as it is very effective for getting rid of
dampness.

Capillaris (Yin chen hao - Artemisia capillaris herba)
Cinnamon twig (Gui zhi - Cinnamomi cassis ramulus)
Poria (Fu ling - Poria cocos sclerotium)
White Atractylodes (Bai zhu - Atractylodes macrocephala rhizoma)
Water Plantain (Ze xie - Alisma plantago-aquatica)
Grifola mushroom (Zhu ling - Polyporus umbellatus / Grifola umbellata)
Agastaches (Huo xiang - Agastaches rugosa / Pogstemi herba)
Talcum (Hua shi - Calcium carbonate)
Scute (Huang qin - Scutellaria baicalensis radix)
Acorus (Shi chang pu - Acorus calamus)
Cluster (Bai dou kou - Amomum kravanh fructus)

Capillaris, White Atractylodes and Aconite Formula

In the case of Yin jaundice, there is deficiency of Spleen and Stomach Qi
causing dampness and cold. The liver and gallbladder are blocked, and the
jaundice causes a darker yellow color to appear, like smoke. There is poor
appetite, bloating, diarrhea and fatigue. The patient is sensitive to cold,
and the stool is soft. There may be a loss of the sense of taste. The tongue
is pale, with a greasy coat, and the pulse is deep and slow.

This form of Yin jaundice is chronic. It is often due to lack of or improper
treatment of jaundice. Capillaris is the King herb, and the other
ingredients are adjusted according to signs and symptoms.

Capillaris (Yin chen hao - Artemisia capillaris herba)
White Atractylodes (Bai zhu - Atractylodes macrocephala rhizoma)
Aconite - (Fu zi - prepared Aconitum palmatum)
Dry Ginger (Gan jiang - dry Zingiber officinalis rhizoma)
Zhi gan cao (Glycyrrhiza glabra radix - honey fried Licorice)
Cinnamon bark (Rou gui - Cinnamon zeylanicum cortex)

Turtle Shell Formula

Sometimes the jaundice progresses to liver enlargement, or what today is know
as cirrhosis. When dampness and mucous stays in the Spleen and Stomach for a long time, it strongly condenses and further blocks the Liver qi, causing
blood stasis and mucous to accumulate in the liver. The main symptoms are
pain in the liver, swollen liver and fluid retention. This condition is very
severe and dangerous.

Turtle Shell formula (Bieja wan) is a classic formula from the Jin Kui Yao
Lue (Formulas from the Golden Cabinet). The dosage of the individual
ingredients is determined by signs and symptoms. It is usually made in the
form of pills by an herbal pharmacist.

Turtle shell (Bie jia - Amyda Sinensis Carapax / Trionyx sinensis)
Scute (Huang qin - Scutellaria baicalensis radix)
Bupleurum (Chai hu - Bupleurum chinensis radix)
Dry Ginger (Gan jiang - dry Zingiber officinalis rhizoma)
Rhubarb (Da huang - Rheum emodi rhizoma)
White Peony (Bai shao - Peonia lactiflora radix)
Red peony (Chi shao - Peonia rubra radix)
Cinnamon twig (Gui zhi - Cinnamomi cassis ramulus)
Magnolia bark (Hou po - Magnolia officinalis cortex)
Mu dan (Mu dan pi - Paeonia suffruticosa cortex)
Pinellia (Ban xia - Pinellia ternata rhizoma)
Ginseng (Ren shen - Panax Ginseng radix)
Peach kernel (Tao ren - Prunus persica semen)
Mirabilitum (Mang xiao - Depuratum mirabilitum)
Cockroach (Tu bie chong - Eupolyphaga sinensis)
Pyrrosia leaves (Shi wei - Pyrrosia lingua folium)
Hornet's nest (Lu feng fang - Polistes mandarinus nidus)
Dianthus (Qu mai - Dianthus superbus herba)
Donkey skin gelatin (E jiao - Equus asinus gelatinum)
Lepidium seeds (Ting li zi - Lepidium apetalum semen)
Campsis (Ling xiao hua - Campsis grandifolia)

Because this formula contains several toxic ingredients, it should only be
prescribed by a competent TCM doctor.

Alan Keith Tillotson, MA, AHG - Medical Herbalist
Naixin Hu Tillotson, OMD, LAc - Chinese Medicine
Chrysalis Natural Medicine Clinic
1008 Milltown Rd., Wilm., DE 19808 USA
(302) 994-0565 (302) 995-0653 fax
email: This email address is being protected from spambots. You need JavaScript enabled to view it.

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