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Neonatal jaundice is one of the most common clinical manifestations of the neonatal period,characterized by a stained yellow of the skin mucous membranes or other organs due to an accumulation of bilirubin in the body.When the unconjugated bilirubin in the blood is too high,it can cause bilirubin encephalopathy (nuclear jaundice),leaving many neurological sequelae,which can lead to death in severe cases.Neonatal jaundice is divided into physiological jaundice and pathological jaundice,belonging to Chinese medicine tāi huáng (yellow fetus) or tāi dăn (jaundiced fetus) category.
The causes of neonatal jaundice relate mainly to retention of dampness before birth,retention,and steaming of damp-heat inside the body,and stagnation of cold-dampness,qi stagnation and blood stasis.The pathogenesis is that the accumulation of dampness or dampness-heat and the liver failing to maintain the normal flow of qi results in a leaking of gallbladder fluid that causes yellowing of the skin and eyes.The disease is located in the liver,gallbladder,spleen,and stomach.
The pregnant mother suffers from dampness or dampness-heat accumulating internally,and it can then transmit to the fetus,or the infant can be invaded by damp-heat during labor or after birth.The damp-heat is unable to be transported and transformed and thus accumulates especially in the spleen and stomach and fumigating the liver and gallbladder which fails to govern the free flow of qi; the bile flows outside the biliary passages and the skin and eyes become bright yellow like orange peels.The internal production of cold-dampness is due to spleen deficiency in congenitally deficient infants or damp invasion after birth.Dampness converts into cold,distressing spleen yang and leading to cold-dampness obstruction and stagnation,which impairs qi movement with the liver failing to govern the free flow of qi;the release of bile results in the yellow and lusterless skin.In some infants with congenital insufficiency,there is stasis and stagnation in the vessels and channels or there are damp-heat accumulation and constraint that is unable to disperse over a long period of time,also callusing qi stagnation and blood stasis that result in jaundice.
a.Physiological jaundice
● General condition is good.
● In full-term infants,it occurs 2 to 3 days after birth,reaches its climax in 4–5 days and fades away in 5–7 days,no later than 2 weeks; in premature infants,it occurs mostly 3–5 days after birth,reaches its climax in 5–7 days,and fades away in 7–9 days,no later than 3–4 weeks.
● In full-term infants,SB (serum bilirubin) <221 μmol/L (12.9 mg/dL); in premature infants,SB < 257 μmol/L (15 mg/dL).In accordance with the above 3 items,and excluding pathological jaundice,it can be confirmed as physiological jaundice.b.Pathological jaundice
● It occurs in 24 hours after birth.
● In full-term infants,SB ＞ 221 μmol/L; in premature infants,SB ＞ 257 μmol/L; or daily rise over 85 μmol/L.
● in full-term infants,the duration time ＞ 2 weeks,while premature infants ＞ 4 weeks.
● It returns after the disappearance.
● CB (serum conjugated bilirubin) ＞ 34 μmol/L.Any of the above may be diagnosed as pathological jaundice.
It is mainly to differentiate the causes of pathological jaundice,commonly involving a neonatal hepatitis,neonatal sepsis,hemolytic disease,biliary obstruction,breast milk jaundice,glucose-6-phosphate dehydrogenase(G-6-PD) deficiency.Because there are many causes of neonatal jaundice and the pathogenesis is complicated,it is necessary to ask for detailed history,have a comprehensive physical examination and necessary imaging and laboratory examinations to clarify the cause of the disease.
Differentiation between yin and yan g patterns should be determined before the identification of being mild or heavy,deficient or excessive.Yang jaundice is marked by bright yellow color similar to orange peel,yellow urine like orange juice,irritability and crying,and a red tongue; while yin jaundice is marked by a persistent dark yellow appearance,loose and white stools,a pale tongue with greasy coating.The mild case has yellow eyes and skin,with a fine spirit while in severe cases,the jaundice gets worse sharply,and the mass below the coastal region enlarges quickly,even loss of consciousness and convulsion appear.Cases of damp-heat retention and fumigation with a short course belong to excessive syndrome,while cases of cold-damp obstruction and stagnation with a long course,and devitalized middle yang belong to deficiency syndrome.Stasis with yellow skin,accompanied with abdominal distention and veins exposed,belongs to the syndrome of deficiency complicated by excess.If the jaundice deepens sharply with cold limbs and faint pulse,it belongs to fetal jaundice desertion syndrome; if the jaundice is significant with screaming,convulsion and opisthotonos,it belongs to syndrome fetal jaundice with stirring wind.
Physiological jaundice can recede spontaneously and does not require special treatment.The essential treatment for pathological jaundice is to resolve dampness and yellowing.Syndromes of yang and yin jaundice are treated respectively by clearing heat and resolving dampness,and by warming spleen-stomach and dissipating dampness.For those with stasis accumulation,treatment focuses on dissolving stasis and dispersing accumulation.The spleen and stomach functions of the newborns are very weak,so it is important to avoid high dose of bitter-cold medicinals for protection of spleen and stomach.
◆ Retention and Fumigation of Damp-heat
Signs and Symptoms: bright yellow cheeks,eyes and skin like orange peel,tiredness,inadequate suckling of milk,thirsty,dry lips,or fever,dysphoria,constipation and deep yellow urine,red tongue,yellow greasy coating,and purple stagnant finger venules.
Essentials: bright yellow cheeks,eyes and skin like orange peel,yellow urine,red tongue,and yellow greasy coating.
Treatment Principles: Clear heat and drain dampness to relieve jaundice.
Formula: Modified Yīn Chén Hāo Tāng (Virgate Wormwood Decoction,茵陈蒿汤) from On Cold Damage ( Shāng Hán Lùn ,伤寒论).
Medicinals: yīn chén (Artemisiae Scopariae Herba), zhī zǐ (Fructus Gardeniae),and dà huáng (Radix et Rhizoma Rhei).
Modifications: For preponderant heat,add hǔ zhàng (Rhizoma Polygoni Cuspidati) and lóng dăn căo (Gentianae Radix et Rhizoma);For damp preponderance,add zhū ling (Polyporus), fú líng (Poria) and huá shí (Talcum);For vomiting,add bàn xià (Rhizoma Pinelliae)and zhú rú (Bambusae Caulis in Taenia); For abdominal distention,add hòu pò (Cortex Magnoliae Officinalis) and zhǐ qiào (Fructus Aurantii); For thirsty and dry lips,add shēng dì huáng (Radix Rehmanniae) and xuán shēn (Radix Scrophulariae).
◆ Cold-damp Obstruction and Stagnation
Signs and Symptoms: dark,yellow cheeks,eyes and skin,spiritless and lassitude,lack of warmth in the limbs,no appetite for milk and food,loose and pale gray stools,dark yellow urine,pale tongue,white and greasy coating,and pale finger venules.
Essentials: dark,yellow cheeks,eyes and skin,spiritless and lassitude,pale tongue with a white and greasy coating.
Treatment Principles: Warm spleen-stomach and dissipate dampness.
Formula: modified Yīn Chén Lǐ Zhōng Tāng (Virgate Wormwood Middle-regulating Decoction,茵陈理中汤) from Comprehensive Medicine According to Master Zhang ( Zhāng Shì Yī Tōng ,张氏医通).
Medicinals: yīn chén (Artemisiae Scopariae Herba), fú líng (Poria), dăng shēn (Radix Codonopsis), gān jiāng (Rhizoma Zingiberis), bái zhú (Rhizoma Atractylodis Macrocephalae),and gān căo (Radix et Rhizoma Glycyrrhizae).
Modifications: For cold limbs,add fù zǐ (Radix Aconiti Lateralis Praeparata) and guì zhī (Ramulus Cinnamomi); for loose stools,add cāng zhú (Rhizoma Atractylodis), yì yǐ rén (Semen Coicis),and zé xiè (Rhizoma Alismatis); for hepatosplenomegaly,add sān léng (Rhizoma Sparganii), é zhú (Rhizoma Curcumae),and chuān xiōng (Rhizoma Chuanxiong); for poor appetite,add shān zhā (Fructus Crataegi) and shā rén (Fructus Amomi).
◆ Jaundice due to Stasis and Accumulation
Signs and Symptoms: gradually increasing dark yellow and lusterless cheeks,eyes and skin,poor appetite,anorexia,stiff abdominal mass below the coastal region,abdominal distention with obvious blue veins or the presence of ecchymosis and non-traumatic hemorrhage,dark red lips,stasis spots on the tongue with a yellow coating,and purple stagnant finger venules.
Essentials: yellow and lusterless cheeks,eyes and skin,stiff abdominal mass below the coastal region,abdominal distention,and stasis spots on the tongue.
Treatment Principles: Dissolve stasis and remove accumulation.
Formula: Modified Xuè Fǔ Zhú Yū Tāng (Blood Mansion Stasis-Expelling Decoction,血府逐瘀汤) from Correction of Errors in Medical Works ( Yī Lín Găi Cuò ,医林改错).
Medicinals: dāng guī (Radix Angelicae Sinensis), shēng dì huáng (Radix Rehmanniae), niú xī (Radix Achyranthis Bidentatae), táo rén (Semen Persicae), hóng huā (Flos Carthami), chái hú (Radix Bupleuri), zhǐ qiào (Fructus Aurantii), chì sháo (Radix Paeoniae Rubra), chuān xiōng (Rhizoma Chuanxiong), jié gěng (Radix Platycodonis),and gān căo (Radix et Rhizoma Glycyrrhizae).
Modifications: For ecchymosis and non-traumatic hemorrhage,add mǔ dān pí (Cortex Moutan) and xiān hè căo (Herba Agrimoniae);for abdominal distention,add mù xiāng (Radix Aucklandiae) and xiāng yuán (Fructus Citri); for stiff abdominal mass below the coastal region,add chuān shān jiă (Squama Manitis) and shuǐ zhì (Hirudo).
◆ Chinese Patent Medicines
Yīn Zhī Huáng Kē Lì / Kǒu Fú Yè (Virgate Wormwood,Gardenia,and Scutellaria Granule/Oral Liquid,茵栀黄颗粒/口服液) for a syndrome of retention and steaming of a dampheat syndrome.
◆ External Treatment of Chinese Medicinals
Yīn chén (Artemisiae Scopariae Herba) 30 g and huáng băi (Cortex Phellodendri Chinensis) 30 g are decocted with water.After deslagging,keep the decoction an appropriate temperature and let the child bathe in it.Repeatedly scrub the child for 10 minutes,once or twice a day.It is applicable to a syndrome of retention and steaming of damp-heat.
1.Avoid infection during pregnancy.Avoid drug abuse,alcohol,pungent and heat-natured foods.Pregnant mothers who have a history of hepatitis should be actively treated.Infants with pathological fetal jaundice should be treated with appropriate prophylaxis.
2.Protect the navel,buttocks,and skin of the newborn,avoid injury,prevent infection,and keep warm.
3.Pay attention to the skin color of the newborn,and know the time of onset and decline of jaundice.
4.Pay attention to systemic symptoms of newborns with neonatal jaundice to observe whether there are signs and symptoms including depressed spirit,drowsiness,vomiting,suckling difficulties,strabismus,restlessness,limb rigidity,and convulsions,in order to detect early and treat timely.