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 jaundice 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.

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 fruit (zhi zi - Gardenia jasminoides)

Rhubarb root (da huang - Rheum emodi rhizoma)

Adjuct herbs are:

If there is pain, add bupleurum root (Chai hu - Bupleurum chinensis radix), turmeric root (jiang huang - Curcuma longa rhizoma) and Sichuan chinaberry fruit (chuan lian zi - Melia toosendan).

If there is nausea, add pinellia tuber (ban xia - Pinellia ternata ) and agastaches (huo xiang - Agastaches rugosa or Pogstemi herba).

If there is agitation and nervousness from the liver heat, add coptis rhizome (huang lian - Coptis chinensis), gentiana root (long dan cao -Gentiana scabra), or bupleurum root (Chai hu - Bupleurum chinensis radix),

If the urine is scanty and yellow, add poria mushroom (fu ling - Poria cocos sclerotium), talcum (hua shi - Calcium carbonate), grifola mushroom (zhu ling - Polyporus umbellatus or Grifola umbellata) or plantago seed (che quian zi - Plantago ovata).

If the heat signs are severe, add scute root (huang qin - Scutellaria baicalensis) and turmeric root (jiang huang - Curcuma longa rhizoma)

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, vomitting, 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 mushroom (fu ling - Poria cocos sclerotium)

White atractylodes rhizome (bai zhu - Atractylodes macrocephala rhizoma)

Water plantain (ae xie - Alisma plantago-aquatica)

Grifola mushroom (zhu ling - Polyporus umbellatus or Grifola umbellata)

Agastaches (huo xiang - Agastaches rugosa or Pogstemi herba)

Talcum (hua shi - Calcium carbonate)

Scute root (huang qin - Scutellaria baicalensis)

Acorus (Shi chang pu - Acorus calamus)

Cluster fruit (bai dou kou - Amomum kravanh)

Add adjunct herbs to this formula as mentioned for Capillaris 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 rhizome (bai zhu - Atractylodes macrocephala rhizoma)

Prepared aconite - (fu zi - prepared Aconitum palmatum)

Dry ginger root (gan jiang - dry Zingiber officinalis rhizoma)

Honey-fried licorice root (zhi gan cao / Glycyrrhiza glabra)

Cinnamon bark (rou gui - Cinnamon zeylanicum)

Add adjunct herbs to this formula as mentioned for Capillaris formula.