bubble_chart Concept

Yellowing, with yellowing of the eyes, urine, face, and body as its main symptoms, especially the yellow staining of the eyes as an important feature, generally starting from the yellowing of the eyes and then spreading throughout the body.

This conditionNeijingis referred to as "jaundice." In subsequent medical texts, it has been called "yellow jaundice," "dietary jaundice," "alcoholic jaundice," "jaundice due to sexual intemperance," "black jaundice," "yang jaundice," "yin jaundice," "acute jaundice," "pestilential jaundice," and other names. Different types of yellowing are discussed together in this section.

bubble_chart Pattern Analysis

1. Dampness-heat︰Yellow eyes and body with bright yellow coloration, or accompanied by fever, thirst, restlessness, and stifling sensation, fatigue and weakness, epigastric abdominal distension and fullness, reduced appetite (anorexia), aversion to greasy food, nausea (vomiting), deep yellow or scanty dark urine, dry stools, yellow and greasy tongue coating, slippery and rapid pulse. This condition falls under the category of "yang jaundice." Its main clinical features include a relatively short course, bright yellow coloration, yellow and greasy tongue coating, and slippery-rapid or wiry-rapid pulse. The disease cause is due to dampness-heat accumulating in the middle energizer, steaming the liver and gallbladder, causing bile leakage, which then permeates the skin and manifests as jaundice. Generally, it can be differentiated into the following three pattern types:
   1. **Heat predominating over dampness**: Heat signs are more pronounced, hence fever, thirst, restlessness with a desire to vomit, scanty dark urine, dry stools, yellow and greasy tongue coating, and wiry-rapid pulse.
   2. **Dampness predominating over heat**: Dampness signs are more pronounced, manifesting as heavy and sluggish body sensation, epigastric abdominal distension and fullness with stifling sensation, poor appetite, thirst without excessive drinking, difficulty in urination, loose stools, yellow, thick, and greasy tongue coating, slippery and slightly rapid pulse, or soggy and moderate pulse.
   3. **Equal severity of dampness and heat**: Fever with irritability and thirst, heaviness of the head and sluggish body, epigastric abdominal distension and fullness, yellow and dark urine, dry or sticky stools with difficulty in passing, yellow, thick, and greasy tongue coating, wiry-rapid or slippery-rapid pulse. The treatment primarily focuses on **clearing and draining damp-heat**.
   For **heat predominating over dampness**, the approach is **clearing heat and draining dampness**, assisted by promoting bowel movement. The recommended formula is **Gardenia and Rhubarb Decoction** . For **dampness predominating over heat**, the approach is **removing dampness and eliminating turbidity**, assisted by clearing heat. The recommended formula is **Powder of Capillaris and Five Ingredients with Poria** . For **equal severity of dampness and heat**, the approach is **clear and drain damp-heat**, assisted by **removing toxin** and resolving turbidity, enabling dampness-heat to be discharged through both urine and stool. The recommended formula is **Virgate Wormwood Decoction** .
2. Cold-dampness︰Yellow eyes and body with a dull yellow hue, poor appetite, abdominal distension and fullness, heavy and fatigued limbs, cold body and extremities, difficulty urinating, loose stools, white and greasy tongue coating, soft and slow or deep and slow pulse. This is caused by cold-dampness obstructing the middle energizer, which damages spleen and stomach yang. Treatment should focus on warming and resolving cold and dampness, supplemented by invigorating the spleen and harmonizing the stomach. The recommended formula is Virgate Wormwood and Atractylodes Macrocephala and Aconite Decoction.
3. Epidemic Toxin︰The onset is sudden, with jaundice rapidly deepening, the body and eyes appearing deep yellow, golden in color, accompanied by high fever, thirst, dysphoria, restlessness, or unconsciousness, delirious speech, or epistaxis, gingival hemorrhage, hematemesis, bloody stool, and the appearance of ecchymosis on the skin. The tongue is deep red with a yellow, greasy, dry, and scanty coating, and the pulse is rapid. Epidemic toxin-induced jaundice, also known as "acute jaundice" or "pestilential jaundice," is caused by exposure to seasonal epidemic pestilence. The condition is severe, with deep yellow discoloration of the body and eyes. It is invariably accompanied by high fever, intense thirst, dysphoria, restlessness, or unconsciousness and delirious speech. When the pathogen invades the nutrient-blood level, the tongue appears deep red with a yellow-brown coating, and symptoms such as epistaxis, gingival hemorrhage, hematemesis, bloody stool, and macules or papules on the skin may occur. In severe cases, lethargy and unconsciousness develop rapidly. Dampness-heat combined with toxins stagnates and transforms into fire, forcing bile to overflow into the skin, manifesting as signs of intense heat-toxin. Treatment involves clearing heat and removing toxins, cooling the blood, and opening the orifices. The recommended formula is modified Rhinoceros Horn Powder.
4. Static Blood︰The complexion is yellow, appearing dull and dark, with a bluish-purple or sallow hue, or there may be a hard mass under the hypochondrium causing pain and discomfort, or slight abdominal distension and fullness with pain but surprisingly normal urination. Spider-like veins may be visible on the skin, accompanied by low-grade fever or black, tarry stools. The tongue texture is purplish-dark or has ecchymosis, and the pulse is wiry and choppy or thin and choppy. The disease often arises from liver depression and qi stagnation, which over time leads to blood stasis, or from prolonged dampness-heat jaundice, where damp stagnation disrupts qi movement, causing stasis in the liver and gallbladder. This results in impaired bile excretion and jaundice. Clinical features include dull jaundice, a sallow complexion, spider-like veins or petechiae on the skin, and hypochondriac masses with pain—symptoms of internal blood stasis. The condition is more stubborn and lingering than cold-dampness jaundice and is difficult to cure quickly. Treatment focuses on activating blood circulation and resolving stasis, softening hardness, and dissipating masses. Prescriptions such as Rhubarb and Ground Beetle Pill are commonly used.
5. Spleen Deficiency with Blood Depletion︰The skin is yellow and dull, mental fatigue lack of strength, palpitation insomnia, dizziness, and pale nails. The tongue texture is pale, and the pulse is soggy and thin. This syndrome is caused by overstrain internal damage or chronic illness, leading to spleen-stomach weakness, deficiency of qi and blood, failure of the liver to receive nourishment, and impaired dispersion, resulting in gall fel overflowing and causing jaundice, also known as "deficiency jaundice." Key points for pattern identification: generalized yellowing of the skin with a dull and lusterless hue, accompanied by symptoms of qi and blood deficiency such as dizziness, palpitation, insomnia, and a pale tongue. Treatment should focus on strengthening the spleen tonifying and replenishing qi and blood. Prescriptions include Minor Center-Fortifying Decoction, Ten Major Tonics Decoction, and others.

Although both cold-dampness and dampness-heat are related to damp stagnation in the middle energizer, with bile not following its normal pathway and overflowing, leading to jaundice, dampness-heat jaundice belongs to yang jaundice, with a bright yellow color like orange peel; cold-dampness jaundice belongs to yin jaundice, with a dull and dark color like smoke. The course of dampness-heat jaundice is relatively short, while that of cold-dampness jaundice is longer. The tongue coating in dampness-heat jaundice is yellow and greasy; in cold-dampness jaundice, it is white and greasy. The pulse in dampness-heat jaundice is slippery and rapid or wiry and rapid, while in cold-dampness jaundice, it is deep and slow or soggy and thin.

Epidemic toxin jaundice and dampness-heat jaundice: Both belong to yang jaundice, with a bright yellow color.

Static blood jaundice and cold-dampness jaundice: Both syndromes belong to yin jaundice, characterized by a slow onset and a dull, lusterless yellow color.

Yellow is the normal color of the spleen-earth. The jaundice discussed in this section must include yellowing of the eyes, body, and urine. Among these, yellowing of the eyes is the key point to distinguish whether jaundice is present. Zabing Yuanliu Xizhu "The Origin and Flow of Various Jaundice": "The classics state that yellowing of the eyes is called jaundice, as the eyes are where the ancestral vessels gather, and the heat from various channels rises to fumigate the eyes, causing them to turn yellow, which can be recognized as jaundice." Throughout history, there have been many classifications of jaundice, but generally, those with a bright yellow color are classified as yang jaundice, while those with a dull and lusterless yellow color are classified as yin jaundice. The dampness-heat jaundice and epidemic toxin jaundice discussed in this section belong to yang jaundice, generally characterized by a sudden onset, severe symptoms, and a relatively short course. Cold-dampness jaundice, static blood jaundice, and spleen deficiency with blood deficiency jaundice belong to yin jaundice, generally characterized by a slow onset, milder symptoms, and a longer course. Clinical differentiation can be made based on the onset characteristics and symptom manifestations, making it not difficult to distinguish. However, if yang jaundice persists for a long time without healing, leading to qi and blood deficiency or stagnation, it can also transform into yin jaundice. Therefore, in diagnosis, one must be flexible, carefully examine the symptoms to determine the cause, to avoid misdiagnosis.

bubble_chart Documentation

1. Jingui Yaolue．"On the Pulse Signs and Treatment of Jaundice Diseases": "The disease of grain jaundice is characterized by alternating chills and fever, loss of appetite, dizziness upon eating, and uneasiness in the heart and chest. Prolonged cases result in yellowing of the skin, known as grain jaundice, which is treated with Virgate Wormwood Decoction." "Bladder urgency, slight abdominal distension and fullness, yellowing of the entire body, blackening of the forehead, and heat in the soles of the feet lead to black jaundice. The abdominal distension and fullness resemble water retention, and the stool is black and sometimes loose. This is a disease of sexual intemperance, not water retention. Cases with abdominal distension and fullness are difficult to treat and are managed with Niter and Alumite Powder." "The disease of alcoholic jaundice is characterized by difficulty in urination, heat in the heart, and heat in the soles of the feet, which are its symptoms." "Yixue Xinwu": "The yellow of dampness-heat jaundice is like the color of oranges or cypress bark, shining due to fire qi, and is called yang jaundice. There is also the yellow of cold-dampness jaundice, which is like the color of smoked yellow, dull and unclear, or accompanied by cold extremities and a deep, thin pulse, known as yin jaundice. Among these, those caused by food injury (dyspepsia) are called grain jaundice; those caused by alcohol injury are called alcoholic jaundice; and those caused by sweat staining clothes are called yellow sweat, all of which are types of yang jaundice. Among these, there is jaundice due to sexual intemperance, which is a type of bright yellow. There are also long-term patients and elderly people with spleen and stomach deficiencies, whose faces and eyes turn yellow, with a dark and unclear color. This is due to the leakage of vital qi from the zang-fu organs to the outside, and is often difficult to treat."