Patient's question:
What medicine should be taken for jaundice? The child's face is very yellow,Doctor's answer:
Jaundice refers to a group of diseases characterized by yellow skin, yellow eyes, and yellow urine. Neonatal jaundice, specifically, is a condition where the skin, eyes, and urine of a newborn appear yellow, which is known as taihuang in traditional Chinese medicine. Neonatal jaundice can be either true or false. True jaundice refers to pathological jaundice, such as hemolytic disease of the newborn, sepsis in newborns, neonatal hepatitis, congenital biliary atresia, and so on. False jaundice, on the other hand, refers to physiological jaundice in newborns, which does not require treatment. If jaundice is detected 24 hours after birth and disappears naturally within 14 days without other symptoms, it is called physiological jaundice. Approximately 50% of normally born infants develop physiological jaundice, and the incidence is even higher in premature infants, reaching up to 80%. Physiological jaundice usually appears on the third day after birth, with early onset on the second day and late onset on the fifth day. The color is typically light yellow and usually resolves within 2-3 days. In more severe cases, it may persist for 5-6 days after jaundice appears, but in premature infants, jaundice should not exceed 7-10 days. Jaundice lasting more than 14 days is considered prolonged jaundice or pathological jaundice caused by other diseases. The order of appearance of physiological jaundice is usually first on the face and neck, then spreading to the chest, abdomen, and limbs. The sclera (the white part of the eyes) may also appear yellow. The cause of physiological jaundice is related to the metabolism of bilirubin in the infant's body after birth. There is an enzyme that eliminates excess bilirubin from the body, but it matures 3-5 days after birth. Therefore, during this period, newborns may have excessive bilirubin, leading to jaundice. Once this enzyme matures, it clears the excess bilirubin, and jaundice disappears. Thus, physiological jaundice does not require treatment—it is a natural part of growth. Pathological jaundice, however, is caused by various underlying conditions and can be quite serious, even life-threatening in some cases. Neonatal hemolytic disease is the most common type of jaundice, occurring when there is a blood type mismatch between the newborn and the mother, leading to the destruction of red blood cells and hemolysis. This can cause anemia, edema, hepatosplenomegaly, and hyperbilirubinemia. If large amounts of bilirubin invade the central nervous system cells, the jaundice becomes severe, known as kernicterus, with a high mortality rate and a tendency to leave lasting sequelae. The most common treatment is exchange transfusion. Mild cases may be treated with phototherapy, also known as blue light therapy, which is a symptomatic treatment and does not address the root cause. Therefore, phototherapy cannot replace exchange transfusion but can reduce the number of transfusions needed. Neonatal hepatitis primarily manifests as jaundice and often appears during the neonatal period, sometimes diagnosed due to prolonged physiological jaundice. After diagnosis and treatment, 60-70% of patients can be cured with a relatively good prognosis. Patients with congenital biliary atresia appear normal at birth but develop yellow skin within 1-2 weeks, which gradually worsens. The color is darker, slightly brownish-green, and is called green jaundice in Western medicine, while traditional Chinese medicine classifies it as yinhuang. Another major characteristic is grayish-white stools. Due to limitations in surgical techniques, only some patients can undergo surgery. Hormone therapy is also an option, but the prognosis for this condition is poor. The liver begins to harden after 3 months, and most patients die from liver failure between 6 months and 2 years of age, with only a few surviving longer. In traditional Chinese medicine, jaundice is generally divided into yinhuang and yanghuang. Yanghuang is caused by heat and toxicity, appearing as bright orange-yellow, while yinhuang is caused by cold and dampness, appearing dull yellow. However, clinical observations show that these two categories do not fully reflect the complexity of the condition, so four types of jaundice in children are commonly used: damp-heat type, heat-toxin type, blood stasis type, and spleen-dampness type. In damp-heat jaundice, the skin appears bright yellow, resembling withered color, accompanied by symptoms such as fever, restlessness, crying, thirst, vomiting, yellow urine, and constipation. Herbal treatments often include yinchang, zhizi, dahuang, huangqin, cheqianzi, zhuru, and chenpi, or intravenous administration of Yin-Zhi-Huang injection once daily. In heat-toxin jaundice, jaundice appears later after birth, accompanied by high fever, restlessness, wheezing, convulsions, or coma, along with gastrointestinal symptoms such as vomiting and diarrhea. This type is usually more severe, often involving kernicterus. Patent medicines like An Gong Ni Huang Wan or Zi Xue Dan can be administered, while decoctions may include water buffalo horn, raw gypsum, roasted zhizi, huanglian, yinchang, cangpu, dahuang, and gouteng, all prepared as a decoction. If the child is comatose and cannot take oral medication, yinchang, zhizi, dahuang, and gancao can be prepared as an enema once daily, or combined with acupuncture and Western medical rescue. In blood stasis jaundice, the face and body appear yellow, with darker and duller color that gradually worsens, accompanied by thinning, reduced appetite, loose stools, and skin bleeding (bruises and petechiae). Traditional Chinese medicine views this as heat invading the body, damaging the spleen and stomach, and obstructing blood flow. Treatment focuses on invigorating blood circulation and resolving stasis, with herbs such as chaihu, chishao, baishao, danggui, taoren, honghua, chuanxiong, foshou, chenpi, fu ling, shan yao, and jixueteng. For spleen-dampness jaundice, the skin appears yellow but does not fade easily, with dull color, lack of luster in the face, thinness, fatigue, poor appetite, soft stools, and cold limbs. Treatment involves strengthening the spleen and resolving dampness, with herbs such as yinchang, bai zhu, ganjiang, dangshen, shan yao, fu ling, foshou, cangpu, yu jin, and jiaoshan, or patent medicines like Jian Pi Wan and Di Yin He Ji. In summary, neonatal jaundice varies widely, and close observation of skin color changes is essential after birth. Special attention should be paid to jaundice that appears too early, persists beyond the expected duration, worsens gradually, or reappears after fading. Additionally, monitor the child's mental state, breathing, feeding, and stool color to detect pathological jaundice early and seek timely treatment.