Icterus neonatorum is the jaundice seen in newborns. It may be considered a physiological condition when the jaundice appears two to three days after birth and disappears spontaneously after about 10 days. Pathologically, jaundice deepens gradually and is accompanied by other symptoms which indicate the presence of various diseases such as neonatal hemolytic disease, septicemia of newborn, neonatal hepatitis, congenital atresia of biliary duct, congenital enzyme defect, etc.

Etiology and Pathogenesis

The causative factors of icterus neonatorum are dampness-heat and cold-dampness which are affected from the mother, or during delivery, or after birth. The hypofunctioning organs, particularly the spleen, fail to eliminate dampness-heat, leading to its retention in the liver and gallbladder and its distribution to the skin. Moreover, on the basis of the deficiency of healthy qi which results from congenital insufficiency or longstanding disease, the maladies of dampness-heat and cold-dampness may lead to the deficiency of spleen-yang and then the retention of the evils, and jaundice results.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation Observation of the following conditions is helpful for this purpose:

(a) Color of the skin: A bright yellow coloration is caused by dampness-heat, while a dull yellow coloration of prolonged duration usually results from cold-dampness.

(b) Mental state: A spirited status indicates a case of physiological jaundice or mild disorder, while listlessness or irritability shows a serious case. Somnolence or irritability accompanied by muscular twitching is the prodromal symptom of the involvement of the Jueyin meridians.

(c) Color of the stool: Yellow or white dry stool is attributed to sthenia-heat syndrome, and yellowish and loose stool to cold-dampness syndrome.

B. Therapeutic principles

Eliminating dampness and relieving jaundice is the chief therapeutic principle for icterus neonatorum, but the therapy of clearing away heat should be supplemented for the cases with dampness-heat syndrome, and the therapy of warming middle-jiao for those cases with cold-dampness syndrome.

A. Malady of dampness-heat (yang-type jaundice)

Manifestations: Deep and bright yellow coloration of skin and sclera, undisturbed mentality, poor appetite, constipation, deep-colored urine, red tongue with yellow, greasy coating and purplish superficial venules of the index finger.

Therapeutic principles: Clear away heat, and eliminate dampness.

Prescription: The Modification of Artemisiae Scorpariae Decoction for Clearing Away Heat and Eliminating Dampness

Herba Artemisiae Scopariae 10 g
Fructus Gardeniae 5 g
Poria 10 g
Caulis Akebiae 1 g
Radix Glycyrrhizae 1 g

Remarks: Add Radix et Rhizoma Rhei (2 g) and Fructus Aurantii Immaturus (2 g) for cases with constipation. Add Polyporus Umbellatus (5 g) and Rhizoma Alismatis (5 g) for those with loose, yellowish stool and yellowish, greasy tongue coating due to the predomination of dampness. Add Radix Rehmanniae (5 g), Cortex Moutan Radicis (5 g), Radix Paeoniae Rubra (5 g) and Pulvis Cornu Rhinocerotis (1 g, mixed with the decoction) for cases with high fever, irritability, coma and convulsions. Purple Snow Pill (0.5 g, twice daily) or Calculus Bovis Bolus for Resurrection (1/3 piece, twice daily) may also be given for these cases.

B. Retention of cold-dampness (yin-type jaundice)

Manifestations: Dull yellow coloration of skin and sclera, sallow complexion, mental fatigue, loss of appetite, abdominal distention, loose yellowish stool, oliguria, pale tongue with white coating, reddish superficial venules of the index finger.

Therapeutic principles: Warm middle-jiao, dispel dampness, invigorate the spleen, and benefit qi.

Prescription: The Modified Decoction of Artemisiae Scopariae for Regulating the Middle-Jiao

Herba Artemisiae Scopariae 5 g
Radix Codonopsis Pilosulae 5 g
Poria 5 g
Rhizoma Atractylodis Macrocephalae 5 g
Rhizoma Zingiberis (dried) 1 g
Radix Glycyrrhizae Praeparata 2 g

Remarks: Add Rhizoma Pinelliae (3 g) and Fructus Hordei Germinatus (5 g, fried) for cases with milk vomiting and nausea. Add Radix Aconiti Lateralis Praeparata (3 g) for those with coldness of limbs. Add Radix Salviae Miltiorrhizae (5 g), Herba Lycopi (5 g), Rhizoma Sparganii (3 g) and Rhizoma Zedoariae (3 g) for those with hepatomegaly and abdominal distention.

Experiential Prescriptions

. Herba Artemisiae Scopariae (10 g), Fructus Gardeniae (5 g) and Herba Patriniae (6 g); prepared as decoction; applicable to cases due to dampness-heat.

B. Herba Artemisiae Scopariae (10 g), and Herba Plantaginis (15 g); prepared as decoction for daily drinking; applicable to cases due to dampness-heat.

Copyright 1995 Hopkins Technology